Trends in the diagnosis and treatment of fulminant myocarditis: a korean nationwide study on clinical outcomes
D Hong, J Seo, J O Choi, D Kang, J H YangAbstract
Background
Although management of fulminant myocarditis has advanced, real-world data on the adoption of diagnostic and therapeutic strategies in clinical practice remain limited. This study aimed to evaluate temporal changes in diagnostic and therapeutic approaches for fulminant myocarditis and assess their impact on clinical outcomes.
Methods
This population-based, nationwide cohort study identified patients with cardiogenic shock due to fulminant myocarditis admitted to the intensive care unit between January 2003 and March 2023 from the Korean National Health Insurance Service database. Patients were categorized into two eras based on the year 2014, when cardiac magnetic resonance imaging (MRI) and endomyocardial biopsy became reimbursable under the national insurance system. The primary outcome was in-hospital mortality.
Results
A total of 1,726 patients were included. The annual number of patients diagnosed with fulminant myocarditis steadily increased, from 25 in 2003 to 101 in 2022. Of these, 686 patients were diagnosed before 2014 and 981 in 2014 or later. The post-2014 group presented with higher severity compared to the pre-2014 group, as indicated by higher Charlson comorbidity index and more frequent use of organ support, including multiple vasopressors and veno-arterial extracorporeal membrane oxygenation. Use of cardiac MRI and endomyocardial biopsy showed an increasing trend over time, whereas corticosteroid use exhibited a decreasing trend in the post-2014 group. In the post-2014 group, endomyocardial biopsy was significantly associated with lower in-hospital mortality (odds ratio, 0.32; 95% confidence interval, 0.17–0.57).
Conclusions
Over two decades, the adoption of advanced diagnostic modalities for fulminant myocarditis has increased, facilitating more guided therapeutic decision-making. Notably, the use of endomyocardial biopsy was associated with a more selective use of steroid therapy and favorable clinical outcomes.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.