Akinori Sawamura1, Takahiro Okumura1, Akihiro Hirakawa2, Masaaki Ito3, Yukio Ozaki4, Nobuyuki Ohte5, Tetsuya Amano6, Toyoaki Murohara1. 1. Department of Cardiology, Nagoya University Graduate School of Medicine. 2. Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo. 3. Department of Cardiology and Nephrology, Mie University Graduate School of Medicine. 4. Department of Cardiology, Fujita Health University. 5. Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences. 6. Department of Cardiology, Aichi Medical University Hospital.
Abstract
BACKGROUND: Cardiac recovery and prevention of end-organ damage are the cornerstones of establishing successful bridge to recovery (BTR) in patients with fulminant myocarditis (FM) supported with percutaneous venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, the timing and method of successful BTR prediction still remain unclear. We aimed to develop a prediction model for successful BTR in patients with FM supported with percutaneous VA-ECMO.Methods and Results: This was a retrospective multicenter chart review enrolling 99 patients (52±16 years; female, 42%) with FM treated with percutaneous VA-ECMO. The S-group comprised patients who experienced percutaneous VA-ECMO decannulation and subsequent discharge (n=46), and the F-group comprised patients who either died in hospital or required conversion to other forms of mechanical circulatory support (n=53). At VA-ECMO initiation (0-h), the S-group had significantly higher left ventricular ejection fraction (LVEF) and lower aspartate aminotransferase (AST) concentration than the F-group. At 48 h, the LVEF, increase in the LVEF, and reduction of AST from 0-h were identified as independent predictors in the S-group. Finally, we developed an S-group prediction model comprising these 3 variables (area under the curve, 0.844; 95% confidence interval, 0.745-0.944). CONCLUSIONS: We developed a model for use 48 h after VA-ECMO initiation to predict successful BTR in patients with FM.
BACKGROUND: Cardiac recovery and prevention of end-organ damage are the cornerstones of establishing successful bridge to recovery (BTR) in patients with fulminant myocarditis (FM) supported with percutaneous venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, the timing and method of successful BTR prediction still remain unclear. We aimed to develop a prediction model for successful BTR in patients with FM supported with percutaneous VA-ECMO.Methods and Results: This was a retrospective multicenter chart review enrolling 99 patients (52±16 years; female, 42%) with FM treated with percutaneous VA-ECMO. The S-group comprised patients who experienced percutaneous VA-ECMO decannulation and subsequent discharge (n=46), and the F-group comprised patients who either died in hospital or required conversion to other forms of mechanical circulatory support (n=53). At VA-ECMO initiation (0-h), the S-group had significantly higher left ventricular ejection fraction (LVEF) and lower aspartate aminotransferase (AST) concentration than the F-group. At 48 h, the LVEF, increase in the LVEF, and reduction of AST from 0-h were identified as independent predictors in the S-group. Finally, we developed an S-group prediction model comprising these 3 variables (area under the curve, 0.844; 95% confidence interval, 0.745-0.944). CONCLUSIONS: We developed a model for use 48 h after VA-ECMO initiation to predict successful BTR in patients with FM.
Entities:
Keywords:
Bridge to recovery; Extracorporeal membrane oxygenation; Fulminant myocarditis; Mechanical circulatory support; Prediction model
Authors: Adamantios Tsangaris; Tamas Alexy; Rajat Kalra; Marinos Kosmopoulos; Andrea Elliott; Jason A Bartos; Demetris Yannopoulos Journal: Front Cardiovasc Med Date: 2021-07-07