Characteristics of histologically proven fulminant myocarditis managed with venoarterial extracorporeal membrane oxygenation: A post-hoc analysis of a Japanese nationwide study.
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引用次数: 0
Abstract
Background: Characteristics of histologically proven fulminant myocarditis (FM) managed with venoarterial extracorporeal membrane oxygenation (VA-ECMO) remain poorly understood. We aimed to identify factors associated with receiving VA-ECMO in patients with FM and with a composite endpoint (90-day mortality or heart transplantation) among VA-ECMO recipients.
Methods: This study used data from the Japanese Registry of Fulminant Myocarditis in a nationwide retrospective cohort of patients with histologically proven FM. Given the competing risk of death, admission factors associated with receiving VA-ECMO were analyzed using the Fine and Gray model. Among VA-ECMO recipients, factors associated with the composite endpoint were assessed by Cox proportional hazards regression.
Results: Of 337 patients (median age, 54 years; 40 % female), 177 (53 %) received VA-ECMO. The composite endpoint occurred in 44 % of VA-ECMO recipients, consisting entirely of mortality events. Female sex [subdistribution hazard ratio (SHR), 1.36; 95 % confidence interval (CI), 1.002-1.84], left ventricular ejection fraction <30 % (SHR, 1.66; 95 % CI, 1.21-2.28), ventricular tachycardia or ventricular fibrillation (SHR, 2.25; 95 % CI, 1.61-3.14), use of more vasopressors and inotropes (SHR, 1.28; 95 % CI, 1.10-1.48), or lactate level ≥ 2 mmol/L (adjusted risk ratio, 1.61; 95 % CI, 1.03-2.51) were associated with a higher risk of receiving VA-ECMO. Among VA-ECMO recipients, older age (HR, 1.20; 95 % CI, 1.0001-1.43), higher peak creatine kinase-MB level (HR, 1.24; 95 % CI, 1.13-1.36), and giant cell myocarditis (HR, 3.71; 95 % CI, 1.63-8.45) were associated with a higher risk of 90-day mortality.
Conclusions: This study characterized key factors associated with receiving VA-ECMO and 90-day mortality among VA-ECMO recipients, enhancing understanding of patient profiles and clinical courses in this high-risk population.
期刊介绍：
The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.
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