A national survey on myocarditis associated with the 2009 influenza A (H1N1) pandemic in Japan

Abstract

Background: An influenza pandemic occurred in 2009 and myocarditis associated with the 2009 influenza A (H1N1) pandemic was reported among hospitalized patients from August 2009.

Methods and results: The Japanese Circulation Society organized the Clinical Research Committee on Myocarditis Associated with Influenza Pandemic A (H1N1) 2009 and called for a case report on myocarditis for a national survey. The diagnosis of myocarditis was performed using the Guidelines for the Diagnosis and Treatment of Myocarditis (JCS 2009). Fifteen patients were reported to the committee. Fulminant myocarditis developed in 10 patients. Mechanical circulatory support (intra-aortic balloon pumping (IABP) and/or percutaneous cardiopulmonary support (PCPS)) was used on all 10 patients, 8 of whom were rescued. Abnormalities on echocardiography and elevated cardiac enzymes were seen in most of the patients. Myocarditis was found by endomyocardial biopsy in 6 patients. Three patients had complications with pneumonia.

Conclusions: In reality, myocarditis associated with pandemic influenza A (H1N1) seemed to be more common in hospitalized patients, compared with previous seasonal influenza virus outbreaks. To avoid misdiagnosis of acute myocarditis associated with influenza pandemic A (H1N1) 2009, it is essential to determine the characteristic symptoms, signs, and laboratory findings of acute myocarditis during influenza pandemics. Mechanical circulatory support (IABP and/or PCPS) was required to rescue patients with fulminant myocarditis.