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The Diagnosis of Acute Myocarditis in Emergency (DAME) score: improving diagnostics within the emergency department.

Published:January 24, 2021DOI:https://doi.org/10.1016/j.ejim.2021.01.011

      Highlights

      • The diagnosis of myocarditis is challenging at Emergency Department.
      • D.A.M.E. score may provide fast identification of patients with myocarditis.
      • DAME score is composed by fever, chest pain, ESR, hs-CRP, troponin, and LVEF.
      • A score>7 showed higher sensibility, specificity and NPV in myocarditis diagnosis.

      Abstract

      Purpose

      . The final diagnosis of myocarditis is challenging. The aim of our study was to provide the D.A.M.E. (Diagnosis of Acute Myocarditis in Emergency) Score for the fast identification of patients suffering from myocarditis at Emergency Department (ED).

      Methods

      . This was a multicenter, retrospective study involving three centers. All medical records from January 2010 to December 2014 reporting a final discharge diagnosis of myocarditis were considered. One hundred-four patients (mean age: 40.2±16.5 years) were enrolled. Clinical, biochemical and instrumental data were gathered. Data were analysed by means of logistic regression model and factorial analysis. A validation cohort from a fourth center was enrolled.

      Results

      . The final determinants of the DAME score were six: fever, chest pain, erythrocyte sedimentation rate (ESR) > 20 mm/h, C-reactive protein (hs-CRP) >3 mg/L, troponin serum levels >3 ng/L, and left ventricle ejection fraction < 50%. All of them received a specified score ranging from 0 to 4. A score > 4 was related to 75% probability of myocarditis; a final score ranging between 1 and 4 was related to 57% probability of myocarditis. ROC curve on the validation cohort (289 patients, 27 with myocarditis) demonstrated the best cut-off to be 7: AUC 0.958 (p< 0.001), sensibility: 100%, specificity: 85.11%, PPV: 40.9%, NPV: 100% (LR+: 6.72; LR-: 0.00). Logistic regression analysis revealed Odds Ratio equal to 2.83 (95% CI 1.90 – 4.20, p < 0.0001).

      Conclusions

      . DAME score can offer a reliable tool in ED setting for the evaluation of patients suffering from suspected myocarditis.

      Keywords

      Abbreviations:

      AUC (area under the curve), BNP (brain natriuretic peptide), CMR (Cardiac magnetic resonance), ECG (electrocardiogram), ED (Emergency Department), ESR (erythrocyte sedimentation rate), hs-CRP (high sensitive C-reactive protein), hs-TnI (high sensitive Troponin I), LR (likelihood ratio), LVEF (left ventricle ejection fraction), NPV (negative predictive value), NT-proBNP (N-terminal prohormone of brain natriuretic peptide), NYHA (New York Heart Association), OR (odds ratio), PPV (positive predictive value), ROC (receiver-operating characteristic)
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