Cardiology Department, Maria Vittoria Hospital, Via Luigi Cibrario 72, 10141 Torino, Italy.
Circulation. 2013 Jul 2;128(1):42-9. doi: 10.1161/CIRCULATIONAHA.113.001531. Epub 2013 May 24.
The natural history of myopericarditis/perimyocarditis is poorly known, and recently published studies have presented contrasting data on their outcomes. The aim of the present article is to assess the prognosis of myopericarditis/perimyocarditis in a multicenter, prospective cohort study.
A total of 486 patients (median age, 39 years; range, 18-83 years; 300 men) with acute pericarditis or a myopericardial inflammatory syndrome (myopericarditis/perimyocarditis; 85% idiopathic, 11% connective tissue disease or inflammatory bowel disease, 5% infective) were prospectively evaluated from January 2007 to December 2011. The diagnosis of acute pericarditis was based on the presence of 2 of 4 clinical criteria (chest pain, pericardial rubs, widespread ST-segment elevation or PR depression, and new or worsening pericardial effusion). Myopericardial inflammatory involvement was suspected with atypical ECG changes for pericarditis, arrhythmias, and cardiac troponin elevation or new or worsening ventricular dysfunction on echocardiography and confirmed by cardiac magnetic resonance. After a median follow-up of 36 months, normalization of left ventricular function was achieved in >90% of patients with myopericarditis/perimyocarditis. No deaths were recorded, as well as evolution to heart failure or symptomatic left ventricular dysfunction. Recurrences (mainly as recurrent pericarditis) were the most common complication during follow-up and were recorded more frequently in patients with acute pericarditis (32%) than in those with myopericarditis (11%) or perimyocarditis (12%; P<0.001). Troponin elevation was not associated with an increase in complications.
The outcome of myopericardial inflammatory syndromes is good. Unlike acute coronary syndromes, troponin elevation is not a negative prognostic marker in this setting.
心肌心包炎的自然病程知之甚少，最近发表的研究报告了其结果的对比数据。本文的目的是在一项多中心前瞻性队列研究中评估心肌心包炎的预后。
2007 年 1 月至 2011 年 12 月，前瞻性评估了 486 例急性心包炎或心肌心包炎炎症综合征（心肌心包炎/心包炎；85%为特发性，11%为结缔组织病或炎症性肠病，5%为感染性）患者。急性心包炎的诊断基于 4 项临床标准中的 2 项（胸痛、心包摩擦音、广泛的 ST 段抬高或 PR 压低、新发或加重的心包积液）。怀疑心肌心包炎炎症累及时，心电图表现为不典型的心包炎改变、心律失常、心脏肌钙蛋白升高或超声心动图新出现或加重心室功能障碍，并通过心脏磁共振证实。在心肌心包炎/心包炎中位随访 36 个月后，>90%的患者左心室功能恢复正常。无死亡病例，也无心力衰竭或有症状的左心室功能障碍进展。在随访期间，最常见的并发症是复发（主要为复发性心包炎），急性心包炎患者（32%）比心肌心包炎患者（11%）或心包炎患者（12%）更常见（P<0.001）。肌钙蛋白升高与并发症增加无关。
心肌心包炎的预后良好。与急性冠状动脉综合征不同，在这种情况下，肌钙蛋白升高不是预后不良的标志物。
