疑似心肌炎患者的临床病程、病毒病因和诊断方法：一项单中心前瞻性研究。

Clinical course, viral etiology, and the diagnostic workup for patients with suspected myocarditis: a single-center prospective study.

机构信息

Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, P.Box. 71526, Assiut, Egypt.

Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.

出版信息

BMC Cardiovasc Disord. 2022 Sep 6;22(1):396. doi: 10.1186/s12872-022-02833-0.

DOI:10.1186/s12872-022-02833-0

PMID:36068503

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9446582/

Abstract

BACKGROUND

Myocarditis is a highly heterogeneous disorder with a challenging diagnostic work-up. We aimed to focus on the possible diagnostic workup for this condition in settings where endomyocardial biopsy as a gold standard is not always feasible, detect the etiologic cardiotropic viruses in our locality, and follow the clinical course in patients admitted with clinically suspected myocarditis.

METHODS

This is a prospective observational study. We recruited patients with clinically suspected myocarditis presenting at a university hospital from October 1st, 2020 until March 31st, 2021. All Patients had a diagnostic coronary angiography and were included only if they had a non-obstructive coronary artery disease. All patients also had cardiac magnetic resonance imaging (CMR) with contrast. Sera were obtained from all suspected patients for detection of antibodies against viruses using enzyme-linked immunosorbent assay, and viral genomes using polymerase chain reaction (PCR), and reverse transcription-PCR. Endomyocardial biopsy was done for patients with a typical CMR picture of myocarditis.

RESULTS

Out of 2163 patients presenting to the hospital within the 6 months, only 51 met the inclusion criteria. Males represented 73%, with a mean age of 39 ± 16 years. CMR showed an ischemic pattern in 4 patients and thus they were excluded. We classified patients into two categories based on CMR results: group A (CMR-positive myocarditis), 12 patients (25.5%), and group B (CMR-negative myocarditis), 35 (74.5%) patients. On serological analysis, 66% of patients (n = 31/47) showed antibodies against the common cardiotropic viruses. Parvovirus B19 IgM in 22 patients (47%) and coxsackievirus IgM in 16 (34%) were the most observed etiologies. Regarding the outcome, 42.5% of patients recovered left ventricular ejection fraction and three patients died at 6 months' clinical follow-up.

CONCLUSION

Patients with Clinically suspected myocarditis represented 2.2% of total hospital admissions in 6 months. CMR is only a good positive test for the diagnosis of acute myocarditis. Parvovirus B19 and coxsackievirus were the most common pathogens in our locality.

TRIAL REGISTRATION

Clinical trial registration no., NCT04312490; first registration: 18/03/2020. First recruited case 01/10/2020. URL: https://register.

CLINICALTRIALS

gov/prs/app/action/SelectProtocol?sid=S0009O3D&selectaction=Edit&uid=U0002DVP&ts=2&cx=9zdfin .

摘要

背景

心肌炎是一种高度异质性疾病，其诊断过程极具挑战性。我们旨在关注在无法进行作为金标准的心肌活检的情况下，该疾病可能的诊断方法，检测我们当地的致心脏病毒性病毒，并对临床上疑似心肌炎的患者进行临床随访。

方法

这是一项前瞻性观察性研究。我们招募了 2020 年 10 月 1 日至 2021 年 3 月 31 日在一所大学医院就诊的临床上疑似心肌炎的患者。所有患者均进行了诊断性冠状动脉造影检查，且仅在冠状动脉无阻塞性疾病的情况下纳入研究。所有患者还接受了心脏磁共振成像（CMR）检查，包括对比剂。从所有疑似患者中采集血清样本，采用酶联免疫吸附试验检测病毒抗体，采用聚合酶链反应（PCR）和逆转录-PCR 检测病毒基因组。对 CMR 表现为典型心肌炎的患者进行心内膜心肌活检。

结果

在 6 个月内就诊的 2163 例患者中，仅有 51 例符合纳入标准。男性占 73%，平均年龄 39±16 岁。4 例患者的 CMR 显示缺血模式，因此被排除在外。我们根据 CMR 结果将患者分为两类：CMR 阳性心肌炎组（A 组），12 例（25.5%）；CMR 阴性心肌炎组（B 组），35 例（74.5%）。血清学分析显示，66%的患者（n=31/47）存在针对常见致心脏病毒性病毒的抗体。22 例（47%）患者存在细小病毒 B19 IgM，16 例（34%）患者存在柯萨奇病毒 IgM。6 个月临床随访时，42.5%的患者左心室射血分数恢复正常，3 例患者死亡。