Efficacy of Methylprednisolone Therapy in Male and Female Patients with Severe Acute Myocarditis: Results of a 6-Month Follow-Up

The aim: to evaluate the efficacy of methylprednisolone therapy in men and women with severe acute myocarditis based on the results of a 6-month follow-up. Materials and methods. The study included 48 patients (26 men and 22 women) with severe acute myocarditis and reduced left ventricular ejection fraction (LVEF ≤40%), with a mean age of 38.2±8.6 years. The diagnosis of myocarditis and severe disease course was established according to the recommendations of the Ukrainian Association of Cardiology. In all patients, the diagnosis was confirmed by contrast-enhanced cardiac magnetic resonance imaging (CMR) with the presence of ≥2 updated Lake Louise criteria. Heart rate variability and cardiac arrhythmias were assessed using 24-hour Holter ECG monitoring. Cardiac structure and function, as well as left ventricular remodeling parameters, were evaluated by transthoracic echocardiography with speckle-tracking analysis. Results. At baseline, men and women with severe acute myocarditis did not differ in the main structural and functional cardiac parameters and were characterized by pronounced left ventricular systolic dysfunction and active myocardial inflammation according to CMR findings. After 6 months of methylprednisolone therapy, both groups demonstrated significant improvement in left ventricular structure and function, myocardial strain parameters, and a reduction in the number of myocardial segments with inflammatory changes on CMR (p<0.01). The improvement in left ventricular remodeling and regression of inflammatory myocardial changes was more pronounced in men than in women. Both groups also showed a reduction in the frequency of supraventricular and ventricular arrhythmias, as well as improvement in heart rate variability parameters, without significant sex-related differences. Conclusions. Methylprednisolone therapy in patients with severe acute myocarditis was associated with improvement in left ventricular structure and function, regression of myocardial inflammatory changes, and a reduction in the frequency of cardiac arrhythmias. The improvement in left ventricular remodeling and regression of myocardial inflammation was more pronounced in men than in women.

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