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Effects of Cardiac Remodeling and Altered Mechanics on Cardiac Outcomes in Fulminant Myocarditis in Children: Insight

Snigdha Bhatia1,2, Gautam K Singh3, Gilda Kadiu3

  • 1Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan/ Central Michigan University College of Medicine, Detroit, MI, USA. snigdhabhatia@gmail.com.

Pediatric Cardiology
|April 24, 2025
PubMed

Insights

Adverse left ventricular remodeling, not the presentation type, predicts outcomes in pediatric myocarditis. Multisystem Inflammatory Syndrome-related myocarditis (MISCM) and viral myocarditis (VM) show different remodeling patterns and patient outcomes.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Research
  • Inflammatory Diseases

Background:

  • Fulminant acute myocarditis can predict cardiac function and patient outcomes.
  • Multisystem Inflammatory Syndrome-related myocarditis (MISCM) and viral myocarditis (VM) are distinct pediatric conditions.
  • Understanding the drivers of adverse left ventricular (LV) remodeling is crucial for predicting outcomes.

Purpose of the Study:

  • To compare pediatric cohorts with MISCM versus non-COVID-19 viral myocarditis (VM).
  • To test the hypothesis that adverse LV remodeling, rather than presentation phenotype, predicts clinical outcomes in pediatric myocarditis.
  • To investigate the role of inflammation-mediated remodeling in determining LV function and patient outcomes.

Main Methods:

  • Retrospective analysis of 54 children with MISCM and 26 children with VM.
  • Comparison of LV remodeling, systolic and diastolic function (ejection fraction, longitudinal strain), and clinical outcomes at hospitalization and one-year follow-up.
  • Utilized non-invasive imaging to assess LV remodeling mechanisms and functional trajectory.

Main Results:

  • VM patients exhibited acute LV remodeling, while MISCM patients did not (LV end-diastolic dimension z score 2.05 vs 0.04, p=0.00).
  • VM patients had more severe LV dysfunction (ejection fraction 39.9% vs 54.6%), higher need for mechanical support (39% vs 7%), and worse outcomes including mortality and heart failure.
  • Abnormal longitudinal strain persisted in both groups at one year, with most VM patients requiring ongoing heart failure treatment.

Conclusions:

  • Inflammation-mediated acute LV remodeling, rather than the initial presentation, appears to determine LV function and patient outcomes in pediatric myocarditis.
  • Non-invasive imaging is valuable for assessing LV remodeling mechanisms and predicting cardiac outcomes.
  • Distinct remodeling patterns in MISCM and VM suggest different pathophysiological pathways impacting long-term cardiac health.

Keywords:
EchocardiogramMISCMyocarditisPediatric

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