Pediatric Heart Disease

1349343 - Children With Recurrent Myocarditis Have Lower Left Ventricular Function And Strain And Higher End Diastolic Volumes By CMR On Initial Presentation

Wednesday, January 25, 2023

Location: E-POSTER

Presenting Author(s)

DV

Danish Vaiyani, MD

Assistant Professor of Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States

Primary Author(s)

DV

Danish Vaiyani, MD

Assistant Professor of Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States

Co-Author(s)

KW

Kevin K. Whitehead, MD, PhD

Associate Professor of Pediatrics
The Children's Hospital of Philadelphia, Pennsylvania, United States
David M. Biko, MD

Assistant Professor
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
MH

Matthew A. Harris, MD

Associate Professor of Pediatrics
Children's Hospital of Philadelphia
Merion Station, Pennsylvania, United States
SP

Sara L. Partington, MD

Assistant Professor of Clinical Medicine
University of Pennsylvania, Pennsylvania, United States
KR

Kathryn Restaino, MD

Heart Failure and CICU Advanced Fellow
Children's Hospital of Philadelphia, Pennsylvania, United States
KL

Kimberly Y. Lin, MD

Associate Professor
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
MF

Mark A. Fogel, MD

Professor of Pediatrics and Radiology
The Children's Hospital of Philadelphia
PHILADELPHIA , Pennsylvania, United States

Disclosure(s):

David M. Biko, MD: No financial relationships to disclose

Background: Children and adults can sufer recurrence of myocarditis months to years after their initial presentation; however predictors ofrecurrence in the pediatric population have not been described to date. We sought to describe cardiac magnetic resonance (CMR) imagingfindings and predictors of recurrence in a pediatric cohort.

Methods: A retrospective chart review of patients < 21 years, clinically diagnosed with acute myocarditis and underwent CMR within 14 dayswas performed. Those who sufered cardiac arrest or with autoimmune disease, known cardiomyopathy or congenital heart disease wereexcluded. Demographic, clinical and CMR data were collected. Logistic regression was used to compare those who fully recovered to thosewith recurrence. Strain was measured using CMR feature tracking.

Results: Of 85 patients who met inclusion, median age 16.3 years (IQR 14.3 - 17.5), 71 fully recovered, 6 had recurrence, 5 were lost to followup and 3 progressed to chronic dilated cardiomyopathy. Median time to recurrence was 534 days (IQR 142-855) and time to CMR followingpresentation was 2 days (IQR 2 - 4). Compared to those who recovered, patients with recurrence had worse left ventricular (LV) ejectionfraction (EF) (56% [46 - 65] versus 65% [60 - 70], p = 0.033), increased indexed LV end diastolic volumes (EDVi) (87.5 cc/m2 (79 - 100)versus 81.0 [71.8 - 88.5], p = 0.045), and worse global circumferential strain (-15.0% [-20.5, -10.4] versus -18.0% [-20.4, -15.6], p = 0.038)at the time of presentation. Other CMR markers were not found to be significantly diferent between groups. (Table 1)

Conclusion: Myocarditis may recur in a small proportion of children. Initial LV ejection fraction and indexed LV end diastolic volume aresignificantly lower and higher, respectively, in children with recurrence. Strain is also lower in those who go on to recur; further work isneeded to determine which are the most useful predictors of recurrence in children