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Clinical characteristics and long-term outcome of acute myocarditis in children

Tadaaki Abe1, Etsuko Tsuda, Aya Miyazaki

  • 1Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita-shi, Osaka, 565-8565, Japan, abechinn@par.odn.ne.jp.

Heart and Vessels
|October 16, 2012
PubMed

Insights

This study on acute myocarditis in children found that high CPK, ventricular tachycardia, and low LVEF in the acute phase, along with persistent wide QRS, predict poor outcomes. However, children without these factors show a fair long-term survival rate.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Pathology
  • Clinical Medicine

Background:

  • Acute myocarditis (AM) in children presents with a wide spectrum of clinical severity, ranging from asymptomatic cases to sudden cardiac death.
  • Understanding the clinical characteristics and long-term prognosis of pediatric AM is crucial for effective management.

Purpose of the Study:

  • To clarify the clinical characteristics of acute myocarditis in children.
  • To analyze the long-term outcomes, including survival rates and persistence of cardiac dysfunction, in pediatric patients diagnosed with AM.

Main Methods:

  • Retrospective analysis of 24 children diagnosed with AM between 1978 and 2010, with a maximum follow-up of 31 years.
  • Assessment of survival rates, persistence of decreased left ventricular ejection fraction (LVEF) using two-dimensional echocardiogram (2DE), and persistence of complete atrioventricular block (CAVB) via Kaplan-Meier method.
  • Univariate analysis to identify factors influencing patient outcomes.

Main Results:

  • The 30-year survival rate for pediatric AM patients was 86%.
  • Persistence of LVEF < 60% was observed in 44% at 1 month, 36% at 1 year, and 18% at 3 years.
  • Predictors of poor outcome included high serum creatine phosphokinase (CPK), ventricular tachycardia, low LVEF in the acute phase, and persistent wide QRS in the late phase.

Conclusions:

  • High CPK, ventricular tachycardia, and low LVEF during the acute phase are significant predictors of poor outcomes in children with AM.
  • Persistence of wide QRS in the late phase is also associated with worse prognosis, including increased mortality and need for heart transplantation.
  • Children without these identified risk factors demonstrate a fair long-term survival rate, highlighting the importance of risk stratification.

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