Kahle Ann-Kathrin, Güde Rebekka, Schwarzl Jana M, Münkler Paula, Akbulak Ruken Ö, Jahnke Charlotte, Bohnen Sebastian, Würger Tilman, Schwarzl Michael, Willems Stephan, Radunski Ulf K, Meyer Christian
Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany.
Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
J Cardiovasc Dev Dis. 2022 Jul 29;9(8):243. doi: 10.3390/jcdd9080243.
Myocarditis is characterized by various clinical manifestations, with ventricular arrhythmia (VA) as a frequent symptom at initial presentation. Here, we investigated characteristics and prognostic relevance of VA in patients with myocarditis. The study population consisted of 76 patients with myocarditis, verified by biopsy and/or cardiac magnetic resonance (CMR) imaging, including 38 consecutive patients with VA (45 ± 3 years, 68% male) vs. 38 patients without VA (NVA) (38 ± 2 years, 84% male) serving as a control group. VA was monomorphic ventricular tachycardia in 55% of patients, premature ventricular complexes in 50% and ventricular fibrillation in 29%. The left ventricular ejection fraction at baseline was 47 ± 2% vs. 40 ± 3% in VA vs. NVA patients (p = 0.069). CMR showed late gadolinium enhancement more often in VA patients (94% vs. 69%; p = 0.016), incorporating 17.6 ± 1.8% vs. 8.2 ± 1.3% of myocardial mass (p < 0.001). Radiofrequency catheter ablation for VA was initially performed in nine (24%) patients, of whom five remained free from any recurrence over 24 ± 3 months. Taken together, in patients with myocarditis, reduced left ventricular ejection fraction does not predict VA occurrence but CMR shows late gadolinium enhancement more frequently and to a larger extent in VA than in NVA patients, potentially guiding catheter ablation as a reasonable treatment of VA in this population.
心肌炎具有多种临床表现，室性心律失常（VA）是初次就诊时常见的症状。在此，我们研究了心肌炎患者VA的特征及其预后相关性。研究人群包括76例经活检和/或心脏磁共振（CMR）成像证实的心肌炎患者，其中38例连续发生VA的患者（45±3岁，68%为男性）与38例无VA（NVA）的患者（38±2岁，84%为男性）作为对照组。55%的患者VA为单形性室性心动过速，50%为室性早搏，29%为心室颤动。VA患者与NVA患者的基线左心室射血分数分别为47±2%和40±3%（p = 0.069）。CMR显示VA患者更常出现钆延迟强化（94%对69%；p = 0.016），累及心肌质量的17.6±1.8%对8.2±1.3%（p < 0.001）。9例（24%）患者最初接受了VA的射频导管消融治疗，其中5例在24±3个月内未出现任何复发。综上所述，在心肌炎患者中，左心室射血分数降低并不能预测VA的发生，但CMR显示VA患者钆延迟强化比NVA患者更频繁、程度更大，这可能指导导管消融作为该人群VA的合理治疗方法。
