Fig 1.
Flow diagram describing the selection of the study population.
EMB, Endomyocardial biopsy.
Table 1.
Baseline characteristics of study population divided on the basis of persistent left ventricular (LV) systolic dysfunction.
Fig 2.
Histological images of three patients with acute LM presenting left ventricular dysfunction at admission.
A-B) Fulminant form with plentiful lymphocytic infiltrate and necrosis, he died during the acute phase (excluded from main analysis); C-D) Fulminant form with plentiful lymphocytic infiltrate, he normalized systolic function during follow-up (included in the main analysis); E-F) non-fulminant form with poor lymphocytic infiltrate, he will maintain LV dysfunction during follow-up (included in the main analysis). LM: Lymphocytic Myocarditis; LV: Left Ventricular. A) HE showing diffuse inflammatory infiltrates and myocardial necrosis. B)Immunohistochemistry showing diffuse CD8+ T cells infiltrates (in red). C) HE showing moderate inflammatory infiltrates and mild myocardial necrosis. D) Immunohistochemistry showing diffuse HLA-DR+ cells (in red). E) HE showing poor inflammatory infiltrates and myocardial necrosis. F) Immunohistochemistry showing mild HLA-DR+ cells (in brown).
Table 2.
Univariable and multivariable analyses for persistent LV systolic dysfunction.
Fig 3.
Receiver operating curves analysis for baseline prediction model of persistent LV systolic dysfunction during follow-up.
The model including poor lymphocytic infiltrate + left ventricular end-diastolic diameter + non-fulminant myocarditis when surviving to the acute phase showed the highest accuracy. Legend. AUC, area under the ROC curve; CI, confidence interval; LVEF: left ventricular ejection fraction;
Fig 4.
Central illustration. Long-term D/HTx-free survival curves according to the persistent LV systolic dysfunction during follow-up.
The curves start from follow-up revaluation. Legend. LV: Left Ventricular; D/HTx: Death or Heart Transplantation.