Fulminant lymphocytic myocarditis: Prediction of successful weaning from Impella support for cardiogenic shock

Abstract

We present a series of four patients with biopsy-proven fulminant lymphocytic myocarditis with cardiogenic shock and discuss whether it is possible to predict recovery of left ventricular function and successful weaning at the time of initial placement of mechanical circulatory support. Impella CP (Abiomed, Danvers, MA, USA) was placed in these patients on admission. Patients 1 and 2 made complete recovery. Patient 3 proceeded to bi-ventricular assist device and is currently waiting for transplantation. Patient 4 proceeded to Impella 5 but died from multiple organ failure. Although the Impella provides excellent hemodynamic support, outcomes of the patients with fulminant myocarditis with Impella support may depend upon the severity of myocarditis and myocardial failure. In addition to the previously reported predictors such as the level of elevated biomarkers, the severity of ventricular wall edema, and the development of rhythm disturbances, the absence of right ventricular dysfunction seems important to predict successful weaning from Impella support. <Learning objective:Fulminant myocarditis carries an extremely high risk of ominous outcomes. Impella device (Abiomed, Danvers, MA, USA) is a catheter-based left ventricular assist device which may help to bridge patients to recovery from left ventricular failure. In order to predict recovery from left ventricular failure caused by fulminant. myocarditis and successful weaning from Impella support, the absence of such features as right ventricular dysfunction, significantly elevated biomarkers, ventricular wall edema, and rhythm disturbances, seems important.>.

Keywords: Cardiogenic shock; Fulminant lymphocytic myocarditis; Impella support; Prediction of successful weaning; Right ventricular dysfunction.