Fulminant myocarditis proven by early biopsy and outcomes
Key result
Early endomyocardial biopsy was associated with higher 1-year survival free of heart transplantation or LVAD compared to delayed biopsy (63% vs. 40%, P=0.021).
Why the study?
Although endomyocardial biopsy is recommended in adult patients with fulminant myocarditis, the clinical impact of its timing remains unclear.
Does early endomyocardial biopsy improve survival free of heart transplantation or left ventricular assist device in adult patients with fulminant myocarditis?
Population
419 adult patients with clinically suspected fulminant myocarditis in ICUs across 36 tertiary centres
Comparison
Early EMB (within 2 days after ICU admission) vs delayed EMB
Design
Multicentre observational study with propensity score-weighted analysis
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
Early EMB was associated with higher 1-year survival free of HTx/LVAD; supports prompt use in suspected fulminant myocarditis but leaves causality open.
Study Design
Type
Cohort (n=419)
Multicenter
Yes
Structured PICO
Does early endomyocardial biopsy improve survival free of heart transplantation or left ventricular assist device in adult patients with fulminant myocarditis?
P
Population
419 adult patients with clinically suspected fulminant myocarditis admitted to intensive care units, followed for 1 year.
E
Exposure
Early endomyocardial biopsy (EMB) performed within 2 days after intensive care unit admission (n=103)
C
Comparator
Delayed endomyocardial biopsy (n=80)
O
Outcome
Survival free of heart transplantation (HTx) or left ventricular assist device (LVAD) at 1 yearhard clinical
Main Result
Odds Ratio: 0.44 (95% CI 0.22–0.86)
Absolute Event Rate: 63% vs 40%
p-value: p=0.016
Performing an endomyocardial biopsy within 2 days of ICU admission for fulminant myocarditis is associated with significantly improved 1-year survival free of heart transplantation or LVAD.
Cite This Study
Ammirati et al. (2023) conducted a cohort in clinically suspected fulminant myocarditis (n=419). Early endomyocardial biopsy vs. Delayed endomyocardial biopsy was evaluated on survival free of heart transplantation (HTx) or left ventricular assist device (LVAD) at 1 year (OR 0.44, 95% CI 0.22-0.86, p=0.016). Early endomyocardial biopsy was associated with higher 1-year survival free of heart transplantation or LVAD compared to delayed biopsy (63% vs. 40%, P=0.021).