Improving Outcomes for Critically Ill Children With Myocarditis

Abstract

Myocarditis is one of the most common identifiable causes of dilated cardiomyopathy in children 1 Towbin JA Lowe AM Colan SD et al. Incidence, causes, and outcomes of dilated cardiomyopathy in children. Jama. 2006; 296 (Oct 181867-76)https://doi.org/10.1001/jama.296.15.1867 Crossref Scopus (730) Google Scholar , 2 Daubeney PE Nugent AW Chondros P et al. Clinical features and outcomes of childhood dilated cardiomyopathy: results from a national population-based study. Circulation. 2006; 114 (Dec 122671-8)https://doi.org/10.1161/circulationaha.106.635128 Crossref Google Scholar . Viral infections are the most frequent underlying etiology for childhood myocarditis 3 Bowles NE Ni J Kearney DL et al. Detection of viruses in myocardial tissues by polymerase chain reaction. evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol. 2003; 42 (Aug 6466-72)https://doi.org/10.1016/s0735-1097(03)00648-x Crossref Google Scholar . The outcomes for children diagnosed with myocarditis are better than for those with idiopathic dilated cardiomyopathy 4 Foerster SR Canter CE Cinar A et al. Ventricular remodeling and survival are more favorable for myocarditis than for idiopathic dilated cardiomyopathy in childhood: an outcomes study from the Pediatric Cardiomyopathy Registry. Circ Heart Fail. 2010; 3 (Nov689-97)https://doi.org/10.1161/circheartfailure.109.902833 Crossref Google Scholar , with approximately 73% 5-year freedom from death or heart transplant 1 Towbin JA Lowe AM Colan SD et al. Incidence, causes, and outcomes of dilated cardiomyopathy in children. Jama. 2006; 296 (Oct 181867-76)https://doi.org/10.1001/jama.296.15.1867 Crossref Scopus (730) Google Scholar . While earlier adult 5 McCarthy 3rd, RE Boehmer JP Hruban RH et al. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med. 2000; 342 (Mar 9690-5)https://doi.org/10.1056/nejm200003093421003 Crossref Google Scholar and pediatric 6 Amabile N Fraisse A Bouvenot J Chetaille P Ovaert C. Outcome of acute fulminant myocarditis in children. Heart. 2006; 92 (Sep1269-73)https://doi.org/10.1136/hrt.2005.078402 Crossref Scopus (142) Google Scholar investigations have demonstrated that myocarditis with a fulminant presentation (presence of hemodynamic compromise/heart failure) has favorable long-term outcome (adult survival: 93%; pediatric survival: 91%), a more recent study found poor outcomes for those with a fulminant presentation (cardiac death or heart transplant 41.4% with 7-year follow-up) 7 Ammirati E Veronese G Brambatti M et al. Fulminant Versus Acute Nonfulminant Myocarditis in Patients With Left Ventricular Systolic Dysfunction. J Am Coll Cardiol. 2019; 74 (Jul 23): 299-311https://doi.org/10.1016/j.jacc.2019.04.063 Crossref PubMed Scopus (107) Google Scholar . This study included mostly adults and did not separate out pediatric vs. adult outcomes for those with a fulminant presentation. It is therefore important to better understand the outcomes specifically for children with myocarditis who have a more fulminant presentation in the current era. Contemporary Care and Outcomes of Critically-ill Children With Clinically Diagnosed MyocarditisJournal of Cardiac FailurePreviewMyocarditis remains a significant and challenging diagnosis in pediatrics.1 According to the National Center for Review and Prevention of Child Deaths database, myocarditis accounts for nearly 5% of all cardiac deaths in children.2 Full-Text PDF