Analysis of clinical parameters and echocardiography as predictors of fatal pediatric myocarditis

Abstract

Pediatric myocarditis symptoms can be mild or as extreme as sudden cardiac arrest. Early identification of the severity of illness and timely provision of critical care is helpful; however, the risk factors associated with mortality remain unclear and controversial. We undertook a retrospective review of the medical records of pediatric patients with myocarditis in a tertiary care referral hospital for over 12 years to identify the predictive factors of mortality. Demographics, presentation, laboratory test results, echocardiography findings, and treatment outcomes were obtained. Regression analyses revealed the clinical parameters for predicting mortality. During the 12-year period, 94 patients with myocarditis were included. Of these, 16 (17%) patients died, with 12 succumbing in the first 72 hours after admission. Fatal cases more commonly presented with arrhythmia, hypotension, acidosis, gastrointestinal symptoms, decreased left ventricular ejection fraction, and elevated isoenzyme of creatine kinase and troponin I levels than nonfatal cases. In multivariate analysis, troponin I > 45 ng/mL and left ventricular ejection fraction < 42% were significantly associated with mortality. Pediatric myocarditis had a high mortality rate, much of which was concentrated in the first 72 hours after hospitalization. Children with very high troponin levels or reduced ejection fraction in the first 24 hours were at higher risk of mortality, and targeting these individuals for more intensive therapies may be warranted.

Zapalenie mięśnia sercowego u dzieci i młodzieży — przegląd piśmiennictwa

“…In total, the summary covers 1,891 children diagnosed with myocarditis (Table 1) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. It is, therefore, a rare disease.…”

“…Usually, two peak incidences are observed. The first takes place in the neonatal period and early infancy, and the second -during puberty [6][7][8][9][10][11][12][13]. According to Rodriguez et al [12], the age < 2 is a factor of poor prognosis.…”

Role of electrocardiograms in assessment of severity and analysis of the characteristics of ST elevation in acute myocarditis: A two‑centre study

“…As mentioned above, ECG has a key role in the assessment of severity. Of note, UCG, whose diagnostic criteria have been suggested and adopted for myocarditis patients, may also be used to distinguish FM from myocarditis (23,24). In the near future, the role of UCG in myocarditis patients we be further studied.…”

Non-coronarogenic causes of increased cardiac troponins in clinical practice

“…Крупный ретроспективный анализ медицинских карт Y. Chang с соавт., включивший 94 педиатрических пациента с острым миокардитом, выявил, что летальные случаи гораздо чаще встречались у детей с повышенными уровнями сердечного тропонина I, креатинкиназы МВ-изоформы; при этом повышенные концентрации данных биомаркеров были связаны с аритмией, гипотензией, ацидозом и сниженной фракцией выброса левого желудочка. Подавляющее большинство пациентов погибало в первые 72 ч. В многомерном анализе очень высокие уровни cTnI (>45нг/мл) и снижение фракции выброса левого желудочка (<42%) были связаны c www.clinpractice.ru высоким риском смерти, особенно в первые 24 ч. По мнению авторов, лицам с высокими концентрациями cTnI оправдано назначение более интенсивной терапии [30].…”