Myocarditis in children and detection of viruses in myocardial tissue: Implications for immunosuppressive therapy

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorCAMARGO, Paulo Roberto
dc.contributor.authorOKAY, Thelma Suely
dc.contributor.authorYAMAMOTO, Lidia
dc.contributor.authorNEGRO, Gilda Maria Barbaro Del
dc.contributor.authorLOPES, Antonio Augusto
dc.date.accessioned2017-11-27T16:33:27Z
dc.date.available2017-11-27T16:33:27Z
dc.date.issued2011
dc.description.abstractBackground: There is scarce information on the potential benefits of immunosuppression in children with myocarditis and viral genomes in myocardium. We investigated the occurrence of myocarditis in children with a preliminary diagnosis of dilated cardiomyopathy, the frequency of cardiotropic viruses in the myocardium, and the response to immunosuppression. Methods: Thirty patients (nine months to 12 years) with left ventricular ejection fraction of 22.8 +/- 4.1% were subjected to right cardiac catheterization and endomyocardial biopsy. Specimens were analyzed for the presence of inflammatory elements (Dallas criteria) and viral genome (polymerase chain reaction). Patients with active myocarditis received immunosuppressants (azatioprine and prednisone) and were recatheterized nine months later. A historical control group of nine patients with myocarditis who did not receive immunosuppressants was included. Results: Active myocarditis was diagnosed in ten patients (five with viral genomes detected). Immunosuppression resulted in a significant increase in left ventricular ejection fraction from 25.2 +/- 2.8% to 45.7 +/- 8.6% (versus 20.0 +/- 4.0% to 22.0 +/- 9.0% in historical controls, p < 0.01) and cardiac index from 3.28 +/- 0.51 L/min/m(2) to 4.40 +/- 0.49 L/min/m(2) (versus 3.50 +/- 0.40 L/min/m(2) to 3.70 +/- 0.50 L/min/m(2) in controls, p < 0.01), regardless of the presence of viral genomes (p - 0.98 and p - 0.22, respectively for the two variables). No relevant clinical events were observed. Non-inflammatory cardiomyopathy was diagnosed in 20 patients (seven with viral genomes). While on conventional therapy, there were four deaths and three assignments to transplantation, and no improvement of left ventricular ejection fraction in the remaining ones (22.5 +/- 3.6% to 27.5 +/- 10.6%). Conclusion: Children with chronic myocarditis seem to benefit from immunosuppressive therapy, regardless of the presence of viral genome in the myocardium.
dc.description.indexMEDLINE
dc.description.sponsorshipFAPESP [03/00037-0]
dc.identifier.citationINTERNATIONAL JOURNAL OF CARDIOLOGY, v.148, n.2, p.204-208, 2011
dc.identifier.doi10.1016/j.ijcard.2009.11.002
dc.identifier.issn0167-5273
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/23282
dc.language.isoeng
dc.publisherELSEVIER IRELAND LTD
dc.relation.ispartofInternational Journal of Cardiology
dc.rightsrestrictedAccess
dc.rights.holderCopyright ELSEVIER IRELAND LTD
dc.subjectCardiomyopathy
dc.subjectMyocarditis
dc.subjectPolymerase chain reaction
dc.subjectCardiotropic viruses
dc.subjectImmunosuppressive therapy
dc.subject.otheridiopathic dilated cardiomyopathy
dc.subject.otherendomyocardial biopsy
dc.subject.otherinfants
dc.subject.otherprednisone
dc.subject.otherdiagnosis
dc.subject.otherpcr
dc.subject.wosCardiac & Cardiovascular Systems
dc.titleMyocarditis in children and detection of viruses in myocardial tissue: Implications for immunosuppressive therapy
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.citation.scopus34
hcfmusp.contributor.author-fmusphcPAULO ROBERTO CAMARGO
hcfmusp.contributor.author-fmusphcTHELMA SUELY OKAY
hcfmusp.contributor.author-fmusphcLIDIA YAMAMOTO
hcfmusp.contributor.author-fmusphcGILDA MARIA BARBARO DEL NEGRO
hcfmusp.contributor.author-fmusphcANTONIO AUGUSTO BARBOSA LOPES
hcfmusp.description.beginpage204
hcfmusp.description.endpage208
hcfmusp.description.issue2
hcfmusp.description.volume148
hcfmusp.origemWOS
hcfmusp.origem.pubmed19945184
hcfmusp.origem.scopus2-s2.0-79953234791
hcfmusp.origem.wosWOS:000288787000021
hcfmusp.publisher.cityCLARE
hcfmusp.publisher.countryIRELAND
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