Kang Tie-Duo, Ren Yan-Long, Zhao Han, Ning Shang-Qiu, Liu Wen-Xian
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Lab for Cardiovascular Precision Medicine, Beijing 100029, China.
World J Clin Cases. 2020 Jan 26;8(2):255-263. doi: 10.12998/wjcc.v8.i2.255.
Fulminant myocarditis is the critical form of myocarditis that is often associated with heart failure, malignant arrhythmia, and circulatory failure. Patients with fulminant myocarditis who end up with severe multiple organic failure and death are not rare.
To analyze the predictors of in-hospital major adverse cardiovascular events (MACE) in patients diagnosed with fulminant myocarditis.
We included a cohort of adult patients diagnosed with fulminant myocarditis who were admitted to Beijing Anzhen Hospital from January 2007 to December 2017. The primary endpoint was defined as in-hospital MACE, including death, cardiac arrest, cardiac shock, and ventricular fibrillation. Baseline demographics, clinical history, characteristics of electrocardiograph and ultrasonic cardiogram, laboratory examination, and treatment were recorded. Multivariable logistic regression was used to examine risk factors for in-hospital MACE, and the variables were subsequently assessed by the area under the receiver operating characteristic curve (AUC).
The rate of in-hospital MACE was 40%. Multivariable logistic regression analysis revealed that baseline QRS duration > 120 ms was the independent risk factor for in-hospital MACE (odds ratio = 4.57, 95%CI: 1.23-16.94, = 0.023). The AUC of QRS duration > 120 ms for predicting in-hospital MACE was 0.683 (95%CI: 0.532-0.833, = 0.03).
Patients with fulminant myocarditis has a poor outcome. Baseline QRS duration is the independent risk factor for poor outcome in those patients.
暴发性心肌炎是心肌炎的一种严重形式，常伴有心力衰竭、恶性心律失常和循环衰竭。最终出现严重多器官功能衰竭和死亡的暴发性心肌炎患者并不少见。
分析诊断为暴发性心肌炎患者住院期间主要不良心血管事件（MACE）的预测因素。
我们纳入了2007年1月至2017年12月在北京安贞医院住院的成年暴发性心肌炎患者队列。主要终点定义为住院期间的MACE，包括死亡、心脏骤停、心源性休克和室颤。记录基线人口统计学、临床病史、心电图和超声心动图特征、实验室检查及治疗情况。采用多变量逻辑回归分析住院期间MACE的危险因素，随后通过受试者工作特征曲线（AUC）下面积评估变量。
住院期间MACE发生率为40%。多变量逻辑回归分析显示，基线QRS时限>120 ms是住院期间MACE的独立危险因素（比值比=4.57，95%CI：1.23-16.94，P=0.023）。QRS时限>120 ms预测住院期间MACE的AUC为0.683（95%CI：0.532-0.833，P=0.03）。
暴发性心肌炎患者预后较差。基线QRS时限是这些患者预后不良的独立危险因素。
