BackgroundAcute myocarditis (AM) can be defined as an inflammatory disease of the myocardium and characterized by large heterogeneity of clinical presentation. Myocarditis is becoming increasingly recognized as a contributor to unexplained mortality, and is thought to be a major cause of sudden cardiac death in the first two decades of life. The present study aimed to search the assessment of repolarization dispersion measured from the 12-lead surface electrocardiogram (including Tp-e interval, Tp-e/QT and Tp-e/QTc ratios) in AM patients.MethodsTotally 56 patients (mean age was 22 ± 3.7 years and 67% of the patients were male) with AM and 56 control subjects (23 ± 4.7 years and 64% of the patients were male) were enrolled. Tp-e intervals, Tp-e/QT and Tp-e/corrected QT (QTc) ratios were calculated from 12-lead electrocardiogram.ResultsHeart rate, QT and QTc values were similar between groups. QRS interval was lower in AM group compared to the control group (p <  0.001). Tp-e, Tp-e/QT and Tp-e/ QTc were significantly higher in AM group (p <  0.001, p <  0.001, p = 0.03 respectively) and they were significantly correlated with high troponin and high sensitive C reactive protein levels. In hospital follow-up time was 6 ± 2 days. Four patients have non sustained ventricular tachyarrhythmias and 1 patient dead because of cardiac arrest.ConclusionsOur study demonstrated that Tp-e intervals, Tp-e/QT and Tp-e/QTc ratios were higher in patients with AM than control subjects. The increased frequency of ventricular arrhythmias can be clarified by increased indexes of ventricular repolarization parameters in patients with AM.

Author's summary Evolution of coronary artery aneurysms (CAAs) has been an ominous clinical finding in patients with Kawasaki disease (KD). CAAs generally emerge within the first few weeks in patients with KD, and appear to be strongly associated with the failure to timely initiate specific management strategies. CAA formation might occasionally arise as a late-onset phenomenon long after the index KD episode. Late CAAs in the setting of KD have particular mechanistic and clinical characteristics. Late CAAs in the setting of KD may be confused with other CAA types (atherosclerotic, etc.), and are possibly underdiagnosed in clinical practice.

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The decision to discontinue statin treatment was made at the patient's discretion in 74% of cases, with higher likelihood of patients with higher educational status deciding to discontinue treatment and switch to non-drug lipid-lowering alternatives. Cardiologists were the physicians most frequently responsible for the initiation of the statin treatment; coverage of several non-life-threatening statin side effects by TV programs and patients' lack of information regarding high cholesterol and related risks were the leading factors predisposing to treatment discontinuation.

Aims: Acute myocarditis is an inflammatory disease of the myocardium and is characterized by a large heterogeneity of clinical presentation. Myocarditis is becoming to be recognized as a contributor to unexplained mortality, and is thought to be a major cause of sudden cardiac death in the first two decades of life. Myocardial inflammation, ion channel dysfunction, electrophysiological and structural remodelling may play important roles in life-threatening arrhythmias. We aimed to investigate the ventricular arrhythmia predictors in myocarditis patients by using electrocardiographic markers. Methods: A total of 56 patients (mean age 22.5 ± 3.7 years; 89% males) with acute myocarditis were enrolled in the study. Tpeak-Tend intervals, Tpeak-Tend/QT and Tpeak-Tend/corrected QT (QTc), cardio-electrophysiological balance (QT/QRS) and heart rate-corrected QT(QTc)/QRS ratios were calculated from 12-lead electrocardiogram. Results: Heart rate, QT and QTc values were similar between groups. QRS complexes were lower in arrhythmia positive group than arrhythmia negative group (p=0.004). Tpeak-Tend intervals, Tpeak-Tend/QT, Tpeak-Tend/ QTc, cardio-electrophysiological balance and heart rate-corrected QT(QTc)/QRS values were significantly higher in arrhythmia positive group (< 0.001, < 0.001, p=0.03, p=0.04 and < 0.001, respectively). Conclusion: In this study, we observed that higher Tpeak-Tend, Tpeak-Tend/QT, Tpeak-Tend/QTc , cardio-electrophysiological balance (ICEB) and heart rate-corrected QT(QTc)/QRS ratio are associated with ventricular arrhythmic episodes in acute myocarditis patients. These electrocardiographic markers may be beneficial to identify high risk patients for arrhytmias complicating myocarditis.