Trajectory And Associated Parameters Of Recovery In Acute Myocarditis With Left Ventricular Dysfunction

초록

Background The improvement in left ventricular (LV) ejection fraction (EF) in acute myocarditis may vary depending on clinical situations. Objectives We investigated the trend of LVEF change and predictors of LV recovery in acute myocarditis with LV systolic dysfunction. Methods This retrospective study included 841 patients from seven hospitals in Korea with biopsy-proven or clinically suspected acute myocarditis. Patients with LV systolic dysfunction (EF ≤ 40%) who were successfully discharged and completed echocardiography at discharge and 6-month follow-up were analyzed. The trajectory of LV systolic function and associated parameters of LV recovery (defined by LVEF > 50% with 10% improvement at discharge or 6-month follow-up) were evaluated. A magnetic resonance imaging (MRI) based scoring system (one point for each finding: pericardial effusion, edema, and late gadolinium enhancement) was adopted to evaluate the role of MRI in predicting LV recovery. Results A total of 155 patients met the enrollment criteria of this study. Among them, 55.5% (86 patients) showed improvement at discharge, and 93% maintained systolic function at 6 months. On 6-month follow-up echocardiography, 78.1% (121 patients) showed improved LV systolic function. In multivariate analysis, the presence of hypertension (HTN), symptom duration before admission, BUN, and LV end-systolic dimension on baseline echocardiography. The chance of improved LV systolic function was significantly lower in patients with higher MRI scores (61% for score 0 vs. 56.2% for score 1 vs. 53.3% for score 2 vs. 26.3% for score 3, p=0.049). Conclusions Most patients recover from LV systolic dysfunction at 6-month follow-up after successful discharge from acute myocarditis. The role of MRI needs further investigation.