ANALYSIS OF EXPRESSION OF VIRAL ANTIGENS AND CLINICAL AND MORPHOLOGICAL DATA IN ACUTE DECOMPENSATED HEART FAILURE WITH ISCHEMIC AND NON-ISCHEMIC ETIOLOGY

Highlights

• Patients with IHD and complete coronary revascularization in history suffering from ADCHF should consider EMB to clarify the etiology of decompensation.
• According to the EMB results, concomitant myocarditis is diagnosed in the majority of patients with IHD and ADCHF.
• The results of immunohistochemistry indicate that patients with IHD and ADCHF often have antigen expression toward cardiotropic viruses.

Abstract

Aim. To compare the clinical and morphological profile of patients with acute decompensated chronic heart failure (ADCHF) with ischemic and non-ischemic etiology with the following determination of the antigen expression toward cardiotropic viruses in myocardium.

Methods. The observational study included 56 patients with ADCHF and LV EF <40%, the patients were divided into 2 groups: patients with ischemic heart disease (IHD) after complete coronary revascularization (n = 26) and patients without IHD (n = 30). All patients underwent standard clinical, instrumental and laboratory examinations (invasive coronary angiography and endomyocardial biopsy (EMB) with morphological analysis and determination of the antigen expression toward cardiotropic viruses).

Results. Patients with ischemic ADCHF presented with fewer rates of shortness of breath during hospitalization compared with patients with non-ischemic ADCHF (12 vs 53%, p = 0.001), fewer rates of wheezing (54 vs 74%, p = 0.014), lower heart rhythm (76 vs 90, p = 0.047) and lower respiratory rate (18.5 vs 22, p = 0.031), lower N-terminal prohormone of brain natriuretic peptide levels (403.1 vs 964.0 pg/mL, p = 0.019), and lower incidence of diffuse LV hypokinesis (58 vs 87%, p = 0.002), but ischemic ADCHF patients also presented with higher rates of edema of the lower extremities (46 vs 20%, p = 0.037) and atrioventricular blockade of varying degree (35 vs 7%, p<0.05). According to EMB data, concomitant myocarditis was diagnosed in 69% of patients with ischemic ADCHF and in 80% of patients with non-ischemic ADCHF. Patients in both groups were more likely to present with the expression of enterovirus antigens (77 and 80%), and less likely to present with the expression of human herpesvirus 6 (HHV-6, 50 and 53%) and Epstein-Barr virus antigens (EBV, 23 and 20%), respectively (there were no statistically significant differences).

Conclusions. Patients with ischemic ADCHF had less pronounced decompensation compared with patients with non-ischemic ADCHF. Patients with ischemic ADCHF have concomitant myocarditis in 69% of cases according to EMB. Enterovirus, HHV-6 and EBV antigens were the most commonly expressed antigens. Thus, the majority of patients with IHD and complete coronary revascularization in history had ADCHF due to a combination of IHD and viral myocarditis.

1. Chen J., Aronowitz P. Congestive Heart Failure. Med Clin North Am. 2022;106(3):447-458. doi: 10.1016/j.mcna.2021.12.002.

2. Mareev V.Yu., Fomin I.V., Ageev F.T., Begrambekova Yu.L., Vasyuk Yu.A., Garganeeva A.A. et al. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8-158. doi:10.18087/cardio.2475. (In Russian)

3. Olejniczak M., Schwartz M., Webber E., Shaffer A., Perry T.E. Viral Myocarditis-Incidence, Diagnosis and Management. J Cardiothorac Vasc Anesth. 2020;34(6):1591-1601. doi: 10.1053/j.jvca.2019.12.052.

4. Vidusa L., Kalejs O., Maca-Kaleja A., Strumfa I. Role of Endomyocardial Biopsy in Diagnostics of Myocarditis. Diagnostics (Basel). 2022;12(9):2104. doi: 10.3390/diagnostics12092104.

5. Caforio A.L., Marcolongo R., Jahns R., Fu M., Felix S.B., Iliceto S. Immune-mediated and autoimmune myocarditis: clinical presentation, diagnosis and management. Heart Failure Reviews 2013;18:715-732. doi:10.1007/s10741-012-9364-5.

6. Basso C., Calabrese F., Angelini A., Carturan E., Thiene G. Classification and histological, immunohistochemical, and molecular diagnosis of inflammatory myocardial disease. Heart Fail Rev. 2013;18(6):673-81. doi: 10.1007/s10741-012-9355-6.

7. Batalov R.E., Rogovskaya Yu.V., Ryabov V.V., Tatarsky R.B., Sazonova S.I., Khlynin M.S., Popov S.V., Karpov R.S. Idiopathic form of atrial fibrillation, inflammation and clinical results of radiofrequency ablation. Russian Journal of Cardiology. 2014;(12):7-12. (In Russian)

8. Dutka M., Bobiński R., Ulman-Włodarz I., Hajduga M., Bujok J., Pająk C., Ćwiertnia M. Various aspects of inflammation in heart failure. Heart Fail Rev. 2020;25(3):537-548. doi: 10.1007/s10741-019-09875-1.

9. Matsuura H., Watanabe N., Shibata Y., Asada Y. Combination of echocardiography and emergency endomyocardial biopsy for suspected myocarditis in the cardiovascular emergency medical care. Journal of Echocardiography. 2021;19(2):86-94. doi: 10.1007/s12574-021-00521-0.

10. Ryabov V.V., Kruchinkina E.V., Rogovskaya Yu.V., Ryabova T.R., Batalov R.E., Karpov R.S. Clinical course of decompensation of ischemic chronic heart failure with left ventricle systolic dysfunction after myocardial revascularization. Emergency Cardiology. 2018;1: 23-31. (In Russian)

11. Blagova OV, Nedostup AV, Kogan EA, Sedov V.P., Donnikov A.V., Kadochnikova V.V., Zaydenov V.A., Kupriyanova A.G., Sulimov V.A.DCMP as a clinical syndrome: results of nosological diagnostics with myocardial biopsy and differentiated treatment in virus-positive and virus-negative patients. Russian Journal of Cardiology. 2016;1:7-19. doi:10.15829/1560-4071-2016-1-7-19. (In Russian)

12. Arutyunov G.P., Paleev F.N., Moiseeva O.M., Dragunov D.O., Sokolova A.V., Arutyunov A.G. et al. 2020 Clinical practice guidelines for Myocarditis in adults. Russian Journal of Cardiology. 2021;26(11):4790. (In Russian)