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Subahi A, Akintoye E, Yassin AS, Abubakar H, Adegbala O, Mishra T, Abdelrahman M, Shokr M, Afonso L. Impact of atrial fibrillation on patients hospitalized for acute myocarditis: Insights from a nationally-representative United States cohort. Clin Cardiol 2019; 42:26-31. [PMID: 30284301 DOI: 10.1002/clc.23088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/17/2018] [Accepted: 09/29/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with increased all-cause mortality in the general population. However, the impact of AF on the in-hospital outcomes of acute myocarditis (AM) patients is not well characterized. METHODS Patients (age ≥ 18 years) with a primary diagnosis of AM in the National Inpatient Sample from 2007 to 2014 were included, using the ICD-9-CM diagnostic codes. We compared the in-hospital outcomes between the AF group and propensity score-matched control group without AF. RESULTS AF was reported in 602 (9%) of the AM patients. Compared to those without AF, AM patients with AF experienced higher in-hospital mortality (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1-2.7, P = 0.02). AF was associated with higher risk of cardiogenic shock (OR 1.9, 95% CI 1.3-2.8, P < 0.001), cardiac tamponade (OR 5.6, 95% CI 1.2-25.3, P = 0.002) and acute kidney injury (OR 1.6, 95% CI 1.1-2.1, P = 0.02). Furthermore, patients with AF were more likely to have non-routine hospital discharge (31.6% vs 38.4% P = 0.02), longer length of stay and higher cost of hospitalization. CONCLUSIONS AF was associated with increased risk of in-hospital mortality and complications in patients admitted to the hospital with acute myocarditis.
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Affiliation(s)
- Ahmed Subahi
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Emmanuel Akintoye
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Ahmed S Yassin
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Hossam Abubakar
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Oluwole Adegbala
- Department of Internal Medicine, Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, New Jersey
| | - Tushar Mishra
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | | | - Mohamed Shokr
- Division of Cardiology, Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Luis Afonso
- Division of Cardiology, Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
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Pelliccia A, Solberg EE, Papadakis M, Adami PE, Biffi A, Caselli S, La Gerche A, Niebauer J, Pressler A, Schmied CM, Serratosa L, Halle M, Van Buuren F, Borjesson M, Carrè F, Panhuyzen-Goedkoop NM, Heidbuchel H, Olivotto I, Corrado D, Sinagra G, Sharma S. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur Heart J 2018; 40:19-33. [DOI: 10.1093/eurheartj/ehy730] [Citation(s) in RCA: 219] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/20/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Antonio Pelliccia
- Department of Medicine, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, Rome, Italy
| | | | - Michael Papadakis
- Cardiology Clinical Academic Group, St George’s, University of London, London, UK
| | - Paolo Emilio Adami
- Department of Medicine, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, Rome, Italy
- International Association of Athletics Federations, IAAF, Monaco
| | - Alessandro Biffi
- Department of Medicine, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, Rome, Italy
| | - Stefano Caselli
- Cardiovascular Center Zürich, Klinik im Park, Zürich Switzerland
| | - Andrè La Gerche
- National Centre for Sports Cardiology, Baker Heart and Diabetes Institute & St Vincent’s Hospital, Melbourne, Australia
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Axel Pressler
- Prevention and Sports Medicine, Technical University of Munich, Germany
- Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance. Munich, Germany
| | | | - Luis Serratosa
- Hospital Universitario Quironsalud Madrid, Spain
- Ripoll y De Prado Sport Clinic, FIFA Medical Centre of Excellence, Spain
| | - Martin Halle
- Prevention and Sports Medicine, Technical University of Munich, Germany
- Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance. Munich, Germany
| | - Frank Van Buuren
- Catholic Hospital Southwestfalia, St. Martinus-Hospital Olpe, Germany
| | - Mats Borjesson
- Department of Neuroscience and Physiology and Center for Health and Performance, Gothenburg University, Gothenburg, Sweden
- Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | | | - Nicole M Panhuyzen-Goedkoop
- Heart Centre & Sports Cardiology Department, Amsterdam Medical Centres, Amsterdam, Netherlands
- Sports Medical Centre Papendal, Arnhem, Netherlands
| | - Hein Heidbuchel
- Cardiology, University Hospital and University of Antwerp, Antwerp, Belgium
- Hasselt University, Hasselt, Belgium
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova Medical School, Padova. Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St George’s, University of London, London, UK
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Detection of influenza myocarditis using national healthcare safety network surveillance definitions accounting for fever in older adults. Infect Control Hosp Epidemiol 2018; 39:1145-1147. [PMID: 29945685 DOI: 10.1017/ice.2018.147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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55
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Duan XL, Li L, Li YN. Association of serum nesfatin-1 concentrations with atrial fibrillation. Kaohsiung J Med Sci 2018; 34:348-351. [DOI: 10.1016/j.kjms.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 12/18/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022] Open
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Ziperstein JC, Churchill TW, Hedgire SS, Dec GW, Stone JR. Case 13-2018: A 53-Year-Old Man with Cardiomyopathy and Recurrent Ventricular Tachycardia. N Engl J Med 2018; 378:1622-1633. [PMID: 29694808 DOI: 10.1056/nejmcpc1800333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Joshua C Ziperstein
- From the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Harvard Medical School - both in Boston
| | - Timothy W Churchill
- From the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Harvard Medical School - both in Boston
| | - Sandeep S Hedgire
- From the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Harvard Medical School - both in Boston
| | - G William Dec
- From the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Harvard Medical School - both in Boston
| | - James R Stone
- From the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Harvard Medical School - both in Boston
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Sobhy NM, Bayoumi YH, Mor SK, El-Zahar HI, Goyal SM. Outbreaks of foot and mouth disease in Egypt: Molecular epidemiology, evolution and cardiac biomarkers prognostic significance. Int J Vet Sci Med 2018; 6:22-30. [PMID: 30255074 PMCID: PMC6148740 DOI: 10.1016/j.ijvsm.2018.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/03/2018] [Accepted: 02/04/2018] [Indexed: 01/10/2023] Open
Abstract
Foot and mouth disease virus (FMDV) was isolated from sloughed tongue epithelium of Egyptian cattle presenting with mouth lesions and ropy salivation in two Egyptian governorates (El-Fayoum and Dakahlia). The virus was isolated in Madin-Darby bovine kidney (MDBK) cells and identified by reverse transcription-polymerase chain reaction (RT-PCR). The complete genome was obtained by next generation sequencing. The strains isolated from El-Fayoum and Dakahlia were serotype A and O, respectively and both isolates had identity with the previously reported Egyptian strains. This study reports successive outbreaks of FMDV that occurred in Egypt during 2015–2016 and describes the dynamics of two outbreaks in addition to the use of cardiac biomarkers in the diagnosis of FMD-related myocarditis in calves and its clinical relevance. Serum cardiac troponin1 (cTn I) and creatinine kinase myocardial band (CK-MB) were measured. Mean serum cardiac troponin1 (cTn I) showed significant increase (P < 0.001) in FMDV-infected calves. The increase in fatal and recovered cases was (2.794 ± 0.502 ng/mL) and (1.196 ± 0.443 ng/mL), respectively, compared to the healthy control cases (0.014 ± 0.002 ng/mL). Thus, the serum cTn-I successfully diagnosed FMD-associated myocarditis in calves but not prognostic for the fatal cases. The FMDV sequences described in this study should further help in studying FMDV endemicity in Egypt, tracking the source of infection, selection of control strategies and vaccine updates. The study also determines the clinical relevance of cardiac biomarkers in diagnosis of FMDV-related myocarditis in infected calves.
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Affiliation(s)
- Nader M Sobhy
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Sharkia 44511, Egypt
| | - Yasmin H Bayoumi
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Sharkia 44511, Egypt
| | - Sunil K Mor
- Department of Veterinary Population Medicine (Virology), University of Minnesota, St. Paul, MN 55108, USA
| | - Heba I El-Zahar
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Sharkia 44511, Egypt
| | - Sagar M Goyal
- Department of Veterinary Population Medicine (Virology), University of Minnesota, St. Paul, MN 55108, USA
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58
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Increased C-reactive protein plasma levels are not involved in the onset of post-operative atrial fibrillation. J Cardiol 2017; 70:578-583. [DOI: 10.1016/j.jjcc.2017.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/06/2017] [Accepted: 03/23/2017] [Indexed: 12/19/2022]
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Chen S, Hoss S, Zeniou V, Shauer A, Admon D, Zwas DR, Lotan C, Keren A, Gotsman I. Electrocardiographic Predictors of Morbidity and Mortality in Patients With Acute Myocarditis: The Importance of QRS-T Angle. J Card Fail 2017; 24:3-8. [PMID: 29158065 DOI: 10.1016/j.cardfail.2017.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Acute myocarditis carries a variable prognosis. We evaluated the morbidity and mortality rates in patients with acute myocarditis and admission electrocardiographic predictors of outcome. METHODS AND RESULTS Patients admitted to a tertiary hospital with a clinical diagnosis of acute myocarditis were evaluated; 193 patients were included. Median follow-up was 5.7 years, 82% were male, and overal median age was 30 years (range 21-39). The most common clinical presentations were chest pain (77%) and fever (53%). The 30-day survival rate was 98.9%. Overall survival during follow-up was 94.3%. The most common abnormalities observed on electrocardiography were T-wave changes (36%) and ST-segment changes (32%). Less frequent changes included abnormal T-wave axis (>105° or < -15°; 16%), abnormal QRS axis (12%), QTc >460 ms (11%), and QRS interval ≥120 ms (5%). Wide QRS-T angle (≥100°) was demonstrated in 13% of the patients and was associated with an increased mortality rate compared with patients with a narrow QRS-T angle (20% vs 4%; P = .007). The rate of heart failure among patients with a wide QRS-T angle was significantly higher (36% vs 10%; P = .001). Cox regression analysis demonstrated that a wide QRS-T angle (≥100°) was a significant independent predictor of heart failure (hazard ratio [HR] 3.20, 95% confidence interval [CI] 1.35-7.59; P < .01) and of the combined end point of death or heart failure (HR 2.56, 95% CI 1.14-5.75; P < .05). CONCLUSIONS QRS-T angle is a predictor of increased morbidity and mortality in acute myocarditis.
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Affiliation(s)
- Shmuel Chen
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Sarah Hoss
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Vicki Zeniou
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Ayelet Shauer
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Dan Admon
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Donna R Zwas
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Chaim Lotan
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Andre Keren
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Israel Gotsman
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel.
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60
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Inaba O, Satoh Y, Isobe M, Yamamoto T, Nagao K, Takayama M. Factors and values at admission that predict a fulminant course of acute myocarditis: data from Tokyo CCU network database. Heart Vessels 2017; 32:952-959. [PMID: 28255801 DOI: 10.1007/s00380-017-0960-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 02/10/2017] [Indexed: 12/30/2022]
Abstract
Prognosis of acute myocarditis is generally benign, but fulminant cases exist which require advanced life support devices, such as percutaneous cardio-pulmonary support (PCPS) and ventricular assist devices (VAD), and lead to fatal outcomes. The purpose of this study was to identify predictors and their values at admission which might foreshadow a fulminant course of myocarditis. Data from 138 patients (mean age 42.0 years, 79 males) with a diagnosis of acute myocarditis in the Tokyo CCU Network database from 2007 to 2009 were analyzed retrospectively. Patients were divided into fulminant (in-hospital death, or PCPS or VAD requirement, N = 42) and non-fulminant groups (N = 96). Clinical data at admission were compared between them. Overall in-hospital mortality was 14.5%. On multivariate analysis, low systolic blood pressure (BPsys, odds ratio (OR)/mmHg 0.97; 95% confidence interval (CI) 0.93-1.00, p = 0.032) and electrocardiographic QRS complex prolongation (OR/10 ms 1.28; 95% CI 1.10-1.59, p = 0.0034) at admission were independent factors associated with a fulminant course. By receiver operator characteristic curve analysis, the area under the curve predicting a fulminant course was 0.769 for low BPsys and 0.821 for prolongation of QRS duration. The optimal cut-off value was 101 mmHg for BPsys (sensitivity 79.5%, specificity 68.0%), and 120 ms for QRS duration (sensitivity 72.2%, specificity 88.0%). Systolic hypotension and prolonged QRS on admission are predictors of a fulminant course of myocarditis.
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Affiliation(s)
- Osamu Inaba
- Tokyo CCU Network Scientific Committee, Tokyo, Japan. .,Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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Atti V, Anderson NM, Day MB. Coxsackie Myocarditis and Hepatitis with Reactivated Epstein-Bar Virus (EBV): A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:166-169. [PMID: 28196967 PMCID: PMC5321173 DOI: 10.12659/ajcr.900096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Female, 57 Final Diagnosis: Coxsackie myocarditis and hepatitis Symptoms: Fever • headache • general malaise • sob. Medication: — Clinical Procedure: Echocardiography • cardiac MRI Specialty: Cardiology
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Affiliation(s)
- Varunsiri Atti
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nathan M Anderson
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mathew B Day
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Lee JJ, Yin X, Hoffmann U, Fox CS, Benjamin EJ. Relation of Pericardial Fat, Intrathoracic Fat, and Abdominal Visceral Fat With Incident Atrial Fibrillation (from the Framingham Heart Study). Am J Cardiol 2016; 118:1486-1492. [PMID: 27666172 DOI: 10.1016/j.amjcard.2016.08.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 01/11/2023]
Abstract
Obesity is associated with increased risk of developing atrial fibrillation (AF). Different fat depots may have differential associations with cardiac pathology. We examined the longitudinal associations between pericardial, intrathoracic, and visceral fat with incident AF. We studied Framingham Heart Study Offspring and Third-Generation Cohorts who participated in the multidetector computed tomography substudy examination 1. We constructed multivariable-adjusted Cox proportional hazard models for risk of incident AF. Body mass index was included in the multivariable-adjusted model as a secondary adjustment. We included 2,135 participants (53.3% women; mean age 58.8 years). During a median follow-up of 9.7 years, we identified 162 cases of incident AF. Across the increasing tertiles of pericardial fat volume, age- and gender-adjusted incident AF rate per 1,000 person-years of follow-up were 8.4, 7.5, and 10.2. Based on an age- and gender-adjusted model, greater pericardial fat (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.03 to 1.34) and intrathoracic fat (HR 1.24, 95% CI 1.06 to 1.45) were associated with an increased risk of incident AF. The HRs (95% CI) for incident AF were 1.13 (0.99 to 1.30) for pericardial fat, 1.19 (1.01 to 1.40) for intrathoracic fat, and 1.09 (0.93 to 1.28) for abdominal visceral fat after multivariable adjustment. After additional adjustment of body mass index, none of the associations remained significant (all p >0.05). Our findings suggest that cardiac ectopic fat depots may share common risk factors with AF, which may have led to a lack of independence in the association between pericardial fat with incident AF.
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Affiliation(s)
- Jane J Lee
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and, Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts
| | - Xiaoyan Yin
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and, Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Caroline S Fox
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and, Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts; Division of Endocrinology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emelia J Benjamin
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and, Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
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Santilli RA, Battaia S, Perego M, Tursi M, Grego E, Marzufero C, Gianella P. Bartonella-associated inflammatory cardiomyopathy in a dog. J Vet Cardiol 2016; 19:74-81. [PMID: 27847165 PMCID: PMC7105015 DOI: 10.1016/j.jvc.2016.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/23/2016] [Accepted: 07/30/2016] [Indexed: 11/30/2022]
Abstract
A 6-year-old, male, mongrel dog was presented for acute onset of dyspnea and cough. At admission, the dog was cachectic and severely depressed. The electrocardiogram showed a sinus rhythm conducted with left bundle truncular branch block and interrupted by frequent multiform ventricular ectopic beats organized in allorhythmias. Thoracic radiographs revealed a marked cardiomegaly with perihilar edema, whereas transthoracic echocardiography revealed a dilated cardiomyopathy with segmental dyskinesis. Furosemide, enalapril, pimobendan, and mexiletine were prescribed, and a Holter was scheduled after resolution of congestive heart failure. Three days later, the dog died suddenly during sleep. Histopathology revealed diffuse myocyte hypertrophy with multifocal hemorrhages, alternating to areas of severe replacement fibrosis and lymphoplasmocytic infiltrates. Immunohystochemistry stains were strongly positive for T-lymphocyte infiltration (CD3) and weakly positive for B-lymphocytes (CD79). Polymerase chain reaction was positive for Bartonella spp. Based on these results, a post-mortem diagnosis of bacterial inflammatory cardiomyopathy was made.
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Affiliation(s)
- R A Santilli
- Clinica Veterinaria Malpensa, Viale Marconi 27, Samarate, Varese, 21017, Italy.
| | - S Battaia
- Ospedale Veterinario I Portoni Rossi, Via Roma 57, Zola Predosa, Bologna, 40069, Italy
| | - M Perego
- Clinica Veterinaria Malpensa, Viale Marconi 27, Samarate, Varese, 21017, Italy
| | - M Tursi
- Department of Veterinary Sciences, University of Turin, Viale da Vinci, Grugliasco, Torino, 10095, Italy
| | - E Grego
- Department of Veterinary Sciences, University of Turin, Viale da Vinci, Grugliasco, Torino, 10095, Italy
| | - C Marzufero
- Department of Veterinary Sciences, University of Turin, Viale da Vinci, Grugliasco, Torino, 10095, Italy
| | - P Gianella
- Department of Veterinary Sciences, University of Turin, Viale da Vinci, Grugliasco, Torino, 10095, Italy
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Myocarditis in Paediatric Patients: Unveiling the Progression to Dilated Cardiomyopathy and Heart Failure. J Cardiovasc Dev Dis 2016; 3:jcdd3040031. [PMID: 29367574 PMCID: PMC5715726 DOI: 10.3390/jcdd3040031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/29/2016] [Accepted: 11/03/2016] [Indexed: 12/15/2022] Open
Abstract
Myocarditis is a challenging and potentially life-threatening disease associated with high morbidity in some paediatric patients, due to its ability to present as an acute and fulminant disease and to ultimately progress to dilated cardiomyopathy. It has been described as an inflammatory disease of the myocardium caused by diverse aetiologies. Viral infection is the most frequent cause of myocarditis in developed countries, but bacterial and protozoal infections or drug hypersensitivity may also be causative agents. The prompt diagnosis in paediatric patients is difficult, as the spectrum of clinical manifestation can range from no myocardial dysfunction to sudden cardiac death. Recent studies on myocarditis pathogenesis have revealed a triphasic nature of this disease, which influences the diagnostic and therapeutic strategies to adopt in each patient. Endomyocardial biopsy remains the gold standard for diagnosing myocarditis, and several non-invasive diagnostic tools can be used to support the diagnosis. Intravenous immunoglobulin has become part of routine practice in the treatment of myocarditis in paediatric patients at many centres, but its true effect on the cardiac function has been the target of many studies. The aim of this review is to approach the recently discovered facets of paediatric myocarditis regarding its progression to dilated cardiomyopathy.
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65
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Pelliccia A, Corrado D, Bjørnstad HH, Panhuyzen-Goedkoop N, Urhausen A, Carre F, Anastasakis A, Vanhees L, Arbustini E, Priori S. Recommendations for participation in competitive sport and leisure-time physical activity in individuals with cardiomyopathies, myocarditis and pericarditis. ACTA ACUST UNITED AC 2016; 13:876-85. [PMID: 17143118 DOI: 10.1097/01.hjr.0000238393.96975.32] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Several relatively uncommon, but important cardiovascular diseases are associated with increased risk for acute cardiac events during exercise (including sudden death), such as hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC) and myo-pericarditis. Practising cardiologists are frequently asked to advise on exercise programmes and sport participation in young individuals with these cardiovascular diseases. Indeed, many asymptomatic (or mildly symptomatic) patients with cardiomyopathies aspire to a physically active lifestyle to take advantage of the many documented benefits of exercise. While recommendations dictating the participation in competitive sport for athletes with cardiomyopathies and myo-pericarditis have recently been published as a consensus document of the European Society of Cardiology, no European guidelines have addressed the possible participation of patients with cardiomyopathies in recreational and amateur sport activities. The present document is intended to offer a comprehensive overview to practising cardiologists and sport physicians of the recommendations governing safe participation in different types of competitive sport, as well as the participation in a variety of recreational physical activities and amateur sports in individuals with cardiomyopathies and myo-pericarditis. These recommendations, based largely on the experience and insights of the expert panel appointed by the European Society of Cardiology, include the most up-to-date information concerning regular exercise and sports activity in patients with cardiomyopathies and myo-pericarditis.
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Affiliation(s)
- Antonio Pelliccia
- National Institute of Sports Medicine, Italian National Olympic Committee, Rome, Italy.
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66
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Abstract
Viral myocarditis remains a prominent infectious-inflammatory disease for patients throughout the lifespan. The condition presents several challenges including varied modes of clinical presentation, a range of timepoints when patients come to attention, a diversity of approaches to diagnosis, a spectrum of clinical courses, and unsettled perspectives on therapeutics in different patient settings and in the face of different viral pathogens. In this review, we examine current knowledge about viral heart disease and especially provide information on evolving understanding of mechanisms of disease and efforts by investigators to identify and evaluate potential therapeutic avenues for intervention.
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Affiliation(s)
- Gabriel Fung
- From the Department of Pathology and Laboratory Medicine (G.F., H.L., Y.Q., D.Y., B.M.), Centre for Heart Lung Innovation (G.F., H.L., Y.Q., D.Y., B.M.), Centre of Excellence for Prevention of Organ Failure (PROOF Centre), and Institute for Heart + Lung Health, St. Paul's Hospital (B.M.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Honglin Luo
- From the Department of Pathology and Laboratory Medicine (G.F., H.L., Y.Q., D.Y., B.M.), Centre for Heart Lung Innovation (G.F., H.L., Y.Q., D.Y., B.M.), Centre of Excellence for Prevention of Organ Failure (PROOF Centre), and Institute for Heart + Lung Health, St. Paul's Hospital (B.M.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Ye Qiu
- From the Department of Pathology and Laboratory Medicine (G.F., H.L., Y.Q., D.Y., B.M.), Centre for Heart Lung Innovation (G.F., H.L., Y.Q., D.Y., B.M.), Centre of Excellence for Prevention of Organ Failure (PROOF Centre), and Institute for Heart + Lung Health, St. Paul's Hospital (B.M.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Decheng Yang
- From the Department of Pathology and Laboratory Medicine (G.F., H.L., Y.Q., D.Y., B.M.), Centre for Heart Lung Innovation (G.F., H.L., Y.Q., D.Y., B.M.), Centre of Excellence for Prevention of Organ Failure (PROOF Centre), and Institute for Heart + Lung Health, St. Paul's Hospital (B.M.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce McManus
- From the Department of Pathology and Laboratory Medicine (G.F., H.L., Y.Q., D.Y., B.M.), Centre for Heart Lung Innovation (G.F., H.L., Y.Q., D.Y., B.M.), Centre of Excellence for Prevention of Organ Failure (PROOF Centre), and Institute for Heart + Lung Health, St. Paul's Hospital (B.M.), University of British Columbia, Vancouver, British Columbia, Canada.
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67
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Du Toit R, Herbst PG, van Rensburg A, du Plessis LM, Reuter H, Doubell AF. Clinical features and outcome of lupus myocarditis in the Western Cape, South Africa. Lupus 2016; 26:38-47. [PMID: 27225211 DOI: 10.1177/0961203316651741] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/20/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND African American ethnicity is independently associated with lupus myocarditis compared with other ethnic groups. In the mixed racial population of the Western Cape, South Africa, no data exists on the clinical features/outcome of lupus myocarditis. OBJECTIVES The objective of this study was to give a comprehensive description of the clinical features and outcome of acute lupus myocarditis in a mixed racial population. METHODS Clinical records (between 2008 and 2014) of adult systemic lupus erythematosus (SLE) patients at a tertiary referral centre were retrospectively screened for a clinical and echocardiographic diagnosis of lupus myocarditis. Clinical features, laboratory results, management and outcome were described. Echocardiographic images stored in a digital archive were reanalysed including global and regional left ventricular function. A poor outcome was defined as lupus myocarditis related mortality or final left ventricular ejection fraction (LVEF) <40%. RESULTS Twenty-eight of 457 lupus patients (6.1%) met inclusion criteria: 92.9% were female and 89.3% were of mixed racial origin. Fifty-three per cent of patients presented within three months after being diagnosed with SLE. Seventy-five per cent had severely active disease (SLE disease activity index ≥ 12) and 67.9% of patients had concomitant lupus nephritis. Laboratory results included: lymphopenia (69%) and an increased aRNP (61.5%). Treatment included corticosteroids (96%) and cyclophosphamide (75%); 14% of patients required additional immunosuppression including rituximab. Diastolic dysfunction and regional wall motion abnormalities occurred in > 90% of patients. LVEF improved from 35% to 47% (p = 0.023) and wall motion score from 1.88 to 1.5 (p = 0.017) following treatment. Overall mortality was high (12/28): five patients (17.9%) died due to lupus myocarditis (bimodal pattern). Patients who died of lupus myocarditis had a longer duration of SLE (p = 0.045) and a lower absolute lymphocyte count (p = 0.041) at diagnosis. LVEF at diagnosis was lower in patients who died of lupus myocarditis (p = 0.099) and in those with a persistent LVEF < 40% (n = 5; p = 0.046). CONCLUSIONS This is the largest reported series on lupus myocarditis. The mixed racial population had a similar prevalence, but higher mortality compared with other ethnic groups (internationally published literature). Patients typically presented with high SLE disease activity and the majority had concomitant lupus nephritis. Lymphopenia and low LVEF at presentation were of prognostic significance, associated with lupus myocarditis related mortality or a persistent LVEF < 40%.
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Affiliation(s)
- R Du Toit
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, Cape Town, South Africa
| | - P G Herbst
- Division Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, Cape Town, South Africa
| | - A van Rensburg
- Division Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, Cape Town, South Africa
| | - L M du Plessis
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, Cape Town, South Africa
| | - H Reuter
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, Cape Town, South Africa
| | - A F Doubell
- Division Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, Cape Town, South Africa
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68
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De Lazzari M, Zorzi A, Baritussio A, Siciliano M, Migliore F, Susana A, Giorgi B, Lacognata C, Iliceto S, Perazzolo Marra M, Corrado D. Relationship between T-wave inversion and transmural myocardial edema as evidenced by cardiac magnetic resonance in patients with clinically suspected acute myocarditis: clinical and prognostic implications. J Electrocardiol 2016; 49:587-95. [PMID: 27178316 DOI: 10.1016/j.jelectrocard.2016.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND The pathophysiologic mechanisms and the prognostic meaning of electrocardiographic (ECG) T-wave inversion (TWI) occurring in a subgroup of patients with clinically suspected acute myocarditis remain to be elucidated. Contrast-enhanced cardiac magnetic resonance (CMR) offers the potential to identify myocardial tissue changes such as edema and/or fibrosis which may underlie TWI. METHODS AND RESULTS We studied 76 consecutive patients (median age 34years) with clinically suspected acute myocarditis, using a comprehensive CMR protocol which included T2 weighted sequences for myocardial edema. At the time of CMR, TWI was observed in 21 (27%) patients. There was a statistically significant association of TWI with the median number of left ventricular (LV) segments showing both any pattern of myocardial edema (transmural and non-transmural) [5 (3-7) vs. 3 (2-4); p=0.015] and myocardial late-gadolinium-enhancement [4 (3-7) vs. 3 (2-4); p=0.002]. Transmural myocardial edema involving ≥2 LV segments was found in 17/21 (81%) patients with TWI versus 13/55 (24%) patients without TWI (p<0.001) and remained the only independent predictor of TWI at multivariable analysis (OR=9.96; 95%CI=2.71-36.6; p=0.001). Overall, topographic concordance between the location of TWI across the ECG leads and the regional distribution of transmural myocardial edema was 88%. There was no association between acute TWI and reduced LV ejection fraction (<55%) at 6-months of follow-up. CONCLUSIONS This is the first study to demonstrate an association between LV transmural myocardial edema as evidenced by CMR sequences and TWI in clinically suspected acute myocarditis. As an expression of reversible myocardial edema, development of TWI during the acute disease phase was not a predictor of LV systolic dysfunction at follow-up.
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Affiliation(s)
- Manuel De Lazzari
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy
| | - Anna Baritussio
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy
| | | | - Federico Migliore
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy
| | - Angela Susana
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy
| | | | | | - Sabino Iliceto
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy
| | | | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy.
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Vlachos K, Letsas KP, Korantzopoulos P, Liu T, Georgopoulos S, Bakalakos A, Karamichalakis N, Xydonas S, Efremidis M, Sideris A. Prediction of atrial fibrillation development and progression: Current perspectives. World J Cardiol 2016; 8:267-276. [PMID: 27022458 PMCID: PMC4807315 DOI: 10.4330/wjc.v8.i3.267] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 10/02/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression (from paroxysmal to persistent and permanent types) have been reported. The most important predictor of AF progression is possibly the arrhythmia itself. The electrical, mechanical and structural remodeling determines the perpetuation of AF and the progression from paroxysmal to persistent and permanent forms. Common clinical scores such as the hypertension, age ≥ 75 years, transient ischemic attack or stroke, chronic obstructive pulmonary disease, and heart failure and the congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category scores as well as biomarkers related to inflammation may also add important information on this topic. There is now increasing evidence that even in patients with so-called lone or idiopathic AF, the arrhythmia is the manifestation of a structural atrial disease which has recently been defined and described as fibrotic atrial cardiomyopathy. Fibrosis results from a broad range of factors related to AF inducing pathologies such as cell stretch, neurohumoral activation, and oxidative stress. The extent of fibrosis as detected either by late gadolinium enhancement-magnetic resonance imaging or electroanatomic voltage mapping may guide the therapeutic approach based on the arrhythmia substrate. The knowledge of these risk factors may not only delay arrhythmia progression, but also reduce the arrhythmia burden in patients with first detected AF. The present review highlights on the conventional and novel risk factors of development and progression of AF.
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70
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Besler C, Schuler G, Lurz P. [Myocarditis in the differential diagnosis of cardiomyopathies. Endomyocardial biopsy or MRI?]. Herz 2016; 40:607-15. [PMID: 25963031 DOI: 10.1007/s00059-015-4229-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Myocarditis is an inflammatory disease of the heart muscle commonly caused by viral pathogens. Dilated cardiomyopathy is a major long-term sequela of myocarditis and at least in part related to post-viral immune-mediated responses. Establishing a diagnosis of myocarditis represents a major challenge because of the variable clinical picture and the lack of readily available, non-invasive diagnostic tests. In recent years, cardiac magnetic resonance imaging (cMRI) has emerged as a promising additional diagnostic tool in patients with suspected myocarditis: cMRI not only provides important insights into structural and functional abnormalities of the heart but relevant tissue pathologies can also be visualized. The diagnostic accuracy of three tissue criteria, i.e. the edema ratio, early gadolinium enhancement ratio and late gadolinium enhancement, has been characterized in several studies. Endomyocardial biopsy (EMB) is widely considered to be the reference standard for diagnosis of myocarditis. Although limited by sampling error, EMB is the only diagnostic procedure that can be used to confirm myocarditis. Laboratory analyses of EMB may provide information about specific causes of myocarditis and are, at least in part, of prognostic relevance. In a subset of patients the results of EMB may guide therapeutic decision-making. Additional efforts are needed in cardiac imaging, molecular characterization of EMB and evaluation of serum biomarkers to improve the diagnostic work-up in patients with suspected myocarditis and to identify potential novel targets for a cause-specific therapy of myocarditis.
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Affiliation(s)
- C Besler
- Abteilung Innere Medizin/Kardiologie, Universität Leipzig - Herzzentrum, Strümpellstr. 39, 04289, Leipzig, Deutschland
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Ng RRG, Tan GHJ, Liu W, Ti LK, Chew STH. The Association of Acute Kidney Injury and Atrial Fibrillation after Cardiac Surgery in an Asian Prospective Cohort Study. Medicine (Baltimore) 2016; 95:e3005. [PMID: 27015175 PMCID: PMC4998370 DOI: 10.1097/md.0000000000003005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Acute kidney injury (AKI) and atrial fibrillation (AF) after cardiac surgery are common occurrences and increase patient morbidity and mortality. Inflammation plays a role in increased incidence of AF in patients with chronic kidney disease (CKD); reactive oxygen species and inflammatory markers which are increased in patients with CKD were found to affect the proper functioning of the intracellular ion channels, connexions (transmembrane proteins found in intercellular gap junctions), and electrical homogeneity of the extracellular matrix which are essential for electrical stability and proper conduction of electrical impulses in the atrium. However, it is not known if similar mechanisms are also involved in AKI. We tested the hypothesis that patients with AKI after cardiac surgery have a higher incidence of postoperative AF.Data from 2885 patients, who had undergone cardiac surgery between August 2008 and July 2012 from the Singapore's 2 major heart centers, were obtained prospectively. Postoperative AKI was defined using the Acute Kidney Injury Network criteria. The primary outcome was postoperative AF, and subjects were considered to have postoperative AF if the AF lasted more than an hour, affected hemodynamics, or required medical treatment.The incidence of AKI was 29.7% and the incidence of postoperative AF was 16.8%. A total of 27.7% of AKI patients developed AF. Patients with AKI had a 2-fold increased risk of developing AF (relative risk [RR], 1.716; 95% confidence interval [CI], 1.433-2.055; P < 0.001). The following factors were found to independently increase the risk of AF in patients with AKI: age (RR, 1.011; 95% CI, 1.000-1.022; P = 0.04), low preoperative hemoglobin (RR, 0.942; 95% CI, 0.888-1.000; P = 0.05), low preoperative estimated glomerular filtration rate (eGFR) (RR, 0.987; 95% CI, 0.980-0.994; P < 0.001), and lowest hematocrit during bypass (RR, 0.943; 95% CI, 0.910-0.978; P < 0.001).Patients with AKI are more likely to develop postoperative AF. These patients were older and had lower preoperative hemoglobin, eGFR, and lower nadir hematocrit during bypass. Identification of high-risk AKI patients with early prevention and treatment of AF should reduce the long-term morbidity and mortality among Asian patients undergoing cardiac surgery.
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Affiliation(s)
- Roderica Rui Ge Ng
- From the Department of Anaesthesiology, Singapore General Hospital (RRGN, STHC); Yong Loo Lin School of Medicine, National University of Singapore (GHJ, WL, LKT); Department of Anaesthesia, National University Health System (LKT); and Department of Cardiovascular and Metabolic Disorders, Duke-NUS Graduate Medical School (STHC), Singapore, Singapore
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Mavrogeni S, Markousis-Mavrogenis G, Kolovou G. How to approach the great mimic? Improving techniques for the diagnosis of myocarditis. Expert Rev Cardiovasc Ther 2015; 14:105-15. [PMID: 26559548 DOI: 10.1586/14779072.2016.1110486] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Myocarditis is characterized by inflammation of the myocardium, assessed by histological, immunological and immunohistochemical criteria, due to exogenous or endogenous causes. Abnormal QRS, increased troponin T and left ventricular regional or global dysfunction may be detected. Strain Doppler echocardiography can detect longitudinal segmental dysfunction of the myocardium, due to edema, which is in agreement with cardiac magnetic resonance imaging. Nuclear imaging shows a good sensitivity, but carries serious limitations. Somatostatin receptor positron emission tomography/computed tomography seems promising. Cardiac magnetic resonance imaging, using T2-weighted, early T1-weighted, delayed enhanced images and recently T2 and T1 mapping, has the best diagnostic capability. Endomyocardial biopsy has further contributed to the etiologic diagnosis of myocarditis. To conclude, cardiac magnetic resonance and endomyocardial biopsy have both significantly increased our diagnostic performance. However, further assessment by multicenter studies is needed to establish a clinically useful algorithm.
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Affiliation(s)
- Sophie Mavrogeni
- a Department of Cardiology , Onassis Cardiac Surgery Center , Athens , Greece
| | | | - Genovefa Kolovou
- a Department of Cardiology , Onassis Cardiac Surgery Center , Athens , Greece
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Ohlow MA, Chen TH, Schmidt A, Saenger J, Lauer B. Clinical profile of patients with advanced age and inflammatoric dilated cardiomyopathy on endomyocardial biopsy. J Geriatr Cardiol 2015; 12:605-12. [PMID: 26788036 PMCID: PMC4712365 DOI: 10.11909/j.issn.1671-5411.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/01/2015] [Accepted: 09/16/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Endomyocardial biopsy (EMB) is an important tool when patients with inflammatoric cardiomyopathy (DCMi) are evaluated. We aimed to assess the clinical profile of elderly patients with DCMi on EMB. METHODS Retrospective study of all consecutive patients hospitalized from January 2007 to December 2011 with clinical suspicion of DCMi undergoing EMB. Patients with evidence of DCMi on EMB (Group 1 ≥ 70 years, n = 85; Group 3 < 70 years; n = 418) were compared to patients of the same age group without evidence of DCMi on EMB (Group 2 ≥ 70 years, n = 45; Group 4 < 70 years; n = 147). RESULTS Among 24,275 patients treated at our institution during the study period, 695 had clinical suspicion of DCMi and underwent EMB; 503 (2.1%) patients had DCMi on EMB. There were more male patients in Group 1, mean age was 74 ± 2.8 years, mean ejection fraction was 38% ± 14%. On presentation, signs of hemodynamic compromise (NYHA functional class III/IV, low cardiac output/index, and low cardiac power index) were more frequent in Group 1. EMB revealed viral genome in 78% of the patients, parvovirus B19 (PVB) was frequently encountered in both age groups (Group 1: 69.4% vs. Group 2: 59.6%); detection of more than one viral genome was more frequent in Group 1 (21.2% vs. 11.2%; P = 0.02) whereas the extent of immune response was significantly lower in individuals with advanced age. CONCLUSIONS In patients ≥ 70 years with DCMi on EMB signs of hemodynamic compromise, detection of multiple viral genomes together with an overall lower extent of immune response were more frequently observed.
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Affiliation(s)
| | - Ting-Hui Chen
- Department of Cardiology, Zentralklinik Bad Berka, Germany
| | | | - Joerg Saenger
- Institute of Pathology, Zentralklinik Bad Berka, Germany
| | - Bernward Lauer
- Department of Cardiology, Zentralklinik Bad Berka, Germany
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Al-Rawahi M, Proietti R, Thanassoulis G. Pericardial fat and atrial fibrillation: Epidemiology, mechanisms and interventions. Int J Cardiol 2015; 195:98-103. [DOI: 10.1016/j.ijcard.2015.05.129] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022]
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Dieval C, Deligny C, Meyer A, Cluzel P, Champtiaux N, Lefevre G, Saadoun D, Sibilia J, Pellegrin JL, Hachulla E, Benveniste O, Hervier B. Myocarditis in Patients With Antisynthetase Syndrome: Prevalence, Presentation, and Outcomes. Medicine (Baltimore) 2015; 94:e798. [PMID: 26131832 PMCID: PMC4504539 DOI: 10.1097/md.0000000000000798] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Antisynthetase syndrome (aSS) corresponds to an overlapping inflammatory myopathy identified by various myositis-specific autoantibodies (directed against tRNA-synthetases). Myocardial involvement in this condition is poorly described.From a registry of 352 aSS patients, 12 cases of myocarditis were retrospectively identified on the basis of an unexplained increase in troponin T/I levels associated with either suggestive cardiac magnetic resonance imaging (MRI) findings, nonsignificant coronary artery abnormalities or positive endomyocardial biopsy.The prevalence of myocarditis in aSS is 3.4% and was not linked to any autoantibody specificity: anti-Jo1 (n = 8), anti-PL7 (n = 3), and anti-PL12 (n = 1). Myocarditis was a part of the first aSS manifestations in 42% of the cases and was asymptomatic (n = 2) or revealed by an acute (n = 4) or a subacute (n = 6) cardiac failure. It should be noted that myocarditis was always associated with an active myositis. When performed (n = 11), cardiac MRI revealed a late hypersignal in the T1-images in 73% of the cases (n = 8). Half of the patients required intensive care. Ten patients (83%) received dedicated cardiotropic drugs. Steroids and at least 1 immunosuppressive drug were given in all cases. After a median follow-up of 11 months (range 0-84) 9 (75%) patients recovered whereas 3 (25%) developed a chronic cardiac insufficiency. No patient died.The prevalence of myocarditis in aSS is similar to that of other inflammatory myopathies. Although the prognosis is relatively good, myocarditis is a severe condition and should be carefully considered as a possible manifestation in active aSS patients.
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Affiliation(s)
- Céline Dieval
- From the Service de Maladies Infectieuses et Maladies du Sang, Centre Hospitalier de Rochefort (CD); Service de Médecine Interne, Centre Hospitalier Universitaire de Fort de France (CD); Service de Rhumatologie, Centre National de Référence des Maladies Autoimmunes et Systémiques Rares, Hôpitaux Universitaires de Strasbourg (AM, JS); Service de Radiologie Vasculaire et Interventionnelle (PC); Département de Médecine Interne et d'Immunologie Clinique, Centre national de Référence des Maladies Neuromusculaires, DHU I2B, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, Paris (NC, DS, OB, BH); Service de Médecine Interne - Centre national de Référence des Maladies Autoimmunes et Systémiques Rares, Hôpital Claude Huriez, Université de Lille, Lille (GL, EH); and Service de Médecine Interne, Hôpital Haut-Lévêque, Pessac, France (J-LP)
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Zhang T, Miao W, Wang S, Wei M, Su G, Li Z. Acute myocarditis mimicking ST-elevation myocardial infarction: A case report and review of the literature. Exp Ther Med 2015; 10:459-464. [PMID: 26622337 PMCID: PMC4508986 DOI: 10.3892/etm.2015.2576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 06/01/2015] [Indexed: 01/05/2023] Open
Abstract
The present study describes the case of a young man aged 22 who had acute retrosternal pain, elevated cardiac markers and electrocardiographic ST-T changes, which led to an original misdiagnosis of acute myocardial infarction. The patient underwent immediate coronary angiography, which revealed normal coronary arteries. Finally, the diagnosis of viral myocarditis was made on consideration of his fever, scattered red dots on his arms and legs and other auxiliary examination results obtained in the following days, which were supportive of the diagnosis. The patient improved on antiviral and myocardial protection therapy and was discharged 2 weeks later. Viral myocarditis is a common disease with a variable natural history. It remains challenging for doctors to differentiate between acute myocarditis and myocardial infarction, particularly in the early stages. A diagnosis of myocarditis should be made on the basis of synthetic evaluation of the evidence, including medical history, clinical presentation and results of the available auxiliary tests, in order to provide guidelines for treatment.
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Affiliation(s)
- Tao Zhang
- Department of Orthopedics, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| | - Wei Miao
- Department of Cardiology, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| | - Shixuan Wang
- Beijing University Medical School, Beijing 100191, P.R. China
| | - Min Wei
- Department of Cardiology, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| | - Guohai Su
- Department of Cardiology, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| | - Zhenhua Li
- Department of Cardiology, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
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Scridon A, Dobreanu D, Chevalier P, Şerban RC. Inflammation, a link between obesity and atrial fibrillation. Inflamm Res 2015; 64:383-93. [DOI: 10.1007/s00011-015-0827-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 12/15/2022] Open
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Maisch B, Ruppert V, Pankuweit S. Management of fulminant myocarditis: a diagnosis in search of its etiology but with therapeutic options. Curr Heart Fail Rep 2015; 11:166-77. [PMID: 24723087 DOI: 10.1007/s11897-014-0196-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fulminant myocarditis is a clinical syndrome with signs of acute heart failure, cardiogenic shock, or life-threating rhythm disturbances in the context of suspected myocarditis. It is not an etiological diagnosis, but may have different underlying causes and pathogenetic processes - viral, bacterial, toxic, and autoreactive. Clinical management of the disease entity at the acute stage involves hemodynamic monitoring in an intensive care unit or similar setting. Rapid routine work-up is mandatory with serial EKGs, echocardiography, cardiac MRI, heart catheterization with endomyocardial biopsy for histology, immunohistology, and molecular analysis for the underlying infection and pathogenesis. Heart failure therapy is warranted in all cases according to current guidelines. For fulminant autoreactive myocarditis, immunosuppressive treatment is beneficial; for viral myocarditis, IVIg can resolve the inflammation, reduce the viral load, and even eradicate the microbial agent. ECMO, IABP, ventricular assist devices, LifeVest, or ICD implantation can bridge to recovery or to heart transplantation.
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Affiliation(s)
- Bernhard Maisch
- Medical Faculty of Philipps University Marburg and Cardiovascular Center Marburg, Erlenring 19, 35037, Marburg, Germany,
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79
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Alsaileek A, Nasim M, Aljizeeri A, Alharthi M, Al-Mallah MH. The role of delayed contrast-enhanced cardiac magnetic resonance in differentiating myocarditis from myocardial infarction. Eur Heart J Suppl 2014. [DOI: 10.1093/eurheartj/suu026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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80
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The spectrum of electrocardiographic manifestations of acute myocarditis: An expanded understanding. J Electrocardiol 2014; 47:941-7. [DOI: 10.1016/j.jelectrocard.2014.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Indexed: 11/17/2022]
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81
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Florian A, Schäufele T, Ludwig A, Rösch S, Wenzelburger I, Yildiz H, Sechtem U, Yilmaz A. Diagnostic value of CMR in young patients with clinically suspected acute myocarditis is determined by cardiac enzymes. Clin Res Cardiol 2014; 104:154-63. [DOI: 10.1007/s00392-014-0770-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 10/01/2014] [Indexed: 11/28/2022]
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82
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Natalia S, Lilyasari O, Wicaksono SH, Kasim M. Clinical presentation of myocarditis in pediatric: the role of cardiac magnetic resonance in diagnosis. MEDICAL JOURNAL OF INDONESIA 2014. [DOI: 10.13181/mji.v23i3.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Myocarditis is an inflammatory disease of myocard with varied onset and clinical presentation which lead to diagnosis difficulties. These difficulties often cause incoming patients with acute condition are not diagnosed as acute myocarditis that subsequently may lead to improper therapy. This circumstance will probably cause more severe myocardial injury and even sudden death. On another circumstance, patients may also come late in conditions of dilated cardiomyopathy (DCM) or aritmogenik cardiomyopathy (ARVD) due to complexities of myocarditis early detection. Therefore, myocarditis diagnosis is extremely important. This case shows how CMR is important and highly accurate in diagnosing myocarditis through a case whereby a boy had complaints of chest pain and his CMR examination showed normal cardiac morphology with normal function of right and left ventricular, but with myocardial edema and tissue fibrosis, which confirmed the diagnosis of myocarditis according to the Lake Louise Consensus criteria. CMR is an important and high accuracy non-invasive diagnostic tool in myocarditis diagnosis.
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83
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Galea R, Cardillo MT, Caroli A, Marini MG, Sonnino C, Narducci ML, Biasucci LM. Inflammation and C-reactive protein in atrial fibrillation: cause or effect? Tex Heart Inst J 2014; 41:461-8. [PMID: 25425976 DOI: 10.14503/thij-13-3466] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Atrial fibrillation is associated with substantial morbidity and mortality rates. The incompletely understood pathogenesis of this cardiac dysrhythmia makes it difficult to improve approaches to primary and secondary prevention. Evidence has accumulated in regard to a relationship between inflammation and atrial fibrillation. Investigators have correlated the dysrhythmia with myocarditis, pericardiotomy, and C-reactive protein levels, suggesting that inflammation causes atrial fibrillation or participates in its onset and continuation. Conversely, other investigators suggest that atrial fibrillation induces an inflammatory response. In this review, we summarize and critically discuss the nature and clinical role of inflammation and C-reactive protein in atrial fibrillation.
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84
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85
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Ukena C, Kindermann M, Mahfoud F, Geisel J, Lepper PM, Kandolf R, Böhm M, Kindermann I. Diagnostic and prognostic validity of different biomarkers in patients with suspected myocarditis. Clin Res Cardiol 2014; 103:743-51. [DOI: 10.1007/s00392-014-0709-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/02/2014] [Indexed: 11/30/2022]
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86
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Pinho-Gomes AC, Reilly S, Brandes RP, Casadei B. Targeting inflammation and oxidative stress in atrial fibrillation: role of 3-hydroxy-3-methylglutaryl-coenzyme a reductase inhibition with statins. Antioxid Redox Signal 2014; 20:1268-85. [PMID: 23924190 PMCID: PMC3934546 DOI: 10.1089/ars.2013.5542] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
SIGNIFICANCE Atrial fibrillation (AF) is a burgeoning health-care problem, and the currently available therapeutic armamentarium is barely efficient. Experimental and clinical evidence implicates inflammation and myocardial oxidative stress in the pathogenesis of AF. RECENT ADVANCES Local and systemic inflammation has been found to both precede and follow the new onset of AF, and NOX2-dependent generation of reactive oxygen species in human right atrial samples has been independently associated with the occurrence of AF in the postoperative period in patients undergoing cardiac surgery. Anti-inflammatory and antioxidant agents can prevent atrial electrical remodeling in animal models of atrial tachypacing and the new onset of AF after cardiac surgery, suggesting a causal relationship between inflammation/oxidative stress and the atrial substrate that supports AF. CRITICAL ISSUES Statin therapy, by redressing the myocardial nitroso-redox balance and reducing inflammation, has emerged as a potentially effective strategy for the prevention of AF. Evidence indicates that statins prevent AF-induced electrical remodeling in animal models of atrial tachypacing and may reduce the new onset of AF after cardiac surgery. However, whether statins have antiarrhythmic properties in humans has yet to be conclusively demonstrated, as data from randomized controlled trials specifically addressing the relevance of statin therapy for the primary and secondary prevention of AF remain scanty. FUTURE DIRECTIONS A better understanding of the mechanisms underpinning the putative antiarrhythmic effects of statins may afford tailoring AF treatment to specific clinical settings and patient's subgroups. Large-scale randomized clinical trials are needed to support the indication of statin therapy solely on the basis of AF prevention.
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Affiliation(s)
- Ana Catarina Pinho-Gomes
- 1 Department of Cardiovascular Medicine, University of Oxford , John Radcliffe Hospital, Oxford, United Kingdom
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87
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Miyake CY, Teele SA, Chen L, Motonaga KS, Dubin AM, Balasubramanian S, Balise RR, Rosenthal DN, Alexander ME, Walsh EP, Mah DY. In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. Am J Cardiol 2014; 113:535-40. [PMID: 24332245 DOI: 10.1016/j.amjcard.2013.10.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/23/2013] [Accepted: 10/23/2013] [Indexed: 11/26/2022]
Abstract
Cardiac arrhythmias are a complication of myocarditis. There are no large studies of in-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. This was a retrospective 2-center review of patients ≤21 years hospitalized with acute myocarditis from 1996 to 2012. Fulminant myocarditis was defined as the need for inotropic support within 24 hours of presentation. Acute arrhythmias occurred at presentation and subacute after admission. Eighty-five patients (59% men) presented at a median age of 10 years (1 day to 18 years). Arrhythmias occurred in 38 patients (45%): 16 acute, 12 subacute, and 9 acute and subacute (1 onset unknown). Arrhythmias were associated with low voltages on the electrocardiogram (14 of 34, 41% vs 6 of 47, 13%; odds ratio [OR] 4.78, 95% confidence interval [CI] 1.60 to 14.31) and worse outcome (mechanical support, orthotopic heart transplant, or death; OR 7.59, 95% CI 2.61 to 22.07) but were not statistically significantly associated with a fulminant course, ST changes, initial myocardial function, lactate, creatinine level, C-reactive protein and/or erythrocyte sedimentation rate, or troponin I level, after adjusting for multiple comparisons. Subacute arrhythmias were associated with preceding ST changes (10 of 15, 67% vs 15 of 59, 25%, OR 5.87, 95% CI 1.73 to 19.93). All patients surviving to discharge had arrhythmia resolution or control before discharge (10 on antiarrhythmic), with 1 exception (patient with complete heart block requiring a pacemaker). At 1-year follow-up, there were 3 recurrences of ventricular arrhythmias, but no arrhythmia-related mortality. In conclusion, arrhythmias are common in pediatric patients with myocarditis, occurring in nearly 1/2 of all hospitalized children and are associated with a worse outcome. Early identification of subacute arrhythmias using electrocardiographic changes may help management. A majority of patients do not require continued postdischarge arrhythmia treatment.
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88
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Hazebroek MR, Everaerts K, Heymans S. Diagnostic approach of myocarditis: strike the golden mean. Neth Heart J 2014; 22:80-4. [PMID: 24399323 PMCID: PMC3967560 DOI: 10.1007/s12471-013-0499-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Myocarditis is a challenging diagnosis due to the extreme diversity of clinical manifestations. The actual incidence of myocarditis is also difficult to determine as endomyocardial biopsy (EMB), the diagnostic gold standard, is used infrequently. Nevertheless, in up to 30 % of patients with biopsy-proven myocarditis, progression to dilated cardiomyopathy (DCM) can occur and is associated with a poor prognosis. Recent position statements of the European Society of Cardiology (ESC) and the American Heart Association vary widely with regard to indications for performing an EMB in these patients. This makes decision-making, in particular for general practitioners (GPs) and regional hospitals, difficult and unclear. Therefore, we will present a short summary of the ESC Working Group on Myocardial and Pericardial Diseases statement and our suggestions for GPs and regional hospitals for the diagnostic approach in patients with suspected myocarditis.
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Affiliation(s)
- M R Hazebroek
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
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89
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Pathak R, Lau DH, Mahajan R, Sanders P. Structural and Functional Remodeling of the Left Atrium: Clinical and Therapeutic Implications for Atrial Fibrillation. J Atr Fibrillation 2013; 6:986. [PMID: 28496919 DOI: 10.4022/jafib.986] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice. Despite advances in our understanding of the pathophysiology of this complex arrhythmia, current therapeutic options remain suboptimal. This review aimed to delineate the atrial structural and functional remodeling leading to the perpetuation of AF. We explored the complex changes seen in the atria in various substrates for AF and the therapeutic options available to prevent these changes or for reverse remodeling. Here we also highlighted the emerging role of aggressive risk factor management aimed at the arrhythmogenic atrial substrate to prevent or retard AF progression.
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Affiliation(s)
- Rajeev Pathak
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Rajiv Mahajan
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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90
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Levenson JE, Kaul DR, Saint S, Nallamothu BK, Gurm HS. Clinical problem-solving. A shocking development. N Engl J Med 2013; 369:2253-8. [PMID: 24304055 DOI: 10.1056/nejmcps1301587] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Joshua E Levenson
- From the Department of Internal Medicine (J.E.L., S.S.) and the Divisions of Infectious Disease (D.R.K.) and Cardiology (B.K.N., H.S.G.), University of Michigan; the Ann Arbor Veterans Affairs (VA) Hospital Outcomes Program of Excellence (HOPE) (S.S.); and the Ann Arbor VA Center for Clinical Management and Research (B.K.N.) - all in Ann Arbor
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91
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Yildiz A, Oylumlu M, Yuksel M, Aydin M, Polat N, Acet H, Akil MA, Bilik MZ, Kaya H, Ertas F. The Association Between the Neutrophil-to-Lymphocyte Ratio and the Presence of Ventricular Premature Contractions in Young Adults. Clin Appl Thromb Hemost 2013; 21:475-9. [PMID: 24203349 DOI: 10.1177/1076029613509478] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inflammation has recently emerged in the pathogenesis of several cardiovascular disorders, including arrhythmias. The neutrophil-lymphocyte ratio (NLR) is a simple marker for the assessment of inflammatory status. Therefore, we aimed to investigate the relationship between the NLR and the ventricular premature contraction (VPC) existence. Patients aged between 18 and 40 years who were referred to the cardiology clinic were enrolled in the study. All patients' complete blood counts and 24-hour Holter recordings were analyzed. The NLR was higher within the VPC group compared to the control group (P < .001). According to the NLR tertiles, VPCs were more common in the higher NLR tertile (P < .001). A cutoff point of 1.80 for the NLR had 71% sensitivity and 60% specificity in predicting VPC in apparently healthy individuals. After multivariate analysis, only the NLR remained significant predictor of presence of VPC. In conclusion, the NLR is independently and significantly associated with VPC existence.
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Affiliation(s)
- Abdulkadir Yildiz
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Mustafa Oylumlu
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Murat Yuksel
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Mesut Aydin
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Nihat Polat
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Halit Acet
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Mehmet Ata Akil
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Mehmet Zihni Bilik
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Hasan Kaya
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Faruk Ertas
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey
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92
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Lee JM, Seo SM, Seo MJ, Min HK, Cho MJ, Kim YS, Kim YS, Baek SH. A case of reversible very low voltage electrocardiogram in fulminant myocarditis. Korean Circ J 2013; 43:565-8. [PMID: 24044017 PMCID: PMC3772303 DOI: 10.4070/kcj.2013.43.8.565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 01/24/2013] [Accepted: 02/14/2013] [Indexed: 11/11/2022] Open
Abstract
Clinical features of acute myocarditis range from a subclinical state to a fulminant state. Fulminant myocarditis with ventricular arrhythmia or atrioventricular block is associated with a high mortality rate. In cases in which aggressive medical therapy for fulminant myocarditis is not likely to be successful, intensive and emergency mechanical circulatory support, such as extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pump, should be considered. We report life salvage of acute fulminant myocarditis in a 53-year-old woman presented with malignant arrhythmia and cardiogenic shock supported by ECMO.
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Affiliation(s)
- Jong Min Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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93
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Mayyas F, Alzoubi KH, Van Wagoner DR. Impact of aldosterone antagonists on the substrate for atrial fibrillation: aldosterone promotes oxidative stress and atrial structural/electrical remodeling. Int J Cardiol 2013; 168:5135-42. [PMID: 23993726 DOI: 10.1016/j.ijcard.2013.08.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/03/2013] [Indexed: 12/31/2022]
Abstract
Atrial fibrillation (AF), the most common cardiac arrhythmia, is an electrocardiographic description of a condition with multiple and complex underlying mechanisms. Oxidative stress is an important driver of structural remodeling that creates a substrate for AF. Oxidant radicals may promote increase of atrial oxidative damage, electrical and structural remodeling, and atrial inflammation. AF and other cardiovascular morbidities activate angiotensin (Ang-II)-dependent and independent cascades. A key component of the renin-angiotensin-aldosterone system (RAAS) is the mineralocorticoid aldosterone. Recent studies provide evidence of myocardial aldosterone synthesis. Aldosterone promotes cardiac oxidative stress, inflammation and structural/electrical remodeling via multiple mechanisms. In HF patients, aldosterone production is enhanced. In patients and in experimental HF and AF models, aldosterone receptor antagonists have favorable influences on cardiac remodeling and oxidative stress. Therapeutic approaches that seek to reduce AF burden by modulating the aldosterone system are likely beneficial but underutilized.
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Affiliation(s)
- Fadia Mayyas
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Jordan.
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94
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Biffi A, Delise P, Zeppilli P, Giada F, Pelliccia A, Penco M, Casasco M, Colonna P, D’Andrea A, D’Andrea L, Gazale G, Inama G, Spataro A, Villella A, Marino P, Pirelli S, Romano V, Cristiano A, Bettini R, Thiene G, Furlanello F, Corrado D. Italian Cardiological Guidelines for Sports Eligibility in Athletes with Heart Disease. J Cardiovasc Med (Hagerstown) 2013; 14:477-99. [DOI: 10.2459/jcm.0b013e32835f6a21] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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95
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Navarro Valverde C, Núñez Gil I, Fernández Ortiz A. Síndrome coronario agudo y coronariografía sin lesiones significativas: ¿lo sabemos todo? Med Clin (Barc) 2013. [DOI: 10.1016/j.medcli.2012.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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96
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Deluigi CC, Ong P, Hill S, Wagner A, Kispert E, Klingel K, Kandolf R, Sechtem U, Mahrholdt H. ECG findings in comparison to cardiovascular MR imaging in viral myocarditis. Int J Cardiol 2013; 165:100-6. [DOI: 10.1016/j.ijcard.2011.07.090] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 07/12/2011] [Accepted: 07/27/2011] [Indexed: 12/12/2022]
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97
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Abstract
An overview of pericarditis, cardiomyopathy, and acute myocarditis is presented. Clinical presentation, causes, physical signs, laboratory testing, and various imaging procedures are discussed. Established pharmacologic and mechanical therapies are reviewed. Short-term and long-term prognoses, when relevant, are discussed.
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Affiliation(s)
- Nicolas W Shammas
- Midwest Cardiovascular Research Foundation, 1622 East Lombard Street, Davenport, IA 52803, USA.
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98
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Multimodality imaging and the emerging role of cardiac magnetic resonance in autoimmune myocarditis. Autoimmun Rev 2012; 12:305-12. [DOI: 10.1016/j.autrev.2012.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 05/16/2012] [Indexed: 02/05/2023]
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99
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Abstract
OPINION STATEMENT Myocarditis is a condition that can have a very wide clinical spectrum ranging from asymptomatic forms to fatal disease, but mostly presenting as new onset heart failure with reduced left ventricular ejection fraction, with or without viral syndrome. This condition is an important cause of sudden cardiac death in young patients. High risk features include second and third degree atrioventricular block or malignant arrhythmias. The diagnostic work-up may be challenging, but non-invasive imaging, primarily cardiac magnetic resonance, plays an increasingly important role, although endomyocardial biopsy is still considered a gold standard for diagnosis. Most importantly, myocarditis can transition to non-ischemic cardiomyopathy with eventually poor outcome. In this review, we will summarize the data on different diagnostic and treatment modalities of this disease.
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100
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Abstract
Myocarditis typically presents with non-specific clinical symptoms, and can easily be missed in the absence of a high index of clinical suspicion. Myocarditis caused by bacterial pathogens is rare in immunocompetent individuals, more commonly seen following viral infection. Although more classically associated with typhoid fever and gastroenteritis, Salmonella species are a rare cause of myocarditis. We report a case of Salmonella enteritidis-induced myocarditis after gastrointestinal infection in a 16 year-old girl, and discuss the diagnostic tools currently utilised to ascertain the diagnosis.
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Affiliation(s)
- Lucy Childs
- Department of Cardiology, Whipps Cross University Hospital, London, UK.
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