Higher peak troponin I (172222 vs 7489 ng/L; p=0.001) and NT-proBNP (36507 vs 5000 pg/mL; p=0.024) were significantly associated with in-hospital mortality or heart transplantation.
Cohort (n=28)
In patients with acute myocarditis and severe left ventricular dysfunction, higher peak troponin I and NT-proBNP levels are significant predictors of in-hospital mortality or need for heart transplantation.
Abstract Background Acute myocarditis presenting with left ventricular (LV) dysfunction may range from mild impairment to cardiogenic shock and multi-organ failure. Data on prognostic markers of mortality and functional recovery in this population remain limited. Purpose To describe the clinical, analytical, and imaging characteristics of patients with acute myocarditis and severe LV dysfunction and to identify predictors of in-hospital mortality/heart transplantation. Methods This was a retrospective study, between January 2020 and August 2025, in which we enrolled 28 patients presenting with acute myocarditis and left ventricular ejection fraction (LVEF) 35%. Patients were classified as recovery (n=24) or death/heart transplantation (n=4) during hospitalization. Data regarding baseline characteristics, procedural details and hospital course outcomes were collected. Results The median age was 43 29.0–59.0 years, with 57.1% male participants. The most frequent symptom was chest pain (71.4%). LVEF at admission was 27% 20.0–32.5. Endomyocardial biopsy was performed in 32.1%, being the most frequent presumed etiology a viral infection (39.3%). Corticosteroids were administered in 32.1%, and IV immunoglobulin (IGV) in 25.0%. Mechanical circulatory support was used in 50% of patients: LVAD (35.7%), VA-ECMO (25%), and microaxial flow pump device (10.7%), with a median support duration of 2 0–11.0 days. Overall mortality or need for heart transplantation reached 14.3% (n=4). These patients showed significantly higher US troponin I peak (ng/L) (172222 82547–255636 vs 7489 2447–35166; p = 0.001), Natriuretic peptide levels (NT-proBNP, pg/mL) (36507 11897–63611 vs 5000 630–12029; p = 0.024), need for mechanical circulatory support and days of support (20 7-41 vs 0 (0-8.5); p = 0.023). No significant differences were found in LVEF at admission in patients who died as compared to the remaining (20 12.5–25 vs 28 20.0–32.5; p = 0.211), corticosteroid use (25.0 % vs 33.3%; p = 0.741). None of the patients who died received immunoglobulin therapy whereas 29% of those who recovered did. (Table 1). Conclusions Higher troponin and NT-proBNP levels were significantly associated with in-hospital mortality or need for heart transplantation. The use of corticosteroids or IV immunoglobulin showed no association with short-term outcomes.
Sesmilo et al. (2026) conducted a cohort in Acute myocarditis with severe left ventricular dysfunction (n=28). Higher peak troponin I (172222 vs 7489 ng/L; p=0.001) and NT-proBNP (36507 vs 5000 pg/mL; p=0.024) were significantly associated with in-hospital mortality or heart transplantation.