Abstract 20288: Prognosis of Patients With Fulminant Myocarditis Requiring Mechanical Circulatory Support
Introduction: Fulminant myocarditis is a rapidly progressive life-threatening disease and requires acute mechanical circulatory support. Venoarterial extracorporeal membranous oxygenation (V-A ECMO) and ventricular assist device was shown to be effective in patients with fulminant myocarditis with hemodynamic collapse. However, the mortality of fulminant myocarditis was still high even under mechanical circulatory support, and the clinical courses of fulminant myocarditis are fully unknown. The purpose of this study was to investigate the prognosis of patients with fulminant myocarditis and to identify the risk factors for mortality.
Methods: We retrospectively studied consecutive patients admitted to our hospitals with the diagnosis of fulminant myocarditis and treated by mechanical circulatory support.
Results: Twenty patients (9 men and 11 women, mean age 50 ± 16 years) were enrolled in the present study. All patients were treated by intra-aortic balloon pumping. V-A ECMO were initiated in 14 (70%) of patients. In-hospital mortality was 30% (6 patients, non-survivor group). All patients with non-survivor group were treated by V-A ECMO. Systolic blood pressure on admission in the non-survivor group was significantly lower than that in the survivor group (77 ± 17 vs. 107 ± 22 mmHg, p = 0.02). C-reactive protein (CRP) (8.3 ± 3.9 vs 3.6 ± 3.0 mg/dl, p = 0.01), creatinine (1.8 ± 1.0 vs 1.1 ± 0.3 mg/dl, p = 0.01), and creatine kinase (CK)-MB (156 ± 131 vs 70 ± 49 IU/L, p = 0.04) levels on admission were significantly higher in the non-survivor group than those in the survivor group. Peak CK-MB level was also higher in non-survivor group (677 ± 808 vs 74 ± 48 IU/L, p = 0.01). There was no significant difference of left ventricular ejection fraction on admission between the 2 groups. Ventricular tachycardia/fibrillation were more frequently observed in the non-survivor group during the clinical course (4 (67%) patients vs. 1 (7%) patient, p = 0.02).
Conclusions: Fulminant myocarditis was associated with high mortality rates despite mechanical circulatory support. Low systolic blood pressure, elevated CRP, creatinine, and CK-MB levels on admission, and lethal ventricular arrhythmia were associated with poor prognosis.
Author Disclosures: N. Nakayama: None. K. Hashiba: None. K. Iwata: None. M. Kiyokuni: None. N. Komura: None. M. Nitta: None. T. Sugano: None. K. Kimura: None.
- © 2016 by American Heart Association, Inc.