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Previous Volume 342:690-695 March 9, 2000 Number 10 Next

	Full Text PDF Editorial by Karliner, J. S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Lymphocytic myocarditis causes left ventricular dysfunction that may be persistent or reversible. There are no clinical criteria that predict which patients will recover ventricular function and which cases will progress to dilated cardiomyopathy. We hypothesized that patients with fulminant myocarditis may have a better long-term prognosis than those with acute (nonfulminant) myocarditis.

Methods We identified 147 patients considered to have myocarditis according to the findings on endomyocardial biopsy and the Dallas histopathological criteria. Fulminant myocarditis was diagnosed on the basis of clinical features at presentation, including the presence of severe hemodynamic compromise, rapid onset of symptoms, and fever. Patients with acute myocarditis did not have these features. The incidence of the end point of this study, death or heart transplantation, was ascertained by contact with the patient or the patient's family or by a search of the National Death Index. The average period of follow-up was 5.6 years.

Results A total of 15 patients met the criteria for fulminant myocarditis, and 132 met the criteria for acute myocarditis. Among the patients with fulminant myocarditis, 93 percent were alive without having received a heart transplant 11 years after biopsy (95 percent confidence interval, 59 to 99 percent), as compared with only 45 percent of those with acute myocarditis (95 percent confidence interval, 30 to 58 percent; P=0.05 by the log-rank test). Fulminant myocarditis was an independent predictor of survival after adjustments were made for age, histopathological findings, and hemodynamic variables. The rate of transplantation-free survival did not differ significantly between the patients considered to have borderline myocarditis and those considered to have active myocarditis according to the Dallas histopathological criteria.

Conclusions Fulminant myocarditis is a distinct clinical entity with an excellent long-term prognosis. Aggressive hemodynamic support is warranted for patients with this condition.

Source Information

From the Division of Cardiology (R.E.M., E.K.K., J.M.H., K.L.B.) and the Department of Pathology (R.H.H., G.M.H.), Johns Hopkins Hospital, Baltimore; and the Division of Cardiology, Hershey Medical Center, Hershey, Pa. (J.P.B.).

Address reprint requests to Dr. Hare at Johns Hopkins Hospital, 600 N. Wolfe St., Carnegie 568, Baltimore, MD 21287, or at jhare{at}mail.jhmi.edu.

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Fulminant Myocarditis
Khairy P., Infante-Rivard C., Karcic A., Conrad A. R., Conraads V., Hare J. M., McCarthy R. E., Baughman K. L.
Extract | Full Text  
N Engl J Med 2000; 343:298-300, Jul 27, 2000. Correspondence

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