Analysis Of Prognosis And Cardiac Magnetic Resonance Features Of Myocarditis

Objective:(1)Analysis of predictive factors for early identification of fulminant myocarditis.(2)Analysis of clinical characteristics and independent risk factors of adverse events in patients with myocarditis during hospitalization.(3)To investigate the imaging features and clinical diagnostic value of cardiac magnetic resonance imaging in patients with myocarditis.Methods:(1)A total of 183 patients who were diagnosed as myocarditis during hospitalization in the Department of Cardiology,The First Hospital of Jilin University from January 1,2019 to July 31,2022 were enrolled.The clinical data of all patients were recorded.According to the diagnostic criteria of fulminant myocarditis,patients were divided into two groups: fulminant myocarditis group(n=34)and non-fulminant myocarditis group(n=149).The clinical data were analyzed to explore the predictive factors of early identification of fulminant myocarditis.(2)According to the definition of adverse events in hospital,183 patients with myocarditis were divided into adverse events group(n=39)and non-adverse events group(n=144).The baseline data,serological indexes,electrocardiogram,echocardiography and treatment regimen of the two groups were analyzed.The possible risk factors of adverse events group were screened by univariate analysis,and then the risk factors of adverse events group were determined by multi-factor Logistic regression analysis.Finally,the ROC curve was drawn to evaluate the predictive value of risk factors for adverse events.(3)A total of 47 patients(n=47)who underwent cardiac magnetic resonance examination were selected from the 183 patients with myocarditis.Their morphological,functional and histological indexes were recorded,and the imaging features and clinical diagnostic value of cardiac magnetic resonance imaging in patients with myocarditis were analyzed.Results:(1)(1)A univariate analysis of the clinical data of the fulminant myocarditis group and the non-fulminant myocarditis group showed that: the majority of patients in the fulminant myocarditis group were female(67.6% vs 34.9%,P<0.001);with more chest pain,and the abnormalities in WBC,NE #,EO #,RBC,Hb,c Tn I,MYO,CK-MB,BNP,Cr,AST,ALT,FT3,LVEF,D-dimer,and albumin levels are more significantly;new abnormal electrocardiogram(abnormal Q wave,QRS>120ms,atrioventricular block,bundle branch block,ventricular premature contraction,short burst ventricular tachycardia,sustained ventricular tachycardia,or ventricular fibrillation),LVEF<50%,and pericardial effusion are more common;during hospitalization,more glucocorticoids,immunoglobulins,positive inotropic drugs,recombinant human natriuretic peptide,anti-infection therapy,antiviral therapy,and non-drug therapy were used,including the use of mechanical ventilation,and temporary pacing.The above differences were statistically significant(P<0.05).(2)Logistic multivariate regression analysis showed that the LVEF<50%(OR=10.743,95%CI:3.815～30.257,P<0.001),the increase of c Tn I(OR=1.089,95%CI:1.036～1.145,P=0.001)and the increase of Ddimer(OR=1.001,95%CI:1.000～1.001,P=0.029)were independent risk factors for predicting fulminant myocarditis.(2)(1)Comparing the clinical data between the adverse events group with and the nonadverse events group,the adverse events group had a higher proportion of women and longer hospitalization days,and the abnormalities in WBC,NE#,EO#,LY#,RBC,Hb,c Tn I,MYO,CK-MB,BNP,Cr,AST,ALT,FT4,LVEF,LAD,LVEDD,albumin,D-dimer,QRS duration and QTc interval levels are more significantly.More prone to LVEF < 50%,pericardial effusion,and new ECG abnormalities(including ST segment elevation,abnormal Q wave,other ST-T abnormalities,QRS > 120 ms,prolonged QTc interval,atrioventricular block,bundle branch block,ventricular extrasystole,paroxysmal ventricular tachycardia),the proportion of aldosterone receptor antagonists,glucocorticoids,immunoglobulins,positive inotropic drugs,recombinant human natriuretic peptides,anti-infective therapy and non-drug therapy,including circulatory assist device(IABP/ECMO),mechanical ventilation and temporary pacing,were significantly higher.The above differences were statistically significant(P<0.05).(2)Multivariate Logistic regression analysis showed that prolonged QRS duration(OR=26.307,95%CI: 6.751～102.521,P<0.001),LVEF<50%(OR=16.479,95%CI: 4.696～57.826,P<0.001),CK-MB level(OR=1.025,95%CI: 1.003～1.048,P=0.028)and neutrophil absolute value(OR=1.335,95%CI: 1.135～1.569,P<0.001)were independent risk factors for nosocomial adverse events in patients with myocarditis.(4)ROC curve analysis showed that the area under the curve(AUC)of LVEF < 50%,prolonged QRS duration,CKMB level and neutrophil absolute value level was 0.932(95%CI:0.892～0.972),sensitivity was88.89%,specificity was 85.61%.(3)CMR in patients with myocarditis can obtain cardiac morphological,functional and histological information,which can be negative or show different degrees of myocardial edema and delayed enhancement signs,and delayed enhancement is most common in the lateral wall and inferior wall of the left ventricle;the enhancement form is the most common under the epicardium and between the muscle walls;and the enhancement mode is the most common under the epicardium of the left ventricular lateral wall.So the CMR has good diagnostic value.Conclusion:(1)The LVEF<50%,the increase of troponin level and the increase of D-dimer level were positive predictors of fulminant myocarditis.(2)LVEF < 50%,QRS>120ms,increased absolute level of serum neutrophils and elevated creatine kinase isoenzyme levels at admission were independent risk factors for death,cardiogenic shock,malignant arrhythmias and new heart failure in patients with acute myocarditis.(3)Cardiac MRI in patients with myocarditis can obtain cardiac morphological,functional and histological information,which may be negative or show varying degrees of myocardial edema and delayed enhancement signs.Delayed enhancement is most commonly in the lateral wall and inferior wall of the left ventricle.The most common enhancement pattern was under the epicardium of left ventricular lateral wall,and the enhancement area showed multi-site,uneven and sparse distribution.the distribution area is not related to the direction of coronary artery,so it has good diagnostic value.