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Meta-Analysis
. 2019 Feb;98(8):e14697.
doi: 10.1097/MD.0000000000014697.

Early characteristics of fulminant myocarditis vs non-fulminant myocarditis: A meta-analysis

Zicheng Wang  1 , Yanwei Wang  1 , Haiyan Lin  1 , Shengjie Wang  1 , Xianlei Cai  2 , Da Gao  1
Affiliations
Meta-Analysis

Early characteristics of fulminant myocarditis vs non-fulminant myocarditis: A meta-analysis

Zicheng Wang et al. Medicine (Baltimore). 2019 Feb.

Abstract

Background: Fulminant myocarditis (FM) is a sub-category myocarditis. Its primary characteristic is a rapidly progressive clinical course that necessitates hemodynamic support. FM can be difficult to predict at the onset of myocarditis. The aim of this meta-analysis was to identify the early characteristics in FM compared to those of non-fulminant myocarditis (NFM).

Methods: We searched the databases of MEDLINE, EMBASE, CENTRAL, for studies comparing FM with acute NFM from January 1, 2000 to June 1, 2018. The baseline variables were compared in each study. Mean differences (MD) and relative ratios (RR) were calculated.

Results: Seven studies (158 FM patients and 388 NFM patients) were included in the analysis. The FM group had significantly lower systolic blood pressure (SBP), higher creatine kinase (CK), wider QRS duration, lower left ventricular ejection fraction (LVEF), thicker left ventricular posterior wall diameter (LVPWd), higher incidence of ST depression, ventricular tachycardia/ventricular fibrillation (Vt/Vf) and syncope, less incidence of chest pain than the NFM groups. There was no difference in terms of heart rate (HR), c-reactive protein (CRP), fever, dyspnea, white blood cells (WBC), atrioventricular block (AVB), Q waves, ST elevation, interventricular septum diameter (IVSd), or end-diastolic left ventricular diameter (LVEDd) between FM and NFM.

Conclusion: We found that the lower SBP, higher CK, wider QRS duration, lower LVEF, thicker LVPWd, higher incidence of ST depression, Vt/Vf and syncope as well as lower incidence of chest pain were early characteristics of FM.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flowchart of studies from search to inclusion.
Figure 2
Figure 2
Chest pain. Risk ratio between FM and NFM; Fever. Risk ratio between FM and NFM; Syncope. Risk ratio between FM and NFM; WBC. Mean difference between FM and NFM. FM = fulminant myocarditis, NFM = non-fulminant myocarditis, WBC = white blood cells.
Figure 3
Figure 3
Funnel plot of included studies.
Figure 4
Figure 4
ST depression. Risk ratio between FM and NFM; Q wave. Risk ratio between FM and NFM; QRS width. Mean difference between FM and NFM; Vt/Vf. Risk ratio between FM and NFM. FM = fulminant myocarditis, NFM = non-fulminant myocarditis, Vt/Vf = ventricular tachycardia/ventricular fibrillation.
Figure 5
Figure 5
LVEF. Mean difference between FM and NFM; IVSd. Mean difference between FM and NFM; LVPWd. Mean difference between FM and NFM. FM = fulminant myocarditis, IVSd = interventricular septum diameter, LVEF = left ventricular ejection fraction, NFM = non-fulminant myocarditis,
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