Key result
The presence of a virus in myocardial tissue did not worsen the long-term prognosis of patients with suspected myocarditis or dilated cardiomyopathy.
Why the study?
The prognostic significance of the presence of viruses in myocardial tissue among patients with myocarditis and cardiomyopathy was not clearly established.
Does the presence of virus in myocardial tissue worsen the prognosis in patients with suspected myocarditis or dilated cardiomyopathy?
Meta-Analysis (n=1,006)
Does the presence of virus in myocardial tissue worsen the prognosis in patients with suspected myocarditis or dilated cardiomyopathy?
The presence of viral infection in myocardial tissue does not significantly worsen the overall long-term prognosis of patients with suspected myocarditis or dilated cardiomyopathy, though specific subgroups may have worse outcomes.
Answers are grounded in this paper and cite their sources.
Viral presence in myocardium not linked to worse prognosis in myocarditis or cardiomyopathy; hypothesis-generating and should not yet change practice.
Aim . Myocarditis and cardiomyopathy impose a substantial economic burden on society. Many studies have examined the effects of various predictors on the prognosis of these diseases, such as the left ventricular systolic function, the New York Heart Association glomerular filtration rate, the QT interval, and the presence of viruses. In the present study, we conducted a meta-analysis of cohort studies to investigate the significance of the presence of viruses in the myocardial tissue on the prognosis of these diseases. Methods . The Embase, PubMed, and Cochrane library databases were searched for relevant literature that had been published between January 1, 1964 and August 14, 2018. The inclusion criteria were patients over 18 years of age, suspected myocarditis or dilated cardiomyopathy, accepted myocardial biopsy, and the detection of virus in the myocardial tissue. Results . In total, 10 studies met the inclusion criteria. These studies included 1006 patients with suspected myocarditis or idiopathic heart disease for whom the primary endpoint was all-cause death, heart transplant, or re-hospitalization due to fatal arrhythmia and heart failure. There was no significant difference in the prognosis of virus-positive and virus-negative patients with myocarditis or dilated cardiomyopathy confirmed by endomyocardial biopsy (EMB) [hazard ratio (HR) = 1.40, 95% confidence interval (CI) = 0.93–2.12, P=0.11]. However, virus-negative patients had a better prognosis following nonspecific treatment (HR = 1.40, 95% CI = 1.06–1.86, P=0.02) and right ventricular biopsy (HR = 2.08, 95% CI = 1.07–4.04, P=0.03). Conclusions . The presence of a virus did not worsen the long-term prognosis of patients with suspected myocarditis or dilated cardiomyopathy. However, virus-positive patients who did not undergo specific treatment or who underwent right ventricular biopsy did have a worse prognosis. Thus, the early diagnosis of the presence of viral infection in the myocardium will improve the prognosis of patients.
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Chen et al. (2019) conducted a meta-analysis in Suspected myocarditis or dilated cardiomyopathy (n=1,006). Presence of virus in myocardial tissue vs. Virus-negative patients was evaluated on All-cause death, heart transplant, or re-hospitalization due to fatal arrhythmia and heart failure (HR 1.40, 95% CI 0.93-2.12, p=0.11). The presence of a virus in myocardial tissue did not worsen the long-term prognosis of patients with suspected myocarditis or dilated cardiomyopathy.
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