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Fulminant Versus Acute Nonfulminant Myocarditis in Patients With Left Ventricular Systolic Dysfunction

Ammirati, Enrico ; Veronese, Giacomo ; Brambatti, Michela ; Merlo, Marco ; Cipriani, Manlio ; Potena, Luciano ; Sormani, Paola ; Aoki, Tatsuo ; Sugimura, Koichiro ; Sawamura, Akinori ; Okumura, Takahiro ; Pinney, Sean ; Hong, Kimberly ; Shah, Palak ; Braun, Öscar ; Van de Heyning, Caroline M. ; Montero, Santiago ; Petrella, Duccio ; Huang, Florent ; Schmidt, Matthieu ; Raineri, Claudia ; Lala, Anuradha ; Varrenti, Marisa ; Foà, Alberto ; Leone, Ornella ; Gentile, Piero ; Artico, Jessica ; Agostini, Valentina ; Patel, Rajiv ; Garascia, Andrea ; Van Craenenbroeck, Emeline M. ; Hirose, Kaoru ; Isotani, Akihiro ; Murohara, Toyoaki ; Arita, Yoh ; Sionis, Alessandro ; Fabris, Enrico ; Hashem, Sherin ; Garcia-Hernando, Victor ; Oliva, Fabrizio ; Greenberg, Barry ; Shimokawa, Hiroaki ; Sinagra, Gianfranco ; Adler, Eric D. ; Frigerio, Maria ; Camici, Paolo G.

Journal of the American College of Cardiology, 2019-07, Vol.74 (3), p.299-311 [Periódico revisado por pares]

United States: Elsevier Inc

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Título:
Fulminant Versus Acute Nonfulminant Myocarditis in Patients With Left Ventricular Systolic Dysfunction
Autor: Ammirati, Enrico ; Veronese, Giacomo ; Brambatti, Michela ; Merlo, Marco ; Cipriani, Manlio ; Potena, Luciano ; Sormani, Paola ; Aoki, Tatsuo ; Sugimura, Koichiro ; Sawamura, Akinori ; Okumura, Takahiro ; Pinney, Sean ; Hong, Kimberly ; Shah, Palak ; Braun, Öscar ; Van de Heyning, Caroline M. ; Montero, Santiago ; Petrella, Duccio ; Huang, Florent ; Schmidt, Matthieu ; Raineri, Claudia ; Lala, Anuradha ; Varrenti, Marisa ; Foà, Alberto ; Leone, Ornella ; Gentile, Piero ; Artico, Jessica ; Agostini, Valentina ; Patel, Rajiv ; Garascia, Andrea ; Van Craenenbroeck, Emeline M. ; Hirose, Kaoru ; Isotani, Akihiro ; Murohara, Toyoaki ; Arita, Yoh ; Sionis, Alessandro ; Fabris, Enrico ; Hashem, Sherin ; Garcia-Hernando, Victor ; Oliva, Fabrizio ; Greenberg, Barry ; Shimokawa, Hiroaki ; Sinagra, Gianfranco ; Adler, Eric D. ; Frigerio, Maria ; Camici, Paolo G.
Assuntos: Acute Disease ; acute myocarditis ; Adult ; Autoimmune diseases ; Biopsy ; Cardiac and Cardiovascular Systems ; Cardiology ; Clinical Medicine ; Death ; endomyocardial biopsy ; eosinophilic myocarditis ; Female ; fulminant myocarditis ; giant cell myocarditis ; Heart ; Heart diseases ; Heart transplantation ; Humans ; Kardiologi ; Klinisk medicin ; Leukocytes (eosinophilic) ; Life Sciences ; Male ; Medical and Health Sciences ; Medical research ; Medicin och hälsovetenskap ; Middle Aged ; Mortality ; Multivariate analysis ; Myocarditis ; Myocarditis - complications ; Myocarditis - pathology ; outcome ; Patients ; Population ; Prognosis ; Retrospective Studies ; Sarcoidosis ; Severity of Illness Index ; Signs and symptoms ; Transplantation ; Ventricle ; Ventricular Dysfunction, Left - complications
É parte de: Journal of the American College of Cardiology, 2019-07, Vol.74 (3), p.299-311
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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Descrição: 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. 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. 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. 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). 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. [Display omitted]
Editor: United States: Elsevier Inc
Idioma: Inglês

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Fulminant Versus Acute Nonfulminant Myocarditis in Patients With Left Ventricular Systolic Dysfunction

United States: Elsevier Inc

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