Abstract
Aim. To evaluate diagnostic significance of non-invasive methods of myocarditis diagnostics. Material and methods. To the study, 141 patient included with suspected myocarditis (104 males, 37 females; age 11-69, mean age 42,7±13,7 y. o.). All patients, together with clinical assessment, underwent standard echocardiography, magnete resonance tomography (MRI) of the heart with contrast enhancement and endomyocardial biopsy with histological and immunohistochemical analysis. Also, the levels of circulating cardiotropic autoantibodies, troponin I and C-reactive protein were measured. Results. There were no significant differences between patients with myocarditis and dilation cardiomyopathy (DCM) in analysis of clinical, anamnestical and standard laboratory data. The differences found, in levels of circulating cardiospecific autoantibodies in myocarditis patients and DCM comparing to almost healthy donors. However the profile of autoantibodies in myocarditis and DCM patients differed only by the level of autoantibodies to cardiac myosin (χ 2 =6,0; р=0,014), cytoplasmic antigen of cardiomyocytes CoS-05-40 (χ 2 =10,2; р=0,001) and the adenine nucleotide translocator protein ANT (epitope EGS) (χ 2 =10,7; р=0,001). Sensitivity of MRI for myocarditis diagnosis is 67%. In acute myocarditis MRI sensitivity is significantly higher than in chronic inflammation: 85% and 63%, respectively. In chronic borderline myocarditis the sensitivity is no more than 55%. Conclusion. Low diagnostic significance of clinical and anamnestic data confirmed, and the data of standard laboratory and instrumental investigation, in diagnostics of myocarditis. In patients with myocarditis and DCM there was a specific autoantibodies profile found, different from that of almost healthy donors. MRI shows the highest sensitivity for acute myocarditis. In chronic one, sensitivity depends on inflammation activeness, making necessary the biopsy.
Highlights
There were no significant differences between patients with myocarditis and dilation cardiomyopathy (DCM) in analysis of clinical, anamnestical and standard laboratory data
9. Caforio A, Tona F, Bottaro S, et al Clinical implications of anti-heart autoantibodies in myocarditis and dilated cardiomyopathy
Summary
Наряду с клиническим обследованием, проводились стандартное эхокардиографическое исследование, магнитно-резонансная томография (МРТ) сердца с контрастным усилением и эндомиокардиальная биопсия (ЭМБ) с гистологическим и иммуногистохимическим анализом. Чувствительность МРТ сердца для диагностики миокардита составила 67%. ДКМП — дилатационная кардиомиопатия, МРТ — магнитно-резонансная томография, ЭМБ — эндомиокардиальная биопсия, LGE (late gadolinium enhancement) — позднее контрастное усиление, МНС (major histocompatibility complex) — главный комплекс гистосовместимости. Такие как электро- и эхокардиографическое исследование, оценка уровня маркеров повреждения миокарда и воспаления имеют довольно низкую специфичность. В последнее время широкое распространение для выявления воспаления в миокарде получила магнитно-резонансная томография сердца (МРТ). Исходя из современных представлений об аутоиммунной природе воспаления миокарда, по мнению большинства экспертов, для диагностики миокардита представляется целесообразным оценивать уровень кардиотропных аутоантител. В связи с этим, цель настоящего исследования — оценить диагностическую значимость неинвазивных методов выявления миокардита у больных с морфологически подтвержденным заболеванием. Таблица 2 Частота выявления повышенного уровня кардиотропных аутоантител у пациентов с миокардитом, ДКМП и у здоровых доноров крови
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