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Acute Myocarditis with Infarct-like Presentation in a Pediatric Population: Role of Cardiovascular Magnetic Resonance

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Abstract

Chest pain is a typical symptom of acute myocarditis in adolescents. It may be indistinguishable from myocardial ischemia so it is called “infarct-like pattern.” Cardiovascular magnetic resonance has an important role as a non-invasive diagnostic tool. The aim of our study is to provide a description of an acute myocarditis series with infarct-like pattern and to evaluate the cardiovascular magnetic resonance role in a pediatric population. We included all pediatric patients (0–16 years) admitted to our hospital (May 2007–May 2016) with clinical diagnosis of acute myocarditis and infarct-like presentation (chest pain, EKG alterations, and released cardiac biomarkers). Diagnosis was confirmed with cardiovascular magnetic resonance using Lake Louise criteria. Seven patients (five males, two females) with a median age of 14 years (12.5–15.2) were included. All patients showed ST-segment changes and released cardiac biomarkers. Three patients had left ventricular hypertrophy and two presented mild systolic left ventricular dysfunction. All patients had at least two positive Lake Louise criteria. Late gadolinium enhancement was positive in all of them. With a median follow-up of 23 months (8–47), all of them are alive, with no cardiac symptoms and normal ventricular function. Infarct-like pattern is a typical presentation of acute myocarditis in adolescents. CMR should be performed in this population and may be considered as a first-line diagnostic tool. Its high sensitivity in infarct-like acute myocarditis may allow us to avoid endomyocardial biopsy. Unlike what was described in adults, late gadolinium enhancement does not imply worse outcome in our series.

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Funding

This research did not receive any specific grant from funding agencies.

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Authors and Affiliations

  1. Pediatric Cardiology Department, Hospital Universitario Materno-Infantil Vall d’Hebrón, Universidad Autónoma de Barcelona, Passeig Vall d’Hebrón, 119-129, 08035, Barcelona, Spain

    Maria Martinez-Villar, Ferran Gran, Anna Sabaté-Rotés, Amparo Castellote, Marc Figueras-Coll, Queralt Ferrer & Ferran Roses-Noguer

  2. Pediatrics Department, Hospital Vega Baja, Orihuela, Alicante, Spain

    Maria Martinez-Villar

  3. Cardiology Department. Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain

    Antonio Tello-Montoliu

  4. Pediatrics Cardiology Department, Hospital Universitario de Girona Dr. Josep Trueta, Universidad de Girona, Girona, Spain

    Marc Figueras-Coll

  5. Paediatric Cardiology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK

    Ferran Roses-Noguer

Authors
  1. Maria Martinez-Villar
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  2. Ferran Gran
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  3. Anna Sabaté-Rotés
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  4. Antonio Tello-Montoliu
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  5. Amparo Castellote
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  6. Marc Figueras-Coll
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  7. Queralt Ferrer
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  8. Ferran Roses-Noguer
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Correspondence to Ferran Gran.

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The authors declare that they have no conflict of interest.

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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. For this type of study formal consent is not required.

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Martinez-Villar, M., Gran, F., Sabaté-Rotés, A. et al. Acute Myocarditis with Infarct-like Presentation in a Pediatric Population: Role of Cardiovascular Magnetic Resonance. Pediatr Cardiol 39, 51–56 (2018). https://doi.org/10.1007/s00246-017-1726-2

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  • DOI: https://doi.org/10.1007/s00246-017-1726-2

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