Márquez-González H, López-Gallegos D, González-Espinosa AMD, Zamudio-López JO, Yáñez-Gutiérrez L

Language: Spanish
References: 22
Page: 296-301
PDF size: 302.86 Kb.

ABSTRACT

Background: Myocarditis is the inflammation of the myocardial tissue, primarily caused by viral infection. Dilated cardiomyopathy (MD) is the most serious complication. Immunomodulatory therapy is not validated in these patients; however, it appears to offer benefits in the prognosis of this disease. The aim of this work was to determine the prognosis of immunomodulatory therapy in the development of MD in pediatric patients with viral myocarditis effect.
Methods: A retrospective cohort of patients between 4 and 17 years diagnosed with viral myocarditis was integrated. It was considered as the main exposure treatment, which was divided into two types: normal (drugs targeted for heart failure and antiviral exclusively) and immunomodulatory (hyperimmune immunoglobulin, azathioprine and prednisone plus usual treatment). Time between diagnosis and treatment, history of asystole and positive for enterovirus and adenovirus antibodies: as measured confounders. The follow-up was 48 months. The outcome variable was the MD (LV diastolic diameter › + 2 Z-score and positive biopsy).
Results: 31 patients were obtained with a median of 5 (4-15) years; 6 received immunomodulatory therapy and regular rest. The MD was presented in 17% of patients exposed to immunomodulatory therapy vs. 35% traditional, with HR = 0.5 (0.1-0.7).
Conclusions: Inmunodulatory therapy is a protective factor for MD in patients with viral myocarditis.

REFERENCES

1. Batra AS, Lewis AB. Acute miocarditis. Currence Opinion in pediatrics. 2001;13(3):234-9.

2. Escher F, Tschöepe C, Lassner D, Schultheiss HP. Myocarditis and inflammatory cardiomyopathy: from diagnosis to treatment. Turk Kardiyol Dern Ars. 2015; 43(8):739-48.

3. Towbin JA, Lowe AM, Colan SD, Sleeper LA, Orav EJ, Clunie S,et al. Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA. 2006; 296(15):1867-76.

4. Karjalainen J, Heikkilä J. Incidence of three presentations of acute myocarditis in young men in military service. A 20-year experience. Eur Heart J .1999;20 (15):1120-5.

5. Liu PP, Mason JW. Advances in the Understanding of Myocarditis. Circulation. 2001;104(09):1076-1082.

6. Kühl U, Lassner D, Wallaschek N, Gross UM, Krueger GR, Seeberg B, et al. Chromosomally integrated human herpesvirus 6 in heart failure: Prevalence and treatment. Eur J Heart Fail. 2015;17(1):9-19.

7. Cooper LT Jr, Hare JM, Tazelaar HD, Edwards WD, Starling RC, Deng MC, et al. Usefulness of immunosuppression for giant cell myocarditis. Am J Cardiol. 2008;102(11):1535-9.

8. Ross RD, Bollinger PO, Pinsly WW. Grading the severity of congetive heart failure in infants. Pediatr Cardiol. 1992;13:72-5.

9. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D et al. Contemporary definitions and classification of the cardio- myopathies: An American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Trans- plantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113(14):1807-1816.

10. Karjalainen J, Heikkilä J. Incidence of three presentations of acute miocarditis in young men in military service. A 20 year experience. Eur Heart J. 1999; 20:1120-1125.

11. Eleftheriu AE, Stamatelopolous SF. Rapid recovery from acute, potentially lethal miocarditis. J Int Med Res. 2009;37:1522-1525.

12. Guillén-Ortega F, Soto ME, Reyes PA. Primary acute myocarditis. A 10-years institutional experience. Arch Cardiol Mex. 2005;75(Suppl 3):S81-8.

13. Chen HS, Wang W, Wu SN, Liu JP. Corticosteroids for viral myocarditis. Cochrane Database of Systematic Reviews 2013;18(10)CD004471. DOI: 10.1002/14651858.CD004471.

14. Mason JW, O’Connell JB, Herskowitz A, Rose NR, McManus BM, Billingham ME et al. A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators. N Engl J Med. 1995;333:269-275.

15. Frustaci A, Russo MA. Chimenti C. Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. Eur Heart J. 2009; 30 (16):1995-2002.

16. Kim H, Sohn S, Park J, Seo J. Fulminant myocarditis successfully treated with high-dose immunoglobulin. Int J Cardiol. 2004;96(3):485-6.

17. Goland S, Czer I, Siegel R, Tabak S, Jordam S, Luthringer D et al. Intravenous inmunoglobulin treatment for acute fulminant inflammatory cardiomyopathy: series of six patients and review of literatura. Can J Cardiol. 2008;24(7):571-4.

18. Eleftheriou AE, Stamatelopoulos SF. Rapid recovery from acute, potentially lethal myocarditis. J Int Med Res. 2009;37(5):1522-25.

19. Kishimoto C, Shioji K, Hashimoto T, Nonogi H, Lee JD, Kato S et al. Therapy with immunoglobulin in patients with acute myocarditis and cardiomyopathy: analysis of leukocyte balance. Heart Vessels. 2014; 29(3):336-42.

20. Dennert R, Velthuis S, Schalla S, Eurlings L, van Suylen, RJ, van Paassen P et al. Intravenous immunoglobulin therapy for patients with idiopathic cardiomyopathy and endomyocardial biopsy-proven high PVB19 viral load. Antivir Ther. 2010;15(2):193-201.

21. McNamara DM, Holubkov R, Starling RC, Dec GW, Loh E, Torre-Amione G et al. Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy. Circulation. 2001;103(18):2254-2259.

22. Kishimoto C, Shioji K, Kinoshita M, Iwase T, Tamaki S, Fujii M et al. Treatment of acute inflammatory cardiomyopathy with intravenous immunoglobulin ameliorates left ventricular function associated with suppression of inflammatory cytokines and decreased oxidative stress. Int J Cardiol. 2003;91:173-178.