Qu Zhao,1,2 Zeping Li,1,2 Dao Wen Wang,1,2 Fan Li,1,2 Li Zhang,3 Jiangang Jiang1,2 

1Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China; 2Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, People’s Republic of China; 3Division of Cardiology, Minda Hospital of Hubei Minzu University, Enshi, 445099, People’s Republic of China

Correspondence: Jiangang Jiang, Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China, Email jiangjg618@126.com

Background: Fulminant myocarditis (FM) is a critical manifestation of myocarditis. However, the clinical features and risk factors associated with its adverse outcomes are not fully understood. Given the high mortality and potential for long-term complications, it is crucial to identify factors that could predict the progression of FM to chronic persistent myocarditis. We hypothesize some clinical or laboratory markers may be predictive of this progression. This study aims to identify clinical factors that may help predict the progress of FM to chronic persistent myocarditis.
Methods: A total of 82 patients with FM treated based on Chinese protocol were included. Kaplan–Meier curve and regression analysis were used to determine the clinical features and prognostic predictors of chronic persistent myocarditis in patients with 24 months of follow-up.
Results: Chronic persistent myocarditis was observed in 20 patients during the follow-up. ROC curve showed that the critical value for chronic persistent myocarditis caused by lactate dehydrogenase (LDH) was 577.00U/L (sensitivity 75.0%, specificity 74.2%). Time from onset to admission over 6 days and LDH > 577.00U/L were identified as risk factors for chronic persistent myocarditis in patients with FM in both univariate and multivariate cox analysis. The hazard ratio and 95% Confidence intervals were 3.35 (1.32– 8.50) (p = 0.011) and 6.11 (2.02– 18.48) (p < 0.001), respectively. The per standard deviation of increment in LDH was associated with the 55% (1.55, 1.11– 2.18) in HR and 95% CI of the occurrence of chronic persistent myocarditis.
Conclusion: About 24.4% of the patients with FM treated based on the life support measures proposed in the consensus of Chinese Society of Cardiology have been observed chronic persistent myocarditis. Time from onset to admission over 6 days and LDH levels > 577.00 U/L at admission may serve as risk factors for the progression from FM to chronic persistent myocarditis.

Keywords: fulminant myocarditis, chronic persistent myocarditis, prognosis