{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:56:19Z","timestamp":1792065379969,"version":"4.4.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>In myocarditis, early identification of high-risk patients is essential, robust prognostic markers are lacking. We aimed to identify early clinical risk stratifier at index hospitalization for major adverse cardiovascular events (MACE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed 725 paediatric patients with possible\/definite myocarditis enrolled in the prospective multicentre MYKKE registry (2013\u20132024). MACE included mechanical circulatory support (MCS), heart transplantation, or death during initial admission. Model-based recursive partitioning (MOB) and bootstrap-based logistic regression with multiple imputation were applied for risk stratifier selection out of 20 baseline variables. The model was externally validated in the Swedish SWEDCON- cohort (n\u2009=\u2009243). Discrimination was assessed by the area under the curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 725 patients (median age 14.3 years [IQR 4.0\u201316.4]; 33% female), 88 (12.2%) experienced MACE (MCS 10.9%, transplantation 4.3%, death 2.2%). MOB identified left ventricular ejection fraction (LVEF)\u2009\u2264\u200939% as the only stable risk stratifier, delineating a \u201cheart failure type\u201d in younger children (1.9 years; LVEF 24%), and a \u201cchest pain type\u201d in adolescents with preserved LVEF (15.6 years; LVEF 59%). LVEF was confirmed as the sole robust risk stratifier (OR per 1% increase: 0.90 ; 95% CI 0.881-0.917; p\u2009&amp;lt;\u20090.01; AUC 0.90, 95% CI 0.896\u20130.903). In SWEDCON (7.4% MACE), discrimination was maintained (AUC 0.894, 95% CI 0.80\u20130.991).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reduced LVEF at presentation was the only reproducible and externally validated risk stratifier of MACE during index hospitalization. Two age-associated clinical patterns were observed: a high-risk \u201cheart failure type\u201d in younger children and low-risk \u201cchest pain type\u201d in adolescents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag259","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:47:46Z","timestamp":1791978466000},"source":"Crossref","is-referenced-by-count":0,"title":["Age-associated clinical patterns in paediatric myocarditis: left ventricular function as the key early risk stratifier"],"prefix":"10.1093","author":[{"given":"Franziska","family":"Seidel","sequence":"first","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9, Department of Congenital Heart Disease \u2013 Peadiatric Cardiology , Berlin ,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin ,","place":["Germany"]},{"name":"Max Delbr\u00fcck Center for Molecular Medicine in the Helmholtz Association (MDC) , 13125 Berlin ,","place":["Germany"]},{"name":"Experimental & Clinical Research Center, a cooperation between the Max-Delbr\u00fcck-Center for Molecular Medicine in the Helmholtz Association & Charit\u00e9 - Universit\u00e4tsmedizin Berlin , Berlin ,","place":["Germany"]},{"name":"DZHK (German Center for Cardiovascular Research) , partner site Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Huber","sequence":"additional","affiliation":[{"name":"University Medical Center G\u00f6ttingen, Department of Medical Statistics , Goettingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Opgen-Rhein","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9, Department of Congenital Heart Disease \u2013 Peadiatric Cardiology , Berlin ,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Boehne","sequence":"additional","affiliation":[{"name":"Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School , Hannover ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Weickmann","sequence":"additional","affiliation":[{"name":"Heart Centre, University of Leipzig, Clinic for Paediatric Cardiology , Leipzig ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Hecht","sequence":"additional","affiliation":[{"name":"Center of Congenital Heart Disease and Paediatric Cardiology, Heart- and Diabetes Center NRW and University Clinic of Ruhr-University Bochum , Bad Oeynhausen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Anderheiden","sequence":"additional","affiliation":[{"name":"University Hospital Erlangen, Department of Paediatric Cardiology , Erlangen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Reineker","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Defects and Paediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, University of Freiburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Rentzsch","sequence":"additional","affiliation":[{"name":"Department of Paediatric Cardiology, Saarland University Hospital , Homburg (Saar) ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gesa","family":"Wiegand","sequence":"additional","affiliation":[{"name":"Department for Paediatric Cardiology, University Hospital T\u00fcbingen , T\u00fcbingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doroth\u00e9e","family":"B\u00f6cker","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Children's Heart Clinic, University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Kiski","sequence":"additional","affiliation":[{"name":"Department of Paediatric Cardiology, University Hospital Muenster , Muenster ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Fischer","sequence":"additional","affiliation":[{"name":"Division of Paediatric Cardiology and Intensive Care Medicine, University Hospital , LMU Munich, Munich ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiebke","family":"Frede","sequence":"additional","affiliation":[{"name":"Department Paediatric and Congenital Cardiology, University Medical Center , Heidelberg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Ruf","sequence":"additional","affiliation":[{"name":"Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Technische Universit\u00e4t M\u00fcnchen , Munich ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantin","family":"Papakostas","sequence":"additional","affiliation":[{"name":"Klinikum Bremen Mitte, Eltern-Kind-Zentrum Prof. Hess , Bremen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gleb","family":"Tarusinov","sequence":"additional","affiliation":[{"name":"Department of Paediatric Cardiology , Herzzentrum Duisburg, Duisburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inga","family":"Voges","sequence":"additional","affiliation":[{"name":"University Hospital Schleswig Holstein, Department for Congenital Heart Disease and Paediatric Cardiology , Kiel ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kaestner","sequence":"additional","affiliation":[{"name":"Division of Paediatric Cardiology, University Hospital , Ulm ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Gummel","sequence":"additional","affiliation":[{"name":"Department for Paediatric Cardiology, University Hospital Giessen , Giessen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assunta","family":"Schiebel","sequence":"additional","affiliation":[{"name":"Division of Paediatric Cardiology and Intensive Care Medicine, Department of Paediatrics and Adolescent Medicine, University Medical Centre G\u00f6ttingen , G\u00f6ttingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Kramp","sequence":"additional","affiliation":[{"name":"Department of Paediatric Cardiology, University Hospital Cologne , Cologne ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9386-0258","authenticated-orcid":false,"given":"Ulrike","family":"Herberg","sequence":"additional","affiliation":[{"name":"Paediatric Cardiology, University Hospital RWTH Aachen , Aachen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunter","family":"Kerst","sequence":"additional","affiliation":[{"name":"Clinic for Paediatric Cardiology and Congenital Heart Disease , Klinikum Stuttgart, Stuttgart ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bardo","family":"Wannenmacher","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University Hospital Halle , Halle ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Gatzweiler","sequence":"additional","affiliation":[{"name":"Department of Paediatric Cardiology, University Hospital Bonn , 53127 Bonn ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8741-3929","authenticated-orcid":false,"given":"Walter","family":"Knirsch","sequence":"additional","affiliation":[{"name":"Paediatric Heart Centre, Paediatric Cardiology, University Children's Hospital Zurich , Zurich ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nele","family":"Rolfs","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9, Department of Congenital Heart Disease \u2013 Peadiatric Cardiology , Berlin ,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin ,","place":["Germany"]},{"name":"Max Delbr\u00fcck Center for Molecular Medicine in the Helmholtz Association (MDC) , 13125 Berlin ,","place":["Germany"]},{"name":"Experimental & Clinical Research Center, a cooperation between the Max-Delbr\u00fcck-Center for Molecular Medicine in the Helmholtz Association & Charit\u00e9 - Universit\u00e4tsmedizin Berlin , Berlin ,","place":["Germany"]},{"name":"DZHK (German Center for Cardiovascular Research) , partner site Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eicke","family":"Schwanzkopf","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9, Department of Congenital Heart Disease \u2013 Peadiatric Cardiology , Berlin ,","place":["Germany"]},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Garfias-Veitl","sequence":"additional","affiliation":[{"name":"University Medical Center G\u00f6ttingen, Department of Medical Statistics , Goettingen ,","place":["Germany"]},{"name":"DZHK (German Center for Cardiovascular Research) , partner site Lower Saxony, G\u00f6ttingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Pickardt","sequence":"additional","affiliation":[{"name":"National Register for Congenital Heart Defects , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Rudolph","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Department of Pediatric Cardiology, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"B\u00f6hmer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Clinic Frankfurt H\u00f6chst , Frankfurt ,","place":["Germany"]},{"name":"Transplant Center, Sahlgrenska University Hospital , Gothenburg ,","place":["Sweden"]},{"name":"Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5347-7441","authenticated-orcid":false,"given":"Tim","family":"Friede","sequence":"additional","affiliation":[{"name":"University Medical Center G\u00f6ttingen, Department of Medical Statistics , Goettingen ,","place":["Germany"]},{"name":"DZHK (German Center for Cardiovascular Research) , partner site Lower Saxony, G\u00f6ttingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2894-6490","authenticated-orcid":false,"given":"Stephan","family":"Schubert","sequence":"additional","affiliation":[{"name":"Center of Congenital Heart Disease and Paediatric Cardiology, Heart- and Diabetes Center NRW and University Clinic of Ruhr-University Bochum , Bad Oeynhausen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Messroghli","sequence":"additional","affiliation":[{"name":"Medical Department of Cardiology, Rhythmology, and Angiology, Medical University Lausitz-Carl Thiem , Cottbus ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,15]]},"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/advance-article-pdf\/doi\/10.1093\/eschf\/xvag259\/71964028\/xvag259.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/advance-article-pdf\/doi\/10.1093\/eschf\/xvag259\/71964028\/xvag259.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:30:28Z","timestamp":1792063828000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/advance-article\/doi\/10.1093\/eschf\/xvag259\/8917294"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/eschf\/xvag259","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"article-number":"xvag259"}}