Age-associated clinical patterns in paediatric myocarditis: left ventricular function as the key early risk stratifier.
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Seidel Franziska, Huber Cynthia, Opgen-Rhein Bernd, Boehne Martin, Weickmann Johannes, Hecht Tobias, Anderheiden Felix, Reineker Katja, Rentzsch Axel, Wiegand Gesa, Böcker Dorothée, Kiski Daniela, Fischer Marcus, Frede Wiebke, Ruf Bettina, Papakostas Konstantin, Tarusinov Gleb, Voges Inga, Kaestner Michael, Gummel Kerstin, Schiebel Assunta, Kramp Jennifer, Herberg Ulrike, Kerst Gunter, Wannenmacher Bardo, Gatzweiler Eva, Knirsch Walter, Rolfs Nele, Schwanzkopf Eicke, Garfias-Veitl Tania, Pickardt Thomas, Rudolph André, Böhmer Jens, Friede Tim, Schubert Stephan, Messroghli Daniel, MYKKE consortium
Аннотация
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.