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. 2018 Dec 3;62(2):187–202. doi: 10.1007/s11427-018-9385-3

Chinese society of cardiology expert consensus statement on the diagnosis and treatment of adult fulminant myocarditis

Daowen Wang 1,✉, Sheng Li 1, Jiangang Jiang 1, Jiangtao Yan 1, Chunxia Zhao 1, Yan Wang 1, Yexin Ma 1, Hesong Zeng 1, Xiaomei Guo 1, Hong Wang 1, Jiarong Tang 1, Houjuan Zuo 1, Li Lin 1, Guanglin Cui 1; Section of Precision Medicine Group of Chinese Society of Cardiology; Editorial Board of Chinese Journal of Cardiology; Working Group of Adult Fulminant Myocarditis
PMCID: PMC7102358  PMID: 30519877

Abstract

Fulminant myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock, with mortality rates as high as 50%–70%. Most importantly, there are no treatment options, guidelines or an expert consensus statement. Here, we provide the first expert consensus, the Chinese Society of Cardiology Expert Consensus Statement on the Diagnosis and Treatment of Fulminant Myocarditis, based on data from our recent clinical trial (NCT03268642). In this statement, we describe the clinical features and diagnostic criteria of fulminant myocarditis, and importantly, for the first time, we describe a new treatment regimen termed life support-based comprehensive treatment regimen. The core content of this treatment regimen includes (i) mechanical life support (applications of mechanical respirators and circulatory support systems, including intraaortic balloon pump and extracorporeal membrane oxygenation, (ii) immunological modulation by using sufficient doses of glucocorticoid, immunoglobulin and (iii) antiviral reagents using neuraminidase inhibitor. The proper application of this treatment regimen may and has helped to save the lives of many patients with fulminant myocarditis.

Keywords: adult fulminant myocarditis, diagnosis and treatment, expert consensus, life support-based comprehensive treatment regimen, cardiogenic shock, mechanical circulatory support

Acknowledgements

This project was funded by the National Key Basic Research Project (2012CB518004) and Natural Science Fund Key Project (81630010). All the physicians and nurses of the Department of Cardiology and some of the physicians and nurses of the Department of Nephrology at Tongji Hospital contributed to the treatment of fulminant myocarditis patients and the formulation of this consensus. Prof. Rutai Hui in Fuwai Hospital gave enthusiastic support and valuable advice to this project. We thank greatly all senior experts for repeated discussion for this expert consensus statement: Jun Pu (Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University), Yundai Chen (Department of Cardiology, Chinese PLA General Hospital), Yugang Dong (Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University), Weiyi Fang (Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University), Junbo Ge, Jingmin Zhou (Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University), Xianghua Fu (Department of Cardiology, the Second Affiliated Hospital of Hebei Medical University), Yong Huo (Department of Cardiology, Peking University First Hospital), Rutai Hui (Department of Cardiology, Fuwai Hospital), Jianjun Tan (Department of Cardiology, the Second Affiliated Hospital of Xiangya School of Medicine, Central South University), Lemin Wang (Department of Cardiology, Tongji Hospital, Tongji University School of Medicine), Zonggui Wu (Department of Cardiology, Changzheng Hospital, the Second Military Medical University), Dingli Xu (Department of Cardiology, Nanfang Hospital, Southern Medical University), Dingcheng Xiang (Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA), Shenghua Zhou, Tianlun Yang (Department of Cardiology, Xiangya Hospital of Central South University), Bo Yu (Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University), Jing Zhang (Fuwai Huazhong Cardiovascular Hospital) and Song Zhang (Cardiovascular Department, Xin Hua Hospital, Affiliated Hospital of Shanghai Jiao Tong University).

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