Abstract 20154: Intravenous Pentaglobin Eradicates Inflammation and Reduces Viral Load in Parvo B19 and Adenovirus Positive Myocarditis
Background: The best treatment of viral heart disease with or without inflammation is unresolved. Patients: We analysed prospectively the clinical outcome and the endomyocardial biopsies(EMBs) of 73 consecutive patients with myocarditis according to the quantitative criteria of the World Heart Federation Criteria (> 14 infiltrating cells/mm2). In 44 pts parvoviruses B19 and in 29 pts adenoviruses were assessed by quantitative PCR as causative viral pathogens. All virus positive patients were treated with 10 to 20 g/day Pentaglobin® i. v.(enriched IgG, IgA and IgM preparation, Biotest) at day 1 and 3. After six months all patients were reevalutated clinically and by EMB.
Methods: The following parameters were analyse before and after therapy: left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), shortening fraction (SF) by transthoracic echocardiography and LVEF or the left ventricular end-diastolic volume index (LVEDVI) using angiography. For exercise capacity we evaluated the exercise ECG by treadmill test and according to the NYHA classification.
Results: After i.v. Pentaglobin therapy, all patients demonstrated a significant clinical improvement of their NYHA class, of their exercise capacity and of their LVEF (from 54,4 to 60,0%l, p<0,005) independent from the respective virus. In 52 of the 73 (71%) pts inflammation had resolved. In 17 of the 19 rebiopsied patients (90%) with a positive PCR for ADV before therapy no viral DNA was recovered after treatment and inflammation had resolved completely. In Parvo B 19 myocarditis inflammation had resolved in 31 of the 44 pts (70%), whereas Parvo B19 DNA was eradicated in only in 18 out of 44 pts (40%). In patients in whom both the virus and inflammation were eradicated the enddiastolic LV dimension decreased and EF increased significantly (p<0,001).
Conclusions: Treatment with twice 10 to 20 g i.v. Pentaglobin is highly effective in resolving myocardial inflammation independent of the underlying viral etiology. However, it eradicates adenoviral infection better than Parvo B19 infection. This treatment should be tested prospectively on viral heart disease without inflammation.
- © 2010 by American Heart Association, Inc.