Ishida Kohki, Wada Hiroshi, Sakakura Kenichi, Kubo Norifumi, Ikeda Nahoko, Sugawara Yoshitaka, Ako Junya, Momomura Shin-ichi
Division of Cardiovascular Medicine, Department of Integrated Medicine I, Saitama Medical Center, Jichi Medical University, Amanuma 1-847, Omiya, Saitama, Japan.
Heart Vessels. 2013 Jan;28(1):86-90. doi: 10.1007/s00380-011-0211-8. Epub 2011 Dec 28.
Fulminant myocarditis is a rapidly progressive, life-threatening disease with severe impairment of systolic left ventricle function in the acute phase. However, the long-term prognosis of patients who survive the acute phase with percutaneous extracorporeal cardiopulmonary support (PCPS) is not established. The purpose of this study was to elucidate the long-term follow-up on chronic cardiac function and long-term outcome. Twenty consecutive patients with fulminant myocarditis in the acute phase supported by PCPS were enrolled between January 1995 and March 2010. Echocardiography was performed at least three times; acute phase (within 3 days from onset), predischarge (days 3-30), and chronic phase (>6 months, 2.67 ± 2.19 years, mean ± SD). The clinical events were queried by their medical record and questionnaires. Eight patients (40%) died in the acute phase. The time course of ejection fraction (%) by echocardiography was 22.7 ± 9.8, 53.1 ± 7.2, and 57.2 ± 9.6 in acute, predischarge, and chronic phase, respectively. Diastolic dimension (mm) was 46.8 ± 7.4, 51.3 ± 2.9, and 50.4 ± 1.8, and systolic dimension (mm) was 41.4 ± 7.7, 36.8 ± 4.0, and 35.2 ± 3.3 in acute, predischarge, and chronic phase, respectively. There was no recurrence or admission related to heart failure during the follow-up period. The cardiac function of patients with fulminant myocarditis recovers rapidly during their stay in hospital. The cardiac function of predischarge patients remains unchanged in the chronic phase. The long-term survival of fulminant myocarditis appears favorable in the chronic phase.
暴发性心肌炎是一种进展迅速、危及生命的疾病，急性期左心室收缩功能严重受损。然而，经皮体外心肺支持（PCPS）治疗后急性期存活患者的长期预后尚不清楚。本研究的目的是阐明慢性心功能的长期随访情况及长期预后。1995年1月至2010年3月期间，连续纳入20例急性期接受PCPS支持的暴发性心肌炎患者。至少进行三次超声心动图检查，分别为急性期（发病后3天内）、出院前（第3 - 30天）和慢性期（>6个月，平均±标准差为2.67±2.19年）。通过病历和问卷查询临床事件。8例患者（40%）在急性期死亡。急性期、出院前和慢性期超声心动图测得的射血分数（%）的时间进程分别为22.7±9.8、53.1±7.2和57.2±9.6。急性期、出院前和慢性期的舒张末期内径（mm）分别为46.8±7.4、51.3±2.9和50.4±1.8，收缩末期内径（mm）分别为41.4±7.7、36.8±4.0和35.2±3.3。随访期间无心力衰竭复发或再入院情况。暴发性心肌炎患者的心功能在住院期间迅速恢复。出院前患者的心功能在慢性期保持不变。暴发性心肌炎患者在慢性期的长期生存率似乎较好。
