Author + information
- Received October 11, 2011
- Revision received December 20, 2011
- Accepted January 2, 2012
- Published online May 1, 2012.
- Stefan Grün, MD⁎,
- Julia Schumm, MD⁎,
- Simon Greulich, MD⁎,
- Anja Wagner, MD†,
- Steffen Schneider, PhD‡,
- Oliver Bruder, MD‡,
- Eva-Maria Kispert, RN⁎,
- Stephan Hill, MD⁎,
- Peter Ong, MD⁎,
- Karin Klingel, MD§,
- Reinhardt Kandolf, MD§,
- Udo Sechtem, MD⁎ and
- Heiko Mahrholdt, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Heiko Mahrholdt, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
Objectives This study sought to evaluate the long-term mortality in patients with viral myocarditis, and to establish the prognostic value of various clinical, functional, and cardiovascular magnetic resonance (CMR) parameters.
Background Long-term mortality of viral myocarditis, as well as potential risk factors for poor clinical outcome, are widely unknown.
Methods A total of 222 consecutive patients with biopsy-proven viral myocarditis and CMR were enrolled. A total of 203 patients were available for clinical follow-up, and 77 patients underwent additional follow-up CMR. The median follow-up was 4.7 years. Primary endpoints were all-cause mortality and cardiac mortality.
Results We found a relevant long-term mortality in myocarditis patients (19.2% all cause, 15% cardiac, and 9.9% sudden cardiac death [SCD]). The presence of late gadolinium enhancement (LGE) yields a hazard ratio of 8.4 for all-cause mortality and 12.8 for cardiac mortality, independent of clinical symptoms. This is superior to parameters like left ventricular (LV) ejection fraction, LV end-diastolic volume, or New York Heart Association (NYHA) functional class, yielding hazard ratios between 1.0 and 3.2 for all-cause mortality and between 1.0 and 2.2 for cardiac mortality. No patient without LGE experienced SCD, even if the LV was enlarged and impaired. When focusing on the subgroup undergoing follow-up CMR, we found an initial NYHA functional class >I as the best independent predictor for incomplete recovery (p = 0.03).
Conclusions Among our population with a wide range of clinical symptoms, biopsy-proven viral myocarditis is associated with a long-term mortality of up to 19.2% in 4.7 years. In addition, the presence of LGE is the best independent predictor of all-cause mortality and of cardiac mortality. Furthermore, initial presentation with heart failure may be a good predictor of incomplete long-term recovery.
This study was funded in part by the Deutsche Forschungsgemeinschaft SFB-TR19, the Federal Ministry of Education and Research (01EZ0817), and the Robert Bosch Foundation (KKF-11-18). All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 11, 2011.
- Revision received December 20, 2011.
- Accepted January 2, 2012.
- American College of Cardiology Foundation