726-4 Favorable Long-term Outcome of Severe Acute Myocarditis in Children not Receiving Immunosuppressive Therapy. A Comparative Study with Adult Patients

Abstract

With the aim to study spontaneous long-term outcome in children with severe acute myocarditis (AM) not receiving immunosuppressive drugs, and to compare children evolution with that of adults with AM, we have prospec-tively assessed 50 patients (15 children, 35 adults) with AM and severe left ventricular dysfunction (left ventricular ejection fraction [LVEF] <40%) diagnosed in our hospital in the last 8 years. Immunosupressive therapy was not used in any patient. Children age ranged from 2 months to 12 years (mean; 2 ± 3 years). Initial LVEF was 30 ± 12% in children and 28 ± 10% in adults (NS). After a follow-up of 21 ± 16 months (range: 1–80), 3 children (20%) and 9 adults (26%) died or required heart transplantation (HT). Probability of being alive and free from HT at 2 years was 75% in children and 60% in adults. LVEF rose at 1 month to 45 ± 14% in children and to 36 ± 13% in adults (p < 0.05), and to 58 ± 15% in children and 40 ± 16 in adults at the end of follow-up (p 0.01). Unfavorable outcome (death, HT or chronic dilated cardiomyopathy with LVEF <45%) occurred in 4 children (16%) and 16 adult patients (46%) (p < 0.05). A lower (<30%) 1-month LVEF and an unfavorable 1-month evolution were the most powerful predictors of non-favorable long-term outcome (p < 0.001). In conclusion, long-term evolution of children with severe AM not re ceiving immunosuppressive drugs is favorable in most cases, and it appears to be better than in adults. Nevertheless, patients in whom LVEF does not improve at short-term appear to be at higher risk for death, and they should be considered for HT.