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Outcomes of Myocarditis in Patients with Normal Left Ventricular Systolic Function on Admission

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Abstract

The objective of this study was to describe a cohort of patients with clinical myocarditis and normal left ventricular (LV) systolic function on admission. A retrospective chart review at seven tertiary pediatric hospitals identified patients aged < 19 years admitted with an ICD-9 code of myocarditis between 2008 and 2012. Patients were excluded if admission LV systolic ejection fraction was < 50%, fractional shortening (FS) was < 28% or if the admitting or consulting cardiologist did not suspect myocarditis. A total of 75 patients met inclusion criteria. The median age was 15.5 years with an Interquartile Range (IQR) of 13.6–16.6. 33% were female. Patients presented most commonly with chest pain (75%) and dyspnea (24%). On admission, median B-type natriuretic peptide (BNP) was 132 pg/mL (IQR 57–689) and median troponin I (TnI) was 8.4 ng/mL (IQR 2.0–20.3). Electrocardiogram revealed ST elevation in the majority (55%). Magnetic resonance imaging was obtained on 40%, with 63% of those showing evidence of inflammation. Therapies included inotropic support (15%), mechanical ventilation (12%), antiarrhythmic medications (9%), and Extracorporeal Membrane Oxygenation (5%). Those with poor outcomes were noted to have significantly higher BNP, TnI, and creatine kinase levels on presentation. One patient was transplanted and 35% were discharged on heart failure medications. At one year follow-up one patient had died of unspecified causes, 15% required readmission for cardiac reasons, and 21% continued on heart failure medications. The risk associated with clinical myocarditis in the setting of normal ventricular function at presentation may be higher than previously suspected.

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Acknowledgements

The authors would like to acknowledge the assistance of Zhining Ou with the statistical analysis performed.

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There was no funding source for this study.

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Correspondence to Spencer B. Barfuss.

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All of the authors have no conflicts of interest to report.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Not obtained due to retrospective study design.

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Barfuss, S.B., Butts, R., Knecht, K.R. et al. Outcomes of Myocarditis in Patients with Normal Left Ventricular Systolic Function on Admission. Pediatr Cardiol 40, 1171–1174 (2019). https://doi.org/10.1007/s00246-019-02127-x

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  • DOI: https://doi.org/10.1007/s00246-019-02127-x

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