Abstract：Objective To investigate the clinical features and prognostic factors in children with fulminant myocarditis. Methods The clinical data of 24 children with fulminant myocarditis were retrospectively analyzed. According to the prognosis, these children were classified into two groups: survival (n=12) and death (n=12). The risk factors influencing prognosis in children with fulminant myocarditis were identified by logistic regression analysis. Results Among the 24 cases of fulminant myocarditis, gastrointestinal symptoms were found as initial symptoms in 14 cases, neurological symptoms in 12 cases, respiratory symptoms in 1 case, and cardiac symptoms in 2 cases. On admission, serum levels of creatine kinase MB, troponin I, and brain natriuretic peptide (BNP) were all increased. Besides, left ventricular ejection fraction (LVEF) decreased in 22 cases (92%), cardiothoracic ratio increased in 10 cases, third-degree atrioventricular block was observed in 8 cases, ST-segment changes were found in 11 cases and ventricular tachycardia was identified in 2 cases. LVEF in the death group was lower than in the survival group (PPOR=7.418; PConclusions Fulminant myocarditis has no specific clinical features in children. A decreased LVEF is a risk factor for poor prognosis in children with fulminant myocarditis.
PEI Liang,YANG Ni,YANG Yu-Hang et al. Clinical features and prognostic factors in children with fulminant myocarditis[J]. CJCP, 2015, 17(11): 1232-1236.
Lee EY, Lee HL, Kim HT, et al. Clinical features and short-term outcomes of pediatric acute fulminant myocarditis in a single center[J]. Korean J Pediatr, 2014, 57(11): 489-495.
[3]
Nakamura T, Ishiha K, Taniguchi Y, et al. Prognosis of patients with fulminant myocarditis managed by peripheral venoarterial extracorporeal membranous oxygenation support: a retrospective single-center study[J]. J Intensive Care, 2015, 3(1): 5.
[4]
Lieberman EB, Hutchins GM, Herskowitz A, et al. Clinicopathologic description of myocarditis[J]. J Am Coll Cardiol, 1991, 18(7): 1617-1626.
[5]
Chang YJ, Chao HC, Hsia SH, et al. Myocarditis presenting as gastritis in children[J]. Pediatr Emerg Care, 2006, 22(6): 439-440.
[6]
Freedman SB, Haladyn JK, Floh A, et al. Pediatric myocarditis: emergency department clinical findings and diagnostic evaluation[J]. Pediatrics, 2007, 120 (6): 1278 -1285.
[7]
Rady HI, Zekri H. Prevalence of myocarditis in pediatric intensive care unit cases presenting with other system involvement[J]. J Pediatr (Rio J), 2015, 91(1): 93-97.
[8]
Amabile N, Fraisse A, Bouvenot J, et al. Outcome of acute fulminant myocarditis in children[J]. Heart, 2006, 92(9): 1269-1273.
[9]
Sankar J, Khalil S, Jeeva Sankar M, et al. Short-term outcomes of acute fulminant myocarditis in children[J]. Pediatr Cardiol, 2011, 32(7): 885-890.
Kato S, Morimoto SI, Hiramitsu S, et al. Risk factors for patients developing a fulminant course with acute myocarditis[J]. Circ J, 2004, 68(8): 734-739.
[12]
Ghelani SJ, Spaeder MC, Pastor W, et al. Demographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006 to 2011[J]. Circ Cardiovasc Qual Outcomes, 2012, 5(5): 622-627.
[13]
郭琳瑛. 儿童暴发性心肌炎[J]. 中国小儿急救医学, 2012, 19(3): 324-326.
[14]
Chen YS, Yu HY, Huang SC, et al. Experience and result of extracorporeal membrane oxygenation in treating fulminant myocarditis with shock: what mechanical support should be considered first?[J]. J Heart Lung Transplant, 2005, 24(1): 81-87.
Sachdeva S, Sonq X, Dham N, et al. Analysis of clinical parameters and cardiac magnetic resonance imaging as predictors of outcome in pediatricmyocarditis[J]. Am J Cardiol, 2015, 115(4): 499-504.
[17]
Kühl U, Schultheiss HP. Myocarditis in children[J]. Heart Fail Clin, 2010, 6(4): 483-496.
Cooper LT. Myocarditis[J]. N Engl J Med, 2009, 360(15): 1526-1538.
[20]
Al-Biltagi M, Issa M, Hagar HA, et al. Circulating cardiac troponins levels and cardiac dysfunction in children with acute and fulminant viral myocarditis[J]. Acta Paediatr, 2010, 99(10): 1510-1516.
