Gran Ferran, Dolader Paola, Juzga-Corrales Diana Carolina, Esmel-Vilomara Roger, Betrian Pedro, Escudero Fuensanta, Sorli Moisés, Melendo Susana, Garrido-Pontnou Marta, Navarro Alexandra, Camacho Jessica, Izquierdo-Blasco Jaume, Daina Carla, Escribà Silvia, Fernández-Polo Aurora, Luis-Garcia Maite, Vera Elena, Martin-Talavera Maria
Pediatric Cardiology, Vall d'Hebron Hospital Campus, Barcelona, Spain.
Pediatric Cardiology, Vall d'Hebron Hospital Campus, Barcelona, Spain.
Int J Cardiol. 2025 Sep 1;434:133337. doi: 10.1016/j.ijcard.2025.133337. Epub 2025 May 4.
Parvovirus B19 (PVB19) is a leading cause of acute myocarditis in children and carries a high risk of mortality or the need for cardiac transplantation. While interferon-beta (IFN-β) has demonstrated modest improvement in adult patients with dilated cardiomyopathy associated with PVB19 infection, clinical experience in pediatric populations remains limited. The objective of this study is to present our clinical experience with IFN-β and corticosteroids in pediatric patients with PVB19 myocarditis.
A prospective cohort study was conducted for 9 years (from May 2015 to September 2024), including pediatric patients diagnosed with PVB19-myocarditis who were treated with a combination of IFN-β and steroids. The diagnosis was confirmed by endomyocardial biopsy (EMB).
A total of 12 patients with 13 episodes of PVB19-myocarditis were treated with a combination of IFN-β and steroids for six months. The median age was 16 months (9.5-31.5), and 50 % were male. Four patients were on extracorporeal membrane oxygenation (ECMO) when treatment commenced. All diagnoses were confirmed by EMB. After 2 weeks receiving IFN-β and corticosteroid therapy, all patients demonstrated clinical and echocardiographic improvement. Complete recovery was achieved in all of them after a median of 59 days (IQR 158.5), post-treatment initiation.
Our findings suggest that the combination of IFN-β and corticosteroids could improve outcomes in pediatric patients with this disease. This approach should be considered for patients with severe presentation, incomplete recovery or limited improvement. Multicenter studies are warranted to validate these results and establish definitive guidelines for the management of PVB19-myocarditis.
细小病毒B19（PVB19）是儿童急性心肌炎的主要病因，具有较高的死亡风险或需要进行心脏移植。虽然β干扰素（IFN-β）已被证明可使成年PVB19感染相关性扩张型心肌病患者有一定程度的改善，但儿科人群的临床经验仍然有限。本研究的目的是介绍我们在PVB19心肌炎儿科患者中使用IFN-β和皮质类固醇的临床经验。
进行了一项为期9年（从2015年5月至2024年9月）的前瞻性队列研究，纳入诊断为PVB19心肌炎并接受IFN-β和类固醇联合治疗的儿科患者。诊断通过心内膜心肌活检（EMB）得以证实。
共有12例患者发生13次PVB19心肌炎发作，接受IFN-β和类固醇联合治疗6个月。中位年龄为16个月（9.5 - 31.5），50%为男性。4例患者在开始治疗时接受体外膜肺氧合（ECMO）治疗。所有诊断均经EMB证实。接受IFN-β和皮质类固醇治疗2周后，所有患者的临床和超声心动图表现均有改善。治疗开始后中位59天（IQR 158.5），所有患者均实现完全康复。
我们的研究结果表明，IFN-β和皮质类固醇联合使用可改善该病儿科患者的预后。对于病情严重、恢复不完全或改善有限的患者，应考虑采用这种方法。有必要开展多中心研究以验证这些结果，并制定PVB19心肌炎管理的明确指南。
