AUTHOR=Cannata Antonio , Bhatti Prashan , Roy Roman , Al-Agil Mohammad , Daniel Allen , Ferone Emma , Jordan Antonio , Cassimon Barbara , Bradwell Susie , Khawaja Abdullah , Sadler Matthew , Shamsi Aamir , Huntington Josef , Birkinshaw Alexander , Rind Irfan , Rosmini Stefania , Piper Susan , Sado Daniel , Giacca Mauro , Shah Ajay M. , McDonagh Theresa , Scott Paul A. , Bromage Daniel I. 

TITLE=Prognostic relevance of demographic factors in cardiac magnetic resonance-proven acute myocarditis: A cohort study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1037837

DOI=10.3389/fcvm.2022.1037837

ISSN=2297-055X

ABSTRACT=Aims
Acute myocarditis (AM) is a heterogeneous condition with variable estimates of survival. Contemporary criteria for the diagnosis of clinically suspected AM enable non-invasive assessment, resulting in greater sensitivity and more representative cohorts. We aimed to describe the demographic characteristics and long-term outcomes of patients with AM diagnosed using non-invasive criteria. 
Methods and Results
A total of 199 patients with cardiac magnetic resonance (CMR)-confirmed AM were included. The majority (n=130, 65%) were male, and the average age was 39±16 years. Half of the patients were White (n=99, 52%), with the remainder from Black and Minority Ethnic (BAME) groups. The most common clinical presentation was chest pain (n=156, 78%), with smaller numbers presenting with breathlessness (n=25, 13%) and arrhythmias (n=18, 9%). Patients admitted with breathlessness were sicker and more often required inotropes, steroids, and renal replacement therapy (p<0.001, p<0.001, and p=0.01, respectively). Over a median follow-up of 53 (IQR 34 – 76) months, 11 patients (6%) experienced an adverse outcome, defined as a composite of all-cause mortality, resuscitated cardiac arrest, and appropriate implantable cardioverter defibrillator (ICD) therapy. Patients in the arrhythmia group had a worse prognosis, with a nearly 7-fold risk of adverse events (hazard ratio [HR] 6.97; 95% Confidence Interval [CI] 1.87 – 26.00, p=0.004). Sex and ethnicity were not significantly associated with the outcome.
Conclusions
AM is highly heterogeneous with an overall favourable prognosis. Three-quarters of patients with AM present with chest pain, which is associated with a benign prognosis. AM presenting with life-threatening arrhythmias is associated with a higher risk of adverse events.