[急性心肌炎的长期临床病程。对99例患者（1987 - 1995年）的系列前瞻性研究]

[Long-term clinical course of acute myocarditis. Prospective study of a series of 99 patients (1987-1995)].

作者信息

Torres F, Anguita M, Giménez D, Mesa D, Tejero I, Franco M, Benítez F, Amat M, Vallés F

机构信息

Servicio de Cardiología, Hospital Universitario Reina Sofia, Córdoba.

出版信息

Rev Esp Cardiol. 1996 Oct;49(10):723-31.

PMID:9036474

Abstract

BACKGROUND

The natural history of acute myocarditis is not well known. The aim of our study was to assess the spontaneous outcome of patients with this disease and its possible relation with progression to chronic dilated cardiomyopathy.

METHODS

With this aim, we have carried out a prospective study of 99 patients consecutively diagnosed with acute myocarditis in our hospital from 1987 to April 1995, with a mean follow-up of 34 +/- 25 months. Acute myocarditis was diagnosed by clinical, echocardiographic and isotopic (detection of myocite damage) data, in absence of any other cardiac lesion.

RESULTS

Mean age was 26 +/- 17 years; 70% of the patients were male. Initial symptoms were dyspnea in 58% of the patients, chest pain in 33% and arrhythmias in 9%. Severe heart failure was present in 62% of the patients, ventricular arrhythmias in 16% and supraventricular arrhythmias in 16%. Cardiothoracic index was 0.50 +/- 0.07. Left ventricular ejection fraction was 0.40 +/- 0.18, although in 44% of the patients it was lower than 0.30. Immunosuppressive therapy was not used in any case. Outcome was favorable in 70% of the patients, who had a normal ejection fraction, while 13% died or needed heart transplantation during follow-up and 17% progressed to stable chronic dilated cardiomyopathy. Final ejection fraction was 0.53 +/- 0.17, significantly higher than the initial, 0.40 +/- 0.18 (p < 0.05); this improvement in ejection fraction was mainly observed during the first month after diagnosis (0.49 +/- 0.18). The proportion of patients with an ejection fraction of less than 0.30 decreased from 44% to 21% at the end of follow-up.

CONCLUSIONS

Spontaneous outcome of acute myocarditis is good in the majority of patients, although an unfavourable evolution was observed in almost 30% of the patients (death, need of heart transplantation or chronic dilated cardiomyopathy). Improvement in ventricular function mainly occurs at short-term, during the first month of evolution in our study.

摘要

背景

急性心肌炎的自然病程尚不明确。我们研究的目的是评估该病患者的自发转归及其与进展为慢性扩张型心肌病的可能关系。

方法

为此，我们对1987年至1995年4月在我院连续诊断为急性心肌炎的99例患者进行了前瞻性研究，平均随访34±25个月。急性心肌炎通过临床、超声心动图和同位素（检测心肌损伤）数据进行诊断，且不存在任何其他心脏病变。

结果

平均年龄为26±17岁；70%的患者为男性。初始症状方面，58%的患者表现为呼吸困难，33%为胸痛，9%为心律失常。62%的患者出现严重心力衰竭，16%为室性心律失常，16%为室上性心律失常。心胸指数为0.50±0.07。左心室射血分数为0.40±0.18，尽管44%的患者该数值低于0.30。所有患者均未使用免疫抑制治疗。70%的患者转归良好，其射血分数正常，而13%的患者在随访期间死亡或需要心脏移植，17%进展为稳定型慢性扩张型心肌病。最终射血分数为0.53±0.17，显著高于初始值0.40±0.18（p<0.05）；射血分数的改善主要在诊断后的第一个月观察到（0.49±有18）。随访结束时，射血分数低于0.30的患者比例从44%降至21%。