Impact of mechanical circulatory support and immunomodulation therapy on outcome of patients with fulminant myocarditis: Chinese registry of fulminant myocarditis

Patients presenting with acute myocarditis and sudden hemodynamic instability (termed fulminant myocarditis [FM]) still have a high mortality and need for heart transplantation, up to 28% at 60 days. 1 , 2 , 3 Recent scientific statements and expert opinion consensus suggests early use of temporary mechanical circulatory supports (t-MCS). 3 , 4 Specifically, Chinese scientific statement proposed an extensive use of t-MCS combined with immunoregulatory therapy (IT), 4 although formal trials are lacking. We present a multicenter, retrospective study to compare the outcome of patients who were treated with t-MCS and IT vs. patients who didn’t receive these treatments. We included patients with the diagnosis of FM based on the presence of viral prodromal signs/symptoms followed by acute onset of severe heart failure (HF) without other relevant differential diagnosis or pre-existing cardiac disorders. Patients who received both t-MCS and IT during hospitalization were classified as t-MCS+IT group. T-MCS used were intra-aortic balloon pulsation (IABP) (median duration 7 days, first to third quartile [Q1–Q3, 4–8]) or venous-arterial extracorporeal membrane oxygenation (VA-ECMO) (median duration 5 days [Q1–Q3, 5–7], or both. IT included methylprednisolone (200–400 mg) or dexamethasone (20–40 mg), qd for 3–5 days of intravenous (IV) and then gradually down titrated and weaned in 7–10 days, and IV immunoglobulin (10–20 g qd for the 3–5 days and then 10 g for another 3–5 days). Patients who didn’t receive both t-MCS and IT were classified as non-t-MCS+IT 3 group. Statistical differences were analyzed using the Mann–Whitney U test for continuous variables. Categorical variables were compared using Fisher’s exact test or χ 2 test.