Characteristics of Clinically Diagnosed Pediatric Myocarditis in a Contemporary Multi-Center Cohort

Ryan J. Butts*, Gerard J. Boyle, Shriprasad R. Deshpande, Katheryn Gambetta, Kenneth R. Knecht, Carolina A. Prada-Ruiz, Marc E. Richmond, Shawn C. West, Ashwin K. Lal

*Corresponding author for this work

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

The objective of this study was to describe a contemporary cohort of pediatric patients hospitalized for clinically suspected myocarditis. A retrospective chart review was performed at seven tertiary pediatric hospitals. Electronic medical records were searched between 2008 and 2012 for patients ≤18 years admitted with an ICD-9 code consistent with myocarditis. Patients were excluded if the admitting or consulting cardiologist did not suspect myocarditis during the admission or an alternative diagnosis was determined. One hundred seventy-one patients were discharged or died with a primary diagnosis of myocarditis. Median age was 13.1 years (IQR 2.1, 15.9), with a bimodal distribution; 24% <2 years and 46% between 13 and 18 years. Patients with moderate or severe systolic dysfunction were younger, had higher BNPs at admission, but had lower troponin. Mortality, heart transplantation, and readmission did not differ between patients who received only IVIG, only steroids, IVIG and steroids, and no immunotherapy. Ninety-four patients (55%) were discharged on heart failure medications, 16 were transplanted, and seven died. The presence at the time of admission of gastrointestinal (GI) symptoms (p = 0.01) and lower echo shortening fraction (SF) (p < 0.01) was associated with death/transplant. Within one year 16% had a readmission, one underwent heart transplant, and 39% received heart failure therapy. Pediatric myocarditis has a bimodal age distribution. The use of IVIG and steroids is not associated with mortality/heart transplantation. The presence of GI symptoms and lower echo SF may identify patients at risk for death and/or transplantation during the admission.

Original languageEnglish (US)
Pages (from-to)1175-1182
Number of pages8
JournalPediatric cardiology
Volume38
Issue number6
DOIs
StatePublished - Aug 1 2017

Fingerprint

Myocarditis
Pediatrics
Intravenous Immunoglobulins
Steroids
International Classification of Diseases
Heart Transplantation
Heart Failure
Transplants
Pediatric Hospitals
Troponin
Mortality
Electronic Health Records
Age Distribution
Tertiary Care Centers
Immunotherapy
Transplantation

Keywords

  • Myocarditis
  • Outcomes
  • Pediatrics

ASJC Scopus subject areas

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

Cite this

Butts, R. J., Boyle, G. J., Deshpande, S. R., Gambetta, K., Knecht, K. R., Prada-Ruiz, C. A., ... Lal, A. K. (2017). Characteristics of Clinically Diagnosed Pediatric Myocarditis in a Contemporary Multi-Center Cohort. Pediatric cardiology, 38(6), 1175-1182. https://doi.org/10.1007/s00246-017-1638-1
Butts, Ryan J. ; Boyle, Gerard J. ; Deshpande, Shriprasad R. ; Gambetta, Katheryn ; Knecht, Kenneth R. ; Prada-Ruiz, Carolina A. ; Richmond, Marc E. ; West, Shawn C. ; Lal, Ashwin K. / Characteristics of Clinically Diagnosed Pediatric Myocarditis in a Contemporary Multi-Center Cohort. In: Pediatric cardiology. 2017 ; Vol. 38, No. 6. pp. 1175-1182.
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Butts, RJ, Boyle, GJ, Deshpande, SR, Gambetta, K, Knecht, KR, Prada-Ruiz, CA, Richmond, ME, West, SC & Lal, AK 2017, 'Characteristics of Clinically Diagnosed Pediatric Myocarditis in a Contemporary Multi-Center Cohort', Pediatric cardiology, vol. 38, no. 6, pp. 1175-1182. https://doi.org/10.1007/s00246-017-1638-1

Characteristics of Clinically Diagnosed Pediatric Myocarditis in a Contemporary Multi-Center Cohort. / Butts, Ryan J.; Boyle, Gerard J.; Deshpande, Shriprasad R.; Gambetta, Katheryn; Knecht, Kenneth R.; Prada-Ruiz, Carolina A.; Richmond, Marc E.; West, Shawn C.; Lal, Ashwin K.

In: Pediatric cardiology, Vol. 38, No. 6, 01.08.2017, p. 1175-1182.

Research output: Contribution to journalArticle

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T1 - Characteristics of Clinically Diagnosed Pediatric Myocarditis in a Contemporary Multi-Center Cohort

AU - Butts, Ryan J.

AU - Boyle, Gerard J.

AU - Deshpande, Shriprasad R.

AU - Gambetta, Katheryn

AU - Knecht, Kenneth R.

AU - Prada-Ruiz, Carolina A.

AU - Richmond, Marc E.

AU - West, Shawn C.

AU - Lal, Ashwin K.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - The objective of this study was to describe a contemporary cohort of pediatric patients hospitalized for clinically suspected myocarditis. A retrospective chart review was performed at seven tertiary pediatric hospitals. Electronic medical records were searched between 2008 and 2012 for patients ≤18 years admitted with an ICD-9 code consistent with myocarditis. Patients were excluded if the admitting or consulting cardiologist did not suspect myocarditis during the admission or an alternative diagnosis was determined. One hundred seventy-one patients were discharged or died with a primary diagnosis of myocarditis. Median age was 13.1 years (IQR 2.1, 15.9), with a bimodal distribution; 24% <2 years and 46% between 13 and 18 years. Patients with moderate or severe systolic dysfunction were younger, had higher BNPs at admission, but had lower troponin. Mortality, heart transplantation, and readmission did not differ between patients who received only IVIG, only steroids, IVIG and steroids, and no immunotherapy. Ninety-four patients (55%) were discharged on heart failure medications, 16 were transplanted, and seven died. The presence at the time of admission of gastrointestinal (GI) symptoms (p = 0.01) and lower echo shortening fraction (SF) (p < 0.01) was associated with death/transplant. Within one year 16% had a readmission, one underwent heart transplant, and 39% received heart failure therapy. Pediatric myocarditis has a bimodal age distribution. The use of IVIG and steroids is not associated with mortality/heart transplantation. The presence of GI symptoms and lower echo SF may identify patients at risk for death and/or transplantation during the admission.

AB - The objective of this study was to describe a contemporary cohort of pediatric patients hospitalized for clinically suspected myocarditis. A retrospective chart review was performed at seven tertiary pediatric hospitals. Electronic medical records were searched between 2008 and 2012 for patients ≤18 years admitted with an ICD-9 code consistent with myocarditis. Patients were excluded if the admitting or consulting cardiologist did not suspect myocarditis during the admission or an alternative diagnosis was determined. One hundred seventy-one patients were discharged or died with a primary diagnosis of myocarditis. Median age was 13.1 years (IQR 2.1, 15.9), with a bimodal distribution; 24% <2 years and 46% between 13 and 18 years. Patients with moderate or severe systolic dysfunction were younger, had higher BNPs at admission, but had lower troponin. Mortality, heart transplantation, and readmission did not differ between patients who received only IVIG, only steroids, IVIG and steroids, and no immunotherapy. Ninety-four patients (55%) were discharged on heart failure medications, 16 were transplanted, and seven died. The presence at the time of admission of gastrointestinal (GI) symptoms (p = 0.01) and lower echo shortening fraction (SF) (p < 0.01) was associated with death/transplant. Within one year 16% had a readmission, one underwent heart transplant, and 39% received heart failure therapy. Pediatric myocarditis has a bimodal age distribution. The use of IVIG and steroids is not associated with mortality/heart transplantation. The presence of GI symptoms and lower echo SF may identify patients at risk for death and/or transplantation during the admission.

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KW - Outcomes

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