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Published on: June 20, 2014
Predictors of outcome of myocarditis
B Kühn1, E D Shapiro, T A Walls
1Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520-8064, USA. Bernhard.Kuhn@cardio.chboston.org
Insights
Pediatric myocarditis can lead to severe heart failure. Key predictors of poor outcomes include low ejection fraction (<30%), left ventricular dilatation, and mitral regurgitation on admission.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Inflammatory Heart Disease
Background:
- Myocarditis in children can result in temporary or persistent severe cardiac failure.
- Understanding outcomes and prognostic indicators is crucial for managing pediatric myocarditis.
Purpose of the Study:
- To investigate the outcomes of pediatric patients diagnosed with myocarditis.
- To identify prognostic features associated with severe cardiac failure in pediatric myocarditis.
Main Methods:
- Retrospective study of 28 pediatric patients diagnosed with myocarditis between 1990 and 2001.
- Analysis of patient data including ejection fraction, shortening fraction, left ventricular size, mitral regurgitation, and arrhythmias on admission.
- Assessment of outcomes at discharge, including cardiac failure development and systolic function.
Main Results:
- 39% of pediatric myocarditis patients developed unremitting severe cardiac failure by discharge.
- Predictive factors for unremitting cardiac failure included admission ejection fraction <30% (64% vs 14%), shortening fraction <15%, left ventricular dilatation, and moderate-to-severe mitral regurgitation.
- At discharge, 25% had depressed systolic function, and 36% had normal systolic function.
Conclusions:
- Pediatric myocarditis carries a significant risk of developing unremitting severe cardiac failure.
- Early identification of prognostic factors like reduced ejection fraction and ventricular dilatation is vital for predicting poor outcomes in pediatric myocarditis.
Abstract:
Heart failure from myocarditis may be transient or may progress to unremitting severe cardiac failure. This study was performed to determine the outcomes and prognostic features of pediatric patients with myocarditis. Patients with the diagnosis of myocarditis between 1990 and 2001 were identified through the coding system of Yale-New Haven Hospital. A total of 28 patients were included, with ages ranging from 1 day to 20 years. Before discharge, 11 patients developed unremitting severe cardiac failure. Of the remaining 17 patients, at the time of discharge 10 had normal systolic function and 7 had decreased systolic function. Unremitting cardiac failure developed in 9 of 14 patients (64%) with an ejection fraction < 30% and in only 2 of 14 (14%) of those with an ejection fraction > or = 30% on admission (p < 0.01). Furthermore, shortening fraction < 15%, left ventricular dilatation, and moderate to severe mitral regurgitation on admission as well as arrhythmia were significantly associated with development of unremitting severe cardiac failure. In this series of patients with myocarditis, by the time of discharge 39% of the patients had developed unremitting severe cardiac failure, 25% had depressed systolic function, and 36% had normal systolic function. Predictive factors at admission for poor outcome were ejection fraction < 30%, shortening fraction < 15%, left ventricular dilatation, and moderate to severe mitral regurgitation.
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