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

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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.

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Data Availability Statement

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIP) (2019R1C1C1009875).

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Authors and Affiliations

  1. Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Sohyeon Kim, Hye Yoon Chung, Ha Young Shin & Seung Woo Kim

  2. Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea

    Sohyeon Kim

  3. Department of Neurology, National Cancer Center, Goyang, Gyeonggi-do, South Korea

    Ki Hoon Kim

  4. Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Hyung Jun Park & Young-Chul Choi

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Correspondence to Seung Woo Kim.

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The authors declare no competing interests.

Ethical standards

This study was conducted in accordance with the ethical standards of the institutional and national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of Severance Hospital (IRB No.4–2021-0745).

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Informed consent was waived by our institutional ethical board because the research involves no more than minimal risk to participants and does not adversely affect their rights and welfare.

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Kim, S., Kim, K.H., Chung, H.Y. et al. Anti-titin antibodies are associated with myocarditis in patients with myasthenia gravis. J Neurol 270, 1457–1465 (2023). https://doi.org/10.1007/s00415-022-11485-1

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  • DOI: https://doi.org/10.1007/s00415-022-11485-1

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