This preprint is under consideration at European Journal of Pediatrics. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research Article
Ferran Gran
Hospital Vall d'Hebron
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9076-241X
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This work is licensed under a CC BY 4.0 License. Read Full License
Background Acute myocarditis is an inflammatory disease of the myocardium, and it can present as severe heart failure in children. Differential diagnosis with genetic cardiomyopathy can be difficult. The objective of this study is to identify patterns of clinical presentation and to assess invasive and non-invasive measures to differentiate patients with acute myocarditis from patients with dilated genetic cardiomyopathy. Material and Methods We performed a retrospective descriptive study of all paediatric patients (0-16 years old) that presented with new-onset heart failure with left ventricle ejection fraction <35% in whom we performed an endomyocardial biopsy (EMB) during the period from April 2007 to December 2020. Results The patients were classified into two groups: Group 1 included 17 patients with myocarditis. Group 2 included 9 patients with genetic cardiomyopathy. Findings favouring a diagnosis of myocarditis included a fulminant or acute presentation (77.8% vs 33.3%, p=0.01), higher degree of cardiac enzyme elevation (p=0.011), lower left ventricular dimension z-score (2.2 vs. 5.4, p = 0.03) increase of ventricular wall thickness (88.8% vs 33.3%, p=0.03), and oedema in the endomyocardial biopsy. Seven (77.8%) patients with genetic cardiomyopathy had inflammation in the endomyocardial biopsy, fulfilling the diagnostic criteria of inflammatory cardiomyopathy. Conclusions Differentiate patients with a myocarditis from those with genetic cardiomyopathy can be challenging, even performing an EMB. Some patients with genetic cardiomyopathy fulfil the diagnostic criteria of inflammatory cardiomyopathy. Using invasive and non-invasive measures may be useful to develop a predictive model to differentiate myocarditis from genetic cardiomyopathy.
Keywords
Paediatric heart failure, Myocarditis, Cardiomyopathy, Endomyocardial biopsy
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CURRENT STATUS: Under Review
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Posted 22 Mar, 2021
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Received 19 Mar, 2021
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This preprint is under consideration at European Journal of Pediatrics. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Ferran Gran
Hospital Vall d'Hebron
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9076-241X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 22 Mar, 2021
No community comments so far
Review #? received
Received 19 Mar, 2021
Reviewers invited
Invitations sent on 19 Mar, 2021
Editor assigned
On 17 Mar, 2021
First submitted
On 20 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pediatrics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Acute myocarditis is an inflammatory disease of the myocardium, and it can present as severe heart failure in children. Differential diagnosis with genetic cardiomyopathy can be difficult. The objective of this study is to identify patterns of clinical presentation and to assess invasive and non-invasive measures to differentiate patients with acute myocarditis from patients with dilated genetic cardiomyopathy. Material and Methods We performed a retrospective descriptive study of all paediatric patients (0-16 years old) that presented with new-onset heart failure with left ventricle ejection fraction <35% in whom we performed an endomyocardial biopsy (EMB) during the period from April 2007 to December 2020. Results The patients were classified into two groups: Group 1 included 17 patients with myocarditis. Group 2 included 9 patients with genetic cardiomyopathy. Findings favouring a diagnosis of myocarditis included a fulminant or acute presentation (77.8% vs 33.3%, p=0.01), higher degree of cardiac enzyme elevation (p=0.011), lower left ventricular dimension z-score (2.2 vs. 5.4, p = 0.03) increase of ventricular wall thickness (88.8% vs 33.3%, p=0.03), and oedema in the endomyocardial biopsy. Seven (77.8%) patients with genetic cardiomyopathy had inflammation in the endomyocardial biopsy, fulfilling the diagnostic criteria of inflammatory cardiomyopathy. Conclusions Differentiate patients with a myocarditis from those with genetic cardiomyopathy can be challenging, even performing an EMB. Some patients with genetic cardiomyopathy fulfil the diagnostic criteria of inflammatory cardiomyopathy. Using invasive and non-invasive measures may be useful to develop a predictive model to differentiate myocarditis from genetic cardiomyopathy.
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