Characteristics of Clinically Diagnosed Pediatric Myocarditis in a Contemporary Multi-Center Cohort

Abstract

The objective of this study was to describe a contemporary cohort of pediatric patients hospitalized for clinically suspected myocarditis. A retrospective chart review was performed at seven tertiary pediatric hospitals. Electronic medical records were searched between 2008 and 2012 for patients ≤18 years admitted with an ICD-9 code consistent with myocarditis. Patients were excluded if the admitting or consulting cardiologist did not suspect myocarditis during the admission or an alternative diagnosis was determined. One hundred seventy-one patients were discharged or died with a primary diagnosis of myocarditis. Median age was 13.1 years (IQR 2.1, 15.9), with a bimodal distribution; 24% <2 years and 46% between 13 and 18 years. Patients with moderate or severe systolic dysfunction were younger, had higher BNPs at admission, but had lower troponin. Mortality, heart transplantation, and readmission did not differ between patients who received only IVIG, only steroids, IVIG and steroids, and no immunotherapy. Ninety-four patients (55%) were discharged on heart failure medications, 16 were transplanted, and seven died. The presence at the time of admission of gastrointestinal (GI) symptoms (p = 0.01) and lower echo shortening fraction (SF) (p < 0.01) was associated with death/transplant. Within one year 16% had a readmission, one underwent heart transplant, and 39% received heart failure therapy. Pediatric myocarditis has a bimodal age distribution. The use of IVIG and steroids is not associated with mortality/heart transplantation. The presence of GI symptoms and lower echo SF may identify patients at risk for death and/or transplantation during the admission.

Severe heart failure and the need for mechanical circulatory support and heart transplantation in pediatric patients with myocarditis: Results from the prospective multicenter registry “MYKKE”

“…It remains unclear which factors influence the clinical course and determine the need for MCS or transplantation in these young children . As long‐term support has been reported as “bridge to recovery or transplantation”, MCS might be employed until cardiac function is stabilized.…”

“…In children, the survival rate in FM has been reported to reach 50%‐90%, although it is unclear if patients need bridging with MCS or HTx . According to the literature, 4%‐9% of pediatric patients with myocarditis require HTx . The subsequent development of DCM is reported in 21% .…”

“…Over the past decade, MCS by ECMO or VAD implantation has become available in a number of pediatric heart centers. So far, there are only few data published on the rate of MCS support, recovery rates, and mortality in pediatric patients with MCS . Clinical data are lacking, and the majority of publications report retrospective data.…”

“…[7][8][9] According to the literature, 4%-9% of pediatric patients with myocarditis require HTx. 10,11 The subsequent development of DCM is reported in 21%. 12 Because severe heart failure might be accompanied by both entities, the relationship between these two entities is not fully understood due to the lack of prospective data and of standardization in diagnosis.…”

“…So far, there are only few data published on the rate of MCS support, recovery rates, and mortality in pediatric patients with MCS. 10,11,15 Clinical data are lacking, and the majority of publications report retrospective data.…”