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.