Features of inflammatory and cytolytic syndromes and their influence on the development of cardiomyofibrosis in patients with myocarditis with heart failure

Abstract

ABSTRACT. The activity and duration of the inflammatory process in myocarditis affects the severity of the course of myocarditis and determines the development of cardiomyofibrosis, arrhythmias, dilatation syndrome, the occurrence and progression of heart failure. The mechanisms that affect the transition from an active inflammatory process to chronic ventricular dysfunction have not yet been elucidated. Aim. To study the peculiarities of the course of acute myocarditis and the impact on the quality of life of patients, the relationship between indicators of the inflammatory syndrome, cardiomyocyte lysis and heart failure with FGF-23. Materials and methods. The clinical course of acute myocarditis of unknown etiology in 42 adults, laboratory parameters related to the severity of the course and the processes of myocardial fibrosis were analyzed. Statistical processing of the research results was carried out using the StatSoft Statistica v 10.0 program with a known number of observations (n). Spearman's rank correlation coefficient was calculated. Results. Myocarditis was mainly of medium-severe course (69.1%) with heart failure (HF) of II A stage (59.5%). 35.7% of patients had complex rhythm and conduction disorders. A reliable increase in Creatine Kinase-MB and troponin T was established, which was more pronounced in severe myocarditis. Markers of inflammation (СRP, fibrinogen), cardiomyocyte lysis (Creatine Kinase-MB, troponin T) and fibroblast growth factor 23 (FGF-23) were reliably correlated with each other. The inflammatory process in the myocardium contributed to the growth of heart failure, which was confirmed by a reliable correlation of CRP with NT-pro BNP (r=0.64, p<0.001). Conclusions. In patients with acute myocarditis, manifestations of pronounced cytolytic syndrome were established. The inflammatory process was closely related to the lysis of cardiomyocytes and contributed to the development of heart failure. Fibroblast growth factor FGF-23 significantly increased with increasing severity of myocarditis and significantly correlated with markers of inflammation, cardiomyocyte lysis, and heart failure. The quality of life of patients with acute myocarditis significantly decreases with the worsening of the severity of the course of the disease and the severity of heart failure.