V.M. Kovalenko, E.G. Nesukay, S.V. Cherniuk, R.M. Kirichenko Myocarditis course predicting based on complex studies of immune status and morphofunctional heart condition

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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