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Contemporary Epidemiology, Management, and In-Hospital Outcomes of Acute Myocarditis: The Prospective Multicenter MyocarditIRM Study

  • 1University of Poitiers, Clinical Investigation Center (INSERM 1402), Cardiology Department, Poitiers Hospital, Poitiers, France. Electronic address: claire.bouleti@gmail.com.
  • 2Medical Pharmacology Department, CHRU de Tours and UMR Inserm 1327 ISCHEMIA Membrane Signalling and Inflammation in Reperfusion Injuries, Tours University, Tours, France.
  • 3Cardiology Department, University Hospital of Toulouse, Toulouse, France.
  • 4Radiology Department, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • 5Cardiology Department, University Hospital of Tours, Tours, France.
  • 6Cardiology Department, Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • 7Radiology Department, Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Radiology Department, Geneva University Hospital, Geneva, Switzerland.
  • 8Cardiology Department, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • 9Radiology Department, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, INSERM PARCC, Université Paris-Cité, Paris, France.
  • 10University of Poitiers, Clinical Investigation Center (INSERM 1402), Cardiology Department, Poitiers Hospital, Poitiers, France.
  • 11Cardiology Department, University Hospital of Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
  • 12Radiology Department, University Hospital of Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
  • 13Cardiology Department, University Hospital of Nîmes, Nîmes, France.
  • 14Cardiology Department, University Hospital of Nancy, Vandoeuvre-les-Nancy, France.
  • 15Cardiology Department, University Hospital of Montpellier, Montpellier, France; Cardiology Department, Jacques Cartier Private Hospital, Massy, France.
  • 16Radiology Department, La Pitie-Salpétrière University Hospital, Assistance Publique-Hôpitaux de Paris, IHU ICAN, Paris, France.
  • 17Cardiology Department, CHRU de Tours and UMR Inserm 1327 ISCHEMIA Membrane Signalling and Inflammation in Reperfusion Injuries, Tours University, Tours, France.
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June 14, 2025

Abstract

BACKGROUND

Despite a frequently favorable evolution during the initial phase, acute myocarditis (AM) remains associated with heart failure and ventricular arrhythmia. There are no large prospective databases to provide robust results.

OBJECTIVES

The aim of this study was to describe baseline characteristics, real-life management, in-hospital outcomes, and determinants of prognosis in a large cohort of patients with AM admitted to cardiology, with a comparison of patients with and without initial severity criteria.

METHODS

MyocarditIRM (French National Observatory Tracking Viral Myocarditis: Mortality, Cardiovascular Events, Sequels on [Magnetic Resonance Imaging] MRI) is a multicenter prospective observational study of patients with AM confirmed by cardiac magnetic resonance. Patients initially admitted to the intensive care unit or those who died before cardiac magnetic resonance-confirmed diagnosis were not included.

RESULTS

In total, 803 consecutive hospitalized patients were enrolled at 49 participating centers between May 2016 and February 2019. The median age was 31 years (Q1-Q3: 23-41 years), and 82% were men. Chest pain was the most frequent symptom (93%), and 112 patients (14%) had severity criteria upon admission (left ventricular ejection fraction <50%, severe ventricular arrythmia, high-degree atrioventricular block, or cardiogenic shock). ST-segment elevation was observed in 49% of patients. Overall, 64 patients (8%) experienced in-hospital complications, defined as a composite of death; left ventricular ejection fraction ≤40%; sustained ventricular or supraventricular arrythmia; cardiogenic shock; and need for mechanical circulatory support, inotropic drugs, temporary cardiac pacing, pacemaker, or cardiac defibrillator implantation. Patients with severity criteria at admission were 10 times more likely to experience in-hospital complications.

CONCLUSIONS

This prospective cohort represents the largest AM database worldwide. Although the recruitment process likely led to a selection of patients with lower risk AM, 8% experienced in-hospital complications, the major prognosis factor being severity criteria upon admission. (French National Observatory Tracking Viral Myocarditis: Mortality, Cardiovascular Events, Sequels on (Magnetic Resonance Imaging) MRI; NCT02717143).

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