{"title":"暴发性心肌炎患者静脉-动脉体外膜氧合支持术后早期恢复的预后因素。","authors":"Tomomi Ueda, Eisuke Amiya, Masaru Hatano, Kosuke Inoue, Junichi Ishida, Shun Minatsuki, Hiroki Yagi, Chie Bujo, Yoshitaka Isotani, Nobutaka Kakuda, Takanobu Yamada, Norifumi Takeda, Hiroshi Akazawa, Koshiro Kanaoka, Kenji Onoue, Yoshihiko Saito, Shungo Hikoso, Issei Komuro, Norihiko Takeda","doi":"10.1161/JAHA.124.039673","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Fulminant myocarditis is life-threatening and often requires mechanical circulatory support. Predicting its clinical course is crucial, yet data on early recovery predictors, particularly with veno-arterial extracorporeal membrane oxygenation, remain lacking.</p><p><strong>Methods and results: </strong>We aimed to identify prognostic factors of early recovery in fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation by retrospective analysis of a nationwide registry in Japan. Early recovery was defined as successful weaning from mechanical circulatory support within 7 days and discharge without heart transplantation or long-term mechanical circulatory support. A total of 343 patients were analyzed; 71 were classified as early recovery and 272 as nonearly recovery. The early recovery group was significantly younger, had higher white blood cell counts, and lower creatine kinase-myocardial band level than the nonearly recovery group. To enhance clinical interpretability, we dichotomized continuous variables using optimal cutoff values derived from the Youden index. Multivariable logistic regression analysis showed the independent factors of early recovery were age ≤40 years (odds ratio [OR], 3.25), white blood cell count ≥11 000/μL (OR, 3.10), and creatine kinase-myocardial band ≤61 U/L (OR, 2.46), and if all conditions were fulfilled, the early recovery rate increased to 61.5%. Additionally, although not statistically significant, the number of rehospitalization with cardiovascular causes, death, or heart transplantation at 1-year follow-up was higher in the nonearly recovery group.</p><p><strong>Conclusions: </strong>Our study suggested younger patients who have a strong inflammatory response but less myocardial damage on admission could recover earlier. Conversely, in cases where mechanical circulatory support duration is prolonged, careful monitoring is required for prolonged left ventricular dysfunction and subsequent prognosis.</p><p><strong>Registration: </strong>URL: https://www.umin.ac.jp/; Unique identifier: UMIN000039763.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039673"},"PeriodicalIF":5.0000,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prognostic Factors Associated With Early Recovery From Veno-Arterial Extracorporeal Membrane Oxygenation Support in Patients With Fulminant Myocarditis.\",\"authors\":\"Tomomi Ueda, Eisuke Amiya, Masaru Hatano, Kosuke Inoue, Junichi Ishida, Shun Minatsuki, Hiroki Yagi, Chie Bujo, Yoshitaka Isotani, Nobutaka Kakuda, Takanobu Yamada, Norifumi Takeda, Hiroshi Akazawa, Koshiro Kanaoka, Kenji Onoue, Yoshihiko Saito, Shungo Hikoso, Issei Komuro, Norihiko Takeda\",\"doi\":\"10.1161/JAHA.124.039673\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Fulminant myocarditis is life-threatening and often requires mechanical circulatory support. Predicting its clinical course is crucial, yet data on early recovery predictors, particularly with veno-arterial extracorporeal membrane oxygenation, remain lacking.</p><p><strong>Methods and results: </strong>We aimed to identify prognostic factors of early recovery in fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation by retrospective analysis of a nationwide registry in Japan. Early recovery was defined as successful weaning from mechanical circulatory support within 7 days and discharge without heart transplantation or long-term mechanical circulatory support. A total of 343 patients were analyzed; 71 were classified as early recovery and 272 as nonearly recovery. The early recovery group was significantly younger, had higher white blood cell counts, and lower creatine kinase-myocardial band level than the nonearly recovery group. To enhance clinical interpretability, we dichotomized continuous variables using optimal cutoff values derived from the Youden index. Multivariable logistic regression analysis showed the independent factors of early recovery were age ≤40 years (odds ratio [OR], 3.25), white blood cell count ≥11 000/μL (OR, 3.10), and creatine kinase-myocardial band ≤61 U/L (OR, 2.46), and if all conditions were fulfilled, the early recovery rate increased to 61.5%. Additionally, although not statistically significant, the number of rehospitalization with cardiovascular causes, death, or heart transplantation at 1-year follow-up was higher in the nonearly recovery group.</p><p><strong>Conclusions: </strong>Our study suggested younger patients who have a strong inflammatory response but less myocardial damage on admission could recover earlier. Conversely, in cases where mechanical circulatory support duration is prolonged, careful monitoring is required for prolonged left ventricular dysfunction and subsequent prognosis.</p><p><strong>Registration: </strong>URL: https://www.umin.ac.jp/; Unique identifier: UMIN000039763.</p>\",\"PeriodicalId\":54370,\"journal\":{\"name\":\"Journal of the American Heart Association\",\"volume\":\" \",\"pages\":\"e039673\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-06-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Heart Association\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/JAHA.124.039673\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/16 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Heart Association","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/JAHA.124.039673","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/16 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Prognostic Factors Associated With Early Recovery From Veno-Arterial Extracorporeal Membrane Oxygenation Support in Patients With Fulminant Myocarditis.
Background: Fulminant myocarditis is life-threatening and often requires mechanical circulatory support. Predicting its clinical course is crucial, yet data on early recovery predictors, particularly with veno-arterial extracorporeal membrane oxygenation, remain lacking.
Methods and results: We aimed to identify prognostic factors of early recovery in fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation by retrospective analysis of a nationwide registry in Japan. Early recovery was defined as successful weaning from mechanical circulatory support within 7 days and discharge without heart transplantation or long-term mechanical circulatory support. A total of 343 patients were analyzed; 71 were classified as early recovery and 272 as nonearly recovery. The early recovery group was significantly younger, had higher white blood cell counts, and lower creatine kinase-myocardial band level than the nonearly recovery group. To enhance clinical interpretability, we dichotomized continuous variables using optimal cutoff values derived from the Youden index. Multivariable logistic regression analysis showed the independent factors of early recovery were age ≤40 years (odds ratio [OR], 3.25), white blood cell count ≥11 000/μL (OR, 3.10), and creatine kinase-myocardial band ≤61 U/L (OR, 2.46), and if all conditions were fulfilled, the early recovery rate increased to 61.5%. Additionally, although not statistically significant, the number of rehospitalization with cardiovascular causes, death, or heart transplantation at 1-year follow-up was higher in the nonearly recovery group.
Conclusions: Our study suggested younger patients who have a strong inflammatory response but less myocardial damage on admission could recover earlier. Conversely, in cases where mechanical circulatory support duration is prolonged, careful monitoring is required for prolonged left ventricular dysfunction and subsequent prognosis.
期刊介绍：
As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice.
JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.
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