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Cases Report of Myocarditis in a Portuguese Tertiary Hospital
Session:
Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker:
Ana Amador
Congress:
CPC 2021
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.6 Myocardial Disease – Clinical
Session Type:
Posters
FP Number:
---
Authors:
Ana Amador; Catarina Martins Da Costa; João Calvão; Catarina Marques; André Cabrita; Sandra Amorim; Filipe Macedo
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Myocarditis is an inflammatory disease of the myocardium with heterogenous etiology, presentation, treatment, and prognosis. <span style="background-color:white">E</span>ndomyocardial biopsy (EMB) is<span style="background-color:white"> the </span>diagnostic gold standard but is done infrequently. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Single center retrospective study of consecutive myocarditis admissions in the Cardiology Department of a Portuguese tertiary center, from January of 2017 to December of 2020. The myocarditis diagnosis was done by magnetic ressonance imaging (MRI) or EMB. C<span style="background-color:white">linical, <em><span style="font-family:"Calibri",sans-serif">analytical</span></em>, <em><span style="font-family:"Calibri",sans-serif">imagiological</span></em> and histological data were analyzed. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: A total of 42 patients were included with median age of 30.5 years and 78.6% men. None had previous cardiopathy. Chest pain was the main symptom in 92.9% of patients and 7.1% had acute heart failure. One patient presented with symptoms lasting more than 1 month and two had fulminant course. Previous respiratory infection and gastroenteritis were present in 42.9% in 21.4% of the patients, respectively. There was ST-segment deviation in 52.4% of cases. Median maximum troponin I was 9200 ng/L (232-453 ng/L). Median C-reactive protein and <em><span style="background-color:white"><span style="font-family:"Calibri",sans-serif">B-type natriuretic peptide</span></span></em><span style="background-color:white"> at admission were 47 mg/dL (1.4-222mg/dL) and 33 mg/dl (10-986 mg/dl), respectively. Systolic left ventricle (LV) function at echocardiogram was preserved in most patients (85.7%), 2 patients had severe systolic biventricular dysfunction. The myocarditis diagnosis relied in EMB in 11.9% of cases and in MRI in 88.1%. <span style="background-color:white">Diagnostic compatible T2-weighted and late gadolinium enhancement images were present in 83.7% and 97.2% of patients, respectively. </span></span>In patients submitted to EMB, etiology was idiopathic in two; one patient had viral myocarditis (parvovirus and herpes 6 virus) and was treated with intravenous immune globulin; and two patients had eosinophilic infiltrates in context of Churg-Strauss and Hypereosinophilic Syndromes and improved with corticotherapy. Three patients with fulminant and subacute course required extracorporeal membrane oxygenation. No deaths were registered. At discharge, most patients had preserved biventricular systolic function (95.2%), only one persisted with severe biventricular dysfunction. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> Although most cases of myocarditis recover without sequelae, a minority progresses to inflammatory cardiomyopathy, as seen in this study. National and international registries are essential to help to determine prognosis predictors. </span></span></p>
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