Abstract 16880: Identifying Non-invasive Tools to Distinguish Acute Myocarditis From Dilated Cardiomyopathy in Children
Introduction: Children with dilated cardiomyopathy (DCM) often require orthotopic heart transplantation. In contrast, children with acute myocarditis may present with similar clinical features to DCM, but many recover completely. Endomyocardial biopsy (EMB) is the gold standard for distinguishing myocarditis from DCM in children with left ventricular dysfunction; however, it is invasive and has potential risks.
Hypothesis: We hypothesize that acute myocarditis can be distinguished from DCM non-invasively using a composite of clinical and laboratory data, which could help obviate the need for EMB.
Methods: All children (<18 years) admitted to our PICU (1996 - 2015) with symptomatic left ventricular dysfunction and a definite diagnosis of DCM or myocarditis based on EMB or explant pathology were included. This is a retrospective chart review of clinical presentation, bloodwork, chest x-ray, echocardiographic, and cardiac catheterization data.
Results: We identified 46 (79%) children with DCM and 12 (21%) with acute myocarditis. Median age was 4.4 y for DCM and 1.6 y for myocarditis. Children with myocarditis were more likely to have a fever, irregular rhythm, elevated cardiac enzymes, wall motion abnormalities, and demonstrate lower left ventricular z-scores and better ventricular function compared to the DCM group (Table).
Conclusions: There are clear differences between patients with myocarditis and DCM that can be detected non-invasively, without the need for EMB. The low number of patients in our cohort precluded a robust multivariable analysis; however, our data suggests that it may be possible to develop a predictive model to differentiate myocarditis and DCM using non-invasive measures. Further prospective study is warranted.
Author Disclosures: D. Suthar: None. D. Dodd: None. J. Godown: None.
- © 2016 by American Heart Association, Inc.