Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-10T09:21:43.221Z Has data issue: false hasContentIssue false
  • English
  • Français

Acute viral myocarditis: role of immunosuppression: a prospective randomised study

Published online by Cambridge University Press:  28 June 2010

Kalim U. Aziz ,
Najma Patel ,
Tareen Sadullah ,
Habiba Tasneem ,
Hasina Thawerani  and
Saeed Talpur
Kalim U. Aziz*
Affiliation:
Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Rafiqui Shaheed Road, Karachi, Pakistan
Najma Patel
Affiliation:
Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Rafiqui Shaheed Road, Karachi, Pakistan
Tareen Sadullah
Affiliation:
Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Rafiqui Shaheed Road, Karachi, Pakistan
Habiba Tasneem
Affiliation:
Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Rafiqui Shaheed Road, Karachi, Pakistan
Hasina Thawerani
Affiliation:
Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Rafiqui Shaheed Road, Karachi, Pakistan
Saeed Talpur
Affiliation:
Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Rafiqui Shaheed Road, Karachi, Pakistan
*
Correspondence to: K. U. Aziz, Professor Emeritus of Paediatric Cardiology, Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Rafiqui (H.J.) Shaheed Road, Karachi, Pakistan. Tel: 92 21 586 6091; Fax: 92 21 920 1287; E-mail: heart@cyber.net.pk
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To conduct a prospective randomised study to show the efficacy of immune suppression with prednisolone, administered at the 3-month duration of acute myocarditis.

Methods

The diagnosis of acute viral myocarditis was made based on echocardiography and serum viral antibodies. The inclusion criterion was acute myocarditis of 3 months duration. In all, 68 of 173 children were available for randomisation into a prednisolone-treated group of 44 and a control group of 24 children. The follow-up period in the prednisolone-treated group was 15.1 plus or minus 9.2 months and 13.6 plus or minus 10.6 months for the control group.

Results

Compared with controls, 1 month after randomisation significantly more children in the prednisolone-treated group increased their ejection fraction to more than 40% (p = 0.029). Discrete analysis of change in the ejection fraction from the one at randomisation to one after 1 month of randomisation of greater than 10% and less than 10% or no change between groups showed a significantly greater number with improvement in the prednisolone-treated group (p = 0.019). At the end of the follow-up visits, a significantly larger number of children in the prednisolone-treated group had an ejection fraction of more than 60% compared with the control group (p = 0.049).

Conclusion

It is concluded that immune suppression with prednisolone, administered at 3 months of the onset of acute myocarditis, is effective in significantly bringing about improvement and cure in persistent left ventricular failure.

Keywords

Acute myocarditisviral myocarditisrandomised study in acute myocarditisimmune suppression in myocarditispersistent myocarditisclinical outcome of myocarditisautoimmune-driven myocarditismyocarditis and left ventricular failure
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 5 , October 2010 , pp. 509 - 515
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Aziz, KU. Acute myocarditis in children, incidence, treatment and prognosis. A developing world problem. Pak Paed Cardiolo J 2001; 3: 121–126.Google Scholar
2. Younas, M, Rathore, AW, Sadiq, M. Acute myocarditis – the commonest cause of cardiac failure in children. Pak Paed J 2003; 27: 63–67.Google Scholar
3. Chan, KY, Iwahara, M, Benson, LN, Wilson, GJ, Freedom, RM. Immune suppressive therapy in the management of acute myocarditis in children:a clinical trial. J Am COll Cardiol 1991; 17: 458–460.CrossRefGoogle Scholar
4. Why, HJF, Meany, BT, Richardson, PJ, et al. Clinical and Prognostic significance of detection of Entero virus RNA in the myocardium of patients with myocarditis or dilated cardiomyopathy. Circulation 1999; 89: 2582–2589.CrossRefGoogle Scholar
5. Lee, K, McCrindle, B, Bohn, D, et al. Clinical outcome of acute myocarditis in children. Heart 1999; 82: 226–233.CrossRefGoogle Scholar
6. English, RF, Janosky, JE, Ettedgui, JA, Webber, SA. Outcome of children with acute myocarditis. Cardiol Young 2004; 14: 448–493.CrossRefGoogle ScholarPubMed
7. Nugent, AW, Daubeny, PEF, Chondros, P, et al. Epidemiology of childhood cardiomyopathy in Australia. New Engl J Med 2003; 348: 1639–1646.CrossRefGoogle ScholarPubMed
8. Burch, M. Immunosuppressive treatment in pediatric myocarditis Scanty Evidence. Heart 2000; 90: 1103–1104.CrossRefGoogle Scholar
9. McCarthy, RE, Boehmer, JP, Hruban, RH, et al. Long term outcome of Fulminant as compared to acute (non fulminant) Myocarditis. New Engl J Med 2000; 342: 690–695.CrossRefGoogle Scholar
10. Spotnitz, MD, Lesch, M. Idiopathic dilated cardiomyopathy as a late complication of healed viral (Coxsackie B virus) myocarditis Historical analysis, review of the literature and postulated unifying hypothesis. Prog Cardiovasc Diseases 2006; 49: 42–57.CrossRefGoogle ScholarPubMed
11. Schultheiss, HP, Kuhl, U. Over view on chronic viral cardiomyopathy. Earnest Shering Res Found Workshop 2006; 55: 3–18.CrossRefGoogle Scholar
12. Ciszewski, A, Bilinska, ZT, Lubiszewska, B, et al. Dilated cardiomyopathy in children clinical course and prognosis. Pediatr cardiol 1994; 15: 121–126.CrossRefGoogle ScholarPubMed
13. Balaji, S, Wiles, HB, Sens, MA, Gillette, PC. Immunosuppressive treatment for myocarditis in children with ventricular ectopic rhythm. Br Heart J 1994; 72: 354–359.CrossRefGoogle ScholarPubMed
14. Ino, T, Okubo, M, Akimoto, K, Nishimoto, K, Yabutak Kawais, S, Okada, R. Corticosteroid therapy for ventricular tachycardia in children with silent lymphocytic myocarditis. J Pedtiatr 1995; 126: 304–308.CrossRefGoogle ScholarPubMed
15. Liu, PP, Mason, JW. Advances in the understanding of myocarditis. Circulation 2001; 104: 1076–1082.CrossRefGoogle ScholarPubMed
16. Kawai, C. From myocarditis to Cardiomyopathy. Mechanism of inflammation and cell death. Circulation 1999; 99: 1091–1100.CrossRefGoogle Scholar
17. Feldman, AM, McNamara, D. Myocarditis. New Engl J Med 2000; 343: 1388–1398.CrossRefGoogle ScholarPubMed
18. Mason, JW, Billingham, ME, Ricci, DR, et al. Treatment of acute inflammatory myocarditis associated by endomyocardial biopsy. Am J Cardiol 1980; 45: 1037–1044.CrossRefGoogle Scholar
19. Martin, AB, Webber, S, Fricker, FY, et al. Acute myocarditis rapid diagnosis by PCR in children. Circulation 1994; 90: 330–339.CrossRefGoogle ScholarPubMed
20. Grogan, M, Redfield, MM, Baily, KR, et al. Long term outcome of patients with biopsy proven myocarditis: comparison with idiopathic dilated cardiomyopathy. J Am Coll Cardiol 1995; 26: 80–84.CrossRefGoogle Scholar
21. McNamara, DM, Holubkov, R, Starling, RC, et al. Controlled trial of intravenous immunoglobulin in recent onset dilated cardiomyopathy. Circulation 2001; 103: 2254–2259.CrossRefGoogle ScholarPubMed
22. Lauer, B, Niederau, C, Kuh, U, et al. Cardiac troponin T in patients with clinically suspected myocarditis. J Am Coll Cardiol 1997; 30: 1354–1359.CrossRefGoogle ScholarPubMed
23. Fuse, K, Kodoma, M, Okura, Y, et al. Predictors of disease course in patients with acute myocarditis. Circulation 2000; 102: 2829–2835.CrossRefGoogle ScholarPubMed
24. Hia, CPP, Yip, BCL, Tai, BC, Quek, SC. Immunosuppressive therapy in acute myocarditis; an 18 year systematic review. Arc Dis Child 2004; 89: 580–584.CrossRefGoogle ScholarPubMed
25. Ducker, NA, Colan, SD, Lewis, AB, et al. Gammaglobulin treatment of acute myocarditis in pediatric population. Circulation 1994; 89: 252–257.CrossRefGoogle Scholar
26. Takada, H, Kishimoto, C, Hiraoka, Y. Therapy with immunoglobulins suppresses myocarditis in a Murine Coxsakie virus B3 model. Circulation 1995; 92: 1604–11611.CrossRefGoogle Scholar
27. Jones, SR, Herskowitz, A, Aulchins, GM, et al. Effect of immunosuppressive therapy in biopsy proved myocarditis and borderline myocarditis on ventricular function. AM J Cardiol 1991; 68: 370–376.CrossRefGoogle ScholarPubMed
28. Maisch, B, Hafnagel, G, Schonian, U, Hengstenberg, C. The European study of Epidemiology and treatment of cardiac influmatory disease. Eur Heart J 1995; 16: 173–175.CrossRefGoogle ScholarPubMed
29. Levi, D, Alejo, SJ. An approach to the treatment of pediatric myocarditis. Paedtr Drug 2002; 4: 637–647.Google Scholar
30. Gagliardi, MG, Bevilacqua, M, Bassono, C, et al. Long term follow up of children and of children with dilated cardiomyopathy. Heart 2004; 90: 1167–1171.CrossRefGoogle ScholarPubMed
31. Kuhl, U, Pauschinger, M, Schwimmbeck, P, et al. Interferon beta treatment improves left ventricular function in patients with persistence of viral genome. Circulation 2003; 107: 2793–2798.CrossRefGoogle Scholar
32. Ellis, CR, Di Salvo, T. Myocarditis: basic and clinical aspects. Cardiol Rev 2007; 15: 170–177.CrossRefGoogle ScholarPubMed
33. Matsumori, A, Tomioka, N, Kawai, C. Protective effect of recombinant alpha interferon on Coxsackie B myocarditis in Mice. Am Heart J 1988; 115: 1229–1232.CrossRefGoogle Scholar
34. Ahdoot, J, Galindo, A, Alijos, JC, et al. Use of OKT3 for acute myocarditis in infants and children. J Heart Lung Transplant 2000; 19: 1118–1121.CrossRefGoogle ScholarPubMed