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Published on: June 20, 2014
Rate and patient features associated with recurrence of acute myocarditis
Ville Kytö1, Jussi Sipilä2, Päivi Rautava3
1Heart Center, Turku University Hospital, Turku, Finland; PET Center, University of Turku, Turku, Finland; Medicine, University of Turku, Turku, Finland.
Background:
Rate and patient features associated with recurrence after acute myocarditis are largely unknown.
Methods And Results:
First recurrence of acute myocarditis was studied in 1662 patients aged 16-70 years using a registry data of 29 hospitals in Finland (median follow-up 4.5 years). Matched intoxication patients served as controls. Incidence rate of first time hospitalization due to acute myocarditis was 5.52 (CI 5.26-5.79) per 100,000 person-years during 2001-2008. During the first 30 days 5.5% (CI 3.5-4.4%) of patients were re-admitted to hospital with acute myocarditis (p<0.0001 vs. controls). After 30 days, recurrence rate was 7.0% (CI 5.7-8.6%; p<0.0001 vs. controls). Acute myocarditis recurred after 365 days in 4.7% (CI 3.2-6.7%) of patients (p<0.0001 vs. controls). During the whole follow-up, recurrence rate was 10.3% (CI 8.8-12.1%; p<0.0001 vs. controls) with median recurrence time of 34.5 days. Prolonged (>7 days) initial admission was associated with recurrences during (HR 2.9; CI 1.6-5.2) and after first month (HR 1.8; CI 1.2-3.2), and overall (HR 2.0; CI 1.3-3.2). Ventricular arrhythmia at initial occurrence was associated with recurrence after 30 days (HR 8.6; CI 2.5-30.1), after 1 year (HR 22.6; CI 2.5-201.4) and overall (HR 6.7; CI 2.3-6.7). Other features associated with recurrence were younger age (>365 days), inflammatory bowel disease (during first month), and chronic pulmonary disease (≥ 30 days).
Conclusions:
Acute myocarditis reoccurs in a significant proportion of patients. Prolonged initial admission, ventricular arrhythmias, younger age, inflammatory bowel disease and chronic pulmonary disease are associated with recurrences at different phases after acute myocarditis.
Insights
Acute myocarditis frequently recurs, with prolonged initial hospital stays and ventricular arrhythmias increasing risk. Younger age, inflammatory bowel disease, and chronic pulmonary disease also correlate with recurrence in patients with acute myocarditis.
Area of Science:
- Cardiology
- Infectious Diseases
- Internal Medicine
Background:
- Recurrence rates and patient-specific predictors following acute myocarditis remain poorly understood.
- Understanding these factors is crucial for managing patient outcomes and preventing future cardiac events.
Purpose of the Study:
- To investigate the incidence and identify features associated with the recurrence of acute myocarditis.
- To analyze the impact of initial admission duration and specific patient characteristics on myocarditis recurrence.
Main Methods:
- A registry-based study involving 1662 patients diagnosed with acute myocarditis across 29 Finnish hospitals.
- A median follow-up of 4.5 years was conducted, with matched intoxication patients serving as controls.
- Statistical analysis included calculating incidence rates and hazard ratios (HR) for recurrence based on various clinical factors.
Main Results:
- The overall recurrence rate of acute myocarditis was 10.3% during the follow-up period.
- Prolonged initial hospital admission (>7 days) was significantly associated with recurrence (overall HR 2.0).
- Ventricular arrhythmias during initial occurrence strongly predicted recurrence (overall HR 6.7), as did younger age, inflammatory bowel disease, and chronic pulmonary disease.
Conclusions:
- Acute myocarditis is a condition with a significant recurrence rate.
- Key predictors for recurrence include prolonged initial admission, ventricular arrhythmias, younger age, inflammatory bowel disease, and chronic pulmonary disease.
- These findings highlight the need for targeted monitoring and management strategies for patients at higher risk of myocarditis recurrence.
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