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

Guangling Li1, Jing Zhang2, Zheng Xu3

  • 1Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China.

International Journal of Cardiology. Heart & Vasculature
|July 18, 2025
PubMed

Insights

Fulminant myocarditis (FM) patients have significantly lower left ventricular ejection fraction (LVEF) than non-FM patients. Early use of intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) improves LVEF in FM patients.

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.
Abstract

Keywords:
Endomyocardial biopsyFulminant myocarditisLeft ventricular ejection fractionNon-fulminant myocarditisTroponin

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