Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel; Medical Corps, Israel Defense Forces, Ramat Gan, Israel.
Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.
Am J Cardiol. 2023 Jul 15;199:18-24. doi: 10.1016/j.amjcard.2023.04.012. Epub 2023 May 23.
Anteroseptal location of late gadolinium enhancement (LGE) in patients with acute myocarditis (AM) detected by cardiovascular magnetic resonance may indicate an independent marker of unfavorable outcomes according to recent data. We aimed to evaluate the clinical characteristics, management, and inhospital outcomes in patients with AM with positive LGE based on its presence in the anteroseptal location. We analyzed data from 262 consecutive patients hospitalized with a diagnosis of AM with positive LGE within 5 days of hospitalization (n = 425). Patients were divided into 2 groups: those with anteroseptal LGE (n = 25, 9.5%) and those with non-anteroseptal LGE (n = 237, 90.5%). Except for age that was higher in patients with anteroseptal LGE, the demographic and clinical characteristics did not differ significantly between both groups including past medical history, clinical presentation, electrocardiogram parameters, and lab values. Moreover, patients with anteroseptal LGE were more likely to present with reduced left ventricular ejection fraction and to receive congestive heart failure treatments. Although univariate analysis showed that patients with anteroseptal LGE were more likely to have inhospital major adverse cardiac events (28% vs 9%, p = 0.003), there was no difference inhospital outcomes on multivariable analysis between both groups (hazard ratio, 1.17 [95% confidence interval, 0.32 to 4.22], p = 0.81). A higher left ventricular ejection fraction in either echocardiography or cardiovascular magnetic resonance corresponded to better inhospital outcomes regardless of the presence or absence of anteroseptal LGE. In conclusion, the presence of anteroseptal LGE did not confer additional prognostic value for inhospital outcomes.
心血管磁共振检测到急性心肌炎（AM）患者延迟钆增强（LGE）的前间隔部位可能是近期数据提示的不利结局的独立标志物。我们旨在根据 LGE 前间隔部位的存在，评估 AM 患者 LGE 阳性患者的临床特征、处理方法和住院结局。我们分析了 262 例住院 AM 患者（住院 5 天内 LGE 阳性）的数据（n=425）。患者分为两组：前间隔 LGE 患者（n=25，9.5%）和非前间隔 LGE 患者（n=237，90.5%）。除了前间隔 LGE 患者年龄较高外，两组的人口统计学和临床特征无显著差异，包括既往病史、临床表现、心电图参数和实验室值。此外，前间隔 LGE 患者更可能出现左心室射血分数降低，并接受充血性心力衰竭治疗。虽然单因素分析显示，前间隔 LGE 患者更可能发生住院期间重大不良心脏事件（28% vs. 9%，p=0.003），但多变量分析显示两组之间住院结局无差异（风险比，1.17[95%置信区间，0.32 至 4.22]，p=0.81）。无论是否存在前间隔 LGE，心脏超声或心血管磁共振的左心室射血分数较高与住院结局更好相关。总之，前间隔 LGE 的存在并不能为住院结局提供额外的预后价值。
