Diagnostic and prognostic markers of morphofunctional heart state impairment and long-term persistence of heart failure in patients with myocarditis

Abstract

The problem of myocarditis, has gained special relevance in recent years, therefore, the search for new diagnostic and prognostic markers of the disease unfavorable course is expedient for the timely appointment of optimal drug therapy, strengthening of regimen measures and adequate monitoring of the patient’s clinical condition. The purpose of the study: to establish laboratory and instrumental markers of morphofunctional heart state impairment and to develop a mathematical model for early prediction of long-term heart failure persistence in patients with myocarditis. We included 80 patients with acute myocarditis with a severe course and reduced left ventricular ejection fraction (LVEF) – ≤40 %. Assessment of laboratory and instrumental indicators was carried out in the 1st month from the onset of symptoms, after 6 and after 12 months of observation. All patients underwent for immunological studies, 24-hour ECG monitoring, echocardiography with speckle-tracking and cardiac magnetic resonance imaging. After 12 months of follow-up frequency of adverse cardiovascular events (ACE) was assessed. Statistical processing included Student’s t-test for comparison of mean values, binary logistic regression and ROC analysis, discriminant analysis. A set of morphofunctional instrumental indicators determined during the 1st month from the onset of myocarditis, which can serve as predictors of cardiovascular events during the next 12 months, was established: left ventricular ejection fraction ≤30 %; indicator of longitudinal global strain ≤7.0 %; the presence of paroxysms of non-sustained ventricular tachycardia; the presence of inflammatory changes in ≥6 segments and delayed contrast enhancement in ≥5 segments of the left ventricle. A mathematical model has been created, with the help of which it is possible to predict the adverse course of the disease with long-term (at least 12 months) persistence of heart failure already within the 1st month from the onset of myocarditis.