成人急性心肌炎的预后及相关因素分析

Prognosis and related factors analysis in adults with acute myocarditis

目的探讨成人急性心肌炎的预后及其相关因素。方法连续人选中国医学科学院阜外医院心内科2006年5月至2018年3月收治的成人急性病毒性心肌炎患者166例(发病时间<1个月)。根据临床诊断分为暴发性心肌炎组(n=30)和非暴发性心肌炎组(n=136)。主要终点事件为死亡、心脏移植、持续性室性心动过速(室速)或心室颤动(室颤)、因心力衰竭再人院或心肌炎复发的复合心血管不良事件。通过Cox比例风险回归模型进行单因素及多因素分析,生存分析采用Kaplan-Meier法,比较两组患者的预后情况。结果暴发性心肌炎组和非暴发性心肌炎组患者院内死亡率分别为30%和0%;长期心血管不良事件发生率分别为40.0%和4.4%。Kaplan-Meier生存曲线显示,暴发性心肌炎组患者长期心血管预后更差(log-rank检验,P<0.01)。Cox多因素分析显示,心肌炎患者入院时CK-MB升高大于3倍(OR=5.092,P=0.002)、入院时LVEF低于50%降低(OR=3.589,P=0.038)是心血管预后不良的独立危险因素。结论成人性暴发性心肌炎患者心血管预后较非暴发性心肌炎更差,入院CK-MB升高大于3倍、LVEF低于50%是预后不良的独立危险因素。

Objective To determine the factors related to the prognosis of adult patients with acute myocarditis. Methods The study population consisted of 166 consecutive patients admitted between May 2006 and March 2018 with a diagnosis of acute myocarditis (onset of symptoms <1 month), of whom 30 were required high-dose inotropes and/or mechanical circulatory support (fulminant myocarditis, FM) and the remaining 136 were hemodynamically stable (non-fulminant myocarditis, NFM). A composite of major adverse cardiac events (MACE) included death, heart transplantation, sustained ventricular tachycardia/fibrillation, heart failure decompensation requiring hospital admission and recurrent acute myocarditis. We performed univariable and multivariable analysis by Cox proportional hazards regression. Survival curves of the two groups were displayed using Kaplan-Meier. Results In the whole population, the rate of in-hospital mortality was 30% versus 0% in FM versus NFM, respectively. Long-term rate of MACE was 40% versus 4.4% in FM versus NFM, respectively. Kaplan Meier survival curves showed that the prognosis was poorer in FM than NFM (log-rank P<0.01). Multivariate Cox regression analysis revealed that elevated CK-MB level higher than 3 times (OR=5.092, P=0.002) and LVEF less than 50% at admission (OR=3.589, P=0.038) were independent risk factors significantly associated with poorer prognosis. Conclusions Prognosis is poorer in FM than NFM. Elevated CK-MB more than 3 times of normal upper limit and LVEF less than 50% at admission are independent risk factors associated with acute myocarditis in adult patients.