Antinuclear antibodies in “infarct like” acute myocarditis: Change in prognosis?

Abstract

Antinuclear antibodies (ANA) are often positive in patients with “infarct like” acute myocarditis. The objectives of this study were to compare the course of “infarct like” acute myocarditis depending on the presence or absence of ANA at diagnosis. All cases of infarct-like acute myocarditis, revealed as an acute coronary syndrome with chest pain, elevated troponin levels and ECG changes, from 2012 to 2018, were included at Dijon University Hospital. The diagnosis of myocarditis was based on clinical symptoms and was confirmed by cardiac magnetic resonance (CMR). CMR was performed in the acute phase, at 3 months and one year after the acute event. A blood sampling including ANA test is obtained at the moment of the diagnostic. Among the patients with “infarct like” acute myocarditis, the ANA assay was performed in 83 patients. In 45 patients (54%), ANA were detected, with a median peak of 160 ( n < 80). Regarding demographic and clinical parameters, no statistical difference was observed between the two groups according the presence or absence of ANA. However, concerning CMR parameters, the initial extent of myocarditis is less important in the positive ANA group but the recovery in this group at three months is lower compared to the negative ANA group (ANA+ group: SQS Score in acute phase = 7.4–SQS Score at 3 months = 4.4–Delta = 4.6 VS ANA- group: SQS Score in acute phase = 8.8–SQS Score at 3 months = 2,9–Delta = 8,1– P = 0.06). Antinuclear antibodies (ANA) are present in patients with “infarct like” acute myocarditis in more than 50% of cases. According to the presence or absence of ANA, the CMR profile is different, both on initial extent and on recovery at distance of the acute phase. These results demonstrate that the presence of ANA, even without other manifestations of an autoimmune disease, influence or affect the course of “infarct like” acute myocarditis.