Clinically suspected pediatric myocarditis in a resource-limited setting: high mortality, care gaps, and real-world management over a 12-year period

Résumé fourni par la source

Data on clinically suspected pediatric myocarditis from low- and middle-income countries are limited because advanced diagnostic tools are often unavailable. We evaluated the clinical presentation, management, outcomes, predictors of in-hospital mortality, and system-level care gaps in children with clinically suspected myocarditis in a resource-limited setting. We conducted a retrospective observational cohort study at a tertiary care hospital in Pakistan. Children aged 1 month to 18 years admitted between January 2011 and June 2023 with clinically suspected myocarditis based on compatible clinical presentation, elevated cardiac biomarkers, and echocardiographic evidence of myocardial dysfunction were included. The primary outcome was in-hospital mortality. Multivariable logistic regression was used to identify independent predictors of death. A total of 130 children were included (mean age 3.7±4.5 years; 57.7% male). Severe left ventricular systolic dysfunction (ejection fraction <30%) was present in 77.7%, and 75.4% required mechanical ventilation. In-hospital mortality was 40.0% (52/130). Persistent liver dysfunction (aOR 6.35, 95% CI 2.40 – 18.25), arrhythmias requiring treatment (aOR 3.84, 95% CI 1.23 - 13.16), and ejection fraction <30% (aOR 3.28, 95%CI 1.16 - 10.19) were independently associated with mortality. Among survivors, one-third were lost to follow-up, and 46.2% of those with follow-up had persistent ventricular dysfunction. No patient underwent cardiac magnetic resonance imaging or endomyocardial biopsy because these modalities were unavailable. Clinically suspected pediatric myocarditis was associated with high mortality, severe ventricular dysfunction, and incomplete recovery. Simple clinical markers may aid risk stratification, while strengthening early recognition and follow-up may improve outcomes in low-resource settings.

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