Persistent left ventricular dysfunction after acute lymphocytic myocarditis: Frequency and predictors

Marco Merlo, Enrico Ammirati, Piero Gentile, Jessica Artico, Antonio Cannatà, Gherardo Finocchiaro, Giulia Barbati, Paola Sormani, Marisa Varrenti, Andrea Perkan, Enrico Fabris, Aneta Aleksova, Rossana Bussani, Duccio Petrella, Manlio Cipriani, Claudia Raineri, Maria Frigerio, Gianfranco Sinagra

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Abstract

Background Persistent left ventricular (LV) systolic dysfunction in patients with acute lymphocytic myocarditis (LM) is widely unexplored. Objectives To assess the frequency and predictors of persistent LV dysfunction in patients with LM and reduced LVEF at admission. Methods and results We retrospectively evaluated 89 consecutive patients with histologically-proven acute myocarditis enrolled at three Italian referral hospitals. A subgroup of 48 patients with LM, baseline systolic impairment and an available echocardiographic assessment at 12 months (6–18) from discharge constituted the study population. The primary study end-point was persistent LV dysfunction, defined as LVEF <50% at 1-year, and was observed in 27/48 patients (56.3%). Higher LV end-diastolic diameter at admission (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.04–1.43, p = 0.002), non-fulminant presentation (OR 8.46, 95% CI 1.28–55.75, p = 0.013) and presence of a poor lymphocytic infiltrate (OR 12.40, 95% CI 1.23–124.97, p = 0.010) emerged as independent predictors of persistent LV dysfunction at multivariate analysis (area under the curve 0.91, 95% CI 0.82–0.99). Pre-discharge LVEF was lower in patients with persistent LV dysfunction compared to the others (32%±8 vs. 53%±8, p <0.001), and this single variable showed the best accuracy in predicting the study end-point (area under the curve 0.95, 95% CI 0.89–1.00). Conclusions More than half of patients presenting with acute LM and LVEF <50% who survive the acute phase show persistent LV dysfunction after 1-year from hospital discharge. Features of sub-acute inflammatory process and of established myocardial damage at initial hospitalization emerged as predictors of this end-point.

Original languageEnglish
Article numbere0214616
JournalPLoS One
Volume14
Issue number3
DOIs
Publication statusPublished - Mar 1 2019

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myocarditis
Myocarditis
Left Ventricular Dysfunction
confidence interval
Confidence Intervals
odds ratio
Odds Ratio
Area Under Curve
multivariate analysis
Hospitalization
Referral and Consultation
Multivariate Analysis
Population

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Merlo, M., Ammirati, E., Gentile, P., Artico, J., Cannatà, A., Finocchiaro, G., ... Sinagra, G. (2019). Persistent left ventricular dysfunction after acute lymphocytic myocarditis: Frequency and predictors. PLoS One, 14(3), [e0214616]. https://doi.org/10.1371/journal.pone.0214616

Persistent left ventricular dysfunction after acute lymphocytic myocarditis : Frequency and predictors. / Merlo, Marco; Ammirati, Enrico; Gentile, Piero; Artico, Jessica; Cannatà, Antonio; Finocchiaro, Gherardo; Barbati, Giulia; Sormani, Paola; Varrenti, Marisa; Perkan, Andrea; Fabris, Enrico; Aleksova, Aneta; Bussani, Rossana; Petrella, Duccio; Cipriani, Manlio; Raineri, Claudia; Frigerio, Maria; Sinagra, Gianfranco.

In: PLoS One, Vol. 14, No. 3, e0214616, 01.03.2019.

Research output: Contribution to journalArticle

Merlo, M, Ammirati, E, Gentile, P, Artico, J, Cannatà, A, Finocchiaro, G, Barbati, G, Sormani, P, Varrenti, M, Perkan, A, Fabris, E, Aleksova, A, Bussani, R, Petrella, D, Cipriani, M, Raineri, C, Frigerio, M & Sinagra, G 2019, 'Persistent left ventricular dysfunction after acute lymphocytic myocarditis: Frequency and predictors', PLoS One, vol. 14, no. 3, e0214616. https://doi.org/10.1371/journal.pone.0214616
Merlo M, Ammirati E, Gentile P, Artico J, Cannatà A, Finocchiaro G et al. Persistent left ventricular dysfunction after acute lymphocytic myocarditis: Frequency and predictors. PLoS One. 2019 Mar 1;14(3). e0214616. https://doi.org/10.1371/journal.pone.0214616
Merlo, Marco ; Ammirati, Enrico ; Gentile, Piero ; Artico, Jessica ; Cannatà, Antonio ; Finocchiaro, Gherardo ; Barbati, Giulia ; Sormani, Paola ; Varrenti, Marisa ; Perkan, Andrea ; Fabris, Enrico ; Aleksova, Aneta ; Bussani, Rossana ; Petrella, Duccio ; Cipriani, Manlio ; Raineri, Claudia ; Frigerio, Maria ; Sinagra, Gianfranco. / Persistent left ventricular dysfunction after acute lymphocytic myocarditis : Frequency and predictors. In: PLoS One. 2019 ; Vol. 14, No. 3.
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abstract = "Background Persistent left ventricular (LV) systolic dysfunction in patients with acute lymphocytic myocarditis (LM) is widely unexplored. Objectives To assess the frequency and predictors of persistent LV dysfunction in patients with LM and reduced LVEF at admission. Methods and results We retrospectively evaluated 89 consecutive patients with histologically-proven acute myocarditis enrolled at three Italian referral hospitals. A subgroup of 48 patients with LM, baseline systolic impairment and an available echocardiographic assessment at 12 months (6–18) from discharge constituted the study population. The primary study end-point was persistent LV dysfunction, defined as LVEF <50{\%} at 1-year, and was observed in 27/48 patients (56.3{\%}). Higher LV end-diastolic diameter at admission (odds ratio [OR] 1.22, 95{\%} confidence interval [CI] 1.04–1.43, p = 0.002), non-fulminant presentation (OR 8.46, 95{\%} CI 1.28–55.75, p = 0.013) and presence of a poor lymphocytic infiltrate (OR 12.40, 95{\%} CI 1.23–124.97, p = 0.010) emerged as independent predictors of persistent LV dysfunction at multivariate analysis (area under the curve 0.91, 95{\%} CI 0.82–0.99). Pre-discharge LVEF was lower in patients with persistent LV dysfunction compared to the others (32{\%}±8 vs. 53{\%}±8, p <0.001), and this single variable showed the best accuracy in predicting the study end-point (area under the curve 0.95, 95{\%} CI 0.89–1.00). Conclusions More than half of patients presenting with acute LM and LVEF <50{\%} who survive the acute phase show persistent LV dysfunction after 1-year from hospital discharge. Features of sub-acute inflammatory process and of established myocardial damage at initial hospitalization emerged as predictors of this end-point.",
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T2 - Frequency and predictors

AU - Merlo, Marco

AU - Ammirati, Enrico

AU - Gentile, Piero

AU - Artico, Jessica

AU - Cannatà, Antonio

AU - Finocchiaro, Gherardo

AU - Barbati, Giulia

AU - Sormani, Paola

AU - Varrenti, Marisa

AU - Perkan, Andrea

AU - Fabris, Enrico

AU - Aleksova, Aneta

AU - Bussani, Rossana

AU - Petrella, Duccio

AU - Cipriani, Manlio

AU - Raineri, Claudia

AU - Frigerio, Maria

AU - Sinagra, Gianfranco

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background Persistent left ventricular (LV) systolic dysfunction in patients with acute lymphocytic myocarditis (LM) is widely unexplored. Objectives To assess the frequency and predictors of persistent LV dysfunction in patients with LM and reduced LVEF at admission. Methods and results We retrospectively evaluated 89 consecutive patients with histologically-proven acute myocarditis enrolled at three Italian referral hospitals. A subgroup of 48 patients with LM, baseline systolic impairment and an available echocardiographic assessment at 12 months (6–18) from discharge constituted the study population. The primary study end-point was persistent LV dysfunction, defined as LVEF <50% at 1-year, and was observed in 27/48 patients (56.3%). Higher LV end-diastolic diameter at admission (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.04–1.43, p = 0.002), non-fulminant presentation (OR 8.46, 95% CI 1.28–55.75, p = 0.013) and presence of a poor lymphocytic infiltrate (OR 12.40, 95% CI 1.23–124.97, p = 0.010) emerged as independent predictors of persistent LV dysfunction at multivariate analysis (area under the curve 0.91, 95% CI 0.82–0.99). Pre-discharge LVEF was lower in patients with persistent LV dysfunction compared to the others (32%±8 vs. 53%±8, p <0.001), and this single variable showed the best accuracy in predicting the study end-point (area under the curve 0.95, 95% CI 0.89–1.00). Conclusions More than half of patients presenting with acute LM and LVEF <50% who survive the acute phase show persistent LV dysfunction after 1-year from hospital discharge. Features of sub-acute inflammatory process and of established myocardial damage at initial hospitalization emerged as predictors of this end-point.

AB - Background Persistent left ventricular (LV) systolic dysfunction in patients with acute lymphocytic myocarditis (LM) is widely unexplored. Objectives To assess the frequency and predictors of persistent LV dysfunction in patients with LM and reduced LVEF at admission. Methods and results We retrospectively evaluated 89 consecutive patients with histologically-proven acute myocarditis enrolled at three Italian referral hospitals. A subgroup of 48 patients with LM, baseline systolic impairment and an available echocardiographic assessment at 12 months (6–18) from discharge constituted the study population. The primary study end-point was persistent LV dysfunction, defined as LVEF <50% at 1-year, and was observed in 27/48 patients (56.3%). Higher LV end-diastolic diameter at admission (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.04–1.43, p = 0.002), non-fulminant presentation (OR 8.46, 95% CI 1.28–55.75, p = 0.013) and presence of a poor lymphocytic infiltrate (OR 12.40, 95% CI 1.23–124.97, p = 0.010) emerged as independent predictors of persistent LV dysfunction at multivariate analysis (area under the curve 0.91, 95% CI 0.82–0.99). Pre-discharge LVEF was lower in patients with persistent LV dysfunction compared to the others (32%±8 vs. 53%±8, p <0.001), and this single variable showed the best accuracy in predicting the study end-point (area under the curve 0.95, 95% CI 0.89–1.00). Conclusions More than half of patients presenting with acute LM and LVEF <50% who survive the acute phase show persistent LV dysfunction after 1-year from hospital discharge. Features of sub-acute inflammatory process and of established myocardial damage at initial hospitalization emerged as predictors of this end-point.

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