Study of glucocorticoid therapy efficiency in patients with chronic myocarditis
One of the most urgent issues of non-coronary heart disease remains the expediency of prescribing immunosuppressive therapy with glucocorticoids (GC) in patients with chronic myocarditis. The purpose of the study was to perform a comparative analysis of the structural and functional heart state in patients with chronic myocarditis who received or did not receive glucocorticoid therapy. The study included 58 patients with chronic myocarditis with reduced left ventricular ejection fraction (LV) and presence of II or higher functional class of heart failure according to New York Heart Association criteria, which were divided into 2 groups: the 1st group consisted of 30 patients who, in addition to standard heart failure therapy, were treated with methylprednisolone 0.5 mg/kg for 4 months with a gradual subsequent dose reduction, and the 2nd group included 28 patients who did not receive immunosuppressive therapy. All patients underwent for a 6-minute walk test, echocardiography with speckle-tracking and cardiac magnetic resonance imaging (CMR). The examination was carried out before the appointment of the GC and after 6 months of treatment. For statistical processing of the results, the software Exсel XP (Missrosoft Office, USA) and statistical program Statistica for Windows 6.0 (Statsoft, USA) were used. Prior to treatment, both groups were comparable to the results of a 6-minute walk test and all echocardiographic parameters, inflammatory and fibrotic changes in the myocardium were detected with approximately same frequency. After 6 months of GC therapy, it was found that the end-diastolic volume index in the 1st group was 17.5% (P <0.05) less and value LV ejection fraction was 13.5% (P <0.05) higher in comparison with the 2nd group, in addition the value of global longitudinal systolic strain was also 27.5% (P <0.01) higher in the 1st group. The frequency of active inflammatory changes detection on CMR - myocardial edema and hyperemia in the 1st group after 6 months was 16.6% and 20.0% respectively, that presented as almost twice lower than in the 1st group; fibrotic changes in the myocardium in 1st group were observed in 66.6% of cases, which was 1.7 times more frequent than in the 2nd group. Significant influence of the appointment of immunosuppressive therapy on the absence of inflammatory changes in the myocardium was confirmed by correlation analysis: the use of GC was associated with the absence of edema and myocardial hyperemia after 6 months of treatment - (r = -0,82; P <0,01) and (r = -0.76; P <0.01) respectively. In patients with chronic myocarditis receiving immunosuppressive therapy, inflammatory changes in the myocardium (edema and hyperemia) were found to be much less common, the end diastolic volume index was significantly lower, LV ejection fraction and parameters of longitudinal global systolic strain were higher in comparison with patients who did not receive GC treatment.
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