TY - JOUR
T1 - Post-discharge arrhythmic risk stratification of patients with acute myocarditis and life-threatening ventricular tachyarrhythmias
AU - Gentile, Piero
AU - Merlo, Marco
AU - Peretto, Giovanni
AU - Ammirati, Enrico
AU - Sala, Simone
AU - Della Bella, Paolo
AU - Aquaro, Giovanni Donato
AU - Imazio, Massimo
AU - Potena, Luciano
AU - Campodonico, Jeness
AU - Foa, Alberto
AU - Raafs, Anne
AU - Hazebroek, Mark
AU - Brambatti, Michela
AU - Cercek, Andreja Cerne
AU - Nucifora, Gaetano
AU - Shrivastava, Sanskriti
AU - Huang, Florent
AU - Schmidt, Matthieu
AU - Muser, Daniele
AU - Van de Heyning, Caroline M.
AU - Van Craenenbroeck, Emeline
AU - Aoki, Tatsuo
AU - Sugimura, Koichiro
AU - Shimokawa, Hiroaki
AU - Cannata, Antonio
AU - Artico, Jessica
AU - Porcari, Aldostefano
AU - Colopi, Marzia
AU - Perkan, Andrea
AU - Bussani, Rossana
AU - Barbati, Giulia
AU - Garascia, Andrea
AU - Cipriani, Manlio
AU - Agostoni, Piergiuseppe
AU - Pereira, Naveen
AU - Heymans, Stephane
AU - Adler, Eric D.
AU - Camici, Paolo Guido
AU - Frigerio, Maria
AU - Sinagra, Gianfranco
PY - 2021/12
Y1 - 2021/12
N2 - Aims The outcomes of patients presenting with acute myocarditis and life-threatening ventricular arrhythmias (LT-VA) are unclear. The aim of this study was to assess the incidence and predictors of recurrent major arrhythmic events (MAEs) after hospital discharge in this patient population. Methods and results We retrospectively analysed 156 patients (median age 44 years; 77% male) discharged with a diagnosis of acute myocarditis and LT-VA from 16 hospitals worldwide. Diagnosis of myocarditis was based on histology or the combination of increased markers of cardiac injury and cardiac magnetic resonance (CMR) Lake Louise criteria. MAEs were defined as the relapse, after discharge, of sudden cardiac death or successfully defibrillated ventricular fibrillation, or sustained ventricular tachycardia (sVT) requiring implantable cardioverter-defibrillator therapy or synchronized external cardioversion. Median follow-up was 23 months [first to third quartile (Q1-Q3) 7-60]. Fifty-eight (37.2%) patients experienced MAEs after discharge, at a median of 8 months (Q1-Q3 2.5-24.0 months; 60.3% of MAEs within the first year). At multivariable Cox analysis, variables independently associated with MAEs were presentation with sVT [hazard ratio (HR) 2.90, 95% confidence interval (CI) 1.38-6.11]; late gadolinium enhancement involving >= 2 myocardial segments (HR 4.51, 95% CI 2.39-8.53), and absence of positive short-tau inversion recovery (STIR) (HR 2.59, 95% CI 1.40-4.79) at first CMR. Conclusions Among patients discharged with a diagnosis of myocarditis and LT-VA, 37.2% had recurrences of MAEs during follow-up. Initial CMR pattern and sVT at presentation stratify the risk of arrhythmia recurrence.
AB - Aims The outcomes of patients presenting with acute myocarditis and life-threatening ventricular arrhythmias (LT-VA) are unclear. The aim of this study was to assess the incidence and predictors of recurrent major arrhythmic events (MAEs) after hospital discharge in this patient population. Methods and results We retrospectively analysed 156 patients (median age 44 years; 77% male) discharged with a diagnosis of acute myocarditis and LT-VA from 16 hospitals worldwide. Diagnosis of myocarditis was based on histology or the combination of increased markers of cardiac injury and cardiac magnetic resonance (CMR) Lake Louise criteria. MAEs were defined as the relapse, after discharge, of sudden cardiac death or successfully defibrillated ventricular fibrillation, or sustained ventricular tachycardia (sVT) requiring implantable cardioverter-defibrillator therapy or synchronized external cardioversion. Median follow-up was 23 months [first to third quartile (Q1-Q3) 7-60]. Fifty-eight (37.2%) patients experienced MAEs after discharge, at a median of 8 months (Q1-Q3 2.5-24.0 months; 60.3% of MAEs within the first year). At multivariable Cox analysis, variables independently associated with MAEs were presentation with sVT [hazard ratio (HR) 2.90, 95% confidence interval (CI) 1.38-6.11]; late gadolinium enhancement involving >= 2 myocardial segments (HR 4.51, 95% CI 2.39-8.53), and absence of positive short-tau inversion recovery (STIR) (HR 2.59, 95% CI 1.40-4.79) at first CMR. Conclusions Among patients discharged with a diagnosis of myocarditis and LT-VA, 37.2% had recurrences of MAEs during follow-up. Initial CMR pattern and sVT at presentation stratify the risk of arrhythmia recurrence.
KW - Acute myocarditis
KW - Ventricular arrhythmias
KW - Arrhythmic risk stratification
KW - Cardiac magnetic resonance
KW - Implantable cardioverter-defibrillator
KW - CARDIOVASCULAR MAGNETIC-RESONANCE
KW - LATE GADOLINIUM ENHANCEMENT
KW - SUDDEN CARDIAC DEATH
KW - EUROPEAN-SOCIETY
KW - FULMINANT
KW - INFLAMMATION
KW - ASSOCIATION
KW - PREDICTORS
KW - MANAGEMENT
U2 - 10.1002/ejhf.2288
DO - 10.1002/ejhf.2288
M3 - Article
C2 - 34196079
SN - 1388-9842
VL - 23
SP - 2045
EP - 2054
JO - European journal of heart failure
JF - European journal of heart failure
IS - 12
ER -