(321) Endomyocardial Biopsy in Myocarditis Identifies Factors That Predict Outcome in Children
Pediatric myocarditis is a rare and challenging disease characterised by a broad spectrum of clinical presentations. The aim of this study is to identify prognostic factors for death and/or cardiac transplantation or myocardial recovery in children with biopsy proven myocarditis and referred to Bamb...
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| Published in: | The Journal of heart and lung transplantation Vol. 42; no. 4; p. S152 |
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| Main Authors: | , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Elsevier Inc
01-04-2023
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| Online Access: | Get full text |
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| Summary: | Pediatric myocarditis is a rare and challenging disease characterised by a broad spectrum of clinical presentations. The aim of this study is to identify prognostic factors for death and/or cardiac transplantation or myocardial recovery in children with biopsy proven myocarditis and referred to Bambino Gesù Children's Hospital from 1988 to 2022.
This is a single-center retrospective study. Inclusion criteria included age <18 years and a diagnosis of biopsy proven myocarditis.
113 patients (mean age 5 ± 5.2 years; M 49) underwent endomyocardial biopsy (EMB), 38% showed a viral myocarditis. The most frequently detected was Parvovirus B19 (24%). Medication used included heart failure therapy (32%), inotropes (78%), immunosuppressive therapy (69%), antiviral therapy (6%) and, finally, mechanical circulatory support (9%) for pts with cardiogenic shock. 13% died or required cardiac transplantation. Multivariate analysis showed negative prognostic factors were: age <1 years (p=0.024) and LVEF <40% at onset (p=0.011) and the presence of virus at EMB (p=0.037). In addition, the presence of fibrosis already at first EMB (p=0.023) as well as the viral co-infection (defined as the presence of ≥2 virus) were significantly related to clinical outcome (p=0.013). In contrast, the absence of virus at EMB was significantly related with ventricular recovery (p=0.019).
This study identified endomyocardial biopsy parameters which help to predict outcome. The presence and number of viruses, and fibrosis at EMB in the acute phase of the disease are negative prognostic factors in children |
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| ISSN: | 1053-2498 1557-3117 |
| DOI: | 10.1016/j.healun.2023.02.1625 |