Rapid Fire Abstracts
Danish Vaiyani, MD
Cardiologist
Children's Hospital of Philadelphia
Andrea Jones, MD
Assistant Professor of Pediatrics
Children's Hospital of Philadelphia
Matthew A. Harris, MD
Associate Director, Cardiac MRI
Children's Hospital of Philadelphia
Kevin K. Whitehead, MD, PhD
Cardiologist
Children's Hospital of Philadelphia
David M. Biko, MD, MBA, FSCMR, FAHA
Chief, Body imaging
Children's Hospital of Philadelphia
Sara Partington, MD
Associate Professor of Pediatrics
Children's Hospital of Philadelphia
Kimberly Y. Lin, MD
Associate Professor
The Children's Hospital of Philadelphia
Mark A. Fogel, MD, FACC, FAHA, MSCMR, FNASCI, FAAP
Professor
University of Pennsylvania
Myocarditis is an inflammatory condition of the heart with supportive care being the first line of treatment. In some cases, intravenous immunoglobulin (IVIg) is administered, though its benefit in the pediatric population is not well understood. We sought to determine if the administration of IVIg to patients with acute myocarditis had an impact on findings on follow up cardiac magnetic resonance study (CMR).
Methods:
We retrospectively reviewed patients < 21 years of age with a clinical diagnosis of acute myocarditis who underwent CMR within 14 days of presentation and returned for follow up CMR. The decision to administer IVIg at the time of initial presentation was determined by the clinical judgement of the attending physician. Demographic, clinical and CMR data were collected. LGE was defined as tissue with a signal intensity of 5 standard deviations above the mean signal intensity of unaffected myocardium on viability imaging; this mass was measured and indexed to total left ventricular mass. Strain was measured using CMR feature tracking. Wilcoxon Rank Sum Test was used to compare continuous variables and Fisher’s exact test was used to compare categorical variables.
Results:
There were no significant baseline differences between those who had received IVIg and those who did not, including no difference in ventricular function, volumes, or strain or indexed LGE mass measured on CMR (Table 1). There was no difference in time to follow up study (Table 1). There continued to be no difference in indexed LGE mass, nor was there a difference in ventricular function, volumes, strain or other findings on follow up MRI (Table 1). There was no difference in the change in indexed LGE mass from initial to follow up study between the two groups (median 8.20% [IQR 1.72, 17.64] versus 10.95 [IQR 3.47, 15.87], p = 0.82). Of 5 patients who received IVIg, 4 recovered and 1 suffered recurrence of myocarditis, while of the 31 patients who did not receive IVIg, 28 recovered, 2 suffered recurrence and 1 passed away.
Conclusion:
Administration of IVIg does not reduce the burden of LGE on follow up CMR in pediatric patients with myocarditis. Additional studies are needed to confirm these findings and their relationship to clinical outcomes, and to determine if there are subgroups with myocarditis that may benefit from IVIg.
