Ji Mengmeng, Jiang Luying, Zhang Zixuan, Jiang Shupeng, Zuo Houjuan
Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Int J Cardiol Heart Vasc. 2025 Jul 28;60:101759. doi: 10.1016/j.ijcha.2025.101759. eCollection 2025 Oct.
Elevated serum high-sensitivity cardiac troponin (hs-cTn) levels are commonly observed in patients with fulminant myocarditis (FM) after the acute phase. This study aims to evaluate the relationship between elevated hs-cTnI levels at 30-day post-discharge and long-term cardiac structure and function.
This study is a retrospective cohort study that selected FM patients hospitalized at Tongji Hospital in Wuhan from April 2016 to December 2022. All patients underwent serial monitoring of hs-cTnI levels. Patients were stratified into two groups based on hs-cTnI levels at 30 days post-discharge: the normal hs-cTnI (N-cTnI) group and the high hs-cTnI (H-cTnI) group. Left ventricular (LV) function and structure were assessed using 2-dimensional volume and speckle tracking strain echocardiography. Measurements were obtained at admission, discharge, and 6 months, 12 months, and annually thereafter post-discharge.
Among 95 patients with analysable echocardiographic data (median age: 33 years; 42.11 % male), the N-cTnI group demonstrated significantly higher proportions of patients meeting cardiac function criteria during follow-up compared to the H-cTnI group: LV ejection fraction (LVEF) > 50 % (95 % vs. 72 %; P = 0.003), global longitudinal strain (GLS) > 16 % (68 % vs. 36 %; P = 0.002), and LV end-diastolic dimension < 5 cm (86 % vs. 65 %; P = 0.020). Given that the primary composite endpoint occurred in only 5 patients, statistical analyses focused on secondary composite endpoints. The incidence of secondary composite endpoints was significantly higher in the H-cTnI group than in the N-cTnI group (61.91 % vs. 16.98 %; P < 0.001). Multivariable Cox regression identified elevated hs-cTnI at 30 days post-discharge (HR: 5.365; 95 % CI: 1.876-15.344; P = 0.002) and LV-GLS at discharge (HR: 0.844; 95 % CI: 0.732-0.974; P = 0.021) as independent predictors of secondary composite endpoints.
Delayed normalization of hs-cTnI after 30 days post-discharge may predict long-term deterioration of cardiac function and structural remodeling in patients with FM.
暴发性心肌炎（FM）患者急性期过后，血清高敏心肌肌钙蛋白（hs-cTn）水平通常会升高。本研究旨在评估出院30天时hs-cTnI水平升高与长期心脏结构和功能之间的关系。
本研究为回顾性队列研究，选取了2016年4月至2022年12月在武汉同济医院住院的FM患者。所有患者均接受hs-cTnI水平的连续监测。根据出院30天时的hs-cTnI水平将患者分为两组：hs-cTnI正常（N-cTnI）组和hs-cTnI高值（H-cTnI）组。使用二维容积和斑点追踪应变超声心动图评估左心室（LV）功能和结构。在入院时、出院时以及出院后6个月、12个月及此后每年进行测量。
在95例有可分析超声心动图数据的患者中（中位年龄：33岁；男性占42.11%），与H-cTnI组相比，N-cTnI组在随访期间达到心脏功能标准的患者比例显著更高：左心室射血分数（LVEF）>50%（95%对72%；P=0.003），整体纵向应变（GLS）>16%（68%对36%；P=0.002），左心室舒张末期内径<5cm（86%对65%；P=0.020）。鉴于仅5例患者出现主要复合终点，统计分析聚焦于次要复合终点。H-cTnI组次要复合终点的发生率显著高于N-cTnI组（61.91%对16.98%；P<0.001）。多变量Cox回归确定出院30天时hs-cTnI升高（HR：5.365；95%CI：1.876 - 15.344；P=0.002）和出院时LV-GLS（HR：0.844；95%CI：0.732 - 0.974；P=0.021）为次要复合终点的独立预测因素。
出院30天后hs-cTnI延迟恢复正常可能预示FM患者心脏功能长期恶化和结构重塑。
