Machado S, Roubille F, Gahide G, Vernhet-Kovacsik H, Cornillet L, Cung T T, Sportouch-Dukhan C, Raczka F, Pasquié J L, Gervasoni R, Macia J C, Cransac F, Davy J-M, Piot C, Leclercq F
Département de cardiologie, CHU Arnaud-de-Villeneuve, 371 avenue du Doyen-Gaston-Giraud, Montpellier, France.
Ann Cardiol Angeiol (Paris). 2010 Feb;59(1):1-7. doi: 10.1016/j.ancard.2009.07.009. Epub 2009 Aug 13.
Myopericarditis are common in clinical practice: up to 15% of acute pericarditis have a significant myocardial involvement as assessed by biological markers. This prospective, bicentric study is aimed at describing a myopericarditis population, the clinical and MRI follow-up, and search for prognosis markers.
Between May 2005 and September 2007, 103 patients hospitalised for acute pericarditis were prospectively enrolled. Physical examination, ECG, echocardiography, biological screening and cardiac MRI, in case of myopericarditis defined as acute pericarditis with troponin I elevation, were performed. Between December 2007 and July 2008, patients were contacted for new clinical and MRI evaluation.
Among the initial population of 103 patients admitted for acute pericarditis, 14 myopericarditis and 38 pericarditis were included. Compared with pericarditis, the myopericarditis group was associated with the following features: younger age (34.9 years [95% CI 28.3-41.2]; p=0.01), ST-segment elevation (nine patients between 14; p=0.03), higher troponin I (7.3 microg/L [95% CI 4.4-10.2]; p<10(-4)) and lower systemic inflammation (CRP peak 38.1mg/L [95% CI 7-69.2]; p=0.01). In the case of myopericarditis, infectious etiologies were predominant (12 patients among 14; p=0.002) and patients stayed longer in hospital (5.8 days [95% CI 4.7-6.8]; p=0.01). Follow-up showed no difference in terms of functional status (p=0.3) and global complications (p=0.9) between paired myopericarditis and pericarditis. Nevertheless, cardiac mortality was higher for myopericarditis (p=0.04). MRI follow-up showed myocardial sequelae without clinical impact.
Myopericarditis significantly distinguished from pericarditis. Three years follow-up showed no difference in terms of global complications but a higher cardiac mortality for myopericarditis. MRI myocardial lesions did not develop into symptomatic sequelae.
心肌心包炎在临床实践中很常见：通过生物标志物评估，高达15%的急性心包炎存在显著的心肌受累情况。这项前瞻性、双中心研究旨在描述心肌心包炎患者群体、进行临床和MRI随访，并寻找预后标志物。
2005年5月至2007年9月期间，前瞻性纳入了103例因急性心包炎住院的患者。进行了体格检查、心电图、超声心动图、生物筛查以及心脏MRI检查（对于定义为伴有肌钙蛋白I升高的急性心包炎的心肌心包炎患者）。2007年12月至2008年7月期间，对患者进行了新的临床和MRI评估。
在最初因急性心包炎入院的103例患者中，纳入了14例心肌心包炎患者和38例心包炎患者。与心包炎相比，心肌心包炎组具有以下特征：年龄较小（34.9岁[95%置信区间28.3 - 41.2]；p = 0.01）、ST段抬高（14例中有9例患者；p = 0.03）、肌钙蛋白I水平较高（7.3μg/L[95%置信区间4.4 - 10.2]；p < 10⁻⁴）以及全身炎症较低（CRP峰值38.1mg/L[95%置信区间7 - 69.2]；p = 0.01）。在心肌心包炎患者中，感染性病因占主导（14例中有12例患者；p = 0.002），且患者住院时间更长（5.8天[95%置信区间4.7 - 6.8]；p = 0.01）。随访显示，配对的心肌心包炎和心包炎患者在功能状态（p = 0.3）和总体并发症（p = 0.9）方面无差异。然而，心肌心包炎患者的心脏死亡率更高（p = 0.04）。MRI随访显示心肌有后遗症，但无临床影响。
心肌心包炎与心包炎有显著区别。三年随访显示，在总体并发症方面无差异，但心肌心包炎患者的心脏死亡率更高。MRI显示的心肌病变未发展为有症状的后遗症。
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