COMPARATIVE STUDY OF SIGNIFICANCE OF NON-INVASIVE DIAGNOSTIC METHODS IN INFLAMMATORY DISEASES OF THE HEART

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 (χ²=6,0; р=0,014), cytoplasmic antigen of cardiomyocytes CoS-05-40 (χ²=10,2; р=0,001) and the adenine nucleotide translocator protein ANT (epitope EGS) (χ²=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.

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