Abstract
Aim Myocarditis and cardiomyopathy impose a substantial economic burden on society. Many studies have examined the effects of various predictors on the prognosis of these diseases, such as the left ventricular systolic function, the New York Heart Association glomerular filtration rate, the QT interval, and the presence of viruses. In the present study, we conducted a meta-analysis of cohort studies to investigate the significance of the presence of viruses in the myocardial tissue on the prognosis of these diseases. Methods The Embase, PubMed, and Cochrane library databases were searched for relevant literature that had been published between January 1, 1964 and August 14, 2018. The inclusion criteria were patients over 18 years of age, suspected myocarditis or dilated cardiomyopathy, accepted myocardial biopsy, and the detection of virus in the myocardial tissue. Results In total, 10 studies met the inclusion criteria. These studies included 1006 patients with suspected myocarditis or idiopathic heart disease for whom the primary endpoint was all-cause death, heart transplant, or re-hospitalization due to fatal arrhythmia and heart failure. There was no significant difference in the prognosis of virus-positive and virus-negative patients with myocarditis or dilated cardiomyopathy confirmed by endomyocardial biopsy (EMB) [hazard ratio (HR) = 1.40, 95% confidence interval (CI) = 0.93–2.12, P = 0.11]. However, virus-negative patients had a better prognosis following nonspecific treatment (HR = 1.40, 95% CI = 1.06–1.86, P = 0.02) and right ventricular biopsy (HR = 2.08, 95% CI = 1.07–4.04, P = 0.03). Conclusions The presence of a virus did not worsen the long-term prognosis of patients with suspected myocarditis or dilated cardiomyopathy. However, virus-positive patients who did not undergo specific treatment or who underwent right ventricular biopsy did have a worse prognosis. Thus, the early diagnosis of the presence of viral infection in the myocardium will improve the prognosis of patients.
Highlights
MethodsE full text of each article that was retrieved was examined by two reviewers (Huan-Ji Zhang and DongHui Zhang) to determine whether the study met the inclusion criteria (see below)
Prospective and retrospective cohort studies relating to suspected myocarditis or idiopathic cardiomyopathy, myocardial biopsy, and the detection of viruses that were published between January 1, 1964 and August 14, 2018 were searched for in Embase, PubMed, and the Cochrane library using the search keywords “congestive cardiomyopathy,” “dilated cardiomyopathy,” “cardiomyopathy,” “myocarditis,” “carditis,” “myocardial biopsy,” “endomyocardial biopsy,” “cardiac biopsies,” and “heart muscle biopsy.” e literature search was undertaken independently by two of the authors (Wen-Hao Chen and You-Sheng Guo) and citation searches were made on related articles to ensure a complete literature search had been undertaken. e full text of each article that was retrieved was examined by two reviewers (Huan-Ji Zhang and DongHui Zhang) to determine whether the study met the inclusion criteria
We found that the removal of Figulla et al.’s study [8] caused the heterogeneity to decrease from 2 = 47%( = 0.05) to 2 = 22% ( = 0.25) and led to a signi cant di erence in the long-term prognosis of the virus-positive and virusnegative groups
Summary
E full text of each article that was retrieved was examined by two reviewers (Huan-Ji Zhang and DongHui Zhang) to determine whether the study met the inclusion criteria (see below). A review of the full text and the nal selection of articles for inclusion in this study was completed by one of the authors (Wen-Hao Chen). Research needed to meet the following criteria for inclusion in this study: (1) cohort study; (2) patients over 18 years of age with suspected myocarditis or dilated cardiomyopathy; (3) accepted myocardial biopsy and detection of a virus in the myocardial tissues
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