Favourable clinical outcome in patients with cardiogenic shock due to fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation

Yasuhide Asaumi, Satoshi Yasuda, Isao Morii, Hiroyuki Kakuchi, Yoritaka Otsuka, Atsushi Kawamura, Yoshikado Sasako, Takeshi Nakatani, Hiroshi Nonogi, Shunichi Miyazaki

Research output: Contribution to journalArticlepeer-review

134 Citations (Scopus)

Abstract

Aims: The clinical outcome of severe acute myocarditis patients with cardiogenic shock who require circulatory support devices is not well known. We studied the survival and clinical courses of patients with fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation (ECMO) and compared them with those of patients with acute non-fulminant myocarditis. Methods and results: Patients with acute myocarditis were divided into the following two groups. Fourteen patients who required ECMO for cardiogenic shock were defined as having fulminant myocarditis (F group), whereas 13 patients who had an acute onset of symptoms, but did not have compromised, were defined as having acute non-fulminant myocarditis (NF group). In the F group, 10 patients were weaned successfully from percutaneous ECMO. Therefore, the overall acute survival rate was 71%. Patients who were not weaned from ECMO showed smaller left ventricular end-diastolic and end-systolic dimensions, thicker left ventricular wall, and higher creatine phosphokinase MB isoform levels than those who were weaned from ECMO. When compared with patients in the NF group, the fractional shortening in the F group was more severely decreased in the acute phase [F: 10±4 vs. NF: 23 ± 8% (mean ± SD), P < 0.001], but recovered in the chronic phase (F: 33±7 vs. NF: 34 ± 6%). The prevalence of adverse clinical events in both groups was similar during the follow-up period of 50 months. Conclusion: In patients with fulminant myocarditis, percutaneous ECMO is a highly effective form of a haemodynamic support. Once a patient recovers from inflammatory myocardial damage, the subsequent clinical outcome is favourable, similar to that observed in patients with acute non-fulminant myocarditis.

Original languageEnglish
Pages (from-to)2185-2192
Number of pages8
JournalEuropean Heart Journal
Volume26
Issue number20
DOIs
Publication statusPublished - 2005 Oct
Externally publishedYes

Keywords

  • Echocardiography
  • Extracorporeal circulation
  • Myocarditis
  • Shock

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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