DOI: 10.1161/circ.148.suppl_1.16217 ISSN: 0009-7322

Abstract 16217: Characteristics and Short-Term Outcomes of Patients With Cardiogenic Shock Secondary to Myocarditis

Raunak M Nair, Abhishek Ramgir R Giri, Sanchit Chawla, Ankit Agrawal, Shashank Shekhar, Andrew Higgins, Ran Lee, Wael A Jaber, Penelope Rampersad, Paul C Cremer, Venu Menon
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background: The clinical profile and short-term prognosis of patients with cardiogenic shock (CS) secondary to myocarditis remains poorly defined.

Methods: All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1 st , 2010, to Dec 31 st , 2021, with a diagnosis of cardiogenic shock (CS) were retrospectively identified through electronic medical records. Patients were further categorized into those with CS secondary to myocarditis (myocarditis-CS) or other etiologies (non-myocarditis-CS). Only patients with confirmed myocarditis with an endomyocardial biopsy or cardiac MRI were included. Descriptive characteristics and short-term outcomes of this group were explored.

Results: A total of 2775 patients were admitted to our CICU with CS of which, 26 patients (1%) had CS secondary to confirmed myocarditis. Compared to patients with non-myocarditis CS, patients with myocarditis-CS were significantly younger (median age of 49 vs 65, p<0.001), had lower prevalence of known coronary artery disease (23% vs 62%, p<0.001), and significantly lower prevalence of other comorbidities (diabetes- 12% vs 42%, dyslipidemia- 23% vs 49%, and hypertension- 31% vs 62, all p<0.05). Amongst patients with myocarditis-CS, 23% (n=6) patients received a heart transplant during the same admission whereas 8% (n=2) were discharged on an LVAD. Viral myocarditis was the most common etiology (35%, n=9), followed by idiopathic myocarditis (23%, n=6), and lymphocytic (15%, n=4). The 30-day all-cause mortality of patients with CS-myocarditis was 8% compared to 22% for those with non-myocarditis CS (p=0.1).

Conclusion: Myocarditis continues to remain an infrequent cause of CS in the contemporary era accounting for around 1% of all CS admissions. A third of these patients would require advanced therapies and so early consideration of a destination mechanical therapy or transplant is vital to ensure optimal care of these patients.

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