Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes

Objectives: Fulminant myocarditis (FM) is a rapidly progressive and frequently fatal form of myocarditis that has been difficult to classify. This study aims to compare the clinical characteristics, treatments and outcomes in patients with fulminant giant cell myocarditis (FGCM) and fulminant lympho...

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Autores principales:	Yuxiao Hu, Jie Ren, Xueqi Dong, Di Zhang, Yi Qu, Chunxue Yang, Yang Sun, Jinghui Li, Fang Luo, Wei Wang, Huanhuan Wang, Ping Qing, Shihua Zhao, Jie Huang, Litian Yu, Yaxin Liu, Huiqiong Tan
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	fulminant myocarditis giant cell myocarditis lymphocytic myocarditis myocardial biopsy heart transplantation outcome Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/cde15553d0034d1a80af5aa95e77c11a
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spelling	oai:doaj.org-article:cde15553d0034d1a80af5aa95e77c11a2021-12-03T05:47:14ZFulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes2297-055X10.3389/fcvm.2021.770549https://doaj.org/article/cde15553d0034d1a80af5aa95e77c11a2021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.770549/fullhttps://doaj.org/toc/2297-055XObjectives: Fulminant myocarditis (FM) is a rapidly progressive and frequently fatal form of myocarditis that has been difficult to classify. This study aims to compare the clinical characteristics, treatments and outcomes in patients with fulminant giant cell myocarditis (FGCM) and fulminant lymphocytic myocarditis (FLM).Methods and Results: In our retrospective study, nine patients with FGCM (mean age 47.9 ± 7.5 years, six female) and 7 FLM (mean age 42.1 ± 12.3 years, four female) patients confirmed by histology in the last 11 years were included. Most patients with FGCM and FLM were NYHA functional class IV (56 vs. 100%, p = 0.132). Patients with FGCM had significantly lower levels of high-sensitivity C-reactive protein [hs-CRP, 4.4 (2.0–10.2) mg/L vs. 13.6 (12.6–14.6) mg/L, P = 0.004, data shown as the median with IQR], creatine kinase-myoglobin [CK-MB, 1.4 (1.0–3.2) ng/ml vs. 14.6 (3.0–64.9) ng/ml, P = 0.025, median with IQR], and alanine aminotransferase [ALT, 38.0 (25.0–61.5) IU/L vs. 997.0 (50.0–3,080.0) IU/L, P = 0.030, median with IQR] and greater right ventricular end-diastolic diameter (RVEDD) [2.9 ± 0.3 cm vs. 2.4 ± 0.6 cm, P = 0.034, mean ± SD] than those with FLM. No differences were observed in the use of intra-aortic balloon pump (44 vs. 43%, p = 1.000) and extracorporeal membrane oxygenation (11 vs. 43%, p = 0.262) between the two groups. The long-term survival rate was significantly lower in FGCM group compared with FLM group (0 vs. 71.4%, p = 0.022). A multivariate cox regression analysis showed the level of hs-CRP (hazard ratio = 0.871, 95% confidence interval: 0.761–0.996, P = 0.043) was an independent prognostic factor for FM patients. Furthermore, the level of hs-CRP had a good ability to discriminate between patients with FGCM and FLM (AUC = 0.94, 95% confidence interval: 0.4213–0.9964).Conclusions: The inflammatory response and myocardial damage in the patients with FGCM were milder than those with FLM. Patients with FGCM had distinctly poorer prognoses compared with those with FLM. Our results suggest that hs-CRP could be a promising prognostic biomarker and a hs-CRP level of 11.71 mg/L is an appropriate cutoff point for the differentiating diagnosis between patients with FGCM and FLM.Yuxiao HuJie RenXueqi DongDi ZhangYi QuChunxue YangYang SunJinghui LiFang LuoWei WangHuanhuan WangPing QingShihua ZhaoJie HuangLitian YuYaxin LiuHuiqiong TanFrontiers Media S.A.articlefulminant myocarditisgiant cell myocarditislymphocytic myocarditismyocardial biopsyheart transplantationoutcomeDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	fulminant myocarditis giant cell myocarditis lymphocytic myocarditis myocardial biopsy heart transplantation outcome Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	fulminant myocarditis giant cell myocarditis lymphocytic myocarditis myocardial biopsy heart transplantation outcome Diseases of the circulatory (Cardiovascular) system RC666-701 Yuxiao Hu Jie Ren Xueqi Dong Di Zhang Yi Qu Chunxue Yang Yang Sun Jinghui Li Fang Luo Wei Wang Huanhuan Wang Ping Qing Shihua Zhao Jie Huang Litian Yu Yaxin Liu Huiqiong Tan Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes
description	Objectives: Fulminant myocarditis (FM) is a rapidly progressive and frequently fatal form of myocarditis that has been difficult to classify. This study aims to compare the clinical characteristics, treatments and outcomes in patients with fulminant giant cell myocarditis (FGCM) and fulminant lymphocytic myocarditis (FLM).Methods and Results: In our retrospective study, nine patients with FGCM (mean age 47.9 ± 7.5 years, six female) and 7 FLM (mean age 42.1 ± 12.3 years, four female) patients confirmed by histology in the last 11 years were included. Most patients with FGCM and FLM were NYHA functional class IV (56 vs. 100%, p = 0.132). Patients with FGCM had significantly lower levels of high-sensitivity C-reactive protein [hs-CRP, 4.4 (2.0–10.2) mg/L vs. 13.6 (12.6–14.6) mg/L, P = 0.004, data shown as the median with IQR], creatine kinase-myoglobin [CK-MB, 1.4 (1.0–3.2) ng/ml vs. 14.6 (3.0–64.9) ng/ml, P = 0.025, median with IQR], and alanine aminotransferase [ALT, 38.0 (25.0–61.5) IU/L vs. 997.0 (50.0–3,080.0) IU/L, P = 0.030, median with IQR] and greater right ventricular end-diastolic diameter (RVEDD) [2.9 ± 0.3 cm vs. 2.4 ± 0.6 cm, P = 0.034, mean ± SD] than those with FLM. No differences were observed in the use of intra-aortic balloon pump (44 vs. 43%, p = 1.000) and extracorporeal membrane oxygenation (11 vs. 43%, p = 0.262) between the two groups. The long-term survival rate was significantly lower in FGCM group compared with FLM group (0 vs. 71.4%, p = 0.022). A multivariate cox regression analysis showed the level of hs-CRP (hazard ratio = 0.871, 95% confidence interval: 0.761–0.996, P = 0.043) was an independent prognostic factor for FM patients. Furthermore, the level of hs-CRP had a good ability to discriminate between patients with FGCM and FLM (AUC = 0.94, 95% confidence interval: 0.4213–0.9964).Conclusions: The inflammatory response and myocardial damage in the patients with FGCM were milder than those with FLM. Patients with FGCM had distinctly poorer prognoses compared with those with FLM. Our results suggest that hs-CRP could be a promising prognostic biomarker and a hs-CRP level of 11.71 mg/L is an appropriate cutoff point for the differentiating diagnosis between patients with FGCM and FLM.
format	article
author	Yuxiao Hu Jie Ren Xueqi Dong Di Zhang Yi Qu Chunxue Yang Yang Sun Jinghui Li Fang Luo Wei Wang Huanhuan Wang Ping Qing Shihua Zhao Jie Huang Litian Yu Yaxin Liu Huiqiong Tan
author_facet	Yuxiao Hu Jie Ren Xueqi Dong Di Zhang Yi Qu Chunxue Yang Yang Sun Jinghui Li Fang Luo Wei Wang Huanhuan Wang Ping Qing Shihua Zhao Jie Huang Litian Yu Yaxin Liu Huiqiong Tan
author_sort	Yuxiao Hu
title	Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes
title_short	Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes
title_full	Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes
title_fullStr	Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes
title_full_unstemmed	Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes
title_sort	fulminant giant cell myocarditis vs. lymphocytic myocarditis: a comparison of their clinical characteristics, treatments, and outcomes
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/cde15553d0034d1a80af5aa95e77c11a
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Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes

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