title: Outcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support.
abstract: OBJECTIVE
  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. This study was designed to evaluate the outcomes, health-related quality of life and frequencies of anxiety, depression and posttraumatic stress disorder symptoms in fulminant myocarditis patients rescued by mechanical circulatory assistance, since these major components of outcome evaluation after serious illnesses have not yet been assessed in this setting.
  
  
  METHODS
  A retrospective, single-center, observational study and a cross-sectional survey to assess 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.
  
  
  METHODS
  An 18-bed tertiary intensive care unit in a university hospital.
  
  
  METHODS
  We analyzed the short- and long-term outcomes of 41 patients hospitalized at our institution between 2003 and 2009 and who received either a Thoratec BiVAD (Thoratec, Pleasanton, CA) (n = 6) or extracorporeal membrane oxygenation (n = 35) to combat refractory cardiogenic shock due to fulminant myocarditis.
  
  
  RESULTS
  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 to age- and sex-matched controls, 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 due to 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.
authors.affiliation: Service de Réanimation Médicale, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris, France.
authors.forename: Mariana
authors.initials: M
authors.lastname: Mirabel
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Trouillet
authors.forename: Philippe
authors.initials: P
authors.lastname: Léger
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality; D003430:Cross-Sectional Studies; D018450:Disease Progression; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006353:Heart-Assist Devices / Q000523:psychology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009205:Myocarditis / Q000150:complications* / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D011237:Predictive Value of Tests; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult