Gavrilenko T.I., Cherniuk S.V., Pidgaina O.A., Ryzhkova N.A., Yakushko L.V.

THE ASSESSMENT OF DIAGNOSTIC AND PROGNOSTIC VALUE OF IMMUNOLOGIC BIOMARKERS IN PATIENTS WITH MYOCARDITIS

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About the author:	Gavrilenko T.I., Cherniuk S.V., Pidgaina O.A., Ryzhkova N.A., Yakushko L.V.
Heading	CLINICAL MEDICINE
Type of article	Scentific article
Annotation	Background. Study of diagnostic and prognostic role of immunologic biomarkers in patients with myocarditis might be useful for prediction of disease clinical course and risk stratification as also for timely correction of patient management. The aim of the study was to establish immunologic biomarkers of the heart structural and functional impairment and heart failure persistence in patients with myocarditis. Material and methods. We studied 70 patients with acute myocarditis and heart failure II or above NYHA class and left ventricular (LV) ejection fraction (EF) ≤ 40%. The examination was performed in the 1-st month from the disease onset and after 12 months of follow-up. All patients underwent for the assessment of immunologic parameters, 2D-echocardiography and cardiac magnetic resonance imaging (MRI). Statistic analysis was performed by the use of Exсel XP (Місrosoft Office, USA) and Statistica for Windows v. 6.0 (Statsoft, USA) software. Results. It was established that in the debut of the disease myocarditis is characterized by the presence of active inflammatory changes in the myocardium, which were detected by cardiac magnetic resonance imaging and accompanied by the activation of immunopathological reactions of cell and humoral type, synthesis of effector T- lymphocytes, anti-myocardial antibodies and proinflammatory cytokines, which caused dilatation and systolic LV dysfunction. The high content of anti-myosin antibodies (≥ 3,0 opt. sq. units) and antibodies to β1-adrenergic receptors (≥ 0,35 opt. sq. units) оn the 1-st month from the onset of myocarditis was associated with active inflammatory changes of the myocardium (oedema and hyperemia) after 12 months of follow-up and high activity of sensitized to myocardium T-lymphocytes (≥ 7,0 %) in the 1-st month from the debut of myocarditis was followed by the presence of LV systolic dysfunction (EF ≤ 40%) after 12 months. The obtained cut-off values of immunologic biomarkers may be useful in clinical practice for the early prediction of myocarditis clinical course, persistence of myocardial inflammation and LV systolic dysfunction in patients with myocarditis after 12 months of follow-up. Conclusion. We detected early immunologic predictors that in the first month after disease onset could be used for prediction of the heart structural and functional impairment and heart failure persistence in patients with myocarditis after 12 months of observation: serum level of anti-myosin antibodies, antibodies to β1-adrenergic receptors and activity of sensitized to myocardium T-lymphocytes.
Tags	myocarditis, immune state, antibodies to myocardium, morphofunctional condition of heart
Bibliography	Kovalenko VM, Lutay MI, Sirenko YUM, Sychov OS. Cardio-vascular diseases: classification, diagnostic and treatment standards. Kyiv, MORION; 2016. 223 p. [in Ukrainian]. Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB. et al. Current state of knowledge on aetiology, diagnosis, management and therapy of myocarditis: a position statement of the ESC Working group on myocardial and pericardial diseases. Eur. Heart J. 2013; 34: 2422–2436. Fung G, Luo H, Qiu Y, Yang D, McManus B. Myocarditis. Circ. Res.  2016; 118: 496–514. Heymans S. The quest for new approaches in myocarditis and inflammatory cardiomyopathy. J. Am coll. Cardiol. 2016; Vol. 68: 2348–2364. Huber SA. Viral myocarditis and dilated cardiomyopathy: etiology and pathogenesis. Curr. Pharm. Des. 2016; 22: 408 – 426. Grun S, Schumm J, Greulich S, Wagner A, Schneider S. Long-term follow-up of biopsy-proven myocarditis. J. Am. Coll. Cardiol. 2012; 59 (18): 1604-1615. Kindermann I, Barth C, Mahfoud F, Ukena C, Lenski M et al. Update on myocarditis. J. Am. Coll. Cardiol. 2012; 59 (9): 779-792. Krejci J, Mlejnek D, Sochorova D., Nemec P. Inflammatory cardiomyopathy: a current view on pathophysiology, diagnosis and treatment. BioMed Res. Int. 2016; Article ID 4087632. Lang R, Badano LP, Mor-Avi V, Afilalo J, Armstrong A. Ernande L. et al. Recommendations for cardiac chamber quantification in adults: an update from the American Society of echocardiography and European Asssociation of cardiovascular imaging. J. Am. Soc. Echocardiogr. 2015; 28(1): 1 – 38. Mahrholdt H, Greuilich S. Prognosis in myocarditis J. Am. Col. Cardiol. 2017; 70: 1988–1990. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats S. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. Heart J. 2016; 37: 2129–2200. Sinagra GF, Anzini M, Pereira NL, Bussani R, Finochiarro G. et al. Myocarditis in clinical practice. Mayo Clin. Proc. 2016; 91(9): 1256-1266. Van Linthout S, Tchoepe C. Viral myocarditis: a prime example for endomyocardial biopsy-guided diagnosis and therapy. Curr. Opin. Cardiol. 2018; 33:325-333. Yang Y, Lv J, Jiang S, Ma Z, Wang D. et al. The emerging role of Toll-like receptor 4 in myocardial inflammation. Cell death and disease. 2016; 7. e2234.
Publication of the article	«World of Medicine and Biology» №2(68), 2019 year, 034-039 pages, index UDK 616127-002-037-073+616.017
DOI	10.26724/2079-8334-2019-2-68-34-39