PMID- 14559127
OWN - NLM
STAT- MEDLINE
DCOM- 20040427
LR  - 20190816
IS  - 0167-5273 (Print)
IS  - 0167-5273 (Linking)
VI  - 91
IP  - 2-3
DP  - 2003 Oct
TI  - Treatment of acute inflammatory cardiomyopathy with intravenous immunoglobulin 
      ameliorates left ventricular function associated with suppression of inflammatory 
      cytokines and decreased oxidative stress.
PG  - 173-8
AB  - Although an autoimmune mechanism has been postulated for myocarditis and dilated 
      cardiomyopathy, immunosuppressive agents had not been shown to be effective. 
      Potential benefits of intravenous immunoglobulin (IVIg) in the therapy of 
      patients with myocarditis and recent onset of dilated cardiomyopathy were 
      reported. Also, experimental studies showed that IVIg is an effective therapy for 
      viral myocarditis by antiviral and anti-inflammatory effects. Accordingly, in the 
      current study, the effects of IVIg in the patients were investigated with the 
      analyses of inflammatory cytokines and oxidative stress. Nine patients (six in 
      myocarditis, three in acute dilated cardiomyopathy) were treated with high-dose 
      intravenous IVIg (1-2 g/kg, over 2 days). All were hospitalized with New York 
      Heart Association (NYHA) class III to IV heart failure, left ventricular ejection 
      fraction (LVEF) <40%, and symptoms for <6 months at the time of presentation. 
      Five patients were diagnosed using endomyocardial biopsy. LVEF determined by 
      echocardiography improved from 19.0+/-7.5% (mean+/-S.D.) at baseline to 
      35.4+/-9.1% at follow up (12.2+/-5.8 days after the treatment) (P<0.01). 
      C-reactive protein and plasma inflammatory cytokines (tumor necrosis factor-alpha 
      and interleukin-6) were decreased by this treatment. In addition, plasma level of 
      thioredoxin, which regulates the cellular state of oxidative stress, was 
      decreased by the treatment. All nine patients improved functionally to NYHA class 
      I to II, and were discharged without side-effects. There have been no subsequent 
      hospitalizations for heart failure during the course of follow-up (3 months-4.5 
      years). LVEF improved 16% of EF in the patients with myocarditis and acute 
      dilated cardiomyopathy with the reduction of cytokines associated with 
      improvement of oxidative stress state by high-dose of IVIg. Thus, IVIg seems to 
      be a promising agent in the therapy of acute inflammatory cardiomyopathy in view 
      of not only suppression of inflammatory cytokines but a reduction of oxidative 
      stress.
FAU - Kishimoto, Chiharu
AU  - Kishimoto C
AD  - Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto 
      University, 54 Kawara-cho, Sakyo-ku, Kyoto 606-8507, Japan. 
      kkishi@kuhp.kyoto-u.ac.jp
FAU - Shioji, Keisuke
AU  - Shioji K
FAU - Kinoshita, Makoto
AU  - Kinoshita M
FAU - Iwase, Tomoyuki
AU  - Iwase T
FAU - Tamaki, Shunichi
AU  - Tamaki S
FAU - Fujii, Manyo
AU  - Fujii M
FAU - Murashige, Akihiro
AU  - Murashige A
FAU - Maruhashi, Hiroyuki
AU  - Maruhashi H
FAU - Takeda, Satoshi
AU  - Takeda S
FAU - Nonogi, Hiroshi
AU  - Nonogi H
FAU - Hashimoto, Tetsuo
AU  - Hashimoto T
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
RN  - 0 (Biomarkers)
RN  - 0 (Cardiotonic Agents)
RN  - 0 (Cytokines)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 52500-60-4 (Thioredoxins)
RN  - 9007-41-4 (C-Reactive Protein)
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Aged
MH  - Biomarkers/blood
MH  - C-Reactive Protein/drug effects/metabolism
MH  - Cardiomyopathy, Dilated/metabolism/physiopathology/*therapy
MH  - Cardiotonic Agents/therapeutic use
MH  - Cytokines/*biosynthesis/*drug effects
MH  - Female
MH  - Follow-Up Studies
MH  - Hospitalization
MH  - Humans
MH  - Immunoglobulins, Intravenous/*therapeutic use
MH  - Intra-Aortic Balloon Pumping
MH  - Male
MH  - Middle Aged
MH  - Myocarditis/metabolism/physiopathology/*therapy
MH  - Oxidative Stress/*drug effects
MH  - Pulmonary Wedge Pressure/drug effects/physiology
MH  - Statistics as Topic
MH  - Stroke Volume/drug effects/physiology
MH  - Thioredoxins/biosynthesis/blood/drug effects
MH  - Treatment Outcome
MH  - Ventricular Function, Left/*drug effects/*physiology
EDAT- 2003/10/16 05:00
MHDA- 2004/04/28 05:00
CRDT- 2003/10/16 05:00
PHST- 2003/10/16 05:00 [pubmed]
PHST- 2004/04/28 05:00 [medline]
PHST- 2003/10/16 05:00 [entrez]
AID - S0167527303000020 [pii]
AID - 10.1016/s0167-5273(03)00002-0 [doi]
PST - ppublish
SO  - Int J Cardiol. 2003 Oct;91(2-3):173-8. doi: 10.1016/s0167-5273(03)00002-0.