Abstract
Fulminant myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock, with mortality rates as high as 50%–70%. Most importantly, there are no treatment options, guidelines or an expert consensus statement. Here, we provide the first expert consensus, the Chinese Society of Cardiology Expert Consensus Statement on the Diagnosis and Treatment of Fulminant Myocarditis, based on data from our recent clinical trial (NCT03268642). In this statement, we describe the clinical features and diagnostic criteria of fulminant myocarditis, and importantly, for the first time, we describe a new treatment regimen termed life support-based comprehensive treatment regimen. The core content of this treatment regimen includes (i) mechanical life support (applications of mechanical respirators and circulatory support systems, including intraaortic balloon pump and extracorporeal membrane oxygenation, (ii) immunological modulation by using sufficient doses of glucocorticoid, immunoglobulin and (iii) antiviral reagents using neuraminidase inhibitor. The proper application of this treatment regimen may and has helped to save the lives of many patients with fulminant myocarditis.
Highlights
Adult fulminant myocarditis, diagnosis and treatment, expert consensus, life support-based comprehensive treatment regimen, cardiogenic shock, mechanical circulatory support
Myocarditis refers to inflammatory injuries caused by various pathogens that can result in dysfunction of the heart, such as decreased systolic or diastolic function and arrhythmias (Caforio et al, 2013; Caforio et al, 2017; Fung et al, 2016; Lazaros et al, 2017; Luyt et al, 2016; Pollack et al, 2015)
It is thought that when acute myocarditis shows a rapid onset and dramatically accelerated progress and a situation arises where patients with severe heart failure, hypotension, or cardiogenic shock must receive positive inotropic drugs and vasoactive agents or mechanical circulation assist device to maintain or save life, the condition may be called fulminant myocarditis
Summary
Chinese expert consensus statement on the diagnosis and treatment of fulminant myocarditis Daowen Wang1*, Sheng Li1, Jiangang Jiang, Jiangtao Yan, Chunxia Zhao, Yan Wang, Yexin Ma1, Hesong Zeng, Xiaomei Guo, Hong Wang, Jiarong Tang, Houjuan Zuo, Li Lin, Guanglin Cui; Section of Precision Medicine Group of Chinese Society of Cardiology, Editorial Board of Chinese Journal of Cardiology & Working Group of Adult Fulminant Myocarditis. Fulminant myocarditis is the most severe type of myocarditis and is characterized by sudden occurrence; rapid progress; hemodynamic dysfunction, such as pump failure and circulation failure that can develop very quickly; and respiratory, liver, or kidney failure which can occur simultaneously All these complications can result in a high mortality rate at the early stage of the disease (Ginsberg and Parrillo, 2013; Gupta et al, 2008; Maisch et al, 2014; McCarthy et al, 2000). Given the very high mortality and the severity of fulminant myocarditis, we have decided to comprehensively review existing publications and summarize our treatment experience in the last three years from registered open clinical trial in order to provide to practicing physicians an expert consensus on its clinical diagnosis and treatment We hope that this will improve treatment standards and greatly improve survival rates. Since viral infection is the dominant cause of fulminant myocarditis, and treatment of fulminant myocarditis resulting from other causes is similar except for antiviral use, this consensus statement is focused on viral fulminant myocarditis
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