Résumé
Objective:To investigate the effect of extracorporeal membrane oxygenation (ECMO) on in-hospital survival and prognosis of adult patients with fulminant myocarditis.Methods:The registration materials of 21 patients with fulminant myocarditis supported by veno-arterial ECMO (VA-ECMO) from March 2019 to January 2022 in the Heart Center of the First Hospital of Lanzhou University were selected from the Chinese Society for Extracorporeal Life Support (CSECLS) Registry Database. The clinical baseline data, laboratory and echocardiographic data, VA-ECMO related parameters, complications and in-hospital outcome were recorded. The main end events of follow-up were death and readmission due to heart failure.Results:① The median age of 21 patients was (42.7±16.4) years, there were 12 males (57.1%) and 9 females (42.9%), and 16 patients (76.2%) survived in hospital and 5 patients (23.8%) died in hospital. ② Compared with the survival group, patients in the death group had a higher proportion of invasive ventilator support and continuous renal replacement therapy (CRRT) [3/16 (18.8%) vs. 4/5 (80.0%), 3/16 (18.8%) vs. 4/5 (80.0%)], and a lower survival after VA-ECMO score (SAVE) [score: -5.0 (-5.0, -3.0) vs. 1.0 (-6.0, 5.0)], the serum creatinine (SCr) level was higher during VA-ECMO support [μmol/L: 248.0 (144.0, 447.0) vs. 83.0 (71.7, 110.9)], the platelet count (PLT) level was lower [×10 9/L: 60.0 (31.5, 96.5) vs. 100.0 (71.0, 139.3)], and the ECMO initial support flow rate was higher (L/min: 3.2±0.7 vs. 2.6±0.4). All the differences were statistically significant (all P < 0.05). ③ The echocardiography indexes of the survival group were significantly improved at discharge compared with those at admission [left ventricular ejection fraction (LVEF, %): 54.0±6.7 vs. 30.0±7.2], left ventricular end-diastolic volume [(LVESV, mL): 55.7±27.5 vs. 85.9±28.7], cardiac index [(CI, L·min -1·m -2): 2.6±0.4 vs. 1.9±0.6], cardiac output [(CO, L/min): 4.5±0.7 vs. 3.2±0.9]. All the differences were statistically significant (all P < 0.05). ④ The median follow-up time of the 16 survivial patients was 9 (2, 14) months. During the follow-up period, 5 patients (31.3%) were readmitted to the hospital due to heart failure (1 case of cardiogenic death). The average ECMO support duration of the 5 patients who readmitted to the hospital due to heart failure was significantly shorter than that of the 11 patients without heart failure [hours: 82.0 (47.0, 99.0) vs. 116.0 (98.0, 156.0), Z = -2.381, P = 0.017]. Conclusions:On the basis of immunomodulatory and other treatments, early application of VA-ECMO in adult patients with fulminant myocarditis can significantly improve in-hospital survival rate and cardiac function. Heart failure after discharge may be related to short VA-ECMO support time during hospitalization.
Résumé
Objective To explore the predictive value of soluble growth STimulation expressed gene 2(sST2) on major adverse cardiovascular events(MACE) of acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).Methods The study included 148 patients with first episode of AMI admitted from January 2015 to May 2016 in the heart center of the First Hospital of Lanzhou University.Serum sST2 level before PCI was tested and all patients were followed up clinically for 6 months after PCI.Results 1.MACEs were found in 23 patients during follow up.The sST2 leveles were significantly higher in patients with MACEs than the non-MACE group [(44.50 ±5.32) ng/ml vs.(23.59±1.15) ng/ml, P=0.001].Pearson correlation analysis showed that serum sST2 were positively correlated with MACE and type Ⅲ procollagen amine terminal peptide (PⅢNP) but was not correlated with NT-proBNP.2.Serum sST2 found to be correlated with the body mass index, blood pressure, triglycerides, aspartate aminotransferase, left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF).3.The area under the ROC curve of sST2 to predict the occurrence of MACE after PCI was 0.787 which was higher than that of NT-proBNP.The area under curve of sST2 combined with NT-proBNP was 0.820.4.The survival rate of patients with serum sST2 level ≤29 ng/ml was higher than patients with sST2>29 ng/ml in 6 months after PCI.Conclusions sST2 is affected by a variety of factors.sST2 combined with NT-proBNP can improve the predictive value of MACE after PCI, and higher the level of sST2, higher the mortality rate in 6 months after PCI.