Studies evaluating prognosis in patients with myocarditis

In a review article D’Ambrosio et al [10] attempted to identify factors at clinical presentation to predict a patient’s clinical course. Patients with a presentation of chest pain and those with brady or narrow complex tachy-arrhythmias tended to have a better recovery of cardiac function and lower mortality (87% 4 year transplant-free survival). Those who presented with heart failure, syncope or ventricular arrhythmias had a poorer prognosis and more patients developed a dilated cardiomyopathy (54% 4 year transplant-free survival). Interestingly, patients who survived the acute phase of a fulminant myocarditis had an excellent 11 year survival of 93% compared with those patients with a non-fulminant picture who had a 45% survival. A mean of 21% of patients with myocarditis developed DCM.

The Myocarditis Treatment Trial demonstrated a 1 year mortality of 20% and 4 year mortality of 56% in patients with biopsy proven myocarditis, with 9% of patients requiring cardiac transplantation. Syncope, bundle branch block and an ejection fraction less than 40% were reported as independent variables associated with a higher mortality and the need for transplantation in this study.