Prognostic value of electrocardiography in patients with fulminant myocarditis supported by percutaneous venoarterial extracorporeal membrane oxygenation ― Analysis from the change pump study ―

CHANGE PUMP Investigators

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Abstract

Background: Fulminant myocarditis (FM) presents various abnormal findings on ECG, the prognostic impact of which has not been not fully elucidated. The aim of this study was therefore to clarify the prognostic value of ECG data in FM patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO). Methods and Results: In this multicenter chart review, we investigated 99 patients with FM supported by VA-ECMO. The final cohort consisted of 87 patients (mean age, 52±16 years; female, 42%) after 12 patients who required conversion to other forms of mechanical circulatory support were excluded. The median LVEF was 14.5%. At the time of VA-ECMO initiation, 38 patients (44%) had arrhythmias including atrial fibrillation (6%), complete atrioventricular block (CAVB; 17%), and ventricular tachycardia or fibrillation (VT/VF; 15%). Of the 49 patients with sinus rhythm (SR), 26 had QRS duration ≥120 ms (wide QRS). On logistic regression analysis, wide QRS predicted in-hospital death in patients with SR (OR, 3.6; 95% CI: 1.07–13.61, P=0.04). Compared with SR with narrow QRS (QRS duration <120 ms), CAVB and VT/VF had a higher risk of in-hospital death (CAVB: OR, 7.20; 95% CI: 1.78–34.15, P=0.005; VT/VF: OR, 8.10; 95% CI: 1.86–42.31, P=0.005). Conclusions: In patients with FM, CAVB and VT/VF carried a higher risk of in-hospital death. Wide QRS also predicted a higher risk of in-hospital death in patients with SR.

Original languageEnglish
Pages (from-to)2089-2095
Number of pages7
JournalCirculation Journal
Volume82
Issue number8
DOIs
Publication statusPublished - 01-01-2018

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Extracorporeal Membrane Oxygenation
Myocarditis
Electrocardiography
Atrioventricular Block
Ventricular Fibrillation
Ventricular Tachycardia
Atrial Fibrillation
Cardiac Arrhythmias
Logistic Models
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{259b003d8605470896fea8f63b6c6187,
title = "Prognostic value of electrocardiography in patients with fulminant myocarditis supported by percutaneous venoarterial extracorporeal membrane oxygenation ― Analysis from the change pump study ―",
abstract = "Background: Fulminant myocarditis (FM) presents various abnormal findings on ECG, the prognostic impact of which has not been not fully elucidated. The aim of this study was therefore to clarify the prognostic value of ECG data in FM patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO). Methods and Results: In this multicenter chart review, we investigated 99 patients with FM supported by VA-ECMO. The final cohort consisted of 87 patients (mean age, 52±16 years; female, 42{\%}) after 12 patients who required conversion to other forms of mechanical circulatory support were excluded. The median LVEF was 14.5{\%}. At the time of VA-ECMO initiation, 38 patients (44{\%}) had arrhythmias including atrial fibrillation (6{\%}), complete atrioventricular block (CAVB; 17{\%}), and ventricular tachycardia or fibrillation (VT/VF; 15{\%}). Of the 49 patients with sinus rhythm (SR), 26 had QRS duration ≥120 ms (wide QRS). On logistic regression analysis, wide QRS predicted in-hospital death in patients with SR (OR, 3.6; 95{\%} CI: 1.07–13.61, P=0.04). Compared with SR with narrow QRS (QRS duration <120 ms), CAVB and VT/VF had a higher risk of in-hospital death (CAVB: OR, 7.20; 95{\%} CI: 1.78–34.15, P=0.005; VT/VF: OR, 8.10; 95{\%} CI: 1.86–42.31, P=0.005). Conclusions: In patients with FM, CAVB and VT/VF carried a higher risk of in-hospital death. Wide QRS also predicted a higher risk of in-hospital death in patients with SR.",
author = "{CHANGE PUMP Investigators} and Akinori Sawamura and Takahiro Okumura and Masaaki Ito and Yukio Ozaki and Yukio Ozaki and Tetsuya Amano and Toyoaki Murohara",
year = "2018",
month = "1",
day = "1",
doi = "10.1253/circj.CJ-18-0136",
language = "English",
volume = "82",
pages = "2089--2095",
journal = "Circulation Journal",
issn = "1346-9843",
publisher = "Japanese Circulation Society",
number = "8",

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TY - JOUR

T1 - Prognostic value of electrocardiography in patients with fulminant myocarditis supported by percutaneous venoarterial extracorporeal membrane oxygenation ― Analysis from the change pump study ―

AU - CHANGE PUMP Investigators

AU - Sawamura, Akinori

AU - Okumura, Takahiro

AU - Ito, Masaaki

AU - Ozaki, Yukio

AU - Ozaki, Yukio

AU - Amano, Tetsuya

AU - Murohara, Toyoaki

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Fulminant myocarditis (FM) presents various abnormal findings on ECG, the prognostic impact of which has not been not fully elucidated. The aim of this study was therefore to clarify the prognostic value of ECG data in FM patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO). Methods and Results: In this multicenter chart review, we investigated 99 patients with FM supported by VA-ECMO. The final cohort consisted of 87 patients (mean age, 52±16 years; female, 42%) after 12 patients who required conversion to other forms of mechanical circulatory support were excluded. The median LVEF was 14.5%. At the time of VA-ECMO initiation, 38 patients (44%) had arrhythmias including atrial fibrillation (6%), complete atrioventricular block (CAVB; 17%), and ventricular tachycardia or fibrillation (VT/VF; 15%). Of the 49 patients with sinus rhythm (SR), 26 had QRS duration ≥120 ms (wide QRS). On logistic regression analysis, wide QRS predicted in-hospital death in patients with SR (OR, 3.6; 95% CI: 1.07–13.61, P=0.04). Compared with SR with narrow QRS (QRS duration <120 ms), CAVB and VT/VF had a higher risk of in-hospital death (CAVB: OR, 7.20; 95% CI: 1.78–34.15, P=0.005; VT/VF: OR, 8.10; 95% CI: 1.86–42.31, P=0.005). Conclusions: In patients with FM, CAVB and VT/VF carried a higher risk of in-hospital death. Wide QRS also predicted a higher risk of in-hospital death in patients with SR.

AB - Background: Fulminant myocarditis (FM) presents various abnormal findings on ECG, the prognostic impact of which has not been not fully elucidated. The aim of this study was therefore to clarify the prognostic value of ECG data in FM patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO). Methods and Results: In this multicenter chart review, we investigated 99 patients with FM supported by VA-ECMO. The final cohort consisted of 87 patients (mean age, 52±16 years; female, 42%) after 12 patients who required conversion to other forms of mechanical circulatory support were excluded. The median LVEF was 14.5%. At the time of VA-ECMO initiation, 38 patients (44%) had arrhythmias including atrial fibrillation (6%), complete atrioventricular block (CAVB; 17%), and ventricular tachycardia or fibrillation (VT/VF; 15%). Of the 49 patients with sinus rhythm (SR), 26 had QRS duration ≥120 ms (wide QRS). On logistic regression analysis, wide QRS predicted in-hospital death in patients with SR (OR, 3.6; 95% CI: 1.07–13.61, P=0.04). Compared with SR with narrow QRS (QRS duration <120 ms), CAVB and VT/VF had a higher risk of in-hospital death (CAVB: OR, 7.20; 95% CI: 1.78–34.15, P=0.005; VT/VF: OR, 8.10; 95% CI: 1.86–42.31, P=0.005). Conclusions: In patients with FM, CAVB and VT/VF carried a higher risk of in-hospital death. Wide QRS also predicted a higher risk of in-hospital death in patients with SR.

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U2 - 10.1253/circj.CJ-18-0136

DO - 10.1253/circj.CJ-18-0136

M3 - Article

VL - 82

SP - 2089

EP - 2095

JO - Circulation Journal

JF - Circulation Journal

SN - 1346-9843

IS - 8

ER -