Features and Outcomes of Histologically Proven Myocarditis With Fulminant Presentation
Authors: Kanaoka Koshiro , Onoue Kenji , Terasaki Satoshi , Nakano Tomoya , Nakai Michikazu , Sumita Yoko , Hatakeyama Kinta , Terasaki Fumio , Kawakami Rika , Iwanaga Yoshitaka , Miyamoto Yoshihiro , Saito Yoshihiko , Yuda Satoshi , Tanno Masaya , Takahashi Toru , Yokoshiki Hisashi , Toba Masahiro , Anzai Toshihisa , Nagai Toshiyuki , Sato Takuma , Takenaka Takashi , Yamazaki Seiji , Katagiri Yuki , Takeuchi Toshiharu , Sugitatsu Kazuya , Kakinoki Shigeo , Matsumoto Tomoaki , Urasawa Kazushi , Tan Michinao , Tsujino Ichizo , Kamigaki Mitsunori , Tomita Hirofumi , Hanada Kenji , Kushibiki Motoi , Nakamura Akihiro , Morino Yoshihiro , Nasu Takahito , Yasuda Satoshi , Suzuki Hideaki , Iwabuchi Kaoru , Tsuji Kanako , Namiuchi Shigeto , Komaru Tatsuya , Yagi Masahiro , Uematsu Shoko , Takahashi Toshiaki , Takeda Satoru , Nakanishi Toru , Watanabe Masafumi , Wanezaki Masahiro , Matsui Motoyuki , Sugawara Shigeo , Takeishi Yasuchika , Oikawa Masayoshi , Komatsu Nobuo , Suzuki Satoshi , Okamoto Hiroshi , Takeyasu Noriyuki , Akiyama Daiki , Eki Yutaka , Kakuta Tsunekazu , Sugiyama Tomoyo , Koizumi Tomomi , Ueno Koji , Kario Kazuomi , Taki Mizuri , Matsumoto Yuri , Yasu Takanori , Nishioka Osamu , Naito Shigeto , Murata Makoto , Tange Shoichi , Kaneko Katsumi , Muto Makoto , Inagaki Hiroshi , Hasegawa Shuichi , Tachibana Eizo , Atsumi Wataru , Suzuki Masahiro , Muramatsu Toshihiro , Yamada Yoshihiro , Taguchi Isao , Fukuda Yoshiaki , Matsui Akihiro , Kanda Junji , Hozawa Koji , Matsumura Akihiko , Shimizu Wataru , Yamamoto Takeshi , Komuro Issei , Hatano Masaru , Ikeda Takanori , Kiuchi Shunsuke , Chikamori Taishiro , Takei Yasuyoshi , Soejima Kyoko , Minamishima Toshinori , Tanaka Hiroyuki , Shimizu Shigeo , Kasao Masashi , Kadohira Tadayuki , Minamino Tohru , Shimada Kazunori , Iwata Hiroshi , Momiyama Yukihiko , Ashikaga Takashi , Nozato Toshihiro , Fujiwara Yasumasa , Inoue Kenji , Sasano Tetsuo , Matsuda Junji , Ishii Yasuhiro , Ono Yuichi , Tanabe Kengo , Horiuchi Yu , Shinke Toshiro , Kodama Yusuke , Moroi Masao , Yazaki Yoshiyuki , Mizumura Taisuke , Ohta Hiroshi , Akashi Yoshihiro , Kotoku Nozomi , Ikari Yuji , Maruyama Mitsunori , Sato Yasuhiro , Tamura Koichi , Konishi Masaaki , Suzuki Hiroshi , Ebato Mio , Fukui Kazuki , Yumoto Kazuhiko , Iwasawa Takamasa , Kashimura Takeshi , Takahashi Kazuyoshi , Okada Yoshinobu , Kaku Bunji , Usuda Kazuo , Maruyama Michiro , Kameyama Tomoki , Higashikata Toshinori , Hodatsu Akihiko , Osato Kazuo , Nagata Yoji , Maeno Koji , Satake Kazuo , Sawanobori Takao , Watanabe Noboru , Kuwahara Koichiro , Motoki Hirohiko , Kitabayashi Hiroshi , Otagiri Kyuhachi , Kono Tsunesuke , Yamagishi Daisuke , Yazaki Yoshikazu , Noda Toshiyuki , Morishima Itsuro , Watanabe Naoki , Tanaka Shinichiro , Onodera Tomoya , Nawada Ryuzo , Watanabe Akinori , Matsunaga Masaki , Suwa Satoru , Sakamoto Hiroshi , Sakamoto Hiroki , Aoyama Takeshi , Kanamori Norio , Muto Masahiro , Maekawa Yuichiro , Ohtani Hayato , Ozaki Yukio , Naruse Kenshin , Takemoto Kenji , Kamiya Haruo , Suzuki Takeshi , Tomita Yasushi , Suzuki Susumu , Kametani Ryosuke , Aoyama Hidekazu , Osanai Hiroyuki , Harada Ken , Kada Kenji , Saeki Tomoaki , Kobayashi Koichi , Ogawa Yasuhiro , Terasawa Akihiro , Shinoda Masanori , Oguri Mitsutoshi , Shimizu Kiyokazu , Sawamura Akinori , Sugiura Atsushi , Hattori Kosuke , Mokuno Shinji , Kondo Kazuhisa , Dohi Kaoru , Moriwaki Keishi , Kasai Atsunobu , Nakakuki Tetsuya , Kaitani Kazuaki , Jinnai Toshikazu , Yamamoto Takashi , Kurata Hiroyuki , Wada Atsuyuki , Akao Masaharu , Hamatani Yasuhiro , Ishibashi Kazuya , Akakabe Yoshiki , Asaumi Yasuhide , Matama Hideo , Sakata Yasushi , Kioka Hidetaka , Takaishi Hiroshi , Iwanaga Yoshitaka , Takase Toru , Matsuda Mitsuo , Sato Fumi , Hasegawa Shinji , Ishigami Kenichi , Ichikawa Minoru , Takagi Takashi , Inoko Moriaki , Hoshiga Masaaki , Fujita Shuichi , Takeda Yoshihiro , Kawarabayashi Takahiko , Takaoka Hideyuki , Nakajima Kenji , Yuguchi Tadashi , Kawasaki Tatsuya , Shinoda Yukinori , Sato Yukihito , Ishihara Masaharu , Matsumoto Yuki , Kawai Hiroya , Takaya Tomofumi , Matsuo Kouki , Mano Toshiaki , Hirata Kenichi , Hisamatsu Eriko , Inoue Nobutaka , Tamita Koichi , Mukohara Naoki , Shimoyama Hisashi , Miyajima Toru , Tamura Toshihiro , Tamaki Yodo , Suzuki Megumi , Yokota Ryoji , Horii Manabu , Yamanaka Kazuo , Kawata Hiroyuki , Hashimoto Yukihiro , Nakada Yasuki , Nakagawa Hitoshi , Ueda Tomoya , Nishida Taku , Seno Ayako , Watanabe Makoto , Akasaka Takashi , Tanimoto Takashi , Toyofuku Mamoru , Yamamoto Kazuhiro , Kinugasa Yoshiharu , Hirai Masayuki , Nasu Hiroshi , Shirota Kinya , Oda Tsuyoshi , Oka Takefumi , Kadota Kazushige , Ohya Masanobu , Ito Hiroshi , Nakamura Kazufumi , Ogura Soichiro , Fuke Soichiro , Uemura Shiro , Matsubara Hiromi , Watanabe Atsuyuki , Morishima Nobuyuki , Kihara Yasuki , Hidaka Takayuki , Ueda Hironori , Ono Yujiro , Muraoka Yuji , Hatanari Miyo , Miyamoto Yoshinori , Dote Keigo , Kato Masaya , Yano Masafumi , Mochizuki Mamoru , Ikeda Yasuhiro , Fujinaga Hiroyuki , Hosokawa Shinobu , Sata Masataka , Yamaguchi Koji , Aki Naoko , Minamino Tetsuo , Miyake Yuichi , Takagi Yuichiro , Doi Masayuki , Taketani Yoshio , Okayama Hideki , Shigematsu Tatsuya , Higaki Akinori , Yamaguchi Osamu , Inaba Shinji , Ikeda Shuntaro , Kawai Kazuya , Kitaoka Hiroaki , Kubo Toru , Ando Kenji , Inui Kaoru , Fukumoto Yoshihiro , Hori Kensuke , Homma Takehiro , Kawasaki Tomohiro , Mohri Masahiro , Fujiwara Masaki , Tsutsui Hiroyuki , Ide Tomomi , Miura Shin-Ichiro , Kuwano Takashi , Shimomura Hideki , Kadokami Toshiaki , Taba Masanao , Kondou Katsuhiro , Kubota Toru , Nagatomo Daisuke , Mukai Yasushi , Matsukawa Ryuichi , Tashiro Hideki , Shimomura Mitsuhiro , Maemura Koji , Kawano Hiroaki , Oku Koji , Yamasa Toshihiko , Kizaki Yoshihisa , Sakamoto Tomohiro , Tamura Yudai , Ito Teruhiko , Fujimoto Kazuteru , Tsujita Kenichi , Takashio Seiji , Kurokawa Hirofumi , Takahashi Naohiko , Saito Shotaro , Arikawa Masaya , Shibata Yoshisato , Nishihira Kensaku , Tsuruda Toshihiro , Sonoda Masahiro , Atsuchi Nobuhiko , Ohishi Mitsuru , Higuchi Koji , Miyata Masaaki , Oketani Naoya , Akimoto Yoshinori , Asahi Tomohiro , Wake Minoru 
Published: October 2022

Background:
Fulminant myocarditis presentation (FMP) is a rare and severe presentation of myocarditis. The natural history of FMP and its clinical features associated with poor outcomes are incompletely understood because there is a lack of generalizable evidence.

Methods:
This multicenter retrospective cohort study included patients hospitalized with histologically proven myocarditis who underwent catecholamine or mechanical support from 235 cardiovascular training hospitals across Japan between April 2012 and March 2017. Clinical features and the prognostic predictors of death or heart transplantation within 90 days on the basis of clinical and pathologic findings were determined using the Kaplan-Meier method, log-rank test, and Cox regression analysis.

Results:
This study included 344 patients with histologically proven FMP (median age, 54 years; 40% female). The median follow-up was 600 days (interquartile range, 36 to 1599 days) and the cumulative risk of death or heart transplantation at 90 days was 29% (n=98). Results from multivariable Cox regression analysis showed that older age, nonsinus rhythm, low left ventricular wall motion (<40%) on admission, and ventricular tachycardia or fibrillation on admission day were associated with worse 90-day survival. Severe histologic damage (damaged cardiomyocytes comprising ≥50% of the total cardiomyocytes) was associated with a worse 90-day prognosis in patients with lymphocytic myocarditis.

Conclusions:
The results from analyses of data from this multicenter registry demonstrated that patients with FMP are at a higher risk of death or heart transplantation in real-world settings. These observations inform which clinical and pathologic findings may be useful for prognostication in FMP.

Registration:

URL:
https://www.umin.ac.jp/ctr
; Unique identifier: UMIN000039763.