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Review
. 2022 May 3;9(5):143.
doi: 10.3390/jcdd9050143.

Pediatric Myocarditis: What Have We Learnt So Far?

Elettra Pomiato  1 , Marco Alfonso Perrone  1 , Rosalinda Palmieri  1 , Maria Giulia Gagliardi  1
Affiliations
Review

Pediatric Myocarditis: What Have We Learnt So Far?

Elettra Pomiato et al. J Cardiovasc Dev Dis. .

Abstract

Myocarditis is an inflammatory disease of the myocardium that is troublesome to diagnose and manage, especially in children. Since the introduction of endomyocardial biopsy (EMB), new diagnostic tools have provided useful data. Especially when enhanced with immunohistochemistry and polymerase chain reaction (PCR) studies, EMB remains the gold standard for the diagnosis. Notably, cardiac magnetic resonance (MRI) is a non-invasive tool that can confirm the diagnosis and has a particular usefulness during the follow-up. The causes of myocarditis are heterogeneous (mostly viral in children). The course and outcome of the illness in the pediatric population represent a complex interaction between etiologic agents and the immune system, which is still not fully understood. The clinical presentation and course of myocarditis vary widely from paucisymptomatic illness to acute heart failure refractory to therapy, arrhythmias, angina-like presentation and sudden cardiac death. In this setting, cardiac biomarkers (i.e., troponins and BNP), although unspecific, can be used to support the diagnosis. Finally, the efficacy of therapeutic strategies is controversial and not confirmed by clinical trials. In this review, we summarized the milestones in diagnosis and provided an overview of the therapeutic options for myocarditis in children.

Keywords: children; endomyocardial biopsy; immune system; inflammatory cardiomyopathy; myocarditis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Myocardial histological sample showing lymphocytic infiltrate and myocyte necrosis. (a) ×10; (b) ×40.
Figure 2
Figure 2
Timelines of milestones in diagnosis and therapy of myocarditis in children. (a) Milestones of diagnosis in pediatric myocarditis over time; (b) Evidence of therapy in children with myocarditis: the therapeutic approach is not supported by specific pediatric clinical trials.
Figure 3
Figure 3
Different techniques for myocarditis assessment with cardiovascular magnetic resonance imaging: T2 STIR sequences reveal areas of myocardial edema in acute setting (panel a); T1 and T2 mapping techniques improved detection of myocardial edema and inflammation (panel b,c); perfusion imaging and early enhancement can be used to detect hyperemia condition (panel d,e); late gadolinium enhancement sequences confirmed acute myocardial inflammatory damage and assessment of myocardial fibrosis (panel f).
See this image and copyright information in PMC

References

    1. Caforio A.L.P., Pankuweit S., Arbustini E., Basso C., Gimeno-Blanes J., Felix S.B., Fu M., Heliö T., Heymans S., Jahns R., et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: A position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur. Heart J. 2013;34:2636–2648. doi: 10.1093/eurheartj/eht210. - DOI - PubMed
    1. Law Y.M., Lal A.K., Chen S., Čiháková D., Cooper L.T., Jr., Deshpande S., Godown J., Grosse-Wortmann L., Robinson J.D., Towbin J.A. Diagnosis and Management of Myocarditis in Children: A Scientific Statement from the American Heart Association. Circulation. 2021;144:e123–e135. doi: 10.1161/CIR.0000000000001001. - DOI - PubMed
    1. Caforio A.L.P., Malipiero G., Marcolongo R., Iliceto S. Myocarditis: A Clinical Overview. Curr. Cardiol. Rep. 2017;19:63. doi: 10.1007/s11886-017-0870-x. - DOI - PubMed
    1. Tschöpe C., Ammirati E., Bozkurt B., Caforio A.L.P., Cooper L.T., Felix S.B., Hare J.M., Heidecker B., Heymans S., Hübner N., et al. Myocarditis and inflammatory cardiomyopathy: Current evidence and future directions. Nat. Rev. Cardiol. 2021;18:169–193. doi: 10.1038/s41569-020-00435-x. - DOI - PMC - PubMed
    1. Richardson P., McKenna R.W., Bristow M., Maisch B., Mautner B., O'Connell J., Olsen E., Thiene G., Goodwin J., Gyarfas I., et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies. Circulation. 1996;93:841–842. doi: 10.1161/01.CIR.93.5.841. - DOI - PubMed

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