Characteristics and Associated Factors of Heart Transplantation in Fulminant Myocarditis Patients Undergoing ECMO

초록

Purpose: Fulminant myocarditis (FM) often progresses to advanced heart failure requiring extracorporeal membrane oxygenation (ECMO), and in severe cases, heart transplantation (HTPL) becomes the only life-saving option. This study aimed to identify predictors of HTPL and evaluate inhospital mortality (IHM) in FM patients on ECMO. Methods: We retrospectively analyzed FM patients requiring ECMO from eight Korean centers (2001-2021). Baseline characteristics were compared between those with and without HTPL, and predictors were assessed by multivariable Cox regression. IHM was compared using Kaplan-Meier analysis adjusted for major covariates. Results: Among 224 FM patients, 34 (15.2%) underwent HTPL. Recipients were older (44.7±14.7 vs. 37.8±18.6 years, p=0.042), had higher SOFA scores (12.1±5.1 vs. 10.2±4.9, p=0.035), lower LVEF (22.9±17.3 vs. 29.4±16.0%, p=0.036), higher peak lactate (9.3±5.0 vs. 7.2±5.2 mmol/L, p=0.028), and less frequent steroid use (36.3% vs. 55.9%, p=0.050). In multivariable analysis, higher SOFA score predicted HTPL (HR 1.10, 95% CI 1.03-1.18, p=0.004), while steroid use was inversely associated (HR 0.34, 95% CI 0.16-0.72, p=0.005). Adjusted IHM was significantly lower among HTPL recipients (HR 0.21, 95% CI 0.06-0.75, p=0.017). Conclusion: In FM patients supported by ECMO, a higher SOFA score was associated with increased likelihood of HTPL, whereas steroid therapy was linked to reduced probability. HTPL recipients had significantly lower in-hospital mortality, suggesting that timely transplantation may improve survival in this critically ill population.