Hong David, Bak Minjung, Park Hyukjin, Kim Hyung Yoon, Lee Seonhwa, Kim In-Cheol, Hyun Junho, Kim So Ree, Kim Mi-Na, Kim Kyung-Hee, Yang Jeong Hoon
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Department of Cardiology, Chonnam National University Hwasun Hospital.
Circ J. 2024 Dec 12. doi: 10.1253/circj.CJ-24-0684.
This study aimed to identify risk factors associated with the implementation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with acute myocarditis and to develop a predictive model.
This retrospective study included 841 patients from 7 hospitals in Korea with biopsy-proven or clinically suspected acute myocarditis. Logistic regression analysis was used to identify the clinical characteristics of patients who required VA-ECMO and to construct a scoring system to predict the implementation of VA-ECMO. Among the study population, 217 (25.8%) patients underwent VA-ECMO. The study population was divided into training (n=621) and testing (n=220) cohorts according to participating center. The final predictive model of VA-ECMO insertion derived from the training cohort included the following: initial mean blood pressure <65 mmHg, cardiac arrest, Glasgow Coma Scale score ≤12, platelet count <100×10/mL, pulmonary congestion on chest X-ray, QRS interval ≥120 ms, left or right bundle branch block, and left ventricular ejection fraction <40%. Using this predictive model, a β coefficient-weighted Korean Acute Myocarditis (KAM) score was developed. External validation of the predictive model and KAM score using the testing cohort showed excellent discriminant ability (areas under the curve of 0.945 and 0.921, respectively).
A risk scoring system based on simple clinical and laboratory parameters at initial presentation could predict the implementation of VA-ECMO and clinical course in patients with acute myocarditis.
本研究旨在确定急性心肌炎患者实施静脉-动脉体外膜肺氧合（VA-ECMO）的相关危险因素，并建立预测模型。
这项回顾性研究纳入了韩国7家医院的841例经活检证实或临床怀疑为急性心肌炎的患者。采用逻辑回归分析确定需要VA-ECMO的患者的临床特征，并构建一个评分系统来预测VA-ECMO的实施情况。在研究人群中，217例（25.8%）患者接受了VA-ECMO。根据参与中心将研究人群分为训练队列（n=621）和测试队列（n=220）。从训练队列得出的VA-ECMO植入最终预测模型包括以下因素：初始平均血压<65 mmHg、心脏骤停、格拉斯哥昏迷量表评分≤12、血小板计数<100×10⁹/mL、胸部X线显示肺淤血、QRS间期≥120 ms、左或右束支传导阻滞以及左心室射血分数<40%。利用该预测模型，开发了一个β系数加权的韩国急性心肌炎（KAM）评分。使用测试队列对预测模型和KAM评分进行外部验证，结果显示具有出色的判别能力（曲线下面积分别为0.945和0.921）。
基于初始就诊时简单临床和实验室参数的风险评分系统可预测急性心肌炎患者VA-ECMO的实施情况及临床病程。
