International journal of cardiology. Heart & vasculature · 2025
Life-threatening arrhythmia in patients with suspected acute myocarditis.
СтатьяНазвание и аннотация: Перевод в очереди
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Krempke Melina, Büchel Jasmin, Bulatova Kseniya, Balestra Gianmarco M, Haaf Philip, Pouly Jeanne, Drews Paul, Mueller Christian, Knecht Sven, Badertscher Patrick, Mahfoud Felix, Kühne Michael, Sticherling Christian, Krisai Philipp
Аннотация
BACKGROUND: Patients with acute myocarditis (AM) often undergo prolonged rhythm monitoring due to the risk for life-threatening arrhythmia.
OBJECTIVE: To describe the occurrence, timing and potential early rule-out of life-threatening arrhythmia in patients with AM.
METHODS: We included consecutive patients with suspected AM admitted to the ICU/IMC for continuous rhythm monitoring into a cohort study. We assessed the incidence and timing of life-threatening arrhythmia (sustained ventricular tachycardia, ventricular fibrillation, cardiac arrest). To rule-out arrhythmia, we evaluated left ventricular ejection fraction (LVEF), maximal cardiac troponin-T (cTnT) levels and a multivariable model.
RESULTS: Among 304 patients with AM (41 ± 16.6 years, 27 % female), 13 life-threatening arrhythmias occurred in 10 (3.3 %) patients. Of these, 8 occurred within 24 h, 2 between 24-48 h and 3 after 72 h of hospitalization. Patients with life-threatening arrhythmia had substantially higher mortality rates (40 % vs. 0.3 %, p < 0.001). There was no binary cut-off for LVEF and cTnT to rule-out arrhythmia. The last life-threatening arrhythmia occurred before the cTnT-peak in 3 (42.9 %), simultaneously with the peak in 1 (14.3 %), and after the peak in 3 (42.9 %) patients. The final multivariable model included female sex, cTnT, and LVEF and demonstrated an area under the curve of 0.98 (95 % CI 0.96-1), with a sensitivity of 99 % and specificity of 75 % to rule-out life-threatening arrhythmia.
CONCLUSIONS: In patients with suspected AM, life-threatening arrhythmias were rare but associated with a 40% mortality rate. A combined model including 3 clinical variables ruled-out life-threatening arrhythmia with a high sensitivity and may help to guide the indication of rhythm monitoring.
OBJECTIVE: To describe the occurrence, timing and potential early rule-out of life-threatening arrhythmia in patients with AM.
METHODS: We included consecutive patients with suspected AM admitted to the ICU/IMC for continuous rhythm monitoring into a cohort study. We assessed the incidence and timing of life-threatening arrhythmia (sustained ventricular tachycardia, ventricular fibrillation, cardiac arrest). To rule-out arrhythmia, we evaluated left ventricular ejection fraction (LVEF), maximal cardiac troponin-T (cTnT) levels and a multivariable model.
RESULTS: Among 304 patients with AM (41 ± 16.6 years, 27 % female), 13 life-threatening arrhythmias occurred in 10 (3.3 %) patients. Of these, 8 occurred within 24 h, 2 between 24-48 h and 3 after 72 h of hospitalization. Patients with life-threatening arrhythmia had substantially higher mortality rates (40 % vs. 0.3 %, p < 0.001). There was no binary cut-off for LVEF and cTnT to rule-out arrhythmia. The last life-threatening arrhythmia occurred before the cTnT-peak in 3 (42.9 %), simultaneously with the peak in 1 (14.3 %), and after the peak in 3 (42.9 %) patients. The final multivariable model included female sex, cTnT, and LVEF and demonstrated an area under the curve of 0.98 (95 % CI 0.96-1), with a sensitivity of 99 % and specificity of 75 % to rule-out life-threatening arrhythmia.
CONCLUSIONS: In patients with suspected AM, life-threatening arrhythmias were rare but associated with a 40% mortality rate. A combined model including 3 clinical variables ruled-out life-threatening arrhythmia with a high sensitivity and may help to guide the indication of rhythm monitoring.