Verlaufskontrolle bei Patientinnen und Patienten mit klinischem Verdacht auf Myokarditis in Abhängigkeit vom Schweregrad

The aim of the present study was to investigate the long-term outcome of patients with initial suspected myocarditis and the associated prognostic significance of anamnestic and diagnostic criteria at entry. This is based on 252 patients who were seen with suspected myocarditis at the University Hospital of Marburg between October 2012 and June 2017. In the next step, 108 patients underwent a follow-up examination within a mean period of 31 months. Retrospective data from physician's letters, laboratory studies, electrocardiography (ECG), echocardiography and MRT examinations were collected and evaluated. In up to 30% of the patients, clinical and diagnostic criteria for myocarditis were still detectable at the time of the follow-up examination. Depending on the persistent symptoms at the time of the post-examination, a number of prognostic predictors could be detected by logistic regression analysis. After the multivariate analysis and backward selection according to Wald, three significant predictors were identified which were associated with a higher risk of adverse prognosis. These were higher age (OR = 1.053; KI = 1.009-1.099; p = 0.019), the detection of a bundle branch block in ECG (OR = 6.325; KI = 1.372-29.152; p = 0.018) and an ejection fraction of less than 50% in echocardiography (OR = 4.347; KI = 1.464 - 12.909; p = 0.008) at baseline. Angina pectoris symptoms, dyspnea and ST segment changes in ECG were predictive only in univariate regression analysis. The angina pectoris symptoms and the ST segment changes in ECG proved to be positive factors influencing the progression of the disease in the patients. In contrast, signs of heart failure, especially the presence of dyspnea at entry, were associated with a worse outcome. In summary, this study showed, that 30% of patients with suspected myocarditis have an increased risk of incomplete recovery. The risk factors included a relevant number of patients with cardiomyopathy and cardiac events with 21%. This shows the importance of clinical and diagnostic criteria in the diagnosis of myocarditis and justifies a structured follow-up examination. Risk patients with clinical suspicion of myocarditis can be identified by combining the identified predictors.