The aim – complex assessment of immune status, heart rate variability, left ventricular (LV) systolic function and cardiac magnetic resonance in patients with myocarditis for the detection of prognostic markers associated with unfavourable course of the disease.

Material and methods. We examined 52 patients with clinically suspected acute diffuse myocarditis – 35 men (67.3 %) and 17 women (32.7 %). The patients underwent examination three times: within the 1st month after disease onset, after 6 and 12 months of observation. All patients at inclusion had sinus rhythm and LV ejection fraction ≤ 40 %. Control group consisted of 25 healthy individuals. Patients underwent dynamic assessment of immune state indicators, Holter ECG monitoring, echocardiography and speckle-tracking, as also cardiac magnetic resonance.

Results. Early predictors of the impaired systolic function after 12 months were: serum concentration of immunoglobulin M (OR 1.46, CI 0.71–1.65, Р<0.05), СD8+ (OR 1.72, CI 0.93–2.50, Р<0.05) and СD16+ (OR 1.89, CI 1.38–2.41, Р<0.05) lymphocytes, myocardium induced blasttransformation lymphocyte activity (OR 3.91, CI 2.41–5.89, Р<0.01), mean myocardial autoantibody titer (OR 3.53, CI 1.82–4.54, Р<0.01), SDNN (OR 2.03, CI 1.50–2.71, Р<0.05), LV end-diastolic volume index (OR 5.22, CI 3.19–7.34, Р<0.01), LV ejection fraction (OR 4.75, CI 3.30–6.84, Р<0.02), LV longitudinal global systolic strain (OR 3.71, CI 2.09–4.53, Р<0.01) obtained within the 1st month after disease onset. As a result we built prognostic model that is characterized by specificity 82.1 %, sensitivity 80.1 %, positive predictive value 81.6 %, negative predictive value 76.0 % and comprises mentioned above markers. Conclusion. Early prognostic markers that might be used during the 1st month after myocarditis onset for the assessment of persistent LV systolic dysfunction were detected that enabled creation of the mathematic model for the early predicting prolonged impairment of heart function in patients with myocarditis.

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The aim – to investigate cardiopulmonary changes in Henoch – Schonlein purpura and to determine the pathogenetic value of the adsorption-rheological properties of blood and endothelial function of vessels.

Material and methods. The study included 144 patients (56 % men and 44 % women), age from 14 to 65 years. ECG and echocardiography, Holter monitoring, angiosonography, spirography, assessment of the alveolar-capillary membrane, X-ray examination of the chest cavity, computer and magnetic resonance imaging of the lungs were performed.

Results. Cardiac involvement is observed in 31 %, and pulmonary – in 5 % of patients, among them cardiac arrhythmias and conduction disorders, changes of the valvular apparatus and size of cameras, systolic and diastolic left ventricular dysfunction, interstitial pneumonitis, fibrosing alveolitis, obstructive bronchitis with pulmonary hypertension, increased pulmonary vascular resistance, deterioration of ventilation and lung diffusion capacity.

Conclusions. Cardiac and pulmonary changes are interrelated with each other, and violations of viscous, elastic, surfactants and relaxation properties of blood, the ratio of endothelium-dependent vasoconstrictors and vasodilators are involved in their pathogenesis.

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The aim – to investigate the relationship between galectin-3 level and heart rhythm disorders in patients with hypertrophic cardiomyopathy (HCM).
Material and methods. We examined 90 patients with HCM, mean age 50.2±16.2 years, 47 males, 43 females. 84 patients had asymmetric hypertrophy, 6 – symmetric hypertrophy. In 64.4 % patients hypertrophy was significant (over 20 mm). 26 patients had obstruction. Physical examination, Holter ECG, cardiac ultrasound and galectin-3 level detection were performed in all patients.
Results. Holter ECG revealed high frequency of heart rhythm disorders. Ventricular extrasystoles (VEs) were present in 70 (80.0 %) of patients. The number of VE varied widely among patients with the highest number of 6291. 27 (30.0 %) patients had paired VEs, 17 (18.9 %) had runs of ventricular tachycardia. 22 (24.4 %) of patients had paroxysmal supraventricular tachycardia. We found correlation between galectin-3 level and Holter ECG monitoring results (number of paired supraventricular extrsystoles and episodes of ST depression, episodes of QT prolongation).
Conclusion. In patients with HCM, high galectin-3 level is associated with heart rhythm disorders, episodes of ST depression, QT prolongation at Holter ECG monitoring.

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The aim – the investigation of immune status properties and structural changes of myocardium in patients with myocarditis and dilated cardiomyopathy (DCM).
Materials and methods. We performed the examination of 82 patients: 54 with myocarditis (1st group) and 28 with DCM (2nd group). Control group included 20 healthy subjects. The average age in all groups had no reliable differences. We studied serum levels of CD8+, CD16+, CD19+ cells, immunoglobulins (Ig) G and M, antimyocardial antibody (ATm) titers and blast transformation lymphocyte activity for myocardium (BTLAm). By means of 2D echocardiography we measured left ventricular (LV) end-diastolic and end-systolic volume indices (iEDV and iESV), as well as LV ejection fraction (EF). The presence of myocardial edema, hyperemia and fibrosis was evaluated with cardiac magnetic resonance (CMR).
Results. In patients of the 2nd group, compared to the 1st one, we observed more pronounced LV dilatation by parameters of LV iEDV value – 118.1±6.0 and 87.1±5.5 ml/m2 respectively (P<0.05) and more significant impairment of LV systolic function by LV EF value – 32.9±1.8 and 40.2±1.9 %, respectively (P<0.01). All patients had left ventricular (LV) systolic dysfunction – LV ejection fraction (EF) ≤ 45 %. At CMR in the 1st group hyperemia was detected in 58.8 %, edema in 38.3 % and fibrotic/necrotic changes in 52.9 % patients, in the 2nd group we observed only diffuse fibrosis in 90.9 % cases. We also found a more pronounced activation of cellular and humoral autoimmune activity in the 1st group, characterized by the higher value of ATm titer by 27.2 % (P<0.05) and BTLAm by 76.9 % (P<0.01) in comparison to the 2nd group. Reliable direct correlation was established in the 1st group of BTLAm and edema with hyperemia – (r=0.82; Р<0.02 and r=0.74; Р<0.01), respectively. Furthermore, in the 1st group we found correlation of ATm titer with presence of edema and hyperemia – (r=0.62 and r=0.70), respectively (P<0.05). At the same time, we didn’t observe any correlation between immunologic markers and MRI changes in patients with DCM. Conclusion. We may suppose that LV dilatation and systolic dysfunction in patients with myocarditis was a sequence of inflammation in the myocardium, characterized by pronounced activation of both cellular and humoral immune response and confirmed at CMR by myocardial edema and hyperemia. Dilatation and LV systolic dysfunction in patients with DCM was not associated with intensity of immune pathologic reactions and was caused by diffuse fibrosis of myocardial tissue observed at CMR.

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The aim – to study heart rate variability (HRV), structural and functional heart state in patients with myocarditis and dilated cardiomyopathy (DCM).

Material and methods. We examined 56 patients: 34 with clinically suspected myocarditis (1st group) and 22 with DCM (2nd group), the average age 38.2±2.9 and 43.1±3.4 years, respectively. All patients had left ventricular systolic dysfunction – ejection fraction ≤ 45 %. Control group included 20 healthy individuals matched by age. By the use of 24-hour ECG monitoring we studied parameters of HRV: standard deviation of normal RR intervals (SDNN), root-mean-square successive difference (RMSSD), low frequency / high frequency power ratio (LF/HF), as well as frequency of ventricular extrasystoles (VE) and incidence of non-sustained ventricular tachycardia (NSVT). All patients underwent echoСG and cardiac MRI for verification of the diagnosis.

Results. In patients of the 1st group hyperemia and edema were detected in 58.8 and 38.2 % of cases respectively, while late enhancement – in 52.9 %. In the 2nd group we observed only late enhancement in multiple segments of myocardium in 90.9 % of the patients that was a distinctive feature of diffuse myocardial fibrosis. Patients of the 2nd group compared to the 1st were characterized by the lower values of SDNN – 82.5±8.9 vs 101.9±7.2 ms (P<0.01), RMSSD – 29.7±4.4 vs 41.6±4.8 ms (P<0.02) and LF/HF ratio – 0.91±0.07 vs 1.39±0.08 (P<0.05) respectively. The frequencies of VE and NSVT were higher in the 2nd group in comparison with the 1st – 1.75±0.24 vs 1.11±0.21 % (P<0.01) and 27.3 vs 18.1 % (P<0.01) respectively. MRI revealed edema and/or hyperemia in the 1st and diffuse myocardial fibrosis in the 2nd group. The strong reverse correlation was found in the 2nd group between SDNN, LF/HF ratio and the presence of diffuse myocardial fibrosis – r=–0.72 (P<0.02); r=–0.74 (P<0.01), respectively. In the 2nd group we observed reverse correlation between SDNN and the frequency of VE and presence of NSVT – r=–0.67 (P<0.01); r=–0.56 (P<0.05) respectively, as also between LF/HF ratio and the presence of NSVT – r=–0.80 (P<0.01). Conclusions. In patients with dilated cardiomyopathy compared to myocarditis we established more pronounced impairment of sympathetic and parasympathetic heart rate regulation by the lower values of SDNN and HF/LF ratio as also more frequent ventricular rhythm disorders that was associated with diffuse myocardial fibrosis. Association of HRV impairment and supraventricular rhythm disorders with atrial dimensions was found in both myocarditis and DCM.

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The aim – to evaluate clinical course of cardiomyopathy in systemic vasculitis associated with antineutrophil antibodies (ANCA-SV), relation of heart disease and changes in large vessels to extracardiac manifestations of the disease, blood antibodies to myeloperoxidase and proteinase-3, vascular endothelial function and serum adsorption-rheological properties.

Material and methods. The study included 129 patients (47 % of men and 53 % of women) with ANCA-SV, among them 59 % with microscopic polyangiitis (MPA), 20 % with Wegener granulomatous polyangiitis (GPA) and 21 % with Churg – Strauss eosinophilic polyangiitis (EPA).

Results. Heart pathology signs were revealed in 62 % of patients with MPA, 50 % with GPA, 52 % with EPA. Among patients with MPA myocardial damage was diagnosed in 83 % cases, endocardium and valve apparatus – in 64 %, in GPA patients – in 92 % and 62 %, respectively, and in EPA – in 86 % and 64 %. Heart involvement was closely related to the pathology of joints, lungs, kidneys, liver and nervous system, determined by the severity of major vascular injury and their ability to vasodilation, depended on age of the patients, renal function and pulmonary artery pressure.

Conclusions. The pathology of the heart in ANCA-SV is one of the most frequent manifestations of disease associated with extracardiac signs of MPA, GPA and EPA.

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The aim – to study the relation between level of galectin-3 prior to surgery and further dynamics of echocardiography parameters and 6-minute walk test in patients with mitral insufficiency.

Material and methods. The study included 48 patients with mitral valve insufficiency. The mean age was 57.5±12.4 years. During the study all patients underwent standard diagnostic examination, including medical history, physical examination, 12-channel electrocardiogram, transthoracic echocardiography to evaluate systolic function and structural heart disease, determination of the galectin-3 level and 6-minute walk test.

Results. The mitral valve surgery had beneficial effect on clinical manifestations and echocardiography parameters. Statistically significant reduction of the size of left atrium and left ventricle was noted. Positive dynamics of the size of left ventricle was observed at 6 months after surgery in group with level of galectin-3 ≤ 18.2 ng/mL. The end diastolic volume decreased in this group from 47.3±5.8 to 34.5±3.9 mm (Р<0.05), end systolic volume – from 65.4±8.0 to 50.8±5.1 mm (Р<0.05). At the same time, EF increased from 52.4±6.7 to 59.3±4.6 %. The results of the 6-minute walk test showed significant increase of the exercise tolerance after surgery. Conclusions. Surgical treatment of mitral regurgitation provides improvement of the structure and function of the heart chambers, as evidenced by the dynamics of echocardiography at 6 months after surgery.

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The aim – to assess blood content of trace elements (Cd, Co, Cu, Pb, Zn) in patients depending on clinical course of chronic rheumatic heart disease (CRHD), to establish prognostic significance of microelementosis and its role in pathogenesis of cardiorespiratory changes.

Material and methods. 105 patients at the age from 15 to 60 years were included, among them 28 % men and 72 % women. The serum content of trace elements was studied by atomic absorption spectrometry.

Results. In patients with CRHD blood Cd was increased by 9 %, Cu reduced by 10 %, Zn – by 5 % and Pb – by 2.2 times. These changes depend on the character of heart defects, surgery performed at the previous stages, cardiac arrhythmias, size of heart cavities, degree of valvular fibrosis, functional class of heart failure (FCHF). Trace elements involved in the pathogenesis of CRHD determine the pressure in the pulmonary artery (Co) and pulmonary vascular resistance (Cu, Pb), FKHF (Cu, Zn, Cd, Co), and disorders of moisture production and lung diffusion capacity.

Conclusions. CRHD is accompanied by marked blood microelementosis of cardiotoxic (Cd, Pb) and cardioprotective trace elements (Cu, Zn), which is closely related to the course, pathogenesis of heart and respiratory changes.

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The aim – to study the features of longitudinal segmental displacement of left ventriclar walls in patients with mitral insufficiency.

Material and methods. Echocardiography has been used to diagnose mitral insufficiency, as well as to determine its severity, intensity of dilatation and evaluation of functional condition of myocardium. It included M- and B-mode echocardiography, continuous and impulse Doppler, color Doppler mapping. Special attention has been given to novel technology of speckle-tracking, based on two-dimensional echocardiography. 54 patients with mitral insufficiency have been involved into the study. 35 patients with normal heart have been assigned to the control group.

Results. Left ventricular volumes were significantly higher in group of patients with mitral insufficiency; at the same time the ejection fraction was normal. The degree of mitral insufficiency reached severe grade, whereas pulmonary hypertension was moderate. No apparent signs of heart failure and coronary arteries involvement were noted. Displacement of basal, middle and apical parts of all walls didn’t differ from the control group. However, the tendency to increase in longitudinal displacement of basal segments in the inferoseptal, posterior, anterior and inferior walls has been noted.

Conclusions. In mitral insufficiency the indices of displacement of basal, middle and apical portions of left ventricular walls were not changed. However, displacement of basal segments of the inferoseptal, posterior, anterior and inferior walls were tending to increase, compared to normal heart.

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Myocardial longitudinal motion disorder is considered a possible pathogenetic factor in the heart failure development, in particluar, in dilated cardiomyopathy. Implementation of the speckle tracking technology provides unique opportunity to study qualitative and quantitative aspects of the myocardial motion by segments.

The aim – to study the features of the left ventricular walls longitudinal displacement in patients with dilated cardiomyopathy with and without left bundle branch block.

Material and methods. Seventy patients with dilated cardiomyopathy and 35 patients without cardiac pathology have been involved into the study. Common laboratory methods of examination and complex echocardiography, including speckle-tracking echocardiography, have been carried out. Patients with dilated cardiomyopathy have been assigned into two groups, according to the stage of heart failure and occurrence of the left bundle branch block.

Results. Higher end-diastolic and end-systolic volumes, as well as lower stroke volume and ejection fraction, higher pulmonary artery hypertension, moderate mitral and tricuspid regurgitation have been noted in patients with dilated cardiomyopathy. These changes were more significant in patients with left bundle branch block. Peak values of the longitudinal displacement were demonstrated in basal segments of the left ventricle both in healthy subjects and in dilated cardiomyopathy. At the same time, the apex of the heart remains almost static.

Conclusions. The longitudinal myocardial displacement of the left ventricle was significantly less along with more heart failure signs and in patients with left bundle branch block.

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