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Published on: May 31, 2017
Lactate Dehydrogenase Indicates Development From Fulminant Myocarditis to Chronic Persistent Myocarditis: A
Qu Zhao1,2, Zeping Li1,2, Dao Wen Wang1,2
1Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
Insights
Fulminant myocarditis progression to chronic persistent myocarditis can be predicted by delayed admission and elevated lactate dehydrogenase (LDH) levels. Identifying these risk factors aids in early intervention for better patient outcomes.
Area of Science:
- Cardiology
- Internal Medicine
- Pathology
Background:
- Fulminant myocarditis (FM) is a severe form of myocarditis with high mortality.
- Predicting progression to chronic persistent myocarditis is crucial for managing long-term complications.
- Clinical and laboratory markers for predicting FM progression remain incompletely understood.
Purpose of the Study:
- To identify clinical factors that predict the progression of fulminant myocarditis to chronic persistent myocarditis.
- To investigate the association between clinical features and adverse outcomes in FM patients.
Main Methods:
- A cohort of 82 patients with FM treated under a Chinese protocol was analyzed.
- Kaplan-Meier curves and regression analyses were employed for prognostic prediction.
- A 24-month follow-up period was utilized to assess outcomes.
Main Results:
- Chronic persistent myocarditis developed in 20 patients (24.4%) during follow-up.
- Lactate dehydrogenase (LDH) levels > 577.00 U/L were identified as a critical predictor (sensitivity 75.0%, specificity 74.2%).
- Time from symptom onset to hospital admission exceeding 6 days and LDH > 577.00 U/L were significant risk factors for progression.
Conclusions:
- Delayed admission (>6 days) and elevated LDH levels (>577.00 U/L) are key risk factors for FM progression to chronic persistent myocarditis.
- These factors can aid in predicting adverse outcomes and guiding clinical management.
- Early detection and intervention strategies are essential for patients with these risk factors.
Background:
Fulminant myocarditis (FM) is a critical manifestation of myocarditis. However, the clinical features and risk factors associated with its adverse outcomes are not fully understood. Given the high mortality and potential for long-term complications, it is crucial to identify factors that could predict the progression of FM to chronic persistent myocarditis. We hypothesize some clinical or laboratory markers may be predictive of this progression. This study aims to identify clinical factors that may help predict the progress of FM to chronic persistent myocarditis.
Methods:
A total of 82 patients with FM treated based on Chinese protocol were included. Kaplan-Meier curve and regression analysis were used to determine the clinical features and prognostic predictors of chronic persistent myocarditis in patients with 24 months of follow-up.
Results:
Chronic persistent myocarditis was observed in 20 patients during the follow-up. ROC curve showed that the critical value for chronic persistent myocarditis caused by lactate dehydrogenase (LDH) was 577.00U/L (sensitivity 75.0%, specificity 74.2%). Time from onset to admission over 6 days and LDH > 577.00U/L were identified as risk factors for chronic persistent myocarditis in patients with FM in both univariate and multivariate cox analysis. The hazard ratio and 95% Confidence intervals were 3.35 (1.32-8.50) (p = 0.011) and 6.11 (2.02-18.48) (p < 0.001), respectively. The per standard deviation of increment in LDH was associated with the 55% (1.55, 1.11-2.18) in HR and 95% CI of the occurrence of chronic persistent myocarditis.
Conclusion:
About 24.4% of the patients with FM treated based on the life support measures proposed in the consensus of Chinese Society of Cardiology have been observed chronic persistent myocarditis. Time from onset to admission over 6 days and LDH levels >577.00 U/L at admission may serve as risk factors for the progression from FM to chronic persistent myocarditis.
