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Updated: Oct 9, 2025

Quantitative Visualization of Leukocyte Infiltrate in a Murine Model of Fulminant Myocarditis by Light Sheet Microscopy
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Quantitative Visualization of Leukocyte Infiltrate in a Murine Model of Fulminant Myocarditis by Light Sheet Microscopy

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Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics,

Yuxiao Hu1, Jie Ren2, Xueqi Dong1

  • 1Emergency and Critical Care Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

Frontiers in Cardiovascular Medicine
|December 20, 2021
PubMed

Insights

Fulminant giant cell myocarditis (FGCM) patients show milder inflammation and myocardial damage but a poorer prognosis than fulminant lymphocytic myocarditis (FLM) patients. High-sensitivity C-reactive protein (hs-CRP) levels can differentiate between FGCM and FLM and predict outcomes.

Area of Science:

  • Cardiology
  • Immunology
  • Pathology

Background:

  • Fulminant myocarditis (FM) is a severe, rapidly progressing, and often fatal cardiac condition that poses classification challenges.
  • Distinguishing between different subtypes of FM is crucial for accurate diagnosis and treatment planning.

Purpose of the Study:

  • To compare the clinical characteristics, treatment modalities, and patient outcomes in individuals diagnosed with fulminant giant cell myocarditis (FGCM) versus fulminant lymphocytic myocarditis (FLM).
  • To identify potential biomarkers for differentiating FGCM from FLM and predicting prognosis in FM patients.

Main Methods:

  • A retrospective analysis of 16 patients (9 FGCM, 7 FLM) diagnosed via histology over an 11-year period.
  • Comparison of clinical data, laboratory markers (including hs-CRP, CK-MB, ALT), echocardiographic parameters (RVEDD), and treatment interventions (IABP, ECMO).
  • Multivariate Cox regression analysis and receiver operating characteristic (ROC) curve analysis were employed to assess prognostic factors and diagnostic accuracy.

Main Results:

  • FGCM patients exhibited significantly lower levels of hs-CRP, CK-MB, and ALT, and a greater RVEDD compared to FLM patients.
  • Despite similar rates of mechanical circulatory support use, FGCM patients had a significantly lower long-term survival rate (0% vs. 71.4%).
  • Elevated hs-CRP levels were identified as an independent negative prognostic factor for FM, with an AUC of 0.94 for differentiating FGCM and FLM.

Conclusions:

  • The inflammatory response and myocardial injury are less pronounced in FGCM compared to FLM.
  • FGCM is associated with a significantly worse prognosis than FLM.
  • hs-CRP serves as a potential prognostic biomarker for FM and can aid in differentiating between FGCM and FLM, with a suggested cutoff of 11.71 mg/L.

Keywords:
fulminant myocarditisgiant cell myocarditisheart transplantationlymphocytic myocarditismyocardial biopsyoutcome

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