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

Spencer B. Barfuss, Ryan Butts, Kenneth R. Knecht, Adriana Prada-Ruiz, Ashwin K. Lal

Research output: Contribution to journalArticle

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1171-1174
Number of pages4
JournalPediatric Cardiology
Volume40
Issue number6
DOIs
StatePublished - Aug 15 2019

Keywords

  • Echocardiography
  • Inflammatory heart disease
  • Myocarditis
  • Myopericarditis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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