Graduate Department, Guangdong Medical University, Zhanjiang, China.
Cardiovascular Center, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.
Cardiovasc Ther. 2019 Dec 16;2019:9342792. doi: 10.1155/2019/9342792. eCollection 2019.
Myocarditis and cardiomyopathy impose a substantial economic burden on society. Many studies have examined the effects of various predictors on the prognosis of these diseases, such as the left ventricular systolic function, the New York Heart Association glomerular filtration rate, the QT interval, and the presence of viruses. In the present study, we conducted a meta-analysis of cohort studies to investigate the significance of the presence of viruses in the myocardial tissue on the prognosis of these diseases.
The Embase, PubMed, and Cochrane library databases were searched for relevant literature that had been published between January 1, 1964 and August 14, 2018. The inclusion criteria were patients over 18 years of age, suspected myocarditis or dilated cardiomyopathy, accepted myocardial biopsy, and the detection of virus in the myocardial tissue.
In total, 10 studies met the inclusion criteria. These studies included 1006 patients with suspected myocarditis or idiopathic heart disease for whom the primary endpoint was all-cause death, heart transplant, or re-hospitalization due to fatal arrhythmia and heart failure. There was no significant difference in the prognosis of virus-positive and virus-negative patients with myocarditis or dilated cardiomyopathy confirmed by endomyocardial biopsy (EMB) [hazard ratio (HR) = 1.40, 95% confidence interval (CI) = 0.93-2.12, = 0.11]. However, virus-negative patients had a better prognosis following nonspecific treatment (HR = 1.40, 95% CI = 1.06-1.86, = 0.02) and right ventricular biopsy (HR = 2.08, 95% CI = 1.07-4.04, = 0.03).
The presence of a virus did not worsen the long-term prognosis of patients with suspected myocarditis or dilated cardiomyopathy. However, virus-positive patients who did not undergo specific treatment or who underwent right ventricular biopsy did have a worse prognosis. Thus, the early diagnosis of the presence of viral infection in the myocardium will improve the prognosis of patients.
心肌炎和心肌病会给社会带来沉重的经济负担。许多研究已经探讨了各种预测因素对这些疾病预后的影响，如左心室收缩功能、纽约心脏协会肾小球滤过率、QT 间期和病毒的存在。本研究对队列研究进行荟萃分析，以探讨心肌组织中病毒的存在对这些疾病预后的意义。
检索 1964 年 1 月 1 日至 2018 年 8 月 14 日发表的相关文献，包括 Embase、PubMed 和 Cochrane 图书馆数据库。纳入标准为年龄大于 18 岁、疑似心肌炎或扩张型心肌病、接受心肌活检以及心肌组织中检测到病毒的患者。
共纳入 10 项研究。这些研究共纳入 1006 例疑似心肌炎或特发性心脏病患者，主要终点为全因死亡、心脏移植或因致命性心律失常和心力衰竭再次住院。心肌活检证实的心肌炎或扩张型心肌病患者中，病毒阳性和病毒阴性患者的预后无显著差异[风险比（HR）=1.40，95%置信区间（CI）=0.93-2.12， = 0.11]。然而，接受非特异性治疗（HR=1.40，95%CI=1.06-1.86， = 0.02）和右心室活检（HR=2.08，95%CI=1.07-4.04， = 0.03）的病毒阴性患者预后更好。
病毒的存在并未加重疑似心肌炎或扩张型心肌病患者的长期预后。然而，未接受特定治疗或接受右心室活检的病毒阳性患者预后较差。因此，早期诊断心肌病毒感染可改善患者的预后。
