Abstract 13153: Clinical Outcomes of Pediatric Myocarditis
Introduction: Current data suggest outcomes in pediatric myocarditis may be influenced by the severity of initial presentation. The aim of this study was to describe the clinical outcomes of pediatric myocarditis by comparing acute fulminant (AFM) and acute non-fulminant myocarditis (AM).
Methods: This is a retrospective study of all pediatric AFM and AM patients admitted to a single center from 2000 - 2012. Myocarditis diagnosis was confirmed using health records and hospital databases. Diagnostic criteria for myocarditis were presence of left ventricular (LV) systolic heart failure with a normal LV size on echo in previously healthy patients; AFM patients also had evidence of cardiogenic shock. Demographics, clinical presentation, hospital course and outcomes were compared between the two groups.
Results: Myocarditis was present in 62 patients (AFM 52%). AFM patients at presentation were younger (6.6 vs 15.6y, p<0.001), more likely to have abnormal vital signs (97 vs 43%, p<0.001), have heart block or ventricular dysrhythmia (38 vs 13%, p=0.02) and lower ejection fraction (32 vs 53%, p<0.001). Abnormal troponin levels at presentation were noted in all patients (median of 100 times beyond the normal upper limit) with no difference between AFM and AM groups. AFM group had a greater frequency of multiorgan dysfunction (61 vs 0%, p<0.001) and ventricular dysrhythmia as complications (47 vs 10%, p=0.002). Treatment with antiviral, steroids or gamma globulin was more frequently employed in the AFM group (53 vs 23%, p=0.02). AFM patients were all admitted to the ICU (intensive care unit) with 28% receiving extracorporeal life support (ECLS). Death occurred in 5 patients with AFM (p=0.05). Echo and clinical recovery were noted in the entire AM group. From the 21 AFM survivors followed, only 1 had echo sequelae of myocarditis; none had heart failure symptoms or required heart transplantation.
Conclusion: Death occurs <10% of myocarditis and exclusively in AFM. Patients with AFM should be transferred early and managed in a tertiary center. These patients have a high incidence of arrhythmia and high likelihood for requiring ECLS. Despite the early mortality risk AFM hospital survivors had excellent functional recovery at midterm, which was comparable to the AM group.
- © 2013 by American Heart Association, Inc.