CLINICAL STUDIES: MYOCARDITIS
Echocardiographic findings in fulminant and acute myocarditis
G. Michael Felker, MD*,
John P. Boehmer, MD, FACC ,
Ralph H. Hruban, MD ,
Grover M. Hutchins, MD,
Edward K. Kasper, MD, FACC*,
Kenneth L. Baughman, MD, FACC* and
Joshua M. Hare, MD, FACC*
* Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
Division of Cardiology, Hershey Medical Center, Hershey, Pennsylvania, USA
Manuscript received June 24, 1999;
revised manuscript received January 21, 2000,
accepted March 6, 2000.
Reprint requests and correspondence: Dr. Joshua M. Hare, Division of Cardiology, the Johns Hopkins Hospital, Carnegie 568, 600 North Wolfe Street, Baltimore, Maryland 21287
jhare{at}mail.jhmi.edu
OBJECTIVES
We sought to use echocardiography to assess the presentation and potential for recovery of left ventricular (LV) function of patients with fulminant myocarditis compared with those with acute myocarditis.
BACKGROUND
The clinical course of patients with myocarditis remains poorly defined. We have previously proposed a classification that provides prognostic information in myocarditis patients. Fulminant myocarditis causes a distinct onset of illness and severe hemodynamic compromise, whereas acute myocarditis has an indistinct presentation, less severe hemodynamic compromise and a greater likelihood of progression to dilated cardiomyopathy.
METHODS
Echocardiography was performed at presentation and at six months to test the hypothesis that fulminant (n = 11) or acute (n = 43) myocarditis could be distinguished morphologically.
RESULTS
Patients with both fulminant (fractional shortening 19 ± 4%) and acute myocarditis (17 ± 7%) had LV systolic dysfunction. Patients with fulminant myocarditis had near normal LV diastolic dimensions (5.3 ± 0.9 cm) but increased septal thickness (1.2 ± 0.2 cm) at presentation, while those with acute myocarditis had increased diastolic dimensions (6.1 ± 0.8 cm, p < 0.01 vs. fulminant) but normal septal thickness (1.0 ± 0.1 cm, p = 0.01 vs. fulminant). At six months, patients with fulminant myocarditis had dramatic improvement in fractional shortening (30 ± 8%) compared with no improvement in patients with acute myocarditis (19 ± 7%, p < 0.01 for interaction between time and type of myocarditis).
CONCLUSIONS
Fulminant myocarditis is distinguishable from acute myocarditis by echocardiography. Patients with fulminant myocarditis exhibit a substantial improvement in ventricular function at six months compared with those with acute myocarditis. Echocardiography has value in classifying patients with myocarditis and may provide prognostic information.
|
Abbreviations and Acronyms
| | DCM | = dilated cardiomyopathy | | LV | = left ventricle or ventricular | | LVEDD | = left ventricular diastolic dimension | | %FS | = percentage fractional shortening |
|
This article has been cited by other articles:
|
|
|
|
 
M. G. Friedrich, U. Sechtem, J. Schulz-Menger, G. Holmvang, P. Alakija, L. T. Cooper, J. A. White, H. Abdel-Aty, M. Gutberlet, S. Prasad, et al.
Cardiovascular magnetic resonance in myocarditis: A JACC White Paper.
J. Am. Coll. Cardiol.,
April 28, 2009;
53(17):
1475 - 1487.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. T. Cooper Jr.
Myocarditis
N. Engl. J. Med.,
April 9, 2009;
360(15):
1526 - 1538.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Dennert, H. J. Crijns, and S. Heymans
Acute viral myocarditis
Eur. Heart J.,
September 1, 2008;
29(17):
2073 - 2082.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. T. Cooper, K. L. Baughman, A. M. Feldman, A. Frustaci, M. Jessup, U. Kuhl, G. N. Levine, J. Narula, R. C. Starling, J. Towbin, et al.
The role of endomyocardial biopsy in the management of cardiovascular disease: A Scientific Statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology
Eur. Heart J.,
December 2, 2007;
28(24):
3076 - 3093.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. T. Cooper, K. L. Baughman, A. M. Feldman, A. Frustaci, M. Jessup, U. Kuhl, G. N. Levine, J. Narula, R. C. Starling, J. Towbin, et al.
The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology
J. Am. Coll. Cardiol.,
November 6, 2007;
50(19):
1914 - 1931.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. T. Cooper, K. L. Baughman, A. M. Feldman, A. Frustaci, M. Jessup, U. Kuhl, G. N. Levine, J. Narula, R. C. Starling, J. Towbin, et al.
The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association, the American College of Cardiology, and the European Society of Cardiology
Circulation,
November 6, 2007;
116(19):
2216 - 2233.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. F. Chen and T. E. Paterick
20-Year-Old Man With Chest Pain and Malaise
Mayo Clin. Proc.,
September 1, 2007;
82(9):
1124 - 1127.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. N. Skouri, G. W. Dec, M. G. Friedrich, and L. T. Cooper
Noninvasive Imaging in Myocarditis
J. Am. Coll. Cardiol.,
November 21, 2006;
48(10):
2085 - 2093.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Asaumi, S. Yasuda, I. Morii, H. Kakuchi, Y. Otsuka, A. Kawamura, Y. Sasako, T. Nakatani, H. Nonogi, and S. Miyazaki
Favourable clinical outcome in patients with cardiogenic shock due to fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation
Eur. Heart J.,
October 2, 2005;
26(20):
2185 - 2192.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.-M. Grinda, P. Chevalier, N. D'Attellis, M.-O. Bricourt, A. Berrebi, P. Guibourt, J.-N. Fabiani, and A. Deloche
Fulminant myocarditis in adults and children: bi-ventricular assist device for recovery
Eur. J. Cardiothorac. Surg.,
December 1, 2004;
26(6):
1169 - 1173.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A Basti, S Taylor, M Tschopp, and J Sztajzel
Fatal fulminant myocarditis caused by disseminated mucormycosis
Heart,
October 1, 2004;
90(10):
e60 - e60.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.M. Hare and K.L. Baughman
Fulminant and acute lymphocytic myocarditis: the prognostic value of clinicopathological classification
Eur. Heart J.,
February 2, 2001;
22(4):
269 - 270.
[PDF]
|
|
|
|
