Analysis of cardiac structural and functional status with different pharmacotherapy regimens in patients with severe myocarditis

Kirichenko R.M., Titova N.S.

Summary. The aim: To analyze various treatment programs for patients with severe myocarditis based on a comprehensive study of the dynamics of the structural and functional state of the heart during 6 months of observation. Materials and methods. Examined 90 patients with acute myocarditis and reduced LV EF; all patients underwent echocardiographic analysis and speckle tracking echocardiography, magnetic resonance imaging, and daily ECG monitoring during the first month of illness and 6 months of follow-up. Results. Patients with a history of COVID-19 infection who received the sacubitril-valsartan combination for 6 months had an average of 9.6 % (p<0.05) higher exercise tolerance according to the 6-minute test, significantly higher values of LV EF (on average by 9.8 %), LGSS and CGSS of LV (on average by 11.8% and 10.2%, respectively), significantly fewer LV segments affected by fibrous changes (on average by 22.5 %), which associated with 1.5 and 2 times fewer ventricular extrasystoles and episodes of unstable ventricular tachycardia, respectively, compared to patients receiving ACE inhibitors. Conclusions. The use of the sacubitril-valsartan combination in patients with myocarditis and reduced LV ejection fraction who had a history of COVID-19 infection is recommended for increasing exercise tolerance, reducing dilatation and improving LV contractility, reducing fibrotic changes in the myocardium, and reducing the frequency of cardiac arrhythmias.

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