The combination of ECMELLA unloading and high-dose immunosuppression can lead to complete recovery in patients with fulminant cytotoxic CD8 T-cell-mediated myocarditis complicated by cardiogenic shock.
May signal need for early MCS in young patients with AV block and myocarditis; leaves open utility of CD8/macrophage profiling for therapy.
A 19-year-old woman with no previous cardiac history was admitted to the hospital with third-degree atrioventricular block and left ventricular dysfunction. Her condition quickly deteriorated to severe biventricular failure and cardiogenic shock requiring mechanical circulatory support. An endomyocardial biopsy revealed lymphocytic myocarditis with no PCR-detectable viral genomes, with CD8 T-cell predominance and pro-inflammatory macrophage expansion shown by myocardial flow cytometry. The therapy consisted of immunosuppression (high-dose methylprednisolone) and temporary mechanical circulatory support with enhanced ability to achieve left ventricular unloading by combination of extracorporeal membrane oxygenation with Impella (ECMELLA). After 2 weeks of support, complete and sustained recovery from myocarditis was observed.
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Jurčová et al. (2020) studied this question.
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