Age-associated clinical patterns in paediatric myocarditis: left ventricular function as the key early risk stratifier
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND AIMS: In myocarditis, early identification of high-risk patients is essential, robust prognostic markers are lacking. We aimed to identify early clinical risk stratifier at index hospitalization for major adverse cardiovascular events (MACE). METHODS: We analysed 725 paediatric patients with possible/definite myocarditis enrolled in the prospective multicentre MYKKE registry (2013-2024). MACE included mechanical circulatory support (MCS), heart transplantation, or death during initial admission. Model-based recursive partitioning (MOB) and bootstrap-based logistic regression with multiple imputation were applied for risk stratifier selection out of 20 baseline variables. The model was externally validated in the Swedish SWEDCON- cohort (n = 243). Discrimination was assessed by the area under the curve (AUC). RESULTS: Among 725 patients (median age 14.3 years [IQR 4.0-16.4]; 33% female), 88 (12.2%) experienced MACE (MCS 10.9%, transplantation 4.3%, death 2.2%). MOB identified left ventricular ejection fraction (LVEF) ≤ 39% as the only stable risk stratifier, delineating a "heart failure type" in younger children (1.9 years; LVEF 24%), and a "chest pain type" in adolescents with preserved LVEF (15.6 years; LVEF 59%). LVEF was confirmed as the sole robust risk stratifier (OR per 1% increase: 0.90 ; 95% CI 0.881-0.917; p < 0.01; AUC 0.90, 95% CI 0.896-0.903). In SWEDCON (7.4% MACE), discrimination was maintained (AUC 0.894, 95% CI 0.80-0.991). CONCLUSION: Reduced LVEF at presentation was the only reproducible and externally validated risk stratifier of MACE during index hospitalization. Two age-associated clinical patterns were observed: a high-risk "heart failure type" in younger children and low-risk "chest pain type" in adolescents.
Source: ESC Heart Failure
Authors: Franziska Seidel, Cynthia Huber, Bernd Opgen-Rhein, Martin Boehne, Johannes Weickmann, Tobias Hecht, Felix Anderheiden, Katja Reineker, Axel Rentzsch, Gesa Wiegand, Dorothée Böcker, Daniela Kiski, Marcus Fischer, Wiebke Frede, Bettina Ruf, Konstantin Papakostas, Gleb Tarusinov, Inga Voges, Michael Kaestner, Kerstin Gummel, Assunta Schiebel, Jennifer Kramp, Ulrike Herberg, Gunter Kerst, Bardo Wannenmacher, Eva Gatzweiler, Walter Knirsch, Nele Rolfs, Eicke Schwanzkopf, Tania Garfias-Veitl, Thomas Pickardt, André Rudolph, Jens Böhmer, Tim Friede, Stephan Schubert, Daniel Messroghli
Institutions: Max Delbrück Center, Humboldt-Universität zu Berlin, Deutsches Herzzentrum der Charité, German Centre for Cardiovascular Research, Charité - Universitätsmedizin Berlin, University of Göttingen, Medizinische Hochschule Hannover, Leipzig Heart Institute, Heart and Diabetes Center North Rhine-Westphalia, Universitätsklinikum Erlangen, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Saarland University, University Children's Hospital Tübingen, University of Tübingen, Universität Hamburg, University Medical Center Hamburg-Eppendorf, University Hospital Münster, LMU Klinikum, München Klinik, Ludwig-Maximilians-Universität München, Heidelberg University, University Hospital Heidelberg, Deutsches Herzzentrum München, Klinikum Bremen-Mitte, BG Klinikum Duisburg, University Hospital Schleswig-Holstein, University of Lübeck, University Hospital Ulm, Universitätsklinikum Gießen und Marburg, Giessen School of Theology, Universitätsmedizin Göttingen, University Hospital Cologne, RWTH Aachen University, Klinikum Stuttgart, University Hospital in Halle, University Hospital Bonn, University Children's Hospital Zurich, Karolinska University Hospital, Karolinska Institutet, Sahlgrenska University Hospital, Klinikum Frankfurt Höchst, University of Gothenburg, Medizinische Universität Lausitz - Carl Thiem
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,850
OpenAlex ID: W7222170377
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