Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, ehae169. https://doi.org/10.1093/eurheartj/ehae169 Dr. Alida L. P. Caforio et al.
Points
- The study aimed to analyze the clinical and diagnostic spectrum and the 1-year outcome in patients with clinically suspected or biopsy-proven myocarditis based on the 2013 European Society of Cardiology criteria.
- A total of 581 patients, including 493 adults and 88 children, were categorized into three groups based on their myocarditis status, and their baseline features, cardiac magnetic resonance findings, and endomyocardial biopsy outcomes were analyzed.
- Endomyocardial biopsy, predominantly right ventricular, exhibited a low complication rate in both children and adults, with no procedure-related deaths, emphasizing its safety.
- A classical myocarditis pattern on cardiac magnetic resonance was more prevalent in adults with biopsy-proven myocarditis compared to children, indicating differences in diagnostic sensitivity between age groups.
- Lower left ventricular ejection fraction and the requirement for immunosuppressants at diagnosis were identified as independent predictors of unfavorable outcome events at the 1-year follow-up, highlighting their prognostic significance in patients with myocarditis.
Summary
The research aimed to provide a comprehensive analysis of the clinical and diagnostic spectrum and the 1-year outcome in patients with clinically suspected or biopsy-proven myocarditis, based on the 2013 European Society of Cardiology criteria. The study, conducted as part of the EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry, included 581 patients, 493 adults, and 88 children, categorized into three groups based on their myocarditis status. The baseline features, including cardiac magnetic resonance findings and endomyocardial biopsy outcomes, were analyzed, and 1-year outcome events such as death, heart transplantation, ventricular assist device (VAD) or implantable cardioverter defibrillator (ICD) implantation, and hospitalization for cardiac causes were assessed.
The results indicated that endomyocardial biopsy, predominantly right ventricular, exhibited a low complication rate in both children and adults, with no procedure-related deaths. Furthermore, the study revealed that a classical myocarditis pattern on cardiac magnetic resonance was more prevalent in adults with biopsy-proven myocarditis compared to children. At the 1-year follow-up, a small percentage of patients experienced adverse outcomes, including death, heart transplantation, VAD or ICD implantation, and hospitalization for cardiac causes. Lower left ventricular ejection fraction and the requirement for immunosuppressants at diagnosis were identified as independent predictors of unfavorable outcome events at one year.
In conclusion, the findings highlighted the safety of endomyocardial biopsy and the less sensitive nature of cardiac magnetic resonance, particularly in children. The predominance of virus-negative lymphocytic myocarditis in both children and adults, along with the low use of immunosuppressive treatments, was also noted. Additionally, the study emphasized the prognostic significance of lower left ventricular ejection fraction and the need for immunosuppressants at diagnosis as independent predictors of adverse outcomes at the 1-year follow-up.
Link to the article: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehae169/7643003
References Caforio, A. L. P., Kaski, J. P., Gimeno, J. R., Elliott, P. M., Laroche, C., Tavazzi, L., Tendera, M., Fu, M., Sala, S., Seferovic, P. M., Heliö, T., Calò, L., Blagova, O., Amin, A., Kindermann, I., Sinagra, G., Frustaci, A., Bonnet, D., Charron, P., … Canpolat, U. (2024). Endomyocardial biopsy: Safety and prognostic utility in paediatric and adult myocarditis in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry. European Heart Journal, ehae169. https://doi.org/10.1093/eurheartj/ehae169
