ABSTRACT
Aim To study clinical features of myoendocarditis and its possible mechanisms, including persistence of SARS-Cov-2 in the myocardium, in the long-term period following COVID-19.Material and methods This cohort, prospective study included 15 patients aged 47.8±13.4 years (8 men) with post-COVID myocarditis. The COVID-19 diagnosis was confirmed for all patients. Median time to seeking medical care after COVID-19 was 4 [3; 7] months. The diagnosis of myocarditis was confirmed by magnetic resonance imaging (MRI) of the heart (n=10) and by endomyocardial biopsy of the right ventricle (n=6). The virus was detected in the myocardium with PCR; immunohistochemical (IHC) study with antibody to SARS-Cov-2 was performed; anticardiac antibody level was measured; and echocardiography and Holter monitoring were performed. Hemodynamically significant coronary atherosclerosis was excluded for all patients older than 40 years.Results All patients showed a clear connection between the emergence or exacerbation of cardiac symptoms and COVID-19. 11 patients did not have any signs of heart disease before COVID-19; 4 patients had previously had moderate arrhythmia or heart failure (HF) without myocarditis. Symptoms of myocarditis emerged at 1-5âmonths following COVID-19. MRI revealed typical late gadolinium accumulation, signs of hyperemia, and one case of edema. The level of anticardiac antibodies was increased 3-4 times in 73â% болÑнÑÑ . Two major clinical variants of post-COVID myocarditis were observed. 1. Arrhythmic (n=6), with newly developed extrasystole or atrial fibrillation without systolic dysfunction. 2. Decompensated variant with systolic dysfunction and biventricular HF (n=9). Mean left ventricular ejection fraction was 34.1±7.8â%, and left ventricular end-diastolic dimension was 5.8±0.7âcm. In one case, myocarditis was associated with signs of IgG4negative aortitis. SARS-Cov-2 RNA was found in 5 of 6 biopsy samples of the myocardium. The longest duration of SARS-Cov-2 persistence in the myocardium was 9 months following COVID-19. By using antibody to the Spike antigen and nucleocapsid, SARS-Cov-2 was detected in cardiomyocytes, endothelium, and macrophages. Five patients were diagnosed with lymphocytic myocarditis; one with giant-cell myocarditis; three patients had signs of endocarditis (infectious, lymphocytic with mural thrombosis).Conclusion Subacute/chronic post-COVID myocarditis with isolated arrhythmias or systolic dysfunction is characterized by long-term (up to 9 months) persistence of SARS-Cov-2 in the myocardium in combination with a high immune activity. Endocarditis can manifest either as infectious or as nonbacterial thromboendocarditis. A possibility of using corticosteroids and anticoagulants in the treatment of post-COVID myoendocarditis should be studied.
Subject(s)
Atrial Fibrillation , COVID-19 , Myocarditis , COVID-19 Testing , Humans , Male , Myocarditis/diagnosis , Myocardium , Myocytes, Cardiac , Prospective Studies , RNA, Viral , SARS-CoV-2 , Stroke Volume , Ventricular Function, LeftABSTRACT
Cytochemical parameters of intracellular metabolism of leukemia cells and bone marrow polyamines were studied in 113 acute lymphoblastic leukemia patients aged from 1 to 14 years. The parameters analyzed characterized the severity of the disease course, cytostatic therapy effectiveness and primary resistance. It is shown that determination of biochemical and cytochemical criteria before the beginning of acute lymphoblastic leukemia therapy may be conducive to the correct choice of treatment.
Subject(s)
Precursor Cell Lymphoblastic Leukemia-Lymphoma/metabolism , Adolescent , Child , Child, Preschool , Cytodiagnosis , Humans , Infant , PrognosisABSTRACT
Several concentrations of Fluorocarbon emulsion as means for anti-ischemic protection of the liver were studied in experiments on 47 rabbits with hypothermic perfusion of isolated liver exposed to 90 minute ischaemia. the best concentration of Fluorocarbon emulsion for perfusion of isolated liver was 12%.
