Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.
Sci Rep. 2021 Feb 4;11(1):3008. doi: 10.1038/s41598-021-82592-8.
Inflammatory cardiomyopathy diagnosed by endomyocardial biopsy (EMB) is common in non-ischemic heart failure (HF) and might be associated with adverse outcome. We aimed to identify markers predicting myocardial inflammation in HF. We screened 517 patients with symptomatic non-ischemic HF who underwent EMB; 397 patients (median age 54 [IQR 43/64], 28.7% females) were included in this study. 230 patients were diagnosed with myocardial inflammation, defined as ≥ 7.0 CD3 lymphocytes/mm and/or ≥ 35.0 Mac1 macrophages/mm and were compared to 167 inflammation negative patients. Patients with myocardial inflammation were more often smokers (52.4% vs. 39.8%, p = 0.013) and had higher C-reactive protein (CRP) levels (5.4 mg/dl vs. 3.7 mg/dl, p = 0.003). In logistic regression models CRP ≥ 8.15 mg/dl (OR 1.985 [95%CI 1.160-3.397]; p = 0.012) and Troponin I (TnI) ≥ 136.5 pg/ml (OR 3.011 [1.215-7.464]; p = 0.017) were independently associated with myocardial inflammation, whereas no association was found for elevated brain natriuretic peptide (OR 1.811 [0.873-3.757]; p = 0.111). In prognostic performance calculation the highest positive predictive value (90%) was detected for the combination of Global longitudinal strain (GLS) ≥ -13.95% and TnI ≥ 136.5 pg/ml (0.90 (0.74-0.96)). Elevated CRP, TnI and GLS in combination with TnI can be useful to detect myocardial inflammation. Smoking seems to predispose for myocardial inflammation.
通过心内膜心肌活检（EMB）诊断的炎症性心肌病在非缺血性心力衰竭（HF）中很常见，并且可能与不良预后相关。我们旨在确定预测 HF 中心肌炎症的标志物。我们筛选了 517 例接受 EMB 的有症状非缺血性 HF 患者；其中 397 例患者（中位年龄 54 [IQR 43/64]，28.7%为女性）纳入本研究。230 例患者被诊断为心肌炎症，定义为≥7.0 CD3 淋巴细胞/mm 和/或≥35.0 Mac1 巨噬细胞/mm，与 167 例炎症阴性患者进行比较。患有心肌炎症的患者更常吸烟（52.4%比 39.8%，p=0.013），C 反应蛋白（CRP）水平更高（5.4 mg/dl 比 3.7 mg/dl，p=0.003）。在逻辑回归模型中，CRP≥8.15 mg/dl（OR 1.985 [95%CI 1.160-3.397]；p=0.012）和肌钙蛋白 I（TnI）≥136.5 pg/ml（OR 3.011 [1.215-7.464]；p=0.017）与心肌炎症独立相关，而脑钠肽升高（OR 1.811 [0.873-3.757]；p=0.111）则没有相关性。在预后性能计算中，检测到最高阳性预测值（90%）的是 GLS 降低（-13.95%）和 TnI 升高（≥136.5 pg/ml）的组合（0.90 [0.74-0.96]）。CRP、TnI 和 GLS 升高，同时 TnI 升高可用于检测心肌炎症。吸烟似乎易患心肌炎症。
