Clinical Course of Patients with Clinically Suspected Myocarditis

Background: Myocarditis is an inflammatory disease of the myocardium. “Clinically suspected myocarditis” (CSM) according to the European Society of Cardiology (ESC) 2013 Task Force criteria, is defined by the presence of >1 clinical presentation and >1 diagnostic criteria, in the absence of CAD. Very limited data are published on clinical course of adult patients with diagnosis of CSM.

Aim: To describe clinical course, recurrence and long-term complications in patients with CSM.

Methods: This prospective study included patients admitted to Kaplan medical center who fulfilled the criteria of CSM. Clinical and echo data were collected. Most of the patients were followed yearly.

Results: Sixty two patients, (mean age 31 ± 9 years, 11% women) were included: 70 % presented with pericardial chest pain. URTI prior to admission was seen in 87%. The majority of patient (79%) presented with ST elevation (47% inferior wall) on ECG. Troponin was elevated in all patients (2200 -61000 pg/ml), 93% of patients had elevated CRP (mean 87 ± 65 mg/l) and 84% elevated ESR (mean 41 ± 32 mm/hr). Third of the patients presented with reduced LVEF (mean 46.5 ± 4.3%) and recovered to normal. In all but 1 patient clinical course was benign without complications and therefore did not undergo myocardial biopsy (EMB). The one patient with presentation of heart failure and VT underwent EMB was diagnosed with intermediated type of giant cell/sarcoidosis myocarditis and was treated appropriately. On mean follow-up 45±25 months, in only 2 patients recurrence of myocarditis occurred.

Conclusion: In our study the all but one patient had no cardiac complications on follow-up and experienced LV recovery. Although The ESC 2013 Task Force recommends consideration of EMB in all cases of CSM, in patients with benign clinical course there is no real need for EMB, however, all patients should been closely followed.