Treatment Of Acute Myocarditis Research Articles

Management of acute myocarditis: a systematic review of clinical practice guidelines and recommendations.

The management of acute myocarditis (AM) is addressed in multiple clinical guidelines. We systematically reviewed current guidelines developed by national and international medical organizations on the management of AM to aid clinical practice. Publications in MEDLINE, EMBASE and Cochrane were identified between 1 January 2013 and 12 April 2024. Additionally, the websites of relevant organizations and the Guidelines International Network, Guideline Central, and NHS knowledge and library hub were reviewed. Two reviewers independently screened titles and abstracts, two reviewers assessed the rigour of guideline development, and one reviewer extracted the recommendations. Two of the three guidelines identified showed good rigour of development. Those rigorously developed agreed on the definition of AM, sampling serum troponin as part of the workflow for AM, testing for B-type natriuretic peptides in heart failure, key diagnostic imaging in the form of cardiovascular magnetic resonance, coronary angiography to exclude significant coronary disease, indications for endomyocardial biopsy (EMB), and indications for immunosuppression and advanced treatment options. Discrepancies exist in sampling creatine kinase-myocardial bound as a marker of myocardial injury, indications for EMB, and indications for immunosuppression and treatment of uncomplicated AM. Evidence is lacking for the use of 18F-Fluorodeoxyglucose Positron Emission Tomography for myocardial imaging, exercise restriction, follow-up measures and genetic testing, and there are few high-quality randomized trials to support treatment recommendations. Recommendations for management of AM in the guidelines have largely been developed from expert opinion rather than trial data.

ASSESSMENT OF CLINICAL FEATURES AND TREATMENT OPTIMIZATION OF ACUTE VARICELLA-ZOSTER VIRUS MYOCARDITIS: AN OBSERVATIONAL STUDY

The purpose of the study: to explore the frequency of development, features of the clinical course and treatment of acute myocarditis in adults with chickenpox. Materials and methods. This study included 240 patients with chickenpox between the ages of 18 and 40 years. Clinical, biochemical, molecular genetics and instrumental examination methods were used for assessment. Examination of selected patients was carried out in the acute period, after normalization of body temperature and before being discharged from the hospital. Student’s t test was used for statistical evaluation. Results and discussion. Acute myocarditis was diagnosed in 16.6% of patients with chickenpox caused by Varicella-zoster virus. A high correlation has been revealed between the severity of chickenpox and the frequency of development, as well as the severity of acute myocarditis in adults. Conclusions. An increase in CRP, sialic acid and fibrinogen in the blood serum of chickenpox patients reflects the severity of the disease, but is not specific for myocarditis. Treatment of acute myocarditis in patients with chickenpox should be early and comprehensive.

Acute myocarditis in children: problems of diagnosis and treatment

Acute myocarditis by the World Health Organization is an inflammatory disease of the heart muscle, confirmed by histologically, immunologically and immunohistochemically. The diagnosis of acute myocarditis in children remains open due to the presence of a number of reasons. First of all, it is difficult to diagnose myocarditis in children due to the variety of clinical manifestations and the presence of nonspecific symptoms of the disease. What matters is the lack of accessibility in the routine practice of a doctor of certain research methods and a sharp limitation in the use of endomyocardial biopsy. The search for differential diagnostic algorithms of the disease continues. According to modern literature, much attention is paid to non-invasive methods for the diagnosis of acute myocarditis in children. The course of acute myocarditis can be complicated by life-threatening cardiac arrhythmias: ventricular extrasystole, lengthening of the corrected QT interval, atrioventricular block. The appearance of cardiac arrhythmias increases the risk of sudden cardiac death. Recommendations for the treatment of myocardium in children often undergo changes due to the small number of multicenter and controlled studies in the pediatric population. The article provides an overview of modern approaches to the treatment of acute myocarditis in children: the use of antiviral drugs, intravenous immunoglobulin, immunosuppressive therapy, especially the treatment of heart failure in acute myocarditis in children.

P3514Diagnosis and treatment of acute myocarditis in Portugal. Data from the national multicenter registry on myocarditis

P3514Diagnosis and treatment of acute myocarditis in Portugal. Data from the national multicenter registry on myocarditis

Abstract 15011: Intravenous Immunoglobulin for Acute Myocarditis is Associated With Increased Resource Utilization but Equivalent Survival: An Outcome Analysis Amongst U.S. Children’s Hospitals

Introduction: Intravenous immunoglobulin (IVIg) is frequently utilized in the treatment of pediatric acute myocarditis (AM) though the data surrounding the efficacy of intravenous immunoglobulin (IVIg) are equivocal. Hypothesis: IVIg utilization does not improve survival in pediatric AM but is associated with increased resource utilization. Methods: A retrospective review of the Pediatric Health Information System database was performed for children <18 years hospitalized with AM between 2004 and 2014. A 1:1 propensity matched case control design was used to compare children who received IVIg (IVIg-group) to those who did not receive IVIg (no IVIg-group). The propensity score was based on a model including treatment with mechanical ventilation (MV), inotropes, or mechanical circulatory support (MCS). High- and low-use hospitals were defined by quartiles of percent usage of IVIg. Results: A total of 1802 children with AM were identified (median age 8y [IQR 1 - 15]; 60% male, 60% IVIg given, 65% inotrope use, 46% MV use, 16% MCS use). After matching, 552 children were included in both the IVIg-group and no IVIg-group. Overall median follow-up of the matched cohort was 1.4y [IQR 0.4-3.4]. Unadjusted in-patient mortality was similar between groups (6% vs. 9%, p=0.09). On multivariable Cox regression, there was no association between IVIg and follow-up mortality (OR 1.0, 95%CI 0.3- 2.9). Although in-patient cardiac transplantation occurred more frequently in the IVIg-group (2% vs. 0%, p<0.001), there was no association between IVIg and cardiac transplantation during the follow up period (OR 0.5, 95%CI 0.2-1.1). Mortality was similar between high- and low-use centers (6% vs. 8%, p=0.316) as was length of stay (7d [IQR 8-18] vs. 7d [4-18], p=0.771). Total charges, as well as pharmacy charges, were significantly higher in the IVIg-group ($125k vs. $77k, $32k vs. $2.8k; p<0.001 for both) and high-use centers ($125k vs. $112k, p=0.025; $27k vs. $5.1k, p<0.001). Conclusions: IVIg is frequently utilized in children for the treatment of AM. Overall survival was similar in patients treated and not treated with IVIg, though resource utilization was significantly increased. Further study is needed to assess the most optimal, cost-effective treatment for AM in children.

症例 IABP,ペースメーカー植え込みによる急性心筋炎の治療

症例 IABP,ペースメーカー植え込みによる急性心筋炎の治療

Neutrophils Sustain Pathogenic CD8 + T Cell Responses in the Heart

This study explores the influence of innate immunity on CD8(+) T-cell responses against heart tissue. Adoptive transfer of ovalbumin-specific CD8(+) effector T cells into CMy-mOva mice, which express ovalbumin in cardiac myocytes, results in a lethal acute myocarditis. The inflammatory infiltrate in the heart includes neutrophils as well as T cells. We used anti-Ly6G antibody to transiently deplete neutrophils at the time of onset of disease. By day 7 after receiving 5 x 10(5) CD8(+) effector T cells, 100% of control Ig-treated CMy-mOva mice had died, while 85% of anti-Ly6G-treated mice survived indefinitely. CD8(+) T-cell infiltration and tissue damage were present in both groups, but the disease was limited in the anti-Ly6G-treated mice, with a rapid disappearance of the adoptively transferred CD8(+) T cells within 11 days. Recovery occurred even though blood neutrophil counts began to rise 48 hours after the last anti-Ly6G treatment. Recovery was associated with a chronic CD4(+) cell infiltrate, and a rapid decline in expression of IFN-gamma and IP-10 mRNA in the myocardium. Neutrophil depletion did not effect survival of CMy-mOva mice that received 3 x 10(6) CD8(+) T cells. These data show that granulocytic inflammation sustains CD8(+) T-cell-mediated heart disease, which has important implications for the pathogenesis and treatment of acute myocarditis and allograft rejection.

High‐dose intravenous immunoglobulin in the treatment of acute myocarditis. A case report and review of the literature

A few reports have suggested the beneficial effect of high-dose intravenous immunoglobulin (IVIG) in the treatment of acute myocarditis and cardiomyopathy. We describe a 49-year-old woman in which acute myocarditis was diagnosed on the basis of clinical and echocardiographic findings. Conventional treatment with captopril and frusemide was administered: intravenous heparin and, subsequently, oral anticoagulants were added because of the appearance of an apical thrombus. On the fifth day of hospitalization, treatment with high-dose (400 mg kg(-1) day(-1)) IVIG was started and prosecuted for 5 days. A dramatic improvement of clinical conditions was observed, with increase of the left ventricular ejection fraction (LVEF) from 30% to 75% within 1 week. One year after the diagnosis the patient is in good health, with steady normal LVEF. The rapid recovery, which was immediately subsequent to the administration of high-dose IVIG, suggests that this kind of treatment has been effective in our patient with acute myocarditis.

Temporary mechanical support with the BVS 5000 assist device during treatment of acute myocarditis.

Ventricular support with the BVS 5000 (Abiomed) has been used as temporary circulatory assist for the failing heart. Our purpose is to summarize four cases illustrating the role of mechanical unloading in acute myocarditis. Four patients aged 16- to 33-year old presented with congestive heart failure 4 to 20 days after a flu-like syndrome. All patients were in severe cardiogenic shock +/- renal and liver dysfunction. Ejection fraction ranged from 5% to 26%. Indications for ventricular assist were failure of maximal medical treatment with > or = two inotropes +/- intra-aortic balloon pump. Myocardial biopsy revealed acute myocarditis in three patients and severe edema in one despite a characteristic clinical course. Two patients received immunotherapy with OKT3. Biventricular assist was used in three patients and left ventricular assist only was used in one. Mean support time was 8.3 days (7 to 11). All patients had recovery of myocardial function and were discharged from the hospital in good condition. The BVS 5000 device provides a safe, simple, and effective method to support the circulation during acute myocarditis. We hypothesize that this may facilitate myocardial recovery by decompressing the distended ventricle. Ventricular assist devices should be used early in the presence of hemodynamic deterioration on maximal medical therapy.