Optimization of immunosuppressive therapy of patients with severe myocarditis
Summary. The Aim. Evaluation of the effectiveness of immunosuppressive therapy with glucocorticoids in patients with severe course of myocarditis. Materials and methods. Examined 72 patients with acute myocarditis and reduced LV EF, of them, 32 had a history of COVID-19 infection, and 40 patients had no history of COVID-19. All patients underwent echocardiographic analysis and speckle tracking echocardiography, magnetic resonance imaging, and daily ECG monitoring during the first month of illness and 6 months of follow-up. Results. It was established that patients after suffering from COVID-19 according to the results of an MRI study, conducted in the 1st month of the disease had an average of 25% more LV segments with inflammatory and 33.3% more fibrotic changes, which was associated with a higher frequency of ventricular extrasystole and episodes of ventricular tachycardia. In addition, in this cohort of patients significantly lower values of LGSS and CGSS of LV were found against the background a comparable value of LVEF. After 6 months of follow-up, a more reliable decrease in the frequency of ventricular arrhythmias and episodes of unstable ventricular tachycardia was found in the group of patients without COVID-19 infection against the background of a significantly smaller number of segments with inflammatory changes with the same volume of LV fibrous lesions. At the same time, the recovery of LV systolic function was more intensive in patients who did not suffer from COVID-19, which was evidenced by higher values of LVEF, LGSS and CGSS of LV compared to those in patients with a history of COVID-19. Conclusions. In patients with a severe course of myocarditis, the use of glucocorticoids is recommended as a pathogenetic therapy (according to the VACU algorithm) with the aim of reducing dilatation and improving the contractile capacity of the LV, reducing the frequency of heart rhythm disturbances and regression of inflammatory damage to the myocardium according to cardiac MRI data.
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