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Publications

Journal Article Epublish

PubMed: 42609710 DOI: 10.1016/j.cjco.2026.03.020

Long-Term Outcomes in Survivors of Fulminant Myocarditis Supported with Venoarterial Extracorporeal Membrane Oxygenation by Discharge Cardiac Function.

CJC Open 8(8):1019-1026

Authors: Maria Lambadaris, Julie K K Vishram-Nielsen, Takahiro Okumura, Yee-Chun Chen, Aristine Cheng, Hsin-Yun Sun, Antonio Loforte, Yasuhide Asaumi, Kenichiro Sawada, Mingjie Huang, Wei C Lee, Thomas Fux, Matteo Pozzi, Heather J Ross, Finn Gustafsson, Hasse Møller-Sørensen, Albert Ariza-Solé, Mario Senechal, Pierre Yves Turgeon, Manuel Martinez-Selles, Francisco J Hernández-Pérez, Roberto Lorusso, Filio Billia, Ana C Alba

Affiliations

  • Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
  • Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
  • Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
  • Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
  • Department of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy.
  • Department of Surgical Sciences, University of Turin, Turin, Italy.
  • Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
  • Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore, Singapore.
  • Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
  • Department of Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
  • Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France.
  • Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
  • Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
  • Department of Cardiothoracic Anaesthesiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
  • Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
  • Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Canada.
  • Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV. School of Biomedical Sciences and Health, Universidad Europea de Madrid. School of Medicine, Universidad Complutense. Madrid, Spain.
  • Department of Cardiology, Heart Failure and Transplant Section, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
  • Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.

Abstract

BACKGROUND

Fulminant myocarditis (FM) is a life-threatening cause of cardiogenic shock. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is often employed as a bridge to recovery, but data on long-term outcomes and prognostic markers post-discharge remain limited. We described long-term outcomes and explored the association between discharge left ventricular ejection fraction (LVEF) and post-discharge events.

METHODS

This retrospective, international, multicentre cohort study included adult FM patients who required VA-ECMO and survived to hospital discharge. Patients were stratified by LVEF ≥ 50% or < 50% at discharge. Cox proportional hazards models were used to assess the association between discharge LVEF and the primary composite endpoint of death, heart transplantation, or durable mechanical circulatory support postdischarge.

RESULTS

A total of 106 patients from 11 centres were included, with a median age of 43 years (interquartile range 29-57); 42% were male. At discharge, LVEF was ≥ 50% in 69 patients and < 50% in 37 patients. Over a median follow-up of 4.4 years (interquartile range 1.6-7.9), 3 patients (2.8%) experienced the composite outcome (2 deaths, 1 left ventricular assist device implantation). Compared with patients discharged with an LVEF ≥ 50%, those with an LVEF < 50% had a numerically higher risk of the composite endpoint (hazard ratio 2.9, 95% confidence interval 0.19-42.9), although this difference was not statistically significant.

CONCLUSIONS

Given the low number of postdischarge events, this study was underpowered to assess the prognostic value of discharge LVEF. However, long-term outcomes were favourable among survivors of FM supported with VA-ECMO, regardless of their LVEF at discharge.

MeSH

Heart Failure, Extracorporeal Membrane Oxygenation, Myocarditis, Heart Transplantation, Membranes