Myocardial Diseases in Thai Children
JARUPIM SOONGSWANG, M.D.*, CHAISIT SANGTA WESIN, M.D.**,
REKWAN SITTIWANGKUL, M.D.***, SUTHEP WANITKUN, M.D.****,
SUNTHORN MUANGMINGSUK, M.D.*****, SOMKIAT SOPONTAMMARAK, M.D.******,
CHAMAPORN KLUNGRATANA, M.D.*, CHARUW AN KANGKAGATE, B.Sc., M.Sc. *******
Affiliation : * Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700,
** Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok 10400,
*** Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50202,
**** Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400,
***** Department of Pediatrics, Faculty of Medicine, Chulalongkom University, Bangkok 10330,
****** Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110,
******* Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
AbstractMyocardial diseases are among the important causes of mortality and morbidity in children.
This drew the authors attention to the study of myocardial diseases in children to find out the out
come, factors affecting the outcome, and management strategies. The authors retrospectively studied
children who had been diagnosed with primary myocardial diseases at six university hospitals in
Thailand from January 1996 to December 2000. The total number of cases was 209 which accounted
for 1.2 per cent of cardiovascular diseases in children. The patients' ages ranged from 0.1-15 years.
These myocardial diseases included dilated cardiomyopathy (DCM) 45 per cent, acute myocarditis
27.3 per cent, hypertrophic cardiomyopathy (HCM) 18.2 per cent, hypertrophic obstructive cardio
myopathy (HOCM) 8.1 per cent and restrictive cardiomyopathy (RCM) 1.4 per cent. Fifty-six per
cent of the patients were female. Congestive heart failure was the most common presenting symp
tom (75%). Median ejection fraction (EF) of acute myocarditis was 42 per cent (15-79%) which
was significantly higher than DCM (33.5%, 10-57%). Serum cardiac troponin T (cTnT) was also
significantly higher in acute myocarditis than in DCM (0.08 ng/ml, 0.01-0.16 vs 0.01 ng/ml, 0.01-
0.10). Within the follow-up period of 1 year (O.l-5.5years), the mortality rates were 18.8 per cent,
17.0 per cent, 5.4 per cent and 33.3 per cent in DCM, acute myocarditis, HCM and RCM respec
tively. Factors associated with the mortality rate in acute myocarditis were admission to ICU and
low left ventricular EF at presentation while IVIG administration and cTnT level did not.
Conclusion : Primary myocardial diseases are uncommon. Most of the patients had com
promised cardiovascular reserve. Admission to ICU and low EF were factors that affected the
mortality in acute myocarditis while intravenous immunoglobulin administration did not. Mortality
rate in the subacute follow-up period was high in all groups.
Keywords : Cardiomyopathy, Myocarditis, Myocardial Diseases
All Articles
Download
