Efficacy of Steroid Therapy in Preventing Adverse Clinical Outcomes in Patients with Fulminant Myocarditis Requiring Mechanical Circulatory Support

There is limited data about the efficacy of steroid therapy in preventing adverse clinical outcomes in fulminant myocarditis requiring mechanical circulatory support (MCS). This study aimed to evaluate the clinical impact of steroid therapy on adverse outcomes in patients with fulminant myocarditis requiring MCS. We enrolled 31 patients with fulminant myocarditis requiring MCS: 10 received steroid therapy (steroid-treated group) and 21 did not (non-treated group). Transthoracic echocardiographic parameters (LVEF, LVDd, and LVDs) and serum biomarkers (NT-proBNP and troponin) were compared between the 2 groups. The composite endpoint was defined as all-cause mortality, initiation of a ventricular assist device, or intracranial hemorrhage leading to discontinuation of MCS. Baseline echocardiographic parameters and levels of serum biomarkers at admission did not significantly differ between the 2 groups ( P > 0.05). LVEF improved significantly from admission to discharge in both groups (steroid-treated group: 21 ± 11% to 60 ± 19%, P < 0.05; non-treated group: 19 ± 12% to 45 ± 19%, P < 0.05). However, the magnitude of improvement was significantly greater in the steroid-treated group ( P < 0.05). Peak troponin levels were also significantly lower in the steroid-treated group compared with the non-treated group (2.8 ± 2.7 ng/mL versus 9.1 ± 8.7 ng/mL, P = 0.023). In Kaplan-Meier analysis, the composite endpoint occurred less frequently in the steroid-treated group than in the non-treated group ( P < 0.05). Steroid therapy may contribute to favorable clinical outcomes in fulminant myocarditis requiring MCS, possibly through attenuation of myocardial injury.