Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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Clinical outcome of acute myocarditis in children according to treatment modalities

  • Kim, Hyun-Jung (Department of Pediatrics, Eulji University School of Medicine) ;
  • Yoo, Gyeong-Hee (Department of Pediatrics, Soonchunhyang University School of Medicine) ;
  • Kil, Hong-Ryang (Department of Pediatrics, Chungnam University School of Medicine)
  • 투고 : 2009.11.16
  • 심사 : 2010.03.17
  • 발행 : 2010.07.15
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초록

Purpose: There is currently little evidence to support intravenous immune globulin (IVIG) therapy for pediatric myocarditis. The purpose of our retrospective study was to assess the effects of IVIG therapy in patients with presumed myocarditis on survival and recovery of ventricular function and to determine the factors associated with its poor outcome. Methods: We reviewed all consecutive cases of patients with myocarditis with left ventricular dysfunction verified by echocardiogram who had visited 3 university hospitals between January 2000 and September 2009. These patients were divided into 2 groups. Group 1 consisted of 23 patients (69.6%) who received IVIG alone or IVIG in combination with steroids, and group 2 consisted of 10 patients (30.3%) who received neither IVIG nor other immunosuppressive agents. Clinical manifestations, laboratory results, echocardiographic findings, and outcomes were compared between these 2 groups. Results: One year after the initial presentation, the difference in the probability of survival did not show statistical significance in IVIGtreated patients ($P$=0.607). Of the echocardiographic parameters on admission, a shortening fraction of less than 15% was associated with unremitting cardiac failure. Furthermore, anemic patients were more likely to have elevated N-terminal fragment levels of the B-type natriuretic peptide (NT-proBNP) in the progressed group ($P$=0.036). Conclusion: There was no difference between the IVIG-treated patients and the control patients in the degree of recovery of left ventricular function and survival. Prospective, randomized, clinical studies are needed to elucidate the effects of IVIG treatment during the acute stage of myocarditis on ultimate outcomes.

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참고문헌

  1. Theleman KP, Kuiper JJ, Roberts WC. Acute myocarditis ( predominately lymphocytic) causing sudden death without heart failure. Am J Cardiol 2001;88:1078-83. https://doi.org/10.1016/S0002-9149(01)02000-8
  2. Doolan A, Langlois N, Semsarian C. Causes of sudden cardiac death in young Australians. Med J Aust 2004;180:110-2.
  3. O'Connell JB, Robinson JA, Henkin RE, Gunnar RM. Immuno-suppressive therapy in patients with congestive cardiomyopathy and myocardial uptake of gallium-67. Circulation 1981;64:780-6. https://doi.org/10.1161/01.CIR.64.4.780
  4. Anderson JL, Fowles RE, Unverferth DV, Mason JW. Immunosuppressive therapy of myocardial inflammatory disease: initial experience and future trials to define indication for therapy. Eur Heart J 1987;8:263-6. https://doi.org/10.1093/eurheartj/8.suppl_J.263
  5. Hirschman SZ, Hammer GS. Coxsackie virus myopericarditis: a microbiological and clinical review. Am J Cardiol 1974;34:224-32. https://doi.org/10.1016/0002-9149(74)90201-X
  6. Lerner AM. Coxsackievirus myocardiopathy. J Infect Dis 1969;120:496-9. https://doi.org/10.1093/infdis/120.4.496
  7. Voight GC. Steroid therapy in viral myocarditis. Am Heart J 1968;75:575-6.
  8. Weller AH, Hall M, Huber SA. Polyclonal immunoglobuliin therapy protects against cardiac damage in experimental coxsackievirus-induced myocarditis. Eur Heart J 1992;13:115-9. https://doi.org/10.1093/oxfordjournals.eurheartj.a060030
  9. Kampmann C, Wiethoff CM, Wenzel A, Stolz G, Betancor M, Wippermann CF, et al. Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe. Heart 2000;83:667-72. https://doi.org/10.1136/heart.83.6.667
  10. Liu PP, Mason JW. Advances in the understanding of myocarditis. Circilation 2001;104:1076-82. https://doi.org/10.1161/hc3401.095198
  11. Amsel SG, Hanukoglu A, Fried D, Wolyvovics M. Myocarditis after triple immunisation. Arch Dis Child 1986;61:403-5. https://doi.org/10.1136/adc.61.4.403
  12. Friedman RA, Duff DF, Schowengerdt KO Jr, Vallejo JG, Towbin JA. Myocarditis. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL, editors. Textbook of pediatric infectious disease. 5th ed. Philadelphia : Saunders, 2004:390-413.
  13. Akhtar N, Ni J, Stromberg D, Rosenthal GL, Bowles NE, Towbin JA. Tracheal aspirate as a substate for polymerase chain reaction detection of viral genome in childhood pneumonia and myocarditis. Circulation 1999;99:2011-8. https://doi.org/10.1161/01.CIR.99.15.2011
  14. Knowlton KU, Lim B-K. Viral myocarditis: is infection of the heart required? J Am Coll Cardiol 2009;53:1227-8. https://doi.org/10.1016/j.jacc.2008.12.035
  15. Caforio AL, Goldman JH, Haven AJ, Baig KM, Libera LD, McKenna WJ. Circulating cardiac-specific autoantibodies as markers of autoimmunity in clinical and biopsy-proven myocarditis. The Myocarditis Treatment Trial Investigators. Eur Heart J 1997;18:270-5. https://doi.org/10.1093/oxfordjournals.eurheartj.a015230
  16. Seong IW, Choe SC, Jeon ES. Fulminant coxsackieviral myocarditis. N Eng J Med 2001;345:379. https://doi.org/10.1056/NEJM200108023450518
  17. Friedman RA, Kearney DL, Moak JP, Fenrich FAL, Perry JC. Persistence of ventricular arrhythmia after resolution of occult myocarditis in children and young adults. J Am Coll Cardiol 1994;24:780-3. https://doi.org/10.1016/0735-1097(94)90029-9
  18. Lauer B, Niederau C, Kuhl U, Schannwell M, Pauschinger M, Strauer B, et al. Cardiac troponin T in patients with clinically suspected myocarditis. J Am Coll Cardiol 1997;30:1354-9. https://doi.org/10.1016/S0735-1097(97)00317-3
  19. Pinamonti B, Alberti E, Cigalotto A, Dreas L, Salvi A, Silvestri F, et al. Echocardiographic findings in myocarditis. Am J Cardiol 1988;62:285-91. https://doi.org/10.1016/0002-9149(88)90226-3
  20. James KB, Lee K, Thomas JD, Hobbs RE, Rincon G, Bott-Silverman C, et al. Left ventricular diastolic dysfunction in lymphocytic myocarditis as assessed by Doppler echocardiography. Am J Cardiol 1994;73:282-5. https://doi.org/10.1016/0002-9149(94)90234-8
  21. Lieback E, Hardouin I, Meyer R, Bellach J, Hetzer R. Clinical value of echocardiographic tissue characterization in the diagnosis of myocarditis. Eur H J 1996;17:135-42. https://doi.org/10.1093/oxfordjournals.eurheartj.a014671
  22. Felker GM, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Baughman KL, et al. Echocardiographic findings in fulminant and acute myocarditis. J Am Coll Cardiol 2000;36:227-32. https://doi.org/10.1016/S0735-1097(00)00690-2
  23. Cappola TP, Felker GM, Kao WHL, Hare JM, Baughman KL, Kasper EK. Pulmonary hypertension and risk of death in cardiomyopathy: patients with myocarditis are at higher risk. Circulation 2002;105:1663-8. https://doi.org/10.1161/01.CIR.0000013771.30198.82
  24. Shanes JG, Gahli J, Billingham ME, Ferrans VJ, Fenoglio JJ, Edwards WD, et al. Interobserver variability in the pathologic interpretation of endomyocardial biopsy results. Circulation 1987;75:401-5. https://doi.org/10.1161/01.CIR.75.2.401
  25. Bowles NE, Ni J, Kearney DL, Pauschinger M, Schultheiss HP, McCarthy R, et al. Detection of viruses in myocardial tissues by polymerase chain reaction: evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol 2003;42:466-72. https://doi.org/10.1016/S0735-1097(03)00648-X
  26. Pankuweit S, Lamparter S, Schoppet M, Maisch B. Parvovirus B19 genome in endomyocardial biopsy specimens. Circulation 2004;109:e179. https://doi.org/10.1161/01.CIR.0000124881.00415.59
  27. Cowie M, Mendez G. BNP and congestive heart failure. Curr Prob Cardiol 2003;28:264-310. https://doi.org/10.1016/j.cpcardiol.2003.09.001
  28. Cowie M, Journain P, Maisel A, Dahlstrom U, Follath F, Isnard R, et al. Clinical applications of B-type natriuretic peptide (BNP) testing. Eur Heart J 2003;24:1710-8. https://doi.org/10.1016/S0195-668X(03)00476-7
  29. Mukoyama M, Nakao K, Saito Y, Ogawa Y, Hosoda K, Suga S, et al. Increased human brain natriuretic peptide in congestive heart failure. N Engl J Med 1990;323:757-8. https://doi.org/10.1056/NEJM199009133231114
  30. Ralli S, Horwich TB, Fonarow GC. Relationship between anemia, cardiac troponin I, and B-type natriuretic peptide levels and mortality in patients with advanced heart failure. Am Heart J 2005;150:1220-7. https://doi.org/10.1016/j.ahj.2005.01.049
  31. Androne AS, Katz SD, Lund L, LaManca J, Hudaihed A, Hryniewicz K, et al. Hemodilution is common in patients with advanced heart failure. Circulation 2003;107:226-9. https://doi.org/10.1161/01.CIR.0000052623.16194.80
  32. Kuhn B, Shaporo ED, Walls TA, Friedman AH. Predictors of outcome of myocarditis. Pediatr Cardiol 2004;25:379-84.
  33. Kwon BS, Lee CH, Choi EY, Lee JH, Jin SM, Bae EJ, et al. Acute myocarditis in children: clinical aspects and outcomes. J Korean Pediatr Heart 2005;9:132-9.
  34. Drucker NA, Colan SD, Lewis AB, Beiser AS, Wessel DL, Takahashi M, et al. $\gamma$-globulin treatment of acute myocarditis in the pediatric population. Circulation 1994;89:252-7. https://doi.org/10.1161/01.CIR.89.1.252
  35. Kim HS, Sohn S, Park JY, Seo JW. Fulminant myocarditissuccessfully treated with high-dose immunoglobulin. Int J Cardiol 2004;96:485-6. https://doi.org/10.1016/j.ijcard.2003.05.037
  36. McNamara DM, Holubkov R, Starling RC, Des GW, Loh E, Torre-Amione G, et al. Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy. Circulation 2001;103:2254-9. https://doi.org/10.1161/01.CIR.103.18.2254

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  3. Acute Myopericarditis caused by Human Metapneumovirus vol.48, pp.1, 2010, https://doi.org/10.3947/ic.2016.48.1.36
  4. Preventing pediatric cardiomyopathy: a 2015 outlook vol.14, pp.3, 2010, https://doi.org/10.1586/14779072.2016.1129899
  5. Experts’ recommendations for the management of cardiogenic shock in children vol.6, pp.None, 2016, https://doi.org/10.1186/s13613-016-0111-2
  6. Role of intravenous immunoglobulin therapy in the survival rate of pediatric patients with acute myocarditis: A systematic review and meta-analysis vol.9, pp.None, 2010, https://doi.org/10.1038/s41598-019-46888-0
  7. Intravenous Immunoglobulin Therapy for Acute Myocarditis in Children and Adults : A Meta-Analysis vol.60, pp.2, 2010, https://doi.org/10.1536/ihj.18-299
  8. Paroxysmal Seizure-Like Activities Caused by Unrecognized Acute Myocarditis Masquerading as Febrile Seizures in Children vol.27, pp.4, 2010, https://doi.org/10.26815/acn.2019.00129
  9. Pediatric Myocarditis Protocol: An Algorithm for Early Identification and Management with Retrospective Analysis for Validation vol.41, pp.2, 2010, https://doi.org/10.1007/s00246-019-02258-1
  10. Diagnosis, Evaluation, and Treatment of Myocarditis in Children vol.67, pp.5, 2010, https://doi.org/10.1016/j.pcl.2020.06.013