Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2020; 8(2): 255-263
Published online Jan 26, 2020. doi: 10.12998/wjcc.v8.i2.255
Risk factors for adverse cardiac events in adults with fulminant myocarditis during hospitalization
Tie-Duo Kang, Yan-Long Ren, Han Zhao, Shang-Qiu Ning, Wen-Xian Liu
Tie-Duo Kang, Yan-Long Ren, Han Zhao, Shang-Qiu Ning, Wen-Xian Liu, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Lab for Cardiovascular Precision Medicine, Beijing 100029, China
Author contributions: Kang TD, Ren YL, and Zhao H contributed equally to this article; Liu WX and Ren YL conceived of the study; Zhao H and Ren YL performed the statistical analysis and drafted the manuscript; Ning SQ and Kang TD collected the clinical data and participated in the design of the study; Ren YL and Kang TD helped to revise the manuscript; all authors read and approved the final manuscript.
Supported by Beijing Natural Science Foundation, No. 7184205; Beijing Talents Fund, No. 2017000021469G224; Foundation of Beijing Anzhen Hospital, Capital Medical University, No. 2016Z07.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and approved by the Clinical Research Ethics Board of Beijing Anzhen Hospital, Capital Medical University (approval number: 2019021X).
Informed consent statement: All subjects provided written informed consent.
Conflict-of-interest statement: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data sharing statement: There are no additional data.
STROBE statement: The manuscript was revised according to the STROBE statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wen-Xian Liu, MD, Chief Physician, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Lab for Cardiovascular Precision Medicine, No. 2, Anzhen Road, Chaoyang District, Beijing 100029, China. 18911662882@163.com
Received: September 6, 2019
Peer-review started: September 6, 2019
First decision: November 12, 2019
Revised: November 29, 2019
Accepted: December 21, 2019
Article in press: December 21, 2019
Published online: January 26, 2020
Processing time: 133 Days and 3.7 Hours
ARTICLE HIGHLIGHTS
Research background

Fulminant myocarditis is the critical form of myocarditis often associated with heart failure, malignant arrhythmia, and circulatory failure. Patients with fulminant myocarditis who end up with severe multiple organic failure and death are not rare.

Research objectives

In this study, the authors aimed to analyze the predictors of in-hospital major adverse cardiovascular events (MACE) in patients diagnosed with fulminant myocarditis.

Research methods

The authors built a cohort of adult patients diagnosed with fulminant myocarditis. The primary endpoint was defined as in-hospital MACE, including death, cardiac arrest, cardiac shock, and ventricular fibrillation. Baseline demographics, clinical history, characteristics of electrocardiograph and ultrasonic cardiogram, laboratory examination, and treatment were recorded.

Research results

The rate of in-hospital MACE was 40%. Multivariable logistic regression analysis demonstrated that baseline QRS duration > 120 ms was an independent risk factor for in-hospital MACE. The area under curve of QRS duration > 120 ms for predicting in-hospital MACE was 0.683.

Research conclusions

The onset of outbreak myocarditis is acute, and the incidence of MACE is higher in female patients during hospitalization. QRS broadening in baseline electrocardiogram (QRS > 120 ms) is an independent risk factor for the occurrence of MACE in outbreak myocarditis patients during hospitalization.

Research perspectives

Baseline QRS width has predictive value for the occurrence of MACE in outbreak myocarditis patients during hospitalization. Patients with these characteristics should be treated actively as soon as possible in clinic, and mechanical support should be given when necessary, in order to improve the prognosis of patients.