Predictors of disease course in patients with acute myocarditis

Background-Clinical manifestations of acute myocarditis, with distinct onse t, vary from asymptomatic to fatal. The predictors of the course of the dis ease in patients with acute myocarditis at initial presentation have not ye t been established. In this study, we examined the predictive values of var ious parameters in the disease course of patients with myocarditis. Methods and Results-Twenty-one consecutive patients who had been diagnosed as having acute myocarditis by histological examinations were analyzed. The patients with myocarditis were divided into the survival group (n=13) and the fatal group (n=8). We examined the parameters of; the clinical state, h emodynamic variables, required therapies, biochemical laboratory data, and cytokines. The control groups were composed of 23 patients with old myocard ial infarction and 20 healthy volunteers. The fatal group had lower blood p ressure and higher pulmonary capillary wedge pressure compared with those v alues in the survival group. Mechanical ventilation support was more freque ntly required in the fatal group. Serum levels of soluble Fas (sFas) and so luble Fas ligand (sFasL) were significantly higher in the myocarditis group than in the 2 control groups. Furthermore, levels were significantly highe r in the fatal group than in the survival group for sFas (13.93+/-4.77 vers us 3.77+/-0.52. ng/mL, respectively; P<0.001) and sFasL (611.4+/-127.7 vers us 269.5+/-37.3 pg/mL, respectively; P<0.05). Other clinical states, hemody namic variables, required therapies, and biochemical laboratory parameters were not different between the 2 groups. Conclusions Elevation of sFas and sFasL levels at initial presentation appe ar to be a good serological marker to predict the prognosis of acute myocar ditis.