Risk factors for patients developing a fulminant course with acute myocarditis

Shigeru Kato, Shin Ichiro Morimoto, Shinya Hiramitsu, Akihisa Uemura, Masatsugu Ohtsuki, Yasuchika Kato, Kenji Miyagishima, Yukihiko Yoshida, Shuji Hashimoto, Hitoshi Hishida

Research output: Contribution to journalArticle

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Abstract

Background A fulminant course can be difficult to predict at the onset of acute myocarditis, so the aim of the present study was to identify the predictive clinical symptoms/signs or laboratory findings. Methods and Results Thirty-nine patients with acute lymphocytic myocarditis, excluding 8 who manifested shock at admission, were studied. The fulminant group was defined as 12 patients who developed shock after admission, requiring intraaortic balloon pumping or percutaneous cardiopulmonary support, and the non-fulminant group comprised the 27 patients without shock. Various parameters at admission were compared between the 2 groups, together with multiple logistic regression analysis, excluding 6 patients with partially missing values. In the fulminant group, C-reactive protein (7.0±7.0 vs 2.3±2.2 mg/dl, p<0.01) and creatine kinase (1,147±876 vs 594±568 IU/L, p<0.05) concentrations were higher, intraventricular conduction disturbances were more frequent (9/12 vs 7/27 patients, p<0.01) and the left ventricular ejection fraction was lower (40.7±13.9 vs 50.1±10.6%, p<0.05) than in the non-fulminant group. In the multiple logistic regression analysis model with the presence/absence of a fulminant course considered as the independent variable, and C-reactive protein, creatine kinase, intraventricular conduction disturbances, and left ventricular ejection fraction as dependent variables, a high-risk group (expected proportion of fulminant course ≥0.5) and a low-risk group (<0.5) could be differentiated. A fulminant course occurred in 9/13 (69%) patients in the high-risk group, but in only 2/20 (10%) patients in the low risk group (p<0.001). Conclusions The risk of a fulminant course of acute myocarditis was high in patients with elevated C-reactive protein, and creatine kinase concentrations, decreased left ventricular ejection fraction, and intraventricular conduction disturbances at the time of admission.

Original languageEnglish
Pages (from-to)734-739
Number of pages6
JournalCirculation Journal
Volume68
Issue number8
DOIs
Publication statusPublished - 01-08-2004

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Myocarditis
Creatine Kinase
Stroke Volume
C-Reactive Protein
Shock
Protein Kinases
Logistic Models
Regression Analysis
Intra-Aortic Balloon Pumping
Signs and Symptoms

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kato, S., Morimoto, S. I., Hiramitsu, S., Uemura, A., Ohtsuki, M., Kato, Y., ... Hishida, H. (2004). Risk factors for patients developing a fulminant course with acute myocarditis. Circulation Journal, 68(8), 734-739. https://doi.org/10.1253/circj.68.734
Kato, Shigeru ; Morimoto, Shin Ichiro ; Hiramitsu, Shinya ; Uemura, Akihisa ; Ohtsuki, Masatsugu ; Kato, Yasuchika ; Miyagishima, Kenji ; Yoshida, Yukihiko ; Hashimoto, Shuji ; Hishida, Hitoshi. / Risk factors for patients developing a fulminant course with acute myocarditis. In: Circulation Journal. 2004 ; Vol. 68, No. 8. pp. 734-739.
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abstract = "Background A fulminant course can be difficult to predict at the onset of acute myocarditis, so the aim of the present study was to identify the predictive clinical symptoms/signs or laboratory findings. Methods and Results Thirty-nine patients with acute lymphocytic myocarditis, excluding 8 who manifested shock at admission, were studied. The fulminant group was defined as 12 patients who developed shock after admission, requiring intraaortic balloon pumping or percutaneous cardiopulmonary support, and the non-fulminant group comprised the 27 patients without shock. Various parameters at admission were compared between the 2 groups, together with multiple logistic regression analysis, excluding 6 patients with partially missing values. In the fulminant group, C-reactive protein (7.0±7.0 vs 2.3±2.2 mg/dl, p<0.01) and creatine kinase (1,147±876 vs 594±568 IU/L, p<0.05) concentrations were higher, intraventricular conduction disturbances were more frequent (9/12 vs 7/27 patients, p<0.01) and the left ventricular ejection fraction was lower (40.7±13.9 vs 50.1±10.6{\%}, p<0.05) than in the non-fulminant group. In the multiple logistic regression analysis model with the presence/absence of a fulminant course considered as the independent variable, and C-reactive protein, creatine kinase, intraventricular conduction disturbances, and left ventricular ejection fraction as dependent variables, a high-risk group (expected proportion of fulminant course ≥0.5) and a low-risk group (<0.5) could be differentiated. A fulminant course occurred in 9/13 (69{\%}) patients in the high-risk group, but in only 2/20 (10{\%}) patients in the low risk group (p<0.001). Conclusions The risk of a fulminant course of acute myocarditis was high in patients with elevated C-reactive protein, and creatine kinase concentrations, decreased left ventricular ejection fraction, and intraventricular conduction disturbances at the time of admission.",
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Kato, S, Morimoto, SI, Hiramitsu, S, Uemura, A, Ohtsuki, M, Kato, Y, Miyagishima, K, Yoshida, Y, Hashimoto, S & Hishida, H 2004, 'Risk factors for patients developing a fulminant course with acute myocarditis', Circulation Journal, vol. 68, no. 8, pp. 734-739. https://doi.org/10.1253/circj.68.734

Risk factors for patients developing a fulminant course with acute myocarditis. / Kato, Shigeru; Morimoto, Shin Ichiro; Hiramitsu, Shinya; Uemura, Akihisa; Ohtsuki, Masatsugu; Kato, Yasuchika; Miyagishima, Kenji; Yoshida, Yukihiko; Hashimoto, Shuji; Hishida, Hitoshi.

In: Circulation Journal, Vol. 68, No. 8, 01.08.2004, p. 734-739.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk factors for patients developing a fulminant course with acute myocarditis

AU - Kato, Shigeru

AU - Morimoto, Shin Ichiro

AU - Hiramitsu, Shinya

AU - Uemura, Akihisa

AU - Ohtsuki, Masatsugu

AU - Kato, Yasuchika

AU - Miyagishima, Kenji

AU - Yoshida, Yukihiko

AU - Hashimoto, Shuji

AU - Hishida, Hitoshi

PY - 2004/8/1

Y1 - 2004/8/1

N2 - Background A fulminant course can be difficult to predict at the onset of acute myocarditis, so the aim of the present study was to identify the predictive clinical symptoms/signs or laboratory findings. Methods and Results Thirty-nine patients with acute lymphocytic myocarditis, excluding 8 who manifested shock at admission, were studied. The fulminant group was defined as 12 patients who developed shock after admission, requiring intraaortic balloon pumping or percutaneous cardiopulmonary support, and the non-fulminant group comprised the 27 patients without shock. Various parameters at admission were compared between the 2 groups, together with multiple logistic regression analysis, excluding 6 patients with partially missing values. In the fulminant group, C-reactive protein (7.0±7.0 vs 2.3±2.2 mg/dl, p<0.01) and creatine kinase (1,147±876 vs 594±568 IU/L, p<0.05) concentrations were higher, intraventricular conduction disturbances were more frequent (9/12 vs 7/27 patients, p<0.01) and the left ventricular ejection fraction was lower (40.7±13.9 vs 50.1±10.6%, p<0.05) than in the non-fulminant group. In the multiple logistic regression analysis model with the presence/absence of a fulminant course considered as the independent variable, and C-reactive protein, creatine kinase, intraventricular conduction disturbances, and left ventricular ejection fraction as dependent variables, a high-risk group (expected proportion of fulminant course ≥0.5) and a low-risk group (<0.5) could be differentiated. A fulminant course occurred in 9/13 (69%) patients in the high-risk group, but in only 2/20 (10%) patients in the low risk group (p<0.001). Conclusions The risk of a fulminant course of acute myocarditis was high in patients with elevated C-reactive protein, and creatine kinase concentrations, decreased left ventricular ejection fraction, and intraventricular conduction disturbances at the time of admission.

AB - Background A fulminant course can be difficult to predict at the onset of acute myocarditis, so the aim of the present study was to identify the predictive clinical symptoms/signs or laboratory findings. Methods and Results Thirty-nine patients with acute lymphocytic myocarditis, excluding 8 who manifested shock at admission, were studied. The fulminant group was defined as 12 patients who developed shock after admission, requiring intraaortic balloon pumping or percutaneous cardiopulmonary support, and the non-fulminant group comprised the 27 patients without shock. Various parameters at admission were compared between the 2 groups, together with multiple logistic regression analysis, excluding 6 patients with partially missing values. In the fulminant group, C-reactive protein (7.0±7.0 vs 2.3±2.2 mg/dl, p<0.01) and creatine kinase (1,147±876 vs 594±568 IU/L, p<0.05) concentrations were higher, intraventricular conduction disturbances were more frequent (9/12 vs 7/27 patients, p<0.01) and the left ventricular ejection fraction was lower (40.7±13.9 vs 50.1±10.6%, p<0.05) than in the non-fulminant group. In the multiple logistic regression analysis model with the presence/absence of a fulminant course considered as the independent variable, and C-reactive protein, creatine kinase, intraventricular conduction disturbances, and left ventricular ejection fraction as dependent variables, a high-risk group (expected proportion of fulminant course ≥0.5) and a low-risk group (<0.5) could be differentiated. A fulminant course occurred in 9/13 (69%) patients in the high-risk group, but in only 2/20 (10%) patients in the low risk group (p<0.001). Conclusions The risk of a fulminant course of acute myocarditis was high in patients with elevated C-reactive protein, and creatine kinase concentrations, decreased left ventricular ejection fraction, and intraventricular conduction disturbances at the time of admission.

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Kato S, Morimoto SI, Hiramitsu S, Uemura A, Ohtsuki M, Kato Y et al. Risk factors for patients developing a fulminant course with acute myocarditis. Circulation Journal. 2004 Aug 1;68(8):734-739. https://doi.org/10.1253/circj.68.734