MAGNETNA REZONANCA SRCA U RANOJ DIJAGNOSTICI INFLAMACIJE MIOKARDA NAKON KOVID-19 INFEKCIJE: SERIJA SLUČAJEVA I PREGLED LITERATURE

Marija Zdravković; Slobodan Klašnja; Maja Popović; Predrag Đuran; Andrea Manojlović; Milica Brajković; Olivera Marković; Igor Jovanović; Marija Branković; Višeslav Popadić

doi:10.5937/smclk2-34913

Marija Zdravković Kliničko-bolnički centar "Bežanijska kosa"
Slobodan Klašnja Kliničko-bolnički centar "Bežanijska kosa"
Maja Popović Kliničko-bolnički centar "Bežanijska kosa"
Predrag Đuran Kliničko-bolnički centar "Bežanijska kosa"
Andrea Manojlović Kliničko-bolnički centar "Bežanijska kosa"
Milica Brajković Kliničko-bolnički centar "Bežanijska kosa"
Olivera Marković Kliničko-bolnički centar "Bežanijska kosa"
Igor Jovanović Kliničko-bolnički centar "Bežanijska kosa"
Marija Branković Kliničko-bolnički centar "Bežanijska kosa"
Višeslav Popadić Kliničko-bolnički centar "Bežanijska kosa"

DOI: https://doi.org/10.5937/smclk2-34913

Ključne reči: KOVID-19, magnetna rezonanca, srce, miokarditis

Sažetak

Iako je na početku svog pojavljivanja smatrana respiratornom bolešću, sa tipičnom prezentacijom po tipu bilateralne pneumonije, KOVID-19 je zapravo multisistemsko oboljenje sa mnogobrojnim ekstrapulmonalnim manifestacijama. U osnovi generalizovanog multisistemskog oštećenja nalazi se oštećenje endotelnih ćelija
kardiovaskularnog sistema, izazvano udruženim delovanjem direktnog uticaja virusa i efektom cirkulišućih citokina na miokard i perikard, koje se može javiti u toku akutne faze infekcije ili nakon toga. Najčešći kardiovaskularni simptomi kod pacijenata, nakon akutne faze KOVID-19 infekcije, jesu zamaranje, malaksalost, kratak dah, bolovi u grudima, lupanje i preskakanje srca. Standardnim dijagnostičkim metodama se kod ovih pacijenata ne registruju značajne promene, mada inflamacija miokarda i pored toga može biti prisutna. Oštećenje miokarda takođe može biti supstrat za pogoršanje srčane insuficijencije, kao i za različite aritmije, potencijalno opasne po život, što je od izuzetnog značaja za dalje lečenje i prognozu. Magnetna rezonanca srca je sofisticirana, nejonizujuća dijagnostička metoda, koja može pružiti
važne informacije u vezi sa funkcijom i volumenom leve i desne komore, tkivnom karakterizacijom i kvantifikacijom fibroznih promena u miokardu. Predstavlja zlatni standard u neinvazivnoj dijagnostici miokarditisa. Kod pacijenata sa prethodnom KOVID-19 infekcijom i postojećim kardiovaskularnim simptomima, mogu se registrovati tipični znaci miokarditisa na magnetnoj rezonanci srca, uključujući
postojanje edema miokarda, nekroze i miokardne fibroze, odnosno ožiljka. Takođe, određenim novim, sofisticiranim sekvencama, u sklopu kardiomagnetne rezonance, moguće je registrovati diskretne promene koje mogu ukazivati na inflamaciju miokarda, bez jasno vidljivih promena na standardnim sekvencama.

U radu predstavljamo seriju slučajeva sa različitim obrascima inflamacije miokarda i perikarda nakon KOVID-19 infekcije, uz komparativni pregled trenutno najrelevantnijih naučnih podataka o mehanizmu, komplikacijama, lečenju i prognozi pacijenata sa post-KOVID miokarditisom, odnosno perikarditisom.

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