Zapalenie mięśnia sercowego – Rokowania, prognozy i postęp choroby

Zapalenie mięśnia sercowego
Rokowania, prognozy i postęp choroby

Zapalenie mięśnia sercowego (myocarditis) charakteryzuje się zróżnicowanym przebiegiem klinicznym i rokowaniem, które zależy od obrazu klinicznego, stopnia dysfunkcji lewej komory oraz cech histopatologicznych. Ogólna śmiertelność wynosi około 4,4%, jednak w piorunującej postaci sięga 26,7% (p<0,001). W przypadku limfocytarnego zapalenia mięśnia sercowego śmiertelność wynosi około 20% w ciągu pierwszego roku i ponad 50% w ciągu 4 lat, natomiast olbrzymiokomórkowe zapalenie mięśnia sercowego wiąże się z najgorszym rokowaniem – mniej niż 20% pacjentów przeżywa 5 lat bez przeszczepu serca. Kluczowymi czynnikami prognostycznymi są klasa czynnościowa NYHA, obecność piorunującego przebiegu, niski poziom albuminy, a u dzieci wiek poniżej 7 lat (OR 10,1; p=0,003), płeć żeńska (OR 4,6; p=0,03), frakcja wyrzutowa 40-55% oraz podwyższony poziom LDH. Badania obrazowe (m.in. powiększenie lewej komory, nadciśnienie płucne, blok odnogi pęczka Hisa, późne wzmocnienie gadolinem w MRI) oraz EKG (rozszerzone zespoły QRS, blok AV, złośliwe arytmie) dostarczają istotnych informacji prognostycznych.

Zapalenie mięśnia sercowego – Rokowanie (Prognosis)

Ogólne rokowanie
Rokowanie w zależności od obrazu klinicznego
Czynniki prognostyczne
Długoterminowe powikłania
Nowoczesne narzędzia prognostyczne
Rokowanie w zależności od odpowiedzi na leczenie
Podsumowanie
Kolejne rozdziały

Zapalenie mięśnia sercowego – Rokowanie (Prognosis)

Zapalenie mięśnia sercowego (myocarditis) jest schorzeniem o bardzo zróżnicowanym przebiegu i rokowaniu, które zależy od wielu czynników, w tym obrazu klinicznego w momencie prezentacji, stopnia dysfunkcji lewej komory oraz charakterystyki histopatologicznej.¹² Choroba może mieć przebieg od łagodnego, samoograniczającego się zapalenia do piorunującego zapalenia mięśnia sercowego z wysoką śmiertelnością.³⁴

Ogólne rokowanie

Ogólne rokowanie u pacjentów z zapaleniem mięśnia sercowego jest zazwyczaj dobre pod względem zarówno przeżywalności, jak i powrotu do zdrowia bez rezydualnej dysfunkcji lewej komory.⁵ Jednak dane wskazują na znaczną zmienność w zależności od postaci klinicznej. W retrospektywnym badaniu obserwacyjnym ogólna śmiertelność wynosiła 4,4%, przy czym w grupie z piorunującym zapaleniem mięśnia sercowego śmiertelność była znacznie wyższa i wynosiła 26,7% w porównaniu do 2,7% w grupie bez piorunującego przebiegu (p<0,001).⁶

Badania długoterminowe wskazują, że pacjenci z ostrym zapaleniem mięśnia sercowego (AM) mają gorsze wyniki zarówno krótko-, jak i długoterminowe w porównaniu z pacjentami z niewyjaśnionym ostrym bólem w klatce piersiowej (UCP). Śmiertelność w ciągu 30 dni była wyższa u pacjentów z AM (OR 3,75, 95% CI 1,9-7,3, p<0,001), a w okresie obserwacji o medianie 7,8 lat pacjenci z AM wykazywali również gorsze przeżycie (OR 2,0, 95% CI 1,69-2,39, p<0,001).⁷

Rokowanie w zależności od obrazu klinicznego

Naturalny przebieg zapalenia mięśnia sercowego znacząco różni się w zależności od początkowej prezentacji klinicznej.⁸ Można wyróżnić kilka głównych postaci klinicznych o odmiennym rokowaniu:

Piorunujące zapalenie mięśnia sercowego

Piorunujące zapalenie mięśnia sercowego charakteryzuje się szybkim pogorszeniem funkcji serca i wysokim ryzykiem zgonu, szczególnie we wczesnym etapie choroby.⁹ Jednak pacjenci, którzy przeżyją fazę ostrą dzięki agresywnemu wsparciu hemodynamicznemu, mają doskonałe długoterminowe rokowanie z przeżyciem wolnym od zdarzeń przekraczającym 90% w okresie 10 lat.¹⁰¹¹ W piorunującym zapaleniu mięśnia sercowego dochodzi do tak zwanej „burzy cytokinowej”, która prowadzi do gwałtownego spadku funkcji serca i wysokiej śmiertelności w fazie ostrej.¹²

Limfocytarne zapalenie mięśnia sercowego

W przypadku potwierdzonego biopsją limfocytarnego zapalenia mięśnia sercowego, średnia śmiertelność wynosi około 20% w ciągu pierwszego roku i ponad 50% w ciągu 4 lat.¹³ Tak wysoka śmiertelność podkreśla wagę wczesnej diagnozy i odpowiedniego leczenia w tej postaci choroby.

Olbrzymiokomórkowe zapalenie mięśnia sercowego

Olbrzymiokomórkowe zapalenie mięśnia sercowego wiąże się z najgorszym rokowaniem spośród wszystkich postaci zapalenia mięśnia sercowego. Mniej niż 20% pacjentów przeżywa 5 lat bez przeszczepu serca.¹⁴ Ta postać wymaga szczególnie intensywnego leczenia i wczesnego rozważenia kwalifikacji do przeszczepu serca.

Czynniki prognostyczne

Zidentyfikowano szereg czynników, które mają istotne znaczenie dla prognozowania przebiegu zapalenia mięśnia sercowego:

Czynniki kliniczne

Po korekcie względem wieku i płci, najsilniejszym predyktorem śmiertelności jest klasa czynnościowa według NYHA w momencie prezentacji.¹⁵ Również piorunujące zapalenie mięśnia sercowego oraz niski poziom albuminy są związane z wyższą śmiertelnością.¹⁶

U pacjentów pediatrycznych z ostrym zapaleniem mięśnia sercowego, czynnikami związanymi z gorszym rokowaniem są:

Wiek poniżej 7 lat (iloraz szans [OR] 10,1; p=0,003)¹⁷
Płeć żeńska (OR 4,6; p=0,03)¹⁸
Piorunujące zapalenie mięśnia sercowego (OR 27,0; p=0,001)¹⁹
Frakcja wyrzutowa między 40-55% przy przyjęciu (najwyższe ryzyko rozwoju kardiomiopatii rozstrzeniowej)²⁰
Podwyższony poziom dehydrogenazy mleczanowej (LDH) – może być istotnym czynnikiem prognostycznym²¹

Czynniki histopatologiczne

Istotne predyktory niekorzystnego rokowania w biopsyjnie potwierdzonym zapaleniu mięśnia sercowego obejmują:

Olbrzymiokomórkowy obraz histopatologiczny²²
Utrzymujący się genom wirusa w powtórnej biopsji endomiokardialnej²³
Podwyższony poziom Fas i ligandu Fas w krążeniu lub w mięśniu sercowym²⁴

Czynniki obrazowe

Badania obrazowe dostarczają ważnych informacji prognostycznych:

Stopień powiększenia i sferyczności lewej komory²⁵
Nadciśnienie płucne²⁶
Blok odnogi pęczka Hisa²⁷
Późne wzmocnienie gadolinem w rezonansie magnetycznym serca – wskazuje na zaburzenia objętości pozakomórkowej w wyniku martwicy komórek lub obrzęku i jest istotnie związane ze zwiększonym ryzykiem zgonu z wszystkich przyczyn, zgonu z przyczyn sercowo-naczyniowych i poważnych zdarzeń sercowo-naczyniowych²⁸

Czynniki elektrokardiograficzne

W elektrokardiogramie (EKG), który jest jednym z najczęściej stosowanych narzędzi przesiewowych w przypadkach podejrzenia patologii sercowej, do niekorzystnych czynników prognostycznych należą:

Rozszerzone zespoły QRS i odstępy QT²⁹
Częściowy lub całkowity blok przedsionkowo-komorowy³⁰
Złośliwe arytmie komorowe, takie jak utrwalony częstoskurcz komorowy lub migotanie komór³¹

Długoterminowe powikłania

Zapalenie mięśnia sercowego może prowadzić do poważnych długoterminowych powikłań, które wpływają na rokowanie:

Niewydolność serca

Badania wskazują, że pacjenci z AM mają wyższe ryzyko rozwoju niewydolności serca (OR 2,3, 95% CI 1,81-2,93, p<0,001) w porównaniu z pacjentami z niewyjaśnionym bólem w klatce piersiowej.³² Ryzyko to utrzymuje się nawet po pierwszym roku od zachorowania.³³

Kardiomiopatia rozstrzeniowa

Obecnie nie jest jasne, dlaczego u niektórych pacjentów następuje całkowity powrót do zdrowia bez rezydualnego uszkodzenia mięśnia sercowego, podczas gdy u innych rozwija się kardiomiopatia rozstrzeniowa.³⁴ U dzieci z ostrym zapaleniem mięśnia sercowego, około 50% przypadków ulega spontanicznej remisji, natomiast pozostali mogą rozwinąć kardiomiopatię rozstrzeniową.³⁵

Zawał mięśnia sercowego

Pacjenci z przebytym zapaleniem mięśnia sercowego mają również wyższe ryzyko zawału mięśnia sercowego (OR 1,3, 95% CI 1,11-1,62, p<0,001) w porównaniu z grupą UCP.³⁶

Nagła śmierć sercowa

Zapalenie mięśnia sercowego jest istotną przyczyną nagłej śmierci sercowej (SCD) u niemowląt, nastolatków i młodych dorosłych. Częstość występowania wykazuje dużą zmienność (1-14%) w zależności od definicji SCD i kryteriów diagnostycznych zapalenia mięśnia sercowego post-mortem.³⁷

Nowoczesne narzędzia prognostyczne

W ostatnich latach rozwinęły się zaawansowane metody prognozowania przebiegu zapalenia mięśnia sercowego:

Modele uczenia maszynowego

Uczenie maszynowe umożliwia lepsze przewidywanie wyników w zadaniach związanych z przeżyciem poprzez analizę złożonych interakcji między różnymi czynnikami ryzyka.³⁸ Modele predykcji przeżycia wykazują solidną moc dyskryminacyjną, szczególnie w warunkach nagłych i w populacji pediatrycznej.³⁹

Sztuczna inteligencja

Modele sztucznej inteligencji (AI) pomagają również w przewidywaniu wyników pacjentów, szczególnie w przypadkach pediatrycznych i tych o złożonym obrazie klinicznym.⁴⁰ AI została wykorzystana z istotnym efektem w określaniu prawdopodobieństwa przeżycia pacjentów z zapaleniem mięśnia sercowego, używając wielu parametrów klinicznych do obliczania wyników z większą precyzją niż konwencjonalne modele statystyczne, takie jak wielozmienne modele ryzyka proporcjonalnego Coxa.⁴¹

Rokowanie w zależności od odpowiedzi na leczenie

Odpowiedź na leczenie jest kluczowym czynnikiem wpływającym na rokowanie. Zapalenie mięśnia sercowego powikłane dysfunkcją lewej komory, niewydolnością serca lub arytmią wiąże się z niekorzystnym rokowaniem pomimo intensywnych badań nad nowymi metodami leczenia.⁴² W celu opracowania terapii opartych na etiologii, skuteczność wielu istniejących, przekwalifikowanych lub nowych terapii wymaga oceny w dużych, kontrolowanych, randomizowanych badaniach.⁴³

Istnieją liczne badania oceniające czynniki prognostyczne i skuteczność różnych form leczenia, m.in.:

Terapia immunosupresyjna u pacjentów z wirusowo-ujemnym przewlekłym zapaleniem mięśnia sercowego⁴⁴
Immunoadsorpcja u kandydatów do przeszczepu z dodatnimi autoprzeciwciałami przeciwko receptorom β1-adrenergicznym⁴⁵
Rezonans magnetyczny serca w stratyfikacji ryzyka pacjentów z podejrzeniem zapalenia mięśnia sercowego⁴⁶

Podsumowanie

Rokowanie w zapaleniu mięśnia sercowego jest zmienne i zależy od wielu czynników, w tym obrazu klinicznego, stopnia dysfunkcji lewej komory, cech histopatologicznych oraz odpowiedzi na leczenie. Większość pacjentów z łagodnym przebiegiem choroby ma dobre rokowanie, jednak pacjenci z obniżoną frakcją wyrzutową, niewydolnością serca, zaawansowanym blokiem przedsionkowo-komorowym, utrwalonymi arytmiami komorowymi lub niestabilnością hemodynamiczną mają gorsze rokowanie z podwyższonym ryzykiem zgonu lub konieczności przeszczepu serca.⁴⁷

Nowoczesne metody prognostyczne, w tym modele oparte na uczeniu maszynowym i sztucznej inteligencji, oferują nowe możliwości dokładniejszego przewidywania przebiegu choroby i optymalizacji strategii leczenia.⁴⁸

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Materiały źródłowe

#1 Characterization and long-term outcomes of patients with myocarditis: a retrospective observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC8039934/
There is limited data on the long-term follow-up of patients with myocarditis. […] The overall prognosis of patients with myocarditis is good in terms of both survival and recovery without residual left ventricular dysfunction. […] Patients with fulminant myocarditis who survive to discharge have a positive prognosis. […] The prognosis of patients with acute/subacute myocarditis varies and is dependent on the clinical presentation, specifically the extent of left ventricular (LV) dysfunction at presentation. […] The overall mortality was 4.4% (9 patients) in the cohort the fulminant myocarditis group mortality was 26.7% (4 patients) and the non-fulminant myocarditis group mortality was 2.7% (5 patients) (p 0.001). […] After adjustment for age and gender, the strongest predictor of mortality was NYHA at the time of presentation. […] Presentation with fulminant myocarditis and a low albumin level were also associated with a higher level of mortality. […] The strongest predictor of mortality was functional level (NYHA classification) at presentation.
#2 Myocarditis – Wikipedia
https://en.wikipedia.org/wiki/Myocarditis
Prognosis Variable […] The prognosis associated with myocarditis is stratified by the severity and time course along which symptoms develop. In addition to symptom severity, there are also several indicators of heart function that can be used to predict patient outcomes, many of which are part of the standard evaluation of patients presenting with cardiovascular dysfunction. Most people with myocarditis have an uncomplicated, self-limited and mild course while making a full recovery. However, those with myocarditis that present with a decreased ejection fraction, or those who present with heart failure, advanced atrioventricular block, with sustained ventricular arrhythmias or with hemodynamic instability have a worse prognosis with an increased risk of death or need for heart transplantation.
#3 Epidemiology and Prognosis of Myocarditis and dilated Cardiomyopathy: Predictive Value of Clinical Parameters and Biopsy Findings | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-7643-8352-7_2
The natural history of myocarditis varies based on its initial clinical presentation. […] Fulminant myocarditis appears to have an excellent, long-term prognosis with event-free survival rate exceeding 90% at 10 years if aggressive hemodynamic support is provided during the acute phase of the illness. […] Mortality for biopsy-verified lymphocytic myocarditis averages 20% at 1 year and over 50% at 4 years. […] Important predictors of adverse prognosis with biopsy-proven myocarditis include giant cell histopathology, persistent viral genome on repeat endomyocardial biopsy, elevated myocardial or circulatory Fas and Fas ligand levels, extent of left ventricular enlargement and sphericity, pulmonary hypertension and bundle branch block. […] Survival with giant cell myocarditis is substantially lower with fewer than 20% of patients surviving 5 years.
#4 Treatment and prognosis of myocarditis in adults – UpToDate
https://www.uptodate.com/contents/treatment-and-prognosis-of-myocarditis-in-adults
Myocarditis refers to inflammation of the heart muscle. The diagnosis may be suspected by clinical and noninvasive features and is confirmed by histopathologic criteria on endomyocardial biopsy. The clinical manifestations of this disorder vary greatly from asymptomatic changes on an electrocardiogram to fulminant heart failure (HF). This topic will review the prognosis and treatment of myocarditis in adults. Treatment of myocarditis consists of both specific therapy aimed at the cause of the myocarditis and nonspecific therapy aimed at the clinical manifestations such as HF and arrhythmias. […] NATURAL HISTORY AND PROGNOSIS […] Variable disease course â The course of myocarditis varies with the presenting clinical syndrome.
#5 Characterization and long-term outcomes of patients with myocarditis: a retrospective observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC8039934/
There is limited data on the long-term follow-up of patients with myocarditis. […] The overall prognosis of patients with myocarditis is good in terms of both survival and recovery without residual left ventricular dysfunction. […] Patients with fulminant myocarditis who survive to discharge have a positive prognosis. […] The prognosis of patients with acute/subacute myocarditis varies and is dependent on the clinical presentation, specifically the extent of left ventricular (LV) dysfunction at presentation. […] The overall mortality was 4.4% (9 patients) in the cohort the fulminant myocarditis group mortality was 26.7% (4 patients) and the non-fulminant myocarditis group mortality was 2.7% (5 patients) (p 0.001). […] After adjustment for age and gender, the strongest predictor of mortality was NYHA at the time of presentation. […] Presentation with fulminant myocarditis and a low albumin level were also associated with a higher level of mortality. […] The strongest predictor of mortality was functional level (NYHA classification) at presentation.
#6 Characterization and long-term outcomes of patients with myocarditis: a retrospective observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC8039934/
There is limited data on the long-term follow-up of patients with myocarditis. […] The overall prognosis of patients with myocarditis is good in terms of both survival and recovery without residual left ventricular dysfunction. […] Patients with fulminant myocarditis who survive to discharge have a positive prognosis. […] The prognosis of patients with acute/subacute myocarditis varies and is dependent on the clinical presentation, specifically the extent of left ventricular (LV) dysfunction at presentation. […] The overall mortality was 4.4% (9 patients) in the cohort the fulminant myocarditis group mortality was 26.7% (4 patients) and the non-fulminant myocarditis group mortality was 2.7% (5 patients) (p 0.001). […] After adjustment for age and gender, the strongest predictor of mortality was NYHA at the time of presentation. […] Presentation with fulminant myocarditis and a low albumin level were also associated with a higher level of mortality. […] The strongest predictor of mortality was functional level (NYHA classification) at presentation.
#7 Characteristics and prognosis in acute myocarditis and unexplained acute chest pain: a nationwide longitudinal cohort study
https://pmc.ncbi.nlm.nih.gov/articles/PMC11973765/
Acute myocarditis (AM) is a disease with variable prognosis, ranging from complete recovery to end-stage heart failure (HF) and death but often challenging to differentiate from unexplained acute chest pain (UCP) in the acute setting. […] AM is associated with worse short-term and long-term outcomes compared with UCP, including a higher risk of developing HF even after the first year. […] Patients with AM presented higher mortality at 30 days compared with patients with UCP (OR 3.75, 95% CI 1.9 to 7.3, p0.001) when analysed by multivariable adjusted logistic regression. […] Under a median follow up of 7.8 years (Q1, Q3; 3.4, 12.3), patients with AM displayed worse survival (OR 2.0, 95% CI 1.69 to 2.39, p0.001) compared with UCP, as well as higher risk for HF (OR 2.3, 95% CI 1.81 to 2.93, p0.001) and myocardial infarction (OR 1.3, 95%CI 1.11 to 1.62, p0.001). […] These findings indicate that patients with AM face a greater risk of both 30 days and long-term mortality as well as an increased likelihood of developing HF compared with patients with UCP.
#8 Epidemiology and Prognosis of Myocarditis and dilated Cardiomyopathy: Predictive Value of Clinical Parameters and Biopsy Findings | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-7643-8352-7_2
The natural history of myocarditis varies based on its initial clinical presentation. […] Fulminant myocarditis appears to have an excellent, long-term prognosis with event-free survival rate exceeding 90% at 10 years if aggressive hemodynamic support is provided during the acute phase of the illness. […] Mortality for biopsy-verified lymphocytic myocarditis averages 20% at 1 year and over 50% at 4 years. […] Important predictors of adverse prognosis with biopsy-proven myocarditis include giant cell histopathology, persistent viral genome on repeat endomyocardial biopsy, elevated myocardial or circulatory Fas and Fas ligand levels, extent of left ventricular enlargement and sphericity, pulmonary hypertension and bundle branch block. […] Survival with giant cell myocarditis is substantially lower with fewer than 20% of patients surviving 5 years.
#9 Myocarditis – Wikipedia
https://en.wikipedia.org/wiki/Myocarditis
Myocarditis has been reported to be a major cause of sudden cardiac death (SCD) in infants, adolescents, and young adults, but the reported rates show wide variation (1 to 14 percent) among young people depending on differences in SCD definition and classification/ definition of myocarditis post-mortem as well as heterogeneity of study populations. […] In fulminant myocarditis, in which an inflammatory cytokine storm occurs, cardiac functions decline rapidly and the death rate is high.
#10 Epidemiology and Prognosis of Myocarditis and dilated Cardiomyopathy: Predictive Value of Clinical Parameters and Biopsy Findings | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-7643-8352-7_2
The natural history of myocarditis varies based on its initial clinical presentation. […] Fulminant myocarditis appears to have an excellent, long-term prognosis with event-free survival rate exceeding 90% at 10 years if aggressive hemodynamic support is provided during the acute phase of the illness. […] Mortality for biopsy-verified lymphocytic myocarditis averages 20% at 1 year and over 50% at 4 years. […] Important predictors of adverse prognosis with biopsy-proven myocarditis include giant cell histopathology, persistent viral genome on repeat endomyocardial biopsy, elevated myocardial or circulatory Fas and Fas ligand levels, extent of left ventricular enlargement and sphericity, pulmonary hypertension and bundle branch block. […] Survival with giant cell myocarditis is substantially lower with fewer than 20% of patients surviving 5 years.
#11 Characterization and long-term outcomes of patients with myocarditis: a retrospective observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC8039934/
There is limited data on the long-term follow-up of patients with myocarditis. […] The overall prognosis of patients with myocarditis is good in terms of both survival and recovery without residual left ventricular dysfunction. […] Patients with fulminant myocarditis who survive to discharge have a positive prognosis. […] The prognosis of patients with acute/subacute myocarditis varies and is dependent on the clinical presentation, specifically the extent of left ventricular (LV) dysfunction at presentation. […] The overall mortality was 4.4% (9 patients) in the cohort the fulminant myocarditis group mortality was 26.7% (4 patients) and the non-fulminant myocarditis group mortality was 2.7% (5 patients) (p 0.001). […] After adjustment for age and gender, the strongest predictor of mortality was NYHA at the time of presentation. […] Presentation with fulminant myocarditis and a low albumin level were also associated with a higher level of mortality. […] The strongest predictor of mortality was functional level (NYHA classification) at presentation.
#12 Myocarditis – Wikipedia
https://en.wikipedia.org/wiki/Myocarditis
Myocarditis has been reported to be a major cause of sudden cardiac death (SCD) in infants, adolescents, and young adults, but the reported rates show wide variation (1 to 14 percent) among young people depending on differences in SCD definition and classification/ definition of myocarditis post-mortem as well as heterogeneity of study populations. […] In fulminant myocarditis, in which an inflammatory cytokine storm occurs, cardiac functions decline rapidly and the death rate is high.
#13 Epidemiology and Prognosis of Myocarditis and dilated Cardiomyopathy: Predictive Value of Clinical Parameters and Biopsy Findings | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-7643-8352-7_2
The natural history of myocarditis varies based on its initial clinical presentation. […] Fulminant myocarditis appears to have an excellent, long-term prognosis with event-free survival rate exceeding 90% at 10 years if aggressive hemodynamic support is provided during the acute phase of the illness. […] Mortality for biopsy-verified lymphocytic myocarditis averages 20% at 1 year and over 50% at 4 years. […] Important predictors of adverse prognosis with biopsy-proven myocarditis include giant cell histopathology, persistent viral genome on repeat endomyocardial biopsy, elevated myocardial or circulatory Fas and Fas ligand levels, extent of left ventricular enlargement and sphericity, pulmonary hypertension and bundle branch block. […] Survival with giant cell myocarditis is substantially lower with fewer than 20% of patients surviving 5 years.
#14 Epidemiology and Prognosis of Myocarditis and dilated Cardiomyopathy: Predictive Value of Clinical Parameters and Biopsy Findings | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-7643-8352-7_2
The natural history of myocarditis varies based on its initial clinical presentation. […] Fulminant myocarditis appears to have an excellent, long-term prognosis with event-free survival rate exceeding 90% at 10 years if aggressive hemodynamic support is provided during the acute phase of the illness. […] Mortality for biopsy-verified lymphocytic myocarditis averages 20% at 1 year and over 50% at 4 years. […] Important predictors of adverse prognosis with biopsy-proven myocarditis include giant cell histopathology, persistent viral genome on repeat endomyocardial biopsy, elevated myocardial or circulatory Fas and Fas ligand levels, extent of left ventricular enlargement and sphericity, pulmonary hypertension and bundle branch block. […] Survival with giant cell myocarditis is substantially lower with fewer than 20% of patients surviving 5 years.
#15 Characterization and long-term outcomes of patients with myocarditis: a retrospective observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC8039934/
There is limited data on the long-term follow-up of patients with myocarditis. […] The overall prognosis of patients with myocarditis is good in terms of both survival and recovery without residual left ventricular dysfunction. […] Patients with fulminant myocarditis who survive to discharge have a positive prognosis. […] The prognosis of patients with acute/subacute myocarditis varies and is dependent on the clinical presentation, specifically the extent of left ventricular (LV) dysfunction at presentation. […] The overall mortality was 4.4% (9 patients) in the cohort the fulminant myocarditis group mortality was 26.7% (4 patients) and the non-fulminant myocarditis group mortality was 2.7% (5 patients) (p 0.001). […] After adjustment for age and gender, the strongest predictor of mortality was NYHA at the time of presentation. […] Presentation with fulminant myocarditis and a low albumin level were also associated with a higher level of mortality. […] The strongest predictor of mortality was functional level (NYHA classification) at presentation.
#16 Characterization and long-term outcomes of patients with myocarditis: a retrospective observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC8039934/
There is limited data on the long-term follow-up of patients with myocarditis. […] The overall prognosis of patients with myocarditis is good in terms of both survival and recovery without residual left ventricular dysfunction. […] Patients with fulminant myocarditis who survive to discharge have a positive prognosis. […] The prognosis of patients with acute/subacute myocarditis varies and is dependent on the clinical presentation, specifically the extent of left ventricular (LV) dysfunction at presentation. […] The overall mortality was 4.4% (9 patients) in the cohort the fulminant myocarditis group mortality was 26.7% (4 patients) and the non-fulminant myocarditis group mortality was 2.7% (5 patients) (p 0.001). […] After adjustment for age and gender, the strongest predictor of mortality was NYHA at the time of presentation. […] Presentation with fulminant myocarditis and a low albumin level were also associated with a higher level of mortality. […] The strongest predictor of mortality was functional level (NYHA classification) at presentation.
#17 Could the unfortunate outcome of pediatric acute myocarditis be predicted? Factors contributing to a poor outcome in myocarditis | Revista Portuguesa de Cardiologia (English edition)
https://www.revportcardiol.org/en-could-unfortunate-outcome-pediatric-acute-articulo-S217420492100252X
Myocarditis has spontaneous resolution in 50% of patients. Our study aimed to define risk factors for developing dilated cardiomyopathy (DCM) and death in pediatric patients with acute myocarditis (AM). […] Patients with poor outcome (DCM development) were under the age of seven (odds ratio [OR] 10.1; p=0.003), more likely to be girls (OR 4.6; p=0.03), and had fulminant myocarditis (OR 27.0; 0.001). […] Acute fulminant myocarditis was an independent risk factor for DCM. Children with EF between 40 and 50% at admission were at highest risk of developing DCM. […] Lactate dehydrogenase value could be a significant prognostic value for the outcome of pediatric myocarditis. […] Factors associated with poor outcomes included younger age, female gender, signs and symptoms of HF, PCR-positive myocarditis, and poor perfusion associated with worse ventricular function on echocardiogram. […] According to multinomial logistic regression, AFM was an independent risk factor for DCM, but patients with EF between 40-55% were at highest risk of DCM. Additionally, LDH due to high specificity and high sensitivity could be a significant prognostic value for the outcome of pediatric myocarditis.
#18 Could the unfortunate outcome of pediatric acute myocarditis be predicted? Factors contributing to a poor outcome in myocarditis | Revista Portuguesa de Cardiologia (English edition)
https://www.revportcardiol.org/en-could-unfortunate-outcome-pediatric-acute-articulo-S217420492100252X
Myocarditis has spontaneous resolution in 50% of patients. Our study aimed to define risk factors for developing dilated cardiomyopathy (DCM) and death in pediatric patients with acute myocarditis (AM). […] Patients with poor outcome (DCM development) were under the age of seven (odds ratio [OR] 10.1; p=0.003), more likely to be girls (OR 4.6; p=0.03), and had fulminant myocarditis (OR 27.0; 0.001). […] Acute fulminant myocarditis was an independent risk factor for DCM. Children with EF between 40 and 50% at admission were at highest risk of developing DCM. […] Lactate dehydrogenase value could be a significant prognostic value for the outcome of pediatric myocarditis. […] Factors associated with poor outcomes included younger age, female gender, signs and symptoms of HF, PCR-positive myocarditis, and poor perfusion associated with worse ventricular function on echocardiogram. […] According to multinomial logistic regression, AFM was an independent risk factor for DCM, but patients with EF between 40-55% were at highest risk of DCM. Additionally, LDH due to high specificity and high sensitivity could be a significant prognostic value for the outcome of pediatric myocarditis.
#19 Could the unfortunate outcome of pediatric acute myocarditis be predicted? Factors contributing to a poor outcome in myocarditis | Revista Portuguesa de Cardiologia (English edition)
https://www.revportcardiol.org/en-could-unfortunate-outcome-pediatric-acute-articulo-S217420492100252X
Myocarditis has spontaneous resolution in 50% of patients. Our study aimed to define risk factors for developing dilated cardiomyopathy (DCM) and death in pediatric patients with acute myocarditis (AM). […] Patients with poor outcome (DCM development) were under the age of seven (odds ratio [OR] 10.1; p=0.003), more likely to be girls (OR 4.6; p=0.03), and had fulminant myocarditis (OR 27.0; 0.001). […] Acute fulminant myocarditis was an independent risk factor for DCM. Children with EF between 40 and 50% at admission were at highest risk of developing DCM. […] Lactate dehydrogenase value could be a significant prognostic value for the outcome of pediatric myocarditis. […] Factors associated with poor outcomes included younger age, female gender, signs and symptoms of HF, PCR-positive myocarditis, and poor perfusion associated with worse ventricular function on echocardiogram. […] According to multinomial logistic regression, AFM was an independent risk factor for DCM, but patients with EF between 40-55% were at highest risk of DCM. Additionally, LDH due to high specificity and high sensitivity could be a significant prognostic value for the outcome of pediatric myocarditis.
#20 Could the unfortunate outcome of pediatric acute myocarditis be predicted? Factors contributing to a poor outcome in myocarditis | Revista Portuguesa de Cardiologia (English edition)
https://www.revportcardiol.org/en-could-unfortunate-outcome-pediatric-acute-articulo-S217420492100252X
Myocarditis has spontaneous resolution in 50% of patients. Our study aimed to define risk factors for developing dilated cardiomyopathy (DCM) and death in pediatric patients with acute myocarditis (AM). […] Patients with poor outcome (DCM development) were under the age of seven (odds ratio [OR] 10.1; p=0.003), more likely to be girls (OR 4.6; p=0.03), and had fulminant myocarditis (OR 27.0; 0.001). […] Acute fulminant myocarditis was an independent risk factor for DCM. Children with EF between 40 and 50% at admission were at highest risk of developing DCM. […] Lactate dehydrogenase value could be a significant prognostic value for the outcome of pediatric myocarditis. […] Factors associated with poor outcomes included younger age, female gender, signs and symptoms of HF, PCR-positive myocarditis, and poor perfusion associated with worse ventricular function on echocardiogram. […] According to multinomial logistic regression, AFM was an independent risk factor for DCM, but patients with EF between 40-55% were at highest risk of DCM. Additionally, LDH due to high specificity and high sensitivity could be a significant prognostic value for the outcome of pediatric myocarditis.
#21 Could the unfortunate outcome of pediatric acute myocarditis be predicted? Factors contributing to a poor outcome in myocarditis | Revista Portuguesa de Cardiologia (English edition)
https://www.revportcardiol.org/en-could-unfortunate-outcome-pediatric-acute-articulo-S217420492100252X
Myocarditis has spontaneous resolution in 50% of patients. Our study aimed to define risk factors for developing dilated cardiomyopathy (DCM) and death in pediatric patients with acute myocarditis (AM). […] Patients with poor outcome (DCM development) were under the age of seven (odds ratio [OR] 10.1; p=0.003), more likely to be girls (OR 4.6; p=0.03), and had fulminant myocarditis (OR 27.0; 0.001). […] Acute fulminant myocarditis was an independent risk factor for DCM. Children with EF between 40 and 50% at admission were at highest risk of developing DCM. […] Lactate dehydrogenase value could be a significant prognostic value for the outcome of pediatric myocarditis. […] Factors associated with poor outcomes included younger age, female gender, signs and symptoms of HF, PCR-positive myocarditis, and poor perfusion associated with worse ventricular function on echocardiogram. […] According to multinomial logistic regression, AFM was an independent risk factor for DCM, but patients with EF between 40-55% were at highest risk of DCM. Additionally, LDH due to high specificity and high sensitivity could be a significant prognostic value for the outcome of pediatric myocarditis.
#22 Epidemiology and Prognosis of Myocarditis and dilated Cardiomyopathy: Predictive Value of Clinical Parameters and Biopsy Findings | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-7643-8352-7_2
The natural history of myocarditis varies based on its initial clinical presentation. […] Fulminant myocarditis appears to have an excellent, long-term prognosis with event-free survival rate exceeding 90% at 10 years if aggressive hemodynamic support is provided during the acute phase of the illness. […] Mortality for biopsy-verified lymphocytic myocarditis averages 20% at 1 year and over 50% at 4 years. […] Important predictors of adverse prognosis with biopsy-proven myocarditis include giant cell histopathology, persistent viral genome on repeat endomyocardial biopsy, elevated myocardial or circulatory Fas and Fas ligand levels, extent of left ventricular enlargement and sphericity, pulmonary hypertension and bundle branch block. […] Survival with giant cell myocarditis is substantially lower with fewer than 20% of patients surviving 5 years.
#23 Epidemiology and Prognosis of Myocarditis and dilated Cardiomyopathy: Predictive Value of Clinical Parameters and Biopsy Findings | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-7643-8352-7_2
The natural history of myocarditis varies based on its initial clinical presentation. […] Fulminant myocarditis appears to have an excellent, long-term prognosis with event-free survival rate exceeding 90% at 10 years if aggressive hemodynamic support is provided during the acute phase of the illness. […] Mortality for biopsy-verified lymphocytic myocarditis averages 20% at 1 year and over 50% at 4 years. […] Important predictors of adverse prognosis with biopsy-proven myocarditis include giant cell histopathology, persistent viral genome on repeat endomyocardial biopsy, elevated myocardial or circulatory Fas and Fas ligand levels, extent of left ventricular enlargement and sphericity, pulmonary hypertension and bundle branch block. […] Survival with giant cell myocarditis is substantially lower with fewer than 20% of patients surviving 5 years.
#24 Epidemiology and Prognosis of Myocarditis and dilated Cardiomyopathy: Predictive Value of Clinical Parameters and Biopsy Findings | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-7643-8352-7_2
The natural history of myocarditis varies based on its initial clinical presentation. […] Fulminant myocarditis appears to have an excellent, long-term prognosis with event-free survival rate exceeding 90% at 10 years if aggressive hemodynamic support is provided during the acute phase of the illness. […] Mortality for biopsy-verified lymphocytic myocarditis averages 20% at 1 year and over 50% at 4 years. […] Important predictors of adverse prognosis with biopsy-proven myocarditis include giant cell histopathology, persistent viral genome on repeat endomyocardial biopsy, elevated myocardial or circulatory Fas and Fas ligand levels, extent of left ventricular enlargement and sphericity, pulmonary hypertension and bundle branch block. […] Survival with giant cell myocarditis is substantially lower with fewer than 20% of patients surviving 5 years.
#25 Epidemiology and Prognosis of Myocarditis and dilated Cardiomyopathy: Predictive Value of Clinical Parameters and Biopsy Findings | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-7643-8352-7_2
The natural history of myocarditis varies based on its initial clinical presentation. […] Fulminant myocarditis appears to have an excellent, long-term prognosis with event-free survival rate exceeding 90% at 10 years if aggressive hemodynamic support is provided during the acute phase of the illness. […] Mortality for biopsy-verified lymphocytic myocarditis averages 20% at 1 year and over 50% at 4 years. […] Important predictors of adverse prognosis with biopsy-proven myocarditis include giant cell histopathology, persistent viral genome on repeat endomyocardial biopsy, elevated myocardial or circulatory Fas and Fas ligand levels, extent of left ventricular enlargement and sphericity, pulmonary hypertension and bundle branch block. […] Survival with giant cell myocarditis is substantially lower with fewer than 20% of patients surviving 5 years.
#26 Epidemiology and Prognosis of Myocarditis and dilated Cardiomyopathy: Predictive Value of Clinical Parameters and Biopsy Findings | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-7643-8352-7_2
The natural history of myocarditis varies based on its initial clinical presentation. […] Fulminant myocarditis appears to have an excellent, long-term prognosis with event-free survival rate exceeding 90% at 10 years if aggressive hemodynamic support is provided during the acute phase of the illness. […] Mortality for biopsy-verified lymphocytic myocarditis averages 20% at 1 year and over 50% at 4 years. […] Important predictors of adverse prognosis with biopsy-proven myocarditis include giant cell histopathology, persistent viral genome on repeat endomyocardial biopsy, elevated myocardial or circulatory Fas and Fas ligand levels, extent of left ventricular enlargement and sphericity, pulmonary hypertension and bundle branch block. […] Survival with giant cell myocarditis is substantially lower with fewer than 20% of patients surviving 5 years.
#27 Epidemiology and Prognosis of Myocarditis and dilated Cardiomyopathy: Predictive Value of Clinical Parameters and Biopsy Findings | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-7643-8352-7_2
The natural history of myocarditis varies based on its initial clinical presentation. […] Fulminant myocarditis appears to have an excellent, long-term prognosis with event-free survival rate exceeding 90% at 10 years if aggressive hemodynamic support is provided during the acute phase of the illness. […] Mortality for biopsy-verified lymphocytic myocarditis averages 20% at 1 year and over 50% at 4 years. […] Important predictors of adverse prognosis with biopsy-proven myocarditis include giant cell histopathology, persistent viral genome on repeat endomyocardial biopsy, elevated myocardial or circulatory Fas and Fas ligand levels, extent of left ventricular enlargement and sphericity, pulmonary hypertension and bundle branch block. […] Survival with giant cell myocarditis is substantially lower with fewer than 20% of patients surviving 5 years.
#28 Myocarditis – Wikipedia
https://en.wikipedia.org/wiki/Myocarditis
An electrocardiogram is one of the most common screening tools used in cases of suspected cardiac pathology, such as myocarditis. The findings that correlate with poorer outcomes are non-specific and include widened QRS complexes and QT intervals, partial or complete atrial-ventricular heart block, and malignant ventricular arrhythmias like sustained ventricular tachycardia or ventricular fibrillation. […] In cases of acute myocarditis, cardiac magnetic resonance imaging can reveal several prognostic indicators that, similar to ECGs, are non-specific and reflect poorer cardiac physiology. Late gadolinium enhancement on cardiac MRI demonstrates perturbations in extracellular volume as a result of cell necrosis or edema, and is significantly associated with increases in all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events.
#29 Myocarditis – Wikipedia
https://en.wikipedia.org/wiki/Myocarditis
An electrocardiogram is one of the most common screening tools used in cases of suspected cardiac pathology, such as myocarditis. The findings that correlate with poorer outcomes are non-specific and include widened QRS complexes and QT intervals, partial or complete atrial-ventricular heart block, and malignant ventricular arrhythmias like sustained ventricular tachycardia or ventricular fibrillation. […] In cases of acute myocarditis, cardiac magnetic resonance imaging can reveal several prognostic indicators that, similar to ECGs, are non-specific and reflect poorer cardiac physiology. Late gadolinium enhancement on cardiac MRI demonstrates perturbations in extracellular volume as a result of cell necrosis or edema, and is significantly associated with increases in all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events.
#30 Myocarditis – Wikipedia
https://en.wikipedia.org/wiki/Myocarditis
An electrocardiogram is one of the most common screening tools used in cases of suspected cardiac pathology, such as myocarditis. The findings that correlate with poorer outcomes are non-specific and include widened QRS complexes and QT intervals, partial or complete atrial-ventricular heart block, and malignant ventricular arrhythmias like sustained ventricular tachycardia or ventricular fibrillation. […] In cases of acute myocarditis, cardiac magnetic resonance imaging can reveal several prognostic indicators that, similar to ECGs, are non-specific and reflect poorer cardiac physiology. Late gadolinium enhancement on cardiac MRI demonstrates perturbations in extracellular volume as a result of cell necrosis or edema, and is significantly associated with increases in all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events.
#31 Myocarditis – Wikipedia
https://en.wikipedia.org/wiki/Myocarditis
An electrocardiogram is one of the most common screening tools used in cases of suspected cardiac pathology, such as myocarditis. The findings that correlate with poorer outcomes are non-specific and include widened QRS complexes and QT intervals, partial or complete atrial-ventricular heart block, and malignant ventricular arrhythmias like sustained ventricular tachycardia or ventricular fibrillation. […] In cases of acute myocarditis, cardiac magnetic resonance imaging can reveal several prognostic indicators that, similar to ECGs, are non-specific and reflect poorer cardiac physiology. Late gadolinium enhancement on cardiac MRI demonstrates perturbations in extracellular volume as a result of cell necrosis or edema, and is significantly associated with increases in all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events.
#32 Characteristics and prognosis in acute myocarditis and unexplained acute chest pain: a nationwide longitudinal cohort study
https://pmc.ncbi.nlm.nih.gov/articles/PMC11973765/
Acute myocarditis (AM) is a disease with variable prognosis, ranging from complete recovery to end-stage heart failure (HF) and death but often challenging to differentiate from unexplained acute chest pain (UCP) in the acute setting. […] AM is associated with worse short-term and long-term outcomes compared with UCP, including a higher risk of developing HF even after the first year. […] Patients with AM presented higher mortality at 30 days compared with patients with UCP (OR 3.75, 95% CI 1.9 to 7.3, p0.001) when analysed by multivariable adjusted logistic regression. […] Under a median follow up of 7.8 years (Q1, Q3; 3.4, 12.3), patients with AM displayed worse survival (OR 2.0, 95% CI 1.69 to 2.39, p0.001) compared with UCP, as well as higher risk for HF (OR 2.3, 95% CI 1.81 to 2.93, p0.001) and myocardial infarction (OR 1.3, 95%CI 1.11 to 1.62, p0.001). […] These findings indicate that patients with AM face a greater risk of both 30 days and long-term mortality as well as an increased likelihood of developing HF compared with patients with UCP.
#33 Characteristics and prognosis in acute myocarditis and unexplained acute chest pain: a nationwide longitudinal cohort study
https://pmc.ncbi.nlm.nih.gov/articles/PMC11973765/
Acute myocarditis (AM) is a disease with variable prognosis, ranging from complete recovery to end-stage heart failure (HF) and death but often challenging to differentiate from unexplained acute chest pain (UCP) in the acute setting. […] AM is associated with worse short-term and long-term outcomes compared with UCP, including a higher risk of developing HF even after the first year. […] Patients with AM presented higher mortality at 30 days compared with patients with UCP (OR 3.75, 95% CI 1.9 to 7.3, p0.001) when analysed by multivariable adjusted logistic regression. […] Under a median follow up of 7.8 years (Q1, Q3; 3.4, 12.3), patients with AM displayed worse survival (OR 2.0, 95% CI 1.69 to 2.39, p0.001) compared with UCP, as well as higher risk for HF (OR 2.3, 95% CI 1.81 to 2.93, p0.001) and myocardial infarction (OR 1.3, 95%CI 1.11 to 1.62, p0.001). […] These findings indicate that patients with AM face a greater risk of both 30 days and long-term mortality as well as an increased likelihood of developing HF compared with patients with UCP.
#34 Myocarditis and inflammatory cardiomyopathy: current evidence and future directions | Nature Reviews Cardiology
https://www.nature.com/articles/s41569-020-00435-x
Inflammatory cardiomyopathy, characterized by inflammatory cell infiltration into the myocardium and a high risk of deteriorating cardiac function, has a heterogeneous aetiology. […] Despite extensive research, inflammatory cardiomyopathy complicated by left ventricular dysfunction, heart failure or arrhythmia is associated with a poor prognosis. […] At present, the reason why some patients recover without residual myocardial injury whereas others develop dilated cardiomyopathy is unclear. […] The current knowledge and open questions regarding the cardiovascular effects associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are also discussed. […] To develop aetiology-based therapies, the efficacy of many existing, repurposed or emerging therapies needs to be evaluated in large, controlled, randomized trials.
#35 Could the unfortunate outcome of pediatric acute myocarditis be predicted? Factors contributing to a poor outcome in myocarditis | Revista Portuguesa de Cardiologia (English edition)
https://www.revportcardiol.org/en-could-unfortunate-outcome-pediatric-acute-articulo-S217420492100252X
Myocarditis has spontaneous resolution in 50% of patients. Our study aimed to define risk factors for developing dilated cardiomyopathy (DCM) and death in pediatric patients with acute myocarditis (AM). […] Patients with poor outcome (DCM development) were under the age of seven (odds ratio [OR] 10.1; p=0.003), more likely to be girls (OR 4.6; p=0.03), and had fulminant myocarditis (OR 27.0; 0.001). […] Acute fulminant myocarditis was an independent risk factor for DCM. Children with EF between 40 and 50% at admission were at highest risk of developing DCM. […] Lactate dehydrogenase value could be a significant prognostic value for the outcome of pediatric myocarditis. […] Factors associated with poor outcomes included younger age, female gender, signs and symptoms of HF, PCR-positive myocarditis, and poor perfusion associated with worse ventricular function on echocardiogram. […] According to multinomial logistic regression, AFM was an independent risk factor for DCM, but patients with EF between 40-55% were at highest risk of DCM. Additionally, LDH due to high specificity and high sensitivity could be a significant prognostic value for the outcome of pediatric myocarditis.
#36 Characteristics and prognosis in acute myocarditis and unexplained acute chest pain: a nationwide longitudinal cohort study
https://pmc.ncbi.nlm.nih.gov/articles/PMC11973765/
Acute myocarditis (AM) is a disease with variable prognosis, ranging from complete recovery to end-stage heart failure (HF) and death but often challenging to differentiate from unexplained acute chest pain (UCP) in the acute setting. […] AM is associated with worse short-term and long-term outcomes compared with UCP, including a higher risk of developing HF even after the first year. […] Patients with AM presented higher mortality at 30 days compared with patients with UCP (OR 3.75, 95% CI 1.9 to 7.3, p0.001) when analysed by multivariable adjusted logistic regression. […] Under a median follow up of 7.8 years (Q1, Q3; 3.4, 12.3), patients with AM displayed worse survival (OR 2.0, 95% CI 1.69 to 2.39, p0.001) compared with UCP, as well as higher risk for HF (OR 2.3, 95% CI 1.81 to 2.93, p0.001) and myocardial infarction (OR 1.3, 95%CI 1.11 to 1.62, p0.001). […] These findings indicate that patients with AM face a greater risk of both 30 days and long-term mortality as well as an increased likelihood of developing HF compared with patients with UCP.
#37 Myocarditis – Wikipedia
https://en.wikipedia.org/wiki/Myocarditis
Myocarditis has been reported to be a major cause of sudden cardiac death (SCD) in infants, adolescents, and young adults, but the reported rates show wide variation (1 to 14 percent) among young people depending on differences in SCD definition and classification/ definition of myocarditis post-mortem as well as heterogeneity of study populations. […] In fulminant myocarditis, in which an inflammatory cytokine storm occurs, cardiac functions decline rapidly and the death rate is high.
#38
https://link.springer.com/article/10.1007/s10741-024-10431-9
Myocarditis, marked by heart muscle inflammation, poses significant clinical challenges. […] Survival prediction models exhibited robust discriminatory power, particularly in emergency settings and pediatric populations. […] Prognosis and the survival prediction is invaluable tool for the further treatment steps. […] Machine learning allows for better prediction of outcomes in survival tasks, by analyzing complex interactions between various risk factors. […] AI models have also assisted in predicting patient outcomes, particularly in pediatric cases and those with complex clinical presentations. […] For example, AI has been used to significant effect in determining survival probabilities for patients with myocarditis, using numerous clinical inputs to calculate outcomes with greater precision than conventional statistical models, such as multivariable Cox hazards model.
#39
https://link.springer.com/article/10.1007/s10741-024-10431-9
Myocarditis, marked by heart muscle inflammation, poses significant clinical challenges. […] Survival prediction models exhibited robust discriminatory power, particularly in emergency settings and pediatric populations. […] Prognosis and the survival prediction is invaluable tool for the further treatment steps. […] Machine learning allows for better prediction of outcomes in survival tasks, by analyzing complex interactions between various risk factors. […] AI models have also assisted in predicting patient outcomes, particularly in pediatric cases and those with complex clinical presentations. […] For example, AI has been used to significant effect in determining survival probabilities for patients with myocarditis, using numerous clinical inputs to calculate outcomes with greater precision than conventional statistical models, such as multivariable Cox hazards model.
#40
https://link.springer.com/article/10.1007/s10741-024-10431-9
Myocarditis, marked by heart muscle inflammation, poses significant clinical challenges. […] Survival prediction models exhibited robust discriminatory power, particularly in emergency settings and pediatric populations. […] Prognosis and the survival prediction is invaluable tool for the further treatment steps. […] Machine learning allows for better prediction of outcomes in survival tasks, by analyzing complex interactions between various risk factors. […] AI models have also assisted in predicting patient outcomes, particularly in pediatric cases and those with complex clinical presentations. […] For example, AI has been used to significant effect in determining survival probabilities for patients with myocarditis, using numerous clinical inputs to calculate outcomes with greater precision than conventional statistical models, such as multivariable Cox hazards model.
#41
https://link.springer.com/article/10.1007/s10741-024-10431-9
Myocarditis, marked by heart muscle inflammation, poses significant clinical challenges. […] Survival prediction models exhibited robust discriminatory power, particularly in emergency settings and pediatric populations. […] Prognosis and the survival prediction is invaluable tool for the further treatment steps. […] Machine learning allows for better prediction of outcomes in survival tasks, by analyzing complex interactions between various risk factors. […] AI models have also assisted in predicting patient outcomes, particularly in pediatric cases and those with complex clinical presentations. […] For example, AI has been used to significant effect in determining survival probabilities for patients with myocarditis, using numerous clinical inputs to calculate outcomes with greater precision than conventional statistical models, such as multivariable Cox hazards model.
#42 Myocarditis and inflammatory cardiomyopathy: current evidence and future directions | Nature Reviews Cardiology
https://www.nature.com/articles/s41569-020-00435-x
Inflammatory cardiomyopathy, characterized by inflammatory cell infiltration into the myocardium and a high risk of deteriorating cardiac function, has a heterogeneous aetiology. […] Despite extensive research, inflammatory cardiomyopathy complicated by left ventricular dysfunction, heart failure or arrhythmia is associated with a poor prognosis. […] At present, the reason why some patients recover without residual myocardial injury whereas others develop dilated cardiomyopathy is unclear. […] The current knowledge and open questions regarding the cardiovascular effects associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are also discussed. […] To develop aetiology-based therapies, the efficacy of many existing, repurposed or emerging therapies needs to be evaluated in large, controlled, randomized trials.
#43 Myocarditis and inflammatory cardiomyopathy: current evidence and future directions | Nature Reviews Cardiology
https://www.nature.com/articles/s41569-020-00435-x
Inflammatory cardiomyopathy, characterized by inflammatory cell infiltration into the myocardium and a high risk of deteriorating cardiac function, has a heterogeneous aetiology. […] Despite extensive research, inflammatory cardiomyopathy complicated by left ventricular dysfunction, heart failure or arrhythmia is associated with a poor prognosis. […] At present, the reason why some patients recover without residual myocardial injury whereas others develop dilated cardiomyopathy is unclear. […] The current knowledge and open questions regarding the cardiovascular effects associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are also discussed. […] To develop aetiology-based therapies, the efficacy of many existing, repurposed or emerging therapies needs to be evaluated in large, controlled, randomized trials.
#44 Myocarditis and inflammatory cardiomyopathy: current evidence and future directions | Nature Reviews Cardiology
https://www.nature.com/articles/s41569-020-00435-x
Predictors of outcome in patients with suspected myocarditis. […] A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. […] Long-term outcome of patients with virus-negative chronic myocarditis or inflammatory cardiomyopathy after immunosuppressive therapy. […] Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. […] Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy: results of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study. […] Long-term benefits of immunoadsorption in (1)-adrenoceptor autoantibody-positive transplant candidates with dilated cardiomyopathy. […] Prognostic value of cardiac magnetic resonance tissue characterization in risk stratifying patients with suspected myocarditis. […] Persistent left ventricular dysfunction after acute lymphocytic myocarditis: frequency and predictors.
#45 Myocarditis and inflammatory cardiomyopathy: current evidence and future directions | Nature Reviews Cardiology
https://www.nature.com/articles/s41569-020-00435-x
Predictors of outcome in patients with suspected myocarditis. […] A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. […] Long-term outcome of patients with virus-negative chronic myocarditis or inflammatory cardiomyopathy after immunosuppressive therapy. […] Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. […] Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy: results of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study. […] Long-term benefits of immunoadsorption in (1)-adrenoceptor autoantibody-positive transplant candidates with dilated cardiomyopathy. […] Prognostic value of cardiac magnetic resonance tissue characterization in risk stratifying patients with suspected myocarditis. […] Persistent left ventricular dysfunction after acute lymphocytic myocarditis: frequency and predictors.
#46 Myocarditis and inflammatory cardiomyopathy: current evidence and future directions | Nature Reviews Cardiology
https://www.nature.com/articles/s41569-020-00435-x
Predictors of outcome in patients with suspected myocarditis. […] A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. […] Long-term outcome of patients with virus-negative chronic myocarditis or inflammatory cardiomyopathy after immunosuppressive therapy. […] Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. […] Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy: results of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study. […] Long-term benefits of immunoadsorption in (1)-adrenoceptor autoantibody-positive transplant candidates with dilated cardiomyopathy. […] Prognostic value of cardiac magnetic resonance tissue characterization in risk stratifying patients with suspected myocarditis. […] Persistent left ventricular dysfunction after acute lymphocytic myocarditis: frequency and predictors.
#47 Myocarditis – Wikipedia
https://en.wikipedia.org/wiki/Myocarditis
Prognosis Variable […] The prognosis associated with myocarditis is stratified by the severity and time course along which symptoms develop. In addition to symptom severity, there are also several indicators of heart function that can be used to predict patient outcomes, many of which are part of the standard evaluation of patients presenting with cardiovascular dysfunction. Most people with myocarditis have an uncomplicated, self-limited and mild course while making a full recovery. However, those with myocarditis that present with a decreased ejection fraction, or those who present with heart failure, advanced atrioventricular block, with sustained ventricular arrhythmias or with hemodynamic instability have a worse prognosis with an increased risk of death or need for heart transplantation.
#48
https://link.springer.com/article/10.1007/s10741-024-10431-9
Myocarditis, marked by heart muscle inflammation, poses significant clinical challenges. […] Survival prediction models exhibited robust discriminatory power, particularly in emergency settings and pediatric populations. […] Prognosis and the survival prediction is invaluable tool for the further treatment steps. […] Machine learning allows for better prediction of outcomes in survival tasks, by analyzing complex interactions between various risk factors. […] AI models have also assisted in predicting patient outcomes, particularly in pediatric cases and those with complex clinical presentations. […] For example, AI has been used to significant effect in determining survival probabilities for patients with myocarditis, using numerous clinical inputs to calculate outcomes with greater precision than conventional statistical models, such as multivariable Cox hazards model.