Ventricular arrhythmias and myocardial inflammation: Long-term follow-up of patients with suspected myocarditis.
Adult
Biopsy
Defibrillators, Implantable
Female
Follow-Up Studies
Humans
Male
Myocarditis
/ diagnosis
Myocardium
/ pathology
Primary Prevention
/ methods
Retrospective Studies
Stroke Volume
/ physiology
Tachycardia, Ventricular
/ complications
Time Factors
Treatment Outcome
Ventricular Function, Left
/ physiology
Heart failure
Implanted cardioverter defibrillator
Myocardial inflammation
Ventricular arrhythmia
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
01 Jan 2019
01 Jan 2019
Historique:
received:
20
03
2018
revised:
09
07
2018
accepted:
30
07
2018
pubmed:
21
8
2018
medline:
25
7
2019
entrez:
21
8
2018
Statut:
ppublish
Résumé
Inflammatory heart disease is known to be associated with ventricular arrhythmias (VA) and impaired ventricular function at presentation or during follow-up. We aimed to investigate the need for implanted cardioverter defibrillator (ICD) due to ventricular dysfunction and occurrence of VA during long-term follow-up in patients admitted with suspected myocarditis. Between 2000 and 2016, 191 patients (age 43 ± 13 years, 71% male, mean left ventricular ejection fraction (LVEF) 33 ± 15%) with clinically suspected myocarditis, who underwent endomyocardial biopsies (EMB), were prospectively enrolled and followed up in 6-months-intervals (median follow-up was 83 (49-156) months). The primary endpoint was deterioration of cardiac function (LVEF ≤ 35%) or occurrence of VA leading to ICD implantation. According to EMB results, patients were stratified in three diagnostic groups: acute myocarditis (5%), chronic myocarditis (50%) and dilated cardiomyopathy (DCM) (45%). An ICD implantation was performed in 58 patients (30%, n = 38 for primary prevention). Besides LVEF at baseline, chronic myocardial inflammation was the only independent predictor of ICD implantation for primary prevention (hazard ratio 2.48 (95% confidence interval 1.02-5.5); p = 0.045). VA requiring ICD therapy occurred in 29 of 58 patients (50%) after a median of 14 (2-37) months without a significant difference between presence and absence of myocardial inflammation. Nearly one third of patients with suspected myocarditis require an ICD due to impaired LVEF or occurrence of VA. Half of these patients experienced VA with adequate ICD therapy.
Sections du résumé
BACKGROUND
BACKGROUND
Inflammatory heart disease is known to be associated with ventricular arrhythmias (VA) and impaired ventricular function at presentation or during follow-up. We aimed to investigate the need for implanted cardioverter defibrillator (ICD) due to ventricular dysfunction and occurrence of VA during long-term follow-up in patients admitted with suspected myocarditis.
METHODS
METHODS
Between 2000 and 2016, 191 patients (age 43 ± 13 years, 71% male, mean left ventricular ejection fraction (LVEF) 33 ± 15%) with clinically suspected myocarditis, who underwent endomyocardial biopsies (EMB), were prospectively enrolled and followed up in 6-months-intervals (median follow-up was 83 (49-156) months). The primary endpoint was deterioration of cardiac function (LVEF ≤ 35%) or occurrence of VA leading to ICD implantation.
RESULTS
RESULTS
According to EMB results, patients were stratified in three diagnostic groups: acute myocarditis (5%), chronic myocarditis (50%) and dilated cardiomyopathy (DCM) (45%). An ICD implantation was performed in 58 patients (30%, n = 38 for primary prevention). Besides LVEF at baseline, chronic myocardial inflammation was the only independent predictor of ICD implantation for primary prevention (hazard ratio 2.48 (95% confidence interval 1.02-5.5); p = 0.045). VA requiring ICD therapy occurred in 29 of 58 patients (50%) after a median of 14 (2-37) months without a significant difference between presence and absence of myocardial inflammation.
CONCLUSIONS
CONCLUSIONS
Nearly one third of patients with suspected myocarditis require an ICD due to impaired LVEF or occurrence of VA. Half of these patients experienced VA with adequate ICD therapy.
Identifiants
pubmed: 30122502
pii: S0167-5273(18)31893-X
doi: 10.1016/j.ijcard.2018.07.142
pii:
doi:
Types de publication
Journal Article
Langues
eng
Pagination
132-137Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2018 Elsevier B.V. All rights reserved.