The relationship between 72-hour ST segment decline and prognostic outcomes in patients with acute fulminant myocarditis complicated by ST-segment elevation on venoarterial extracorporeal membrane oxygenation support

Objective: To compare differences in ST-segment decline between surviving and non-surviving patients with acute fulminant myocarditis (AFM) complicated by ST-segment elevation supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO). Methods We retrospectively analyzed the clinical data from patients with AFM complicated by ST elevation receiving VA-ECMO support in our hospital between January 2017 and December 2019. Based on survivorship status at discharge, patients were separated into survivor and non-survivor groups. The degree of decrease in the sum of ST-segment elevation amplitudes (∑STE) at 24 h, 48 h, and 72 h was then compared between these groups to assess the prognostic relevance of these parameters as a noninvasive electrophysiological cardiac biomarker. Results In total, 19 AFM patients that underwent VA-ECMO support were included in this study cohort. The mean age of these patients was 35, and 14 survived treatment (73.7%), while 5 did not. Following VA-ECMO support, the 72h∑STE in the survivor group was 0.09 ± 0.093 mm, with this value being significantly lower than that observed in the non-survivor group (0.24 ± 0.270 mm). Significant differences in both 48h∆∑STE (0.73 ± 0.298 vs. 0.65 ± 0.112, P < 0.05) and 72h∆∑STE (0.81 ± 0.353 vs. 0.78 ± 0.045, P < 0.01) were observed when comparing the survivor and non-survivor groups, and the decrease was significantly greater in the survivor group relative to the non-survivor group. Conclusions VA-ECMO can effectively treat cardiac arrest or cardiogenic shock resulting from AFM. The magnitude of ST-segment retreat may be associated with patient recovery following myocardial injury, potentially predicting prognostic outcomes together with other indicators in a manner that can guide treatment-related decision-making or inform ECG frequency.