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Cambios en la supervivencia y la función ventricular izquierda en miocarditis aguda fulminante versus no fulminante

Enrico Ammirati¹, Manlio Cipriani², Marzia Lilliu²

¹From Transplant Center and De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., M.C., M.L., M.V., A.G., F.M.T., M.F.); Cardiovascular Magnetic Resonance Unit (P.S., P.P., A.R.), Cardiovascular Imaging Service (A.M.), Cardiothoracic Anesthesiology Unit (M.B., M.P.G., M.M.), Cardiac Surgery Unit (C.F.R.), and Coronary Care Unit (F.O.), De Gasperis Cardio Center, and Pathology Laboratories (D.P., E.B.), Niguarda Hospital, Milan, Italy; Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (C.R., S.G.); Cardiac Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo and the University of Pavia, Italy (R.T.); and Vita Salute University and San Raffaele Hospital, Milan, Italy (P.G.C.). enrico.ammirati@ospedaleniguarda.it camici.paolo@hsr.it.

|June 4, 2017

Resumen

Los pacientes con miocarditis fulminante (FM) se enfrentan a una mayor mortalidad y necesidades de trasplante de corazón que los pacientes con miocarditis no fulminante (NFM). A pesar de la recuperación inicial, los pacientes con FM muestran una fracción de eyección ventricular inferior izquierda persistente a largo plazo.

Área de la Ciencia:

Cardiología
Médico interno
Patología

Sus antecedentes:

Estudios anteriores sugirieron mejores resultados para la miocarditis fulminante (FM) a pesar de su presentación severa.
Este estudio analiza retrospectivamente los resultados y los cambios en la fracción de eyección ventricular izquierda (LVEF) en FM frente a la miocarditis aguda no fulminante (NFM).

Objetivo del estudio:

Para comparar los resultados clínicos y los cambios en el LVEF entre los pacientes con FM y NFM.
Investigar el pronóstico a largo plazo y la recuperación funcional en diferentes formas de miocarditis aguda.

Principales métodos:

Análisis retrospectivo de 187 pacientes consecutivos con miocarditis aguda (55 FM, 132 NFM).
Subanálisis de 130 pacientes adultos con miocarditis viral aguda.
Se excluyen los tipos específicos de miocarditis (células gigantes, eosinofílica, sarcoidosis) y los pacientes menores de 15 años.

Principales resultados:

Los pacientes con FM presentaron tasas significativamente más altas de muerte hospitalaria o trasplante de corazón (25,5% frente a 0%) y una menor supervivencia a los 9 años (64,5% frente a 100%).
La FM mostró una mayor mejora de la FEV durante la hospitalización (32% frente a 3%), pero la FEV se mantuvo más baja en el seguimiento (29% frente a 9% con FEV < 55%).
Se observaron tendencias similares en el subgrupo de la miocarditis viral, contradiciendo los hallazgos anteriores.

Conclusiones:

La miocarditis fulminante se asocia con un aumento de la mortalidad y las tasas de trasplante cardíaco en comparación con la FMN.
Los pacientes con fibromialgia experimentan un deterioro inicial de LVEF más severo, con un LVEF persistentemente más bajo en el seguimiento a largo plazo a pesar de una mejora significativa.
Estos hallazgos ponen de relieve un pronóstico más pobre para la FM que el reportado anteriormente, incluso en casos virales.

Palabras clave:

oxigenación de la membrana extracorpórea Inmunodepresión imágenes por resonancia magnética Miocarditis en el corazón resultado del tratamiento

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