Why the study?
The definition of fulminant myocarditis has varied greatly over the past 20 years, causing conflicting reports on prognosis and treatment strategies due to differing study inclusion criteria.
Fulminant myocarditis is a severe clinical presentation requiring endomyocardial biopsy for aetiology-directed management and is associated with a worsened long-term prognosis.
Requires biopsy to identify histotypes in fulminant myocarditis; leaves open etiology-specific management strategies.
Fulminant myocarditis, rather than being a distinct form of myocarditis, is instead a peculiar clinical presentation of the disease. The definition of fulminant myocarditis has varied greatly in the last 20 years, leading to conflicting reports on prognosis and treatment strategies, mainly because of varied inclusion criteria in different studies. The main conclusion of this review is that fulminant myocarditis may be due to different histotypes and aetiologies that can be diagnosed only by endomyocardial biopsy and managed by aetiology-directed treatment. This life-threatening presentation requires rapid, targeted management both in the short term (mechanical circulatory support, inotropic and antiarrhythmic treatment and endomyocardial biopsy) and in the long term (including prolonged follow-up). Fulminant presentation has also recently been identified as a risk factor for worsened prognosis, even long after the resolution of the acute phase of myocarditis.
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Giordani et al. (2023) studied this question.
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