Abstract
ObjectivePatients with acute fulminant myocarditis often have more adverse cardiovascular events and higher mortality. The purpose of this study was to evaluate the usefulness of age, creatinine, and left ventricular ejection fraction (ACEF score), in determining the risk that acute fulminant myocarditis will lead to serious cardiovascular events, death, and cardiac dysfunction.MethodsWe retrospectively reviewed the demographics, laboratory tests, medications, echocardiographic examinations, in-hospital clinical outcomes, major adverse cardiovascular events (MACE), and survival rate at 1 year in the medical records of 220 consecutive subjects suffering from acute fulminant myocarditis from January 2013 to June 2019.ResultsTwo hundred twenty patients were divided into a survivor group and a non-survivor group. This study found that patients in the non-survivor group were older, had higher heart rates, and had more serious injuries to multiple organ functions. A high ACEF score at admission was independently associated with an unfavorable prognosis, and it was a predictor of in-hospital mortality. The current analysis extends the predictive performance of the ACEF scores at 30 days by evaluating echocardiographic data as applied to survivors of fulminant myocarditis and cumulative rates of MACE at 1 year. The results indicated that patients with high ACEF scores had poor recovery of cardiac function, and higher rates of MACE, all-cause death, and heart failure at 1 year than the low-ACEF group.ConclusionThe ACEF score was identified as an effective predictor of poor in-hospital outcomes, worse cardiac recovery after 30 days, and higher rates of MACE, all-cause death, and heart failure at 1 year in patients who had acute fulminant myocarditis. These data suggest that its predictive accuracy means the ACEF score could be used to assess the prognosis of patients with acute fulminant myocarditis.
Highlights
Acute myocarditis is an autoimmune inflammation of the myocardium to the possible sources with the expression of various clinical manifestations, myocardial damage, hemodynamic disorders, severe arrhythmias, and unfavorable prognosis (McCarthy et al, 2000; Eckart et al, 2004; Gupta et al, 2008; Sharma et al, 2019)
A number of risk factors have been associated with in-hospital mortality and longer-term outcomes in patients who suffer from acute fulminant myocarditis, especially renal dysfunction and impaired cardiac function (Yang et al, 2012; Xu et al, 2018)
With respect to echocardiographic data (LAd, left ventricular end diastolic dimensions (LVEDd), pericardial effusion, weakening motion of the ventricular wall, and valve regurgitation), patients who suffered acute fulminant myocarditis in the non-survivor group had no significant difference when compared with patients in the survivor group (Table 1)
Summary
Acute myocarditis is an autoimmune inflammation of the myocardium to the possible sources with the expression of various clinical manifestations, myocardial damage, hemodynamic disorders, severe arrhythmias, and unfavorable prognosis (McCarthy et al, 2000; Eckart et al, 2004; Gupta et al, 2008; Sharma et al, 2019). A number of risk factors have been associated with in-hospital mortality and longer-term outcomes in patients who suffer from acute fulminant myocarditis, especially renal dysfunction and impaired cardiac function (Yang et al, 2012; Xu et al, 2018). Until now, there have been few simple and effective tools to evaluate the in-hospital and 30 day prognosis and longterm survival in patients after acute fulminant myocarditis. The age, creatinine, and left ventricular ejection fraction (ACEF) score was originally developed to predict 1 year mortality in patients who survived for >30 days after acute myocardial infarction (Lee et al, 2015) and to assess mortality risk in elective cardiac operations (Ranucci et al, 2009). The results might help clinical physicians in clinical assessment and decision-making
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