Thorac Cardiovasc Surg 2019; 67(S 02): S101-S128
DOI: 10.1055/s-0039-1679088
Short Presentations
Sunday, February 17, 2019
Auf den Punkt gebracht – DGPK
Georg Thieme Verlag KG Stuttgart · New York

Impact of Endomyocardial Biopsy on Treatment and Outcome in Pediatric Myocarditis: Results from the German Multicenter Registry for Pediatric Myocarditis “MYKKE”

F. Degener
1   Deutsches Herzzentrum Berlin, Berlin, Germany
2   Institute for Computational and Cardiovascular Medicine, Charite - Universitätsmedizin Berlin, Berlin, Germany
3   DZHK (Germany Center for cardiovascular Research), Partner Site Berlin, Berlin, Germany
,
B. Opgen-Rhein
4   Department of Pediatric Cardiology, Charite – Universitätsmedizin Berlin, Berlin, Germany
,
R. Wagner
5   Heart Center Leipzig, Pediatric Cardiology, Leipzig, Germany
,
M. Boehne
6   Department of Pediatric Cardiology, Hannover Medical School, Hannover, Germany,
,
A. Weigelt
7   Department of Pediatric Cardiology, Universität Erlangen, Erlangen, Germany
,
K. Reineker
8   Department of Pediatric Cardiology, Universitäts Herzzentrum Freiburg Bad Krozingen, Freiburg, Germany
,
A. Racolta
9   Department of Pediatric Cardiology, Herz- und Diabeteszentrum NRW Universitätsklinik Bochum, Bad Oeynhausen, Germany
,
G. Müller
10   Department of Pediatric Cardiology, Universitäts Herzzentrum Hamburg, Hamburg, Germany
,
G. Wiegand
11   Department of Pediatric Cardiology, Universitätskinderklinik Tübingen, Tübingen, Germany
,
D. Kiski
12   Department of Pediatric Cardiology, Universitätsklinik Münster, Münster, Germany
,
A. Rentzsch
13   Department of Pediatric Cardiology, Saarland University, Hombrg/Saar, Germany
,
K. Papakostas
14   Department of Pediatric Cardiology, Klinikum Links der Weser, Bremen, Germany
,
B. Ruf
15   Department of Pediatric Cardiology, Deutsches Herzzentrum München, München, Germany
,
T. Hannes
16   Department of Pediatric Cardiology, Uniklinik Köln, Köln, Germany
,
M. Khalil
17   Department of Pediatric Cardiology, Universitätsklinik Gießen u. Marburg Standort Gießen, Gießen, Germany
,
M. Fischer
18   Department of Pediatric Cardiology, Klinikum Grosshadern der LMU München, München, Germany
,
M. Kaestner
19   Department of Pediatric Cardiology, Universitätsklinikum Ulm, Ulm, Germany
,
M. Steinmetz
20   Department of Pediatric Cardiology, Universitätsmedizin Göttingen, Göttingen, Germany
,
N. Freudenthal
21   Department of Pediatric Cardiology, Universität Bonn, Bonn, Germany
,
G. Fischer
22   Department of Pediatric Cardiology, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
,
E. Panagiotou
23   Department of Pediatric Cardiology, Uniklinik RWTH Aachen, Aachen, Germany
,
U. Schweigmann
24   Klinikum Stuttgart, Pediatric Cardiology, Stuttgart, Germany
,
T. Pickardt
25   Competence Network for Congenital Heart Defects, Berlin, Germany
,
K. Klingel
26   Department of Cardiopathology, Institute for Pathology and Neuropathology, Universitätsklinik Tübingen, Tübingen, Germany
,
D. Messroghli
3   DZHK (Germany Center for cardiovascular Research), Partner Site Berlin, Berlin, Germany
27   Department of Internal Medicine - Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
,
S. Schubert
3   DZHK (Germany Center for cardiovascular Research), Partner Site Berlin, Berlin, Germany
28   Department of Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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Publikationsverlauf

Publikationsdatum:
28. Januar 2019 (online)

 

    Objective: Endomyocardial biopsy (EMB) in pediatric patients is divergently discussed, but it might identify the underlying etiology of severe heart failure. EMB might trigger therapeutic interventions and have a prognostic value. As there is no standard, the aim of this study was to analyze the impact of EMB in pediatric patients with suspected myocarditis.

    Methods: EMB results from patients enrolled between September 2013 and August 2018 in the German prospective multicenter registry “MYKKE” were analyzed.

    Results: In 56% (200/357) of patients an EMB was performed. EMB results from 182 patients were available for analysis. Median age was 13.0 (1.2–16.3) years. Time between symptom onset and EMB was 11.0 (4.0–26.5) days, between first admission and EMB 3.0 (1.0–8.8) days. Ninety per cent were taken from right ventricle (RV), 5% from left ventricle (LV), and 5% from LV/RV. In 137 (75%) patients, a myocarditis was reported: acute myocarditis (18%), subacute/chronic myocarditis (41%), status postmyocarditis (10%), borderline myocarditis (4%), and hypersensitivity myocarditis (1%). In 7%, no relevant inflammation was documented, 6% had a DCM, 2% LVNC, 2% HCM; 9% had other diagnosis. In 42% (77/167), cardiotropic viruses in the myocardium could be detected (57% PBV19; 18% HHV6; 13% PVB19/HHV6; 4% CMV; 3% enterovirus; 1% EBV, HHV6/7), with mostly low viral loads (n = 56). Time between admission (p = 0.149) and symptom onset (p = 0.096) had no significant impact on virus detection or diagnosis of myocarditis. Immunoglobins were not administered more frequently after virus detection (p = 0.525) or diagnosis myocarditis (p = 0.293). Eight patients (4%) received immunosuppressive and 22 (12%) a virostatic therapy. Virus positivity or the diagnosis of myocarditis had no significant impact on need for HTX, MCS, or death. Age groups or the normalization of ejection fraction at follow-up was neither correlated with myocardial virus detection nor inflammation.

    Conclusion: The rate of myocarditis and viral DNA detection in pediatric EMB for suspected myocarditis is unexpected high. Although a large proportion of subacute or chronic cases and low viral loads are detected, it does not trigger a specific therapy or influence outcome in this cohort. Timing may play a critical role for viral detection and therapeutic interventions. For that purpose, further investigations and standardized protocols are necessary to allow comparing EMB findings and advancing the understanding of myocarditis.


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    Die Autoren geben an, dass kein Interessenkonflikt besteht.