Abstract 15273: Multidisciplinary Treatment for Fulminant Myocarditis
Introduction: Fulminant myocarditis is one of the most challenging diseases to diagnose and treat. We sought to examine the outcomes of our multidisciplinary treatment strategy for fulminant myocarditis.
Methods: A retrospective review of consecutive 30 patients (21 male, 9 female, mean age 39.2 ± 16.8 [9 - 72] years) with fulminant myocarditis from 2009 to 2015 was conducted.
Results: Twenty-five patients required mechanical circulatory support (MCS). Percutaneous extracorporeal membrane oxygenation (ECMO) was inserted in 23 of them and temporary ventricular assist device (t-VAD) with extracorporeal centrifugal pump(s) in 2 of them. Sixteen of the ECMO-supported patients were later transitioned to t-VAD. Of the 18 patients with t-VAD, heart function recovered and the VAD was explanted in 10. Four patients were successfully bridged to long-term VAD and the other 4 died on t-VAD. Two patients were directly bridged to long-term VAD by ECMO. Heart function recovered only with percutaneous ECMO in 4 patients and 1 died on ECMO. All five deaths were due to neurological complications. Overall survival rate was 83.3%. High total bilirubin level at the time of VAD conversion was the significant risk factor for patients’ death after VAD conversion. Pathologically, 7 patients (23.3%) had eosinophilic myocarditis and 1(3.3%) had giant-cell myocarditis, and all the 8 patients underwent immunosuppressive therapy including steroids. Heart function recovered to normal level in 7 of them (87.5%). In eosinophilic cardiomyopathy, serum level of eosinophilic cationic protein was a good indicator of activity of the disease and effectiveness of immunosuppressive therapy. T cell (Treg) and adiponectine (APN) were recruited into the cardiac tissue of fulminant myocarditis, and the ratio of APN/Foxp3 double-positive Treg to CD3 T-cell was associated with recovery of cardiac function.
Conclusions: Over 80% of the patients with fulminant myocarditis were rescued with aggressive MCS therapy. Endomyocardial biopsy is very important because immunosuppressive therapy carries promising outcomes in certain etiologies.
Author Disclosures: S. Saito: None. K. Toda: None. T. Nakamura: None. S. Miyagawa: None. Y. Yoshikawa: None. S. Fukushima: None. K. Domae: None. Y. Tsukamoto: None. F. Sera: None. Y. Sakata: None. Y. Sawa: None.
- © 2016 by American Heart Association, Inc.