Management perspectives from the 2019 Wuhan international workshop on fulminant myocarditis.

Affiliation

Veronese G(1), Ammirati E(2), Chen C(3), Klingel K(4), Suzuki M(5), Okumura T(6), Maisch B(7), Zuo H(3), Ni L(3), Jiang J(3), Zhang J(8), Wang H(3), Zhou N(3), Tschope C(9), Cooper LT(10), Wang DW(11).
Author information:
(1)"De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Health Sciences, University of Milano-Bicocca, Monza, Italy.
(2)"De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. Electronic address: [Email]
(3)Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
(4)Cardiopathology, Institute for Pathology, University Hospital of Tübingen, Tübingen, Germany.
(5)Sakakibara Heart Institute, Tokyo, Japan.
(6)Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
(7)Mais Philipps University of Marburg, Faculty of Medicine, Marburg, Germany.
(8)Henan Provincial People's Hospital, Zhengzhou, China.
(9)Department of Cardiology, Campus Virchow and Berlin Institute of Health, Center for Regenerative Therapies, Charité Universitätsmedizin, Berlin, Germany.
(10)Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA.
(11)Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: [Email]

Abstract

Fulminant myocarditis (FM) is a form of acute myocardial inflammation leading to rapid-onset hemodynamic instability due to cardiogenic shock or life-threatening arrhythmias. As highlighted by recent registries, FM is associated with high rates of death and heart transplantation, regardless of the underlying histology. Because of a paucity of evidence-based management strategies exists for this disease, an International workshop on FM was held in Wuhan, China, in October 2019, in order to share knowledge on the disease and identify areas of consensus. The present report highlights both agreements and controversies in FM management across the world, focusing the attention on areas of opportunity, FM definition, the use of endomyocardial biopsy and viral identification on heart specimens, treatment algorithms including immunosuppression and the timing of circulatory support escalation. This report incorporates the most recent recommendations from national and international professional societies. Main areas of interest and aims of future prospective observational registries and randomized controlled trials were finally identified and suggested.