Outcomes for children with acute myocarditis

Abstract

The optimum treatment for myocarditis in children is unknown. We present outcomes for this disease as seen in a large series of children. Thus, we identified all children seen with myocarditis at Children's Hospital of Pittsburgh since 1985, including only those with biopsy-proven myocarditis, or cardiac dysfunction and proof of concomitant cardiotropic viral infection. Outcomes were defined as complete recovery, incomplete recovery, and death or transplantation. We identified 41 patients, 37 proven by histology, and 4 patients who were too unstable for biopsy but had proof of viral infection. Of the group, 27 (66%) made a complete recovery, 4 (10%) had incomplete recovery, and 10 (24%) either died (5) or underwent transplantation (5). The median time to death or transplantation was 8.4 months, with a range from 1 day to 49 months. Steroids had been administered to 16 patients, of whom 10 made a complete recovery, 2 an incomplete recovery, 2 died, and 2 were transplanted. Intravenous immune globulin was given in isolation to one patient, who made a complete recovery, and to 18 in combination with steroids, of whom 12 made a complete recovery, 2 an incomplete recovery, 2 died, and 2 were transplanted. The remaining 6 patients received neither steroids nor intravenous immune globulin, and of these, 4 made a complete recovery, 1 was transplanted, and 1 died. Freedom from death or transplantation was 81% at 1 year, and 74% at 5 years, with no difference between the modes of treatments. The median time to recovery of function was also comparable between the groups. Thus, in our patients, treatment with intravenous immune globulin appeared to confer no advantage to steroid therapy alone. These data emphasise the need for randomised trials to assess the efficacy of current treatments, as well as that of new therapies.

Diagnosis and Treatment of Myocarditis in Children in the Current Era

“…78 Acute myocarditis in children has been associated with a good prognosis with a good chance for ultimate recovery of left ventricular dysfunction. 12,74,77,79,80 Within the North American Pediatric Cardiomyopathy Registry (PCMR; 43 Figure 1), 372 myocarditis patients diagnosed by biopsy (n=119) or clinical criteria (n=253) were compared with 1123 patients diagnosed with idiopathic dilated cardiomyopathy. Outcomes were similar in the biopsy and clinically diagnosed myocarditis patients and substantially better than in children diagnosed with idiopathic dilated cardiomyopathy.…”

“…A 2005 meta-analysis of the use of IVIG for acute myocarditis in children or adults 132,133 could not find enough evidence to recommend its routine use for acute myocarditis. Furthermore, a benefit of IVIG therapy cannot be discerned in recent single-center 80 and multicenter 43,77 outcome studies of pediatric myocarditis.…”

Indications for Heart Transplantation in Pediatric Heart Disease

“…33 Symptoms appear to provide poor prognostic capability because even asymptomatic patients with incidental discovery of dilated cardiomyopathy can have a poor prognosis. 34 Studies [35][36][37] of pediatric myocarditis suggest a 50% to 80% chance for resolution of their dilated cardiomyopathies within 2 years after presentation. Interestingly, an acute presentation with severe symptomatology, so-called fulminant myocarditis, 37 has a high likelihood of resolution.…”

Experience in the Observation of Acute and Fulminant Myocarditis in Children

“…Постмиокардитическая дилатационная кардиомиопатия сформировалась у 14,3% наблюдав-шихся в катамнезе детей, что согласуется с резуль-татами наблюдений R. English и соавт. -у 10% [12]. Резидуальная сердечная недостаточность 2-го функционального класса сохранялась через 6 мес -3 года от дебюта болезни у 21,4%, что мало отлича-ется от данных T. Saji и соавт.…”

“…При этом установлено, что внутри-венный иммуноглобулин не является эффективным в долговременном прогнозе [11]. Несмотря на обна-деживающие результаты иммуносупрессивной либо противовирусной терапии в специфических клиниче-ских ситуациях, согласно последним данным, требует-ся продолжение больших рандомизированных иссле-дований для оценки этих видов лечения по строгим клиническим показаниям [12].…”