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Cited by 69Viral Infections and Immunology ResearchTakotsubo Cardiomyopathy and Associated PhenomenaMechanical Circulatory Support Devices

Fulminant myocarditis proven by early biopsy and outcomes

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Huang, Florent, Ammirati, Enrico, Ponnaiah, Maharajah, Montero, Santiago, Raimbault, Victor, Abrams, Darryl, Lebreton, Guillaume, Pellegrino, Vincent +85 more·2023·European Heart Journal
DOI 10.1093/eurheartj/ehad707
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Abstract

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.

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  • Prompt EMB is important in patients with fulminant myocarditis.

    “highlighting the importance of prompt EMB in patients with fulminant myocarditis.”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [248]

  • In 419 adults with clinically suspected fulminant myocarditis, early EMB within 2 days of intensive care admission was associated with reduced rates of death, heart transplantation, and LV device implantation at 1 year compared with delayed EMB.

    “recent multicenter data involving 419 adults with clinically suspected fulminant myocarditis demonstrated that early EMB, within 2 days of intensive care admission, was associated with reduced rates of death, heart transplantation, and L V device implantation at 1 year compared with delayed EMB”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [248]

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Authors
Huang, F., Ammirati, E., Ponnaiah, M., Montero, S., Raimbault, V., Abrams, D., Lebreton, G., Pellegrino, V., Ihle, J., Bottiroli, M., Persichini, R., Barrionuevo-Sánchez, M. I., Ariza-Solé, A., Ng, P. Y., Sin, S. W. C., Ayer, R., Buscher, H., Belaid, S., Delmas, C., Ferreira, R., Roncon-Albuquerque, R., López-Sobrino, T., Bunge, J. J. H., Fisser, C., Franchineau, G., McCanny, J., Ohshimo, S., Sionis, A., Hernández-Pérez, F. J., Barge-Caballero, E., Balik, M., Muglia, H., Park, S., Donker, D. W., Porral, B., Aïssaoui, N., Mekontso Dessap, A., Burgos, V., Lesouhaitier, M., Fried, J., Jung, J.-S., Rosillo, S., Scherrer, V., Nseir, S., Winszewski, H., Jorge-Pérez, P., Kimmoun, A., Diaz, R., Combes, A., Schmidt, M., for the FULLMOON Study Group, Huang, F., Kerneis, M., Montalescot, G., Collet, J. P., Delmas, C., Belaid, S., Lavie-Badie, Y., Biendel, C., Lesouhaitier, M., Tadié, J.-M., Scherrer, V., Barge-Caballero, E., Blanco-Canosa, P., Grille-Cancela, Z., Porral, B., Raposeiras, S., Rosillo, S., López-de-Sá, E., Sionis, A., Hernando, V. G., López-Sobrino, T., Riba, R. A., Sandoval, E., Burgos, V., Lera, M. R., Alvarez, A. C., Bustamante, C. C., Martínez, N. R., Martín, P. J.-P., García-González, J., Martín-Cabeza, M. M., Miranda, D. R., Bunge, J. J. H., Caliskan, K., Fried, J., Ching, S. S. W., Jung, J.-S., Kim, J., Shin, H. J., Ohshimo, S., Kikutani, K., & Shime, N.
Affiliations
  • Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
  • Pitié-Salpêtrière Hospital (FR)
  • Universitat Autònoma de Barcelona (ES)
  • Assistance Publique – Hôpitaux de Paris (FR)
  • NewYork–Presbyterian Hospital (US)
  • Sorbonne Université (FR)
  • The Alfred Hospital (AU)
  • Centre Hospitalier Universitaire de La Réunion (RE)
  • Bellvitge University Hospital (ES)
  • Intensive Cardiac Care Unit, Cardiology Department, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Bellvitge University Hospital , L'Hospitalet de Llobregat , Barcelona, Spain
  • Queen Mary Hospital (CN)
  • Department of Anaesthesiology, The University of Hong Kong , Hong-Kong , China
  • St Vincent's Hospital Sydney (AU)
  • Intensive Care Unit, Saint João Hospital , Porto , Portugal
  • University Hospital Regensburg (DE)
  • Guy's and St Thomas' NHS Foundation Trust (GB)
  • Hospital Universitario Puerta de Hierro Majadahonda (ES)
  • Department of Anaesthesiology and Intensive Care, General University Hospital , Prague , Czech Republic
  • Erasmus Hospital (BE)
  • Hallym University Sacred Heart Hospital (KR)
  • University Medical Center Utrecht (NL)
  • Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Mondor Hospital , Créteil , France
  • Centre National de la Recherche Scientifique (FR)
  • Centre Hospitalier Universitaire de Besançon (FR)
  • Department of Cardiology, Hospital Universitario de Canarias Nuestra Señora de Candelaria , Canary Islands , Tenerife, Spain
  • Inserm (FR)
  • Department of Cardiology, Clínica Las Condes , Las Condes , Chile
  • Hôpital Foch (FR)
  • Hôpital Rangueil (FR)
  • Hôpital Pontchaillou (FR)
  • Hospital Clínic de Barcelona (ES)
  • Erasmus MC (NL)
  • Hiroshima University (JP)
ORCID
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2023-11-06
Volume
44
Issue
48
Pages
5110-5124
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehad707
OpenAlex
W4388539915
Cited by
69
References
5
Citations by year
2026: 25 · 2025: 31 · 2024: 10 · 2023: 3
FWCI
13.58
Type
journal article
Language
en
Open access
Licence
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations
  • European Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
  • HAL (submittedVersion)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • The HKU Scholars Hub (University of Hong Kong) (submittedVersion, cc-by-nc-nd)
  • University of Twente Research Information (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
  • Physical Sciences › Engineering › Biomedical Engineering › Mechanical Circulatory Support Devices
Keywords
fulminant myocarditis, endomyocardial biopsy, biopsy timing, early diagnosis, heart transplantation, left ventricular assist device, mechanical circulatory support, intensive care unit admission, survival outcomes, cardiac magnetic resonance imaging
MeSH terms
Adult, Biopsy, Cardiac Catheterization, Humans, Magnetic Resonance Imaging, Myocarditis, Myocardium, Retrospective Studies, Heart Transplantation

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