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European Heart Journal Advance Access originally published online on July 13, 2005
European Heart Journal 2005 26(20):2185-2192; doi:10.1093/eurheartj/ehi411
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Favourable clinical outcome in patients with cardiogenic shock due to fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation

Yasuhide Asaumi, Satoshi Yasuda, Isao Morii, Hiroyuki Kakuchi, Yoritaka Otsuka, Atsushi Kawamura, Yoshikado Sasako, Takeshi Nakatani, Hiroshi Nonogi and Shunichi Miyazaki*

Division of Cardiology and Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-0873, Japan

Received 31 March 2004; revised 17 May 2005; accepted 16 June 2005; online publish-ahead-of-print 13 July 2005.

* Corresponding author: Tel: +81 6 6833 5012; fax: +81 6 6872 7486. E-mail address: smiyazak{at}hsp.ncvc.go.jp

Aims The clinical outcome of severe acute myocarditis patients with cardiogenic shock who require circulatory support devices is not well known. We studied the survival and clinical courses of patients with fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation (ECMO) and compared them with those of patients with acute non-fulminant myocarditis.

Methods and results Patients with acute myocarditis were divided into the following two groups. Fourteen patients who required ECMO for cardiogenic shock were defined as having fulminant myocarditis (F group), whereas 13 patients who had an acute onset of symptoms, but did not have compromised, were defined as having acute non-fulminant myocarditis (NF group). In the F group, 10 patients were weaned successfully from percutaneous ECMO. Therefore, the overall acute survival rate was 71%. Patients who were not weaned from ECMO showed smaller left ventricular end-diastolic and end-systolic dimensions, thicker left ventricular wall, and higher creatine phosphokinase MB isoform levels than those who were weaned from ECMO. When compared with patients in the NF group, the fractional shortening in the F group was more severely decreased in the acute phase [F: 10±4 vs. NF: 23±8% (mean±SD), P<0.001], but recovered in the chronic phase (F: 33±7 vs. NF: 34±6%). The prevalence of adverse clinical events in both groups was similar during the follow-up period of 50 months.

Conclusion In patients with fulminant myocarditis, percutaneous ECMO is a highly effective form of a haemodynamic support. Once a patient recovers from inflammatory myocardial damage, the subsequent clinical outcome is favourable, similar to that observed in patients with acute non-fulminant myocarditis.

Key Words: Echocardiography • Extracorporeal circulation • Myocarditis • Shock


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