Abstract

Objective

The aim of this study was to examine the long-term risk of heart failure (HF) and all-cause mortality, in patients discharged alive following hospitalization for myocarditis. Background. Prognosis in patients with apparently uncomplicated myocarditis is in general perceived as good, but data on long-term outcomes are sparse. Methods. From nationwide Danish registries we included patients without prior cardiac disease, discharged alive with a first-time diagnosis of myocarditis 1996–2016. Patients were matched 1:10 by age- and sex, with controls from the general population. Risk of HF hospitalization and death in cases and controls was compared by use of adjusted Cox regression analyses. Results. We identified 1557 patients with a first-time diagnosis of myocarditis, 72% men, median age 39 years. Patients with myocarditis had more hypertension, diabetes, and cancer, and received more pharmacotherapy prior to hospitalization compared to matched controls. During a mean follow-up of 8.5 years, the event rate of HF hospitalization was 8.7 vs. 2.2 per 1000 patient-years (py) in cases and controls; HR 4.59 (95% CI; 3.58–5.88) and for all-cause mortality, event rate 21.9 vs 11.2 per 1000 py; HR 2.10 (95% CI; 1.82–2.43). Among 784 patients with no events or HF medication one year after diagnosis, risk of HF hospitalization (HR 2.15; 95% CI; 1.18–3.92), and all-cause mortality (HR 1.62; 95% CI; 1.21–2.16) remained elevated compared to matched controls. Conclusion. Myocarditis in younger patients without prior cardiac disease was associated with a long-term excess risk of HF hospitalization, and death, even in patients free of events and HF medication 1 year after discharge.

• Highlights

• Myocarditis ranges from chest discomfort to severe heart failure.

• In most patients, left ventricular ejection fraction recovers but the long-term adverse cardiac risk is unknown.

• Patients with myocarditis and no prior cardiac disease were at higher risk of death and heart failure

• Routine follow-up may be warranted following an episode of acute myocarditis.

中文翻译：

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急性心肌炎住院后的长期预后——一项匹配的全国队列研究

摘要

客观的

本研究的目的是检查因心肌炎住院后存活出院的患者发生心力衰竭 (HF) 和全因死亡率的长期风险。背景。明显无并发症的心肌炎患者的预后通常被认为是好的，但关于长期结果的数据很少。方法。从丹麦全国登记处，我们纳入了 1996-2016 年首次诊断出心肌炎且没有心脏病史的患者。患者按年龄和性别按 1:10 匹配，对照组来自普通人群。通过使用调整后的 Cox 回归分析比较病例和对照中 HF 住院和死亡的风险。结果. 我们确定了 1557 名首次诊断为心肌炎的患者，其中 72% 为男性，中位年龄为 39 岁。与匹配的对照组相比，心肌炎患者有更多的高血压、糖尿病和癌症，并且在住院前接受了更多的药物治疗。在平均 8.5 年的随访期间，病例和对照组的 HF 住院事件发生率为 8.7 对 2.2/1000 患者年 (py)；HR 4.59 (95% CI; 3.58–5.88) 和全因死亡率，事件发生率 21.9 对 11.2/1000 py；HR 2.10 (95% CI; 1.82–2.43)。在 784 名诊断后一年无事件或 HF 药物治疗的患者中，HF 住院风险（HR 2.15；95% CI；1.18–3.92）和全因死亡率（HR 1.62；95% CI；1.21–2.16）仍然升高与匹配的对照相比。结论. 既往没有心脏病史的年轻患者的心肌炎与心衰住院和死亡的长期超额风险相关，即使是在出院后 1 年没有事件和心衰药物治疗的患者中也是如此。

• 强调

• 心肌炎的范围从胸部不适到严重的心力衰竭。

• 在大多数患者中，左心室射血分数恢复，但长期不良心脏风险尚不清楚。

• 患有心肌炎且既往无心脏病的患者死亡和心力衰竭的风险更高

• 急性心肌炎发作后可能需要进行常规随访。