Comparative study between the efficacy of Intravenous Immunoglobulin alone versus the efficacy of Intravenous Immunoglobulin combined with Steroids in treatment of Acute Myocarditis in Pediatric patients in Qena University Hospital

Abstract

Background: High-dose immunosuppressive steroids may help myocarditis regain left ventricular systolic function. Steroid therapy effects are disputed. Evidence suggests IVIG, which works in immune-mediated disorders, may treat acute myocarditis. Objectives: Comparing the efficacy of IVIG alone versus the efficacy of IVIG combined with steroids in treatment of acute myocarditis in pediatric patients. Patients and methods: This study included pediatric cases with myocarditis diagnosed using clinical, echocardiographic, electrocardiographic, and enzyme tests. Patients who consent to IVIG or IVIG with pulse steroids were included. Group-1 (IVIG alone) and Group-2 (IVIG plus steroids) were evaluated at presentation, one week, and one month. A complete history, Modified Ross heart failure classification, CK-MB, Troponin-I, ECG, and echocardiogram were done. Results: The median patient age was 2.1years (range:1day–11years), 70% were males, and 80 % were rural. There was in-significant difference regarding Ross classification at time of diagnosis. Ross class I was in 73.53% after one month (p=0.003). After one week, there was significant difference regarding Troponin levels (p=0.049) with range of 0.02-30 ng/ml, and there was significant difference (p=0.010) between the 2 groups regarding the incidence of abnormal rhythm which affected 47.37% in group (1) compared to 10% in group (2). After one month, there was significant difference regarding Troponin levels (p=0.014) with range of 0.01-12 ng/ml. There was significant difference (p=0.019), regarding fraction shortening which was higher in Group 2 (35.83±3.76) compared to Group 1 (31.25±5.87). Conclusion: Combining steroids with IVIG is more advantageous than receiving IVIG alone in treating pediatric acute myocarditis.

Keywords

• acute myocarditis ivig steroids pediatrics