title: [Effect of immune therapy in the prognosis of viral myocarditis in pediatric patients].
abstract: BACKGROUND
  Myocarditis is the inflammation of the myocardial tissue, primarily caused by viral infection. Dilated cardiomyopathy (MD) is the most serious complication. Immunomodulatory therapy is not validated in these patients; however, it appears to offer benefits in the prognosis of this disease. The aim of this work was to determine the prognosis of immunomodulatory therapy in the development of MD in pediatric patients with viral myocarditis effect.
  
  
  METHODS
  A retrospective cohort of patients between 4 and 17 years diagnosed with viral myocarditis was integrated. It was considered as the main exposure treatment, which was divided into two types: normal (drugs targeted for heart failure and antiviral exclusively) and immunomodulatory (hyperimmune immunoglobulin, azathioprine and prednisone plus usual treatment). Time between diagnosis and treatment, history of asystole and positive for enterovirus and adenovirus antibodies: as measured confounders. The follow-up was 48 months. The outcome variable was the MD (LV diastolic diameter > + 2 Z-score and positive biopsy).
  
  
  RESULTS
  31 patients were obtained with a median of 5 (4-15) years; 6 received immunomodulatory therapy and regular rest. The MD was presented in 17% of patients exposed to immunomodulatory therapy vs. 35% traditional, with HR = 0.5 (0.1-0.7).
  
  
  CONCLUSIONS
  Inmunodulatory therapy is a protective factor for MD in patients with viral myocarditis.
authors.affiliation: Servicio de Cardiopatías Congénitas, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México. horacioinvestigacion@hotmail.com.
authors.forename: Horacio
authors.initials: H
authors.lastname: Márquez-González
authors.forename: Diana
authors.initials: D
authors.lastname: López-Gallegos
authors.forename: Alicia María Dolores
authors.initials: AM
authors.lastname: González-Espinosa
authors.forename: Jonathan Omar
authors.initials: JO
authors.lastname: Zamudio-López
authors.forename: Lucelli
authors.initials: L
authors.lastname: Yáñez-Gutiérrez
mesh_terms: D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use*; D056747:Immunomodulation; D008297:Male; D009205:Myocarditis / Q000175:diagnosis / Q000188:drug therapy*; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014777:Virus Diseases / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D001379:Azathioprine; D011241:Prednisone
keywords: Dilated cardiomyopathy; Myocarditis; Virus diseases