Clinical course, viral etiology, and the diagnostic workup for patients with suspected myocarditis: a single-center
Shimaa S Khidr1, Mohamed Ahmed El-Mokhtar2, Shery Refaat Asaad3
1Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, P.Box. 71526, Assiut, Egypt. shaimaakhidr@gmail.com.
Insights
This study investigated diagnosing myocarditis without biopsies, finding Parvovirus B19 and coxsackievirus are common causes. Cardiac MRI is useful, but diagnosis remains challenging for this heterogeneous heart condition.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Diagnostics
Background:
- Myocarditis presents diagnostic challenges, especially when endomyocardial biopsy is not feasible.
- This study focuses on alternative diagnostic approaches and local etiological factors.
Purpose of the Study:
- To evaluate diagnostic workup for clinically suspected myocarditis.
- To identify prevalent cardiotropic viruses in the study's locality.
- To track the clinical course of patients with suspected myocarditis.
Main Methods:
- Prospective observational study of 51 patients with suspected myocarditis.
- Utilized coronary angiography, cardiac magnetic resonance imaging (CMR), and serological assays (ELISA, PCR).
- Endomyocardial biopsy performed for CMR-indicated cases.
Main Results:
- 25.5% of patients had CMR-positive myocarditis; 74.5% were CMR-negative.
- Serological analysis revealed common cardiotropic viruses in 66% of patients.
- Parvovirus B19 IgM (47%) and coxsackievirus IgM (34%) were the most frequent viral markers.
- 42.5% recovered left ventricular ejection fraction; 3 patients died within 6 months.
Conclusions:
- Clinically suspected myocarditis accounted for 2.2% of hospital admissions.
- Cardiac MRI is a valuable tool for diagnosing acute myocarditis.
- Parvovirus B19 and coxsackievirus are the primary identified pathogens in this region.
Background:
Myocarditis is a highly heterogeneous disorder with a challenging diagnostic work-up. We aimed to focus on the possible diagnostic workup for this condition in settings where endomyocardial biopsy as a gold standard is not always feasible, detect the etiologic cardiotropic viruses in our locality, and follow the clinical course in patients admitted with clinically suspected myocarditis.
Methods:
This is a prospective observational study. We recruited patients with clinically suspected myocarditis presenting at a university hospital from October 1st, 2020 until March 31st, 2021. All Patients had a diagnostic coronary angiography and were included only if they had a non-obstructive coronary artery disease. All patients also had cardiac magnetic resonance imaging (CMR) with contrast. Sera were obtained from all suspected patients for detection of antibodies against viruses using enzyme-linked immunosorbent assay, and viral genomes using polymerase chain reaction (PCR), and reverse transcription-PCR. Endomyocardial biopsy was done for patients with a typical CMR picture of myocarditis.
Results:
Out of 2163 patients presenting to the hospital within the 6 months, only 51 met the inclusion criteria. Males represented 73%, with a mean age of 39 ± 16 years. CMR showed an ischemic pattern in 4 patients and thus they were excluded. We classified patients into two categories based on CMR results: group A (CMR-positive myocarditis), 12 patients (25.5%), and group B (CMR-negative myocarditis), 35 (74.5%) patients. On serological analysis, 66% of patients (n = 31/47) showed antibodies against the common cardiotropic viruses. Parvovirus B19 IgM in 22 patients (47%) and coxsackievirus IgM in 16 (34%) were the most observed etiologies. Regarding the outcome, 42.5% of patients recovered left ventricular ejection fraction and three patients died at 6 months' clinical follow-up.
Conclusion:
Patients with Clinically suspected myocarditis represented 2.2% of total hospital admissions in 6 months. CMR is only a good positive test for the diagnosis of acute myocarditis. Parvovirus B19 and coxsackievirus were the most common pathogens in our locality.
Trial Registration:
Clinical trial registration no., NCT04312490; first registration: 18/03/2020. First recruited case 01/10/2020. URL: https://register.
Clinicaltrials:
gov/prs/app/action/SelectProtocol?sid=S0009O3D&selectaction=Edit&uid=U0002DVP&ts=2&cx=9zdfin .
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