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Development of diastolic heart failure in a 6-year follow-up study in patients after acute myocarditis
Felicitas Escher1, Dirk Westermann, Regina Gaub
1Department of Cardiology and Pneumonology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
Insights
Long-term follow-up of acute myocarditis patients reveals that while most recover normal left ventricular function, nearly half develop heart failure with normal ejection fraction, indicating diastolic dysfunction risks.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Acute myocarditis (AMC) can impact long-term cardiac health.
- Assessing prognosis in AMC patients with initially normal left ventricular (LV) function is crucial.
Purpose of the Study:
- To analyze the long-term prognosis of patients discharged with normal LV function after acute myocarditis.
- To identify risks and clinical outcomes in this patient cohort over time.
Main Methods:
- Prospective study of 50 AMC patients with endomyocardial biopsies (EMBs).
- Mean follow-up of 72 months including tissue Doppler imaging (TDI) and clinical assessment.
- Analysis of LV function, heart failure symptoms, diastolic dysfunction parameters, and NT-proBNP levels.
Main Results:
- 90% of patients maintained or improved LV function.
- 49% developed heart failure with normal ejection fraction (HFNEF) despite preserved ejection fraction.
- HFNEF was linked to abnormal diastolic function indices (E/A ratio, deceleration time, E/E') and elevated NT-proBNP.
Conclusions:
- AMC is associated with risks beyond LV dilatation, including symptomatic diastolic dysfunction years later.
- Early identification of diastolic dysfunction is important for managing AMC survivors.
Background:
The aim of this study was to analyse the long-term prognosis of patients with acute myocarditis (AMC) who had been discharged from hospital while having normal left ventricular (LV) function.
Methods And Results:
50 patients with acute myocarditis who underwent endomyocardial biopsies (EMBs) were prospectively studied. Their clinical condition was examined during a mean follow-up period of 72 (54-78) months, including tissue Doppler imaging (TDI). 4% (2/50) died, and 6% (3/50) developed dilated cardiomyopathy. 45/50 (90%) showed a normal or improvement in LV function over time. In the course of the follow-up, 49% (22/45) suffered from heart failure symptoms despite a normal ejection fraction (HFNEF). This was associated with an abnormal E/A ratio, an impaired deceleration time of early mitral flow velocity and isovolumic relaxation time, and a pathological increase in the LV filling index E/E', in contrast to patients without heart failure symptoms (E/E'(septal) 10.9 (9.3-13.8) vs 6.8 (6.4-9.1); p=0.001). Plasma N-terminal proB-type natriuretic peptide levels were increased threefold in patients with HFNEF (19.9 (10.6-24.1) vs 7.3 (4.2-11.9) pmol/l; p=0.006).
Conclusions:
It is assumed that the evidence for AMC is associated not only with the risk of developing LV dilatation but also with an increased risk of symptomatic diastolic dysfunction after several years.
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