September 10, 2025European Heart Journal
Fulminant myocarditis: outcome predictors in an international cohort study
Key result
Giant-cell myocarditis was associated with the highest 1-year mortality (54%) compared to lymphocytic (25%), eosinophilic (28%), and necrotizing eosinophilic (33%) subtypes (P=0.04).
Why the study?
Evidence on long-term outcomes, mortality risk factors, and targeted treatment options in fulminant myocarditis remains limited.
Population
271 consecutive adult patients admitted for fulminant myocarditis at 26 European tertiary centres
Comparison
Histopathologic subgroups (LM vs EM vs NEM vs GCM) and patients with inconclusive or no EMB
Design
Multicentre retrospective cohort study
Follow-up
1 year
Authors
Discussion
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Implication
Clinicians may use these predictors for risk counseling now; leaves open prospective validation before changing management.
Key Points
- To evaluate mortality rates, independent risk factors, and long-term functional recovery across histopathological subtypes in adults hospitalized with fulminant myocarditis.
- Retrospective multicenter cohort study including 271 consecutive adult patients admitted for fulminant myocarditis across 26 European tertiary centres between January 2012 and November 2022.
- Endomyocardial biopsy classified 146 patients into lymphocytic (n = 99), eosinophilic (n = 18), necrotizing eosinophilic (n = 3), or giant-cell myocarditis (n = 26), while 125 had inconclusive or unperformed biopsies.
- In-hospital and 1-year mortality associations with prespecified risk factors were evaluated using multivariable logistic regression generalized linear models.
- Overall in-hospital and 1-year mortality rates were 31% and 34%, respectively, with 6% of patients (n = 17) undergoing heart transplantation during follow-up.
- One-year mortality differed significantly across biopsy-confirmed groups, reaching 54% in giant-cell myocarditis versus 25% in lymphocytic, 28% in eosinophilic, and 33% in necrotizing eosinophilic myocarditis (P = .04).
- Older age, lower initial pH, and a histopathologic diagnosis of giant-cell myocarditis independently predicted in-hospital and 1-year mortality, whereas patients surviving to discharge achieved excellent long-term ventricular recovery.
Study Design
Type
Cohort (n=271)
Multicenter
Yes
Structured PICO
P
Population
271 adult patients with fulminant myocarditis admitted to 26 European tertiary centers between 2012 and 2022, followed for 1 year.
O
Outcome
In-hospital and 1-year mortalityhard clinical
Main Result
Absolute Event Rate: 54% vs 25%
p-value: p=0.04
Fulminant myocarditis carries a high in-hospital mortality (31%), with older age, lower pH, and giant-cell histology serving as independent predictors of death.
Cite This Study
Majunke et al. (2025) conducted a cohort in Fulminant myocarditis (n=271). Giant-cell myocarditis (GCM) vs. Other histopathologic subtypes (LM, EM, NEM) was evaluated on In-hospital and 1-year mortality (p=0.04). Giant-cell myocarditis was associated with the highest 1-year mortality (54%) compared to lymphocytic (25%), eosinophilic (28%), and necrotizing eosinophilic (33%) subtypes (P=0.04).