Cardiology in the Young

Original Articles

Acute viral myocarditis: role of immunosuppression: a prospective randomised study

Kalim U. Aziza1 c1, Najma Patela1, Tareen Sadullaha1, Habiba Tasneema1, Hasina Thawerania1 and Saeed Talpura1

a1 Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Rafiqui Shaheed Road, Karachi, Pakistan

Abstract

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).

Conclusion 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.

(Received November 11 2009)

(Accepted March 14 2010)

(Online publication June 28 2010)

Correspondence:

c1 Correspondence to: K. U. Aziz, Professor Emeritus of Paediatric Cardiology, Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Rafiqui (H.J.) Shaheed Road, Karachi, Pakistan. Tel: 92 21 586 6091; Fax: 92 21 920 1287; E-mail: heart@cyber.net.pk