Homocysteine is a risk factor for reduced ejection fraction in children with myocarditis: a single-center study

The relationship between homocysteine (HCY) and ejection fraction (EF) has been demonstrated in diseases such as coronary artery disease, but the relationship between HCY and EF in pediatric patients with myocarditis remains unclear. The aim of this study was to investigate the relationship between HCY and EF in pediatric patients with myocarditis.

This single-center cross-sectional study included 164 pediatric myocarditis patients aged 1-18 years, including 104 males and 60 females, at Anzhen Hospital (2023-2024) in Beijing. Patient demographic characteristics were collected, and blood tests were performed to assess HCY, routine blood tests, and markers of myocardial damage. EF was measured using 3.0T cardiac magnetic resonance (CMR), and patients were grouped using EF < 55% as the cutoff value. Statistical analyses were performed using t-tests, Binary logistic regression and Restrict cubic spline (RCS), and subgroup analyses [age, sex, body mass index (BMI)].

Of the 164 patients, 31% (n = 51) had EF values < 55%. High HCY concentration demonstrated a statistically positive relationship with the risk of occurrence of EF < 55% (OR = 1.033, P = 0.034). Subgroup analysis showed a stronger correlation in men (OR = 1.045, P = 0.016) and in those with a BMI ≥ 24 kg/m² (OR = 1.083, P = 0.010). The RCS showed a non-significant trend of increasing EF < 55% (P > 0.05).

The findings suggest that elevated HCY levels are a risk factor for EF < 55% in pediatric patients with myocarditis, especially in males and overweight individuals.