Is Myocarditis an Independent Risk Factor for Post-Transplant Mortality in Pediatric Heart Transplant Recipients?

Abstract

Background— Previous studies suggest that children with myocarditis who receive heart transplantation (HT) may be at higher risk of post-transplant mortality compared with children who are transplanted for idiopathic dilated cardiomyopathy. We hypothesized that these differences are because of more severe heart failure at HT in children with myocarditis. Methods and Results— We identified 221 children with myocarditis and 1583 with idiopathic dilated cardiomyopathy who were <18 years old and listed for HT in the United States between July 2004 and December 2013 using the Organ Procurement and Transplant Network database. We compared baseline characteristics at listing and at HT and used Cox models to determine whether myocarditis is independently associated with wait-list mortality (or becoming too sick to transplant) or post-transplant graft loss (death/re-HT). Children with myocarditis were more likely to be listed while on assisted ventilation, mechanical circulatory support and with renal dysfunction. Overall, 137 children with myocarditis and 1249 with idiopathic dilated cardiomyopathy received HT. In unadjusted analysis, children with myocarditis were at higher risk of wait-list mortality (hazard ratio 2.1; 95% confidence interval 1.5–3.0) and showed a trend toward increased risk of post-transplant graft loss (hazard ratio 1.4; 95% confidence interval 1.0–2.2). However, in adjusted analysis, myocarditis was not associated with wait-list mortality (hazard ratio 1.3, 95% confidence interval 0.9–1.9) or post-transplant graft loss (hazard ratio 1.3, 95% confidence interval 0.9–2.0). Conclusions— Among children listed for HT, those with myocarditis have more severe heart failure than children with idiopathic dilated cardiomyopathy. After adjustment for severity of illness, myocarditis does not confer additional risk for wait-list or post-transplant mortality.

The Impact of Sacrubitril/Valsartan on Clinical Treatment and hs-cTnT and NT-ProBNP Serum Levels and the Left Ventricular Function in Patients with Chronic Heart Failure

“…Because of its sensitivity, specificity, reproducibility, and lower detection threshold than the traditional cardiac troponin T (cTnT), it has become the gold standard for the diagnosis of myocardial injury 7,8) and is positively associated with the degree of myocardial injury. 9) When heart failure occurs, the blood pumping function of the heart declines, causing myocardial ischemia by reducing the perfusion of the coronary arteries; to compensate, heart rate increases rapidly. This eventually leads to injury of the cardiomyocytes, which release of hs-cTnT into blood.…”

Comparison of inhospital outcomes of pediatric heart transplantation between single ventricle congenital heart disease and cardiomyopathy

“…The inclusion criteria for the CM group were all patients with a diagnosis of myocarditis (391.2; 422; or 429.0) or primary CM (425) who were 4 years of age or older at the time of discharge during the same time period above. Myocarditis and primary CM were included as an amalgam cohort because there is no difference in post‐OHT mortality between the two . Exclusion criteria included having multiple OHTs and presence of both SV and myocarditis or CM codes during the hospitalization for OHT (Figure ).…”

“…Myocarditis and primary CM were included as an amalgam cohort because there is no difference in post-OHT mortality between the two. 15 Exclusion criteria included having multiple OHTs and presence of both SV and myocarditis or CM codes during the hospitalization for OHT ( Figure 1). For comparison, the Organ Procurement and Transplant Network database was queried for all pediatric heart transplants performed during the study collection period, January 1, 2004 to September 31, 2015.…”