A NEW SCORING SYSTEM TO PREDICT THE EFFICACY OF STEROID-THERAPY FOR PATIENTS WITH ACTIVE MYOCARDITIS - A RETROSPECTIVE STUDY

The efficacy of steroid therapy for active myocarditis is controversia l, so a new scoring system was constructed based on 6 clinical paramet ers: (1) the mode of onset of the disease; (2) complications of immune -related systemic disorders; (3) evidence of viral infection; (4) the population of infiltrating inflammatory cells; (5) the appearance of m ultinucleated giant cells in endomyocardial biopsy specimens; and (6) the duration of active myocarditis. Points from -2 to +2 were assigned to each parameter and the total score was calculated from the 6 param eters. Twenty-one patients with clinically suspected myocarditis, who had been admitted to hospital from 1987, were retrospectively analyzed by this scoring system. Sixteen patients were treated without cortico steroids at presentation, and 5 patients were treated by conventional methods with adjunctive use of corticosteroids. In 10 patients of the non-steroid group myocarditis improved and their mean score was -4.8 a t presentation. In 6 patients of the non-steroid group, myocarditis an d cardiac symptoms persisted after initial therapy, and their score at presentation was -0.8. In 2 patients of the steroid group myocarditis improved after initial therapy and their score was +2, In 2 other pat ients of the steroid group, myocarditis and cardiac symptoms persisted and their score was +3, Another patient of the steroid group died fro m congestive heart failure and his score was -5 at presentation. In 8 of 9 patients with persistent myocarditis, the secondary phase therapy was challenged. Seven patients were treated with corticosteroids and 6 patients improved. Their score at the secondary phase was +2,5, Over all, non-steroid conventional treatment was successful in patients wit h the scores from -5 to -4, and steroid therapy succeeded in patients with scores from 0 to +6. Although this is a retrospective study, this scoring system is able to predict the efficacy of steroid therapy in patients with clinically suspected active myocarditis,