Fulminant Versus Acute Nonfulminant Myocarditis in Patients With Left Ventricular Systolic Dysfunction

Ammirati, Enrico; Veronese, Giacomo; Brambatti, Michela; Merlo, Marco; Cipriani, Manlio; Potena, Luciano; Scocco, Paola; Aoki, Tatsuo; Sugimura, Koichiro; Sawamura, Akinori; Okumura, Takahiro; Pinney, Sean; Hong, Kimberly N.; Shah, Palak; Braun, Öscar; Heyning, Caroline M. Van De; Montero, Santiago; Petrella, Duccio; Huang, Florent; Schmidt, Matthieu; Raineri, Claudia; Lala, Anuradha; Varrenti, Marisa; Foà, Alberto; Leone, Ornella; Gentile, Piero; Artico, Jessica; Agostini, Valentina; Patel, Ravi; Garascia, Andrea; Craenenbroeck, Emeline M. Van; Hirose, Kaoru; Isotani, Akihiro; Murohara, Toyoaki; Arita, Yoh; Sionís, Alessandro; Fabris, Enrico; Hashem, Sherin I.; García-Hernando, Victor; Oliva, Fabrizio; Greenberg, Barry D.; Shimokawa, Hiroaki; Sinagra, Gianfranco; Adler, Eric; Frigerio, Maria; Camici, Paolo G.

doi:10.1016/j.jacc.2019.04.063

Cited by 163 publications

(220 citation statements)

References 32 publications

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“…The mortality rate of FM ranges from 40 to 70% in most centers [17,21]. The current Chinese publication on "Life support-based comprehensive treatment regimen" demonstrated a mortality rate of less than 5% [22].…”

Section: Viral Fulminant Myocarditismentioning

confidence: 99%

SARS-CoV-2: a potential novel etiology of fulminant myocarditis

Chen

Zhou

Wang

2020

Herz

336

303

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Section: Viral Fulminant Myocarditismentioning

confidence: 99%

SARS-CoV-2: a potential novel etiology of fulminant myocarditis

Chen

Zhou

Wang

2020

Herz

336

303

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“…1 Prognostic differences have been suggested on the basis of initial presentation of myocarditis, with patients in fulminant myocarditis and histologically proven GCM both highly associated with short-term mortality. 2 Early reports of GCM demonstrated survival rates around 5 1/2 months after diagnosis; however, modern reports have shown 5 year survival free from death or heart transplant of 52-72% with immunosuppression. [3][4][5] Some patients respond to immunosuppression; many require transplantation for long-term survival.…”

Section: Introductionmentioning

confidence: 99%

“…Severe, rapidly progressive heart failure in young to middle‐aged adults characterizes the most frequently reported presentation of GCM . Prognostic differences have been suggested on the basis of initial presentation of myocarditis, with patients in fulminant myocarditis and histologically proven GCM both highly associated with short‐term mortality . Early reports of GCM demonstrated survival rates around 5 1/2 months after diagnosis; however, modern reports have shown 5 year survival free from death or heart transplant of 52–72% with immunosuppression .…”

Section: Introductionmentioning

confidence: 99%

A giant mystery in giant cell myocarditis: navigating diagnosis, immunosuppression, and mechanical circulatory support

et al. 2019

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Giant cell myocarditis is a rare but often devastating diagnosis. Advances in cardiac imaging and mechanical circulatory support have led to earlier and more frequent diagnoses and successful management. This disease state has wide variation in acuity of presentation, and consequently, optimal treatment ranging from intensity and type of immunosuppression to mechanical circulatory support is not well defined. The following case describes the management of a patient with an unusual presentation of giant cell myocarditis over a 10 year course of advanced heart failure therapies and immunomodulatory support. This case highlights emerging concepts in the management of giant cell myocarditis including sub‐acute presentations, challenges in diagnosis, and treatment modalities in the modern era.

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“…4 Even in patients with lymphocytic myocarditis, which is considered as more benign variant of FM, event rates are still high especially if associated with LV dysfunction or ventricular tachyarrhythmia. 5 Early institution of MCS and early myocardial biopsy to ascertain prognosis and to guide immunosuppression is critical to successful management of FM. 3,6 While the role of immunosuppression in lymphocytic FM is not yet fully defined due to lack of randomized human studies, it may be considered if acute viral infection in the biopsy is ruled out and if there is high likelihood of autoimmune aetiology, for example in patients with pre-existing autoimmune disease.…”

Section: Discussionmentioning

confidence: 99%

Complete recovery of fulminant cytotoxic CD8 T‐cell‐mediated myocarditis after ECMELLA unloading and immunosuppression

et al. 2020

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A 19-year-old woman with no previous cardiac history was admitted to the hospital with third-degree atrioventricular block and left ventricular dysfunction. Her condition quickly deteriorated to severe biventricular failure and cardiogenic shock requiring mechanical circulatory support. An endomyocardial biopsy revealed lymphocytic myocarditis with no PCR-detectable viral genomes, with CD8 T-cell predominance and pro-inflammatory macrophage expansion shown by myocardial flow cytometry. The therapy consisted of immunosuppression (high-dose methylprednisolone) and temporary mechanical circulatory support with enhanced ability to achieve left ventricular unloading by combination of extracorporeal membrane oxygenation with Impella (ECMELLA). After 2 weeks of support, complete and sustained recovery from myocarditis was observed.

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Fulminant Versus Acute Nonfulminant Myocarditis in Patients With Left Ventricular Systolic Dysfunction

Cited by 163 publications

References 32 publications

SARS-CoV-2: a potential novel etiology of fulminant myocarditis

SARS-CoV-2: a potential novel etiology of fulminant myocarditis

A giant mystery in giant cell myocarditis: navigating diagnosis, immunosuppression, and mechanical circulatory support

Complete recovery of fulminant cytotoxic CD8 T‐cell‐mediated myocarditis after ECMELLA unloading and immunosuppression

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