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Prognostic utility of echocardiographically derived left ventricular strain in assessing neonatal enteroviral myocarditis outcome

Published online by Cambridge University Press:  18 May 2022

Hugh F. Bigg Open the ORCID record for Hugh F. Bigg [Opens in a new window] ,
Steven J. Kindel ,
Evelyn Kuhn  and
Peter C. Frommelt
Hugh F. Bigg*
Affiliation:
Division of Cardiology, Department of Pediatrics, Herma Heart Institute, Children’s Hospital of Wisconsin, Milwaukee, WI, USA
Steven J. Kindel
Affiliation:
Division of Cardiology, Department of Pediatrics, Herma Heart Institute, Children’s Hospital of Wisconsin, Milwaukee, WI, USA
Evelyn Kuhn
Affiliation:
Business Intelligence and Warehousing, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
Peter C. Frommelt
Affiliation:
Division of Cardiology, Department of Pediatrics, Herma Heart Institute, Children’s Hospital of Wisconsin, Milwaukee, WI, USA
*
Author for correspondence: H. F. Bigg, DO, Children’s Hospital of Wisconsin, 9000 W Wisconsin Ave MS 713, Milwaukee, WI 53226, USA. Tel: 414 266 5789; Fax: 414 266 2294. E-mail: hbigg@chw.org
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Abstract

Background:

Neonatal enteroviral myocarditis is a rare but potentially fatal illness. We sought to identify echocardiographic markers at diagnosis that could help risk-stratify infants for poor outcome and to characterise late sequelae.

Methods:

We reviewed data for infants <30 days of age diagnosed with enteroviral myocarditis between 1999 and 2019 at Children’s Wisconsin. Echo measures were collected retrospectively from the initial neonatal study including left ventricular ejection fraction, shortening fraction, diastolic and systolic dimensions, and peak global circumferential and longitudinal strain.

Results:

Fourteen neonates were diagnosed at an average age of 11 days. All had abnormal left ventricular ejection fraction (mean 38%; range 22–53%) at diagnosis. Three infants died, and one required transplantation during initial hospital. The 10 transplant-free survivors had significantly better global circumferential strain and global longitudinal strain at the initial echo compared to the 4 who died or needed transplant (global circumferential strain −13.2% versus −6.8%, p = 0.005; global longitudinal strain −8.8% versus −4.7%, p = 0.016). All other measures of left ventricular systolic function/dimensions were similar between the two groups. Follow-up data were available for 8/10 survivors; 5/8 had a persistently abnormal echo at an average interval of 8.3 years. 4/8 developed a left ventricular aneurysm that was consistently localised to the posterior basal wall.

Conclusions:

Neonatal enteroviral myocarditis carries a high risk of early mortality and late morbidity. Echo-derived left ventricular strain measures have utility in risk stratifying infants with enteroviral myocarditis. Most survivors continue to have late dysfunction necessitating cardiology surveillance and medical therapy.

Keywords

Myocarditisenterovirusleft ventricular aneurysmechocardiographymyocardial strain
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 5 , May 2023 , pp. 704 - 709
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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