Circulation, Vol 89, 252-257, Copyright © 1994 by American Heart Association
NA Drucker, SD Colan, AB Lewis, AS Beiser, DL Wessel, M Takahashi, AL Baker, AR Perez-Atayde and JW Newburger
BACKGROUND: Myocardial damage in myocarditis is mediated, in part, by
immunological mechanisms. High-dose intravenous gamma-globulin (IVIG) is an
immunomodulatory agent that is beneficial in myocarditis secondary to
Kawasaki disease, as well as in murine myocarditis. Since 1990, the routine
management of presumed acute myocarditis at Children's Hospital, Boston,
and Children's Hospital, Los Angeles, has included administration of
high-dose IVIG. METHODS AND RESULTS: We treated 21 consecutive children
presenting with presumed acute myocarditis with IVIG, 2 g/kg, over 24
hours, in addition to anticongestive therapies. A comparison group
comprised 25 recent historical control patients meeting identical
eligibility criteria but not receiving IVIG therapy. Left ventricular
function was assessed during five time intervals: 0 to 7 days, 1 to 3
weeks, 3 weeks to 3 months, 3 to 6 months, and 6 to 12 months. At
presentation, the IVIG and non-IVIG groups had comparable left ventricular
enlargement and poor fractional shortening. Compared with the non-IVIG
group, those treated with IVIG had a smaller mean adjusted left ventricular
end- diastolic dimension and higher fractional shortening in the periods
from 3 to 6 months (P = .008 and P = .033, respectively) and 6 to 12 months
(P = .072 and P = .029, respectively). When adjusting for age, biopsy
status, intravenous inotropic agents, and angiotensin-converting enzyme
inhibitors, patients treated with IVIG were more likely to achieve normal
left ventricular function during the first year after presentation (P =
.03). By 1 year after presentation, the probability of survival tended to
be higher among IVIG-treated patients (.84 versus .60, P = .069). We
observed no adverse effects of IVIG administration. CONCLUSIONS: These data
suggest that use of high-dose IVIG for treatment of acute myocarditis is
associated with improved recovery of left ventricular function and with a
tendency to better survival during the first year after presentation.
ARTICLES
Gamma-globulin treatment of acute myocarditis in the pediatric population
Department of Cardiology, Children's Hospital, Boston, Mass. 02115.
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