Four-Year Experience of the German Multicenter Registry for Pediatric Patients with Suspected Myocarditis: MYKKE

F. Degener; B. Opgen-Rhein; M. Böhne; A. Weigelt; R. Wagner; G. Müller; A. Racolta; A. Rentzsch; K. Papakostas; K. Reineker; D. Kiski; B. Ruf; G. Wiegand; T. Hannes; M. Khalil; M. Fischer; M. Kaestner; M. Steinmetz; G. Fischer; N. Freudenthal; T. Pickardt; D. Messroghli; S. Schubert

doi:10.1055/s-0038-1628324

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2018; 66(S 02): S111-S138
DOI: 10.1055/s-0038-1628324

Oral Presentations

Monday, February 19, 2018

DGPK: Basic Science and Clinical Studies

Georg Thieme Verlag KG Stuttgart · New York

Four-Year Experience of the German Multicenter Registry for Pediatric Patients with Suspected Myocarditis: MYKKE

F. Degener

¹Deutsches Herzzentrum Berlin, Klinik für Angeborene Herzfehler - Kinderkardiologie, Berlin, Germany

,

B. Opgen-Rhein

³Charité - Universitätsmedizin Berlin, Klinik für Pädiatrie mit Schwerpunkt Kardiologie, Berlin, Germany

,

M. Böhne

⁴Medizinische Hochschule Hannover, Kinderkardiologie, Hannover, Germany

,

A. Weigelt

⁵Universitätsklinikum Erlangen, Kinderkardiologie, Erlangen, Germany

,

R. Wagner

⁶Herzzentrum Leipzig, Kinderkardiologie, Leipzig, Germany

,

G. Müller

⁷Universitäres Herzzentrum Hamburg, Kinderkardiologie, Hamburg, Germany

,

A. Racolta

⁸Herz- und Diabeteszentrum NRW, Zentrum für angeborene Herzfehler, Bad Oeynhausen, Germany

,

A. Rentzsch

⁹Universität des Saarlandes, Kinderkardiologie, Homburg/Saar, Germany

,

K. Papakostas

¹⁰Klinikum Links der Weser, Strukturelle und angeborene Herzfehler / Kinderkardiologie, Bremen, Germany

,

K. Reineker

¹¹Universitäts Herzzentrum Freiburg Bad Krozingen, Kinderkardiologie, Freiburg, Germany

,

D. Kiski

¹²Universitätsklinikum Münster, Klinik für Kinder- und Jugendmedizin/Pädiatrische Kardiologie, Münster, Germany

,

B. Ruf

¹³Deutsches Herzzentrum München, Technische Universität München, Angeborene Herzfehler/Kinderkardiologie, München, Germany

,

G. Wiegand

¹⁴Universitätskinderklinik Tübingen, Kinderkardiologie, Tübingen, Germany

,

T. Hannes

¹⁵Uniklinik Köln, Klinik für angeborene Herzfehler und Pädiatrische Kardiologie, Köln, Germany

,

M. Khalil

¹⁶Universitätsklinik Giessen, Abteilung für Kinderkardiologie, Giessen, Germany

,

M. Fischer

¹⁷Klinikum der Universität München, Abteilung Kinderkardiologie und Pädiatrische Intensivmedizin, München, Germany

,

M. Kaestner

¹⁸Universitätsklinikum Ulm, Kinderkardiologie, Ulm, Germany

,

M. Steinmetz

¹⁹Universitätsmedizin Göttingen, Klinik für Pädiatrische Kardiologie und Intensivmedizin, Göttingen, Germany

,

G. Fischer

²⁰Universitätsklinikum Schleswig-Holstein, Klinik für angeborene Herzfehler und Kinderkardiologie, Kiel, Germany

,

N. Freudenthal

²¹Universitätsklinikum Bonn, Abteilung für Kinderkardiologie, Bonn, Germany

,

T. Pickardt

²²Kompetenznetz Angeborene Herzfehler, Berlin, Germany

,

D. Messroghli

²DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Standort Berlin, Berlin, Germany

,

S. Schubert

¹Deutsches Herzzentrum Berlin, Klinik für Angeborene Herzfehler - Kinderkardiologie, Berlin, Germany

› Author Affiliations

Abstract

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Objectives: Myocarditis is one of the leading causes of severe heart failure in children. In pediatric myocarditis, the development of severe heart failure may depend on age, genetic and immunological factors. MYKKE aims to close this knowledge gap by acquiring data on incidence, diagnostic and therapeutic approaches.

Methods: MYKKE is a multicenter prospective data acquisition on hospitalized pediatric patients with suspected myocarditis. Between September 2013 and 2017 twenty centers included clinical data into an online database.

Results: A total of 272 patients were included, 67% male, median age (range) 13 (0–17) years with two age peaks: 0 to < 2 years (24%), 2 to 12 years (21%), and 13 to 18 years (55%). Leading symptoms at admission were: decrease of exercise capacity (68%), angina (39%), dyspnea (36%), arrhythmia (28%), and syncope (18%). Sudden cardiac death occurred rarely (4%). 55% had general symptom`s caused by infection within the last 6 weeks, fever in 35%. Patients under 2 years of age had a higher incidence of a severely reduced left ventricular ejection fraction (EF< 30%) compared with age groups 2 to 12 years (40%) and 13–18y (7%); p < 0.001. They also had the highest need for ventricular assist device (VAD) and/or ECMO therapy (23%; 2–12 years 18%; 13–18 years 4%); p < 0.001.

Fifteen patients died during follow-up, 8 of them have had a VAD/ECMO therapy, which means an overall mortality of 5.5% and 21% in the ECMO/VAD group (n = 8/31). Most children died in the 0- to < 2-year (11%) and 2- to 12-year group (11%) compared with 1% in the 13–18-year group. Eighteen patients were directed to heart transplantation (HTx) and in eleven patients HTx was performed.

Conclusion: With its ongoing enrollment, MYKKE has become a valuable registry for suspected myocarditis in children and adolescents. The data underline two age peaks and age depending outcomes, with a more severe clinical course including VAD/ECMO therapy and more adverse events in the youngest patients. These differences within the age groups will be further studied in the registry by genetic and immunological analyzes.