Fulminant myocarditis (FM) is a severe and acute inflammation of the heart muscle, which can lead to life-threatening complications. Despite the introduction of aggressive treatment strategies, the adult survivors of FM continue to experience long-term adverse cardiovascular events. In recent years, the Chinese protocol for treating FM has emerged as a promising therapeutic approach. However, the impact of this treatment on the left ventricular (LV) function changes and echocardiographic predictors in adult survivors of FM remains unknown. This article aims to reveal the latest findings on LV function changes and echocardiographic predictors in adult survivors of FM treated with the Chinese protocol, shedding light on the effectiveness of this treatment strategy.
A previous case series of patients with fulminant myocarditis (FM) reported conflicting results in terms of prognosis and left ventricular (LV) functional recovery in the long-term. However, the current study found that patients treated with a Chinese protocol in the acute phase had favourable clinical outcomes and a much better long-term prognosis compared to previous reports. All patients survived during the 2-year follow-up, and both LV ejection fraction (LVEF) and LV chamber dimension did not significantly change. Global longitudinal strain (GLS) showed mild but significant improvement, and patients with GLS greater than 13.2% at discharge were more likely to have GLS normalization at two years.
The present study included only viral-FM adults who presented with acute onset of cardiac symptoms within 2 weeks and with a distinct viral prodrome to exclude potential cofounding effects from children and other forms of myocarditis. The Chinese protocol included both mechanical circulatory support and immunomodulation therapy. Temporary mechanical circulatory support was given priority, with intra-aortic balloon pump (IABP) as the primary therapy and extracorporeal membrane oxygenation (ECMO) used as an additional therapy if needed. The importance of temporary devices such as IABP and intravenous ECMO in the treatment was highlighted to ensure high survival rate with excellent recovery of LV function in acute phase.
The results of the study agree with the 2000 McCarthy study and the 2017 Ammirati study, both of which reported better long-term survival of FM. However, a relatively large proportion of patients with viral FM had residual LV dysfunction in the long-term, which suggests the need for further studies to investigate outcomes and future functional changes.
The study also sought to ascertain whether early echocardiographic parameters could predict outcomes or LV functional recovery after discharge. GLS was used to evaluate LV function, as it was found to be more sensitive than LVEF in detecting cardiac dysfunction and could provide more information in myocarditis. GLS at discharge was found to be associated with GLS at two years, with patients with GLS less than 13.2% at discharge less likely to have GLS normalization at two years. Therefore, the severity of LV dysfunction at discharge but not at presentation could predict LV functional recovery in the long-term, and GLS could provide additional prognostic information than LVEF.
In conclusion, echocardiographic assessment of left ventricular function is crucial in the management of adult survivors of fulminant myocarditis. The Chinese protocol has shown promising results in improving prognosis and decreasing mortality rates in these patients. Monitoring and early detection of echocardiographic predictors can aid clinicians in making informed decisions regarding treatment and follow-up care. Further research is needed to fully understand the mechanisms underlying these changes and to develop more targeted interventions for patients with fulminant myocarditis. It is our hope that this study will contribute to a better understanding of this complex and devastating condition and lead to improved outcomes for patients worldwide.
