COMPARATIVE ANALYSIS OF CHANGES IN THE IMMUNE STATUS AND THE STRUCTURAL AND FUNCTIONAL STATE OF THE HEART IN PATIENTS WITH MYOCARDITIS ACCORDING TO THE RESULTS OF A 12-MONTH PERIOD OF OBSERVATION
Summary. Myocarditis is an inflammatory lesion of the heart muscle, characterized by heterogeneity of clinical symptoms and an unpredictable course. Studies devoted to the analysis of dynamic changes in the immune status and their impact on the structural and functional state of the heart are promising for predicting the severity of the disease course, timely correction of management therapies for patients with myocarditis, and prevention of complications. Purpose. To establish the features of myocarditis clinical course based on the study of the immune status and the structural and functional state of the heart. Materials and methods. 80 patients with acute myocarditis (AM) with reduced ejection fraction (EF) of the left ventricle (LV) were included in the study. Examinations were carried out in the first month from the onset of symptoms before the appointment of treatment, after 6 and 12 months of observation. All patients were examined for indicators of immune status, echocardiography and magnetic resonance imaging (MRI) of the heart. Results. In the first month from the onset of clinical symptoms, myocarditis was characterized by pronounced activation of immunopathological reactions, dilatation and low LVEF, the average value of which was (33.1±2.2)%. After 12 months of observation, on the background of a decrease in the activity of the immune-inflammatory response and a decrease in the number of LV segments involved in the pathological process, there was a gradual recovery of the structural and functional state of the heart, which was manifested by a decrease in dilatation and an increase in LVEF on average to (43.8±2.6)%. A direct correlation was established between the persistence of LV inflammatory changes on cardiac MRI after 12 months and the titer of antibodies to the myocardium (r = 0.60; p<0.02), the content of pro-inflammatory interleukin-17A (r = 0.51; p< 0.05), as well as a strong inverse correlation with a high concentration of anti-inflammatory interleukin-10 (r = -0.73; p<0.01) determined within the 1st month from the onset of the disease. Conclusions. It was established that the high activity of immunopathological reactions in the 1st month from the onset of myocarditis is associated with long-term persistence of the inflammatory process in myocardium, dilatation and reduction of left ventricular contractile function.
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