Intravenous Immunoglobulin Therapy in Myocarditis
-
Amir Hossein Mansourabadi
,
Ladan Gol Mohammad pour Afrakoti
,
Abbas Shabanian
,
Reza Shabanian
,
Aliakbar Amirzargar
Abstract
Myocarditis is an inflammatory disease of the myocardium with lymphocyte infiltration and myocyte necrosis leading to a wide range of clinical presentations including heart failure, arrhythmia, and cardiogenic shock. Infectious and noninfectious agents may trigger the disease. The fact that immunosuppressive drugs are useful in several kinds of autoimmune myocarditis is proof of the autoimmune mechanisms involved in the development of myocarditis. Pathogenic mechanisms in myocardial inflammation are including inflammasome activation followed by myocyte destruction, myocarditis, and pericarditis. Intravenous immunoglobulin (IVIG) is a serum product made up of immunoglobulins, widely used in a variety of diseases. This product is effective in several immune-mediated pathologies. As well as the determined usage of IVIG in Kawasaki disease, IVIG may be useful in several kinds of heart failure including fulminant myocarditis, acute inflammatory cardiomyopathy, Giant Cell Myocarditis, and peripartum cardiomyopathy. Generally, IVIG is used in two different doses of low dose (200 to 400 mg/kg) and high dose (2 g/kg) regimen. The exact therapeutic effects of IVIG are not clear, however over the last decades, our knowledge about its mechanism of function has greatly enhanced. IVIG administration should be based on the accepted protocols of its transfusion. In this review article, we try to provide an overview of the different kinds of myocarditis, pathologic mechanisms and their common treatments and evaluation of the administration of IVIG in these diseases. Furthermore, we will review current protocols using IVIG in each disease individually.
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3. Schultheiss H-P, Kühl U, Cooper LT. The management of myocarditis. Eur Heart J. 2011;32(21):2616-25.
4. Maisch B, Alter P. Treatment options in myocarditis and inflammatory cardiomyopathy : Focus on i.v. immunoglobulins. Herz. 2018;43(5):423-30.
5. Kloos W, Katus HA, Meder B. Genetic cardiomyopathies. Lessons learned from humans, mice, and zebrafish. Herz. 2012;37(6):612-7.
6. Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, et al. Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2008;29(2):270-6.
7. Yu D-Q, Wang Y, Ma G-Z, Xu R-H, Cai Z-X, Ni C-M, et al. Intravenous immunoglobulin in the therapy of adult acute fulminant myocarditis: A retrospective study. Exp Ther Med. 2014;7(1):97-102.
8. Sen-Chowdhry S, Syrris P, Prasad SK, Hughes SE, Merrifield R, et al. Left-dominant arrhythmogenic cardiomyopathy: an under-recognized clinical entity. J Am Coll Cardiol. 2008;52(25):2175-87.
9. Burke MA, Cook SA, Seidman JG, Seidman CE. Clinical and Mechanistic Insights Into the Genetics of Cardiomyopathy. J Am Coll Cardiol. 2016;68(25):2871-86.
10. Gavazzi A, De Maria R, Renosto G, Moro A, Borgia M, Caroli A, et al. The spectrum of left ventricular size in dilated cardiomyopathy: clinical correlates and prognostic implications. SPIC (Italian Multicenter Cardiomyopathy Study) Group. Am Heart J. 1993;125(2 Pt 1):410-22.
11. Mendes LA, Picard MH, Dec GW, Hartz VL, Palacios IF, Davidoff R. Ventricular remodeling in active myocarditis. Myocarditis Treatment Trial. Am Heart J. 1999;138(2 Pt 1):303-8.
12. Emanuelsson H, Karlson BW, Herlitz J. Characteristics and prognosis of patients with acute myocardial infarction in relation to occurrence of congestive heart failure. Eur Heart J. 1994;15(6):761-8.
13. Yusuf S, Pearson M, Sterry H, Parish S, Ramsdale D, Rossi P, et al. The entry ECG in the early diagnosis and prognostic stratification of patients with suspected acute myocardial infarction. Eur Heart J. 1984;5(9):690-6.
14. Zarifa A, Kim PY, Gilchrist S, Iliescu C, Suarez-Almazor ME, Lopez-Mattei J, et al. Expression of T-cell populations and molecular markers of human myocardium with checkpoint-induced myocarditis. J Clin Oncol. 2019;37(8_suppl):79-.
15. Escher F, Tschoepe C, Lassner D, Schultheiss HP. Myocarditis and inflammatory cardiomyopathy: from diagnosis to treatment. Turk Kardiyol Dern Ars : Turk Kardiyoloji Derneginin yayin organidir. 2015;43(8):739-48.
16. Gil KE, Pawlak A, Gil RJ, Frontczak-Baniewicz M, Bil J. The role of invasive diagnostics and its impact on the treatment of dilated cardiomyopathy: A systematic review. Adv Med Sci. 2016;61(2):331-43.
17. Di Filippo S. Improving outcomes of acute myocarditis in children. Expert Rev Cardiovasc Ther. 2016;14(1):117-25.
18. Ando T, Yamasaki Y, Takakuwa Y, Iida H, Asari Y, Suzuki K, et al. Concurrent onset of acute lupus myocarditis, pulmonary arterial hypertension and digital gangrene in a lupus patient: a possible role of vasculitis to the rare disorders. Modern Rheumatology Case Reports. 2019(just-accepted):1-14.
19. Johnson N, Suri D, Gupta A, Rawat A, Singh S. 137 Myocarditis in pediatric lupus: A clinical conundrum. Arch Dis Child; 2019.
20. Meier LA, Binstadt BA. The Contribution of Autoantibodies to Inflammatory Cardiovascular Pathology. Front Immunol. 2018;9(911).
21. Caforio AL, Mahon NJ, Tona F, McKenna WJ. Circulating cardiac autoantibodies in dilated cardiomyopathy and myocarditis: pathogenetic and clinical significance. Eur J Heart Fail. 2002;4(4):411-7.
22. Neu N, Beisel K, Traystman M, Rose N, Craig S. Autoantibodies specific for the cardiac myosin isoform are found in mice susceptible to Coxsackievirus B3-induced myocarditis. J Immunol. 1987;138(8):2488-92.
23. Nagatomo Y, Tang WW. Autoantibodies and cardiovascular dysfunction: cause or consequence? Curr Heart Fail Rep. 2014;11(4):500-8.
24. Nussinovitch U, Shoenfeld Y. The clinical and diagnostic significance of anti-myosin autoantibodies in cardiac disease. Clin Rev Allergy Immunol. 2013;44(1):98-108.
25. Nagatomo Y, Tang WHW. Autoantibodies and cardiovascular dysfunction: cause or consequence? Curr Heart Fail Rep. 2014;11(4):500-8.
26. Warraich RS, Noutsias M, Kasac I, Seeberg B, Dunn MJ, Schultheiss H-P, et al. Immunoglobulin G3 cardiac myosin autoantibodies correlate with left ventricular dysfunction in patients with dilated cardiomyopathy: immunoglobulin G3 and clinical correlates. Am Heart J. 2002;143(6):1076-84.
27. Caforio AL, Tona F, Bottaro S, Vinci A, Dequal G, Daliento L, et al. Clinical implications of anti-heart autoantibodies in myocarditis and dilated cardiomyopathy. Autoimmunity. 2008;41(1):35-45.
28. Vilela EM, Bettencourt-Silva R, da Costa JT, Barbosa AR, Silva MP, Teixeira M, et al. Anti-cardiac troponin antibodies in clinical human disease: a systematic review. Ann Transl Med. 2017;5(15):307-.
29. Shabanian R, Abozari M, Kiani A, Seifirad S, Zamani G, Nahalimoghaddam A, Kocharian A. Myocardial performance index and atrial ejection force in patients with Duchenne's muscular dystrophy. Echocardiography. 2011;28(10): 1088-1094.
30. Pettersson K, Eriksson S, Wittfooth S, Engström E, Nieminen M, Sinisalo J. Autoantibodies to cardiac troponin associate with higher initial concentrations and longer release of troponin I in acute coronary syndrome patients. Clin Chem. 2009;55(5):938-45.
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| Files | ||
| Issue | Vol 19 No 4 (2020) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijaai.v19i4.4109 | |
| PMID | 33463100 | |
| Keywords | ||
| High dose intravenous immunoglobulin Inflammation Intravenous immunoglobulin Low dose intravenous immunoglobulin Myocarditis | ||
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How to Cite
1.
Mansourabadi AH, Gol Mohammad pour Afrakoti L, Shabanian A, Shabanian R, Amirzargar A. Intravenous Immunoglobulin Therapy in Myocarditis. Iran J Allergy Asthma Immunol. 2020;19(4):323-336.
