Association Between Vasoactive Inotropic Score and Clinical Outcomes in Patients With Fulminant Myocarditis

This study aimed to evaluate the prognostic value of the vasoactive inotropic score (VIS) in patients with fulminant myocarditis according to the application of venoarterial-extracorporeal membrane oxygenation (VA-ECMO).

This study retrospectively analyzed 417 patients with biopsy-proven or clinically suspected fulminant myocarditis from 7 hospitals in Korea. The primary outcome was a composite of all-cause death, heart transplantation, or the use of left ventricular assist device (LVAD) at 1 year.

The median VIS was 19.9, and 217 (52.0%) patients received VA-ECMO. The primary outcome occurred in 105 patients (26.7%). All-cause death, heart transplantation, and the implantation of LVAD occurred in 81 (20.7%), 30 (8.7%), and 1 (0.3%) patients, respectively. VIS was associated with the risk of the primary outcome in both patients treated with VA-ECMO (hazard ratio [HR], 1.017 for every 10-point increase; 95% confidence interval [CI], 1.007-1.028; p=0.001) and patients without VA-ECMO (HR, 1.128 for every 10-point increase; 95% CI, 1.079-1.179; p<0.001), but the effect was greater in patients without who did not receive VA-ECMO (interaction p<0.001). Furthermore, the predictive performance of VIS for the primary outcome was significantly lower in patients with VA-ECMO than in those without VA-ECMO (C-index, 0.555 vs. 0.780; p value for C-index comparison, 0.002).

In patients with fulminant myocarditis, the prognostic value of VIS was more prominent in patients without VA-ECMO than in patients with VA-ECMO. These findings suggest that the prognostic value of VIS is weakened under the influence of VA-ECMO.

ClinicalTrials.gov Identifier: NCT05933902.