In-Hospital Arrhythmia Development and Outcomes in Pediatric Patients With Acute Myocarditis

Miyake, Christina Y.; Teele, Sarah A.; Chen, Liyuan; Motonaga, Kara S.; Dubin, Anne M.; Balasubramanian, Sowmya; Balise, Raymond R.; Rosenthal, David N.; Alexander, Mark E.; Walsh, Edward P.; Mah, Douglas Y.

doi:10.1016/j.amjcard.2013.10.021

Cited by 73 publications

(70 citation statements)

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“…11 It is hardly the early clinical course of FM. Miyake et al reported that arrhythmia was associated with low voltage on ECG and worse outcome in pediatric patients with acute myocarditis, 19 although we could not investigate the voltages in the present study. Therefore, we consider that the ECG provides clinicians with useful, although not definitive, information for initial judgment regarding risk stratification.…”

Section: Discussioncontrasting

confidence: 51%

Prognostic Value of Electrocardiography in Patients With Fulminant Myocarditis Supported by Percutaneous Venoarterial Extracorporeal Membrane Oxygenation　― Analysis From the CHANGE PUMP Study ―

Sawamura

Okumura

et al. 2018

Circ J

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on behalf of the CHANGE PUMP InvestigatorsBackground: Fulminant myocarditis (FM) presents various abnormal findings on ECG, the prognostic impact of which has not been not fully elucidated. The aim of this study was therefore to clarify the prognostic value of ECG data in FM patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO). Methods and Results:In this multicenter chart review, we investigated 99 patients with FM supported by VA-ECMO. The final cohort consisted of 87 patients (mean age, 52±16 years; female, 42%) after 12 patients who required conversion to other forms of mechanical circulatory support were excluded. The median LVEF was 14.5%. At the time of VA-ECMO initiation, 38 patients (44%) had arrhythmias including atrial fibrillation (6%), complete atrioventricular block (CAVB; 17%), and ventricular tachycardia or fibrillation (VT/VF; 15%). Of the 49 patients with sinus rhythm (SR), 26 had QRS duration ≥120 ms (wide QRS). On logistic regression analysis, wide QRS predicted in-hospital death in patients with SR (OR, 3.6; 95% CI: 1.07-13.61, P=0.04). Compared with SR with narrow QRS (QRS duration <120 ms), CAVB and VT/VF had a higher risk of in-hospital death (CAVB: OR, 7.20; 95% CI: 1.78-34.15, P=0.005; VT/VF: OR, 8.10; 95% CI: 1.86-42.31, P=0.005). Conclusions:In patients with FM, CAVB and VT/VF carried a higher risk of in-hospital death. Wide QRS also predicted a higher risk of in-hospital death in patients with SR.

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Section: Discussioncontrasting

confidence: 51%

Prognostic Value of Electrocardiography in Patients With Fulminant Myocarditis Supported by Percutaneous Venoarterial Extracorporeal Membrane Oxygenation　― Analysis From the CHANGE PUMP Study ―

Sawamura

Okumura

et al. 2018

Circ J

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“…In the present study, there was no significant difference in initial infusion rate, maintenance infusion rate, or duration of milrinone treatment between patients with or without arrhythmia in group B. In fact, heart failure due to myocarditis or dilated cardiomyopathy itself increased the vulnerability of the patients to tachyarrhythmia and conduction disturbance 24). Ichikawa et al25) reported that 3 of 7 patients with fulminant myocarditis developed ventricular tachycardia or ventricular fibrillation.…”

Section: Discussioncontrasting

confidence: 44%

Safety and Efficacy of the Off-Label Use of Milrinone in Pediatric Patients with Heart Diseases

et al. 2014

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Background and ObjectivesMilrinone is often used in children to treat acute heart failure and prevent low cardiac output syndrome after cardiac surgery. Due to the lack of studies on the long-term milrinone use in children, the objective of this study was to assess the safety and efficacy of the current patterns of milrinone use for ≥3 days in infants and children with heart diseases.Subjects and MethodsWe retrospectively reviewed the medical records of patients aged <13 years who received milrinone for ≥3 days from January 2005 to December 2012. Patients' characteristics including age, sex, height, weight, and body surface area were recorded. The following parameters were analyzed to identify the clinical application of milrinone: initial infusion rate, maintenance continuous infusion rate, total duration of milrinone therapy, and concomitantly infused inotropes. The safety of milrinone was determined based on the occurrence of adverse events such as hypotension, arrhythmia, chest pain, headache, hypokalemia, and thrombocytopenia.ResultsWe assessed 730 admissions (684 patients) during this period. Ventricular septal defects were the most common diagnosis (42.4%) in these patients. Milrinone was primarily used after cardiac surgery in 715 admissions (97.9%). The duration of milrinone treatment varied from 3 to 64.4 days (≥7 days in 149 admissions). Ejection fraction and fractional shortening of the left ventricle improved in patients receiving milrinone after cardiac surgery. Dose reduction of milrinone due to hypotension occurred in only 4 admissions (0.5%). Although diverse arrhythmias occurred in 75 admissions (10.3%), modification of milrinone infusion to manage arrhythmia occurred in only 3 admissions (0.4%). Multivariate analysis indicated that the development of arrhythmia was not influenced by the pattern of milrinone use.ConclusionMilrinone was generally administered for ≥3 days in children with heart diseases. The use of milrinone for ≥3 days was effective in preventing low cardiac output after cardiac surgery when combined with other inotropes, suggesting that milrinone could be safely employed in pediatric patients with heart diseases.

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“…discovered that increases in the Ccr are related to poor outcomes ( P = 0.01, OR = 4.5, 95% CI : 1.40–14.30) in young patients with acute myocarditis. [15] However, the Ccr was not significantly associated with poor outcomes in young patients with myocarditis after Bonferroni correction. In another retrospective study, acute kidney injuries (AKIs) defined as AKI Network Stage 3 ( P = 0.007) and Sequential Organ Failure Assessment scores ( P = 0.03) were identified as predictors of in-hospital mortality in multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

“…found that in-hospital arrhythmias were associated with worse outcomes in patients with myocarditis ( P = 0.01, OR = 7.59, 95% CI : 2.61–22.07), these outcomes included mechanical-assist device use, heart transplantation, or death. [15] In a study on children with acute fulminant myocarditis, the overall patient survival rate was 78% (14/18), and three of the four nonsurviving patients died of VT and heart failure refractory to medical treatment. [19]…”

Section: Discussionmentioning

confidence: 99%

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

Zhao

Gao

et al. 2017

Chinese Medical Journal

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Background:Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some patients. However, little is known about the predictors of in-hospital mortality in patients with suspected myocarditis. Thus, the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction model.Methods:A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First Hospital between January 2003 and December 2013. A total of 238 males (59%) and 165 females (41%) were enrolled in this study. We divided the above patients into two subgroups (survival and nonsurvival), according to their clinical in-hospital outcomes. To maximize the effectiveness of the prediction model, we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis, based on data pertaining to previously established risk factors and basic patient characteristics. We subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression analyses. Finally, we identified the independent risk factors for in-hospital mortality using our risk prediction model.Results:The following prediction model for in-hospital mortality in patients with suspected myocarditis, including creatinine clearance rate (Ccr), age, ventricular tachycardia (VT), New York Heart Association (NYHA) classification, gender and cardiac troponin T (cTnT), was established in the study: P = ea/(1 + ea) (where e is the exponential function, P is the probability of in-hospital death, and a = −7.34 + 2.99 × [Ccr <60 ml/min = 1, Ccr ≥60 ml/min = 0] + 2.01 × [age ≥50 years = 1, age <50 years = 0] + 1.93 × [VT = 1, no VT = 0] + 1.39 × [NYHA ≥3 = 1, NYHA <3 = 0] + 1.25 × [male = 1, female = 0] + 1.13 × [cTnT ≥50 μg/L = 1, cTnT <50 μg/L = 0]). The area under the receiver operating characteristic curve was 0.96 (standard error = 0.015, 95% confidence interval [CI]: 0.93-0.99). The model demonstrated that a Ccr <60 ml/min (odds ratio [OR] = 19.94, 95% CI: 5.66–70.26), an age ≥50 years (OR = 7.43, 95% CI: 2.18–25.34), VT (OR = 6.89, 95% CI: 1.86–25.44), a NYHA classification ≥3 (OR = 4.03, 95% CI: 1.13–14.32), male gender (OR = 3.48, 95% CI: 0.99–12.20), and a cTnT level ≥50 μg/L (OR = 3.10, 95% CI: 0.91–10.62) were the independent risk factors for in-hospital mortality.Conclusions:A Ccr <60 ml/min, an age ≥50 years, VT, an NYHA classification ≥3, male gender, and a cTnT level ≥50 μg/L were the independent risk factors resulting from the prediction model for in-hospital mortality in patients with suspected myocarditis. In addition, sufficient life support during the early stage of the disease might improve the prognoses of patients with suspected myocarditis with multiple risk factors for in-hospital mortality.

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In-Hospital Arrhythmia Development and Outcomes in Pediatric Patients With Acute Myocarditis

Cited by 73 publications

References 13 publications

Prognostic Value of Electrocardiography in Patients With Fulminant Myocarditis Supported by Percutaneous Venoarterial Extracorporeal Membrane Oxygenation　― Analysis From the CHANGE PUMP Study ―

Prognostic Value of Electrocardiography in Patients With Fulminant Myocarditis Supported by Percutaneous Venoarterial Extracorporeal Membrane Oxygenation　― Analysis From the CHANGE PUMP Study ―

Safety and Efficacy of the Off-Label Use of Milrinone in Pediatric Patients with Heart Diseases

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

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In-Hospital Arrhythmia Development and Outcomes in Pediatric Patients With Acute Myocarditis

Cited by 73 publications

References 13 publications

Prognostic Value of Electrocardiography in Patients With Fulminant Myocarditis Supported by Percutaneous Venoarterial Extracorporeal Membrane Oxygenation ― Analysis From the CHANGE PUMP Study ―

Prognostic Value of Electrocardiography in Patients With Fulminant Myocarditis Supported by Percutaneous Venoarterial Extracorporeal Membrane Oxygenation ― Analysis From the CHANGE PUMP Study ―

Safety and Efficacy of the Off-Label Use of Milrinone in Pediatric Patients with Heart Diseases

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

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Product

Resources

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Prognostic Value of Electrocardiography in Patients With Fulminant Myocarditis Supported by Percutaneous Venoarterial Extracorporeal Membrane Oxygenation　― Analysis From the CHANGE PUMP Study ―

Prognostic Value of Electrocardiography in Patients With Fulminant Myocarditis Supported by Percutaneous Venoarterial Extracorporeal Membrane Oxygenation　― Analysis From the CHANGE PUMP Study ―