Korean J Pediatr.  2010 Jul;53(7):745-752. 10.3345/kjp.2010.53.7.745.

Clinical outcome of acute myocarditis in children according to treatment modalities

• Kim HJ
• Yoo GH
• Kil HR

• KMID: 2073605
• DOI: http://doi.org/10.3345/kjp.2010.53.7.745

Abstract

PURPOSE
There is currently little evidence to support intravenous immune globulin (IVIG) therapy for pediatric myocarditis. The purpose of our retrospective study was to assess the effects of IVIG therapy in patients with presumed myocarditis on survival and recovery of ventricular function and to determine the factors associated with its poor outcome.
METHODS
We reviewed all consecutive cases of patients with myocarditis with left ventricular dysfunction verified by echocardiogram who had visited 3 university hospitals between January 2000 and September 2009. These patients were divided into 2 groups. Group 1 consisted of 23 patients (69.6%) who received IVIG alone or IVIG in combination with steroids, and group 2 consisted of 10 patients (30.3%) who received neither IVIG nor other immunosuppressive agents. Clinical manifestations, laboratory results, echocardiographic findings, and outcomes were compared between these 2 groups.
RESULTS
One year after the initial presentation, the difference in the probability of survival did not show statistical significance in IVIG-treated patients (P=0.607). Of the echocardiographic parameters on admission, a shortening fraction of less than 15% was associated with unremitting cardiac failure. Furthermore, anemic patients were more likely to have elevated N-terminal fragment levels of the B-type natriuretic peptide (NT-proBNP) in the progressed group (P=0.036).
CONCLUSION
There was no difference between the IVIG-treated patients and the control patients in the degree of recovery of left ventricular function and survival. Prospective, randomized, clinical studies are needed to elucidate the effects of IVIG treatment during the acute stage of myocarditis on ultimate outcomes.

Keyword

Myocarditis; Children; Outcome; Immune globulin

MeSH Terms

Child
Heart Failure
Hospitals, University
Humans
Immunoglobulins, Intravenous
Immunosuppressive Agents
Myocarditis
Natriuretic Peptide, Brain
Retrospective Studies
Steroids
Ventricular Dysfunction, Left
Ventricular Function
Ventricular Function, Left
Immunoglobulins, Intravenous
Immunosuppressive Agents
Natriuretic Peptide, Brain
Steroids