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ECPB 2019, 86(2): 59–65
https://doi.org/10.25040/ecpb2019.02.059
Research articles

Prognostic Assessment of Immunosuppressive Treatment Efficiency in Patients with Acute Myocarditis

S.V. CHERNIUK
Abstract

Inroduction. Making a decision about the usage of immunosuppressive therapy with corticosteroids (CS) in patients with myocarditis nowadays remains one of the urgent tasks of modern practical cardiology. Currently there is no consensus on the need for the use of CS in patients with myocarditis, as complex studies in this direction have not been performed yet, but the available data and expert opinions are controversial and do not answer the questions regarding indications and contraindications, terms, target doses and modes of CS use in patients with myocarditis. The purpose of the study was to identify immunological predictors and develop a mathematical model for the early prediction of the effectiveness of a 6-month course of immunosuppressive therapy in patients with myocarditis. Materials and methods. 40 patients have been studied with acute myocarditis and heart failure II or above NYHA class and left ventricular (LV) ejection fraction (EF) ≤40 %, the thorough examinations were performed in the 1-st month from the disease onset and after 6 months of follow-up. All patients received the immunosuppressive treatment with CS (Methylprednisolone in the daily dose of 0,3 mg/kg during 3 months with the gradual dose decrease and full cancellation after 6 months). The patients underwent the assessment of immunologic parameters, 2D-echocardiography and cardiac magnetic resonance imaging (MRI). The statistical analysis was performed by means of using Exсel XP (Місrosoft Office, USA) and Statistica for Windows version 6.0 (StatSoft, USA) software. The obtained results revealed that the use of a 6-month course of CS treatment in patients with myocarditis and impaired left ventricular ejection fraction is effective in decreasing the immunopathological reactions activity, reducing the left ventricular dilatation and improving the LV systolic function. The predictors of the LV systolic function improvement in patients with myocarditis were established, which can be used as the argument in favor of 6-month course of treatment with corticosteroids treatment: serum titre of antibodies to the myocardium (<20.0 conv. un.), the content of anti-cardiomyosin antibodies (<5.0 opt. sq. un.) and antibodies to β1-adrenergic receptor (<0.70 opt. sq. un.), the concentrations of the tumor necrosis factor-α (>18.0 pg/ml) and interleukin-1β (>7.0 pg/ml), the activity of the blast-transformation reaction of lymphocytes induced by myocardium (>6.0%), expression of Toll-like receptors of the 2nd (>8.5 CIF) and 4th (> 13.0 CIF) type were defined in the 1st month after myocarditis onset. Conclusions. A mathematical model was developed for the early prediction of the 6-month course of the immunosuppressive therapy with corticosteroids effectiveness in patients with acute myocarditis that could be used for the early prognostication of the LV function improvement or persistence of the LV systolic dysfunction after 6 months of treatment. The sensitivity of the model is 84.2 %, specificity – 79.4 %, the positive predictive value – 80.2 %, and the negative predictive value – 74.3 %.

Recieved: 13.05.2019

Keywords: acute myocarditis, immune state, systolic dysfunction, corticosteroids, prognostic model

Full text: PDF (Eng) 389K

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