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Článek

PubMed

Záznam pochází z PubMed

Fulminant myocarditis proven by early biopsy and outcomes

European heart journal. 2023 Dec 21 ; 44 (48) : 5110-5124.

Eur Heart J
ISSN 1522-9645 | 0195-668X
Zdroj

Jazyk angličtina Země Anglie, Velká Británie Médium print

Typ dokumentu časopisecké články

Perzistentní odkaz https://www.medvik.cz/link/pmid37941449

PubMed 37941449
DOI 10.1093/eurheartj/ehad707
PII: 7370226
Knihovny.cz E-zdroje

Klíčová slova
ECMO, Endomyocardial biopsy, Fulminant myocarditis, Mechanical circulatory support, Outcome,
MeSH
biopsie metody MeSH
dospělí MeSH
lidé MeSH
magnetická rezonanční tomografie MeSH
myokard patologie MeSH
myokarditida * komplikace MeSH
retrospektivní studie MeSH
srdeční katetrizace MeSH
transplantace srdce * MeSH
Check Tag
dospělí MeSH
lidé MeSH
Publikační typ
časopisecké články MeSH

BACKGROUND AND AIMS: While endomyocardial biopsy (EMB) is recommended in adult patients with fulminant myocarditis, the clinical impact of its timing is still unclear. METHODS: Data were collected from 419 adult patients with clinically suspected fulminant myocarditis admitted to intensive care units across 36 tertiary centres in 15 countries worldwide. The diagnosis of myocarditis was histologically proven in 210 (50%) patients, either by EMB (n = 183, 44%) or by autopsy/explanted heart examination (n = 27, 6%), and clinically suspected cardiac magnetic resonance imaging confirmed in 96 (23%) patients. The primary outcome of survival free of heart transplantation (HTx) or left ventricular assist device (LVAD) at 1 year was specifically compared between patients with early EMB (within 2 days after intensive care unit admission, n = 103) and delayed EMB (n = 80). A propensity score-weighted analysis was done to control for confounders. RESULTS: Median age on admission was 40 (29-52) years, and 322 (77%) patients received temporary mechanical circulatory support. A total of 273 (65%) patients survived without HTx/LVAD. The primary outcome was significantly different between patients with early and delayed EMB (70% vs. 49%, P = .004). After propensity score weighting, the early EMB group still significantly differed from the delayed EMB group in terms of survival free of HTx/LVAD (63% vs. 40%, P = .021). Moreover, early EMB was independently associated with a lower rate of death or HTx/LVAD at 1 year (odds ratio of 0.44; 95% confidence interval: 0.22-0.86; P = .016). CONCLUSIONS: Endomyocardial biopsy should be broadly and promptly used in patients admitted to the intensive care unit for clinically suspected fulminant myocarditis.

Acute Cardiac Care Unit Department of Cardiology Hospital Marqués de Valdecilla Santander Spain

Acute Cardiovascular Care Unit Cardiology Departament de Medicina Hospital Germans Trias i Pujol Universitat Autònoma de Barcelona Spain

Adult Intensive Care Unit Queen Mary Hospital Hong Kong China

Advanced Heart Failure and Transplant Unit Department of Cardiology Hospital Universitario Puerta de Hierro Madrid Spain

Cardiology Department Complejo Hospitalario Universitario de A Coruña CIBERCV A Coruña Spain

Cardiovascular and Respiratory Physiology TechMed Center University of Twente Enschede The Netherlands

CHRU de NANCY Service de Médecine Intensive et Réanimation Inserm U1116 Université de Lorraine Nancy France

Columbia University College of Physicians and Surgeons NewYork Presbyterian Hospital and Center for Acute Respiratory Failure Columbia University Medical Center New York NY USA

De Gasperis Cardio Center and Transplant Center Niguarda Hospital Milan Italy

Departement of Infectious Diseases and Intensive Care Unit Pontchaillou Hospital Rennes 35200 France

Department of Anaesthesiology and Intensive Care General University Hospital Prague Czech Republic

Department of Anaesthesiology The University of Hong Kong Hong Kong China