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

Chengjun Zhang1, Xiuwen Ren2, Yufan Xu2

  • 1Department of Pediatric, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Frontiers in Pediatrics
|March 13, 2026
PubMed

Insights

Elevated homocysteine (HCY) is linked to reduced ejection fraction (EF) in children with myocarditis. This risk is higher in males and overweight pediatric patients, indicating HCY as a potential biomarker.

Area of Science:

  • Cardiology
  • Pediatric Medicine
  • Biochemistry

Background:

  • The association between homocysteine (HCY) and ejection fraction (EF) is established in adults with cardiovascular diseases.
  • However, the relationship between HCY and EF in pediatric patients diagnosed with myocarditis is not well understood.

Purpose of the Study:

  • To investigate the potential relationship between homocysteine levels and ejection fraction in pediatric patients suffering from myocarditis.
  • To identify HCY as a possible risk factor for reduced EF in this specific pediatric population.

Main Methods:

  • A cross-sectional study involving 164 pediatric myocarditis patients (aged 1-18 years) was conducted.
  • Homocysteine levels and ejection fraction, measured by 3.0T cardiac magnetic resonance (CMR), were assessed.
  • Statistical analyses included t-tests, binary logistic regression, and restricted cubic spline (RCS) modeling, with subgroup analyses by age, sex, and BMI.

Main Results:

  • 31% of the pediatric patients exhibited reduced ejection fraction (EF < 55%).
  • Elevated homocysteine levels showed a significant positive association with the risk of reduced EF (OR = 1.033, P = 0.034).
  • Subgroup analyses revealed a stronger correlation between high HCY and reduced EF in males and in patients with a BMI ≥ 24 kg/m².

Conclusions:

  • Elevated homocysteine levels represent a significant risk factor for reduced ejection fraction in pediatric patients with myocarditis.
  • The association is particularly pronounced in male pediatric patients and those who are overweight.
  • These findings highlight the potential role of HCY as a biomarker for assessing cardiac function in pediatric myocarditis.
Abstract

Keywords:
cardiac MRIcardiac magnetic resonanceejection fractionhomocysteinemyocarditispediatrics

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