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Multicenter Study
. 2025 Aug;12(4):2932-2945.
doi: 10.1002/ehf2.15304. Epub 2025 May 22.

Acute myocarditis according to age: Presentation, management and early outcomes

Clément Karsenty  1   2 , Paul Vignaud  1 , Clara Brusq  3 , Pamela Moceri  4 , Pascal Lim  5 , Edouard Gerbaud  6   7 , Olivier Lairez  8 , Coline Lelarge  9 , Caroline Ovaert  10   11   12 , Claire Bouleti  13 , Oscar Werner  13 , Vanina Bongard  3 , Thibaud Genet  14 , Laurent Bonnemains  15 , Christophe Tron  16 , Elise Barre  17 , Margaux Boddaert  18 , Jacques Mansourati  19 , Chérine Benzouid  20 , François Roubille  21   22 , Hadi Khachab  23 , Sabrina Uhry  24 , Ariel Cohen  25 , Benoit Lattuca  26 , Sylvie Di Filippo  27 , Clément Delmas  28   29
Affiliations
Multicenter Study

Acute myocarditis according to age: Presentation, management and early outcomes

Clément Karsenty et al. ESC Heart Fail. 2025 Aug.

Abstract

Aims: Acute myocarditis (AM) is a rare but severe disease affecting patients of all ages. Large multicentric studies comparing children and adults are currently lacking. We aimed to elucidate differences in presentation, management, and outcomes of AM across age groups.

Methods: We analysed a comprehensive French national cohort study, encompassing 53 paediatric and adult units from March 2020 to November 2021, collecting data on baseline characteristics, evolution, management and in-hospital complications. Myocarditis-related events (MRE) within 30 days included all-cause death, cardiogenic shock, cardiac arrest, ventricular arrhythmias or complete AV block.

Results: We included 745 AM patients (328 children and 417 adults), mainly male (73.4%) with a median age of 10.9 years [Q1-Q3 (7.3-14.6)] for children and 28.7 years [22.6-41.2] for adults. Multisystem inflammatory syndrome (MIS) was more prevalent among children (69.8%), and infectious aetiologies dominated in adults (13.4 vs. 52.4%). Children exhibited more severe clinical presentation (15.9 vs. 7.2%, P < 0.001, with heart failure and 14.4 vs. 6.9%, P < 0.001, with cardiogenic shock), requiring higher use of inotropes (25.0 vs. 9.4%, P < 0.001), vasopressors (12.0 vs. 6.2%, P < 0.001), and ventilatory support (13.7% vs. 7.9%, P = 0.01). Cardiac treatments were used less frequently in children, and corticosteroids (68.3 vs, 14.3, P < 0.001) and immunomodulators (65.1 vs. 4.5%, P < 0.001) were more common. MRE occurrence was substantial but not significantly different between children and adults (18.1 vs. 13.4%, P = 0.09). Extra-cardiac manifestations at admission were significant predictors of MRE [adjusted odds ratio 2.40 (1.43-4.38)], regardless of MIS status.

Conclusions: AM exhibits variations in presentation, aetiologies and management but has a comparable 30 day prognosis in children and adults. These findings underscore the importance of tailored management strategies in AM across different age groups.

Keywords: Acute myocarditis; Epidemiology; Mortality; Paediatric cardiology; Prognosis.

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Conflict of interest statement

The authors declare that they have no conflict of interest regarding this work.

Figures

Figure 1
Figure 1
Pie chart of the distribution of myocarditis aetiologies according to age (children vs. adults). MIS, multisystem inflammatory syndrome.
Figure 2
Figure 2
Unadjusted cumulative and specific myocarditis‐related events (MRE) at 30 days of acute myocarditis according to age (children vs. adults). MRE were defined as the composite of all‐cause death, cardiogenic shock, resuscitated cardiac arrest, ventricular arrhythmia or complete atrio‐ventricular block within 30 days. AV, atrioventricular.
See this image and copyright information in PMC

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