Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
J Cardiovasc Med (Hagerstown). 2013 Mar;14(3):235-41. doi: 10.2459/JCM.0b013e328351da6e.
The natural history of perimyocarditis (PMY) is not yet completely known. We aimed to analyse the clinical laboratory data of PMY at diagnosis and during follow-up, in order to assess the natural history and prognostic stratification of the disease (including different aetiology).
We enrolled 62 consecutive patients (men 79%, aged 38 ± 18 years) with PMY (84% idiopathic, 8% autoimmune, 8% infective) from August 2002 to July 2010. The diagnosis has been made according to clinical and laboratory data (significant increase of troponin I in all patients). After at least 1 year (mean follow-up: 1635 ± 298 days), 59 patients (95%) had available data.
Chest pain was present in 59 patients (95%), flu-like syndrome in 36 (58%) and pericardial rubs in 15 (24%). None of the patients showed heart failure at presentation. At admission, eight patients (13%) presented mild-moderate left ventricular systolic dysfunction, 13 (22%) showed wall motion abnormalities, and 10 (17%) showed mild pericardial effusion. At 1 year no patients died, developed heart failure or showed abnormal echocardiogram. NSAIDs were the first choice therapy in 61 (98%) patients with clinical resolution in 58 (95%) of them. Seven patients (12%) experienced intermittent recurrences without development of constrictive pericarditis or heart failure.
This study underlines the benign mid- to long-term outcome of PMY regardless of clinical laboratory characteristics at presentation, different aetiology and possibility of relapses; minimizing the role of endomyocardial biopsy in these specific patients.
心肌炎的自然病程尚不完全清楚。我们旨在分析心肌炎诊断时和随访期间的临床实验室数据，以评估疾病的自然病程和预后分层（包括不同病因）。
我们纳入了 2002 年 8 月至 2010 年 7 月期间连续 62 例心肌炎患者（男性占 79%，年龄 38±18 岁）（84%为特发性，8%为自身免疫性，8%为感染性）。诊断依据临床和实验室数据（所有患者的肌钙蛋白 I 均显著升高）。至少随访 1 年（平均随访时间：1635±298 天）后，59 例患者（95%）获得了可用数据。
59 例患者（95%）存在胸痛，36 例（58%）存在流感样综合征，15 例（24%）存在心包摩擦音。入院时，8 例（13%）患者存在轻度至中度左心室收缩功能障碍，13 例（22%）患者存在节段性室壁运动异常，10 例（17%）患者存在轻度心包积液。1 年后无患者死亡、发生心力衰竭或出现异常超声心动图。61 例（98%）患者首选 NSAIDs 治疗，其中 58 例（95%）患者临床缓解。7 例（12%）患者间歇性复发，但无缩窄性心包炎或心力衰竭发生。
本研究强调了心肌炎的中至长期预后良好，无论患者的临床实验室特征、病因和复发可能性如何；在这些特定患者中，应尽量减少心内膜心肌活检的作用。
