Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis
Enrico Ammirati1, Manlio Cipriani2, Marzia Lilliu2
1From Transplant Center and De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., M.C., M.L., M.V., A.G., F.M.T., M.F.); Cardiovascular Magnetic Resonance Unit (P.S., P.P., A.R.), Cardiovascular Imaging Service (A.M.), Cardiothoracic Anesthesiology Unit (M.B., M.P.G., M.M.), Cardiac Surgery Unit (C.F.R.), and Coronary Care Unit (F.O.), De Gasperis Cardio Center, and Pathology Laboratories (D.P., E.B.), Niguarda Hospital, Milan, Italy; Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (C.R., S.G.); Cardiac Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo and the University of Pavia, Italy (R.T.); and Vita Salute University and San Raffaele Hospital, Milan, Italy (P.G.C.). enrico.ammirati@ospedaleniguarda.it camici.paolo@hsr.it.
Fulminant myocarditis (FM) patients face higher mortality and heart transplant needs than non-fulminant myocarditis (NFM) patients. Despite initial recovery, FM patients show persistently lower left ventricular ejection fraction (LVEF) long-term.
Area of Science:
- Cardiology
- Internal Medicine
- Pathology
Background:
- Previous studies suggested better outcomes for fulminant myocarditis (FM) despite severe presentation.
- This study retrospectively analyzes outcomes and left ventricular ejection fraction (LVEF) changes in FM versus acute non-fulminant myocarditis (NFM).
Purpose of the Study:
- To compare the clinical outcomes and LVEF changes between patients with FM and NFM.
- To investigate long-term prognosis and functional recovery in different forms of acute myocarditis.
Main Methods:
- Retrospective analysis of 187 consecutive acute myocarditis patients (55 FM, 132 NFM).
- Subanalysis of 130 adult patients with acute viral myocarditis.
- Exclusion of specific myocarditis types (giant-cell, eosinophilic, sarcoidosis) and patients under 15.
Main Results:
- FM patients had significantly higher in-hospital death or heart transplantation rates (25.5% vs 0%) and lower 9-year survival (64.5% vs 100%).
- FM showed greater LVEF improvement during hospitalization (32% vs 3%), but LVEF remained lower at follow-up (29% vs 9% with LVEF <55%).
- Similar trends were observed in the viral myocarditis subgroup, contradicting previous findings.
Conclusions:
- Fulminant myocarditis is associated with increased mortality and heart transplantation rates compared to NFM.
- FM patients experience more severe initial LVEF impairment, with persistently lower LVEF at long-term follow-up despite significant improvement.
- These findings highlight a poorer prognosis for FM than previously reported, even in viral cases.
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