Comparison of the Clinical Presentation, Treatment, and Outcome of Fulminant and Acute Myocarditis in Children

Saji, Tsutomu; Matsuura, Hiroyuki; Hasegawa, Katsuhiko; Nishikawa, Toshio; Yamamoto, Eiichi; Ohki, Hirotaka; Yasukochi, Satoshi; Arakaki, Yoshio; Joo, Kunio; Nakazawa, Makoto

doi:10.1253/circj.cj-11-1032

Cited by 91 publications

(103 citation statements)

References 51 publications

(31 reference statements)

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“…Перечисленные методы соответствовали совре-менным принципам лечения миокардита у детей в странах Европы [1,5,14], в Японии [10] и США, а также российским клиническим рекомендаци-ям по диагностике и лечению миокардита у детей под ред. академика А.А.…”

Section: таблица 3 исходы наблюдения (N=14)unclassified

“…Резидуальная сердечная недостаточность 2-го функционального класса сохранялась через 6 мес -3 года от дебюта болезни у 21,4%, что мало отлича-ется от данных T. Saji и соавт. -у 15,1% [10]. Спустя 6 мес -3 года серьезные аритмии сохранились у 1/5 части пациентов, они продолжили получать антиа-ритмические препараты и один ребенок -постоян-ную электрокардиостимуляцию.…”

Section: таблица 3 исходы наблюдения (N=14)unclassified

“…По данным T. Saji и соавт. [10], доля детей с серьезными аритмиями после перенесенного острого/фульминантного ми-окардита составила 20,8%.…”

Section: таблица 3 исходы наблюдения (N=14)unclassified

“…[13] сообщают о выжи-ваемости 92% больных. По данным аналогичного национального исследования миокардита у детей в Японии [10], выжили 79,9%, в нашем исследова-нии -94,4%.…”

Section: таблица 3 исходы наблюдения (N=14)unclassified

“…В первую очередь применяются методы лечения сердечной недостаточности (медикаментозные препараты, ис-кусственные устройства механической поддержки насосной функции сердца), этиотропные агенты (при верификации возбудителя), иммуносупрессоры (если исключена инфекционная этиология), в неко-торых ситуациях -внутривенный человеческий им-муноглобулин [1,5,10]. Первичные данные о лечении острого миокардита внутривенным иммуноглобули-ном показывали, что применение высокодозного вну-тривенного иммуноглобулина ассоциируется с улуч-шением сократимости миокарда левого желудочка и тенденцией к повышению выживаемости в течение первого года заболевания [10]. В более поздних иссле-дованиях, включая рандомизированные испытания, проведено сравнение лечения данным препаратом и стероидами.…”

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Experience in the Observation of Acute and Fulminant Myocarditis in Children

Bregel¹,

Субботин²,

Белозеров³

et al. 2017

Ross. vestn. perinatol. pediatr.

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DOI: 10.21508/1027DOI: 10.21508/ -4065-2017 The results of observation of 17 patients aged 2 months to 16 years with acute and fulminant myocarditis (FM) were analyzed. Patients were observed in the period 2013-2016. Diagnostics used clinical data, laboratory and instrumental studies. Of 17 patients, acute myocarditis was diagnosed in 14 children, fulminant in 3. Therapy included, first of all, measures for the treatment of heart failurediuretics (furosemide, verospiron, triampur), angiotensin converting enzyme (ACE) inhibitors (captopril), beta-blockers, digoxin inotropic agents. Intravenous human immunoglobulin was administered at a dose of 1-2 g/kg/course in 5 of 17 (29.4%) patients. When the pathogen was verified, specific antiviral therapy (acyclovir, ganciclovir, cymevene) was administered in a standard mode. Immunosuppressive therapy (prednisolone, delagil) was prescribed for two of them. Nonsteroidal anti-inflammatory drugs (ibuprofen, diclofenac) was obtained in children with acute myocarditis duration of over 2 weeks (13 children) prior to 2016. Nonsteroidal antiinflammatory drugs were not administered to hemodynamically unstable patients, regardless of the time period of observation. Overall, 16 out of 17 (94.4%) patients recovered with apparent regression of signs of myocarditis on the background of treatmentthe symptoms of acute heart failure and cardiogenic shock were treated, and then manifestations of chronic congestive heart failure gradually decreased. 1 (5,6%) child with fulminant myocarditis died. After 6 months to 3 years, 14 children were observed. Follow-up within 6 months to 3 years showed that the diameter of the left ventricle normalized in 10 out of 14 (71.4%). Two out of 14 children (14.3%) formed postmyocardial dilated cardiomyopathy. Key words: children, myocarditis acute and fulminant, treatment, outcome, prognosis.For citation : Bregel L.V., Subbotin V.M., Belozerov Yu.M., Efremova O.S., Tolstikova T.V., Matyunova A.E., Mikhalevich I.M. Experience in the observation of acute and fulminant myocarditis in children. Ros Vestn Perinatol i Pediatr 2017; 62:(6): 69-76 (in Russ).

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Section: таблица 3 исходы наблюдения (N=14)unclassified

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Experience in the Observation of Acute and Fulminant Myocarditis in Children

Bregel¹,

Субботин²,

Белозеров³

et al. 2017

Ross. vestn. perinatol. pediatr.

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Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021

Oster

Shay

et al. 2022

JAMA

496

495

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IMPORTANCEVaccination against COVID-19 provides clear public health benefits, but vaccination also carries potential risks. The risks and outcomes of myocarditis after COVID-19 vaccination are unclear.OBJECTIVE To describe reports of myocarditis and the reporting rates after mRNA-based COVID-19 vaccination in the US. DESIGN, SETTING, AND PARTICIPANTS Descriptive study of reports of myocarditis to the Vaccine Adverse Event Reporting System (VAERS) that occurred after mRNA-based COVID-19 vaccine administration between December 2020 and August 2021 in 192 405 448 individuals older than 12 years of age in the US; data were processed by VAERS as of September 30, 2021. EXPOSURES Vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna).MAIN OUTCOMES AND MEASURES Reports of myocarditis to VAERS were adjudicated and summarized for all age groups. Crude reporting rates were calculated across age and sex strata. Expected rates of myocarditis by age and sex were calculated using 2017-2019 claims data. For persons younger than 30 years of age, medical record reviews and clinician interviews were conducted to describe clinical presentation, diagnostic test results, treatment, and early outcomes. RESULTS Among 192 405 448 persons receiving a total of 354 100 845 mRNA-based COVID-19 vaccines during the study period, there were 1991 reports of myocarditis to VAERS and 1626 of these reports met the case definition of myocarditis. Of those with myocarditis, the median age was 21 years (IQR, 16-31 years) and the median time to symptom onset was 2 days (IQR, 1-3 days). Males comprised 82% of the myocarditis cases for whom sex was reported. The crude reporting rates for cases of myocarditis within 7 days after COVID-19 vaccination exceeded the expected rates of myocarditis across multiple age and sex strata. The rates of myocarditis were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.9 per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and 56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively). There were 826 cases of myocarditis among those younger than 30 years of age who had detailed clinical information available; of these cases, 792 of 809 (98%) had elevated troponin levels, 569 of 794 (72%) had abnormal electrocardiogram results, and 223 of 312 (72%) had abnormal cardiac magnetic resonance imaging results. Approximately 96% of persons (784/813) were hospitalized and 87% (577/661) of these had resolution of presenting symptoms by hospital discharge. The most common treatment was nonsteroidal anti-inflammatory drugs (589/676; 87%). CONCLUSIONS AND RELEVANCEBased on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose in adolescent males and young men. This risk should be ...

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Effects of the elective introduction of extracorporeal membrane oxygenation on outcomes in pediatric myocarditis cases

Nosaka

Muguruma

Fujiwara

et al. 2014

Acute Medicine & Surgery

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Aim:To investigate the necessary indicators to diagnose pediatric myocarditis and choose appropriate candidates for extracorporeal membrane oxygenation therapy. Methods:We retrospectively reviewed the medical records of children aged <16 years of age who were diagnosed with myocarditis and admitted to the pediatric intensive care unit in a Japanese children's hospital from 2002 to 2013. We collected demographic data and symptoms and signs during the entire clinical course, investigated the survival and neurological outcomes, and identified the predictors of death.Results: Twenty-nine patients (median age, 5 years) met the inclusion criteria. Fever and gastrointestinal symptoms occurred in approximately 80% of the patients as initial symptoms and central nervous system symptoms were the most frequent symptom on emergency presentation (41%). Extracorporeal membrane oxygenation was administered to 16 patients; of these, five died. Of the 24 surviving patients, 23 achieved favorable neurological outcomes. Four of eight patients died following cardiopulmonary resuscitationtriggered extracorporeal membrane oxygenation, and one of eight died following elective extracorporeal membrane oxygenation. Multivariate analysis using stepwise logistic regression analysis revealed creatinine level as an independent predictor of death. Conclusion:It is important to consider myocarditis when evaluating children with gastrointestinal or central nervous system symptoms. The elective introduction of extracorporeal membrane oxygenation before the completion of end-organ dysfunction has a positive effect on outcomes in pediatric myocarditis cases. Transfer to an institution that can initiate extracorporeal membrane oxygenation support should be promptly considered when managing pediatric myocarditis.

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Comparison of the Clinical Presentation, Treatment, and Outcome of Fulminant and Acute Myocarditis in Children

Cited by 91 publications

References 51 publications

Experience in the Observation of Acute and Fulminant Myocarditis in Children

Experience in the Observation of Acute and Fulminant Myocarditis in Children

Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021

Effects of the elective introduction of extracorporeal membrane oxygenation on outcomes in pediatric myocarditis cases

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