Lee Cheng-Han, Tsai Wei-Chuan, Hsu Chih-Hsin, Liu Ping-Yen, Lin Li-Jen, Chen Jyh-Hong
Int J Cardiol. 2006 Apr 28;109(1):142-5. doi: 10.1016/j.ijcard.2005.04.014.
Patients who develop fulminant myocarditis often die of sudden cardiac arrest, arrhythmia, or severe heart failure soon after onset if they do not receive percutaneous cardiopulmonary support in time. The purpose of this study was to identify the risk factors of clinical symptoms/signs or laboratory findings that could predict the fulminant course of acute myocarditis.
Thirty-five patients (mean age 28 +/- 8 years, 17 males) who had been admitted to intensive care unit with the diagnosis of acute myocarditis by clinical presentations were retrospectively recruited. They were divided into the fulminant group (n = 11) and the non-fulminant group (n = 24). Clinical features, laboratory data, and images on admission were analyzed. Overall in-hospital mortality was 17% (6/35). Mortality was higher in the fulminant group (45% vs. 4%, p = 0.027). Multivariate analysis revealed that prolongations of the QRS complex (118 +/- 27 vs. 88 +/- 10 ms, p = 0.048) and depressed left ventricular ejection fraction (41 +/- 7% vs. 57 +/- 7%, p = 0.027) were the only independent factors significantly associated with the fulminant course of acute myocarditis.
The in-hospital mortality of acute fulminant myocarditis was high. Prolongations of the QRS complex and depressed left ventricular ejection fraction on admission were independent positive predictors for the development of acute fulminant myocarditis.
暴发性心肌炎患者如果不及时接受经皮心肺支持，发病后常很快死于心脏骤停、心律失常或严重心力衰竭。本研究的目的是确定可预测急性心肌炎暴发性病程的临床症状/体征或实验室检查结果的危险因素。
回顾性纳入35例因临床表现而入住重症监护病房且诊断为急性心肌炎的患者（平均年龄28±8岁，男性17例）。他们被分为暴发性组（n = 11）和非暴发性组（n = 24）。分析了入院时的临床特征、实验室数据和影像学资料。总体住院死亡率为17%（6/35）。暴发性组的死亡率更高（45%对4%，p = 0.027）。多因素分析显示，QRS波群时限延长（118±27 vs. 88±10 ms，p = 0.048）和左心室射血分数降低（41±7%对57±7%，p = 0.027）是与急性心肌炎暴发性病程显著相关的仅有的独立因素。
急性暴发性心肌炎的住院死亡率很高。入院时QRS波群时限延长和左心室射血分数降低是急性暴发性心肌炎发生的独立阳性预测因素。
