Related Factors Analysis In Adults With Acute Severe Viral Myocarditis

Objectives:To determine the factors related to adult patients with acute severe viral myocarditis.Methods:The study population consisted of 169 consecutive adult patients admitted between May 2006 and March 2018 with diagnoses of acute viral myocarditis(onset of symptoms<1 month).They were divided into two groups according to clinical presentations:severe myocarditis group(n=49,presented with life threatening arrhythmias,heart failure or cardiogenic shock)and non-severe myocarditis group(n=120,relatively stable without presentations aforementioned).Clinical presentations,electrocardiography,laboratory tests,echocardiography features at admission were analyzed by using univariate and multivariate Logistic regression model.Results:Compared to non-severe myocarditis group,symptoms of chest tightness and syncope were more prevalent in severe myocarditis group.Blood pressure at admission was lower,heart rate was higher,while prevalence of ventricular tachycardia,ventricular fibrillation and Ⅱ degree to complete atrioventricular block were higher in severe myocarditis group than in non-severe myocarditis group.White blood cell count,C reactive protein,creatine kinase isoenzyme MB type(CK-MB),as well as troponin I level were lower in severe myocarditis group than in non-severe myocarditis group.Left ventricular ejection fraction(LVEF)was significantly lower,and the prevalence of pericardial effusion was higher in severe myocarditis group than in non-severe group.All P values<0.001.Multivariate logistic regression analysis revealed that prolonged QRS interval(odd ratio1.030,95%CI:1.007-1.053,P=0.010),elevated CK-MB level(odd ratio 1.022,95%CI:1.004-1.041,P=0.01 9)),low serum free triiodothyronine(FT3)level(odd ratio 0.068,95%CI:0.016-0.287,P<0.001)and lower LVEF at admission(odd ratio 0.912,95%CI:0.854-0.975,P=0.007)were independent risk factors associated with severe myocarditis.Conclusions:Prolonged QRS interval,elevated CK-MB,low serum FT3 and low LVEF at admission are independent risk factors associated with acute severe myocarditis in adult patients with acute viral myocarditis.Objective:To determine the impact of low T3 syndrome on in-hospital adverse cardiovascular events in adult patients with acute viral myocarditis.Methods:The study population consisted of 134 consecutive patients admitted between January 2002 and March 2018 with diagnoses of acute viral myocarditis(onset of symptoms<1 month),patients were divided into low serum free triiodothyronine(FT3)group(n=20)and normal FT3 group(n=114).General information,clinical presentation,electrocardiography at admission,laboratory tests,echocardiography features were analyzed.Low T3 syndrome was defined as a state with decreased FT3 and total triiodothyronine(TT3),normal or decreased free thyroxine(FT4)and total thyroxine(TT4)as well as normal thyroid stimulating hormone(TSH).Composite adverse cardiovascular events included death,persistent ventricular tachycardia(VT)or ventricular fibrillation(VF)and cardiac arrest.Risk factors related with composite adverse cardiovascular events in adult patients with acute viral myocarditis were analyzed by logistic regression analysis.Results:Systolic blood pressure was significantly lower(P<0.001),while heart rate was higher(P=0.004)and the prevalence of VT/VF were significantly higher(P=0.017)in low T3 group than in the normal T3 group.Level of white blood cell,C response protein,fasting glucose(all P values<0.001)as well as creatinine(P=0.035)were significantly higher,while level of FT3 and left ventricular ejection fraction(LVEF)were significantly lower(both P values<0.001)in low T3 group than in normal T3 group.Multivariate logistic regression analysis revealed that LVEF at admission less than 40%(odd ratio=6.323,95%CI 1.420～28.156,P=0.016)and FT3 level less than 1.79ng/L(odd ratio=5.413,95%CI 1.012～28.952,P=0.048)were independent risk factors of composite adverse cardiovascular events in adult patients with acute viral myocarditis.Conclusions:Low FT3 might increase the risk of in-hospital adverse cardiovascular events in adult patients with acute viral myocarditis.Objects:Previous studies have suggested that low T3 status is a predictor for adverse prognosis of cardiac diseases.This study aims to investigate the role of free triiodothyronine(FT3)in the prognosis of acute myocarditis patients.Methods:A total of 173 consecutive patients with acute myocarditis admitted in Fuwai Hospital between September 2009 and February 2019 completed thyroid function evaluations.Patients who had been treated before admission with drugs that might affect thyroid function were excluded from the study.All patients were divided into two groups according to FT3 levels:low FT3 group(n=54,FT3<3.54 pmol/L)and normal FT3 group(n=119,FT3≥3.54 pmol/L).General information,clinical presentation,electrocardiography at admission,laboratory tests,echocardiography features were analyzed.Low T3 syndrome was defined as a state with decreased FT3 and total triiodothyronine(TT3),normal or decreased free thyroxine(FT4)and total thyroxine(TT4)as well as normal thyroid stimulating hormone(TSH).The primary endpoint was major adverse cardiac events(MACE),including all-cause death,heart transplantation,rehospitalization for heart failure and sustained ventricular tachycardia(>30s).Results:During the 3.5±2.8 years follow-up,the rate of MACE was 29.6%versus 3.5%in low FT3 group versus normal FT3 group,respectively(P<0.0001).Long-term at 8 years MACE-free survival were lower in low FT3 group versus normal FT3 group(52.9%versus 92.3%,log-rank P<0.0001),respectively.Univariate Cox analysis showed that LVEF<50%[hazard ratio(HR)10.231,95%confidence interval(CI):3.418-30.624,P<0.0001)and low FT3 level(HR 0.360,95%CI:0.223-0.582,P<0.0001)were strongest predictors of MACE.After adjustment for traditional risk predictors,the prognostic value of FT3 status was still significant(HR 0.540,95%CI:0.316-0.922,P=0.024).Compared with normal FT3 group,those in low FT3 group were at a much higher risk of MACE(HR 5.074,95%CI:1.518-16.964,P=0.008).Conclusions:Low T3 syndrome was a strong predictor of poor prognosis in patients with acute myocarditis.These findings suggest that FT3 level could serve as a biomarker for risk stratification in acute myocarditis patients.