Follow-Up of Changes in Myocardial Structure in Patients with Chronic Heart Failure, Assessed with Contrast-Enhanced MRI

The purpose: to follow-up the pathological changes in the cardiac  muscle using contrast-enhanced MRI (in comparison with  endomyocardial biopsy), in patients with chronic heart failure due to dilated cardiomyopathy. Materials and methods. This study comprised 29 pa tients (as  51.1 ± 11.03 years old). Everybody underwent cardiac contrast- enhanced MRI, at admission and in 6 month, the endomyocardial  biopsy was carried out in 19 patients. Results. Myocarditis with different degrees of activity was revealed  in 14 patients, from the results of a histological examination of the  cardiac muscle. The patients were assembled to two groups,  depending on the severity of the inflammatory changes; the data were compared with the results of the endomyocardial biopsy. In the group of patients with a moderate degree of activity of the  inflammatory process, myocardial fibrosis prevailed, in the group of patients with pronounced activity it was oedema, with a relatively  smaller volume of myocardial fibrosis. In six months of monitoring,  the number of pathologically altered segments of the myocardium  increased (from 2.7 ± 1.7 to 3.05 ± 1.7) and the thickness of the  paramagnetic contrast uptake to the cardiac muscle also increased (from 4.4 ± 1.4 to 4.8 ± 1.9 mm), despite the specific therapy kept carried out this time.   Conclusion. The development of dilated cardiomyopathy and  chronic heart failure, in a significant number of cases causes of  inflammatory changes in the myocardium, followed by manifestation  of dilated cardiomyopathy, and the progression of fibrotic changes in  the myocardium was observed even after elimination of the causative agent.