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Left ventricular end-diastolic dimension as a predictive factor of outcomes in children with acute myocarditis

Published online by Cambridge University Press:  26 May 2016

Geena Kim Open the ORCID record for Geena Kim [Opens in a new window] ,
Gil-Ho Ban ,
Hyoung-Doo Lee ,
Si-Chan Sung ,
Hyungtae Kim  and
Kwang-Ho Choi
Geena Kim
Affiliation:
Heart Center, Pusan National University Children’s Hospital, Yangsan, Republic of Korea
Gil-Ho Ban
Affiliation:
Heart Center, Pusan National University Children’s Hospital, Yangsan, Republic of Korea
Hyoung-Doo Lee*
Affiliation:
Heart Center, Pusan National University Children’s Hospital, Yangsan, Republic of Korea
Si-Chan Sung
Affiliation:
Heart Center, Pusan National University Children’s Hospital, Yangsan, Republic of Korea
Hyungtae Kim
Affiliation:
Heart Center, Pusan National University Children’s Hospital, Yangsan, Republic of Korea
Kwang-Ho Choi
Affiliation:
Heart Center, Pusan National University Children’s Hospital, Yangsan, Republic of Korea
*
Correspondence to: H. D. Lee, MD, PhD, Department of Pediatrics, Pusan National University Children’s Hospital, Beomeu-li, Mulgum-eup, Yangsan, Keungsangnam-do 626-770, Republic of Korea. Tel: +82 55 360 3600; Fax: +82 55 360 2181; E-mail: hdlee@pusan.ac.kr
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Abstract

In this study, we sought predictors of mortality in children with acute myocarditis and of incomplete recovery in the survivor group. We classified our patients into three groups according to their outcomes at last follow-up: full recovery was classified as group I, incomplete recovery was classified as group II, and death was classified as group III. In total, 55 patients were enrolled in the study: 33 patients in group I, 11 patients in group II, and 11 patients in group III. The initial left ventricular fractional shortening – left ventricular fractional shortening – was significantly lower in group III (p=0.001), and the left ventricular end-diastolic dimension z score was higher in groups II and III compared with group I (p=0.000). A multivariate analysis showed that the left ventricular end-diastolic dimension z score (odds ratio (OR), 1.251; 95% confidence interval (CI), 1.004–1.559), extracorporeal membrane oxygenation (OR, 9.842; 95% CI, 1.044–92.764), and epinephrine infusion (OR, 18.552; 95% CI, 1.759–195.705) were significant predictors of mortality. The left ventricular end-diastolic dimension z score was the only factor that predicted incomplete recovery in the survivor group (OR, 1.360; 95% CI, 1.066–1.734; p=0.013). The receiver operating characteristic curve of the left ventricular end-diastolic dimension z score at admission showed a cut-off level of 3.01 for predicting mortality (95% CI, 0.714–0.948). In conclusion, a high left ventricular end-diastolic dimension z score on admission was a significant predictor of worse outcomes, both regarding mortality and incomplete recovery.

Keywords

Myocarditischildoutcomepredictor
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 3 , March 2017 , pp. 443 - 451
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Copyright
© Cambridge University Press 2016 

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References

1. Cooper, LT Jr. Myocarditis. N Engl J Med 2009; 360: 1526–1538.Google Scholar
2. Abe, T, Tsuda, E, Miyazaki, A, et al. Clinical characteristics and long-term outcome of acute myocarditis in children. Heart Vessels 2013; 28: 632–638.Google Scholar
3. Ghelani, SJ, Spaeder, MC, Pastor, W, et al. Demographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006 to 2011. Circ Cardiovasc Qual Outcomes 2012; 5: 622–627.Google Scholar
4. Kuhn, B, Shapiro, ED, Walls, TA, et al. Predictors of outcome of myocarditis. Pediatr Cardiol 2004; 25: 379–384.Google Scholar
5. Lee, KJ, McCrindle, BW, Bohn, DJ, et al. Clinical outcomes of acute myocarditis in childhood. Heart 1999; 82: 226–233.Google Scholar
6. Anderson, BR, Silver, ES, Richmond, ME, et al. Usefulness of arrhythmias as predictors of death and resource utilization in children with myocarditis. Am J Cardiol 2014; 114: 1400–1405.CrossRefGoogle ScholarPubMed
7. McCarthy, RE 3rd, Boehmer, JP, Hruban, RH, et al. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med 2000; 342: 690–695.CrossRefGoogle ScholarPubMed
8. Hare, JM, Baughman, KL. Fulminant and acute lymphocytic myocarditis: the prognostic value of clinicopathological classification. Eur Heart J 2001; 22: 269–270.Google Scholar
9. Lee, CH, Tsai, WC, Hsu, CH, et al. Predictive factors of a fulminant course in acute myocarditis. Int J Cardiol 2006; 109: 142–145.Google Scholar
10. Sankar, J, Khalil, S, Jeeva Sankar, M, et al. Short-term outcomes of acute fulminant myocarditis in children. Pediatr Cardiol 2011; 32: 885–890.Google Scholar
11. Teele, SA, Allan, CK, Laussen, PC, et al. Management and outcomes in pediatric patients presenting with acute fulminant myocarditis. J Pediatr 2011; 158: 638–643.e631.CrossRefGoogle ScholarPubMed
12. Lee, EY, Lee, HL, Kim, HT, et al. Clinical features and short-term outcomes of pediatric acute fulminant myocarditis in a single center. Korean J Pediatr 2014; 57: 489–495.Google Scholar
13. Kampmann, C, Wiethoff, CM, Wenzel, A, et al. Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe. Heart 2000; 83: 667–672.Google Scholar
14. English, RF, Janosky, JE, Ettedgui, JA, et al. Outcomes for children with acute myocarditis. Cardiol Young 2004; 14: 488–493.CrossRefGoogle ScholarPubMed
15. Miyake, CY, Teele, SA, Chen, L, et al. In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. Am J Cardiol 2014; 113: 535–540.Google Scholar
16. Anderson, BR, Silver, ES, Richmond, ME, et al. Usefulness of arrhythmias as predictors of death and resource utilization in children with myocarditis. Am J Cardiol 2014; 114: 1400–1405.CrossRefGoogle ScholarPubMed
17. Kindermann, I, Kindermann, M, Kandolf, R, et al. Predictors of outcome in patients with suspected myocarditis. Circulation 2008; 118: 639–648.Google Scholar
18. Felker, GM, Boehmer, JP, Hruban, RH, et al. Echocardiographic findings in fulminant and acute myocarditis. J Am Coll Cardiol 2000; 36: 227–232.Google Scholar
19. Wilmot, I, Morales, DL, Price, JF, et al. Effectiveness of mechanical circulatory support in children with acute fulminant and persistent myocarditis. J Card Fail 2011; 17: 487–494.Google Scholar
20. Duncan, BW, Bohn, DJ, Atz, AM, et al. Mechanical circulatory support for the treatment of children with acute fulminant myocarditis. J Thorac Cardiovasc Surg 2001; 122: 440–448.Google Scholar
21. Everitt, MD, Sleeper, LA, Lu, M, et al. Recovery of echocardiographic function in children with idiopathic dilated cardiomyopathy: results from the pediatric cardiomyopathy registry. J Am Coll Cardiol 2014; 63: 1405–1413.Google Scholar
22. Baughman, KL. Diagnosis of myocarditis: death of Dallas criteria. Circulation 2006; 113: 593–595.Google Scholar