OBJECTIVES We sought to use echocardiography to assess the presentation and
potential for recovery of left ventricular (LV) function of patients with
fulminant myocarditis compared with those with acute myocarditis.
BACKGROUND The clinical course of patients with myocarditis remains poorly
defined. We have previously proposed a classification that provides prognos
tic information in myocarditis patients. Fulminant myocarditis causes a dis
tinct onset of illness and severe hemodynamic compromise, whereas acute myo
carditis has an indistinct presentation, less severe hemodynamic compromise
and a greater likelihood of progression to dilated cardiomyopathy.
METHODS Echocardiography was performed at presentation and at six months to
test the hypothesis that fulminant (n = 11) or acute (n = 43) myocarditis
could be distinguished morphologically.
RESULTS Patients with both fulminant (fractional shortening 19 +/- 4%) and
acute myocarditis (17 +/- 7%) had LV systolic dysfunction. Patients with fu
lminant myocarditis had near normal LV diastolic dimensions (5.3 +/- 0.9 cm
) but increased septal thickness (1.2 +/- 0.2 cm) at presentation, while th
ose with acute myocarditis had increased diastolic dimensions (6.1 +/- 0.8
cm, p < 0.01 vs. fulminant) but normal septal thickness (1.0 +/- 0.1 cm, p
= 0.01 vs. fulminant). At six months, patients with fulminant myocarditis h
ad dramatic improvement in fractional shortening (30 +/- 8%) compared with
no improvement in patients with acute myocarditis (19 +/- 7%, p < 0.01 for
interaction between time and type of myocarditis).
CONCLUSIONS Fulminant myocarditis is distinguishable from acute myocarditis
by echocardiography. Patients with fulminant myocarditis exhibit a substan
tial improvement in ventricular function at six months compared with those
with acute myocarditis. Echocardiography has value in classifying patients
with myocarditis and may provide prognostic information. (C) 2000 by the Am
erican College of Cardiology.