COMPARATIVE ANALYSIS OF THE IMMUNOSUPPRESSIVE THERAPY EFFECTIVENESS IN PATIENTS WITH SEVERE MYOCARDITIS AFTER COVID-19 INFECTION
Summary. Myocarditis is an inflammatory disease of the myocardium associated with cardiac dysfunction. Symptoms are non-specific and depend on the degree of myocardial inflammation and systolic dysfunction, the course may be asymptomatic, due to which the disease may not be recognized in time. As a result of the COVID-19 pandemic, numerous cases of myocarditis associated with SARS-CoV-2 have been described. Glucocorticoids have common points of application regarding the impact on the main pathogenetic mechanisms in both myocarditis and COVID-19 infection. Purpose. To investigate the structural and functional state of the heart and the prevalence of inflammatory myocardial damage in patients with severe course of myocarditis after COVID-19 infection who are on glucocorticoid therapy. Materials and methods. 66 patients with severe course of myocarditis were included in the study. which were divided into 4 groups: 1st group — 23 patients with a history of COVID-19 infection; 2nd group — 23 patients who did not have a history of COVID-19; 3rd group — 10 patients who did not receive glucocorticoid therapy and had a history of COVID-19; 4th group — 10 patients who did not receive glucocorticoid therapy and did not have a history of COVID-19. Examinations were carried out in the 1st month from the onset of symptoms before the start of treatment with glucocorticoids and after 6 months of observation. Quantitative content of C-reactive protein and brain natriuretic peptide precursor in blood plasma was determined for all patients, and transthoracic echocardiography and cardiac magnetic resonance (CMR) with contrast were performed. Results. When analyzing the results of the study, reverse LV remodeling was noted in all groups, but in the groups receiving glucocorticoids, the end-diastolic dimensions of the LV returned to normal faster. When assessing heart lesions according to CMR data after a 6-month course of treatment, a smaller number of LV segments affected by inflammatory lesions was noted in the groups receiving glucocorticoids. Conclusions. The use of glucocorticoids proved to be the most effective in improving contractility and normalizing the size of the left ventricle precisely in the group of patients who suffered from COVID-19, which indicates the pathogenetic validity of prescribing immunosuppressive therapy for this category of patients.
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