The Prognostic Value of Left Ventricular Ejection Fraction Upon Patients with Myocarditis.

Background: Myocarditis is a heterogenic medical condition. There is limited data regarding its` clinical presentation, associated imaging characteristics as well as in hospital outcomes.

Aim: To characterize patients admitted with myocarditis in a large tertiary medical center and compare findings and clinical outcomes consisting of major adverse clinical events (congestive heart failure, ventricular arrhythmias, and in-hospital death) between those presenting with a left ventricular ejection fraction (LVEF) of below and above 45%.

Methods: We evaluated 157 consecutive patients admitted due to myocarditis in the Sheba medical center. Data was collected for clinical presentation, imaging findings as well as in hospital outcomes and length of hospitalization. Patients were stratified into those with a LVEF< 45% (18 patients) versus those with an LVEF ≥45% (139 patients).

Results: Most patients were males (87%) with a mean age of 38±17 years. The most common findings at presentation were chest pain (94%), fever (67%), and an abnormal ECG (90%). The mean LVEF was 54±9. Patients with an LVEF<45% were more likely to have ST depression upon the presenting ECG (50% vs. 20%, p=0.004), have higher peak troponin levels (18±18 vs. 6±10, p<0.001), as well as a reduced LVEF at follow up cardiac MRI during hospitalization (51%±11 vs. 57%±6.7, p<0.02). MACE was higher among those with a LVEF<45% (28% vs. 4%, p=0.003), with a trend towards a longer duration of hospitalization (10±12 vs. 4±2 days, p=0.065).

Conclusions: Among patients presenting with myocarditis. The presence of higher troponin levels and ST depression is associated with a higher likelihood of a LVEF<45%. Patients with an LVEF<45% have a more complicated in hospital course.