Department of Cardiology, Nagoya University Graduate School of Medicine.
Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo.
Circ J. 2018 Feb 23;82(3):699-707. doi: 10.1253/circj.CJ-17-0549. Epub 2017 Oct 27.
Cardiac recovery and prevention of end-organ damage are the cornerstones of establishing successful bridge to recovery (BTR) in patients with fulminant myocarditis (FM) supported with percutaneous venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, the timing and method of successful BTR prediction still remain unclear. We aimed to develop a prediction model for successful BTR in patients with FM supported with percutaneous VA-ECMO.Methods and Results:This was a retrospective multicenter chart review enrolling 99 patients (52±16 years; female, 42%) with FM treated with percutaneous VA-ECMO. The S-group comprised patients who experienced percutaneous VA-ECMO decannulation and subsequent discharge (n=46), and the F-group comprised patients who either died in hospital or required conversion to other forms of mechanical circulatory support (n=53). At VA-ECMO initiation (0-h), the S-group had significantly higher left ventricular ejection fraction (LVEF) and lower aspartate aminotransferase (AST) concentration than the F-group. At 48 h, the LVEF, increase in the LVEF, and reduction of AST from 0-h were identified as independent predictors in the S-group. Finally, we developed an S-group prediction model comprising these 3 variables (area under the curve, 0.844; 95% confidence interval, 0.745-0.944).
We developed a model for use 48 h after VA-ECMO initiation to predict successful BTR in patients with FM.
在接受经皮静脉动脉体外膜肺氧合（VA-ECMO）支持的暴发性心肌炎（FM）患者中，心脏恢复和预防终末器官损伤是建立成功桥接恢复（BTR）的基石。然而，成功 BTR 预测的时机和方法仍不清楚。我们旨在为接受经皮 VA-ECMO 支持的 FM 患者建立成功 BTR 的预测模型。
这是一项回顾性多中心图表回顾研究，共纳入 99 例（52±16 岁；女性占 42%）接受经皮 VA-ECMO 治疗的 FM 患者。S 组包括经历经皮 VA-ECMO 脱管和随后出院的患者（n=46），F 组包括在医院死亡或需要转换为其他形式机械循环支持的患者（n=53）。在 VA-ECMO 启动时（0 小时），S 组的左心室射血分数（LVEF）明显高于 F 组，天冬氨酸转氨酶（AST）浓度较低。在 48 小时时，LVEF、LVEF 的增加和 AST 从 0 小时的减少被确定为 S 组的独立预测因子。最后，我们开发了一个包含这 3 个变量的 S 组预测模型（曲线下面积，0.844；95%置信区间，0.745-0.944）。
我们开发了一种模型，可在 VA-ECMO 启动后 48 小时用于预测 FM 患者的成功 BTR。
