3. Clinical features and outcome of patients with recurrent myocarditis

• Main Authors: Abdullah M. Alotaibi, Ahmed Aljizeeri, Mouaz Al-mallah, Ahmed Alsaileek
• Format: Article
• Language: English
• Published: Saudi Heart Association 2017-10-01
• Series: Journal of the Saudi Heart Association
• Online Access: http://www.sciencedirect.com/science/article/pii/S1016731517300799

Clinical research. Presentation Type: Oral presentation. Introduction: Myocarditis can be associated with short and long term major cardiac event. However, most episodes are self-limited and rarely recurrent. The aim of this analysis was to describe a series of six patients who had multiple episodes of recurrent myocarditis and characterize their clinical, laboratory, electrocardiographic (ECG) and imaging features. Methodology: The patients were identified from cardiac MRI (CMR) database during the period of 2007–2016. Patients records were reviewed for demographic data, laboratory results including serum troponin I, ECG findings, coronary angiography, imaging findings from echocardiography and CMR. The diagnosis of acute myocarditis was ascertained by a combined clinical and imaging findings. Patients with myocarditis related to connective tissue disease were excluded. Results: During the study period, a total of 37 patients presented with acute myocarditis of which 6 (16.2%) patients (mean age 31.7 ± 10.4 years, 100% males) had multiple recurrent episodes; twice in 4 patients and 4 episodes in 2 patients (Table 1). The mean interval period between the first and last attack was 3.3 years (range was 0.8–5.0). After a median follow-up of 4.4 years, there was evidence of new epicardial or mid-wall myocardial delayed enhancement (MDE) with every new episode and all patients had persistent MDE on the last CMR. However, no patient developed persistent heart failure symptoms or left ventricular ejection fraction <40%. Only one patient had transient heart failure symptoms which improved on angiotensin converting enzyme inhibitors and beta blockers. Table 1 demonstrates imaging findings from the last echocardiography and CMR examinations. Conclusion: Recurrent myocarditis in our population is probably under-reported. One in six patients with myocarditis had clinical and imaging proven recurrence. The use of CMR may help to ascertain the diagnosis in otherwise unexplained elevated cardiac markers. The long term management and outcome of recurrent myocarditis requires further study.