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

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)


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 languageEnglish
Pages (from-to)5110-5124
Number of pages15
JournalEuropean heart journal
Issue number48
Early online date6 Nov 2023
Publication statusPublished - 21 Dec 2023


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


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