Scolaris Content Display Scolaris Content Display

Corticosteroids for viral myocarditis

This is not the most recent version

Abstract

available in

Background

Myocarditis is an uncommon heart disease. There is experimental evidence showing that autoimmune mechanisms follow viral infection, resulting in inflammation and necrosis in myocardium. However, the use of corticosteroids as immunosuppressives in this condition remains controversial.

Objectives

To assess the beneficial and harmful effects of treating viral myocarditis with corticosteroids.

Search methods

Trials were identified by searching The Cochrane Heart Group Register ( to April 2004), the Cochrane Library (Issue 4, 2003), and MEDLINE, EMBASE, BIOSIS for meeting abstracts, LILACS, and Chinese Biomedical CD Database from their date of inception to April 20, 2004. Four Chinese medical journals were handsearched. A total of 507 articles were found but none of them was eligible to be included in our review.

Selection criteria

Randomised controlled trials of corticosteroids for viral myocarditis compared with no intervention, placebo, supportive therapy, antiviral agents therapy or conventional therapy, including trials of corticosteroids plus other treatment versus other treatment alone, irrespective of blinding, publication status, or language.

Data collection and analysis

Two reviewers extracted data independently. We asked authors of trials to provide information when diagnosis or methodology was unclear or data were incomplete. Results were presented as risk ratios (RR) and weighted mean differences (WMD), both with 95% confidence intervals (CI).

Main results

No randomised controlled trials of corticosteroids for viral myocarditis were found that met our inclusion criteria.

Authors' conclusions

There is no randomised evidence to support the use of corticosteroids for viral myocarditis. Further clinical trials are needed.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

available in

Corticosteroids may be effective in treating people with viral myocarditis

Viral infection occasionally triggers myocarditis (inflammation and necrosis of the heart muscle) which can result in severe, acute heart failure. The first signs of this condition may be flu‐like symptoms which evolve into non‐specific chest discomfort, shortness of breath or palpitations. The majority of patients recover spontaneously but others have continuing heart problems which require medication and can be severe enough to cause death.

Corticosteroids may suppress the inflammatory immune response to viral infection and improve outcomes but their use remains controversial. The review authors made a thorough search of the medical literature. No randomised trials which met the inclusion criteria compared corticosteroids with placebo, supportive therapy, antiviral therapy or conventional therapy, including trials of corticosteroids plus other treatment versus other treatment alone, for viral myocarditis.
Trials identified failed to use appropriate diagnostic criteria, were of poor methodological quality or used corticosteroids with additional Chinese traditional medicines in addition, which the control group did not receive. The reviewers concluded that further RCTs comparing corticosteroids in patients suffering viral myocarditis with placebo are warranted.