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Predictors of Outcome of Myocarditis

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Abstract

Heart failure from myocarditis may be transient or may progress to unremitting severe cardiac failure. This study was performed to determine the outcomes and prognostic features of pediatric patients with myocarditis. Patients with the diagnosis of myocarditis between 1990 and 2001 were identified through the coding system of Yale–New Haven Hospital. A total of 28 patients were included, with ages ranging from 1 day to 20 years. Before discharge, 11 patients developed unremitting severe cardiac failure. Of the remaining 17 patients, at the time of discharge 10 had normal systolic function and 7 had decreased systolic function. Unremitting cardiac failure developed in 9 of 14 patients (64%) with an ejection fraction <30% and in only 2 of 14 (14%) of those with an ejection fraction ≥30% on admission (p < 0.01). Furthermore, shortening fraction <15%, left ventricular dilatation, and moderate to severe mitral regurgitation on admission as well as arrhythmia were significantly associated with development of unremitting severe cardiac failure. In this series of patients with myocarditis, by the time of discharge 39% of the patients had developed unremitting severe cardiac failure, 25% had depressed systolic function, and 36% had normal systolic function. Predictive factors at admission for poor outcome were ejection fraction <30%, shortening fraction <15%, left ventricular dilatation, and moderate to severe mitral regurgitation.

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Acknowledgments

We are indebted to George Lister, who provided helpful guidance, and to Stephen Roth for critical reading of the manuscript. Albert Delgrego’s help in locating the tapes of the echocardiograms and the support of the staff of the pediatric echocardiography laboratory are gratefully acknowledged.

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Authors and Affiliations

  1. Department of Pediatrics, Yale University School of Medicine, P.O. Box 208064, New Haven, CT, 06520-8064, USA

    B. Kühn & T. A. Walls

  2. Department of Epidemiology and Investigative Medicine and Children’s Clinical Research Center, Yale University School of Medicine, P.O. Box 208064, New Haven, CT, 06520-8064, USA

    E. D. Shapiro

  3. Section of Pediatric Cardiology, Yale University School of Medicine, P.O. Box 208064, New Haven, CT, 06520-8064, USA

    A. H. Friedman

  4. Current address: Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA

    B. Kühn

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  1. B. Kühn
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Correspondence to B. Kühn.

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Kühn, B., Shapiro, E.D., Walls, T.A. et al. Predictors of Outcome of Myocarditis. Pediatr Cardiol 25, 379–384 (2004). https://doi.org/10.1007/s00246-003-0568-2

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