Clinical presentation and early predictors for poor outcomes in pediatric myocarditis: A retrospective study

Abstract

BACKGROUND Myocarditis is an important cause of morbidity and mortality in children, leading to long-term sequelae including chronic congestive heart failure, dilated cardiomyopathy, heart transplantation, and death. The initial diagnosis of myocarditis is usually based on clinical presentation, but this widely ranges from the severe sudden onset of a cardiogenic shock to asymptomatic patients. Early recognition is essential in order to monitor and start supportive treatment prior to the development of severe adverse events. Of note, many cases of fulminant myocarditis are usually misdiagnosed as otherwise minor conditions during the weeks before the unexpected deterioration. AIM To provide diagnostic clues to make an early recognition of pediatric myocarditis. To investigate early predictors for poor outcomes. METHODS We conducted a retrospective cross-sectional single-center study from January 2008 to November 2017 at the Pediatric Department of our institution, including children < 18-years-old diagnosed with myocarditis. Poor outcome was defined as the occurrence of any of the following facts: death, heart transplant, persistent left ventricular systolic dysfunction or dilation at hospital discharge (early poor outcome), or after 1 year of follow-up (late poor outcome). We analyzed different clinical features and diagnostic test findings in order to provide diagnostic clues for myocarditis in children. Multivariable stepwise logistic regression analysis was performed using all variables that had been selected by univariate analysis to determine independent factors that predicted a poor early or late outcome in our study population. RESULTS A total of 42 patients [69% male; median age of 8 (1.5-12) years] met study inclusion criteria. Chest pain (40%) was the most common specific cardiac symptom. Respiratory tract symptoms (cough, apnea, rhinorrhea) (38%), shortness of breath (35%), gastrointestinal tract symptoms (vomiting, abdominal pain, diarrhea) (33%), and fever (31%) were the most common non-cardiac initial complaints. Tachycardia (57%) and tachypnea (52%) were the most common signs on the initial physical exam followed by nonspecific signs of respiratory tract infection (44%) and respiratory distress (35%). Specific abnormal signs of heart failure such as heart murmur (26%), systolic hypotension (24%), gallop rhythm (20%), or hepatomegaly (20%) were less prevalent. Up to 43% of patients presented an early poor outcome, and 16% presented a late poor outcome. In multivariate analysis, an initial left ventricular ejection fraction (LVEF) < 30% remained the only significant predictor for early [odds ratio (OR) (95%CI) = 21 (2-456), P = 0.027) and late [OR (95%CI) = 8 (0.56-135), P = 0.047) poor outcome in children with myocarditis. LVEF correlated well with age ( r = 0.51, P = 0.005), days from the...

Predictors for In-hospital Mortality in Pediatric Patients with Acute Myocarditis – a Retrospective Study

“…1,[9][10][11][12] Cardiovascular signs are minimal, but certain signs of heart failure, tachycardia, hypotension, syncope (full atrioventricular block or other tachyarrhythmia), chest pain, or even cardiogenic shock can also be found. 2,8,[11][12][13][14][15] Since there are some cases when The management and diagnosis of patients with acute myocarditis remains a challenge. 4,5,[9][10][11][12]23 Currently, there is a lack of data regarding the incidence and factors associated with short-term outcomes in pediatric patients admitted for acute myocarditis.…”

“…In children with myocarditis, a history of viral infection can be frequently identified.The diagnosis of myocarditis is usually based on complex clinical and paraclinical data. Endomyocardial biopsy is the gold standard diagnosis technique for inflammatory heart disease, but when histological sampling is performed in a limited area, it can lead to false negative results, while CMR enables the identification of myocarditis in all cases 13,[22][23][24][25]. In our study population, the clinical presentation varied from the presence of peripheral edema and hepatomegaly as signs of congestive heart failure, to respiratory and digestive symptoms which may also be signs of viral infections that have led to the occurrence of acute myocarditis.…”

Miocardiopatía dilatada por miocarditis aguda: ¿Bordetella pertussis como agente causal?

“…Algunos estudios indican, durante la hospitalización inicial, parámetros pronóstico que podrían ayudar a identificar a los pacientes de alto riesgo, principalmente: mediciones ecocardiográficas (fracción de acortamiento, FEVI menor de 30%, presiones de llenado auricular), hemodinámicas y séricas (proBNP > 2000 pg/ mL con buena correlación y peor FEVI, colesterol sérico, ácido úrico y saturación venosa mixta), incluso factores como: edad menor de 2 años al ingreso o curso prolongado de la enfermedad. 5 Además del tratamiento médico, una proporción de pacientes requerirá trasplante cardíaco en los primeros 12 meses del ingreso hospitalario. 12 La vacunación contra Bordetella pertussis durante el embarazo es efectiva y segura.…”

Inflammatory heart diseases in children

“…Klinička slika. Miokarditis se klinički ispoljava znacima infekcije i imunske reakcije, ali i znacima oštećenja miokarda kao što su znaci srčane insuficijencije i poremećaji srčanog ritma [9]. Klinička slika značajno zavisi i od uzrasta.…”

“…Kod novorođenčeta i odojčeta, kod kojih miokarditis nastaje intrauterino, klinička slika je veoma teška i nerijetko dovodi do iznenadne smrti. Miokarditis se u tom uzrastu ispoljava nespecifičnim poremećajima, poput letargije, povišene temperature, neadekvatnog dobijanja u tjelesnoj težini, respiratornog distresa, kardiomegalije, tahikardija i promjena na EKG-u [9][10][11].…”