Mirabel M, Luyt CE, Leprince P, Trouillet JL, Léger P, Pavie A, Chastre J, Combes A.;Critical Care Medicine. 39(5):1029-1035, May 2011.
OBJECTIVE:This study was designed to evaluate the outcomes, health-related quality of life, and frequencies of anxiety, depression, and posttraumatic stress disorder symptoms in patients with fulminant myocarditis rescued by mechanical circulatory assistance, because these major components of outcome evaluation after serious illnesses have not yet been assessed in this setting.
DESIGN, SETTING, AND PATIENTS:Myocarditis is a rare disease that may progress rapidly to refractory cardiogenic shock and death. In such situations, emergent initiation of mechanical circulatory assistance is the only therapeutic option to rescue these dying patients. We assessed health-related quality of life by the Short Form-36 questionnaire and frequencies of anxiety, depression, and posttraumatic stress disorder symptoms by the Hospital Anxiety and Depression Scale and the Impact of Event Scale, respectively.
MEASUREMENTS AND MAIN RESULTS:Between 2003 and 2009, 41 patients received either a Thoratec (Thoratec, Pleasanton, CA) left ventricular assist device (n = 6) or extracorporeal membrane oxygenation (n = 35) to combat refractory cardiogenic shock resulting from fulminant myocarditis. Intensive care unit survival was 68% and four (10%) patients underwent heart transplantation. Independent predictors of in-intensive care unit death were Simplified Acute Physiology Score II ≥56 (odds ratio, 10.23) and troponin Ic ≥12 μg/L (odds ratio, 7.49) at admission. Complete follow-up (median, 525 days) was available for 26 of 28 survivors. Compared with age- and sex-matched control subjects, Short Form-36 evaluation of health-related quality of life revealed satisfactory mental health and vitality but persistent physical and psychosocial-related difficulties. Lastly, anxiety, depression, and/or posttraumatic stress disorder symptoms were reported by 38%, 27%, and 27% of the patients, respectively.
CONCLUSIONS:Mechanical circulatory assistance rescued 68% of patients with refractory circulatory failure resulting from fulminant myocarditis. Greater disease severity and higher troponin Ic levels at extracorporeal membrane oxygenation initiation predicted poorer prognosis. Because up to one-third of the patients reported anxiety, depression, and/or posttraumatic stress disorder symptoms, strategies aimed at attenuating their emotional and psychologic distress might significantly improve their long-lasting well-being.