title: Intravenous immunoglobulin treatment for acute fulminant inflammatory cardiomyopathy: series of six patients and review of literature.
abstract: BACKGROUND
  Although an autoimmune mechanism has been postulated for myocarditis and acute-onset inflammatory dilated cardiomyopathy (DCM), immunomodulatory treatment strategies are still under investigation.
  
  
  RESULTS
  The clinical data of six patients with acute inflammatory DCM referred for evaluation for possible heart transplantation were reviewed. All patients were admitted with acute congestive heart failure and severely impaired left ventricular (LV) function and were treated with high-dose (2 g/kg) intravenous immunoglobulin (IVIG). The diagnosis of acute inflammatory DCM was based on recent onset of congestive heart failure (New York Heart Association functional class III or IV) with severely depressed LV ejection fraction ([LVEF] 30% or lower) occurring shortly after viral-like illness. All patients had inflammation on endomyocardial biopsy or elevated cardiac enzymes, as well as a normal coronary angiogram. All patients were in New York Heart Association class I or II at the time of hospital discharge. The mean LVEF improved from 21.7+/-7.5% at baseline to 50.3+/-8.6% at discharge (P=0.005). Four patients had complete recovery (LVEF 50% or higher) and two patients had partial LV recovery. Patients were followed for a median 13.2 months (range two to 24 months) and had a mean LVEF of 53+/-6% (P not significant versus LVEF at discharge).
  
  
  CONCLUSIONS
  Therapy with intravenous high-dose IVIG may be a potentially useful treatment in selected patients if given early in the course of acute fulminant inflammatory DCM. A randomized, prospective trial is warranted to prove the real benefit of IVIG in this patient population.
authors.affiliation: Division of Cardiology, Universigy of California, Los Angeles, CA 90048, USA.
authors.forename: Sorel
authors.initials: S
authors.lastname: Goland
authors.forename: Lawrence S C
authors.initials: LS
authors.lastname: Czer
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
authors.forename: Steven
authors.initials: S
authors.lastname: Tabak
authors.forename: Stanley
authors.initials: S
authors.lastname: Jordan
authors.forename: Daniel
authors.initials: D
authors.lastname: Luthringer
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Bernice
authors.initials: B
authors.lastname: Coleman
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kass
authors.forename: Alfredo
authors.initials: A
authors.lastname: Trento
mesh_terms: D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D009206:Myocardium / Q000473:pathology; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000601:surgery
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors