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Myopericardial syndromes in a pediatric cohort: A 5-year observational study.

Marina Pons-Espinal*, Sara Bobillo-Pérez, Silvia Simó-Nebot, Mònica Girona-Alarcon, Mònica Balaguer Gargallo, Joan Sanchez-de-Toledo, Iolanda Jordan-García

Introduction: There is a clinical spectrum of myopericardial syndrome regarding the involvement of the myocardium, from myopericarditis to myocarditis.

Objectives: The aim of this study was to describe and compare the clinical presentation, the therapeutic management and the clinical evolution of myocarditis and myopericarditis.

Methods: This was a retrospective observational study in a third level pediatric hospital, including children <18 years old diagnosed with myocarditis or myopericarditis from June 2015 to June 2020.

Results: There were included 24 patients (15 myocarditis and 9 myopericarditis). Only myocarditis presents with respiratory symptoms and abnormal chest radiograph, as well as worse general condition in the emergency department (p<0.01). Patients with myocarditis were younger, 14.4 months (IQR=3-60) vs. 197.5 (IQR=183-208) (p<0.01), presented with more tachycardia (p<0.01) and more metabolic acidosis (p=<0.01). On echocardiography, they had worst ventricular ejection fraction, 35% (IQR=25-40) vs. 71% (IQR=60-75), p<0.01. Fourteen myocarditis (93%) were admitted to the intensive care unit; five (36%) were placed on extracorporeal membrane oxygenation. Patients with myocarditis had significantly longer admissions, 23 days (IQR=12-38) vs. 5 (IQR=2-8) (p<0.01).

Conclusion: Myocarditis had a more severe clinical presentation, and required more frequently intensive care. Respiratory symptoms may help to predict poor prognosis in these patients.