The Role of Inflammatory Markers in the Evaluation of Myocardium Alterations, Diagnostics and Prognosis in Patients With Infective Endocarditis

Abstract

The results of the examination of 121 patients with infective endocarditis (IE), who received inpatient treatment at the Botkin State Clinical Hospital from 2008 to 2016, were presented in the article. The obtained data on primary and secondary IE with complicated and uncomplicated disease development was analyzed. Diagnostic significance of the dynamic assays of the highly sensitive C-reactive protein (hsСRP), tumor necrosis factor α (TNFα), and highly sensitive troponin I (hsTnI) in the evaluation of the infective toxic process activity, disease severity, and complications were identified. The obtained results indicate the high informative value of the dynamic assay of the levels of TNFα, hsСRP, and hsTnI in patients with IE. The authors established the correlation between the levels of the markers, and the expression of toxic and infectious syndrome manifestations, severity of the disease, and development of complications. A direct correlation was established between the increase in the pro-inflammatory cytokines levels and hsTnI level. It was shown that the increase in troponin concentration corresponded to the expressed morphofunctional alterations in patients with severe HF. Morphological study of the cardiomyocyte destruction revealed the formation of focal dystrophy, development of focal and diffuse fibrosis, indicated on the non-coronarogenic myocardium damage in patients with IE. The myocardium alterations were caused by many factors (hypoxia, microcirculation failure, permeability disorders, etc.), and the cytotoxic effect of pro-inflammatory cytokines, in particular, TNFα, played an essential role in their development. Myocardium alterations, along with the valve destruction, become an important part of the pathogenesis of hemodynamic disorders in patients with IE.