Fulminant Versus Acute Nonfulminant Myocarditis in Patients With Left Ventricular Systolic Dysfunction
Por:
Ammirati, E, Veronese, G, Brambatti, M, Merlo, M, Cipriani, M, Potena, L, Sormani, P, Aoki, T, Sugimura, K, Sawamura, A, Okumura, T, Pinney, S, Hong, K, Shah, P, Braun, O, Van de Heyning, CM, Montero, S, Petrella, D, Huang, F, Schmidt, M, Raineri, C, Lala, A, Varrenti, M, Foa, A, Leone, O, Gentile, P, Artico, J, Agostini, V, Patel, R, Garascia, A, Van Craenenbroeck, EM, Hirose, K, Isotani, A, Murohara, T, Arita, Y, Sionis, A, Fabris, E, Hashem, S, Garcia-Hernando, V, Oliva, F, Greenberg, B, Shimokawa, H, Sinagra, G, Adler, ED, Frigerio, M, Camici, PG
Publicada:
23 jul 2019
Resumen:
BACKGROUND Fulminant myocarditis (FM) is a form of acute myocarditis characterized by severe left ventricular systolic dysfunction requiring inotropes and/or mechanical circulatory support. A single-center study found that a patient with FM had better outcomes than those with acute nonfulminant myocarditis (NFM) presenting with left ventricular systolic dysfunction, but otherwise hemodynamically stable. This was recently challenged, so disagreement still exists.
OBJECTIVES This study sought to provide additional evidence on the outcome of FM and to ascertain whether patient stratification based on the main histologic subtypes can provide additional prognostic information.
METHODS A total of 220 patients (median age 42 years, 46.3% female) with histologically proven acute myocarditis (onset of symptoms <30 days) all presenting with left ventricular systolic dysfunction were included in a retrospective, international registry comprising 16 tertiary hospitals in the United States, Europe, and Japan. The main endpoint was the occurrence of cardiac death or heart transplantation within 60 days from admission and at long-term follow-up.
RESULTS Patients with FM (n = 165) had significantly higher rates of cardiac death and heart transplantation compared with those with NFM (n = 55), both at 60 days (28.0% vs. 1.8%, p = 0.0001) and at 7-year follow-up (47.7% vs. 10.4%, p < 0.0001). Using Cox multivariate analysis, the histologic subtype emerged as a further variable affecting the outcome in FM patients, with giant cell myocarditis having a significantly worse prognosis compared with eosinophilic and lymphocytic myocarditis. In a subanalysis including only adults with lymphocytic myocarditis, the main endpoints occurred more frequently in FM compared with in NFM both at 60 days (19.5% vs. 0%, p = 0.005) and at 7-year follow up (41.4% vs. 3.1%, p = 0.0004).
CONCLUSIONS This international registry confirms that patients with FM have higher rates of cardiac death and heart transplantation both in the short-and long-term compared with patients with NFM. Furthermore, we provide evidence that the histologic subtype of FM carries independent prognostic value, highlighting the need for timely endomyocardial biopsy in this condition. (C) 2019 by the American College of Cardiology Foundation.
Filiaciones:
Ammirati, E:
Osped Niguarda Ca Granda, De Gasperis Cardio Ctr, Milan, Italy
Veronese, G:
Osped Niguarda Ca Granda, De Gasperis Cardio Ctr, Milan, Italy
Univ Milano Bicocca, Dept Hlth Sci, Monza, Italy
Brambatti, M:
Univ Calif San Diego, Dept Med, Div Cardiol, La Jolla, CA 92093 USA
Merlo, M:
Univ Trieste, Azienda Sanit Univ Integrata ASUITS, Cardiothorac Dept, Trieste, Italy
Cipriani, M:
Osped Niguarda Ca Granda, De Gasperis Cardio Ctr, Milan, Italy
Potena, L:
Acad Hosp S Orsola Malpighi, Bologna, Italy
Sormani, P:
Osped Niguarda Ca Granda, De Gasperis Cardio Ctr, Milan, Italy
Aoki, T:
Tohoku Univ, Grad Sch Med, Sendai, Miyagi, Japan
Sugimura, K:
Tohoku Univ, Grad Sch Med, Sendai, Miyagi, Japan
Sawamura, A:
Nagoya Univ, Grad Sch Med, Nagoya, Aichi, Japan
Okumura, T:
Nagoya Univ, Grad Sch Med, Nagoya, Aichi, Japan
Pinney, S:
Icahn Sch Med Mt Sinai, New York, NY 10029 USA
Hong, K:
Univ Calif San Diego, Dept Med, Div Cardiol, La Jolla, CA 92093 USA
Shah, P:
Inova Heart & Vasc Inst, Falls Church, VA USA
Braun, O:
Lund Univ, Dept Cardiol, Clin Sci, Lund, Sweden
Skane Univ Hosp, Lund, Sweden
Van de Heyning, CM:
Antwerp Univ Hosp, Dept Cardiol, Edegem, Belgium
Montero, S:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Biomed Res Inst IIB St Pau, CIBER CV,Dept Cardiol, Barcelona, Spain
Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, Med Intens Care Unit, Paris 13, France
Petrella, D:
Osped Niguarda Ca Granda, De Gasperis Cardio Ctr, Milan, Italy
Huang, F:
Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, Med Intens Care Unit, Paris 13, France
Schmidt, M:
Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, Med Intens Care Unit, Paris 13, France
Raineri, C:
Ist Ricovero & Cura Carattere Sci Policlin San Ma, Pavia, Italy
Lala, A:
Icahn Sch Med Mt Sinai, New York, NY 10029 USA
Varrenti, M:
Osped Niguarda Ca Granda, De Gasperis Cardio Ctr, Milan, Italy
Univ Milano Bicocca, Dept Hlth Sci, Monza, Italy
Foa, A:
Acad Hosp S Orsola Malpighi, Bologna, Italy
Leone, O:
Acad Hosp S Orsola Malpighi, Bologna, Italy
Gentile, P:
Univ Trieste, Azienda Sanit Univ Integrata ASUITS, Cardiothorac Dept, Trieste, Italy
Artico, J:
Univ Trieste, Azienda Sanit Univ Integrata ASUITS, Cardiothorac Dept, Trieste, Italy
Agostini, V:
Acad Hosp S Orsola Malpighi, Bologna, Italy
Patel, R:
Inova Heart & Vasc Inst, Falls Church, VA USA
Garascia, A:
Osped Niguarda Ca Granda, De Gasperis Cardio Ctr, Milan, Italy
Van Craenenbroeck, EM:
Antwerp Univ Hosp, Dept Cardiol, Edegem, Belgium
Hirose, K:
Kokura Mem Hosp, Kitakyushu, Fukuoka, Japan
Isotani, A:
Kokura Mem Hosp, Kitakyushu, Fukuoka, Japan
Murohara, T:
Nagoya Univ, Grad Sch Med, Nagoya, Aichi, Japan
Arita, Y:
Osaka Hosp, Japan Community Healthcare Org, Osaka, Japan
Sionis, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Biomed Res Inst IIB St Pau, CIBER CV,Dept Cardiol, Barcelona, Spain
Fabris, E:
Univ Trieste, Azienda Sanit Univ Integrata ASUITS, Cardiothorac Dept, Trieste, Italy
Hashem, S:
Univ Calif San Diego, Dept Pathol, La Jolla, CA 92093 USA
Garcia-Hernando, V:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Biomed Res Inst IIB St Pau, CIBER CV,Dept Cardiol, Barcelona, Spain
Oliva, F:
Osped Niguarda Ca Granda, De Gasperis Cardio Ctr, Milan, Italy
Greenberg, B:
Univ Calif San Diego, Dept Med, Div Cardiol, La Jolla, CA 92093 USA
Shimokawa, H:
Tohoku Univ, Grad Sch Med, Sendai, Miyagi, Japan
Sinagra, G:
Univ Trieste, Azienda Sanit Univ Integrata ASUITS, Cardiothorac Dept, Trieste, Italy
Adler, ED:
Univ Calif San Diego, Dept Med, Div Cardiol, La Jolla, CA 92093 USA
Frigerio, M:
Osped Niguarda Ca Granda, De Gasperis Cardio Ctr, Milan, Italy
Camici, PG:
Univ Vita Salute San Raffaele, Milan, Italy
Hosp San Raffaele, Milan, Italy
Bronze
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