Acute viral myocarditis: role of immunosuppression: a prospective randomised study.
OBJECTIVE
To conduct a prospective randomised study to show the efficacy of immune suppression with prednisolone, administered at the 3-month duration of acute myocarditis.


METHODS
The diagnosis of acute viral myocarditis was made based on echocardiography and serum viral antibodies. The inclusion criterion was acute myocarditis of 3 months duration. In all, 68 of 173 children were available for randomisation into a prednisolone-treated group of 44 and a control group of 24 children. The follow-up period in the prednisolone-treated group was 15.1 plus or minus 9.2 months and 13.6 plus or minus 10.6 months for the control group.


RESULTS
Compared with controls, 1 month after randomisation significantly more children in the prednisolone-treated group increased their ejection fraction to more than 40% (p = 0.029). Discrete analysis of change in the ejection fraction from the one at randomisation to one after 1 month of randomisation of greater than 10% and less than 10% or no change between groups showed a significantly greater number with improvement in the prednisolone-treated group (p = 0.019). At the end of the follow-up visits, a significantly larger number of children in the prednisolone-treated group had an ejection fraction of more than 60% compared with the control group (p = 0.049).


CONCLUSIONS
It is concluded that immune suppression with prednisolone, administered at 3 months of the onset of acute myocarditis, is effective in significantly bringing about improvement and cure in persistent left ventricular failure.
Aziz
Kalim U
KU
Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan. heart@cyber.net.pk
Patel
Najma
N
Sadullah
Tareen
T
Tasneem
Habiba
H
Thawerani
Hasina
H
Talpur
Saeed
S
D000208:Acute Disease; D000914:Antibodies, Viral / Q000032:analysis; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007113:Immunity, Innate; D007165:Immunosuppression Therapy / Q000379:methods*; D009205:Myocarditis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome; D014777:Virus Diseases / Q000188:drug therapy* / Q000276:immunology
D000914:Antibodies, Viral; D005938:Glucocorticoids; D011239:Prednisolone