Fulminant myocarditis in adults: a narrative review
Santiago Montero1
Darryl Abrams2
Enrico Ammirati3
Florent Huang4
Dirk W.Donker5
Guillaume Hekimian6
Cosme García-García7
Antoni Bayes-Genis7
Alain Combes6
Matthieu Schmidt6
1.Acute Cardiovascular Care Unit,Heart Institute,Hospital Germans Trias i Pujol,Departament de Medicina,Universitat Autònoma de Barcelona,CIBERCV,Spain;Assistance Publique-H?pitaux de Paris,Pitié-Salpêtrière Hospital,Medical Intensive Care Unit,Paris,France2.Columbia University Vagelos College of Physicians&Surgeons/NewYork-Presbyterian Hospital,New York,USA;Center for Acute Respiratory Failure,Columbia University Irving Medical Center,New York,USA3.De Gasperis Cardio Center and Transplant Center,Niguarda Hospital,Milano,Italy4.Cardiology,H?pital Foch,Suresnes,Paris,France5.Intensive Care Center,University Medical Center Utrecht,Utrecht,the Netherlands;Cardiovascular and Respiratory Physiology,TechMed Center,University of Twente,Enschede,the Netherlands6.Assistance Publique-H?pitaux de Paris,Pitié-Salpêtrière Hospital,Medical Intensive Care Unit,Paris,France;Sorbonne Université,INSERM UMRS_1166-iCAN,Institute of Cardiometabolism and Nutrition,Paris,France7.Acute Cardiovascular Care Unit,Heart Institute,Hospital Germans Trias i Pujol,Departament de Medicina,Universitat Autònoma de Barcelona,CIBERCV,Spain
摘要：Fulminant myocarditis (FM) is an uncommon syndrome characterized by sudden and severe hemodynamic comp-romise secondary to acute myocardial inflammation, often presenting as profound cardiogenic shock, life-threatening ventricular arrhythmias and/or electrical storm. FM may be refractory to conventional therapies and require mechanical circulatory support (MCS). The immune system has been recognized as playing a pivotal role in the pathophysiology of myocarditis, leading to an in-creased focus on immunosuppressive treatment strategies. Recent data have highlighted not only the fact that FM has signific-antly worse outcomes than non-FM, but that prognosis and management strategies of FM are heavily dependent on histological subtype, placing greater emphasis on the role of endomyocardial biopsy in diagnosis. The impact of subtype on severity and pro-gnosis will likewise influence how aggressively the myocarditis is managed, including whether MCS is warranted. Many pati-ents with refractory cardiogenic shock secondary to FM end up requiring MCS, with venoarterial extracorporeal membrane oxygenation demonstrating favorable survival rates, particularly when initiated prior to the development of multiorgan failure. Among the challenges facing the field are the need to more precisely identify immunopathophysiological pathways in order to develop targeted therapies, and the need to better optimize the timing and management of MCS to minimize complications and maximize outcomes.
机标关键词：reviewadultsfulminantmyocarditisnarrative
论文发表日期：2022-02-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：15( 137-151 )