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Fulminant myocarditis in adults: a narrative review

Journal of Geriatric Cardiology 2022年第2期19卷 137-151页

作者： Santiago Montero Darryl Abrams Enrico Ammirati Florent Huang dirk wdonker Guillaume Hekimian Cosme García-García Antoni Bayes-Genis Alain Combes Matthieu Schmidt Acute Cardiovascular Care Unit Heart InstituteHospital Germans Trias i PujolDepartament de MedicinaUniversitat Autònoma de BarcelonaCIBERCVSpain Assistance Publique-Hôpitaux de Paris Pitié-Salpêtrière HospitalMedical Intensive Care UnitParisFrance Columbia University Vagelos College of Physicians&Surgeons/NewYork-Presbyterian Hospital New YorkUSA Center for Acute Respiratory Failure Columbia University Irving Medical CenterNew YorkUSA De Gasperis Cardio Center and Transplant Center Niguarda HospitalMilanoItaly Cardiology Hôpital FochSuresnesParisFrance Intensive Care Center University Medical Center UtrechtUtrechtthe Netherlands Cardiovascular and Respiratory Physiology TechMed CenterUniversity of TwenteEnschedethe Netherlands Sorbonne Université INSERM UMRS_1166-iCANInstitute of Cardiometabolism and NutritionParisFrance

Fulminant myocarditis(FM)is an uncommon syndrome characterized by sudden and severe hemodynamic compromise secondary to acute myocardial inflammation,often presenting as profound cardiogenic shock,life-threatening ventricular arrhythmias and/or electrical *** may be refractory to conventional therapies and require mechanical circulatory support(MCS).The immune system has been recognized as playing a pivotal role in the pathophysiology of myocarditis,leading to an increased focus on immunosuppressive treatment *** data have highlighted not only the fact that FM has significantly worse outcomes than non-FM,but that prognosis and management strategies of FM are heavily dependent on histological subtype,placing greater emphasis on the role of endomyocardial biopsy in *** impact of subtype on severity and prognosis will likewise influence how aggressively the myocarditis is managed,including whether MCS is *** patients with refractory cardiogenic shock secondary to FM end up requiring MCS,with venoarterial extracorporeal membrane oxygenation demonstrating favorable survival rates,particularly when initiated prior to the development of multiorgan *** the challenges facing the field are the need to more precisely identify immunopathophysiological pathways in order to develop targeted therapies,and the need to better optimize the timing and management of MCS to minimize complications and maximize outcomes.

关键词： myocarditis initiated storm

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