Department of Cardiology, Rabin Medical Center - Beilinson Hospital, Petah Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
Int J Cardiol. 2018 Nov 1;270:197-199. doi: 10.1016/j.ijcard.2018.05.128. Epub 2018 Jun 1.
Myocardial involvement is common in acute idiopathic pericarditis and can, in some cases, lead to life-threatening complications. Acute idiopathic pericarditis is often preceded by various prodromal symptoms, but whether these symptoms can predict myocardial involvement is unclear. The aim of the study was to examine the value of different prodromal symptoms of acute idiopathic pericarditis for predicting myocardial involvement.
Patients diagnosed with acute idiopathic pericarditis in 2007-2017 at our hospital were identified by database search. Demographic parameters, levels of plasma cardiac troponin and creatine kinase, and findings on echocardiography, magnetic resonance imaging, cardiac computed tomography and coronary angiography and data on prodromal symptoms were extracted from the medical files. The final cohort included 239 patients (73.2% males) aged 18-89 years. The most common prodromal symptoms were fever, chills, cough, sore throat, abdominal pain, and diarrhea. Myocardial involvement was observed in 83 patients (34.7%), leading to cardiogenic shock in 4 (4.8%). Patients with myocardial involvement more often had prodromal diarrhea, fever, sore throat, vomiting, atypical chest pain, and pharyngitis. On multivariate analysis, diarrhea, sore throat and fever were strong independent predictors of myocardial involvement (OR, 14.257, 95% CI, 3.920-51.782, p < 0.001, OR, 9.6, 95% CI, 2.934-31.982, p < 0.001 and OR, 2.445, 95% CI, 1.077-5.550, p = 0.025). Diarrhea was associated with left ventricular dysfunction as well.
In acute idiopathic pericarditis, prodromal diarrhea, sore throat and fever strongly predict myocardial involvement, resulting in life-threatening hemodynamic compromise in a minority of the patients.
心肌受累在急性特发性心包炎中很常见，在某些情况下可导致危及生命的并发症。急性特发性心包炎常伴有各种前驱症状，但这些症状是否可以预测心肌受累尚不清楚。本研究旨在探讨急性特发性心包炎不同前驱症状对预测心肌受累的价值。
通过数据库检索，确定了 2007 年至 2017 年在我院诊断为急性特发性心包炎的患者。从病历中提取人口统计学参数、血浆心肌肌钙蛋白和肌酸激酶水平、超声心动图、磁共振成像、心脏计算机断层扫描和冠状动脉造影结果以及前驱症状数据。最终纳入了 239 例年龄 18-89 岁的患者（73.2%为男性）。最常见的前驱症状是发热、寒战、咳嗽、咽痛、腹痛和腹泻。83 例（34.7%）患者发生心肌受累，其中 4 例（4.8%）发生心源性休克。有心肌受累的患者更常出现前驱性腹泻、发热、咽痛、呕吐、非典型胸痛和咽炎。多变量分析显示，腹泻、咽痛和发热是心肌受累的独立强预测因素（OR 14.257，95%CI 3.920-51.782，p<0.001；OR 9.6，95%CI 2.934-31.982，p<0.001；OR 2.445，95%CI 1.077-5.550，p=0.025）。腹泻也与左心室功能障碍有关。
在急性特发性心包炎中，前驱性腹泻、咽痛和发热强烈提示心肌受累，导致少数患者出现危及生命的血流动力学紊乱。
