The cTnI-, BUN-, and LVFS-based scoring model identified children with acute myocarditis at risk of ventricular arrhythmia with AUC 0.871 in training and 0.837 in validation sets, sensitivity up to 78.6%, specificity up to 94.4%.
Observational (n=312)
No
A simple scoring model based on cTnI, BUN, and LVFS can effectively identify children with acute myocarditis at high risk for early ventricular arrhythmias.
Effect estimate: OR cTnI ≥ 0.1945 ng/mL=9.114; OR BUN ≥ 4.55 mmol/L=9.796; OR LVFS ≤ 0.33=6.005
p-value: p=<0.05 for risk factors
Early identification of ventricular arrhythmia (VA) risk in children with acute myocarditis (AMC) is challenging, as existing tools lack pediatric targeting. AMC’s non-specific early symptoms in children lead to underdiagnosis. VA, a major complication of AMC, is linked to poor prognosis, but not all cases present at admission, highlighting the need for simple, accessible predictive indicators. This retrospective single-center study included 312 children (1 month − 17 years) with AMC (2021–2024), divided into a training set (n = 208, 2021–2023) and validation set (n = 104, 2024). Eligibility required first-time AMC diagnosis without admission VA. Univariate analysis (P < 0.05) and binary logistic regression identified independent VA risk factors. Continuous variables were dichotomized via receiver operating characteristic curves, and a scoring model was constructed, with internal validation of discriminative performance and calibration. Forty-four children (14.1%) developed VA, mostly within the first week. Independent risk factors were cardiac troponin I (cTnI ≥ 0.1945 ng/mL, OR = 9.114), blood urea nitrogen (BUN ≥ 4.55 mmol/L, OR = 9.796), and left ventricular fraction shortening (LVFS ≤ 0.33, OR = 6.005). The model assigned 3 points to cTnI/BUN and 2 to LVFS (total 0–8 points). At cutoff ≥ 4 points: training set (sensitivity = 70.0%, specificity = 90.4%, AUC = 0.871); validation set (sensitivity = 78.6%, specificity = 94.4%, accuracy = 92.3%, AUC = 0.837). Calibration was acceptable (Hosmer-Lemeshow P = 0.288). The cTnI-, BUN-, and LVFS-based scoring model offers a simple, effective tool for early VA risk stratification in children with AMC. It aids targeted monitoring and intervention, improving clinical decision-making. Limitations include retrospective single-center design and small sample size; prospective multicenter validation is needed.
Li et al. (Thu,) conducted a observational in Children aged 1 month to 17 years with first diagnosed acute myocarditis without ventricular arrhythmia on admission (n=312). cTnI-, BUN-, and LVFS-based scoring model for early identification of ventricular arrhythmia risk vs. No scoring model (baseline clinical monitoring) was evaluated on Development of ventricular arrhythmia (VA) during hospitalization (OR cTnI ≥ 0.1945 ng/mL=9.114; OR BUN ≥ 4.55 mmol/L=9.796; OR LVFS ≤ 0.33=6.005, p=<0.05 for risk factors). The cTnI-, BUN-, and LVFS-based scoring model identified children with acute myocarditis at risk of ventricular arrhythmia with AUC 0.871 in training and 0.837 in validation sets, sensitivity up to 78.6%, specificity up to 94.4%.