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. adult fulminant myocarditis, diagnosis and treatment, expert consensus, life support-based comprehensive treatment regimen, cardiogenic shock, mechanical circulatory support Citation:

First case of COVID-19 complicated with fulminant myocarditis: a case report and insights

“…In this case, the patient had the following features: sudden onset, obvious symptoms of viral infection, rapid emergence of severe hemodynamic disorders, severe myocardial injury, and diffuse decreased ventricular wall movement. The above features are all in accordance with the diagnostic criteria of fulminant myocarditis [5]. This patient's PASP gradually increased, suggesting that the pulmonary lesions were gradually aggravated.…”

“…Bedside echocardiography showed an enlarged left ventricle (61 mm), diffuse myocardial dyskinesia along with a low left ventricular ejection fraction (LVEF) (32%), pulmonary hypertension (44 mmHg), and no decrease in right cardiac function (Figs. 4,5). No pericardial effusion was observed.…”

Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China

“…In this study, we first reported that the infection of SARS-CoV-2 may cause fulminant myocarditis. Given that fulminant myocarditis is characterized by a rapid progress and a severe state of illness [3], our results should alert physicians to pay attention not only to the symptoms of respiratory dysfunction but also the symptoms of cardiac injury.…”

SARS-CoV-2: a potential novel etiology of fulminant myocarditis

“…immunoglobins, neuraminidase inhibitors, and active mechanical lifesupport treatments. The life-support treatments comprised the application of mechanical respirators and circulatory support systems, of which intra-aortic balloon pulsation (IABP) or Impella implantation or extracorporeal membrane oxygenation (ECMO) as well as cardiac pacemaker are part of the current therapeutic armamentarium [23]. The important and life-saving role of IABP, Impella, and ECMO has been underlined also by European and American centers [24][25][26].…”