Fulminant myocarditis (FM) is an uncommon syndrome characterized by sudden and severe hemodynamic comp-romise secondary to acute myocardial inflammation, often presenting as profound cardiogenic shock, life-threatening ventricular arrhythmias and/or electrical storm. FM may be refractory to conventional therapies and require mechanical circulatory support (MCS). The immune system has been recognized as playing a pivotal role in the pathophysiology of myocarditis, leading to an in-creased focus on immunosuppressive treatment strategies. Recent data have highlighted not only the fact that FM has signific-antly worse outcomes than non-FM, but that prognosis and management strategies of FM are heavily dependent on histological subtype, placing greater emphasis on the role of endomyocardial biopsy in diagnosis. The impact of subtype on severity and pro-gnosis will likewise influence how aggressively the myocarditis is managed, including whether MCS is warranted. Many pati-ents with refractory cardiogenic shock secondary to FM end up requiring MCS, with venoarterial extracorporeal membrane oxygenation demonstrating favorable survival rates, particularly when initiated prior to the development of multiorgan failure. Among the challenges facing the field are the need to more precisely identify immunopathophysiological pathways in order to develop targeted therapies, and the need to better optimize the timing and management of MCS to minimize complications and maximize outcomes.

Santiago Montero;Darryl Abrams;Enrico Ammirati;Florent Huang;Dirk W.Donker;Guillaume Hekimian;Cosme García-García;Antoni Bayes-Genis;Alain Combes;Matthieu Schmidt

Acute Cardiovascular Care Unit,Heart Institute,Hospital Germans Trias i Pujol,Departament de Medicina,Universitat Autònoma de Barcelona,CIBERCV,Spain;Assistance Publique-H?pitaux de Paris,Pitié-Salpêtrière Hospital,Medical Intensive Care Unit,Paris,France;Columbia University Vagelos College of Physicians&Surgeons/NewYork-Presbyterian Hospital,New York,USA;Center for Acute Respiratory Failure,Columbia University Irving Medical Center,New York,USA;De Gasperis Cardio Center and Transplant Center,Niguarda Hospital,Milano,Italy;Cardiology,H?pital Foch,Suresnes,Paris,France;Intensive Care Center,University Medical Center Utrecht,Utrecht,the Netherlands;Cardiovascular and Respiratory Physiology,TechMed Center,University of Twente,Enschede,the Netherlands;Sorbonne Université,INSERM UMRS_1166-iCAN,Institute of Cardiometabolism and Nutrition,Paris,France

老年心脏病学杂志（英文版）

[1]Santiago Montero;Darryl Abrams;Enrico Ammirati;Florent Huang;Dirk W.Donker;Guillaume Hekimian;Cosme García-García;Antoni Bayes-Genis;Alain Combes;Matthieu Schmidt-.Fulminant myocarditis in adults: a narrative review)[J].老年心脏病学杂志（英文版）,2022(02):137-151

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