Identifying different phenotypes in acute fulminant myocarditis patients treated with venoarterial extracorporeal...

The timing and management of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adult acute fulminant myocarditis (AFM) patients remain unclear, highlighting the need for research on patient heterogeneity and potential subgroups. To address this, we used latent class analysis (LCA) to identify different clinical phenotypes in a single-center cohort of AFM patients treated with VA-ECMO.

We reviewed 55 VA-ECMO-treated AFM patients admitted to Zhongshan People's Hospital from May 1, 2003 to January 1, 2022. We performed LCA using patient demographics, treatment regimens and prognostic factors: age, sex, comorbidities, complications, drug therapy, mechanical assisted therapy, lactate level, myocardial enzyme profile level, aortic valve non opening, mean arterial pressure (MAP), left ventricular ejection fraction (LVEF), the timing of VA-ECMO initiation. Three patient clusters were identified: C1 (n = 20) had the earliest time from admission to VA-ECMO initiation (4.78 ± 2.76 h); C2 (n = 9) exhibited the highest lactate level (17.05 ± 8.16 mmol/L), and the most frequent aortic valve non-opening rate (88.9 %); C3 (n = 26) was characterized by the highest LVEF (0.28 ± 0.07) and MAP (54.34 ± 9.62 mmHg). Among all clusters, C2 had the highest in-hospital mortality (66.7 %), whereas C3 had the lowest (3.8 %).

Using LCA, we identified three clinical phenotypes of AFM patients treated with VA-ECMO. These may reflect different pathophysiological processes in this patient population. Our findings may help identify treatment targets and select patients for future clinical trials.