Hyun Junho, Pack Dayoung, Bak Minjung, Park Hyukjin, Kim Hyung Yoon, Lee Seonhwa, Kim In-Cheol, Kim So Ree, Kim Mi-Na, Kim Kyung-Hee, Lee Sang Eun, Yang Jeong Hoon
Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean Circ J. 2025 May;55(5):410-422. doi: 10.4070/kcj.2024.0229. Epub 2024 Dec 10.
Data are limited on the clinical manifestations and outcomes of acute myocarditis from a large-scale registry. We investigated acute myocarditis's clinical characteristics and prognosis from a large-scale, multi-center registry in the Republic of Korea.
We collected data from seven hospitals between 2001 and 2021. Clinical variables and outcomes during the index hospitalization and follow-up periods were analyzed. We also evaluated inter-center and temporal differences in diagnostic and treatment patterns.
Eight hundred forty-one patients diagnosed with acute myocarditis were included. Common symptoms included chest pain (60.4%), followed by fever or myalgia (46.3%), and dyspnea (45.7%). Fulminant myocarditis occurred in 421 (50.1%), with 217 requiring extracorporeal membrane oxygenation (ECMO) support. Endomyocardial biopsy (EMB) was performed in 276 (32.8%) patients, and biopsy-proven diagnosis was made in 234 (27.8%). Based on the EMB results, lymphocytic myocarditis was the predominant form (69.6%), followed by eosinophilic (13.8%) and giant cell myocarditis (1.4%). Eighty-three in-hospital (9.9%) and 16 (1.9%) additional mortality during the follow-up occurred. An increase in the use of EMB, cardiac imaging, and immunosuppressive therapy was noted over time, but in-hospital mortality remained unchanged. Remarkable variations in diagnosis and treatment were observed across different centers.
This study unveiled clinical features of acute myocarditis in the Republic of Korea, including a high incidence of fulminant myocarditis and complex cases requiring ECMO. Given the considerable inter-center variation in diagnostic and treatment patterns and prognosis, protocolized future trials are needed to clarify diagnosis and treatment in patients with acute myocarditis.
ClinicalTrials.gov Identifier: NCT05933902.
来自大规模注册研究的关于急性心肌炎临床表现和预后的数据有限。我们从韩国一项大规模、多中心注册研究中调查了急性心肌炎的临床特征和预后。
我们收集了2001年至2021年间七家医院的数据。分析了索引住院期间和随访期间的临床变量及预后。我们还评估了诊断和治疗模式在不同中心之间以及随时间的差异。
纳入了841例诊断为急性心肌炎的患者。常见症状包括胸痛（60.4%），其次是发热或肌痛（46.3%）以及呼吸困难（45.7%）。暴发性心肌炎发生在421例（50.1%）患者中，其中217例需要体外膜肺氧合（ECMO）支持。276例（32.8%）患者进行了心内膜心肌活检（EMB），234例（27.8%）经活检确诊。根据EMB结果，淋巴细胞性心肌炎是主要类型（69.6%），其次是嗜酸性粒细胞性（13.8%）和巨细胞性心肌炎（1.4%）。住院期间有83例（9.9%）死亡，随访期间又有16例（1.9%）死亡。随着时间的推移，EMB、心脏成像和免疫抑制治疗的使用有所增加，但住院死亡率保持不变。不同中心在诊断和治疗方面存在显著差异。
本研究揭示了韩国急性心肌炎的临床特征，包括暴发性心肌炎的高发病率以及需要ECMO的复杂病例。鉴于诊断和治疗模式以及预后在不同中心之间存在相当大的差异，未来需要进行标准化试验以明确急性心肌炎患者的诊断和治疗。
ClinicalTrials.gov标识符：NCT05933902。
