THE ROLE OF CARDIAC MAGNETIC RESONANCE IN CLINICAL MONITORING AND ASSESSMENT OF PATHOGENETIC THERAPY EFFICIENCY IN PATIENTS WITH SEVERE COURSE OF MYOCARDITIS
Authors: Cherniuk S. , Marchenko K. 
Published: November 2024

Introduction. Diagnosis of myocarditis often causes significant difficulties due to the heterogeneity of clinical manifestations, the absence of specific symptoms and generally recognized recommendations for diagnosis and treatment. In recent years cardiac magnetic resonance (CMR) has become not only the most common and informative diagnostic tool for myocarditis, but also a method of monitoring the effectiveness of anti-inflammatory therapy.The purpose of the study was to investigate the structural and functional state of the heart and the prevalence of the inflammatory process in patients with severe course of myocarditis associated with COVID-19 infection, who received glucocorticoid therapy.Material and methods. 80 patients with a severe course of myocarditis and reduced ejection fraction (EF) of the left ventricle (LV) were included and divided into 4 groups: 1st group - 25 patients who received glucocorticoid (GC) therapy and had a history of COVID-19 infection; the 2nd group – 25 patients who received GC therapy and did not have a history of COVID-19 infection; the 3rd group – 15 patients who did not receive GC therapy and had a history of COVID-19 infection; the 4th group – 15 patients who did not receive GC therapy and had no history of COVID-19 infection. All patients underwent echocardiography with the speckle-tracking technique and CMR with gadolinium enhancement.Results and discussion. The use of glucocorticoids in addition to optimal drug therapy for heart failure in patients with severe myocarditis who had a recent history of COVID-19 infection showed high efficacy after 6 months: the number of LV segments with inflammatory changes or delayed enhancement on CMR was, respectively by 44,2% and 32,5% less, and the value of the LV EF and the index of longitudinal global systolic deformation of the left ventricle were 15,0% and 24,3% higher in comparison with those in patients who did not receive pathogenetic therapy. In patients of the 1st group, the absence of a linear lesion on CMR at the onset of the disease was associated with recovery of LVEF to ≥50% after 6 months of treatment (r=0,66; p<0.01); a similar regularity was established also in the 2nd group (r=0,59; p<0.05). On the other hand, in patients of the 3rd and 4th groups, who did not receive immunosuppressive therapy with GC, no reliable correlations were established between the absence of a linear lesion on CMR at the onset of myocarditis and recovery of LVEF after 6 months.Conclusions. CMR in patients with myocarditis, including those associated with coronavirus disease, is the main non-invasive method for diagnosis, clinical monitoring, prognosis and determining the tactics of pathogenetic therapy. The presence of a linear lesion on CMR in patients with myocarditis is associated both with a more severe course of the disease, pronounced dilatation and a more significant violation of the LV contractile ability at the onset of the disease, and with a slower recovery of the structural and functional state of the heart despite the influence of drug therapy.