Clinical Characterization of Patients Hospitalized for Acute Myocarditis

Background:
Acute myocarditis (AMyo) is an inflammatory disease of the myocardium, more prevalent among young patients and its diagnosis based on hybrid clinical and laboratory criteria.

Aim:
To characterize the clinical, ECG, laboratory, ECHO and CMR parameters of patients hospitalized for the diagnosis of AMyo or Perimyocarditis (PeriMyo).

Methods:
All patients hospitalized between 2002-2016 for the diagnosis of AMyo /PeriMyo based on symptoms of new onset chest pain and/or heart failure, ECG ST-T changes and elevation of CK and/or cTnI were included in the study. During 2015-2016, 30 patients underwent CMR imaging.

Results:
269 AMyo/PeriMyo patients were included, 79% were men. As compared to women, men were younger (33+13.5 vs. 47+16, years, p<0.0001), had more frequently normal LV-function by ECHO (84% vs 70%, p=0.02), had undergone less frequently cardiac catheterization (26% vs. 45%, p=0.008), but had similar frequency of normal coronary arteries (80% vs 72%). None of the patients with abnormal coronaries required percutaneous intervention. None of the patients died during hospitalization.

The maximal (median) CK, cTnl and CRP levels were: 259 IU/L, 4.53 mcg/L and 2.5 mg/dL, respectively. There was no correlation between maximal cTnl level and degree of LV-dysfunction by ECHO, however, a correlation was noted between maximal cTnI level and number of segments with late Gadolinium enhancement (LGE) in CMR imaging (Figure).

Conclusions:
AMyo/ PeriMyo is more frequent among young men that have less frequently LV-dysfunction as compared to women, with good in hospital outcome. High cTnl levels reflect more extensive myocardial involvement as confirmed by CMR imaging.