Prognostic factors for heart recovery in adult patients with acute fulminant myocarditis and cardiogenic shock supported with extracorporeal membrane oxygenation

Background: Extracorporeal membrane oxygenation (ECMO) is an effective support method for acute fulminant myocarditis (AFM) with cardiogenic shock. However, decidingwhether to bridge to a left ventricular assist device (LVAD) or to maintain ECMO support until heart recovery is still controversial. Material andmethods: This was a retrospective observational study froma single center. Eighty-eight adultswith AFMand ECMO support between 2006 and 2018were included. The primary endpointwas heart recoverywithout heart transplantation or long-term LVAD support. Results: The heart recovery group contained 43 patients, of whom 41 were discharged after being weaned off ECMO and the other two after LVAD. Five patients with heart transplants and one with long-termLVAD support were discharged, accounting for an overall survival of 55.7%. Multivariate logistic regression revealed that peak CK-MB level, severe intraventricular conduction disturbance (asystole) and malignant arrhythmia (VT or VF) were prognostic factors for nonrecovery (P =.027 and 0.017, respectively), while early intravenous immunoglobulin (IVIG) use before ECMO was highly likely to have a protective effect with a trend toward statistical significance (P=.079). A risk scorewas developed: 4 points for VT/VF/asystole, 1 point for every 100 mu g/L increase in the peak CK-MB level, up to a maximum of 5 points, and -3 points for early IVIG use. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.818. Conclusion: High CK-MB levels and VT/VF/asystole in patientswith AFMare associated with poor heart recovery. Early IVIG use shows a potentially protective effect. (c) 2020 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).