Introduction: Fulminant myocarditis (FM) is a severe and rapidly progressive cardiac inflammatory disease which has historically high mortality rates of >50%. However, recent improvements in treatment options, especially in mechanical circulatory support (MCS), have significantly enhanced survival rates (1,2).
Patients and Methods: We retrospectively analyzed data from patients who required MCS for FM from the beginning of 2023 to the present. We used descriptive statistical methods to analyze demographic and epidemiological data, treatment options, laboratory data and outcomes.
Results: Since the beginning of 2023, eight patients admitted for FM required MCS. 50% were male, median age 40 years (range 18 – 55 years). The cause of FM was Influenza in 4 cases, SARS-CoV-2 in 1 case, S. pyogenes in 1 case, while the etiology remains unknown in 2 cases. Before the initiation of MCS, median lactates were 10.55 mmol/L (range 2 – 13.6 mmol/L) and median mean arterial pressure was 68.5 mmHg (range 45 – 85 mmHg). All patients were on inotropic support with dobutamine (median dose 9.72 mcg/kg/min, range 4.48 – 16.6mcg/kg/min) and two received additional milrinone at a dose of 0.5 mcg/kg/min. Four patients required support with norepinephrine (median dose 0.26 mcg/kg/min, range 0.11 – 0.4 mcg/kg/min) and two required additional support with argipressin and angiotensin II. Upon admission, laboratory findings showed a median NT-proBNP of 18,069 ng/L (range 3,373–25,252 ng/L), median troponin I of 3,929.5 ng/L (range 8.5–>50,000 ng/L), and median CRP of 69.3 mg/L (range 2.60–268.7 mg/L). Three patients were placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO) for transport to University Hospital Center Zagreb. In total, 6 patients required VA-ECMO support, of whom 4 needed left ventricular unloading (2 with Impella and 2 with ProtekSolo), and 2 required reconfiguration of the ECMO circuit to VAV ECMO due to poor oxygenation. One patient was solely on Impella CP support, and one patient was solely on VV ECMO support. Median MCS support time was 216 hours (range 98 – 480 hours). All patients were successfully weaned from MCS, although one patient died due to MCS complications. In one case, heart function did not recover, leading to the implantation of long-term MCS. Full patients’ data are shown inTable 1 andFigure 1.
Conclusion: Our data support the finding that MCS should be considered in FM and that MCS can be associated with promising results.