Outcome Of Acute Myocarditis Research Articles

The Influence of Biological Sex on Presentation and Outcomes of Acute Myocarditis: A Systematic Review and Meta-Analysis.

There is growing evidence of sex-related differences in the epidemiology and pathophysiology of cardiovascular diseases. This is the first systematic review and meta-analysis that aimed to highlight the sex-specific differences in the clinical features and outcomes of acute myocarditis. Electronic searches were performed on Scopus, Embase, and PubMed from inception up to June 2023 to identify studies comparing the clinical features and outcomes of acute myocarditis in males and females. Both qualitative and quantitative summaries were conducted. In this systematic review and meta-analysis of 11 studies involving 34,791 patients presenting with acute myocarditis. Male patients, who comprised 69.8% of the entire pooled population, presented at a markedly younger age (mean difference: -8.99 years; 95% CI: -13.60, -4.38; p=0.0001). They also had significantly lower rates of hypertension, diabetes mellitus, and coronary artery disease compared to female patients (p<0.01). Male patients were more likely to present with ST elevation (RR: 2.57 [1.38, 4.79]; p=0.003) and higher C-reactive protein levels (RR: 3.04 [2.75, 3.34]; p<0.00001) compared to female patients. This review underscores the crucial sex-specific evaluation in acute myocarditis, necessitating tailored approaches in assessment and diagnostic evaluation, and emphasizing the need for additional research in this domain.

Predicting factors and outcomes of acute myocarditis in children - a 5-year experience in a teaching hospital from the Eastern province of Saudi Arabia.

Myocarditis in children is not very common, but the state of the disease is similar to viral influenza, making it challenging for a clinician to make an early diagnosis and treatment plan. Elevated levels of inflammatory biomarkers like C-reactive protein, serum lactate, troponin, and abnormal ECG may be helpful for high-index suspicion of myocarditis. This study aimed to determine the predicting factors and outcomes of acute myocarditis in children admitted to a teaching hospital in the Eastern province of Saudi Arabia. Complete medical records of 80 pediatric patients with acute myocarditis over 5 years (from 2015 to 2019) were retrieved, including demographic characteristics, laboratory investigations including cardiac enzymes (serum lactate, CPR, and troponin), and ECG findings for the diagnosis of myocarditis based on tachycardia and bradycardia. There were 22 (27.5%) mortalities that took place during the hospital stay. Low WBC (mmol/dl) levels were associated with in-hospital mortality (p 0.001), whereas high serum lactate levels (>2 mmol) were not. Association of troponin level (0.15ng/mL) was not significantly associated with mortality (p=0.496). The area under the ROC=0.947 (95% C.I: 0.88-1.0) revealed highly significant predictive validity at the 2.3 best cutoff point, having 90.9% and 87.9% sensitivity and specificity, respectively. Clinical factors and elevated biomarkers were associated with poor prognosis and in-hospital mortality in pediatric myocarditis. Serum lactate and troponin levels demonstrated high predictive validity for early diagnosis.

Myocarditis in Children: Impact of Early Presentation on Disease Outcomes at a Single Tertiary Center in Saudi Arabia.

PurposeMyocarditis is the inflammation of the heart muscle and can be caused by a variety of infections, incendiary diseases, and pollutants. It is challenging for an emergency pediatrician to have a sufficiently high degree of suspicion for myocarditis to avoid diagnostic delay given the broad overlap of myocarditis symptoms with other disease processes. The study aimed to evaluate the impact of early presentation and diagnosis on the outcomes of acute myocarditis in children.Patients and MethodsWe performed a retrospective analysis of the complete records of 80 pediatric patients diagnosed with acute myocarditis between 2015 and 2019 at a single tertiary center in Saudi Arabia. Patients were two weeks to 14 years of age and were admitted to the pediatric intensive care unit (PICU) for various sequelae of myocarditis. Data from routine clinical and laboratory investigations were collected.ResultsThe incidence of delayed presentation at the hospital after the onset of symptoms of myocarditis was 42.5%. A total of 22 (27.5%) patients expired during their hospital stay. There was marginally significant association of earlier presentation with in-hospital survival (80.4% vs 61.8%) and delayed presentation with higher proportion of in-hospital mortality (38.2% vs 19.6%, p=0.064). The rate of mechanical ventilator was also marginally significant in delayed presentation (p=0.068). Shock and multisystem organ failure were the significantly associated manifestations of delayed acute myocarditis presentations. Length of stay in PICU was also significant in delayed presentation group. The impact of presenting symptoms, ECG findings, and use of mechanical ventilator was not significantly associated with delayed presentation.ConclusionAn earlier presentation may have a substantial impact on overall prognosis and length of PICU stay and may lead to comparatively lesser frequency of mechanical ventilation use.

Acute Myocarditis in Children: a 10-year Nationwide Study (2007-2016) based on the Health Insurance Review and Assessment Service Database in Korea.

Background and ObjectivesWe performed a nationwide study to assess the incidence, treatment patterns, and outcomes of acute myocarditis in Korean children.MethodsThe nationwide incidence, treatment patterns, and outcomes of acute myocarditis in Korean children were assessed using data between 2007 and 2016 from the Health Insurance Review and Assessment database.ResultsWe investigated 1,627 children during the study period. The overall incidence of acute myocarditis was 1.4 per 100,000 children in 2007 and 2.1 per 100,000 children in 2016, which indicates a significant increase in the trend over time. A bimodal age distribution was observed with a larger peak in infancy and a smaller peak in the mid-teenage years. No sex difference was observed in the incidence rate of acute myocarditis in children aged ≤5 years (373 boys vs. 366 girls); however, the incidence rate of acute myocarditis in adolescents aged ≥13 years showed significant male preponderance (482 boys vs. 152 girls). Acute fulminant myocarditis occurred in 371 children (22.8%) who needed extracorporeal membrane oxygenation and/or mechanical ventilator support. Of the 371 children with acute fulminant myocarditis, 258 (69.5%) survived. The survival rate of children with acute fulminant myocarditis remained nearly identical over the 10-year study period.ConclusionsThis was the first nationwide epidemiological study to investigate acute myocarditis in Korean children. In our view, this study would help clinicians in decision-making and planning for optimal management of acute myocarditis in children.

341 Favourable Outcome of Acute Myocarditis Diagnosed by Cardiac Magnetic Resonance Imaging

341 Favourable Outcome of Acute Myocarditis Diagnosed by Cardiac Magnetic Resonance Imaging

Trends of Admission and Hospital Outcomes of Acute Myocarditis. Insight from the U.S. Nationwide Inpatient Sample 2010-2014

Trends of Admission and Hospital Outcomes of Acute Myocarditis. Insight from the U.S. Nationwide Inpatient Sample 2010-2014

Clinicodemographic features and outcome of acute myocarditis in children admitted at tertiary care hospital

BackgroundMyocarditis is an inflammatory disorder of myocardium associated with high mortality and morbidity. It is often difficult to diagnose because it can either be asymptomatic or mimic other illnesses. This study is conducted to evaluate clinicodemographic features and outcome of acute myocarditis in children admitted at a tertiary care hospital. MethodsMedical records of all children aged 1month to 16years who were admitted between 2005 and 2013 at Aga Khan University Hospital, Karachi and discharged with a diagnosis of myocarditis were reviewed retrospectively. Clinical and demographic features, management and outcome were recorded. ResultsRecords of a total of 62 patients with the diagnosis of myocarditis were reviewed retrospectively between 2005 and 2013. Median age of patients was 12.5months with 28 (45%) females and 34 (55%) males. The main presenting complaint observed was irritability (73%) and least common symptom was abdominal pain (23%) while the most frequently occurring examination finding was tachycardia (90%). Length of the hospital stay was 8±4.7days with 21 (34%) admissions in the ward and 41 (66%) in intensive care unit. ConclusionThe most frequent presentation in our study was irritability, followed by difficulty in breathing while the least common symptom was abdominal pain. Tachycardia was the commonest clinical sign observed so it is important to look for heart rate and rhythm in a sick child with irritability.

0532: Features and outcomes of acute myocarditis in children

This study was to assess features and outcomes of children with acute myocarditis. Patients <18y with acute myocarditis (proved by virology and/ or MRI and/ or complete recovery of myocardial function) were included. Clinical data, echocardiographic parameters and outcomes were collected and cases divided in groups I (< 2y), II (2 to 10y) and III (>10y). 72 patients were included (1983 to 2012), 30males, aged 4.1±5.1y (med1.5y): 43 in group I, 17 in II and 12 in III. Heart failure was present at onset in 57(78%): 8 cardiogenic shock (12%), 30 severeHF (44%) were more frequent in I (56%) and II (46%) than in III (17%, p< 0.0001), chest pain (15.5%) was more frequent in III (83%). LVSF at diagnosis was 18.4±9%: 16% and 15% in groups I and II vs 30.5% in III (p= 0.0001). Aortic VTI was 11.4±5.8cm: 8cm and 11 in groups I and II vs 17 in group III (p< 0.05). Mitral regurgitation was present in 76.5%, pericarditis in 16.4%, thromboembolic events occurred in 5(7%), arrhythmias in 7(10%). Virus was found in 27=37.5% (1virus in 24, >in 3). Nine patients died (13%) within 2months post-diagnosis (2days to 8.6months), 1 was transplanted (3rdmonth), 19 have sequellae (27.5%), 40 recovered (58%), at FU= 5.5±5.6y. Inotrope was needed in 34(47%):51%, 59% and 16% of groups I, II and III respectively (p<0.0001). Six (8.3%, 1 in groupIII) needed mechanical circulatory support (3ECMO, 3VAD), within day-14 from onset: 1 died on support, 5 were weaned-off (duration of support: 4d to 3mos). Survival was 96%, 90%, 87.5% and 86% at 1, 3 and 6months, 2y and 10y of FU. All patients in III survived. Ten-yr survival was 81.4% in I, 88.2% in II (p= NS). LVSF improved from 18.4±8.9% at onset, to 24.6±10.3% at 1stmth, 26.5±8.6% at 3rdmth, 30.7±8.6% at 6thmth, 38±7% at last FU. Abstract 0254 - Figure: Increase in HMDP heart retention after 16months. Acute myocarditis in children has favourable outcomes despite early mortality. Myocardial dysfunction and heart failure are less frequent in patients > 10years. Mechanical circulatory support lessens mortality. Myocardial contractility progressively improves within the first 6months after onset.

Immunosuppressive therapy in acute myocarditis: an 18 year systematic review

Background: Immunosuppressive therapy is reportedly ineffective in adults with acute myocarditis. Aims: To systematically review the impact of immunosuppressive therapy on the outcome of acute myocarditis in children. Methods: A...