Rationale for the use of immunosuppressive therapy in patients with acute myocarditis
To date, the expediency of immunosuppressive treatment with corticosteroids in patients with myocarditis is one of the most controversial issues of modern cardiology. The purpose of the study was to establish predictors of corticosteroid therapy efficiency in patients with acute myocarditis. 47 patients with acute myocarditis were examined, who received immunosuppressive therapy for 6 months. All patients underwent for immune state assessment, echocardiography and cardiac magnetic resonance imaging. Statistical processing of the results was performed using Excel XP and Statistica for Windows v. 6.0 programming studying Student's criterion, parametric correlation analysis and distribution of the studied indicators by binary scale. It has been established that the appointment of immunosuppressive therapy in patients with high activity of immunopathological reactions of humoral type in the debut of myocarditis after 6 months of treatment leads to a decrease in the activity of autoimmune damage of the myocardium, recovery of left ventricular systolic function and improvement of heart failure functional class. The predictors of heart failure functional class improvement after 6-months of corticosteroid treatment were determined as: concentrations of immunoglobulin M>2,5 g/l, CD19+ lymphocytes >0,23 × 109/l, tumor necrosis factor α>200 pg/ml, interleukin-1β >150 pg/ml, content of circulating immune complexes >75 un. opt. sq., titre of antibodies to myocardium >20.0 conv. un. before the start of immunosuppressive therapy, as well as the absence of fibrotic changes in the left ventricular myocardium on cardiac MRI. Thus, early prognostic markers of the effectiveness of glucocorticoid therapy in patients with acute myocarditis were established. Further research should focus on the search for criteria of immunosuppressive therapy effectiveness and the introduction of clear recommendations for clinical practice that will contain indications and contraindications for its management in patients with myocarditis.
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