ANALYSIS OF THE REASONS OF LATER DIAGNOSTICS OF MYOCARDITIS
https://doi.org/10.18705/2311-4495-2018-5-2-5-14
Abstract
The verification of the diagnosis of “myocarditis”, despite the active introduction of modern survey methods, is still complicated, which leads not only to late diagnosis, but also to worsening the prognosis of patients. The purpose of this study was to identify the causes of late diagnosis of inflammatory diseases of the myocardium, evaluate the factors influencing the course of the disease, and the effectiveness of the therapy in patients with morphologically documented myocarditis. The study involved 50 patients with morphologically documented myocarditis. The duration of follow-up was 3.5±1.6 years. In 59% of cases, myocarditis was diagnosed within a period exceeding 6 months of the first clinical and instrumental manifestations. Long-term prognosis of patients with regard to global contractility of the left ventricle depended on the timing of verification of the diagnosis (c² = 6.9, p <0.05) and the clinical variant of the debut of the myocarditis (c² = 13.7, p <0.01). There was a significant deterioration in the prognosis in patients who have a heart failure clinic and rhythm disorders in the onset of the disease, as well as in patients with late diagnosis of the disease due to erroneous treatment. It was concluded that the presence of idiopathic rhythm disturbances should be considered as an excuse for excluding myocarditis in patients with already diagnosed heart diseases. The study proved an improvement in the prognosis on the background of combined therapy for heart failure (ACE inhibitors, beta-blockers and diuretics) (c² = 9.28, p <0.01), and statin therapy (c² = 6.04, p <0.05).
About the Authors
S. V. Ivanova
Almazov National Medical Research Centre
Russian Federation
Russian Federation
Sofya V. Ivanova - medical resident.
Akkuratova str. 2, Saint Petersburg, 197341
V. A. Titov
Almazov National Medical Research Centre
Russian Federation
Russian Federation
Vladislav A. Titov – MD.
Saint Petersburg
L. B. Mitrofanov
Almazov National Medical Research Centre
Russian Federation
Russian Federation
Lubov` B. Mitrofanova - PhD, prof., Head of the laboratory of pathomorphology.
Saint Petersburg
O. M. Moiseeva
Almazov National Medical Research Centre
Russian Federation
Russian Federation
Olga M. Moiseeva - MD, PhD, prof., Head of the Department of Noncoronary Diseases.
Saint Petersburg
References
1. Moiseeva OM. Myocarditis: the basic principles of diagnosis and treatment. Kardiologiya: novosti, mneniya, obucheniye= Cardiology: news, opinions, training. 2016; 1(8): 50−64. In Russian.
2. Runov A, Kurchakova E, Khaschevskaya D, et al. Viral reseptor gene expression and myocarditis development. Medical Virology. 2016; 30(1): 39−47. In Russian.
3. Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European Heart J. 2013; 34(33): 2636−2648.
4. Leone O, Veinot JP, Angelini A, et al. 2011 consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology. Cardiovascular Pathology. 2012; 21(4): 245–274.
5. Paleyev NR, Paleyev FN. Non-coronary myocardial disease and its classification. Rossiyskiy kardiologicheskiy zhurnal=Russian journal of cardiology. 2009; 3: 5-9. In Russian.
6. Anzini M, Merlo M, Sabbadini G, et al. Long-term evolution and prognostic stratification of biopsy-proven active myocarditis. Circulation. 2013; 128(22): 2384−2394.
7. Tereshchenko SN, Arutyunov GP, Gilyarevsky SR. Clinical guidelines. Diagnosis and treatment of myocarditis. Evraziyskiy kardiologicheskiy zhurnal=Eurasian heart journal. 2015; 3: 3−17. In Russian.
8. Antonova TV, Zhevnerova NS. Viral myocarditis: etiology and pathogenesis, problems of diagnostics. Zhurnal Infektologii=Journal of infections. 2013; 5(2): 13−21. In Russian.
9. Mitrofanova LB, Kovalskiy GB. Myocardial morphological changes in atrial fibrillation. Arkhiv patologii=Archives of parhologies. 2011; 6: 10−14. In Russian.
10. Blagova OV, Nedostup AV. Contemporary masks of the myocarditis (from clinical signs to diagnosis). Rossiyskiy kardiologicheskiy zhurnal=Russian journal of cardiology. 2014; 5: 13−22. In Russian.
11. Birnie DH, Kandolin R, Nery PB, et al. Cardiac manifestations of sarcoidosis: diagnosis and management. European Heart J. 2017; 38(35): 2663−2670.
12. Kouranos V, Tzelepis GE, Rapti A, et al. Complementary Role of CMR to Conventional Screening in the Diagnosis and Prognosis of Cardiac Sarcoidosis. JACC Cardiovasc Imaging. 2017; 10(12): 1437−1447.
13. Kytö V, Sipilä J, Rautava P. The effects of gender and age on occurrence of clinically suspected myocarditis in adulthood. Heart. 2013; 99(22): 1681-1684.
14. Dennert R, Crijns HJ, Heymans S. Acute viral myocarditis. European Heart J. 2008; 29(17): 2073−2082.
15. Liu W, Li WM, Gao C, et al. Effects of atorvastatin on the Th1/Th2 polarization of ongoing experimental autoimmune myocarditis in Lewis rats. J. of autoimmunity. 2005; 25(4): 258-263.
16. Lazzerini PE, Capecchi PL, Laghi-Pasini F. Statinsas a New Therapeutic Perspective in Myocarditis and Postmyocarditis Dilated Cardiomyopathy. Cardiovascular Drugs and Therapy. 2013; 27(5): 365-369.
17. Syrovnev VA, Lebedev DS, Mitrofanova LB, et al. Interventional treatment in patients with myocarditis: Pro and Contra. Kardiologiya=Cardiology. 2017; 57(3): 49-56. In Russian
Review
For citations:
Ivanova S.V., Titov V.A., Mitrofanov L.B., Moiseeva O.M. ANALYSIS OF THE REASONS OF LATER DIAGNOSTICS OF MYOCARDITIS. Translational Medicine. 2018;5(2):5-14. (In Russ.) https://doi.org/10.18705/2311-4495-2018-5-2-5-14
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