Department of Cardiology Nagoya University Graduate School of Medicine Nagoya Japan.
Department of Nephrology Nagoya University Graduate School of Medicine Nagoya Japan.
J Am Heart Assoc. 2022 Feb 15;11(4):e023719. doi: 10.1161/JAHA.121.023719. Epub 2022 Feb 8.
Background Prognoses and long-term cardiac function of patients with fulminant myocarditis have not been fully elucidated. Therefore, we clarified the prognoses and long-term cardiac function according to required percutaneous mechanical circulatory support and histological findings among patients with fulminant myocarditis. Methods and Results We conducted a multicenter retrospective medical record review of 216 patients with fulminant myocarditis requiring percutaneous mechanical circulatory support. Sixty-one patients were treated with intra-aortic balloon pump or Impella alone, and 155 patients received veno-arterial extracorporeal membrane oxygenation and were treated with or without intra-aortic balloon pump or Impella. Histologically, 107 patients had lymphocytic myocarditis; 34, eosinophilic myocarditis; and 4, giant cell myocarditis. Freedom from composite end point (death, durable left ventricular assist device implantation, and heart transplantation) was 66% at 90 days, 62% at 1 year, and 57% at 6 years. Veno-arterial extracorporeal membrane oxygenation use was associated with poor prognosis in the multivariable analysis (hazard ratio [HR], 5.27; 95% CI, 1.60-17.36). The eosinophilic myocarditis subgroup showed better prognosis (HR, 0.28; 95% CI, 0.10-0.80) compared with the lymphocytic myocarditis subgroup but not in the multivariable analysis. Ventricular tachycardia/ventricular fibrillation rhythm at admission, high C-reactive protein level, and no endomyocardial biopsy were also associated with poor prognosis. The left ventricular ejection fraction at 1 year was ≤50% in 16% of patients and was lower in patients with eosinophilic myocarditis (median: 57.9% [48.8-65.0%]) than in those with lymphocytic myocarditis (65.0% [58.6-68.7%]) (=0.036). Conclusions Patients with fulminant myocarditis who received veno-arterial extracorporeal membrane oxygenation had a poor prognosis. Long-term cardiac function was impaired in some patients, especially those with eosinophilic myocarditis.
暴发性心肌炎患者的预后和长期心功能尚未完全阐明。因此，我们根据暴发性心肌炎患者所需的经皮机械循环支持和组织学发现，阐明了预后和长期心功能。
我们对 216 例需要经皮机械循环支持的暴发性心肌炎患者进行了多中心回顾性病历回顾。61 例患者接受主动脉内球囊泵或 Impella 单独治疗，155 例患者接受静脉-动脉体外膜肺氧合治疗，并接受或不接受主动脉内球囊泵或 Impella 治疗。组织学上，107 例为淋巴细胞性心肌炎；34 例为嗜酸性粒细胞性心肌炎；4 例为巨细胞性心肌炎。90 天无复合终点（死亡、永久性左心室辅助装置植入和心脏移植）的比例为 66%，1 年为 62%，6 年为 57%。多变量分析显示静脉-动脉体外膜肺氧合的使用与预后不良相关（风险比[HR]，5.27；95%可信区间[CI]，1.60-17.36）。与淋巴细胞性心肌炎亚组相比，嗜酸性粒细胞性心肌炎亚组的预后较好（HR，0.28；95%CI，0.10-0.80），但多变量分析中无统计学意义。入院时出现室性心动过速/心室颤动节律、高 C 反应蛋白水平和未行心肌活检也与预后不良相关。1 年后左心室射血分数≤50%的患者占 16%，且嗜酸性粒细胞性心肌炎患者（中位数：57.9%[48.8-65.0%]）低于淋巴细胞性心肌炎患者（65.0%[58.6-68.7%]）（=0.036）。
接受静脉-动脉体外膜肺氧合治疗的暴发性心肌炎患者预后较差。一些患者，特别是嗜酸性粒细胞性心肌炎患者，长期心功能受损。
