Novel insights into short-term troponin remeasurement and long-term cardiac function and structure following fulminant myocarditis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-07-28 DOI:10.1016/j.ijcha.2025.101759

Mengmeng Ji , Luying Jiang , Zixuan Zhang, Shupeng Jiang, Houjuan Zuo

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Abstract

Background

Elevated serum high-sensitivity cardiac troponin (hs-cTn) levels are commonly observed in patients with fulminant myocarditis (FM) after the acute phase. This study aims to evaluate the relationship between elevated hs-cTnI levels at 30-day post-discharge and long-term cardiac structure and function.

Methods

This study is a retrospective cohort study that selected FM patients hospitalized at Tongji Hospital in Wuhan from April 2016 to December 2022. All patients underwent serial monitoring of hs-cTnI levels. Patients were stratified into two groups based on hs-cTnI levels at 30 days post-discharge: the normal hs-cTnI (N-cTnI) group and the high hs-cTnI (H-cTnI) group. Left ventricular (LV) function and structure were assessed using 2-dimensional volume and speckle tracking strain echocardiography. Measurements were obtained at admission, discharge, and 6 months, 12 months, and annually thereafter post-discharge.

Results

Among 95 patients with analysable echocardiographic data (median age: 33 years; 42.11 % male), the N-cTnI group demonstrated significantly higher proportions of patients meeting cardiac function criteria during follow-up compared to the H-cTnI group: LV ejection fraction (LVEF) > 50 % (95 % vs. 72 %; P = 0.003), global longitudinal strain (GLS) > 16 % (68 % vs. 36 %; P = 0.002), and LV end-diastolic dimension < 5 cm (86 % vs. 65 %; P = 0.020). Given that the primary composite endpoint occurred in only 5 patients, statistical analyses focused on secondary composite endpoints. The incidence of secondary composite endpoints was significantly higher in the H-cTnI group than in the N-cTnI group (61.91 % vs. 16.98 %; P < 0.001). Multivariable Cox regression identified elevated hs-cTnI at 30 days post-discharge (HR: 5.365; 95 % CI: 1.876–15.344; P = 0.002) and LV-GLS at discharge (HR: 0.844; 95 % CI: 0.732–0.974; P = 0.021) as independent predictors of secondary composite endpoints.

Conclusion

Delayed normalization of hs-cTnI after 30 days post-discharge may predict long-term deterioration of cardiac function and structural remodeling in patients with FM.

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暴发性心肌炎后短期肌钙蛋白重新测量和长期心功能和结构的新见解

背景：在暴发性心肌炎（FM）患者急性期后，血清高敏心肌肌钙蛋白（hs-cTn）水平普遍升高。本研究旨在评估出院后30天hs-cTnI水平升高与长期心脏结构和功能的关系。方法选取2016年4月至2022年12月在武汉市同济医院住院的FM患者进行回顾性队列研究。所有患者均接受hs-cTnI水平的连续监测。根据出院后30天hs-cTnI水平将患者分为两组：正常hs-cTnI （N-cTnI）组和高hs-cTnI （H-cTnI）组。采用二维体积和斑点跟踪应变超声心动图评估左心室功能和结构。在入院、出院、出院后6个月、12个月和每年进行测量。结果95例可分析超声心动图资料的患者(中位年龄：33岁；42.11%男性)，N-cTnI组在随访期间显示符合心功能标准的患者比例明显高于H-cTnI组：左室射血分数（LVEF） >；50% (95% vs. 72%；P = 0.003)，全局纵向应变（GLS） >；16% (68% vs. 36%；P = 0.002)，左室舒张末期尺寸<；5 cm (86% vs. 65%；p = 0.020)。鉴于主要复合终点仅发生在5例患者中，统计分析侧重于次要复合终点。H-cTnI组二次复合终点的发生率显著高于N-cTnI组(61.91% vs 16.98%；P & lt;0.001)。多变量Cox回归发现，出院后30天hs-cTnI升高(HR: 5.365；95% ci: 1.876-15.344；P = 0.002)和放电时LV-GLS (HR: 0.844；95% ci: 0.732-0.974；P = 0.021)作为次要复合终点的独立预测因子。结论出院后30天hs-cTnI延迟正常化可预测FM患者心功能和结构重构的长期恶化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.