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The recommendations are dedicated to contemporary aspects of epidemiology, etiology, pathogenesis, diagnosis, etiology-based, pathogenetic and symptomatic treatment of myocarditis. Various pathogenetic mechanisms that cause the development and progression of inflammatory heart disease and cause dilatation and systolic dysfunction, lead to heart failure and the development of other complications of myocarditis are described in detail. These recommendations present the modern classification of myocarditis, approved in Ukraine, and modern algorithms for diagnosis and clinical management of patients, in particular the algorithm that justifies the appointment of glucocorticoids for patients with myocarditis. The characteristics of different variants of myocarditis are also presented with clarifications concerning diagnosis and treatment. Much attention is paid to various approaches to the etiotropic and pathogenetic treatment of myocarditis and their possible prospects. It is obvious that in order to standardize approaches to the diagnosis and management of acute and chronic myocarditis, it is necessary to conduct large-scale multicenter studies and create special registries. In addition, in the current context of the COVID-19 pandemic, the pathological effects of SARS-Cov-2 as a trigger of myocarditis need further study, in particular in terms of impact on the prognosis and approaches to pathogenetic therapy in such patients. Unification of terminology and approaches to diagnosis and clinical monitoring of patients with myocarditis can improve management tactics and increase the survival rate of such patients. To identify high-risk patients (with arrhythmias, high probability of recurrence or transformation of myocarditis into dilated cardiomyopathy) and candidates for heart transplantation, the most promising is the creation of special databases of such patients

The aim of the study - to evaluate the efficacy of glucocorticoids (GC) in patients with acute myocarditis (AM) after COVID-19 infection. Material and methods We included 60 pts with severe AM and heart failure (HF) with reduced (<40%) left ventricular (LV) ejection fraction (EF) who had COVID-19 infection 1–2 months before the enrollment. According to the results of cardiac magnetic resonance (CMR) included pts had ≥2 Lake Louise criteria for myocarditis. All pts on the background of HF therapy (β-blockers, ACE-inhibitors, MRA antagonists, diuretics) were prescribed GC: 0.25 mg/kg per day methylprednisolone for 3 months, followed by a gradual dose reduction of 1–2 mg per week until complete discontinuation after 6 months. Evaluation before the start of GC therapy and after 6 months included CMR, 2D- and speckle-tracking echocardiography. Results After 6 months according to the results of CMR the number of LV segments with inflammatory lesions decreased to (3,58±0,42) from (6,32±0,77) segments in average (p=0,001). This was followed by improvement of LV systolic function: increase of LV EF in average to (43,5±2,6) from (32,2±2,4) % (p=0,003), longitudinal global systolic strain (LGSS) absolute value to (11,3±1,1) from (7,9±0,5) % (p=0,012) and circumferential global systolic strain (CGSS) to (12,1±1,0) from (8,9±0,6) % (p=0,023). Also we observed LV volume reduction: decrease of LV end-diastolic (from 118,9±8,6 to 95,3±7,2 ml/m2, p=0,033) and LV end-systolic (from 80,1±5,1 to 59,1±4,4 ml/m2, p=0,027) volume indexes. Wherein in 24 of 60 pts (41,6%) on the background of significant decrease in the number of LV segments with inflammatory lesions (to 1,34±0,21 from 6,12±0,73 segments, p=0,0001) after 6 months we observed the recovery of LV EF ≥50%, followed by an improvement of LGSS and CGSS on 42,1 and 39,4% respectively (p=0,001). According to multivariate regression analysis, predictors of LV EF recovery (≥50%) after 6 months of GC treatment were established: presence of inflammatory lesions in ≤5,0 LV segments, values of LGSS and CGSS ≥9.0% and ≥9.5% respectively before the start of GC. Conclusions The use of GC in pts with severe AM after COVID-19 was followed by the decrease of LV segments number affected by inflammation, improvement of LV systolic function and reduction of LV volume indexes. In 41,6% of pts GC therapy was associated with LV EF recovery after 6 months and predictors of its effectiveness were found: presence of inflammatory lesions in ≤5,0 LV segments, values of LGSS and CGSS ≥9.0% and ≥9.5% respectively before the start of GC. Funding Acknowledgement Type of funding sources: None.

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