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Development of diastolic heart failure in a 6-year follow-up study in patients after acute myocarditis
  1. Felicitas Escher1,
  2. Dirk Westermann1,
  3. Regina Gaub1,
  4. Johannes Pronk1,
  5. Thomas Bock2,
  6. Nidal Al-Saadi3,
  7. Uwe Kühl1,
  8. Heinz-Peter Schultheiss1,
  9. Carsten Tschöpe1,4
  1. 1Department of Cardiology and Pneumonology, Charité–University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
  2. 2Robert Koch Institute Berlin, Berlin, Germany
  3. 3Interdisciplinary Cardiac Imaging Center Berlin, Berlin, Germany
  4. 4Berlin-Brandenburg Center for Regenerative Therapies, Berlin Germany
  1. Correspondence to C Tschöpe, Department of Cardiology and Pneumonology, Charité–Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany; carsten.tschoepe{at}


Background The aim of this study was to analyse the long-term prognosis of patients with acute myocarditis (AMC) who had been discharged from hospital while having normal left ventricular (LV) function.

Methods and Results 50 patients with acute myocarditis who underwent endomyocardial biopsies (EMBs) were prospectively studied. Their clinical condition was examined during a mean follow-up period of 72 (54–78) months, including tissue Doppler imaging (TDI). 4% (2/50) died, and 6% (3/50) developed dilated cardiomyopathy. 45/50 (90%) showed a normal or improvement in LV function over time. In the course of the follow-up, 49% (22/45) suffered from heart failure symptoms despite a normal ejection fraction (HFNEF). This was associated with an abnormal E/A ratio, an impaired deceleration time of early mitral flow velocity and isovolumic relaxation time, and a pathological increase in the LV filling index E/E′, in contrast to patients without heart failure symptoms (E/E′septal 10.9 (9.3–13.8) vs 6.8 (6.4–9.1); p=0.001). Plasma N-terminal proB-type natriuretic peptide levels were increased threefold in patients with HFNEF (19.9 (10.6–24.1) vs 7.3 (4.2–11.9) pmol/l; p=0.006).

Conclusions It is assumed that the evidence for AMC is associated not only with the risk of developing LV dilatation but also with an increased risk of symptomatic diastolic dysfunction after several years.

  • Diastolic dysfunction
  • myocarditis
  • cardiomyopathy dilated
  • inflammation

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  • Funding This study was supported by a Deutsche Forschungsgemeinschaft (DFG) grant to the SFB Transregio 19 (A2, B5, Z1).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Deutsche Forschungsgemenschaft through SFB/Transregio 19.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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