Long term follow up of children with myocarditis treated by immunosuppression and of children with dilated cardiomyopathy.

Heart (British Cardiac Society)

PubMedID: 15367516

Gagliardi MG, Bevilacqua M, Bassano C, Leonardi B, Boldrini R, Camassei FD, Fierabracci A, Ugazio AG, Bottazzo GF. Long term follow up of children with myocarditis treated by immunosuppression and of children with dilated cardiomyopathy. Heart. 2004;90(10):1167-71.
OBJECTIVE
To describe the treatment and long term outcome after immunosuppressive treatment of children with myocarditis.

METHODS AND RESULTS
114 patients with newly diagnosed dilated cardiomyopathy were divided into three groups, according to the histological pattern: group A, acute myocarditis; group B, borderline myocarditis; and group C, non-inflammatory cardiomyopathy. Groups A and B were treated with cyclosporine and prednisone in addition to conventional treatment. Survivors of the whole cohort were analysed for 13 year transplant-free survival and assessed for left ventricular function. Event-free survival at 13 years was 97 (3)% for group A, 70 (8)% for group B, and 32 (7)% for group C (p < 0.0001). It was 96 (4)% at one year and 83 (5)% at 13 years for the cumulated myocarditis group (A and B). Cardiac function recovered completely in 79% of survivors in group A, 64% in group B, and 36% in group C. The rate of complete recovery in the cumulated group (A and B) was 70%.

CONCLUSIONS
The high long term survival rate of this cohort of children with myocarditis is probably due to the effect of short term immunosuppression. This result differs from previously published series of conventionally treated children, whose survival probability at one year was about 60%.