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Chinese society of cardiology expert consensus statement on the diagnosis and treatment of adult fulminant myocarditis

Abstract

Fulminant myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock, with mortality rates as high as 50%–70%. Most importantly, there are no treatment options, guidelines or an expert consensus statement. Here, we provide the first expert consensus, the Chinese Society of Cardiology Expert Consensus Statement on the Diagnosis and Treatment of Fulminant Myocarditis, based on data from our recent clinical trial (NCT03268642). In this statement, we describe the clinical features and diagnostic criteria of fulminant myocarditis, and importantly, for the first time, we describe a new treatment regimen termed life support-based comprehensive treatment regimen. The core content of this treatment regimen includes (i) mechanical life support (applications of mechanical respirators and circulatory support systems, including intraaortic balloon pump and extracorporeal membrane oxygenation, (ii) immunological modulation by using sufficient doses of glucocorticoid, immunoglobulin and (iii) antiviral reagents using neuraminidase inhibitor. The proper application of this treatment regimen may and has helped to save the lives of many patients with fulminant myocarditis.

References

  • Abdel-Aty, H., Boyé, P., Zagrosek, A., Wassmuth, R., Kumar, A., Messroghli, D., Bock, P., Dietz, R., Friedrich, M.G., and Schulz-Menger, J. (2005). Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis. J Am Coll Cardiol 45, 1815–1822.

    Article  PubMed  Google Scholar 

  • Al-Khatib, S.M., Stevenson, W.G., Ackerman, M.J., Bryant, W.J., Callans, D.J., Curtis, A.B., Deal, B.J., Dickfeld, T., Field, M.E., Fonarow, G.C., et al. (2018). 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary. Circulation 138.

    Google Scholar 

  • Ammirati, E., Cipriani, M., Lilliu, M., Sormani, P., Varrenti, M., Raineri, C., Petrella, D., Garascia, A., Pedrotti, P., Roghi, A., et al. (2017a). Survival and left ventricular function changes in fulminant versus nonfulminant acute myocarditis. Circulation 136, 529–545.

    Article  PubMed  Google Scholar 

  • Ammirati, E., Moroni, F., Sormani, P., Peritore, A., Milazzo, A., Quattrocchi, G., Cipriani, M., Oliva, F., Giannattasio, C., Frigerio, M., et al. (2017b). Quantitative changes in late gadolinium enhancement at cardiac magnetic resonance in the early phase of acute myocarditis. Int J Cardiol 231, 216–221.

    Article  PubMed  Google Scholar 

  • Asaumi, Y., Yasuda, S., Morii, I., Kakuchi, H., Otsuka, Y., Kawamura, A., Sasako, Y., Nakatani, T., Nonogi, H., and Miyazaki, S. (2005). Favourable clinical outcome in patients with cardiogenic shock due to fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation. Eur Heart J 26, 2185–2192.

    Article  PubMed  Google Scholar 

  • Baccouche, H., Mahrholdt, H., Meinhardt, G., Merher, R., Voehringer, M., Hill, S., Klingel, K., Kandolf, R., Sechtem, U., and Yilmaz, A. (2009). Diagnostic synergy of non-invasive cardiovascular magnetic resonance and invasive endomyocardial biopsy in troponin-positive patients without coronary artery disease. Eur Heart J 30, 2869–2879.

    Article  CAS  PubMed  Google Scholar 

  • Badawy, S.S.I., and Fahmy, A. (2012). Efficacy and cardiovascular tolerability of continuous veno-venous hemodiafiltration in acute decompensated heart failure: a randomized comparative study. J Crit Care 27, 106.e7–106.e13.

    Article  PubMed  Google Scholar 

  • Barrie, M., McKnight, L., and Solanki, P. (2012). Rapid resolution of acute fulminant myocarditis after IVIG and steroid treatment. Case Rep Crit Care 2012, 1–4.

    Article  Google Scholar 

  • Bjelakovic, B., Vukomanovic, V., and Jovic, M. (2016). Fulminant myocarditis in children successfully treated with high dose of methyl-prednisolone. Ind J Pediatr 83, 268–269.

    Article  Google Scholar 

  • Bock, C.T., Klingel, K., and Kandolf, R. (2010). Human parvovirus B19-associated myocarditis. New Engl J Med 362, 1248–1249.

    Article  CAS  PubMed  Google Scholar 

  • Bulut, D., Scheeler, M., Wichmann, T., Börgel, J., Miebach, T., and Mügge, A. (2010). Effect of protein A immunoadsorption on T cell activation in patients with inflammatory dilated cardiomyopathy. Clin Res Cardiol 99, 633–638.

    Article  CAS  PubMed  Google Scholar 

  • Burns, D.J.P., and Quantz, M.A. (2015). Use of the Impella 5.0 device as a bridge to recovery in adult fulminant viral myocarditis. Innov-Tech Techniques Cardiothor Vascular Surg 10, 279–281.

    Article  Google Scholar 

  • Caforio, A.L.P., Pankuweit, S., Arbustini, E., Basso, C., Gimeno-Blanes, J., Felix, S.B., Fu, M., Heliö, T., Heymans, S., Jahns, R., et al. (2013). Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European society of cardiology working group on myocardial and pericardial diseases. Eur Heart J 34, 2636–2648.

    Article  Google Scholar 

  • Caforio, A.L.P., Malipiero, G., Marcolongo, R., and Iliceto, S. (2017). Myocarditis: a clinical overview. Curr Cardiol Rep 19, 63.

    Article  CAS  PubMed  Google Scholar 

  • Chakko, S., Woska, D., Martinez, H., Marchena, E.D., Futterman, L., Kessler, K.M., and Myerburg, R.J. (1991). Clinical, radiographic, and hemodynamic correlations in chronic congestive heart failure: conflicting results may lead to inappropriate care. Am J Med 90, 353–359.

    Article  CAS  PubMed  Google Scholar 

  • Chen, H.S., Wang, W., Wu, S.N., and Liu, J.P. (2013). Corticosteroids for viral myocarditis. Cochrane Database Syst Rev 20.

    Google Scholar 

  • Chen, J., Lai, J., Yang, L., Ruan, G., Chaugai, S., Ning, Q., Chen, C., and Wang, D.W. (2016). Trimetazidine prevents macrophage-mediated septic myocardial dysfunction via activation of the histone deacetylase sirtuin 1. Brit J Pharmacol 173, 545–561.

    Article  CAS  Google Scholar 

  • Cheng, R., Hachamovitch, R., Kittleson, M., Patel, J., Arabia, F., Moriguchi, J., Esmailian, F., and Azarbal, B. (2014). Clinical outcomes in fulminant myocarditis requiring extracorporeal membrane oxygenation: a weighted meta-analysis of 170 patients. J Card Fail 20, 400–406.

    Article  PubMed  Google Scholar 

  • Deubner, N., Berliner, D., Schlipp, A., Gelbrich, G., Caforio, A.L.P., Felix, S.B., Fu, M., Katus, H., Angermann, C.E., Lohse, M.J., et al. (2010). Cardiac β1-adrenoceptor autoantibodies in human heart disease: rationale and design of the Etiology, Titre-C ourse, and Survival (ETiCS) Study. Eur J Heart Fail 12, 753–762.

    Article  CAS  PubMed  Google Scholar 

  • Diddle, J.W., Almodovar, M.C., Rajagopal, S.K., Rycus, P.T., and Thiagarajan, R.R. (2015). Extracorporeal membrane oxygenation for the support of adults with acute myocarditis. Crit Care Med 43, 1016–1025.

    Article  CAS  PubMed  Google Scholar 

  • Drucker, N.A., Colan, S.D., Lewis, A.B., Beiser, A.S., Wessel, D.L., Takahashi, M., Baker, A.L., Perez-Atayde, A.R., and Newburger, J.W. (1994). Gamma-globulin treatment of acute myocarditis in the pediatric population. Circulation 89, 252–257.

    Article  CAS  PubMed  Google Scholar 

  • Felix, S.B., Beug, D., and Dörr, M. (2015). Immunoadsorption therapy in dilated cardiomyopathy. Expert Rev Cardiovasc Ther 13, 145–152.

    Article  CAS  PubMed  Google Scholar 

  • Felker, G.M., Boehmer, J.P., Hruban, R.H., Hutchins, G.M., Kasper, E.K., Baughman, K.L., and Hare, J.M. (2000). Echocardiographic findings in fulminant and acute myocarditis. J Am Coll Cardiol 36, 227–232.

    Article  CAS  PubMed  Google Scholar 

  • Felker, G.M., Mentz, R.J., Teerlink, J.R., Voors, A.A., Pang, P.S., Ponikowski, P., Greenberg, B.H., Filippatos, G., Davison, B.A., Cotter, G., et al. (2015). Serial high sensitivity cardiac troponin T measurement in acute heart failure: insights from the RELAX-AHF study. Eur J Heart Fail 17, 1262–1270.

    Article  CAS  PubMed  Google Scholar 

  • Fung, G., Luo, H., Qiu, Y., Yang, D., and McManus, B. (2016). Myocarditis. Circ Res 118, 496–514.

    Article  CAS  Google Scholar 

  • Ganatra, S., and Neilan, T.G. (2018). Immune checkpoint inhibitorassociated myocarditis. Oncologist 23, 879–886.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ginsberg, F., and Parrillo, J.E. (2013). Fulminant myocarditis. Crit Care Clin 29, 465–483.

    Article  PubMed  Google Scholar 

  • Goland, S., Czer, L.S.C., Siegel, R.J., Tabak, S., Jordan, S., Luthringer, D., Mirocha, J., Coleman, B., Kass, R.M., and Trento, A. (2008). Intravenous immunoglobulin treatment for acute fulminant inflammatory cardiomyopathy: series of six patients and review of literature. Can J Cardiol 24, 571–574.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • JCS Joint Working Group, (2011). Guidelines for diagnosis and treatment of myocarditis (JCS 2009). Circ J 75, 734–743.

    Article  Google Scholar 

  • Gupta, S., Markham, D.W., Drazner, M.H., and Mammen, P.P. (2008). Fulminant myocarditis. Nat Rev Cardiol 5, 693–706.

    Article  Google Scholar 

  • Hsu, K.H., Chi, N.H., Yu, H.Y., Wang, C.H., Huang, S.C., Wang, S.S., Ko, W.J., and Chen, Y.S. (2011) Extracorporeal membranous oxygenation support for acute fulminant myocarditis: analysis of a single center's experience. Eur J Cardiothoracic Surg.

    Google Scholar 

  • Hu, W.H., Liu, C.W., Hu. W., Lu, J., Zhu, Y., Wang, J.R., and Liu, B.W. (2014). Analysis of ECMO treatment in five fulminant myocarditis patients. Chin J Crit Care Med 7, 354–357.

    Google Scholar 

  • Hufnagel, G., Pankuweit, S., Richter, A., Schonian, U., and Maisch, B. (1995). The European study of epidemiology and treatment of cardiac inflammatory disease (ESETCID). Eur Heart J 16, 173–175.

    Article  PubMed  Google Scholar 

  • Ihdayhid, A.R., Chopra, S., and Rankin, J. (2014). Intra-aortic balloon pump. Curr Opin Cardiol 29, 285–292.

    Article  PubMed  Google Scholar 

  • Isogai, T., Yasunaga, H., Matsui, H., Tanaka, H., Horiguchi, H., and Fushimi, K. (2015). Effect of intravenous immunoglobulin for fulminant myocarditis on in-hospital mortality: propensity score analyses. J Card Fail 21, 391–397.

    Article  CAS  PubMed  Google Scholar 

  • Jensen, L.D., and Marchant, D.J. (2016). Emerging pharmacologic targets and treatments for myocarditis. Pharmacol Ther 161, 40–51.

    Article  CAS  PubMed  Google Scholar 

  • Jiang, L., Miao, K., Cui, G.N., Zuo, H.J., Li, R., Wang, D.W., and Jiang, J. G. (2017). Efficacy of circulatory support in patients with cardiogenic shock. J Intern Inten Med (China) 23, 459–461.

    Google Scholar 

  • Johnson, D.B., Balko, J.M., Compton, M.L., Chalkias, S., Gorham, J., Xu, Y., Hicks, M., Puzanov, I., Alexander, M.R., Bloomer, T.L., et al. (2016). Fulminant myocarditis with combination immune checkpoint blockade. New Engl J Med 375, 1749–1755.

    Article  CAS  PubMed  Google Scholar 

  • Kindermann, I., Barth, C., Mahfoud, F., Ukena, C., Lenski, M., Yilmaz, A., Klingel, K., Kandolf, R., Sechtem, U., Cooper, L.T., et al. (2012). Update on myocarditis. J Am Coll Cardiol 59, 779–792.

    Article  PubMed  Google Scholar 

  • Kishimoto, C., Shioji, K., Hashimoto, T., Nonogi, H., Lee, J.D., Kato, S., Hiramitsu, S., and Morimoto, S. (2014). Therapy with immunoglobulin in patients with acute myocarditis and cardiomyopathy: analysis of leukocyte balance. Heart Vessels 29, 336–342.

    Article  PubMed  Google Scholar 

  • Kühl, U., Lassner, D., von Schlippenbach, J., Poller, W., and Schultheiss, H.P. (2012). Interferon-Beta improves survival in enterovirus-associated cardiomyopathy. J Am Coll Cardiol 60, 1295–1296.

    Article  PubMed  Google Scholar 

  • Lazaros, G., Oikonomou, E., and Tousoulis, D. (2017). Established and novel treatment options in acute myocarditis, with or without heart failure. Expert Rev Cardiovasc Ther 15, 25–34.

    Article  CAS  PubMed  Google Scholar 

  • Leone, O., Veinot, J.P., Angelini, A., Baandrup, U.T., Basso, C., Berry, G., Bruneval, P., Burke, M., Butany, J., Calabrese, F., et al. (2012). 2011 consensus statement on endomyocardial biopsy from the association for European cardiovascular pathology and the society for cardiovascular pathology. Cardiovasc Pathol 21, 245–274.

    Article  PubMed  Google Scholar 

  • Li, S., Ran, X., Cui, G., Miao, K., Zhao, C., Yuan, S., Yan, J., Lan, L., Liu, Z., Zhou, N., et al. (2017). A life support based comprehensive treatment regimen dramatically lowers the in-hospital mortality of patients with fulminant myocarditis—a multiple center study. New Engl J Med, Submitted.

    Google Scholar 

  • Lorusso, R., Centofanti, P., Gelsomino, S., Barili, F., Di Mauro, M., Orlando, P., Botta, L., Milazzo, F., Actis Dato, G., Casabona, R., et al. (2016). Venoarterial extracorporeal membrane oxygenation for acute fulminant myocarditis in adult patients: a 5-year multi-institutional experience. Ann Thorac Surg 101, 919–926.

    Article  PubMed  Google Scholar 

  • Luyt, C.E., Hékimian, G., and Ginsberg, F. (2016). What’s new in myocarditis? Intens Care Med 42, 1055–1057.

    Article  Google Scholar 

  • Luyt, C.E., Landivier, A., Leprince, P., Bernard, M., Pavie, A., Chastre, J., and Combes, A. (2012). Usefulness of cardiac biomarkers to predict cardiac recovery in patients on extracorporeal membrane oxygenation support for refractory cardiogenic shock. J Crit Care 27, 524.e7–524. e14.

    Article  CAS  PubMed  Google Scholar 

  • Maejima, Y., Yasu, T., Kubo, N., Kawahito, K., Omura, N., Katsuki, T., Tsukamoto, Y., Sugawara, Y., Hashimoto, S., Tsuruya, Y., et al. (2004). Long-term prognosis of fulminant myocarditis rescued by percutaneous cardiopulmonary support device. Circ J 68, 829–833.

    Article  PubMed  Google Scholar 

  • Mahfoud, F., Gärtner, B., Kindermann, M., Ukena, C., Gadomski, K., Klingel, K., Kandolf, R., Böhm, M., and Kindermann, I. (2011). Virus serology in patients with suspected myocarditis: utility or futility? Eur Heart J 32, 897–903.

    Article  CAS  PubMed  Google Scholar 

  • Maisch, B., Ruppert, V., and Pankuweit, S. (2014). Management of fulminant myocarditis: a diagnosis in search of its etiology but with therapeutic options. Curr Heart Fail Rep 11, 166–177.

    Article  CAS  PubMed  Google Scholar 

  • Maisel, A., Mueller, C., Nowak, R., Peacock, W.F., Landsberg, J.W., Ponikowski, P., Mockel, M., Hogan, C., Wu, A.H.B., Richards, M., et al. (2010). Mid-region pro-hormone markers for diagnosis and prognosis in acute dyspnea. J Am Coll Cardiol 55, 2062–2076.

    Article  CAS  PubMed  Google Scholar 

  • Maisel, A.S., Krishnaswamy, P., Nowak, R.M., McCord, J., Hollander, J.E., Duc, P., Omland, T., Storrow, A.B., Abraham, W.T., Wu, A.H.B., et al. (2002). Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. New Engl J Med 347, 161–167.

    Article  CAS  PubMed  Google Scholar 

  • Mariani, J., Macchia, A., Belziti, C., Deabreu, M., Gagliardi, J., Doval, H., Tognoni, G., and Tajer, C. (2011). Noninvasive ventilation in acute cardiogenic pulmonary edema: a meta-analysis of randomized controlled trials. J Card Fail 17, 850–859.

    Article  PubMed  Google Scholar 

  • McCarthy, R.E., Boehmer, J.P., Hruban, R.H., Hutchins, G.M., Kasper, E. K., Hare, J.M., and Baughman, K.L. (2000). Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. New Engl J Med 342, 690–695.

    Article  PubMed  Google Scholar 

  • McMurray, J.J.V., Adamopoulos, S., Anker, S.D., Auricchio, A., Böhm, M., Dickstein, K., Falk, V., Filippatos, G., Fonseca, C., Gomez-Sanchez, M. A., et al. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur J Heart Fail 14, 803–869.

    Article  CAS  PubMed  Google Scholar 

  • Miao, K., Chen, C., Cui, G.N., Ma, F., Wang, H., Wang, D.W., Jiang, J.G. (2017). Statistical analysis on differences in different treatments for adults with fulminant myocarditis. J Intern IntenMed (China) 23, 465–468.

    Google Scholar 

  • Moe, G.W., Howlett, J., Januzzi, J.L., Zowall, H., and Zowall, H. (2007). N-terminal pro-B-type natriuretic peptide testing improves the management of patients with suspected acute heart failure: primary results of the Canadian prospective randomized multicenter IMPROVECHF study. Circulation 115, 3103–3110.

    Article  CAS  PubMed  Google Scholar 

  • Mueller, C., Laule-Kilian, K., Scholer, A., Frana, B., Rodriguez, D., Schindler, C., Marsch, S., and Perruchoud, A.P. (2004). Use of B-type natriuretic peptide for the management of women with dyspnea. Am J Cardiol 94, 1510–1514.

    Article  CAS  PubMed  Google Scholar 

  • Nakamura, T., Ishida, K., Taniguchi, Y., Nakagawa, T., Seguchi, M., Wada, H., Sugawara, Y., Funayama, H., Mitsuhashi, T., and Momomura, S.I. (2015). Prognosis of patients with fulminant myocarditis managed by peripheral venoarterial extracorporeal membranous oxygenation support: a retrospective single-center study. J Intens Care 3, 5.

    Article  Google Scholar 

  • Nakashima, H., Umeyama, Y., and Minami, K. (2013). Successive immunosuppressive treatment of fulminant myocarditis that is refractory to mechanical circulatory support. Am J Case Rep 14, 116–119.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nikolaou, M., Parissis, J., Yilmaz, M.B., Seronde, M.F., Kivikko, M., Laribi, S., Paugam-Burtz, C., Cai, D., Pohjanjousi, P., Laterre, P.F., et al. (2013). Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J 34, 742–749.

    Article  PubMed  Google Scholar 

  • Okai, I., Inoue, K., Maruyama, M., Maruyama, S., Komatsu, K., Nishizawa, H., Okazaki, S., Fujiwara, Y., Sumiyoshi, M., and Daida, H. (2012). Transbrachial intra-aortic balloon pumping for a patient with fulminant myocarditis. Heart Vessels 27, 639–642.

    Article  PubMed  Google Scholar 

  • Page, R.L., Joglar, J.A., Caldwell, M.A., Calkins, H., Conti, J.B., Deal, B. J., Estes Iii, N.A.M., Field, M.E., Goldberger, Z.D., Hammill, S.C., et al. (2016). 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: executive summary. J Am Coll Cardiol 67, 1575–1623.

    Article  PubMed  Google Scholar 

  • Parekh, D., Jeewa, A., Tume, S.C., Dreyer, W.J., Pignatelli, R., Horne, D., Justino, H., and Qureshi, A.M. (2018). Percutaneous mechanical circulatory support using Impella devices for decompensated cardiogenic shock. Asaio J 64, 98–104.

    Article  PubMed  Google Scholar 

  • Park, M., Sangean, M.C., Volpe, M.S., Feltrim, M.I.Z., Nozawa, E., Leite, P.F., Passos Amato, M.B., and Lorenzi-Filho, G. (2004). Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema. Crit Care Med 32, 2407–2415.

    Article  PubMed  Google Scholar 

  • Pelliccia, F., Kaski, J.C., Crea, F., and Camici, P.G. (2017). Pathophysiology of Takotsubo syndrome. Circulation 135, 2426–2441.

    Article  CAS  PubMed  Google Scholar 

  • Pinamonti, B., Alberti, E., Cigalotto, A., Dreas, L., Salvi, A., Silvestri, F., and Camerini, F. (1988). Echocardiographic findings in myocarditis. Am J Cardiol 62, 285–291.

    Article  CAS  PubMed  Google Scholar 

  • Pollack, A., Kontorovich, A.R., Fuster, V., and Dec, G.W. (2015). Viral myocarditis-diagnosis, treatment options and current controversies. Nat Rev Cardiol 12, 670–680.

    Article  Google Scholar 

  • Ponikowski, P., Voors, A.A., Anker, S.D., Bueno, H., Cleland, J.G.F., Coats, A.J.S., Falk, V., González-Juanatey, J.R., Harjola, V.P., Jankowska, E.A., et al. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 37, 2129–2200.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pozzi, M., Banfi, C., Grinberg, D., Koffel, C., Bendjelid, K., Robin, J., Giraud, R., and Obadia, J.F. (2016). Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock due to myocarditis in adult patients. J Thorac Dis 8, e495–E502.

    Article  PubMed  PubMed Central  Google Scholar 

  • Priori, S.G., Blomström-Lundqvist, C., Mazzanti, A., Blom, N., Borggrefe, M., Camm, J., Elliott, P.M., Fitzsimons, D., Hatala, R., Hindricks, G., et al. (2015). 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace euv319.

    Google Scholar 

  • Rodríguez, A., Alvarez-Rocha, L., Sirvent, J.M., Zaragoza, R., Nieto, M., Arenzana, A., Luque, P., Socías, L., Martín, M., Navarro, D., et al. (2012). Recomendaciones del Grupo de Trabajo Enfermedades Infecciosas (GTEI) de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) y el Grupo de Estudio de Infecciones en el Paciente Crítico (GEIPC) de la Sociedad Española de Enfermedades Infecciosas y Microbiología clínica (SEIMC) para el diagnóstico y tratamiento de la gripe A/H1N1 en pacientes adultos graves hospitalizados en las Unidades de Cuidados Intensivos. Med Intensiva 36, 103–137.

    Article  PubMed  Google Scholar 

  • Ryu, D.R., Heo, J.W., Lee, S.H., Lee, W., Choi, J.W., Kim, H.Y., Lee, B.K., and Cho, B.R. (2013). Fulminant myocarditis: the role of cardiac magnetic resonance imaging. Int J Cardiol 168, e58–e59.

    Article  PubMed  Google Scholar 

  • Saeed, M., Liu, H., Liang, C.H., and Wilson, M.W. (2017). Magnetic resonance imaging for characterizing myocardial diseases. Int J Cardiovasc Imag 33, 1395–1414.

    Article  Google Scholar 

  • Schmidt, M., Burrell, A., Roberts, L., Bailey, M., Sheldrake, J., Rycus, P.T., Hodgson, C., Scheinkestel, C., Cooper, D.J., Thiagarajan, R.R., et al. (2015). Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J 36, 2246–2256.

    Article  CAS  PubMed  Google Scholar 

  • Shioji, K., Kishimoto, C., and Sasayama, S. (2001). Fc receptor-mediated inhibitory effect of immunoglobulin therapy on autoimmune giant cell myocarditis: concomitant suppression of the expression of dendritic cells. Circ Res 89, 540–546.

    Article  CAS  PubMed  Google Scholar 

  • Sodhi, N., and Lasala, J.M. (2017). Mechanical circulatory support in acute decompensated heart failure and shock. Interv Cardiol Clin 6, 387–405.

    PubMed  Google Scholar 

  • Sun, D., Ding, H., Zhao, C., Li, Y., Wang, J., Yan, J., and Wang, D.W. (2017). Value of SOFA, APACHE IV and SAPS II scoring systems in predicting short-term mortality in patients with acute myocarditis. Oncotarget 8.

    Google Scholar 

  • Thiele, H., Zeymer, U., Neumann, F.J., Ferenc, M., Olbrich, H.G., Hausleiter, J., de Waha, A., Richardt, G., Hennersdorf, M., Empen, K., et al. (2013). Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABPSHOCK II): final 12 month results of a randomised, open-label trial. Lancet 382, 1638–1645.

    Article  PubMed  Google Scholar 

  • Tong, L., and Zhu, Y.F. (2014). Clinical analysis of 36 children with fulminant myocarditis. ChongQin Med 4241–4242.

    Google Scholar 

  • Ukena, C., Mahfoud, F., Kindermann, I., Kandolf, R., Kindermann, M., and Böhm, M. (2011). Prognostic electrocardiographic parameters in patients with suspected myocarditis. Eur J Heart Fail 13, 398–405.

    Article  PubMed  Google Scholar 

  • Ukimura, A., Izumi, T., Matsumori, A., and Clinical Research Committee on Myoc, A. (2010). A national survey on myocarditis associated with the 2009 influenza A (H1N1) pandemic in Japan. Circ J 74, 2193–2199.

    Article  PubMed  Google Scholar 

  • Ukimura, A., Ooi, Y., Kanzaki, Y., Inomata, T., and Izumi, T. (2013). A national survey on myocarditis associated with influenza H1N1pdm2009 in the pandemic and postpandemic season in Japan. J Infection ChemoTher 19, 426–431.

    Article  Google Scholar 

  • Unverzagt, S., Buerke, M., de Waha, A., Haerting, J., Pietzner, D., Seyfarth, M., Thiele, H., Werdan, K., Zeymer, U., and Prondzinsky, R. (2015). Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev 75.

    Google Scholar 

  • van Diepen, S., Katz, J.N., Albert, N.M., Henry, T.D., Jacobs, A.K., Kapur, N.K., Kilic, A., Menon, V., Ohman, E.M., Sweitzer, N.K., et al. (2017). Contemporary management of cardiogenic shock: a scientific statement from the American heart association. Circulation 136, e232.

    Article  PubMed  Google Scholar 

  • Vital, F.M., Ladeira, M.T., and Atallah, A.N. (2013). Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev, CD005351.

    Book  Google Scholar 

  • von Knobelsdorff-Brenkenhoff, F., Schüler, J., Dogangüzel, S., Dieringer, M.A., Rudolph, A., Greiser, A., Kellman, P., and Schulz-Menger, J. (2017). Detection and monitoring of acute myocarditis applying quantitative cardiovascular magnetic resonance. Circ Cardiovasc Imag 10.

    Google Scholar 

  • Wang, D.W. (2017). Contemporary management of fulminant myocarditis. J Intern Inten Med (China) 23, 441–442.

    Google Scholar 

  • Wang, Y., Yuan, Y., Wang, Q., Shao, W., and Cui, L. (2013). Sixty-four cases of fulminant myocarditis in children. Chin J Pr Pediatr 12, 935–937.

    Google Scholar 

  • Wei, X.X., Wang, D.W., and Li, S. (2017). Application of emergency coronary angiography in adult patients with fulminant myocarditis. J Intern Inten Med (China) 23, 462–464.

    Google Scholar 

  • Weng, C.L., Zhao, Y.T., Liu, Q.H., Fu, C.J., Sun, F., Ma, Y.L., Chen, Y.W., and He, Q.Y. (2010). Meta-analysis: noninvasive ventilation in acute cardiogenic pulmonary edema. Ann Intern Med 152, 590–600.

    Article  PubMed  Google Scholar 

  • Yang, G.T., Ding, J., Guan, M.Z., Zhang, D.H., Ding, M.Y., Gu, R.X., Sun, Y., Xu, G.Q., Peng, C.F., and Han, Y.L. (2016). Extracorporeal membrane oxygenation for rescuing fulminant myocarditis patients complicated with multiple organ failure. Clin J Med Officers 44, 1140–1143.

    Google Scholar 

  • Yoshimizu, N., Tominaga, T., Ito, T., Nishida, Y., Wada, Y., Sohmiya, K., Tanaka, S., Shibata, K., Kanzaki, Y., Ukimura, A., et al. (2014). Repetitive fulminant influenza myocarditis requiring the use of circulatory assist devices. Intern Med 53, 109–114.

    Article  PubMed  Google Scholar 

  • Yu, D.Q., Wang, Y., Ma, G.Z., Xu, R.H., Cai, Z.X., Ni, C.M., Chen, P., and Zhu, Z.D. (2014). Intravenous immunoglobulin in the therapy of adult acute fulminant myocarditis: a retrospective study. Exp Ther Med 7, 97–102.

    Article  CAS  PubMed  Google Scholar 

  • Zeymer, U., and Thiele, H. (2017). Mechanical support for cardiogenic shock. J Am Coll Cardiol 69, 288–290.

    Article  PubMed  Google Scholar 

  • Zhang, L., Wei, T.T., Li, Y., Li, J., Fan, Y., Huang, F.Q., Cai, Y.Y., Ma, G., Liu, J.F., Chen, Q.Q., et al. (2018). Functional metabolomics characterizes a key role for N-acetylneuraminic acid in coronary artery diseases. Circulation 137, 1374–1390.

    Article  CAS  PubMed  Google Scholar 

  • Zhou, N., Zuo, H., Su, Y., Miao, K., Jiang, J., Wang, L., and Wang, W. D. (2017). Clinical characteristics of old patients with fulminant myocarditis. J Crit Care Intern Med 23, 456–458.

    Google Scholar 

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Acknowledgements

This project was funded by the National Key Basic Research Project (2012CB518004) and Natural Science Fund Key Project (81630010). All the physicians and nurses of the Department of Cardiology and some of the physicians and nurses of the Department of Nephrology at Tongji Hospital contributed to the treatment of fulminant myocarditis patients and the formulation of this consensus. Prof. Rutai Hui in Fuwai Hospital gave enthusiastic support and valuable advice to this project. We thank greatly all senior experts for repeated discussion for this expert consensus statement: Jun Pu (Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University), Yundai Chen (Department of Cardiology, Chinese PLA General Hospital), Yugang Dong (Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University), Weiyi Fang (Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University), Junbo Ge, Jingmin Zhou (Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University), Xianghua Fu (Department of Cardiology, the Second Affiliated Hospital of Hebei Medical University), Yong Huo (Department of Cardiology, Peking University First Hospital), Rutai Hui (Department of Cardiology, Fuwai Hospital), Jianjun Tan (Department of Cardiology, the Second Affiliated Hospital of Xiangya School of Medicine, Central South University), Lemin Wang (Department of Cardiology, Tongji Hospital, Tongji University School of Medicine), Zonggui Wu (Department of Cardiology, Changzheng Hospital, the Second Military Medical University), Dingli Xu (Department of Cardiology, Nanfang Hospital, Southern Medical University), Dingcheng Xiang (Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA), Shenghua Zhou, Tianlun Yang (Department of Cardiology, Xiangya Hospital of Central South University), Bo Yu (Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University), Jing Zhang (Fuwai Huazhong Cardiovascular Hospital) and Song Zhang (Cardiovascular Department, Xin Hua Hospital, Affiliated Hospital of Shanghai Jiao Tong University).

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Correspondence to Daowen Wang.

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Wang, D., Li, S., Jiang, J. et al. Chinese society of cardiology expert consensus statement on the diagnosis and treatment of adult fulminant myocarditis. Sci. China Life Sci. 62, 187–202 (2019). https://doi.org/10.1007/s11427-018-9385-3

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Keywords

  • adult fulminant myocarditis
  • diagnosis and treatment
  • expert consensus
  • life support-based comprehensive treatment regimen
  • cardiogenic shock
  • mechanical circulatory support