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Thioredoxin, adiponectin and clinical course of acute fulminant myocarditis
  1. Jin-Oh Choi1,
  2. Soo-Hyeon Yun1,
  3. Kiick Sung2,
  4. Young Tak Lee2,
  5. Joong-Il Park3,
  6. Eun-Seon Ju1,
  7. Sang-Chol Lee1,
  8. Seung Woo Park1,
  9. Duk-Kyung Kim1,
  10. Jae K Oh1,4,
  11. Eun-Seok Jeon1
  1. 1Division of Cardiology, Department of Medicine, Seoul, Korea
  2. 2Division of Thoracic Surgery, Cardiac and Vascular Centre, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
  3. 3Division of Cardiology, Department of Internal Medicine, Cardiac and Vascular Centre, Seoul Veterans Hospital, Seoul, Korea
  4. 4Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  1. Correspondence to Eun Seok Jeon, Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50, Irwon-dong, Gangnam-gu, Seoul 135-710, Korea; esjeon{at}


Background In an animal model of viral myocarditis, plasma levels of thioredoxin and adiponectin have been reported to be associated with the severity of inflammation and recovery of ventricular dysfunction, respectively. However, there have been few reports about the clinical significance of these cytokine levels in human myocarditis.

Objectives To examine the hypothesis that cytokine levels correlate with clinical courses of patients with acute fulminant myocarditis (FM).

Methods A total of 33 consecutive patients with biopsy-proven acute myocarditis were evaluated. Twenty patients were ascribed to an FM group and the other 13 patients were grouped as a non-fulminant group (NFM). Plasma cytokine levels at the time of admission and after 2 weeks were evaluated and correlated with the duration of mechanical circulatory support application.

Results Plasma thioredoxin level at admission was raised in the FM group (3.08±2.15 ng/ml) compared with the NFM group (1.63±0.45 ng/ml, p=0.011) and reduced after an initial unstable period. However there was no significant difference in plasma adiponectin level between the two groups. In a multivariable regression model, increased plasma thioredoxin level (OR=5.79, 95% CI 1.67 to 20.1, p=0.006) and reduced plasma adiponectin level (OR=0.16, 95% CI 0.055 to 0.49, p=0.001) were associated with longer duration of mechanical circulatory support application in the patients with FM, which in turn was significantly related to death or cardiac transplantation.

Conclusion In patients with acute myocarditis, the plasma thioredoxin level was increased in the more severe form, and a reduced level of adiponectin was closely correlated with worse short-term outcome in patients with FM.

  • Fulminant myocarditis
  • thioredoxin
  • adiponectin
  • mechanical circulatory support
  • heart failure
  • intensive care
  • myocarditis
  • cytokines

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  • Funding This study was supported by a grant from the Korea Healthcare technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A085046) and supported by Samsung Medical Center Clinical Research Development Program grant, #CRS-108-69-3.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Samsung Medical Centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.