Giordani Andrea Silvio, Baritussio Anna, Vicenzetto Cristina, Peloso-Cattini Maria Grazia, Pontara Elena, Bison Elisa, Fraccaro Chiara, Basso Cristina, Iliceto Sabino, Marcolongo Renzo, Caforio Alida Linda Patrizia
Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova Padua, Italy.
Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova Padua, Italy.
Eur Cardiol. 2023 Apr 20;18:e15. doi: 10.15420/ecr.2022.54. eCollection 2023.
Fulminant myocarditis, rather than being a distinct form of myocarditis, is instead a peculiar clinical presentation of the disease. The definition of fulminant myocarditis has varied greatly in the last 20 years, leading to conflicting reports on prognosis and treatment strategies, mainly because of varied inclusion criteria in different studies. The main conclusion of this review is that fulminant myocarditis may be due to different histotypes and aetiologies that can be diagnosed only by endomyocardial biopsy and managed by aetiology-directed treatment. This life-threatening presentation requires rapid, targeted management both in the short term (mechanical circulatory support, inotropic and antiarrhythmic treatment and endomyocardial biopsy) and in the long term (including prolonged follow-up). Fulminant presentation has also recently been identified as a risk factor for worsened prognosis, even long after the resolution of the acute phase of myocarditis.
暴发性心肌炎并非心肌炎的一种独特形式，而是该疾病一种特殊的临床表现。在过去20年里，暴发性心肌炎的定义差异很大，导致关于预后和治疗策略的报道相互矛盾，主要原因是不同研究中的纳入标准各不相同。本综述的主要结论是，暴发性心肌炎可能由不同的组织学类型和病因引起，只有通过心内膜心肌活检才能诊断，并采用病因导向治疗。这种危及生命的表现需要在短期内（机械循环支持、使用正性肌力药物和抗心律失常治疗以及心内膜心肌活检）和长期内（包括长期随访）进行快速、有针对性的管理。暴发性表现最近也被确定为预后恶化的一个危险因素，即使在心肌炎急性期消退很久之后也是如此。
