Intravenous immunoglobulin in the therapy of adult acute fulminant myocarditis: A retrospective study

Abstract

Acute fulminant myocarditis (AFM) is a serious heart disease with limited treatment. This observational retrospective study aimed to investigate whether intravenous immunoglobulin (IVIG) was able to improve left ventricular function and reduce the episodes of arrhythmia in adult patients with AFM. The medical records of all patients with AFM who were admitted to the Critical Care Unit of Guangdong General Hospital (Guangzhou, China) between January 2001 and December 2010 were reviewed. A cohort of 58 patients was included in the study. Of these 58, 32 patients were treated with IVIG (400 mg/kg per day) for five days, while the remaining patients did not receive IVIG therapy. The patients who received IVIG therapy had a higher left ventricular ejection fraction (LVEF) and a reduced left ventricular end-diastolic diameter (LVDD) compared with the non-IVIG therapy patients four weeks subsequent to the treatment (PLVEF=0.011 and PLVDD=0.048). The post-treatment incidence of ventricular tachycardia/ventricular fibrillation (VT/VF) and atrioventricular block (AVB) was reduced in the patients who received IVIG therapy compared with the baseline values (PVT/VF=0.025, PAVB=0.003); however, no significant differences were observed in the non-IVIG therapy patients (PVT/VF=0.564, PAVB=0.083) following treatment. There were two mortalities in the IVIG therapy group and seven in the non-IVIG therapy group (P=0.072). This retrospective study suggested that the use of IVIG for the treatment of AFM may be associated with improved left ventricular function and reduced episodes of fulminant arrhythmias.

Chinese society of cardiology expert consensus statement on the diagnosis and treatment of adult fulminant myocarditis

“…A retrospective study of 58 fulminant myocarditis patients in Guangdong province of China revealed that compared with patients who did not receive IVIG, patients treated with 400 mg kg -1 IVIG had a remarkable improvement in LVEF and LVEDD after 4 weeks (P=0.011 and 0.048, respectively). In addition, the incidence rate of ventricular tachycardia or fibrillation decreased significantly in the treatment group (P=0.025), and there was a clear tendency toward decreased mortality that did not reach statistical significance (6% vs. 27%, P=0.072) (Yu et al, 2014). Treatment with IVIG should be administered in sufficient doses as early as possible.…”

Intravenous Immunoglobulin Therapy for Acute Myocarditis in Children and Adults

“…A retrospective study indicated that applying IVIG to AFM patients may improve left ventricular function and reduce the incidence of fulminant arrhythmias. 7) Nevertheless, another two randomized controlled trials (RCTs) in pediatric or adult patients reported inconsistent results. 8,9) In those studies, no remarkable difference in survival rate was found, and there was no rigorous evidence indicating whether IVIG could amplify the improvement in left ventricular function.…”

Effect of Acute Immunosuppression on Left Ventricular Recovery and Mortality in Fulminant Viral Myocarditis: A Case Series and Review of Literature

“…Of note, a total of 27 patients that did not receive immunosuppressive treatment were included in two of those studies. 53,56 Seven patients died in this control group, suggesting a mortality rate of 26%. Various immunosuppressive regimens were studied in the last decades, and their role in recent-onset idiopathic or inflammatory cardiomyopathy remains highly controversial.…”