Predictive value of the INFLA-SCORE in patients with myocarditis: insights from the nationwide prospective pre-MYO registry

Introduction and Aim

Myocarditis presents with high clinical heterogeneity, and predicting long-term symptom recurrence remains a challenge despite current diagnostic standards. The INFLA-SCORE, a multidimensional systemic inflammation index, may better characterize this inflammatory burden. We evaluated the utility of the INFLA-SCORE in predicting clinical management and 1-year outcomes within a large, prospective, nationwide myocarditis cohort.

Methods

Patients with confirmed myocarditis and complete baseline data were selected from the Pre-MYO registry (76 centers, Spain). The INFLA-SCORE, a composite index of systemic inflammation (CRP, leukocyte count, and neutrophil-to-lymphocyte ratio), was calculated at admission. Patients were stratified into quartiles (Q1–Q4) to assess the score's discriminative capacity. The primary endpoint was 1-year MACE (cardiovascular death, heart failure hospitalization, or life-threatening arrhythmias). Secondary endpoints included 1-year symptom recurrence and LVEF recovery.

Results

The cohort included 658 patients (mean age 40.6±18.8 years; 79.2% male). Baseline LVEF was preserved (54.4%±10.6), and CMR findings, including late gadolinium enhancement, were evenly distributed across the inflammatory spectrum (p=0.887). Markers of acute myocardial injury, such as peak troponin and NT-proBNP levels, showed no significant differences between groups, confirming the INFLA-SCORE successfully stratified the population into quartiles, from Q1 (median -8) to Q4 (median 9). Clinical management at discharge varied by inflammatory baseline: Q4 patients were significantly more likely to receive corticosteroids than Q1 (15.9% vs. 5.9%; p=0.020). Other treatments, such as colchicine (51.7%) and NSAIDs (34.8%), were used homogeneously (Table 1).

At 1-year, MACE incidence was low (1.5%) and did not differ across quartiles (p=0.298; Figure 1). However, a notable clinical trend appeared in symptom recurrence: Q4 patients exhibited the lowest rate (30.7%) vs. Q1 (44.7%; p=0.069), primarily driven by lower recurrent chest pain in the most inflamed group (28.0% vs. 41.6%; p=0.090). Readmission and LVEF recovery were similar across quartiles, suggesting the score correlates with therapeutic decisions and the subsequent symptomatic course rather than hard endpoints.

Conclusions

The INFLA-SCORE effectively identifies myocarditis patients with a higher systemic inflammatory burden who are more frequently targeted for corticosteroid therapy in real-world practice. This high-score phenotype showed a more favorable symptomatic course with lower recurrence of chest pain at 1 year, suggesting that early, personalized anti-inflammatory interventions guided by this score could reduce the long-term symptomatic burden.Table 1.Myocarditis outcomes by INFLA-SCOREFigure 1.Clinical outcomes by INFLA-SCORE