Assessing outcomes of acute myocarditis in Saudi Arabia: A retrospective tertiary center experience

Abdullah M. Bin Abdu; Mohammed S. Assiri; Abdullah N. Altasan; Yousef I. Alghamdi; Abdullah S. Alshalawi; Faisal N. Alqahtani; Abdulmajeed A. Aljabr; Osamah A. Alnahdi; Abdullah I. Alhamzani; Saud N. Alghamdi; Raed J. Alzahrani; Bandar M. Alshahrani; Mohammed A. Alzahrani; May S. Alshalawi

doi:10.15537/smj.2025.46.1.20240705

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Figure 1
- Flowchart of exclusion criteria and follow-up.
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Figure 2
- Kaplan Meier curve for cardiac related adverse events.

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Table 1

- Baseline demographics at admission in acute myocarditis patients.

Variable	N (%)
Age, mean±SD, years	33.5±10.2
Female	22 (26.2)
Comorbidities
Heart failure	17 (20.2)
Hypertension	14 (16.7)
Auto-immune disease	11 (13.1)
Dyslipidemia	10 (11.9)
Diabetes mellitus	9 (10.7)
Chronic kidney disease	4 (4.8)
Clinical presentation
Symptoms onset, mean±SD, days	3.2±3.4
Fulminant	11 (13.1)
Chest pain	70 (83.3)
Dyspnea	34 (40.5)
Fever	21 (25)
Nausea and vomiting	15 (17.9)
Palpitations	13 (15.5)
Syncope	5 (6)
Respiratory tract infection	23 (27.4)
COVID-19	9 (10.7)
ECG Changes
ST-T changes	38 (45.2)
Ventricular arrhythmias	0 (0)
BBB	0 (0)
AV block	2 (2.4)
Lab Findings
Increased troponin I*	84 (100)
Increased CK-MB, CK	64 (76.2)
Increased BNP	20 (23.8)
Increased WBC	26 (31)
Increased lactate	13 (15.5)
Increased CRP, ESR	36 (42.9)
ECHO findings
Pericardial effusion	7 (1.2)
LVEF, mean±SD	46±12.4

Values are presented as values and percentage (%). This table presents the clinical and laboratory characteristics of patients in the study. The data is summarized using numbers (n) and percentages (%), or mean ± standard deviation (mean±SD) where applicable. Mean±SD: Mean value with standard deviation. ECG: electrocardiogram, ST-T Changes: changes in the ST segment or T wave on an ECG. BBB: bundle branch block, AV block: atrioventricular block, Troponin I: cardiac troponin I, a biomarker for cardiac muscle injury. CK-MB: Creatine Kinase-MB, an enzyme found in the heart muscle, used as a biomarker for myocardial infarction, CK: creatine kinase, an enzyme indicative of muscle damage. BNP: B-type natriuretic peptide, a biomarker used in the diagnosis of heart failure. WBC: white blood cells, an indicator of infection or inflammation. CRP: C-reactive protein, a marker of inflammation. ESR: erythrocyte sedimentation rate, another marker of inflammation. ECHO: echocardiogram, an ultrasound of the heart. LVEF: left ventricular ejection fraction, a measure of the heart’s pumping efficiency. SD: standard deviation

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Table 2

- Univariate and multivariate analysis of confounding factors.

Variable	n (%)
Variable	LVEF >50% (41)	LVEF<50% (43)	P-value
In-hospital complication
Total death	0 (0)	2 (4.7)	0.494
Cardiac death	0 (0)	1 (2.3)	1
Htx	0 (0)	0 (0)	N/A
VA-ECMO	0 (0)	3 (7)	0.241
Cardiogenic shock	2 (4.9)	9 (20.9)	0.116
Post-discharge
Total death	0	2 (4.7)	0.494
Cardiac death	0	2 (4.7)	0.494
Htx	0	0	N/A
New onset HF	3 (7.3)	11 (25.6)	0.079

This table presents the univariate and multivariate analysis of various risk factors and their association with the clinical outcome. The hazard ratios (with 95% confidence intervals). A P-value of less than 0.05 indicates statistical significance. LVEF: left ventricular ejection vraction, BNP: B-type natriuretic peptide, CK: creatine kinase, CK-MB: creatine Kinase-MB, a heart-specific isoenzyme of CK. CRP: C-reactive protein, ESR: erythrocyte sedimentation rate

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Table 3

- Cardiac related adverse events after acute event.

Variables	Univariate		Multivariate
Variables	Hazard	P-value	Hazard	P-value
LVEF<50%	2.6 (1.1-6.2)	0.037	3.7 (1.4-9.6)	<0.01
Fulminant	1.4 (0.6-3)	0.741	0.8 (0.3-2.4)	0.668
Female	2.2 (1-5)	0.054	0.7 (0.2-2)	0.475
Heart Failure	1 (0.3-3.3)	0.960	0.9 (0.2-4.4)	0.189
Elevated BNP	0.9 (0.4-2.4)	0.906	0.6 (0.2-1.8)	0.369
Elevated CK, CK-MB	0.7 (0.3-1.7)	0.466	1 (0.4-2.5)	0.945
Elevated Lactate	0.9 (0.3-2.6)	0.809	0.4 (0.1-1.8)	0.233
Elevated CRP, ESR	1.7 (0.8-3.8)	0.199	1.1 (0.5-2.8)	0.775

This table summarizes the in-hospital and post-discharge clinical outcomes of patients, categorized by their Left Ventricular Ejection Fraction (LVEF). Patients are divided into two groups: those with LVEF > 50% and those with LVEF <50%. The number (n) and percentage (%) of patients experiencing each outcome are presented for both groups. A p-value of <0.05 indicates statistical significance. LVEF: Left Ventricular Ejection Fraction. n (%): Number and percentage of patients. Htx: Heart transplantation. VA-ECMO: Veno-Arterial extracorporeal membrane oxygenation, New Onset HF: Instances of new-onset heart failure diagnosed after discharge.