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Anti-titin antibodies are associated with myocarditis in patients with myasthenia gravis

Authors
 Sohyeon Kim  ;  Ki Hoon Kim  ;  Hye Yoon Chung  ;  Hyung Jun Park  ;  Young-Chul Choi  ;  Ha Young Shin  ;  Seung Woo Kim 
Citation
 JOURNAL OF NEUROLOGY, Vol.270(3) : 1457-1465, 2023-03 
Journal Title
JOURNAL OF NEUROLOGY
ISSN
 0340-5354 
Issue Date
2023-03
MeSH
Autoantibodies ; Connectin ; Humans ; Myasthenia Gravis* / diagnosis ; Myocarditis* / complications ; Myocarditis* / diagnosis ; Retrospective Studies ; Thymoma* ; Thymus Neoplasms*
Keywords
Anti-titin autoantibody ; Myasthenia gravis ; Myocarditis ; Thymoma
Abstract
Background: Myasthenia gravis (MG) can affect cardiac muscles with variable presentations. Myocarditis is a rare but potentially serious cardiac manifestation of MG. Although thymomas and anti-titin antibodies have been suggested as risk factors for myocarditis in patients with MG, their independent influence on myocarditis has rarely been assessed.

Methods: A retrospective chart review was conducted on 247 patients diagnosed with MG who were tested for anti-titin antibodies. Myocarditis was diagnosed on the basis of the European Society of Cardiology 2013 Task Force criteria for clinically suspected myocarditis. Patients were classified into myocarditis-positive and myocarditis-negative groups. Multivariate analysis was performed to analyze the risk factors for myocarditis.

Results: Of the 247 patients, 25 (10.1%) were myocarditis-positive and 222 (89.9%) were myocarditis-negative. Anti-titin antibody positivity was higher in the myocarditis-positive group than in the myocarditis-negative group (68.0% vs. 28.4%, p < 0.001). A history of MG crisis was more frequent in the myocarditis-positive group than in the myocarditis-negative group (64.0% vs. 10.4%, p < 0.001). The presence of anti-titin antibodies (odds ratio [OR] 7.906; confidence interval [CI] 2.460-25.401) and MG crisis (OR 24.807; CI 7.476-82.311) was significantly associated with myocarditis. The Cox regression model showed that the anti-titin antibody levels (hazard ratio [HR] 3.639; 95% CI 1.557-8.505) and MG crisis (HR 6.137; 95% CI 2.639-14.272) were significant risk factors for the development of myocarditis.

Conclusion: The presence of anti-titin antibody was associated with myocarditis in patients with MG, whereas thymoma was not. Although rare, early suspicion of myocarditis could be required, especially in patients with MG having anti-titin antibodies.
Full Text
https://link.springer.com/article/10.1007/s00415-022-11485-1
DOI
10.1007/s00415-022-11485-1
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung Woo(김승우) ORCID logo https://orcid.org/0000-0002-5621-0811
Park, Hyung Jun(박형준)
Shin, Ha Young(신하영) ORCID logo https://orcid.org/0000-0002-4408-8265
Chung, Hye Yoon(정혜윤)
Choi, Young Chul(최영철) ORCID logo https://orcid.org/0000-0001-5525-6861
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/197693
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