Luo Liu, Huang Yanyun, Qiao Xiaoyu, Pang Yusheng
Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Front Pediatr. 2025 Jul 3;13:1616751. doi: 10.3389/fped.2025.1616751. eCollection 2025.
The aim of this study was to describe the characteristics and outcomes of acute myocarditis (AM) patients while seeking accessible and valid early predictors for the development of dilated cardiomyopathy (DCM).
We conducted a retrospective evaluation of 136 consecutive AM patients admitted to our hospital. The patients were categorized into two groups according to their left ventricular ejection fraction (LVEF) at presentation: those with an impaired LVEF of ≤55% and those with a normal LVEF of >55%. Multivariate logistic regression analyses were conducted to identify early predictors of DCM.
The median age of the study participants was 10.35 years (5.60-14.70), and most of the participants (66.91%) were males. Thirty-eight (27.94%) patients had an LVEF of ≤55%. Compared with those with an LVEF >55%, patients with an LVEF ≤55% presented significantly elevated levels of cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), as well as more pronounced clinical manifestations, including a greater prevalence of fulminant myocarditis, New York Heart Association (NYHA) class II-IV, abnormal electrocardiogram results, and enlargement of the left ventricle on echocardiography. Univariate analysis revealed that patients with an LVEF of ≤55% had an increased risk of poor outcomes and DCM development. These patients faced the greatest likelihood of death and heart transplantation within the first year following discharge. During short-term follow-up, 15.44% of the children with AM progressed to DCM. According to the multivariable analysis, a higher baseline LV end-diastolic diameter z score (LVEDD z-score) independently predicted this progression (odds ratio [OR], 2.685; 95% confidence interval [CI], 1.232-5.851; = 0.013).
Patients with AM and LVEF ≤55% had a more severe clinical course, higher rates of poor outcomes, and increased risk of DCM progression. Moreover, this subgroup was at the greatest risk for death and heart transplant within the first year post-discharge. During short-term follow-up, 15.44% of the children diagnosed with AM progressed to DCM, with a higher baseline LVEDD z-score identified as a potential early predictor for this progression.
本研究旨在描述急性心肌炎（AM）患者的特征及预后，同时寻找可及且有效的扩张型心肌病（DCM）发生的早期预测指标。
我们对我院收治的136例连续的AM患者进行了回顾性评估。根据患者就诊时的左心室射血分数（LVEF）将其分为两组：LVEF≤55%的受损组和LVEF>55%的正常组。进行多因素逻辑回归分析以确定DCM的早期预测指标。
研究参与者的中位年龄为10.35岁（5.60 - 14.70），大多数参与者（66.91%）为男性。38例（27.94%）患者的LVEF≤55%。与LVEF>55%的患者相比，LVEF≤55%的患者心肌肌钙蛋白I（cTnI）和N末端B型脑钠肽原（NT-proBNP）水平显著升高，临床表现也更明显，包括暴发性心肌炎的患病率更高、纽约心脏协会（NYHA）心功能分级为II - IV级、心电图结果异常以及超声心动图显示左心室增大。单因素分析显示，LVEF≤55%的患者预后不良和发生DCM的风险增加。这些患者在出院后第一年内死亡和心脏移植的可能性最大。在短期随访中，15.44%的AM患儿进展为DCM。根据多变量分析，较高的基线左心室舒张末期直径z评分（LVEDD z评分）可独立预测这一进展（比值比[OR]，2.685；95%置信区间[CI]，1.232 - 5.851；P = 0.013）。
AM且LVEF≤55%的患者临床病程更严重，预后不良率更高，DCM进展风险增加。此外，该亚组在出院后第一年内死亡和心脏移植的风险最大。在短期随访中，15.44%被诊断为AM的儿童进展为DCM，较高的基线LVEDD z评分被确定为这一进展的潜在早期预测指标。
