Tara Shuhei, Yamamoto Takeshi, Kanaoka Koshiro, Oka Eiichiro, Shiomura Reiko, Matsuda Junya, Nakata Jun, Miyachi Hideki, Onoue Kenji, Saito Yoshihiko, Shimizu Wataru, Asai Kuniya
Division of Cardiovascular Intensive Care, Nippon Medical School Hospital Tokyo Japan.
Department of Cardiovascular Medicine, Nippon Medical School Tokyo Japan.
Circ Rep. 2024 Jul 5;6(8):322-332. doi: 10.1253/circrep.CR-24-0059. eCollection 2024 Aug 9.
Cardioprotective drugs have not been previously shown to improve the prognosis in patients with fulminant myocarditis presentation (FMP). We aimed to investigate whether cardioprotective drugs, including angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) and β-blocker, administered during hospitalization improved the prognosis in patients with FMP.
This multicenter cohort study conducted in Japan included 755 patients with clinically diagnosed FMP. Those who died within 14 days of admission were excluded, and 588 patients (median age 53 [37-65] years and 40% female) were evaluated. The primary outcome was the composite of 90-day mortality or heart transplantation. The patients were divided into 4 groups according to whether they were administered ACEI/ARB or β-blocker during hospitalization. Administration of ACEI/ARB without β-blocker improved the overall patient outcomes (log-rank test [vs. ACEI/ARB - and β-blocker -]: ACEI/ARB + and β-blocker -, P<0.001; ACEI/ARB - and β-blocker +, P=0.256). Subsequently, a matched cohort of 146 patient pairs was generated for patients with or without ACEI/ARB administration during hospitalization. The outcome-free survival at 90 days was significantly higher in the ACEI/ARB administration group than in the non-administration group (hazard ratio 0.37; 95% confidence interval 0.19-0.71).
Administration of ACEI or ARB during hospitalization was associated with favorable outcomes in terms of 90-day mortality and heart transplantation events in patients with clinically diagnosed FMP.
此前尚无证据表明心脏保护药物可改善暴发性心肌炎（FMP）患者的预后。我们旨在研究住院期间使用包括血管紧张素转换酶抑制剂（ACEI）/血管紧张素II受体阻滞剂（ARB）和β受体阻滞剂在内的心脏保护药物是否能改善FMP患者的预后。
这项在日本进行的多中心队列研究纳入了755例临床诊断为FMP的患者。排除入院14天内死亡的患者，对588例患者（中位年龄53岁[37 - 65岁]，40%为女性）进行评估。主要结局为90天死亡率或心脏移植的复合结局。根据住院期间是否使用ACEI/ARB或β受体阻滞剂将患者分为4组。单独使用ACEI/ARB可改善总体患者预后（对数秩检验[与同时使用ACEI/ARB和β受体阻滞剂相比]：使用ACEI/ARB且未使用β受体阻滞剂组，P<0.001；未使用ACEI/ARB且使用β受体阻滞剂组，P = 0.256）。随后，针对住院期间使用或未使用ACEI/ARB的患者生成了146对匹配队列。ACEI/ARB使用组90天无事件生存率显著高于未使用组（风险比0.37；95%置信区间0.19 - 0.71）。
对于临床诊断为FMP的患者，住院期间使用ACEI或ARB与90天死亡率和心脏移植事件方面的良好结局相关。
