Fulminant Versus Acute Nonfulminant Myocarditis in Patients With Left Ventricular Systolic Dysfunction

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:74

Article

Ammirati, Enrico¹  Veronese, Giacomo^1,2  Brambatti, Michela³  Merlo, Marco⁴  Cipriani, Manlio¹  Potena, Luciano⁵  Sormani, Paola¹  Aoki, Tatsuo⁶  Sugimura, Koichiro⁶  Sawamura, Akinori⁷  Okumura, Takahiro⁷  Pinney, Sean⁸  Hong, Kimberly³  Shah, Palak⁹  Braun, Oscar^10,11  Van de Heyning, Caroline M.¹²  Montero, Santiago^13,14  Petrella, Duccio¹  Huang, Florent¹⁴  Schmidt, Matthieu¹⁴  Raineri, Claudia¹⁵  Lala, Anuradha⁸  Varrenti, Marisa^1,2  Foa, Alberto⁵  Leone, Ornella⁵  Gentile, Piero⁴  Artico, Jessica⁴  Agostini, Valentina⁵  Patel, Rajiv⁹  Garascia, Andrea¹  Van Craenenbroeck, Emeline M.¹²  Hirose, Kaoru¹⁶  Isotani, Akihiro¹⁶  Murohara, Toyoaki⁷  Arita, Yoh¹⁷  Sionis, Alessandro¹³  Fabris, Enrico⁴  Hashem, Sherin¹⁸  Garcia-Hernando, Victor¹³  Oliva, Fabrizio¹  Greenberg, Barry³  Shimokawa, Hiroaki⁶  Sinagra, Gianfranco⁴  Adler, Eric D.³  Frigerio, Maria¹  Camici, Paolo G.^19,20 

[1] Osped Niguarda Ca Granda, De Gasperis Cardio Ctr, Milan, Italy

[2] Univ Milano Bicocca, Dept Hlth Sci, Monza, Italy

[3] Univ Calif San Diego, Dept Med, Div Cardiol, La Jolla, CA 92093 USA

[4] Univ Trieste, Azienda Sanit Univ Integrata ASUITS, Cardiothorac Dept, Trieste, Italy

[5] Acad Hosp S Orsola Malpighi, Bologna, Italy

[6] Tohoku Univ, Grad Sch Med, Sendai, Miyagi, Japan

[7] Nagoya Univ, Grad Sch Med, Nagoya, Aichi, Japan

[8] Icahn Sch Med Mt Sinai, New York, NY 10029 USA

[9] Inova Heart & Vasc Inst, Falls Church, VA USA

[10] Lund Univ, Dept Cardiol, Clin Sci, Lund, Sweden

[11] Skane Univ Hosp, Lund, Sweden

[12] Antwerp Univ Hosp, Dept Cardiol, Edegem, Belgium

[13] Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Biomed Res Inst IIB St Pau, CIBER CV,Dept Cardiol, Barcelona, Spain

[14] Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, Med Intens Care Unit, Paris 13, France

[15] Ist Ricovero & Cura Carattere Sci Policlin San Ma, Pavia, Italy

[16] Kokura Mem Hosp, Kitakyushu, Fukuoka, Japan

[17] Osaka Hosp, Japan Community Healthcare Org, Osaka, Japan

[18] Univ Calif San Diego, Dept Pathol, La Jolla, CA 92093 USA

[19] Univ Vita Salute San Raffaele, Milan, Italy

[20] Hosp San Raffaele, Milan, Italy

关键词: acute myocarditis;    endomyocardial biopsy;    eosinophilic myocarditis;    fulminant myocarditis;    giant cell myocarditis;    outcome;   

DOI  :  10.1016/j.jacc.2019.04.063

来源: Elsevier

【 摘 要 】

BACKGROUND Fulminant myocarditis (FM) is a form of acute myocarditis characterized by severe left ventricular systolic dysfunction requiring inotropes and/or mechanical circulatory support. A single-center study found that a patient with FM had better outcomes than those with acute nonfulminant myocarditis (NFM) presenting with left ventricular systolic dysfunction, but otherwise hemodynamically stable. This was recently challenged, so disagreement still exists. OBJECTIVES This study sought to provide additional evidence on the outcome of FM and to ascertain whether patient stratification based on the main histologic subtypes can provide additional prognostic information. METHODS A total of 220 patients (median age 42 years, 46.3% female) with histologically proven acute myocarditis (onset of symptoms <30 days) all presenting with left ventricular systolic dysfunction were included in a retrospective, international registry comprising 16 tertiary hospitals in the United States, Europe, and Japan. The main endpoint was the occurrence of cardiac death or heart transplantation within 60 days from admission and at long-term follow-up. RESULTS Patients with FM (n = 165) had significantly higher rates of cardiac death and heart transplantation compared with those with NFM (n = 55), both at 60 days (28.0% vs. 1.8%, p = 0.0001) and at 7-year follow-up (47.7% vs. 10.4%, p < 0.0001). Using Cox multivariate analysis, the histologic subtype emerged as a further variable affecting the outcome in FM patients, with giant cell myocarditis having a significantly worse prognosis compared with eosinophilic and lymphocytic myocarditis. In a subanalysis including only adults with lymphocytic myocarditis, the main endpoints occurred more frequently in FM compared with in NFM both at 60 days (19.5% vs. 0%, p = 0.005) and at 7-year follow up (41.4% vs. 3.1%, p = 0.0004). CONCLUSIONS This international registry confirms that patients with FM have higher rates of cardiac death and heart transplantation both in the short-and long-term compared with patients with NFM. Furthermore, we provide evidence that the histologic subtype of FM carries independent prognostic value, highlighting the need for timely endomyocardial biopsy in this condition. (C) 2019 by the American College of Cardiology Foundation.

【 授权许可】

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