Results of one-year follow-up of patients with severe myocarditis associated with COVID-19 on glucocorticoid therapy

Abstract

The aim of the study – to investigate the effectiveness and safety of glucocorticoid therapy in patients with severe myocarditis associated with COVID-19.
Materials and methods. The results are based on data obtained from 72 patients with severe acute myocarditis (AM) and heart failure (HF) with reduced left ventricular ejection fraction (LVEF ≤ 40 %). Patients were divided into two groups: the group 1 included 34 patients with AM, who had a documented history of coronavirus disease ≤ 3 months before the onset of clinical symptoms of AM; the group 2 consisted of 38 patients with AM, who had no history of coronavirus disease. All patients received optimal therapy for heart failure during all period of follow-up and immunosuppressive therapy with glucocorticoids (GKs) within first 6 months from the onset of AM. Patients underwent for echocardiography with speckle tracking and cardiac magnetic resonance (CMR). The studies were conducted three times: in the first month from the onset of clinical symptoms of myocarditis, after 6 months, and after 12 months of observation.
Results and discussion. After 6 months of follow-up, improvements in the structural and functional state of the heart were observed in both groups, with group 1 showing greater increases in LVEF and LGSS by 13.1 % and 22.2 %, respectively (p<0.05). Additionally, group 1 exhibited a reduction in the number of LV segments affected by inflammatory changes and the total number of damaged segments by 28.4 % and 18.3 %, respectively, compared to group 2 (p<0.05–0.001). After 12 months results of CMR demonstrated significantly less myocardial damage in group 1 compared to group 2: the total number of LV segments affected by inflammation and/or fibrosis was 39.0 % lower (p<0.001). The most common complications of GKs therapy after 6 months were obesity (13.88 %) and leukocytosis (12.50 %), while hypokalemia occurred in 6.94 % of cases. Complications such as arterial hypertension, hyperglycemia, functional hypercortisolism, and myalgia were recorded in 4.16 % of cases. After 12 months, a significant reduction or complete resolution of GC-associated complications was observed in most patients: only 7 cases (9.72 %) of pathology associated with GC therapy were recorded.
Conclusions. In patients with acute severe myocarditis with a history of coronavirus disease, glucocorticoid therapy demonstrated greater efficacy in improving the structural and functional state of the heart after 6 months of follow-up compared to patients without a history of COVID-19. The use of glucocorticoids in patients with severe myocarditis was associated with the development of complications in more than a half of patients within the first 6 months of follow-up, while after 12 months, there was a significant reduction in their frequency or their complete regression. During the 12-month observation period, none of the patients developed diseases or pathological conditions associated with glucocorticoid use that required inpatient treatment.