Insights Into the Natural History of Recurrent Myocarditis, A Multicenter International Study (Re-Myo Study).
Recurrence of acute myocarditis (AM) is challenging. The management and natural history of patients who experience a recurrence of AM (Re-AM) remain poorly characterized. The aim of this study is to investigate clinical characteristics and outcomes of patients with Re-AM.
In this international multicenter study, 141 consecutive patients with biopsy-proven or cardiac magnetic resonance-proven Re-AM (35 [26-45] years, 77% male, median left ventricular ejection fraction 55%) were investigated and compared with 372 consecutive patients with single acute myocarditis (S-AM). The primary outcome was a composite of all-cause mortality, heart transplant and major ventricular arrhythmias.
Patients with Re-AM had more frequently a family history of cardiomyopathy (19% in Re-AM versus 2.8% in S-AM, P<0.001) and a diffuse late gadolinium enhancement compared with patients with S-AM (46% in Re-AM versus 34% in S-AM, P=0.019). The extent of late gadolinium enhancement also increased between the first and the second AM episode in patients with Re-AM (P=0.001). During a median follow-up of 33 months (interquartile range, 23-52) patients with Re-AM had a higher risk of primary outcome (P=0.001) compared with patients with S-AM, as well as a significantly elevated competing risk of major ventricular arrhythmias (P<0.001), which remained independently associated even after adjustment (hazard ratio, 2.15 [95% CI, 1.15-4.04], P=0.017). A family history of cardiomyopathy, autoimmune diseases, and ring-like late gadolinium enhancement was independently associated with a higher risk of recurrent AM.
Re-AM is a distinct clinical subgroup of AM associated with generally worse prognosis and a specific increased arrhythmic risk compared with S-AM.
In this international multicenter study, 141 consecutive patients with biopsy-proven or cardiac magnetic resonance-proven Re-AM (35 [26-45] years, 77% male, median left ventricular ejection fraction 55%) were investigated and compared with 372 consecutive patients with single acute myocarditis (S-AM). The primary outcome was a composite of all-cause mortality, heart transplant and major ventricular arrhythmias.
Patients with Re-AM had more frequently a family history of cardiomyopathy (19% in Re-AM versus 2.8% in S-AM, P<0.001) and a diffuse late gadolinium enhancement compared with patients with S-AM (46% in Re-AM versus 34% in S-AM, P=0.019). The extent of late gadolinium enhancement also increased between the first and the second AM episode in patients with Re-AM (P=0.001). During a median follow-up of 33 months (interquartile range, 23-52) patients with Re-AM had a higher risk of primary outcome (P=0.001) compared with patients with S-AM, as well as a significantly elevated competing risk of major ventricular arrhythmias (P<0.001), which remained independently associated even after adjustment (hazard ratio, 2.15 [95% CI, 1.15-4.04], P=0.017). A family history of cardiomyopathy, autoimmune diseases, and ring-like late gadolinium enhancement was independently associated with a higher risk of recurrent AM.
Re-AM is a distinct clinical subgroup of AM associated with generally worse prognosis and a specific increased arrhythmic risk compared with S-AM.
Authors
Baggio Baggio, Cannata Cannata, Gasperetti Gasperetti, Ammirati Ammirati, Gentile Gentile, Peretto Peretto, Savonitto Savonitto, Cecere Cecere, Collini Collini, Sikking Sikking, Mistrulli Mistrulli, Pagannone Pagannone, Rossi Rossi, Schmidt Schmidt, Compagnucci Compagnucci, Casella Casella, Artico Artico, Ciabatti Ciabatti, Fabris Fabris, Perazzolo Marra Perazzolo Marra, Pieroni Pieroni, Bromage Bromage, Scott Scott, Saguner Saguner, Verdonschot Verdonschot, Mohiddin Mohiddin, Calo Calo, Imazio Imazio, Heymans Heymans, Sinagra Sinagra, Marco Marco,
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