Asaumi Yasuhide, Yasuda Satoshi, Morii Isao, Kakuchi Hiroyuki, Otsuka Yoritaka, Kawamura Atsushi, Sasako Yoshikado, Nakatani Takeshi, Nonogi Hiroshi, Miyazaki Shunichi
Division of Cardiology and Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-0873, Japan.
Eur Heart J. 2005 Oct;26(20):2185-92. doi: 10.1093/eurheartj/ehi411. Epub 2005 Jul 13.
The clinical outcome of severe acute myocarditis patients with cardiogenic shock who require circulatory support devices is not well known. We studied the survival and clinical courses of patients with fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation (ECMO) and compared them with those of patients with acute non-fulminant myocarditis.
Patients with acute myocarditis were divided into the following two groups. Fourteen patients who required ECMO for cardiogenic shock were defined as having fulminant myocarditis (F group), whereas 13 patients who had an acute onset of symptoms, but did not have compromised, were defined as having acute non-fulminant myocarditis (NF group). In the F group, 10 patients were weaned successfully from percutaneous ECMO. Therefore, the overall acute survival rate was 71%. Patients who were not weaned from ECMO showed smaller left ventricular end-diastolic and end-systolic dimensions, thicker left ventricular wall, and higher creatine phosphokinase MB isoform levels than those who were weaned from ECMO. When compared with patients in the NF group, the fractional shortening in the F group was more severely decreased in the acute phase [F: 10+/-4 vs. NF: 23+/-8% (mean+/-SD), P<0.001], but recovered in the chronic phase (F: 33+/-7 vs. NF: 34+/-6%). The prevalence of adverse clinical events in both groups was similar during the follow-up period of 50 months.
In patients with fulminant myocarditis, percutaneous ECMO is a highly effective form of a haemodynamic support. Once a patient recovers from inflammatory myocardial damage, the subsequent clinical outcome is favourable, similar to that observed in patients with acute non-fulminant myocarditis.
需要循环支持装置的重症急性心肌炎合并心源性休克患者的临床结局尚不清楚。我们研究了接受经皮体外膜肺氧合（ECMO）支持的暴发性心肌炎患者的生存率和临床病程，并将其与急性非暴发性心肌炎患者进行比较。
急性心肌炎患者分为以下两组。14例因心源性休克需要ECMO的患者被定义为暴发性心肌炎（F组），而13例症状急性发作但未出现功能障碍的患者被定义为急性非暴发性心肌炎（NF组）。在F组中，10例患者成功脱离经皮ECMO。因此，总体急性生存率为71%。未脱离ECMO的患者比脱离ECMO的患者左心室舒张末期和收缩末期内径更小，左心室壁更厚，肌酸磷酸激酶同工酶MB水平更高。与NF组患者相比，F组急性期的缩短分数下降更为严重[F组：10±4 vs. NF组：23±8%（平均值±标准差），P<0.001]，但在慢性期有所恢复（F组：33±7 vs. NF组：34±6%）。在50个月的随访期内，两组不良临床事件的发生率相似。
对于暴发性心肌炎患者，经皮ECMO是一种高效的血流动力学支持方式。一旦患者从炎症性心肌损伤中恢复，随后的临床结局良好，与急性非暴发性心肌炎患者相似。
