Background: The prognosis of pericarditis with concomitant myocarditis, especially in the setting of troponin elevation, is a reason for concern because it could imply an adverse outcome.
Methods: We performed a comprehensive Medline search of all publications from 2000 to 2013 with the MeSH terms 'pericarditis', 'myocarditis' and 'prognosis'. Additional publications were sought using the reference lists of identified papers, the published reviews on this topic, and a search of abstracts from the American Heart Association, American College of Cardiology, and European Society of Cardiology scientific sessions.
Results: We identified eight major clinical series evaluating the prognosis of myopericarditis. Studies included a total of 389 patients with myopericarditis (mean age 31.7 years, men-to-women ratio 4.0). After a mean follow-up of 31 months, residual left-ventricular dysfunction was reported in 3.5% without cases of heart failure. Recurrences occurred in 13.0% of cases mainly as recurrent pericarditis (>90%), cardiac tamponade and constrictive pericarditis in less than 1% of cases. The overall prognosis seems good (no mortality), with only one single discordant study reporting three deaths: one related to cardiac tamponade and two sudden cardiac deaths during hospitalization, but no out-of-hospital deaths during follow-up.
Conclusion: Myopericarditis has a good overall prognosis. Troponin elevation in this setting does not predict an adverse outcome in most cases. Thus it is important to reassure the patients on their prognosis, explaining the nature of the disease and the likely course. Diagnostic and therapeutic choices should take into account the overall good outcome of these patients, including less invasive diagnostic tools and toxic drugs.