High-Dose IVIG Associated with Improved Recovery of Left Ventrical Function in Acute Myocarditis and/or Early DCM

To evaluate the effect of intravenous immune globulin (IVIG) on cardiac rhythm and function in children younger than 12 years of age presenting with acute myocarditis and/or early dilated cardiomyopathy (DCM), investigators at a tertiary hospital in India conducted a retrospective analysis of case records between January 2010 and December 2012. Of 28 children who met inclusion criteria, 12 had received treatment with IVIG (1 g/kg per day) for two days, while the remaining 16 did not receive IVIG therapy. At baseline, children in the two groups did not differ significantly with regard to echocardiographic measures of left ventricular function, including mean left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDD).

At both three months and six months post-treatment, children treated with IVIG had significantly higher LVEF than those not treated with IVIG. From a mean baseline of 35.3%, LVEF in the IVIG group at three and six months increased to 50.8% and 62.2%, respectively, while LVEF in the control group increased from a mean of 33.5% to 43.3% and 50.6%. Differences at both three and six months were highly significant (P < 0.01). LVEDD in the IVIG group also significantly improved in relation to the control group: respectively decreasing by 11% and 2% at three months (P < 0.01), and by 14.4% and 7.5% at six months (P < 0.01).

Episodes of ventricular tachycardia/fibrillation and atrioventricular block were reduced significantly in the IVIG group. There were two deaths in the IVIG therapy group and seven deaths in the non-treated control group (P = 0.032). In their brief report, the investigators concluded that these results suggest that IVIG treatment of acute myocarditis and/or early dilated cardiomyopathy is associated with improved recovery of left ventricular function and a reduction in episodes of fulminant arrhythmias.