Fulminant myocarditis proven by early biopsy and outcomes

Florent Huang; Enrico Ammirati; Maharajah Ponnaiah; Santiago Montero; Victor Raimbault; Darryl Abrams; Guillaume Lebreton; Vincent Pellegrino; Joshua Ihle; Maurizio Bottiroli; Romain Persichini; Marisa Isabel Barrionuevo-Sánchez; Albert Ariza-Solé; Pauline Yeung Ng; Simon Wai Ching Sin; Raj Ayer; Hergen Buscher; Slimane Belaid; Clément Delmas; Rita Ferreira; Roberto Roncon Albuquerque; Teresa López-Sobrino; Jeroen J.H. Bunge; Chrisoph Fisser; Guillaume Franchineau; Jamie Mccanny; Shinichiro Ohshimo; Alessandro Sionis; Francisco José Hernández-Pérez; Eduardo Barge-Caballero; Martin Balik; Henrique Muglia; Sunghoon Park; Dirk W. Donker; Beatriz Porral; Nadia Aïssaoui; Arnand Mekontso Dessap; Virginia Burgos; Mathieu Lesouhaitier; Justin Fried; Jae-Seung Jung; Sandra Rosillo; Vincent Scherrer; Saad Nseir; Hadrien Winszewski; Pablo Jorge-Pérez; Antoine Kimmoun; Rodrigo Diaz; Alain Combes; Matthieu Schmidt; FULLMOON Study Grp

doi:10.1093/eurheartj/ehad707

Fulminant myocarditis proven by early biopsy and outcomes

Florent Huang, Enrico Ammirati, Maharajah Ponnaiah, Santiago Montero, Victor Raimbault, Darryl Abrams, Guillaume Lebreton, Vincent Pellegrino, Joshua Ihle, Maurizio Bottiroli, Romain Persichini, Marisa Isabel Barrionuevo-Sánchez, Albert Ariza-Solé, Pauline Yeung Ng, Simon Wai Ching Sin, Raj Ayer, Hergen Buscher, Slimane Belaid, Clément Delmas, Rita FerreiraRoberto Roncon Albuquerque, Teresa López-Sobrino, Jeroen J.H. Bunge, Chrisoph Fisser, Guillaume Franchineau, Jamie Mccanny, Shinichiro Ohshimo, Alessandro Sionis, Francisco José Hernández-Pérez, Eduardo Barge-Caballero, Martin Balik, Henrique Muglia, Sunghoon Park, Dirk W. Donker, Beatriz Porral, Nadia Aïssaoui, Arnand Mekontso Dessap, Virginia Burgos, Mathieu Lesouhaitier^*, Justin Fried, Jae-Seung Jung, Sandra Rosillo, Vincent Scherrer, Saad Nseir, Hadrien Winszewski, Pablo Jorge-Pérez, Antoine Kimmoun, Rodrigo Diaz, Alain Combes, Matthieu Schmidt, FULLMOON Study Grp

^*Corresponding author for this work

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Abstract

BACKGROUND AND AIMS: While endomyocardial biopsy (EMB) is recommended in adult patients with fulminant myocarditis, the clinical impact of its timing is still unclear. METHODS: Data were collected from 419 adult patients with clinically suspected fulminant myocarditis admitted to intensive care units across 36 tertiary centres in 15 countries worldwide. The diagnosis of myocarditis was histologically proven in 210 (50%) patients, either by EMB (n = 183, 44%) or by autopsy/explanted heart examination (n = 27, 6%), and clinically suspected cardiac magnetic resonance imaging confirmed in 96 (23%) patients. The primary outcome of survival free of heart transplantation (HTx) or left ventricular assist device (LVAD) at 1 year was specifically compared between patients with early EMB (within 2 days after intensive care unit admission, n = 103) and delayed EMB (n = 80). A propensity score-weighted analysis was done to control for confounders. RESULTS: Median age on admission was 40 (29-52) years, and 322 (77%) patients received temporary mechanical circulatory support. A total of 273 (65%) patients survived without HTx/LVAD. The primary outcome was significantly different between patients with early and delayed EMB (70% vs. 49%, P = .004). After propensity score weighting, the early EMB group still significantly differed from the delayed EMB group in terms of survival free of HTx/LVAD (63% vs. 40%, P = .021). Moreover, early EMB was independently associated with a lower rate of death or HTx/LVAD at 1 year (odds ratio of 0.44; 95% confidence interval: 0.22-0.86; P = .016). CONCLUSIONS: Endomyocardial biopsy should be broadly and promptly used in patients admitted to the intensive care unit for clinically suspected fulminant myocarditis.

Original language	English
Pages (from-to)	5110-5124
Number of pages	15
Journal	European heart journal
Volume	44
Issue number	48
Early online date	6 Nov 2023
DOIs	https://doi.org/10.1093/eurheartj/ehad707 https://doi.org/10.1093/eurheartj/ehad813
Publication status	Published - 21 Dec 2023

Keywords

ECMO
Endomyocardial biopsy
Fulminant myocarditis
Mechanical circulatory support
Outcome
2023 OA procedure

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Huang, F., Ammirati, E., Ponnaiah, M., Montero, S., Raimbault, V., Abrams, D., Lebreton, G., Pellegrino, V., Ihle, J., Bottiroli, M., Persichini, R., Barrionuevo-Sánchez, M. I., Ariza-Solé, A., Ng, P. Y., Sin, S. W. C., Ayer, R., Buscher, H., Belaid, S., Delmas, C., ... Grp, FULLMOON. S. (2023). Fulminant myocarditis proven by early biopsy and outcomes. European heart journal, 44(48), 5110-5124. https://doi.org/10.1093/eurheartj/ehad707, https://doi.org/10.1093/eurheartj/ehad813

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title = "Fulminant myocarditis proven by early biopsy and outcomes",

abstract = "BACKGROUND AND AIMS: While endomyocardial biopsy (EMB) is recommended in adult patients with fulminant myocarditis, the clinical impact of its timing is still unclear. METHODS: Data were collected from 419 adult patients with clinically suspected fulminant myocarditis admitted to intensive care units across 36 tertiary centres in 15 countries worldwide. The diagnosis of myocarditis was histologically proven in 210 (50%) patients, either by EMB (n = 183, 44%) or by autopsy/explanted heart examination (n = 27, 6%), and clinically suspected cardiac magnetic resonance imaging confirmed in 96 (23%) patients. The primary outcome of survival free of heart transplantation (HTx) or left ventricular assist device (LVAD) at 1 year was specifically compared between patients with early EMB (within 2 days after intensive care unit admission, n = 103) and delayed EMB (n = 80). A propensity score-weighted analysis was done to control for confounders. RESULTS: Median age on admission was 40 (29-52) years, and 322 (77%) patients received temporary mechanical circulatory support. A total of 273 (65%) patients survived without HTx/LVAD. The primary outcome was significantly different between patients with early and delayed EMB (70% vs. 49%, P = .004). After propensity score weighting, the early EMB group still significantly differed from the delayed EMB group in terms of survival free of HTx/LVAD (63% vs. 40%, P = .021). Moreover, early EMB was independently associated with a lower rate of death or HTx/LVAD at 1 year (odds ratio of 0.44; 95% confidence interval: 0.22-0.86; P = .016). CONCLUSIONS: Endomyocardial biopsy should be broadly and promptly used in patients admitted to the intensive care unit for clinically suspected fulminant myocarditis.",

keywords = "ECMO, Endomyocardial biopsy, Fulminant myocarditis, Mechanical circulatory support, Outcome, 2023 OA procedure",

author = "Florent Huang and Enrico Ammirati and Maharajah Ponnaiah and Santiago Montero and Victor Raimbault and Darryl Abrams and Guillaume Lebreton and Vincent Pellegrino and Joshua Ihle and Maurizio Bottiroli and Romain Persichini and Barrionuevo-S{\'a}nchez, {Marisa Isabel} and Albert Ariza-Sol{\'e} and Ng, {Pauline Yeung} and Sin, {Simon Wai Ching} and Raj Ayer and Hergen Buscher and Slimane Belaid and Cl{\'e}ment Delmas and Rita Ferreira and Albuquerque, {Roberto Roncon} and Teresa L{\'o}pez-Sobrino and Bunge, {Jeroen J.H.} and Chrisoph Fisser and Guillaume Franchineau and Jamie Mccanny and Shinichiro Ohshimo and Alessandro Sionis and Hern{\'a}ndez-P{\'e}rez, {Francisco Jos{\'e}} and Eduardo Barge-Caballero and Martin Balik and Henrique Muglia and Sunghoon Park and Donker, {Dirk W.} and Beatriz Porral and Nadia A{\"i}ssaoui and Dessap, {Arnand Mekontso} and Virginia Burgos and Mathieu Lesouhaitier and Justin Fried and Jae-Seung Jung and Sandra Rosillo and Vincent Scherrer and Saad Nseir and Hadrien Winszewski and Pablo Jorge-P{\'e}rez and Antoine Kimmoun and Rodrigo Diaz and Alain Combes and Matthieu Schmidt and Grp, {FULLMOON Study}",

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month = dec,

day = "21",

doi = "10.1093/eurheartj/ehad707",

language = "English",

volume = "44",

pages = "5110--5124",

journal = "European heart journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "48",

}

Huang, F, Ammirati, E, Ponnaiah, M, Montero, S, Raimbault, V, Abrams, D, Lebreton, G, Pellegrino, V, Ihle, J, Bottiroli, M, Persichini, R, Barrionuevo-Sánchez, MI, Ariza-Solé, A, Ng, PY, Sin, SWC, Ayer, R, Buscher, H, Belaid, S, Delmas, C, Ferreira, R, Albuquerque, RR, López-Sobrino, T, Bunge, JJH, Fisser, C, Franchineau, G, Mccanny, J, Ohshimo, S, Sionis, A, Hernández-Pérez, FJ, Barge-Caballero, E, Balik, M, Muglia, H, Park, S, Donker, DW, Porral, B, Aïssaoui, N, Dessap, AM, Burgos, V, Lesouhaitier, M, Fried, J, Jung, J-S, Rosillo, S, Scherrer, V, Nseir, S, Winszewski, H, Jorge-Pérez, P, Kimmoun, A, Diaz, R, Combes, A, Schmidt, M & Grp, FULLMOONS 2023, 'Fulminant myocarditis proven by early biopsy and outcomes', European heart journal, vol. 44, no. 48, pp. 5110-5124. https://doi.org/10.1093/eurheartj/ehad707, https://doi.org/10.1093/eurheartj/ehad813

TY - JOUR

T1 - Fulminant myocarditis proven by early biopsy and outcomes

AU - Huang, Florent

AU - Ammirati, Enrico

AU - Ponnaiah, Maharajah

AU - Montero, Santiago

AU - Raimbault, Victor

AU - Abrams, Darryl

AU - Lebreton, Guillaume

AU - Pellegrino, Vincent

AU - Ihle, Joshua

AU - Bottiroli, Maurizio

AU - Persichini, Romain

AU - Barrionuevo-Sánchez, Marisa Isabel

AU - Ariza-Solé, Albert

AU - Ng, Pauline Yeung

AU - Sin, Simon Wai Ching

AU - Ayer, Raj

AU - Buscher, Hergen

AU - Belaid, Slimane

AU - Delmas, Clément

AU - Ferreira, Rita

AU - Albuquerque, Roberto Roncon

AU - López-Sobrino, Teresa

AU - Bunge, Jeroen J.H.

AU - Fisser, Chrisoph

AU - Franchineau, Guillaume

AU - Mccanny, Jamie

AU - Ohshimo, Shinichiro

AU - Sionis, Alessandro

AU - Hernández-Pérez, Francisco José

AU - Barge-Caballero, Eduardo

AU - Balik, Martin

AU - Muglia, Henrique

AU - Park, Sunghoon

AU - Donker, Dirk W.

AU - Porral, Beatriz

AU - Aïssaoui, Nadia

AU - Dessap, Arnand Mekontso

AU - Burgos, Virginia

AU - Lesouhaitier, Mathieu

AU - Fried, Justin

AU - Jung, Jae-Seung

AU - Rosillo, Sandra

AU - Scherrer, Vincent

AU - Nseir, Saad

AU - Winszewski, Hadrien

AU - Jorge-Pérez, Pablo

AU - Kimmoun, Antoine

AU - Diaz, Rodrigo

AU - Combes, Alain

AU - Schmidt, Matthieu

AU - Grp, FULLMOON Study

PY - 2023/12/21

Y1 - 2023/12/21

N2 - BACKGROUND AND AIMS: While endomyocardial biopsy (EMB) is recommended in adult patients with fulminant myocarditis, the clinical impact of its timing is still unclear. METHODS: Data were collected from 419 adult patients with clinically suspected fulminant myocarditis admitted to intensive care units across 36 tertiary centres in 15 countries worldwide. The diagnosis of myocarditis was histologically proven in 210 (50%) patients, either by EMB (n = 183, 44%) or by autopsy/explanted heart examination (n = 27, 6%), and clinically suspected cardiac magnetic resonance imaging confirmed in 96 (23%) patients. The primary outcome of survival free of heart transplantation (HTx) or left ventricular assist device (LVAD) at 1 year was specifically compared between patients with early EMB (within 2 days after intensive care unit admission, n = 103) and delayed EMB (n = 80). A propensity score-weighted analysis was done to control for confounders. RESULTS: Median age on admission was 40 (29-52) years, and 322 (77%) patients received temporary mechanical circulatory support. A total of 273 (65%) patients survived without HTx/LVAD. The primary outcome was significantly different between patients with early and delayed EMB (70% vs. 49%, P = .004). After propensity score weighting, the early EMB group still significantly differed from the delayed EMB group in terms of survival free of HTx/LVAD (63% vs. 40%, P = .021). Moreover, early EMB was independently associated with a lower rate of death or HTx/LVAD at 1 year (odds ratio of 0.44; 95% confidence interval: 0.22-0.86; P = .016). CONCLUSIONS: Endomyocardial biopsy should be broadly and promptly used in patients admitted to the intensive care unit for clinically suspected fulminant myocarditis.

AB - BACKGROUND AND AIMS: While endomyocardial biopsy (EMB) is recommended in adult patients with fulminant myocarditis, the clinical impact of its timing is still unclear. METHODS: Data were collected from 419 adult patients with clinically suspected fulminant myocarditis admitted to intensive care units across 36 tertiary centres in 15 countries worldwide. The diagnosis of myocarditis was histologically proven in 210 (50%) patients, either by EMB (n = 183, 44%) or by autopsy/explanted heart examination (n = 27, 6%), and clinically suspected cardiac magnetic resonance imaging confirmed in 96 (23%) patients. The primary outcome of survival free of heart transplantation (HTx) or left ventricular assist device (LVAD) at 1 year was specifically compared between patients with early EMB (within 2 days after intensive care unit admission, n = 103) and delayed EMB (n = 80). A propensity score-weighted analysis was done to control for confounders. RESULTS: Median age on admission was 40 (29-52) years, and 322 (77%) patients received temporary mechanical circulatory support. A total of 273 (65%) patients survived without HTx/LVAD. The primary outcome was significantly different between patients with early and delayed EMB (70% vs. 49%, P = .004). After propensity score weighting, the early EMB group still significantly differed from the delayed EMB group in terms of survival free of HTx/LVAD (63% vs. 40%, P = .021). Moreover, early EMB was independently associated with a lower rate of death or HTx/LVAD at 1 year (odds ratio of 0.44; 95% confidence interval: 0.22-0.86; P = .016). CONCLUSIONS: Endomyocardial biopsy should be broadly and promptly used in patients admitted to the intensive care unit for clinically suspected fulminant myocarditis.

KW - ECMO

KW - Endomyocardial biopsy

KW - Fulminant myocarditis

KW - Mechanical circulatory support

KW - Outcome

KW - 2023 OA procedure

U2 - 10.1093/eurheartj/ehad707

DO - 10.1093/eurheartj/ehad707

M3 - Article

C2 - 37941449

SN - 0195-668X

VL - 44

SP - 5110

EP - 5124

JO - European heart journal

JF - European heart journal

IS - 48

ER -

Fulminant myocarditis proven by early biopsy and outcomes

Abstract

Keywords

UN SDGs

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