Does Cardiac Remodeling in Pediatric Myocarditis
Associated with Initial Cardiac Function?
Poomiporn Katanyuwong, MD¹ , ², Siwat Srimuang, MD¹, Sakda Arj-Ong Vallibhakara, MD, PhD³ , ⁴
Affiliation : ¹ Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ² Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ³ Research & Innovation and Academic Affairs, ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand ⁴ Child Safety Promotion and Injury Prevention Research Center (CSIP), Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background: In pediatric myocarditis, the relationship between cardiac remodeling with initial cardiac function remains
uncertain. The authors hypothesized that cardiac remodeling in viral myocarditis is not associated with initial cardiac function.
Objective: The primary objective is to determine an association between cardiac remodeling with initial cardiac function, and the secondary aim is to study the factors that influence cardiac remodeling.
Materials and Methods: A retrospective cohort study of children under 15 years old, clinically diagnosed as presumed acute viral myocarditis and treated at Ramathibodi Hospital between January 2002 and June 2017.
Results: Twenty-three patients were enrolled. Patients had a median age of two years (25 days-14.5 years), and 15 (65%) patients were female. The most common presenting symptoms were respiratory, cardiac, and gastrointestinal symptoms, respectively. The various supportive treatments included Dobutamine (80%), intravenous immunoglobulin (86%), and mechanical ventilator usage (80%). Fifteen patients (65%) survived at discharge, six (25%) expired, and two (9%) were referred to another institution for cardiac transplantation. Nineteen patients (83%) had an initial left ventricular ejection fraction (LVEF) of less than 55%. In this group, eight (40%) patients had completed cardiac remodeling during the follow-up period. The authors found that those with initial mild-to-moderate systolic dysfunction had a better chance for complete remodeling as compared with those who had an initial severe systolic dysfunction. Factor associated with incomplete cardiac remodeling was dopamine usage (OR 0.06, 95% CI 0.0049 to 0.7345, p=0.028).
Conclusion: Initial cardiac function is important and associated with complete cardiac remodeling. Those with initial mild-to- moderate systolic dysfunction have better remodeling and recovery than the one with initial severe systolic dysfunction.
Received 25 August 2020 | Revised 15 September 2020 | Accepted 30 September 2020
doi.org/10.35755/jmedassocthai.2020.10.12128
Keywords : Myocarditis, Pediatric, Cardiac function, Cardiac remodeling
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