Long-term left ventricular ejection function in fulminant and non-fulminant myocarditis: A multicenter study in...

Area of Science:

• Cardiology
• Internal Medicine
• Critical Care Medicine

Background:

• A knowledge gap exists in comparing left ventricular ejection fraction (LVEF) changes between fulminant myocarditis (FM) and non-FM (NFM) patients.
• Acute myocarditis diagnosis is often confirmed via endomyocardial biopsy (EMB) or cardiac magnetic resonance imaging (CMR).

Purpose of the Study:

• To compare LVEF changes over time in FM versus NFM patients.
• To evaluate the impact of mechanical circulatory support on LVEF in FM patients.

Main Methods:

• A multicenter retrospective study included 324 patients with confirmed acute myocarditis.
• Mixed-effects models and multi-model adjustment were used to analyze LVEF changes.
• Sensitivity analysis was performed on patients aged 15 years and older.

Main Results:

• FM patients had a significantly higher risk of low LVEF (<55%) at follow-up compared to NFM patients (OR=7.438, P<0.001).
• NFM patients demonstrated superior LVEF compared to FM patients across all follow-up intervals.
• Early use of intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) was associated with improved LVEF in FM patients (OR=0.030, P=0.001 for IABP; OR=0.339, P=0.030 for ECMO).

Conclusions:

• Fulminant myocarditis is associated with persistently lower LVEF compared to non-fulminant myocarditis.
• Early implementation of IABP and ECMO may improve long-term LVEF outcomes in patients with FM.