Pediatric suspected myocarditis linked to 40% mortality in Pakistan cohort

A retrospective observational study at a tertiary care hospital in Pakistan found 40.0% in-hospital mortality among 130 children with clinically suspected myocarditis admitted over a 12-year period. The cohort also showed frequent severe cardiac dysfunction and incomplete post-discharge follow-up. These findings describe one resource-limited hospital and may not represent the full burden of pediatric myocarditis across Pakistan or other low- and middle-income countries.

Researchers reviewed children aged one month to 18 years who were admitted between January 2011 and June 2023. Children were included when they had a compatible clinical presentation, elevated cardiac biomarkers and echocardiographic evidence of myocardial dysfunction. The mean age was 3.7 years with a standard deviation of 4.5 years, and 57.7% of the cohort was male. Severe left ventricular systolic dysfunction, defined as an ejection fraction below 30%, was present in 77.7% of the children, and 75.4% required mechanical ventilation. The supplied study abstract does not specify the exact timing of these assessments relative to admission.

Multivariable logistic regression identified three clinical factors independently associated with death. Persistent liver dysfunction had an adjusted odds ratio of 6.35, with a 95% confidence interval of 2.40–18.25. Arrhythmias requiring treatment had an adjusted odds ratio of 3.84, with a 95% confidence interval of 1.23–13.16. An ejection fraction below 30% was also associated with mortality, with an adjusted odds ratio of 3.28 and a 95% confidence interval of 1.16–10.19. Because the study was retrospective, single-center and limited to 130 children, these wide confidence intervals reflect substantial uncertainty. The results are associations within the study population rather than validated clinical prediction rules.

Diagnostic resources were constrained at the study hospital. No patient underwent cardiac magnetic resonance imaging or endomyocardial biopsy because these modalities were unavailable. The cases were therefore characterized as clinically suspected myocarditis, based on compatible clinical findings, cardiac biomarkers and echocardiographic dysfunction, rather than confirmed by virus detection, magnetic-resonance criteria or tissue examination. Cardiac magnetic resonance imaging and endomyocardial biopsy were not performed, and the available evidence does not establish how their absence changed etiologic or tissue-level classification. Within this documented diagnostic framework, clinicians nevertheless identified a substantial group of children with myocardial dysfunction and poor in-hospital outcomes.

Follow-up data also limited conclusions about recovery. Among children who survived, one-third were lost to follow-up. Of the survivors with follow-up data, 46.2% had persistent ventricular dysfunction. The report does not establish whether that dysfunction later resolved or worsened, and the missing follow-up data prevent a complete assessment of long-term recovery. Overall, the study documents two measured system-level gaps: high mortality during the index admission and incomplete monitoring after discharge. The authors conclude that simple clinical markers may aid risk stratification, while strengthening early recognition and follow-up may improve care in low-resource settings; the study itself does not test those proposed improvements.

Subject of Research: Outcomes and care gaps in clinically suspected pediatric myocarditis in a resource-limited hospital cohort

Article Title: Clinically suspected pediatric myocarditis in a resource-limited setting: high mortality, care gaps, and real-world management over a 12-year period

Article References: Ali, F., Ullah, M. K., Munir, T., Usmani, A., Samad, N., Akhtar, S., & Hasan, B. (2026). Clinically suspected pediatric myocarditis in a resource-limited setting: high mortality, care gaps, and real-world management over a 12-year period. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07413-1

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07413-1

Keywords: pediatric myocarditis, childhood heart failure, in-hospital mortality, ventricular dysfunction, Pakistan, resource-limited care, retrospective cohort, cardiac biomarkers, echocardiography, follow-up gaps, Clinically, suspected