2020 Clinical practice guidelines for Myocarditis in adults

Arutyunov, G. P.; Палеев, Ф. Н.; Моисеева, О. М.; Драгунов, Д О; Соколова, Aнна; Arutyunov, A G; Жиров, И. В.; Благова, О В; Привалова, Е. В.; Габрусенко, С. А.; Garganeeva, A. A.; Gendlin, G. E.; Gilyarevsky, S. R.; Duplyakov, D. V.; Зайратьянц, О. В.; Karateev, D. E.; Козиолова, Н. А.; Космачева, Е. Д.; Кочетов, А. Г.; Lopatin, Yu. M.; Мелехов, А. В.; Mitrofanova, Lubov; Narusov, O Yu; Nasonova, Svetlana N.; Недоступ, А В; Nikulina, S. Yu.; Orlova, Yа A; Потешкина, Н. Г.; Ребров, А. П.; Saidova, M. A.; Седов, В П; Синицын, В. Е.; Sitnikova, M. Yu.; Скворцов, А. А.; Skibitsky, V. V.; Стукалова, О. В.; Tarlovskaya, E. I.; Терещенко, С. Н.; Usov, V. Yu.; Famin, I. V.; Чесникова, А. И.; Шапошник, И. И.; Шостак, Н. А.

doi:10.15829/1560-4071-2021-4790

Cited by 24 publications

(10 citation statements)

References 224 publications

(316 reference statements)

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“…Нами было сделано предположение, что подход в виде квадротерапии может быть эффективен и у лиц молодого возраста, имеющих симптомы и признаки ХСН после перенесенного миокардита. Тем более, что в текущей редакции клинических рекомендаций по лечению миокардитов представлены указания по терапии стабильной недостаточности кровообращения после перенесенного миокардита: с целью уменьшения риска прогрессирования заболевания рекомендован постоянный прием иАПФ, БРА, БРА/АРНИ, ББ, ивабрадина (в случае непереносимости ББ) и АМКР [10].…”

Section: Discussionunclassified

“…В текущей редакции клинических рекомендаций по лечению миокардитов, осложненных систоличе-КЛИНИЧЕСКИЙ СЛУЧАЙ ской дисфункцией миокарда, предложено рассматривать консервативную терапию и принципы ведения, аналогичные при острой и ХСН [10].…”

Section: ключевые моменты Key Messagesunclassified

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Twenty-four-year-old patient with heart failure after myocarditis. Results of quadruple therapy: a case report

et al. 2023

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Introduction. The data of epidemiological studies indicate maintaining high prevalence of heart failure (HF) and an unfavorable prognosis for such patients, which creates the need to change the treatment approach. A feature of the case presented is the young age of the patient and a significant effect that was achieved with quadruple therapy for HF with reduced ejection fraction (EF) after myocarditis.Short description. A three-year follow-up of a patient with HFrEF was carried out. In 2019, at the age of 21, the patient had acute myocarditis, diagnosed according to magnetic resonance imaging. The outcome was postmyocarditis cardiosclerosis, complicated by HFrEF. She had two episodes of HF decompensation, followed by hospitalizations in a cardiology hospital. During the treatment, a quadruple therapy was initiated (angiotensin receptor-neprilysin inhibitor, beta-blocker, mineralocorticoid receptor antagonist, sodium-glucose cotransporter 2 inhibitor), against which a significant improve was noted in the form of decrease in congestion symptoms, natriuretic peptide level from 1956 to 501,4 pg/ml, an increase in LVEF from 33% to 39%. The patient is currently on the waiting list for a donor heart transplant.Conclusion. The case report focuses on the complexity of not only the timely diagnosis of myocarditis, but also the treatment of its consequences. The appointment of quadruple therapy for a patient with HF after myocarditis has improved the patient’s clinical condition before heart transplantation. However, this approach needs to be confirmed in a larger number of patients.

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Section: Discussionunclassified

Section: ключевые моменты Key Messagesunclassified

Twenty-four-year-old patient with heart failure after myocarditis. Results of quadruple therapy: a case report

et al. 2023

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“…В нашем исследовании в группе без морфологической верификации диагноза мы также активно использовали МРТ сердца, оно выполнено 31 пациенту и является одним из малых критериев диагностики миокардита в алгоритме неинвазивной диагностики. Примечательно, что в европейских рекомендациях 2013г определение миокардита включает в себя его обязательную морфологическую верификацию, в то время как в отечественных рекомендациях 2020г к этому вопросу подходят несколько мягче и в определении миокардита как нозологии эти указания отсутствуют [9].…”

Section: Discussionunclassified

“…Биоптаты исследовались при помощи световой микроскопии с применением окрасок гематоксилинэозином, по Ван Гизону, Мэссону, Перлсу, конго красным, ШИК-реактивом, а также методом полимеразной цепной реакции на геном кардиотропных вирусов (аденовирусы, Herpes Simplex Virus Type 2, Cytomegalovirus, Herpes Simplex Virus Type 1, Epstein-Barr virus, Varicella zoster virus, Parvovirus B19, Human Herpes Virus 6, Human Herpes Virus 8). Для постановки диагноза миокардита при морфологическом исследовании миокарда использовались Далласские критерии, дополненные иммуногистохимическим исследованием с использованием антител к маркерам Т-лимфоцитов (CD45+ и CD3+), макрофагов (CD68+), В-лимфоцитов (CD20+) [8,9].…”

Section: миокардит эндокардит и кардиомиопатииunclassified

Prevalence of myocarditis and its contribution to the course of primary myocardial hypertrophy

Lutokhina,

Blagova,

Kogan

et al. 2023

Russ J Cardiol

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Aim. To assess the incidence of myocarditis in patients with primary myocardial hypertrophy and to study its contribution to the disease course.Material and methods. The study included 100 patients with primary left ventricular myocardial hypertrophy, 52 men and 48 women (mean age, 51,5±15,7 years; followup period 10,4 [2,1; 36,1] months). All patients underwent electrocardiography, 24-hour electrocardiographic monitoring, echocardiography, as well as DNA analysis (n=96), myocardium pathological study (n=29), cardiac magnetic resonance imaging (n=31), cardiac multislice computed tomography (n=26), assessment of anti-cardiac antibodies (n=43), free light chain level in serum and urine by immunofixation method (n=10); 99mTc-pyrophosphate myocardial scintigraphy (n=5); biopsy of the rectal mucosa and/or subcutaneous fat for amyloid (n=9).Results. In 68%, true (sarcomeric) hypertrophic cardiomyopathy (HCM) was diagnosed, in 16% — amyloidosis with cardiac involvement, in 10% — storage diseases, in 3% — neuromuscular diseases, in 2% — myocardial hypertrophy was combined with severe restriction (mixed phenotype), and in 1% — LEOPARD syndrome. Concomitant myocarditis was diagnosed in 30% of patients. In HCM, myocarditis was detected in 31% of cases. These patients had a significantly higher heart failure class (heart failure class 3 [2; 3] vs 2 [1; 3], p=0,026) and mortality (33,3% vs 6,4%, p=0,01). In amyloidosis, the incidence of myocarditis was 31,3%. In these patients, ventricular tachycardia was observed significantly more often: 80,0% vs 18,2% (p=0,036). The prevalence of concomitant myocarditis in the subgroup of storage diseases was 30%: 2 patients with Fabry disease and 1 patient with Danon disease. Of the three patients with neuromuscular diseases, myocarditis was diagnosed in 1. In the subgroups with the restrictive phenotype and LEOPARD syndrome, no cases of myocarditis were recorded. Treatment of myocarditis made it possible to stabilize the patients' condition.Conclusion. Concomitant myocarditis led to heart failure progression, worsening ventricular arrhythmias and, as a consequence, an increased risk of sudden cardiac death. It is necessary to actively diagnose and treat myocarditis in patients with primary myocardial hypertrophy.

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“…Подозрение на миокардит определяется клинической картиной (боль в области сердца), данными электрокардиограммы (элевация сегмента ST), лабораторными данными (например, повышением уровня тропонинов), а также визуализирующими методикамиэхокардиографией и магнитно-резонансной томографией (МРТ) [29]. Эффективность последней подчёркивается и в российских клинических рекомендациях по диагностике миокардита [30].…”

Section: диагностика миокардита в том числе ассоциированного с Covid-19unclassified

COVID-19-related cardiac lesion: The questions of pathogenesis and diagnostics

Filatova

Мершина

Sinitsyn

2023

Digital Diagnostics

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Coronavirus infection is a topic that has not lost its relevance in the medical community to date. Among the heterogeneous clinical manifestations of this disease lesions of cardiac structures often occur. They are mainly of inflammatory nature and can be both acute and delayed. It is well known that the prognosis for patients with cardiac lesions significantly worsens; timely diagnosis and treatment initiation play an important role in preventing severe complications. This review presents the current literature data on the pathogenesis of cardiac lesions in COVID-19 patients, discusses the issues of rational diagnosis of this pathology using modern techniques: laboratory, functional, imaging (cardiac magnetic resonance plays the main role among them) and invasive ones. Currently, it is recognized that the diagnosis of myocarditis associated with coronavirus infection has a number of fundamental differences from the diagnosis of myocarditis of other nature. In addition, the main aspects of inflammatory heart lesions associated with COVID-19 vaccination are discussed, since this complication occurs more frequently than it is commonly believed. It is often a reason to refuse vaccination; however, this decision may cause severe consequences both for the individual and for the population as a whole.

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2020 Clinical practice guidelines for Myocarditis in adults

Cited by 24 publications

References 224 publications

Twenty-four-year-old patient with heart failure after myocarditis. Results of quadruple therapy: a case report

Twenty-four-year-old patient with heart failure after myocarditis. Results of quadruple therapy: a case report

Prevalence of myocarditis and its contribution to the course of primary myocardial hypertrophy

COVID-19-related cardiac lesion: The questions of pathogenesis and diagnostics

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