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Power JR, Keyt LK, Adler ED. Myocarditis following COVID-19 vaccination: incidence, mechanisms, and clinical considerations. Expert Rev Cardiovasc Ther 2022; 20:241-251. [PMID: 35414326 PMCID: PMC9115793 DOI: 10.1080/14779072.2022.2066522] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/12/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Vaccines have demonstrated protection against the morbidity and mortality of COVID-19, but concerns regarding the rare side effect of acute myocarditis have stymied immunization efforts. This review aims to describe the incidence and theorized mechanisms of COVID vaccine-associated myocarditis and review relevant principles for management of vaccine-associated myocarditis. AREAS COVERED Epidemiologic studies of myocarditis after COVID vaccination are reviewed, which show an incidence of approximately 20-30 per million patients. The vast majority of these cases are seen with mRNA vaccines especially in male patients under 30 years of age. Mechanisms are largely theoretical, but molecular mimicry and dysregulated innate immune reactions have been proposed. While studies suggest that this subtype of myocarditis is mild and self-limited, long-term evidence is lacking. Principles of myocarditis treatment and surveillance are outlined as they apply to COVID vaccine-associated myocarditis. EXPERT OPINION COVID vaccine-associated myocarditis is rare but well described in certain at-risk groups. Better understanding of its pathogenesis is key to mitigating this complication and advancing vaccination efforts. Risk-benefit analyses demonstrate that individual- and population-level benefits of vaccination exceed the risks of this rare and mild form of myocarditis.
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Affiliation(s)
- John R. Power
- Division of Cardiovascular Medicine, University of California San Diego, San Diego, California, United States
| | - Lucas K. Keyt
- Division of Cardiovascular Medicine, University of California San Diego, San Diego, California, United States
| | - Eric D. Adler
- Division of Cardiovascular Medicine, University of California San Diego, San Diego, California, United States
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Vilas-Boas DF, Oliveira RRG, Gonçalves-Santos E, Silva LS, Diniz LF, Mazzeti AL, Brancaglion GA, Carvalho DT, Caldas S, Novaes RD, Caldas IS. 4-nitrobenzoylcoumarin potentiates the antiparasitic, anti-inflammatory and cardioprotective effects of benznidazole in a murine model of acute Trypanosoma cruzi infection. Acta Trop 2022; 228:106314. [PMID: 35038424 DOI: 10.1016/j.actatropica.2022.106314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/31/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
Abstract
The anti-inflammatory and cardioprotective potential of coumarin metabolites in infectious myocarditis remains overlooked. Thus, the impact of the synthetic 4-nitrobenzoylcoumarin (4NB) alone and combined with benznidazole (Bz) in a murine model of Trypanosoma cruzi-induced acute myocarditis was investigated. Swiss mice infected with T. cruzi were randomized in 8 groups: uninfected, infected untreated or treated with 50 and 100 mg/kg 4NB or Bz alone and combined. Treatments were administered by gavage for 20 days. Cytokines (IL-2, IL-6, IL-10, IL-17, TNFα, and IFN-γ), immunoglobulin reactivity index (total IgG, IgG1, IgG2a and IgG2b), atrial natriuretic peptide (ANP), parasitemia, serum transaminases, heart and liver cellularity were analyzed. T. cruzi infection induced blood parasitism, heart and liver inflammation, upregulated all cytokines, IgG reactivity index, ANP and transaminase levels, determining 43% mortality in untreated mice. Transaminase levels, mean parasitemia, heart inflammation and ANP were reduced in 4NB-treated mice, reaching a 100% survival rate. Total survival (100%) was also obtained in all combinations of Bz and 4NB, which were effective in reducing blood parasitism, transaminases, cytokines and ANP levels, IgG reactivity index, liver and heart interstitial cellularity compared to 50 mg/kg Bz. Our findings indicated that 4NB alone and combined with Bz was well tolerated, showing no evidence of hepatotoxicity. Mainly in combination, these drugs exerted protective effects against T. cruzi-induced acute myocarditis by attenuating blood parasitism, systemic and heart inflammation. Thus, combinations based on 4NB and Bz are potentially relevant to develop new and more effective drug regimens for the treatment of T. cruzi-induced myocarditis.
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Affiliation(s)
- Diego F Vilas-Boas
- Departamento de Patologia e Parasitologia, Universidade Federal de Alfenas, 37130-001 Alfenas, MG, Brazil
| | - Raphaela R G Oliveira
- Departamento de Patologia e Parasitologia, Universidade Federal de Alfenas, 37130-001 Alfenas, MG, Brazil
| | - Elda Gonçalves-Santos
- Departamento de Biologia Estrutural, Universidade Federal de Alfenas, 37130-000 Alfenas, MG, Brazil
| | - Luana S Silva
- Departamento de Patologia e Parasitologia, Universidade Federal de Alfenas, 37130-001 Alfenas, MG, Brazil
| | - Lívia F Diniz
- Departamento de Patologia e Parasitologia, Universidade Federal de Alfenas, 37130-001 Alfenas, MG, Brazil
| | - Ana L Mazzeti
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, 21040-360 Rio de Janeiro, RJ, Brazil
| | - Guilherme A Brancaglion
- Departamento de Alimentos e Medicamentos, Faculdade de Ciências Farmacêuticas, Universidade Federal de Alfenas, 37130-000 Alfenas, MG, Brazil
| | - Diogo T Carvalho
- Departamento de Alimentos e Medicamentos, Faculdade de Ciências Farmacêuticas, Universidade Federal de Alfenas, 37130-000 Alfenas, MG, Brazil
| | - Sergio Caldas
- Fundação Ezequiel Dias, 30510-010 Belo Horizonte, MG, Brazil
| | - Rômulo D Novaes
- Departamento de Biologia Estrutural, Universidade Federal de Alfenas, 37130-000 Alfenas, MG, Brazil
| | - Ivo S Caldas
- Departamento de Patologia e Parasitologia, Universidade Federal de Alfenas, 37130-001 Alfenas, MG, Brazil.
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53
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Castillo AV, Ivsic T. Overview of pediatric myocarditis and pericarditis. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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54
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Ueda Y, Usuki K, Fujita J, Matsumura I, Aotsuka N, Sekiguchi N, Nakazato T, Iwasaki H, Takahara‐Matsubara M, Sugimoto S, Goto M, Naoe T, Kizaki M, Miyazaki Y, Aakashi K. Phase 1/2 study evaluating the safety and efficacy of DSP-7888 dosing emulsion in myelodysplastic syndromes. Cancer Sci 2022; 113:1377-1392. [PMID: 34932235 PMCID: PMC8990724 DOI: 10.1111/cas.15245] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/11/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022] Open
Abstract
DSP-7888 is an immunotherapeutic cancer vaccine derived from the Wilms' tumor gene 1 (WT1) protein. This phase 1/2 open-label study evaluated the safety and efficacy of DSP-7888 dosing emulsion in patients with myelodysplastic syndromes (MDS). DSP-7888 was administered intradermally (3.5 or 10.5 mg) every 2 weeks for 6 months and then every 2-4 weeks until lack of benefit. Twelve patients were treated in phase 1 (3.5 mg, n = 6; 10.5 mg, n = 6), with no dose-limiting toxicities reported. Thus, the 10.5 mg dose was selected as the recommended phase 2 dose, and 35 patients were treated in phase 2. Forty-seven patients received ≥1 dose of the study drug and comprised the safety analysis set. The most common adverse drug reaction (ADR) was injection site reactions (ISR; 91.5%). Grade 3 ISR were common (58.8%) in phase 1 but occurred less frequently in 2 (22.9%) following implementation of risk minimization strategies. Other common ADR were pyrexia (10.6%) and febrile neutropenia (8.5%). In the efficacy analysis set, comprising patients with higher-risk MDS after azacitidine failure in phases 1 and 2 (n = 42), the disease control rate was 19.0%, and the median overall survival (OS) was 8.6 (90% confidence interval [CI], 6.8-10.3) months. Median OS was 10.0 (90% CI, 7.6-11.4) months in patients with a WT1-specific immune response (IR; n = 33) versus 4.1 (90% CI, 2.3-8.1) months in those without a WT1-specific IR (n = 9; P = .0034). The acceptable safety and clinical activity findings observed support the continued development of DSP-7888 dosing emulsion.
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Affiliation(s)
- Yasunori Ueda
- Department of Hematology/OncologyKurashiki Central HospitalOkayamaJapan
| | - Kensuke Usuki
- Department of HematologyNTT Medical Center TokyoTokyoJapan
| | - Jiro Fujita
- Department of Hematology and OncologyOsaka University HospitalOsakaJapan
| | - Itaru Matsumura
- Department of Hematology and RheumatologyKindai University HospitalOsakaJapan
| | - Nobuyuki Aotsuka
- Department of Hematology OncologyJapanese Red Cross Narita HospitalChibaJapan
| | - Naohiro Sekiguchi
- Department of HematologyNational Hospital Organization Disaster Medical CenterTokyoJapan
| | - Tomonori Nakazato
- Department of HematologyYokohama Municipal Citizen’s HospitalKanagawaJapan
| | - Hiromi Iwasaki
- Department of HematologyNational Hospital Organization Kyushu Medical CenterFukuokaJapan
| | | | | | | | - Tomoki Naoe
- National Hospital Organization Nagoya Medical CenterAichiJapan
| | | | - Yasushi Miyazaki
- Department of HematologyAtomic Bomb Disease and Hibakusha Medicine UnitAtomic Bomb Disease InstituteNagasaki UniversityNagasakiJapan
| | - Koichi Aakashi
- Department of Medicine and Biosystemic Science Faculty of MedicineKyushu UniversityFukuokaJapan
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Feng Y, Ye D, Wang Z, Pan H, Lu X, Wang M, Xu Y, Yu J, Zhang J, Zhao M, Xu S, Pan W, Yin Z, Ye J, Wan J. The Role of Interleukin-6 Family Members in Cardiovascular Diseases. Front Cardiovasc Med 2022; 9:818890. [PMID: 35402550 PMCID: PMC8983865 DOI: 10.3389/fcvm.2022.818890] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/11/2022] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular disease is one of the main causes of human mortality. Cytokines play crucial roles in the development of cardiovascular disease. Interleukin (IL)-6 family members are a series of cytokines, including IL-6, IL-11, IL-30, IL-31, OSM, LIF, CNTF, CT-1, CT-2, and CLC, that regulate multiple biological effects. Experimental and clinical evidence shows that IL-6 family members are closely related to cardiovascular diseases such as atherosclerosis, hypertension, aortic dissection, cardiac fibrosis, and cardiomyopathy. This review mainly discusses the role of IL-6 family members in cardiovascular disease for the sake of identifying possible intervention targets for cardiovascular disease prevention and treatment.
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Affiliation(s)
- Yongqi Feng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Di Ye
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Zhen Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Heng Pan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Xiyi Lu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Menglong Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Yao Xu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Junping Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Jishou Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Mengmeng Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Shuwan Xu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Wei Pan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Zheng Yin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Jing Ye
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
- Jing Ye
| | - Jun Wan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
- *Correspondence: Jun Wan
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56
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Moisa SM, Miron IC, Tarca E, Trandafir L, Lupu VV, Lupu A, Rusu TE. Non-Cardiac Cause of Death in Selected Group Children with Cardiac Pathology: A Retrospective Single Institute Study. CHILDREN 2022; 9:children9030335. [PMID: 35327707 PMCID: PMC8946943 DOI: 10.3390/children9030335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 12/05/2022]
Abstract
Background: Pediatricians and pediatric surgeons often face children with cardiomegaly and dilatative or hypertrophic cardiomyopathies presenting with or without symptoms. Some of these patients have already been diagnosed and received medication, and some present with completely unrelated pathologies. Methods: We performed a 4-year retrospective study on the causes and mechanisms of death of children with cardiac pathology who died outside the cardiology clinic of our hospital by studying the hospital charts and necropsy reports. All children who were in this situation in our hospital were included. Results: Most children in our study group were infants (81.82%), most were boys (81.82%), and in most cases, the cause or mechanism of death was unrelated to their heart condition, whether it had already been diagnosed or not (one case probably died as a result of a malignant ventricular arrhythmia). Additionally, 27.27% of children died as a consequence of bronchopneumonia, the same percentage died as a consequence of an acquired non-pulmonary disease or after surgery, and 18.18% died as a consequence of congenital malformations. Conclusions: Cardiac disease needs to be thoroughly investigated using multiple tools for all children presenting with heart failure symptoms, those with heart murmurs, and children scheduled for surgery of any type. The intensive care specialist and surgeon need to be aware of any heart pathology before non-cardiac surgical interventions.
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Affiliation(s)
- Stefana Maria Moisa
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.M.M.); (I.C.M.); (E.T.); (L.T.)
| | - Ingrith Crenguta Miron
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.M.M.); (I.C.M.); (E.T.); (L.T.)
| | - Elena Tarca
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.M.M.); (I.C.M.); (E.T.); (L.T.)
| | - Laura Trandafir
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.M.M.); (I.C.M.); (E.T.); (L.T.)
| | - Vasile Valeriu Lupu
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.M.M.); (I.C.M.); (E.T.); (L.T.)
- Correspondence: (V.V.L.); (A.L.)
| | - Ancuta Lupu
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (S.M.M.); (I.C.M.); (E.T.); (L.T.)
- Correspondence: (V.V.L.); (A.L.)
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Altered Phenotype of Circulating Dendritic Cells and Regulatory T Cells from Patients with Acute Myocarditis. J Immunol Res 2022; 2022:8873146. [PMID: 35265721 PMCID: PMC8901353 DOI: 10.1155/2022/8873146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/19/2022] [Accepted: 02/05/2022] [Indexed: 11/17/2022] Open
Abstract
Dendritic cells (DCs) and regulatory T cells (Tregs) play an essential role in myocarditis. However, a particular DC phenotype in this disease has not been assessed. Herein, we aim to evaluate myeloid (mDCs) and plasmacytoid DC (pDC) phenotype, as well as Treg levels from myocarditis patients and healthy controls. Using multiparametric flow cytometry, we evaluated the levels of myeloid DCs (mDCs), plasmacytoid DCs (pDCs), and Tregs in peripheral blood from myocarditis patients (n = 16) and healthy volunteers (n = 16) and performed correlation analysis with clinical parameters through Sperman test. DCs from myocarditis patients showed a higher expression of costimulatory molecules while a diminished expression of the inhibitory receptors, ILT2 and ILT4. Even more, Treg cells from myocarditis patients displayed higher levels of FOXP3 compared to controls. Clinically, the increased levels of mDCs and their higher expression of costimulatory molecules correlate with a worse myocardial function, higher levels of acute phase reactants, and higher cardiac enzymes. This study shows an activating phenotype of circulating DCs from myocarditis patients. This proinflammatory status may contribute to the pathogenesis and immune deregulation in acute myocarditis.
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A Review of the Role of Imaging Modalities in the Evaluation of Viral Myocarditis with a Special Focus on COVID-19-Related Myocarditis. Diagnostics (Basel) 2022; 12:diagnostics12020549. [PMID: 35204637 PMCID: PMC8870822 DOI: 10.3390/diagnostics12020549] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 12/12/2022] Open
Abstract
Viral myocarditis is inflammation of the myocardium secondary to viral infection. The clinical presentation of viral myocarditis is very heterogeneous and can range from nonspecific symptoms of malaise and fatigue in subclinical disease to a more florid presentation, such as acute cardiogenic shock and sudden cardiac death in severe cases. The accurate and prompt diagnosis of viral myocarditis is very challenging. Endomyocardial biopsy is considered to be the gold standard test to confirm viral myocarditis; however, it is an invasive procedure, and the sensitivity is low when myocardial involvement is focal. Cardiac imaging hence plays an essential role in the noninvasive evaluation of viral myocarditis. The current coronavirus disease 2019 (COVID-19) pandemic has generated considerable interest in the use of imaging in the early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related myocarditis. This article reviews the role of various cardiac imaging modalities used in the diagnosis and assessment of viral myocarditis, including COVID-19-related myocarditis.
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Maetani T, Hamaguchi T, Nishimura T, Marumo S, Fukui M. Durvalumab-associated Late-onset Myocarditis Successfully Treated with Corticosteroid Therapy. Intern Med 2022; 61:527-531. [PMID: 34433717 PMCID: PMC8907760 DOI: 10.2169/internalmedicine.7644-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a 66-year-old man with locally advanced non-small-cell lung cancer (NSCLC) who developed durvalumab-associated myocarditis. The patient underwent durvalumab administration every two weeks following concurrent chemoradiotherapy, without any adverse events or apparent disease progression. He presented with fatigue and dyspnea on exertion seven months after the first administration. Myocarditis was suspected based on laboratory data, an electrocardiogram, echocardiography, and magnetic resonance imaging findings. The definitive diagnosis was confirmed by a myocardial biopsy. Myocarditis was alleviated by cessation of durvalumab and corticosteroid therapy. This is a noteworthy case to describe late-onset myocarditis following the administration of durvalumab for NSCLC.
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Affiliation(s)
- Tomoki Maetani
- Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Japan
| | - Toka Hamaguchi
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Japan
| | - Takafumi Nishimura
- Department of Medical Oncology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Japan
| | - Satoshi Marumo
- Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Japan
| | - Motonari Fukui
- Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Japan
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60
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Zhang T, Wang C, Wei J, Zhu Z, Wang X, Sun C. Ligand-of-Numb protein X1 controls the coxsackievirus B3-induced myocarditis via regulating the stability of coxsackievirus and adenovirus receptor. Genes Immun 2022; 23:42-46. [PMID: 35115665 DOI: 10.1038/s41435-022-00163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 11/09/2022]
Abstract
Group B coxsackieviruses (CVBs) are the main cause of virus-induced myocarditis. CVBs use coxsackievirus and adenovirus receptor (CAR) for infection and targeting CAR has been shown to ameliorate CVBs-induced myocarditis. Ligand-of-Numb protein X1 (LNX1) is an E3 ubiquitin ligase that was shown to interact with CAR. However, the precise effect of LNX1 on CAR and the roles of LNX1 on CVBs-induced myocarditis remain unknown. In the present study, we generated mice deficient in LNX1 in the heart and evaluated the symptoms of myocarditis after CVB3 infection. We also monitored the expression and ubiquitination of CAR in LNX1-deficient cardiomyocytes after CVBs infection. We found that CVBs infection decreased CAR expression while promoted the expression of LNX1. Mice with deficiency of LNX1 in the heart had normal myocardial development while had deteriorated myocarditis symptoms after CVB3 infection. In LNX1-deficient cardiomyocytes, decreased ubiquitination of CAR and upregulation of CAR were observed after CVB3 infection. In summary, LNX1 controls CVB3-induced myocarditis by regulating the expression of CAR.
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Affiliation(s)
- Ting Zhang
- Department of Cardiology, XI'AN International Medical Center Hospital, No. 777, Xitai Road, Chang'an District, Xi'an, 710100, Shaanxi, China
| | - Changying Wang
- Department of Cardiology, XI'AN International Medical Center Hospital, No. 777, Xitai Road, Chang'an District, Xi'an, 710100, Shaanxi, China
| | - Jinjuan Wei
- Department of Cardiology, XI'AN International Medical Center Hospital, No. 777, Xitai Road, Chang'an District, Xi'an, 710100, Shaanxi, China
| | - Zhenyin Zhu
- Department of Cardiology, XI'AN International Medical Center Hospital, No. 777, Xitai Road, Chang'an District, Xi'an, 710100, Shaanxi, China
| | - Xiaoni Wang
- Department of Cardiology, XI'AN International Medical Center Hospital, No. 777, Xitai Road, Chang'an District, Xi'an, 710100, Shaanxi, China
| | - Chuang Sun
- Department of Cardiology, XI'AN International Medical Center Hospital, No. 777, Xitai Road, Chang'an District, Xi'an, 710100, Shaanxi, China.
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61
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Venkataraman S, Bhardwaj A, Belford PM, Morris BN, Zhao DX, Vallabhajosyula S. Veno-Arterial Extracorporeal Membrane Oxygenation in Patients with Fulminant Myocarditis: A Review of Contemporary Literature. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:215. [PMID: 35208538 PMCID: PMC8876206 DOI: 10.3390/medicina58020215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/12/2022] [Accepted: 01/27/2022] [Indexed: 11/16/2022]
Abstract
Fulminant myocarditis is characterized by life threatening heart failure presenting as cardiogenic shock requiring inotropic or mechanical circulatory support to maintain tissue perfusion. There are limited data on the role of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the management of fulminant myocarditis. This review seeks to evaluate the management of fulminant myocarditis with a special emphasis on the role and outcomes with VA-ECMO use.
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Affiliation(s)
- Shreyas Venkataraman
- Department of Medicine, Barnes-Jewish Hospital, Washington University of Saint Louis, St. Louis, MO 63110, USA;
| | - Abhishek Bhardwaj
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH 44106, USA;
| | - Peter Matthew Belford
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (P.M.B.); (D.X.Z.)
| | - Benjamin N. Morris
- Section of Cardiovascular and Critical Care Anesthesia, Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA;
| | - David X. Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (P.M.B.); (D.X.Z.)
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (P.M.B.); (D.X.Z.)
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Mirna M, Paar V, Topf A, Kraus T, Sotlar K, Aigner A, Ewe A, Watzinger S, Podesser BK, Hackl M, Pistulli R, Hoppe UC, Kiss A, Lichtenauer M. A new player in the game: treatment with antagomiR-21a-5p significantly attenuates histological and echocardiographic effects of experimental autoimmune myocarditis. Cardiovasc Res 2022; 118:556-572. [PMID: 33483746 DOI: 10.1093/cvr/cvab015] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 01/09/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS Myocarditis is associated with formidable symptoms and increased risk of adverse outcomes. Current approaches mostly rely on symptomatic treatments, warranting novel concepts for clinical practice. The aim of this study was to investigate the microRNA (miRNA) expression profile of Balb/c mice with experimental autoimmune myocarditis (EAM), choose a representative miRNA to antagonize after review of available literature and test its effects on myocardial inflammation in vitro and in vivo. METHODS AND RESULTS Phase 1: EAM was induced in 12 male Balb/c mice, 10 animals served as controls. After sacrifice, next-generation sequencing (NGS) of the miRNA expression profile was performed. Based on these results, H9C2 cells and human ventricular cardiac fibroblasts exposed to lipopolysaccharide (LPS) were treated with the selected candidate antagomiR-21a-5p. Phase 2: EAM was induced in 48 animals. Thereof, 24 animals were either treated with antagomiR-21a-5p or negative control oligonucleotide in a nanoparticle formulation. Transthoracic echocardiography (TTE) was performed on Days 0, 7, 14, and 21. Histopathological examination was performed after sacrifice. Phase 1: EAM resulted in a significant up-regulation of 27 miRNAs, including miR-21a-5p (log2FC: 2.23, adj. P = 0.0026). Transfection with antagomiR-21a-5p resulted in a significant reduction of TNFα, IL-6, and collagen I in vitro. Phase 2: Treatment with antagomiR-21a-5p, formulated in polymeric nanoparticles for systemic injection, significantly attenuated myocardial inflammation (P = 0.001) and fibrosis (P = 0.013), as well as myocardial 'hypertrophy' on TTE. CONCLUSIONS Silencing of miR-21a-5p results in a significant reduction of the expression of pro-inflammatory cytokines in vitro, as well as a significant attenuation of inflammation, fibrosis and echocardiographic effects of EAM in vivo.
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Affiliation(s)
- Moritz Mirna
- Department of Cardiology, University Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Vera Paar
- Department of Cardiology, University Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Albert Topf
- Department of Cardiology, University Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Theo Kraus
- University Institute of Pathology, Paracelsus Medical University of Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Karl Sotlar
- University Institute of Pathology, Paracelsus Medical University of Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Achim Aigner
- Rudolf-Boehm-Institut for Pharmacology und Toxicology, Clinical Pharmacology, University of Leipzig, Faculty of Medicine, Haertelstraße 16-18, 04107 Leipzig, Germany
| | - Alexander Ewe
- Rudolf-Boehm-Institut for Pharmacology und Toxicology, Clinical Pharmacology, University of Leipzig, Faculty of Medicine, Haertelstraße 16-18, 04107 Leipzig, Germany
| | - Simon Watzinger
- Ludwig Boltzmann Institute for Cardiovascular Research at Center for Biomedical Research, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria
| | - Bruno K Podesser
- Ludwig Boltzmann Institute for Cardiovascular Research at Center for Biomedical Research, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria
| | | | - Rudin Pistulli
- Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany
| | - Uta C Hoppe
- Department of Cardiology, University Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Attila Kiss
- Ludwig Boltzmann Institute for Cardiovascular Research at Center for Biomedical Research, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria
| | - Michael Lichtenauer
- Department of Cardiology, University Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
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63
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Radovanovic M, Jevtic D, Calvin AD, Petrovic M, Paulson M, Rueda Prada L, Sprecher L, Savic I, Dumic I. "Heart in DRESS": Cardiac Manifestations, Treatment and Outcome of Patients with Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome: A Systematic Review. J Clin Med 2022; 11:jcm11030704. [PMID: 35160164 PMCID: PMC8836915 DOI: 10.3390/jcm11030704] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 02/07/2023] Open
Abstract
Cardiac involvement in drug reaction with eosinophilia and systemic symptoms (DS) is rare but associated with high mortality. The aim of this research was to systematically review case reports by PRISMA guidelines in order to synthetize the knowledge of cardiac manifestations of DS. We identified 42 cases from 36 case reports. Women were two times more affected than men. Two-thirds of patients had cardiac manifestation in the initial phase of the disease, while in one-third of cases cardiac manifestations developed later (mean time of 70 ± 63 days). The most common inciting medications were minocycline (19%) and allopurinol (12%). In 17% of patients, the heart was the only internal organ affected, while the majority (83%) had at least one additional organ involved, most commonly the liver and the kidneys. Dyspnea (55%), cardiogenic shock (43%), chest pain (38%), and tachycardia (33%) were the most common cardiac signs and symptoms reported. Patients frequently had an abnormal ECG (71.4%), and a decrease in left ventricular ejection fraction was the most common echocardiographic finding (45%). Endomyocardial biopsy or histological examination at autopsy was performed in 52.4%, with the predominant finding being fulminant eosinophilic myocarditis with acute necrosis in 70% of those biopsied. All patients received immunosuppressive therapy with intravenous steroids, while non-responders were more likely to have received IVIG, cyclosporine, mycophenolate, and other steroid-sparing agents (60%). Gender and degree of left ventricular systolic dysfunction were not associated with outcomes, but short latency between drug exposure and the first DRESS symptom onset (<15 days) and older age (above 65 years) was associated with death. This underscores the potential importance of heightened awareness and early treatment.
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Affiliation(s)
- Milan Radovanovic
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA; (M.R.); (A.D.C.); (M.P.); (L.R.P.); (L.S.)
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Djordje Jevtic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.J.); (I.S.)
| | - Andrew D. Calvin
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA; (M.R.); (A.D.C.); (M.P.); (L.R.P.); (L.S.)
- Department of Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Marija Petrovic
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Margaret Paulson
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA; (M.R.); (A.D.C.); (M.P.); (L.R.P.); (L.S.)
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Libardo Rueda Prada
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA; (M.R.); (A.D.C.); (M.P.); (L.R.P.); (L.S.)
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Lawrence Sprecher
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA; (M.R.); (A.D.C.); (M.P.); (L.R.P.); (L.S.)
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Ivana Savic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.J.); (I.S.)
| | - Igor Dumic
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA; (M.R.); (A.D.C.); (M.P.); (L.R.P.); (L.S.)
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
- Correspondence:
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64
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Sharifrazi D, Alizadehsani R, Joloudari JH, Band SS, Hussain S, Sani ZA, Hasanzadeh F, Shoeibi A, Dehzangi A, Sookhak M, Alinejad-Rokny H. CNN-KCL: Automatic myocarditis diagnosis using convolutional neural network combined with k-means clustering. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:2381-2402. [PMID: 35240789 DOI: 10.3934/mbe.2022110] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Myocarditis is the form of an inflammation of the middle layer of the heart wall which is caused by a viral infection and can affect the heart muscle and its electrical system. It has remained one of the most challenging diagnoses in cardiology. Myocardial is the prime cause of unexpected death in approximately 20% of adults less than 40 years of age. Cardiac MRI (CMR) has been considered a noninvasive and golden standard diagnostic tool for suspected myocarditis and plays an indispensable role in diagnosing various cardiac diseases. However, the performance of CMR depends heavily on the clinical presentation and features such as chest pain, arrhythmia, and heart failure. Besides, other imaging factors like artifacts, technical errors, pulse sequence, acquisition parameters, contrast agent dose, and more importantly qualitatively visual interpretation can affect the result of the diagnosis. This paper introduces a new deep learning-based model called Convolutional Neural Network-Clustering (CNN-KCL) to diagnose Myocarditis. In this study, we used 47 subjects with a total number of 98,898 images to diagnose myocarditis disease. Our results demonstrate that the proposed method achieves an accuracy of 97.41% based on 10 fold-cross validation technique with 4 clusters for diagnosis of Myocarditis. To the best of our knowledge, this research is the first to use deep learning algorithms for the diagnosis of myocarditis.
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Affiliation(s)
- Danial Sharifrazi
- Department of Computer Engineering, School of Technical and Engineering, Shiraz Branch, Islamic Azad University, Shiraz, IR
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, VIC 3216, AU
| | | | - Shahab S Band
- Future Technology Research Center, College of Future, National Yunlin University of Science and Technology 123 University Road, Section 3, Douliou, Yunlin 64002, TW
| | - Sadiq Hussain
- System Administrator, Dibrugarh University, Assam 786004, IN
| | - Zahra Alizadeh Sani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Omid hospital, Iran University of Medical Sciences, Tehran, IR
| | | | - Afshin Shoeibi
- FPGA Laboratory, Faculty of Electrical Engineering, K. N. Toosi University of Technology, Tehran, IR
| | - Abdollah Dehzangi
- Department of Computer Science, Rutgers University, Camden, NJ 08102, USA
- Center for Computational and Integrative Biology, Rutgers University, Camden, NJ 08102, USA
| | - Mehdi Sookhak
- Department of Computer Science, Texas A & M University at Corpus Christi, Corpus Christi, TX 78412, USA
| | - Hamid Alinejad-Rokny
- BioMedical Machine Learning Lab (BML), The Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW 2052, AU
- Health Data Analytics Program, AI-enabled Processes (AIP) Research Centre, Macquarie University, Sydney 2109, AU
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65
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Seidman MA, McManus B. Myocarditis. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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66
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Hu Y, Ren J, Dong X, Zhang D, Qu Y, Yang C, Sun Y, Li J, Luo F, Wang W, Wang H, Qing P, Zhao S, Huang J, Yu L, Liu Y, Tan H. Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes. Front Cardiovasc Med 2021; 8:770549. [PMID: 34926619 PMCID: PMC8678080 DOI: 10.3389/fcvm.2021.770549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives: Fulminant myocarditis (FM) is a rapidly progressive and frequently fatal form of myocarditis that has been difficult to classify. This study aims to compare the clinical characteristics, treatments and outcomes in patients with fulminant giant cell myocarditis (FGCM) and fulminant lymphocytic myocarditis (FLM). Methods and Results: In our retrospective study, nine patients with FGCM (mean age 47.9 ± 7.5 years, six female) and 7 FLM (mean age 42.1 ± 12.3 years, four female) patients confirmed by histology in the last 11 years were included. Most patients with FGCM and FLM were NYHA functional class IV (56 vs. 100%, p = 0.132). Patients with FGCM had significantly lower levels of high-sensitivity C-reactive protein [hs-CRP, 4.4 (2.0–10.2) mg/L vs. 13.6 (12.6–14.6) mg/L, P = 0.004, data shown as the median with IQR], creatine kinase-myoglobin [CK-MB, 1.4 (1.0–3.2) ng/ml vs. 14.6 (3.0–64.9) ng/ml, P = 0.025, median with IQR], and alanine aminotransferase [ALT, 38.0 (25.0–61.5) IU/L vs. 997.0 (50.0–3,080.0) IU/L, P = 0.030, median with IQR] and greater right ventricular end-diastolic diameter (RVEDD) [2.9 ± 0.3 cm vs. 2.4 ± 0.6 cm, P = 0.034, mean ± SD] than those with FLM. No differences were observed in the use of intra-aortic balloon pump (44 vs. 43%, p = 1.000) and extracorporeal membrane oxygenation (11 vs. 43%, p = 0.262) between the two groups. The long-term survival rate was significantly lower in FGCM group compared with FLM group (0 vs. 71.4%, p = 0.022). A multivariate cox regression analysis showed the level of hs-CRP (hazard ratio = 0.871, 95% confidence interval: 0.761–0.996, P = 0.043) was an independent prognostic factor for FM patients. Furthermore, the level of hs-CRP had a good ability to discriminate between patients with FGCM and FLM (AUC = 0.94, 95% confidence interval: 0.4213–0.9964). Conclusions: The inflammatory response and myocardial damage in the patients with FGCM were milder than those with FLM. Patients with FGCM had distinctly poorer prognoses compared with those with FLM. Our results suggest that hs-CRP could be a promising prognostic biomarker and a hs-CRP level of 11.71 mg/L is an appropriate cutoff point for the differentiating diagnosis between patients with FGCM and FLM.
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Affiliation(s)
- Yuxiao Hu
- Emergency and Critical Care Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jie Ren
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xueqi Dong
- Emergency and Critical Care Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Di Zhang
- Emergency and Critical Care Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yi Qu
- Emergency and Critical Care Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chunxue Yang
- Emergency and Critical Care Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yang Sun
- Department of Pathology, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jinghui Li
- Magnetic Resonance Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Fang Luo
- Emergency and Critical Care Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Wei Wang
- Emergency and Critical Care Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Huanhuan Wang
- Emergency and Critical Care Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ping Qing
- Emergency and Critical Care Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Shihua Zhao
- Magnetic Resonance Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jie Huang
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Litian Yu
- Emergency and Critical Care Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yaxin Liu
- Emergency and Critical Care Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Huiqiong Tan
- Emergency and Critical Care Center, National Center for Cardiovascular Diseases of China, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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67
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Affiliation(s)
- Melina Müller
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Leslie T Cooper
- Department of Cardiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Bettina Heidecker
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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68
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COVID-19, the Pandemic of the Century and Its Impact on Cardiovascular Diseases. CARDIOLOGY DISCOVERY 2021; 1:233-258. [PMID: 34888547 PMCID: PMC8638821 DOI: 10.1097/cd9.0000000000000038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/19/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection likely ranks among the deadliest diseases in human history. As with other coronaviruses, SARS-CoV-2 infection damages not only the lungs but also the heart and many other organs that express angiotensin-converting enzyme 2 (ACE2), a receptor for SARS-CoV-2. COVID-19 has upended lives worldwide. Dietary behaviors have been altered such that they favor metabolic and cardiovascular complications, while patients have avoided hospital visits because of limited resources and the fear of infection, thereby increasing out-hospital mortality due to delayed diagnosis and treatment. Clinical observations show that sex, age, and race all influence the risk for SARS-CoV-2 infection, as do hypertension, obesity, and pre-existing cardiovascular conditions. Many hospitalized COVID-19 patients suffer cardiac injury, acute coronary syndromes, or cardiac arrhythmia. SARS-CoV-2 infection may lead to cardiomyocyte apoptosis and necrosis, endothelial cell damage and dysfunction, oxidative stress and reactive oxygen species production, vasoconstriction, fibrotic and thrombotic protein expression, vascular permeability and microvascular dysfunction, heart inflammatory cell accumulation and activation, and a cytokine storm. Current data indicate that COVID-19 patients with cardiovascular diseases should not discontinue many existing cardiovascular therapies such as ACE inhibitors, angiotensin receptor blockers, steroids, aspirin, statins, and PCSK9 inhibitors. This review aims to furnish a framework relating to COVID-19 and cardiovascular pathophysiology.
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69
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Schultheiss HP, Baumeier C, Aleshcheva G, Bock CT, Escher F. Viral Myocarditis-From Pathophysiology to Treatment. J Clin Med 2021; 10:jcm10225240. [PMID: 34830522 PMCID: PMC8623269 DOI: 10.3390/jcm10225240] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 12/17/2022] Open
Abstract
The diagnosis of acute and chronic myocarditis remains a challenge for clinicians. Characterization of this disease has been hampered by its diverse etiologies and heterogeneous clinical presentations. Most cases of myocarditis are caused by infectious agents. Despite successful research in the last few years, the pathophysiology of viral myocarditis and its sequelae leading to severe heart failure with a poor prognosis is not fully understood and represents a significant public health issue globally. Most likely, at a certain point, besides viral persistence, several etiological types merge into a common pathogenic autoimmune process leading to chronic inflammation and tissue remodeling, ultimately resulting in the clinical phenotype of dilated cardiomyopathy. Understanding the underlying molecular mechanisms is necessary to assess the prognosis of patients and is fundamental to appropriate specific and personalized therapeutic strategies. To reach this clinical prerequisite, there is the need for advanced diagnostic tools, including an endomyocardial biopsy and guidelines to optimize the management of this disease. The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has currently led to the worst pandemic in a century and has awakened a special sensitivity throughout the world to viral infections. This work aims to summarize the pathophysiology of viral myocarditis, advanced diagnostic methods and the current state of treatment options.
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Affiliation(s)
| | - Christian Baumeier
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany
| | - Ganna Aleshcheva
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany
| | - C-Thomas Bock
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
- Institute of Tropical Medicine, University of Tuebingen, 72074 Tuebingen, Germany
| | - Felicitas Escher
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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70
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MicroRNA-324-3p Plays A Protective Role Against Coxsackievirus B3-Induced Viral Myocarditis. Virol Sin 2021; 36:1585-1599. [PMID: 34632544 DOI: 10.1007/s12250-021-00441-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/28/2021] [Indexed: 02/05/2023] Open
Abstract
Viral myocarditis (VM) is an inflammatory disease of the myocardium associated with heart failure, which is caused by common viral infections. A majority of the infections are initiated by coxsackievirus B3 (CVB3). MicroRNAs (miRNAs) have a major role in various biological processes, including gene expression, cell growth, proliferation, and apoptosis, as well as viral infection and antiviral immune responses. Although, miRNAs have been found to regulate viral infections, their role in CVB3 infection remains poorly understood. In the previous study, miRNA microarray results showed that miR-324-3p expression levels were significantly increased when cells and mice were infected with CVB3. It was also found that miR-324-3p downregulated TRIM27 and decreased CVB3 replication in vitro and in vivo. In vitro, analysis of downstream signaling of TRIM27 revealed that, miR-324-3p inhibited CVB3 infection, and reduced cytopathic effect and viral plaque formation by reducing the expression of TRIM27. In vivo, miR-324-3p decreased the expression of TRIM27, reduced cardiac viral replication and load, thereby strongly attenuating cardiac injury and inflammation. Taken together, this study suggests that miR-324-3p targets TRIM27 to inhibit CVB3 replication and viral load, thereby reducing the cardiac injury associated with VM.
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71
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Schultheiss HP, Baumeier C, Pietsch H, Bock CT, Poller W, Escher F. Cardiovascular consequences of viral infections: from COVID to other viral diseases. Cardiovasc Res 2021; 117:2610-2623. [PMID: 34609508 PMCID: PMC8500164 DOI: 10.1093/cvr/cvab315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/28/2021] [Indexed: 12/15/2022] Open
Abstract
Infection of the heart muscle with cardiotropic viruses is one of the major aetiologies of myocarditis and acute and chronic inflammatory cardiomyopathy (DCMi). However, viral myocarditis and subsequent dilated cardiomyopathy is still a challenging disease to diagnose and to treat and is therefore a significant public health issue globally. Advances in clinical examination and thorough molecular genetic analysis of intramyocardial viruses and their activation status have incrementally improved our understanding of molecular pathogenesis and pathophysiology of viral infections of the heart muscle. To date, several cardiotropic viruses have been implicated as causes of myocarditis and DCMi. These include, among others, classical cardiotropic enteroviruses (Coxsackieviruses B), the most commonly detected parvovirus B19, and human herpes virus 6. A newcomer is the respiratory virus that has triggered the worst pandemic in a century, SARS-CoV-2, whose involvement and impact in viral cardiovascular disease is under scrutiny. Despite extensive research into the pathomechanisms of viral infections of the cardiovascular system, our knowledge regarding their treatment and management is still incomplete. Accordingly, in this review, we aim to explore and summarize the current knowledge and available evidence on viral infections of the heart. We focus on diagnostics, clinical relevance and cardiovascular consequences, pathophysiology, and current and novel treatment strategies.
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Affiliation(s)
| | - Christian Baumeier
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany
| | - Heiko Pietsch
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany.,Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany, partner site
| | - C Thomas Bock
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, 13353 Germany.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Wolfgang Poller
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany, partner site.,Department of Cardiology, Campus Benjamin Franklin.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Felicitas Escher
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany.,Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany, partner site
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72
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Mirna M, Schmutzler L, Topf A, Hoppe UC, Lichtenauer M. Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio predict length of hospital stay in myocarditis. Sci Rep 2021; 11:18101. [PMID: 34518607 PMCID: PMC8438016 DOI: 10.1038/s41598-021-97678-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/20/2021] [Indexed: 02/08/2023] Open
Abstract
Neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are associated with the severity of various diseases. The aim of this study was to demonstrate the relationship of NLR and MLR with the severity of myocarditis. 202 consecutive patients with myocarditis were retrospectively enrolled in this study. Laboratory parameters and clinical data were extracted from hospital records and discharge letters. Median NLR was 2.48 (IQR 1.55-4.58) and median MLR was 0.42 (IQR 0.39-0.58). NLR and MLR correlated with HF, CRP and leukocyte count, MLR further correlated inversely with LV systolic function (rs = - 0.379, p = 0.030). Both ratios correlated better with length of hospital stay (NLR: rs = 0.435, p = 0.003; MLR: rs = 0.534, p < 0.0001) than CRP, leukocyte count, IL-6 or procalcitonin. AUCs for the prediction of prolonged hospital stay (NLR = 0.75, MLR = 0.80), and optimal cut-offs therefor were calculated. Patients who had in-hospital complications showed a higher NLR, however, this remained statistically insignificant. NLR and MLR correlated with the length of stay, as well as with several clinical and laboratory parameters in patients with myocarditis. Since white blood cell differentials are relatively easy and fast to perform, both ratios could facilitate further risk stratification in affected patients.
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Affiliation(s)
- Moritz Mirna
- Department of Internal Medicine II, Division of Cardiology, Universitätsklinikum Der Paracelsus Medizinischen Universität, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Lukas Schmutzler
- Department of Internal Medicine II, Division of Cardiology, Universitätsklinikum Der Paracelsus Medizinischen Universität, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Albert Topf
- Department of Internal Medicine II, Division of Cardiology, Universitätsklinikum Der Paracelsus Medizinischen Universität, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Universitätsklinikum Der Paracelsus Medizinischen Universität, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Universitätsklinikum Der Paracelsus Medizinischen Universität, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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McLean K, Johnson TJ. Myopericarditis in a previously healthy adolescent male following COVID-19 vaccination: A case report. Acad Emerg Med 2021; 28:918-921. [PMID: 34133825 PMCID: PMC8441784 DOI: 10.1111/acem.14322] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/19/2022]
Abstract
We report the case of a previously healthy 16‐year‐old male who developed myopericarditis following the second dose of his Pfizer‐BioNTech COVID‐19 vaccine, with no other identified triggers. Adolescents and young adults experiencing chest pain after COVD‐19 vaccination should seek emergent medical care, and emergency providers should have a low threshold to consider and evaluate for myopericarditis. More data are needed to better understand the potential association between COVID‐19 vaccines and myopericarditis. If a true causal link is identified, the risk must also be viewed in context with the millions of patients who have been safely vaccinated and the known morbidity and mortality from COVID‐19 infection. As we see widespread vaccine rollout, it is important that all potential adverse reactions are reported as we continue to monitor for more rare but potentially serious side effects not identified in vaccination trials.
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Affiliation(s)
- Kelsey McLean
- Department of Pediatrics University of California–Davis Sacramento California USA
| | - Tiffani J. Johnson
- Department of Emergency Medicine University of California–Davis Sacramento California USA
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Abstract
Background: The incidence of myocarditis in patients with coronavirus disease 2019 (COVID-19) remains unknown; however, increasing evidence links COVID-19 to cardiovascular complications such as arrhythmias, heart failure, cardiogenic shock, fulminant myocarditis, and cardiac death. We present a case of suspected COVID-19–induced myopericarditis and discuss the diagnostic implications, pathophysiology, and management. Case Report: A 72-year-old female was admitted to the hospital with acute on chronic respiratory failure in the setting of COVID-19. The next day, she developed pressure-like retrosternal chest pain. Laboratory findings revealed elevated cardiac enzymes and inflammatory markers consistent with myocardial injury. Electrocardiogram revealed diffuse ST segment elevations without reciprocal changes, concerning for myopericarditis. Transthoracic echocardiography showed new findings of severely reduced left ventricular (LV) systolic function, with an estimated ejection fraction (EF) of 20%. Her hospital course was further complicated by cardiogenic shock that required treatment in the intensive care unit with vasopressors and inotropes. During the next few days, she had almost full recovery of her LV function, with EF improving to 50%. However, her clinical status deteriorated, likely the result of a bowel obstruction. She was transitioned to comfort care at the request of her family, and she died shortly after. Conclusion: This case highlights diagnostic and therapeutic challenges that physicians may encounter when managing acute cardiac injury in the setting of COVID-19. The multiple mechanisms of COVID-19–related myocardial injury may influence the approach to diagnosis and treatment.
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Piccirillo F, Watanabe M, Di Sciascio G. Diagnosis, treatment and predictors of prognosis of myocarditis. A narrative review. Cardiovasc Pathol 2021; 54:107362. [PMID: 34192559 DOI: 10.1016/j.carpath.2021.107362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/31/2022] Open
Abstract
Although it has been recognized for almost two centuries, myocarditis is still a challenging diagnosis due to the wide heterogeneity of its clinical manifestations and evolution. Moreover, the diagnostic gold standard, endomyocardial biopsy (EMB), is infrequently used, making hard to determine the exact incidence of myocarditis. Clinical presentation includes a wide range of symptoms, ranging from asymptomatic or subclinical disease with mild dyspnea and chest pain to sudden death, due to cardiogenic shock or malignant ventricular arrhythmias. Equally, the evolution of myocarditis largely varies: albeit short-term prognosis is usually good, with complete or partial recovery, dilated cardiomyopathy with chronic heart failure is the major long-term consequence of myocarditis, developing often several years after the acute onset. This narrative review aims to summarize the current knowledge about myocarditis, with a particular attention to predictors of short- and long-term prognosis, in order to provide a rational and practical approach to the diagnosis, evaluation and treatment of suspected myocarditis.
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Affiliation(s)
- Francesco Piccirillo
- Unit of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Mikiko Watanabe
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - Germano Di Sciascio
- Unit of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
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Traverse EM, Hopkins HK, Vaidhyanathan V, Barr KL. Cardiomyopathy and Death Following Chikungunya Infection: An Increasingly Common Outcome. Trop Med Infect Dis 2021; 6:108. [PMID: 34206332 PMCID: PMC8293388 DOI: 10.3390/tropicalmed6030108] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022] Open
Abstract
Chikungunya virus (CHIKV) is vectored by Aedes aegypti and Aedes albopictus mosquitoes and is found throughout tropical and sub-tropical regions. While most infections cause mild symptoms such as fever and arthralgia, there have been cases in which cardiac involvement has been reported. In adults, case reports include symptoms ranging from tachycardia and arrythmia, to myocarditis and cardiac arrest. In children, case reports describe symptoms such as arrythmia, myocarditis, and heart failure. Case reports of perinatal and neonatal CHIKV infections have also described cardiovascular compromise, including myocardial hypertrophy, ventricular dysfunction, myocarditis, and death. Myocarditis refers to inflammation of the heart tissue, which can be caused by viral infection, thus becoming viral myocarditis. Since viral myocarditis is linked as a causative factor of other cardiomyopathies, including dilated cardiomyopathy, in which the heart muscle weakens and fails to pump blood properly, the connection between CHIKV and the heart is concerning. We searched Pubmed, Embase, LILACS, and Google Scholar to identify case reports of CHIKV infections where cardiac symptoms were reported. We utilized NCBI Virus and NCBI Nucleotide to explore the lineage/evolution of strains associated with these outbreaks. Statistical analysis was performed to identify which clinical features were associated with death. Phylogenetic analysis determined that CHIKV infections with cardiac symptoms are associated with the Asian, the East Central South African, and the Indian Ocean lineages. Of patients admitted to hospital, death rates ranged from 26-48%. Myocarditis, hypertension, pre-existing conditions, and the development of heart failure were significantly correlated with death. As such, clinicians should be aware in their treatment and follow-up of patients.
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Affiliation(s)
- Elizabeth M. Traverse
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL 33612, USA; (E.M.T.); (H.K.H.)
| | - Hannah K. Hopkins
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL 33612, USA; (E.M.T.); (H.K.H.)
| | | | - Kelli L. Barr
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL 33612, USA; (E.M.T.); (H.K.H.)
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A bioinformatics approach for identifying potential molecular mechanisms and key genes involved in COVID-19 associated cardiac remodeling. GENE REPORTS 2021; 24:101246. [PMID: 34131597 PMCID: PMC8192842 DOI: 10.1016/j.genrep.2021.101246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023]
Abstract
In 2019 coronavirus disease (COVID-19), whose main complication is respiratory involvement, different organs may also be affected in severe cases. However, COVID-19 associated cardiovascular manifestations are limited at present. The main purpose of this study was to identify potential candidate genes involved in COVID-19-associated heart damage by bioinformatics analysis. Differently expressed genes (DEGs) were identified using transcriptome profiles (GSE150392 and GSE4172) downloaded from the GEO database. After gene and pathway enrichment analyses, PPI network visualization, module analyses, and hub gene extraction were performed using Cytoscape software. A total of 228 (136 up and 92 downregulated) overlapping DEGs were identified at these two microarray datasets. Finally, the top hub genes (FGF2, JUN, TLR4, and VEGFA) were screened out as the critical genes among the DEGs from the PPI network. Identification of critical genes and mechanisms in any disease can lead us to better diagnosis and targeted therapy. Our findings identified core genes shared by inflammatory cardiomyopathy and SARS-CoV-2. The findings of the current study support the idea that these key genes can be used in understanding and managing the long-term cardiovascular effects of COVID-19.
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Diagnosis and Management of Myocarditis: An Evidence-Based Review for the Emergency Medicine Clinician. J Emerg Med 2021; 61:222-233. [PMID: 34108120 DOI: 10.1016/j.jemermed.2021.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Myocarditis is a potentially fatal condition that can be misdiagnosed in the emergency department (ED) setting. OBJECTIVE The purpose of this narrative review article is to provide a summary of the background, pathophysiology, diagnosis, and management of myocarditis, with a focus on emergency clinicians. DISCUSSION Myocarditis occurs when inflammation of the heart musculature causes cardiac dysfunction. Symptoms may range from mild to severe and are often preceded by a viral prodrome. Laboratory assessment and an electrocardiogram can be helpful for the diagnosis, but echocardiography is the ideal test in the ED setting. Some patients may also require advanced imaging, though this will often occur during hospitalization or follow-up. Treatment is primarily focused on respiratory and hemodynamic support. Initial hemodynamic management includes vasopressors and inotropes, whereas more severe cases may require an intra-aortic balloon pump, extracorporeal membrane oxygenation, or a ventricular assist device. Nonsteroidal anti-inflammatory drugs should be avoided while intravenous immunoglobulin is controversial. CONCLUSION Myocarditis is a serious condition with the potential for significant morbidity and mortality. It is important for clinicians to be aware of the current evidence regarding the diagnosis, management, and disposition of these patients.
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79
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Carretta DM, Silva AM, D’Agostino D, Topi S, Lovero R, Charitos IA, Wegierska AE, Montagnani M, Santacroce L. Cardiac Involvement in COVID-19 Patients: A Contemporary Review. Infect Dis Rep 2021; 13:494-517. [PMID: 34206074 PMCID: PMC8293198 DOI: 10.3390/idr13020048] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/22/2021] [Accepted: 05/26/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The widely variable clinical manifestations of SARS-CoV2 disease (COVID-19) range from asymptomatic infections to multiple organ failure and death. Among the organs affected is the heart. This does not only affect people who already have previous cardiovascular problems, but also healthy people. This is a reason not to overlook any symptoms or to perform targeted examinations, even if apparently unrelated to the heart, for quick recognition and timely therapy. Aim of the study: This review recapitulates the current state of knowledge on the potential mechanisms and manifestation of myocarditis in patients with COVID-19 infection. Methods: A web-based search of published data was performed for all relevant studies on patients diagnosed with a COVID-19-induced acute myocarditis, and a total of 50 reports were included. The analysis of the studies evaluated highlights a male predominance, with the average age of patients being 55 years. The most common presenting symptoms included fever, shortness of breath, cough, and chest pain. Among ECG changes, non-specific ST-segment and T-wave amplitude alterations and ventricular tachycardia episodes were reported. Finally, we wanted to use a general evaluation without distinguishing between various countries, taking into consideration only the peer or reviewer, regardless of the declared value of the journals that have been published. Results and critical findings: The most common presenting symptoms included fever, shortness of breath, cough, and chest pain. Among ECG changes, non-specific ST-segment and T-wave amplitude alterations and ventricular tachycardia episodes were reported. In most patients, elevated levels of cardiac and inflammatory biomarkers were measured. Left ventricular dysfunction and hypokinesis were commonly exhibited symptoms. Cardiac Magnetic Resonance Imaging (CMRI) confirmed the diagnosis of myocarditis with features of cardiac edema and cardiac injury. Nine patients underwent histopathological examination. Treatment with corticosteroids and immunoglobulins was the most applied strategy following the administration of antivirals. Discussion: Despite the exponentially growing knowledge on the management of COVID-19 infection, current available data on SARS-CoV2-correlated myocarditis are still limited, and several difficulties may be encountered in the differential diagnosis of acute myocarditis in the context of COVID-19 disease. Conclusions: While diagnostic criteria and evaluation strategies for myocarditis are well described, no guidelines for the diagnosis and treatment of myocarditis in COVID-19 patients have yet been established. Therefore, further research is needed to advance the understanding of this disease process and define the most appropriate strategic approach in these patients.
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Affiliation(s)
- Domenico Maria Carretta
- AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Coronary Unit and Electrophysiology/Pacing Unit, Cardio-Thoracic Department, Policlinico University Hospital of Bari, 70124 Bari, Italy;
| | - Aline Maria Silva
- AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Cardiac Surgery, Policlinico University Hospital of Bari, 70124 Bari, Italy; (A.M.S.); (D.D.)
| | - Donato D’Agostino
- AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Cardiac Surgery, Policlinico University Hospital of Bari, 70124 Bari, Italy; (A.M.S.); (D.D.)
| | - Skender Topi
- Department of Clinical Disciplines, School of Technical Medical Sciences, University of Elbasan “A. Xhuvani”, 3001 Elbasan, Albania;
| | - Roberto Lovero
- AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Clinical Pathology Unit, Policlinico University Hospital of Bari, 70124 Bari, Italy;
| | - Ioannis Alexandros Charitos
- Emergency/Urgent Department, National Poisoning Center, Riuniti University Hospital of Foggia, 71122 Foggia, Italy
- Correspondence: (I.A.C.); (L.S.)
| | - Angelika Elzbieta Wegierska
- Department of Interdisciplinary Medicine, Microbiology and Virology Unit, University of Bari “Aldo Moro”, Piazza G. Cesare, 11, 70124 Bari, Italy;
| | - Monica Montagnani
- Department of Biomedical Sciences and Human Oncology—Section of Pharmacology, School of Medicine, University of Bari “Aldo Moro”, Policlinico University Hospital of Bari, p.zza G. Cesare 11, 70124 Bari, Italy;
| | - Luigi Santacroce
- Department of Interdisciplinary Medicine, Microbiology and Virology Unit, University of Bari “Aldo Moro”, Piazza G. Cesare, 11, 70124 Bari, Italy;
- Correspondence: (I.A.C.); (L.S.)
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Favere K, Bosman M, Klingel K, Heymans S, Van Linthout S, Delputte PL, De Sutter J, Heidbuchel H, Guns PJ. Toll-Like Receptors: Are They Taking a Toll on the Heart in Viral Myocarditis? Viruses 2021; 13:v13061003. [PMID: 34072044 PMCID: PMC8227433 DOI: 10.3390/v13061003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 12/30/2022] Open
Abstract
Myocarditis is an inflammatory disease of the heart with viral infections being the most common aetiology. Its complex biology remains poorly understood and its clinical management is one of the most challenging in the field of cardiology. Toll-like receptors (TLRs), a family of evolutionarily conserved pattern recognition receptors, are increasingly known to be implicated in the pathophysiology of viral myocarditis. Their central role in innate and adaptive immune responses, and in the inflammatory reaction that ensues, indeed makes them prime candidates to profoundly affect every stage of the disease process. This review describes the pathogenesis and pathophysiology of viral myocarditis, and scrutinises the role of TLRs in every phase. We conclude with directions for future research in this field.
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Affiliation(s)
- Kasper Favere
- Laboratory of Physiopharmacology, GENCOR, University of Antwerp, 2610 Antwerp, Belgium; (M.B.); (P.-J.G.)
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, 2610 Antwerp, Belgium;
- Department of Cardiology, Antwerp University Hospital, 2650 Antwerp, Belgium
- Department of Internal Medicine, Ghent University, 9000 Ghent, Belgium;
- Correspondence:
| | - Matthias Bosman
- Laboratory of Physiopharmacology, GENCOR, University of Antwerp, 2610 Antwerp, Belgium; (M.B.); (P.-J.G.)
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital Tuebingen, 72076 Tuebingen, Germany;
| | - Stephane Heymans
- Department of Cardiology, Maastricht University, 6229 ER Maastricht, The Netherlands;
- Centre for Molecular and Vascular Biology, KU Leuven, 3000 Leuven, Belgium
| | - Sophie Van Linthout
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health (BIH) at Charité, Universitätsmedizin Berlin, 10117 Berlin, Germany;
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
| | - Peter L. Delputte
- Laboratory of Microbiology, Parasitology and Hygiene, University of Antwerp, 2610 Antwerp, Belgium;
| | - Johan De Sutter
- Department of Internal Medicine, Ghent University, 9000 Ghent, Belgium;
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, 2610 Antwerp, Belgium;
- Department of Cardiology, Antwerp University Hospital, 2650 Antwerp, Belgium
| | - Pieter-Jan Guns
- Laboratory of Physiopharmacology, GENCOR, University of Antwerp, 2610 Antwerp, Belgium; (M.B.); (P.-J.G.)
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81
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Rroku A, Kottwitz J, Heidecker B. Update on myocarditis - what we know so far and where we may be heading. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:455–467. [PMID: 32319308 DOI: 10.1177/2048872620910109] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Andi Rroku
- Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | | | - Bettina Heidecker
- Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
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Combination of echocardiography and emergency endomyocardial biopsy for suspected myocarditis in the cardiovascular emergency medical care. J Echocardiogr 2021; 19:86-94. [PMID: 33661474 DOI: 10.1007/s12574-021-00521-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
Myocarditis is a fatal inflammatory disease of myocardium, diagnosed with clinical and histopathological findings by endomyocardial biopsy (EMB). Myocarditis has a variety of clinical presentations and a dynamic and sometimes rapid process of severity. Echocardiography plays an important role in the management of myocarditis because it has noninvasiveness and portability. Once acute myocarditis is suspected by an echocardiography, pathological information should be required as early as possible. In our cardiovascular center, emergency EMB suspecting myocarditis was performed in 19 cases (1.3%) among consecutive 1469 cases (70.1 ± 12.6 years old, male 67.5%) undergoing emergency coronary angiograms from April 2014 to September 2017. Hematoxylin-eosin stain of the biopsy specimens were prepared with microwave-accelerated histoprocessing within 3-5 hours after EMB for rapid pathological diagnosis of myocarditis. We reviewed the value of emergency echo-EMB combination leading to the early decision making of intensive care, corticosteroids and proper mechanical circulatory support prior to the possible sudden collapse in patients with myocarditis.
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83
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Clozapine-Associated Myocarditis: A Protocol for Monitoring Upon Clozapine Initiation and Recommendations for How to Conduct a Clozapine Rechallenge. J Clin Psychopharmacol 2021; 41:180-185. [PMID: 33587399 DOI: 10.1097/jcp.0000000000001358] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Clozapine is the only medication with Food and Drug Administration approval for treatment-resistant schizophrenia. However, it is underutilized in the United States because of several life-threatening adverse effects, including clozapine-associated myocarditis (CAM), and a limited understanding of how to manage these complications. To date, recommendations for rechallenging patients with CAM that incorporate the cardiac literature or cardioprotective medications have not been developed. FINDINGS In this article, we outline a protocol developed with cardiologists and guided by the cardiac literature that provides direction on how to monitor for the initial development of CAM and how to rechallenge patients with CAM. Furthermore, we present 2 successful cases of clozapine rechallenge that were managed using this protocol. CONCLUSIONS In both cases, the patients showed marked improvement in their psychiatric symptoms and functioning, demonstrating the importance of considering rechallenge in patients after CAM.
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84
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Parsamanesh N, Karami-Zarandi M, Banach M, Penson PE, Sahebkar A. Effects of statins on myocarditis: A review of underlying molecular mechanisms. Prog Cardiovasc Dis 2021; 67:53-64. [PMID: 33621589 DOI: 10.1016/j.pcad.2021.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/13/2021] [Indexed: 12/20/2022]
Abstract
Myocarditis refers to the clinical and histological characteristics of a diverse range of inflammatory cellular pathophysiological conditions which result in cardiac dysfunction. Myocarditis is a major cause of mortality in individuals less than 40 years of age and accounts for approximately 20% of cardiovascular disease (CVD) events. Myocarditis contributes to dilated cardiomyopathy in 30% of patients and can progress to cardiac arrest, which has a poor prognosis of <40% survival over 10 years. Myocarditis has also been documented after infection with SARS-CoV-2. The most commonly used lipid-lowering therapies, HMG-CoA reductase inhibitors (statins), decrease CVD-related morbidity and mortality. In addition to their lipid-lowering effects, increasing evidence supports the existence of several additional beneficial, 'pleiotropic' effects of statins. Recently, several studies have indicated that statins may attenuate myocarditis. Statins modify the lipid oxidation, inflammation, immunomodulation, and endothelial activity of the pathophysiology and have been recommended as adjuvant treatment. In this review, we focus on the mechanisms of action of statins and their effects on myocarditis, SARS-CoV-2 and CVD.
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Affiliation(s)
- Negin Parsamanesh
- Department of Molecular Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Maciej Banach
- Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Zeromskiego 113, Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.
| | - Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Quercetin Efficiently Alleviates TNF-α-Stimulated Injury by Signal Transducer and Activator of Transcription 1 and Mitogen-Activated Protein Kinase Pathway in H9c2 Cells: A Protective Role of Quercetin in Myocarditis. J Cardiovasc Pharmacol 2021; 77:570-577. [PMID: 33657050 DOI: 10.1097/fjc.0000000000001000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/29/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT This study aimed to evaluate the protective effect of quercetin and its in-depth mechanism in TNF-α-stimulated cardiomyocytes. The differential expression of TNF-alpha (TNF-α) and signal transducer and activator of transcription 1 (STAT1) was analyzed based on the GEO database. H9c2 cells were stimulated with TNF-α to simulate myocarditis. Cell counting kit-8 assay and flow cytometry assay were performed to detect the cell viability and apoptosis. ELISA was used to measure the levels of proinflammatory cytokines (IL-6 and IL-17A) and anti-inflammatory cytokine (IL-10). STAT1 expression was downregulated by transfection with si-STAT1, and its expression was detected using quantitative real-time polymerase chain reaction and Western blot. Western blot was also performed to assess the expression of the mitogen-activated protein kinase (MAPK) pathway-related factors. In this article, TNF-α was highly expressed in patients with myocarditis, and TNF-α (20 μg/mL) declined the viability of H9c2 cells. Quercetin pretreatment partially alleviated the decrease of cell viability, the increase of apoptosis, and the release of inflammatory cytokines (IL-10, IL-6, and IL-17A) induced by TNF-α. In addition, TNF-α increased STAT1 expression, but quercetin prevented the TNF-α-increased STAT1 level. Remarkably, knockdown of STAT1 enhanced the protective effect of quercetin on TNF-α-injured H9c2 cells. Moreover, quercetin restrained the TNF-α-induced activation of the MAPK pathway. Also, the inhibitory effect of quercetin on the pathway was aggravated by STAT1 lacking. In summing, quercetin plays a protective role in TNF-α-stimulated H9c2 cell injury, which may be related to the regulation of STAT1 and MAPK pathway.
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Hu Q, Chang CP, Rowe K, Snyder J, Deshmukh V, Newman M, Fraser A, Smith K, Gren LH, Porucznik C, Stanford JB, Gaffney D, Henry NL, Lopez I, Hashibe M. Disparities in Cardiovascular Disease Risk Among Hispanic Breast Cancer Survivors in a Population-Based Cohort. JNCI Cancer Spectr 2021; 5:pkab016. [PMID: 33889806 PMCID: PMC8052955 DOI: 10.1093/jncics/pkab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/18/2020] [Accepted: 01/20/2021] [Indexed: 12/22/2022] Open
Abstract
Background Breast cancer is the leading cause of cancer death among Hispanic women. The aim of our study was to estimate cardiovascular disease (CVD) risk among Hispanic and non-Hispanic White (NHW) breast cancer survivors compared with their respective general population cohorts. Methods Cohorts of 17 469 breast cancer survivors (1774 Hispanic and 15 695 NHW) in the Utah Cancer Registry diagnosed between 1997 and 2016, and 65 866 women (6209 Hispanic and 59 657 NHW) from the general population in the Utah Population Database were identified. Cox proportional hazards models were used to estimate hazard ratios (HRs) for CVD. Results The risk of diseases of the circulatory system was higher in Hispanic than NHW breast cancer survivors 1-5 years after cancer diagnosis, in comparison with their respective general population cohorts (HRHispanic = 1.94, 99% confidence interval [CI] = 1.49 to 2.53; HNHW = 1.38, 99% CI = 1.33 to 1.43; 2-sided Pheterogeneity = .01, respectively). Increased risks were observed for both Hispanic and NHW breast cancer survivors for diseases of the heart and the veins and lymphatics, compared with the general population cohorts. More than 5 years after cancer diagnosis, elevated risk of diseases of the veins and lymphatics persisted in both ethnicities. The CVD risk due to chemotherapy and hormone therapy was higher in Hispanic than NHW breast cancer survivors but did not differ for distant stage, higher baseline comorbidities, or baseline smoking. Conclusions We observed a risk difference for diseases of the circulatory system between Hispanic and NHW breast cancer survivors compared with their respective general population cohorts but only within the first 5 years of cancer diagnosis.
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Affiliation(s)
- Qingqing Hu
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Chun-Pin Chang
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Vikrant Deshmukh
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Michael Newman
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Ken Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Lisa H Gren
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Christina Porucznik
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joseph B Stanford
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - David Gaffney
- Huntsman Cancer Institute, Salt Lake City, UT, USA.,Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - N Lynn Henry
- Division of Hematology/Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Ivette Lopez
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mia Hashibe
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA.,Utah Cancer Registry, Salt Lake City, UT, USA
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87
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Golpour A, Patriki D, Hanson PJ, McManus B, Heidecker B. Epidemiological Impact of Myocarditis. J Clin Med 2021; 10:603. [PMID: 33562759 PMCID: PMC7915005 DOI: 10.3390/jcm10040603] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/24/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Myocarditis is an inflammatory disease of the heart muscle with a wide range of potential etiological factors and consequently varying clinical patterns across the world. In this review, we address the epidemiology of myocarditis. Myocarditis was considered a rare disease until intensified research efforts in recent decades revealed its true epidemiological importance. While it remains a challenge to determine the true prevalence of myocarditis, studies are underway to obtain better approximations of the proportions of this disease. Nowadays, the prevalence of myocarditis has been reported from 10.2 to 105.6 per 100,000 worldwide, and its annual occurrence is estimated at about 1.8 million cases. This wide range of reported cases reflects the uncertainty surrounding the true prevalence and a potential underdiagnosis of this disease. Since myocarditis continues to be a significant public health issue, particularly in young adults in whom myocarditis is among the most common causes of sudden cardiac death, improved diagnostic and therapeutic procedures are necessary. This manuscript aims to summarize the current knowledge on the epidemiology of myocarditis, new diagnostic approaches and the current epidemiological impact of the COVID-19 pandemic.
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Affiliation(s)
- Ainoosh Golpour
- Campus Benjamin Franklin, Charite Universitätsmedizin Berlin, 12203 Berlin, Germany;
| | - Dimitri Patriki
- Department of Medicine, Cantonal Hospital of Baden, 15005 Baden, Switzerland;
| | - Paul J. Hanson
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC V5K0A1, Canada; (P.J.H.); (B.M.)
| | - Bruce McManus
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC V5K0A1, Canada; (P.J.H.); (B.M.)
| | - Bettina Heidecker
- Campus Benjamin Franklin, Charite Universitätsmedizin Berlin, 12203 Berlin, Germany;
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88
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Sawalha K, Abozenah M, Kadado AJ, Battisha A, Al-Akchar M, Salerno C, Hernandez-Montfort J, Islam AM. Systematic Review of COVID-19 Related Myocarditis: Insights on Management and Outcome. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 23:107-113. [PMID: 32847728 PMCID: PMC7434380 DOI: 10.1016/j.carrev.2020.08.028] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also referred to as COVID-19, was declared a pandemic by the World Health Organization in March 2020. The manifestations of COVID-19 are widely variable and range from asymptomatic infection to multi-organ failure and death. Like other viral illnesses, acute myocarditis has been reported to be associated with COVID-19 infection. However, guidelines for the diagnosis of COVID-19 myocarditis have not been established. METHODS Using a combination of search terms in the PubMed/Medline, Ovid Medline and the Cochrane Library databases and manual searches on Google Scholar and the bibliographies of articles identified, we reviewed all cases reported in the English language citing myocarditis associated with COVID-19 infection. RESULTS Fourteen records comprising a total of fourteen cases that report myocarditis/myopericarditis secondary to COVID-19 infection were identified. There was a male predominance (58%), with the median age of the cases described being 50.4 years. The majority of patients did not have a previously identified comorbid condition (50%), but of those with a past medical history, hypertension was most prevalent (33%). Electrocardiogram findings were variable, and troponin was elevated in 91% of cases. Echocardiography was performed in 83% of cases reduced function was identified in 60%. Endotracheal intubation was performed in the majority of cases. Glucocorticoids were most commonly used in treatment of myocarditis (58%). Majority of patients survived to discharge (81%) and 85% of those that received steroids survived to discharge. CONCLUSION Guidelines for diagnosis and management of COVID-19 myocarditis have not been established and our knowledge on management is rapidly changing. The use of glucocorticoids and other agents including IL-6 inhibitors, IVIG and colchicine in COVID-19 myocarditis is debatable. In our review, there appears to be favorable outcomes related to myocarditis treated with steroid therapy. However, until larger scale studies are conducted, treatment approaches have to be made on an individualized case-by-case basis.
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Affiliation(s)
- Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States of America,Corresponding author at: University of Massachusetts Medical School-Baystate Medical Center, 759 chestnut, street, Springfield, MA 01199, United States of America
| | - Mohammed Abozenah
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States of America
| | - Anis John Kadado
- Department of Cardiology, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States of America
| | - Ayman Battisha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States of America
| | - Mohammad Al-Akchar
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States of America
| | - Colby Salerno
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States of America
| | - Jaime Hernandez-Montfort
- Heart and Vascular Institute, Cleveland Clinic Florida, Weston, FL 33331, United States of America
| | - Ashequl M. Islam
- Department of Cardiology, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States of America
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89
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Pietsch H, Escher F, Aleshcheva G, Lassner D, Bock CT, Schultheiss HP. Detection of parvovirus mRNAs as markers for viral activity in endomyocardial biopsy-based diagnosis of patients with unexplained heart failure. Sci Rep 2020; 10:22354. [PMID: 33339949 PMCID: PMC7749156 DOI: 10.1038/s41598-020-78597-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 11/22/2020] [Indexed: 12/16/2022] Open
Abstract
Erythroparvovirus (B19V) genomes have been detected in various organs of infected individuals including endothelial cells of the heart muscle. However, the role of B19V as a causative pathogen of myocardial damage is still unknown. The majority of reports focus on the presence of viral DNA ignoring proof of viral RNAs as important markers for viral activity. During this study, we established (RT-) qPCR to characterize expression of B19V RNAs (NS1 and VP1/2) in endomyocardial biopsies (EMBs) of 576 patients with unexplained heart failure. 403/576 (70%) EMBs were positive for B19V DNA. B19V mRNAs NS1 and/or VP1/2, indicating viral activity, could be detected in 38.5% of B19V DNA positive samples using the newly established B19V RT-PCRs. 22.1% of samples were characterized by only NS1 mRNA detection while 6.0% revealed only VP1/2 mRNA expression. Detection of both intermediates was successful in 10.4% of samples. Applying the molecular testing, our study revealed that a high proportion (38.5%) of B19V DNA positive EMBs was characterized by viral transcriptional activity. Further prospective studies will evaluate relevance of viral transcription intermediates as a diagnostic marker to differentiate between latent B19V infection and clinically relevant transcriptionally active B19V-infection of the heart muscle.
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Affiliation(s)
- Heiko Pietsch
- IKDT Institute of Cardiac Diagnostics and Therapy GmbH, Moltkestrasse 31, 12203, Berlin, Germany.,Department of Cardiology, Campus Rudolf Virchow, Charité-University Medicine Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Felicitas Escher
- IKDT Institute of Cardiac Diagnostics and Therapy GmbH, Moltkestrasse 31, 12203, Berlin, Germany.,Department of Cardiology, Campus Rudolf Virchow, Charité-University Medicine Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Ganna Aleshcheva
- IKDT Institute of Cardiac Diagnostics and Therapy GmbH, Moltkestrasse 31, 12203, Berlin, Germany
| | - Dirk Lassner
- IKDT Institute of Cardiac Diagnostics and Therapy GmbH, Moltkestrasse 31, 12203, Berlin, Germany
| | - Claus-Thomas Bock
- IKDT Institute of Cardiac Diagnostics and Therapy GmbH, Moltkestrasse 31, 12203, Berlin, Germany
| | - Heinz-Peter Schultheiss
- IKDT Institute of Cardiac Diagnostics and Therapy GmbH, Moltkestrasse 31, 12203, Berlin, Germany.
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90
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Agdamag ACC, Edmiston JB, Charpentier V, Chowdhury M, Fraser M, Maharaj VR, Francis GS, Alexy T. Update on COVID-19 Myocarditis. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E678. [PMID: 33317101 PMCID: PMC7764165 DOI: 10.3390/medicina56120678] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) gained worldwide attention at the end of 2019 when it was identified to cause severe respiratory distress syndrome. While it primarily affects the respiratory system, we now have evidence that it affects multiple organ systems in the human body. Cardiac manifestations may include myocarditis, life threatening arrhythmias, acute coronary syndrome, systolic heart failure, and cardiogenic shock. Myocarditis is increasingly recognized as a complication of Coronavirus-19 (COVID-19) and may result from direct viral injury or from exaggerated host immune response. The diagnosis is established similar to other etiologies, and is based on detailed history, clinical exam, laboratory findings and non-invasive imaging studies. When available, cardiac MRI is the preferred imaging modality. Endomyocardial biopsy may be performed if the diagnosis remains uncertain. Current management is mainly supportive with the potential addition of interventions recommended for severe COVID-19 disease, such as remdesivir, steroids, and convalescent plasma. In the setting of cardiogenic shock and refractory, life-threatening arrhythmias that persist despite medical therapy, advanced mechanical circulatory support devices should be considered. Ultimately, early recognition and aggressive intervention are key factors in reducing morbidity and mortality. Our management strategy is expected to evolve further as we learn more about COVID-19 disease and the associated cardiac complications.
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Affiliation(s)
- Arianne Clare C. Agdamag
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (A.C.C.A.); (M.F.); (V.R.M.); (G.S.F.)
| | - Jonathan B. Edmiston
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (J.B.E.); (V.C.)
| | - Victoria Charpentier
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (J.B.E.); (V.C.)
| | | | - Meg Fraser
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (A.C.C.A.); (M.F.); (V.R.M.); (G.S.F.)
| | - Valmiki R. Maharaj
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (A.C.C.A.); (M.F.); (V.R.M.); (G.S.F.)
| | - Gary S. Francis
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (A.C.C.A.); (M.F.); (V.R.M.); (G.S.F.)
| | - Tamas Alexy
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (A.C.C.A.); (M.F.); (V.R.M.); (G.S.F.)
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91
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Jia T, Wang C, Han Z, Wang X, Ding M, Wang Q. Experimental Rodent Models of Cardiovascular Diseases. Front Cardiovasc Med 2020; 7:588075. [PMID: 33365329 PMCID: PMC7750387 DOI: 10.3389/fcvm.2020.588075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/09/2020] [Indexed: 12/26/2022] Open
Abstract
Cardiovascular diseases, as the most common non-communicable disease in the world, cause a high mortality rate today and bring a serious medical burden to countries worldwide, especially in low- and middle-income countries. Experimental rodent models are widely used for cardiovascular diseases researches due to the effective simulation of human cardiovascular diseases, strong reproductive ability, and easy detection. Herein, we will summarize the pathological manifestations of common cardiovascular diseases and illustrate the establishment of corresponding experimental rodent models in detail.
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Affiliation(s)
- Tian Jia
- School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Chen Wang
- School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Zhengxi Han
- School of Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiaozhi Wang
- Department of Cardiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
| | - Ming Ding
- School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Quanyi Wang
- School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
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92
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Leláková V, Béraud-Dufour S, Hošek J, Šmejkal K, Prachyawarakorn V, Pailee P, Widmann C, Václavík J, Coppola T, Mazella J, Blondeau N, Heurteaux C. Therapeutic potential of prenylated stilbenoid macasiamenene F through its anti-inflammatory and cytoprotective effects on LPS-challenged monocytes and microglia. JOURNAL OF ETHNOPHARMACOLOGY 2020; 263:113147. [PMID: 32736058 DOI: 10.1016/j.jep.2020.113147] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Macaranga Thou. (Euphorbiaceae) is a large genus that comprises over 300 species distributed between Western Africa and the islands of the South Pacific. Plants of this genus have a long-standing history of use in traditional medicine for different purposes, including the treatment of inflammation. Fresh and dried leaves of certain Macaranga species (e.g. M. tanarius (L.) Müll.Arg.), have been used to treat cuts, bruises, boils, swellings, sores and covering of wounds in general. Several reports described Macaranga spp. being a rich source of polyphenols, such as prenylated stilbenoids and flavonoids, mostly responsible for its biological activity. Similarly, an abundant content of prenylated stilbenes was also described in M. siamensis S.J.Davies, species recently identified (2001) in Thailand. While the respective biological activity of the prenylated stilbenes from M. siamensis was poorly investigated to date, our recent study pointed out the interest as the natural source of several novel anti-inflammatory stilbenoids isolated from this species. AIM OF THE STUDY This work investigated the potential anti-inflammatory effects of the stilbenoid macasiamenene F (MF) isolated from M. siamensis S.J.Davies (Euphorbiaceae) on the lipopolysaccharide (LPS)-induced inflammation-like response of monocytes and microglia, major cells involved in the peripheral and central inflammatory response, respectively. MATERIALS AND METHODS LPS-induced stimulation of TLR4 signaling led to the activation of inflammatory pathways in in vitro models of THP-1 and THP-1-XBlue™-MD2-CD14 human monocytes, BV-2 mouse microglia, and an ex vivo model of brain-sorted mouse microglia. The ability of the stilbenoid MF to intervene in the IкB/NF-кB and MAPKs/AP-1 inflammatory cascade was investigated. The gene and protein expressions of the pro-inflammatory cytokines IL-1β and TNF-α were evaluated at the transcription and translation levels. The protective effect of MF against LPS-triggered microglial loss was assessed by cell counting and the LDH assay. RESULTS MF demonstrated beneficial effects, reducing both monocyte and microglial inflammation as assessed in vitro. It efficiently inhibited the degradation of IкBα, thereby reducing the NF-кB activity and TNF-α expression in human monocytes. Furthermore, the LPS-induced expression of IL-1β and TNF-α in microglia was dampened by pre-, co-, or post-treatment with MF. In addition to its anti-inflammatory effect, MF demonstrated a cytoprotective effect against the LPS-induced death of BV-2 microglia. CONCLUSION Our research into anti-inflammatory and protective effects of MF has shown that it is a promising candidate for further in vitro and in vivo investigations of MF interventions with respect to acute and chronic inflammation, including potentially beneficial effects on the inflammatory component of brain diseases such as stroke and Alzheimer's disease.
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Affiliation(s)
- Veronika Leláková
- Université Côte D'Azur, CNRS, IPMC, UMR7275, 660 Route des Lucioles, Sophia Antipolis, F-06560, Valbonne, France; Department of Molecular Pharmacy, Faculty of Pharmacy, Masaryk University, Palackého tř. 1946/1, CZ-612 00, Brno, Czech Republic.
| | - Sophie Béraud-Dufour
- Université Côte D'Azur, CNRS, IPMC, UMR7275, 660 Route des Lucioles, Sophia Antipolis, F-06560, Valbonne, France.
| | - Jan Hošek
- Department of Molecular Pharmacy, Faculty of Pharmacy, Masaryk University, Palackého tř. 1946/1, CZ-612 00, Brno, Czech Republic; Division of Biologically Active Complexes and Molecular Magnets, Regional Centre of Advanced Technologies and Materials, Faculty of Science, Palacký University in Olomouc, Šlechtitelů 27, CZ-783 71, Olomouc, Czech Republic.
| | - Karel Šmejkal
- Department of Natural Drugs, Faculty of Pharmacy, Masaryk University, Palackého tř. 1946/1, CZ-612 00, Brno, Czech Republic.
| | | | - Phanruethai Pailee
- Chulabhorn Research Institute, Kamphaeng Phet 6 Road, Laksi, TH-10210, Bangkok, Thailand.
| | - Catherine Widmann
- Université Côte D'Azur, CNRS, IPMC, UMR7275, 660 Route des Lucioles, Sophia Antipolis, F-06560, Valbonne, France.
| | - Jiří Václavík
- Department of Natural Drugs, Faculty of Pharmacy, Masaryk University, Palackého tř. 1946/1, CZ-612 00, Brno, Czech Republic.
| | - Thierry Coppola
- Université Côte D'Azur, CNRS, IPMC, UMR7275, 660 Route des Lucioles, Sophia Antipolis, F-06560, Valbonne, France.
| | - Jean Mazella
- Université Côte D'Azur, CNRS, IPMC, UMR7275, 660 Route des Lucioles, Sophia Antipolis, F-06560, Valbonne, France.
| | - Nicolas Blondeau
- Université Côte D'Azur, CNRS, IPMC, UMR7275, 660 Route des Lucioles, Sophia Antipolis, F-06560, Valbonne, France.
| | - Catherine Heurteaux
- Université Côte D'Azur, CNRS, IPMC, UMR7275, 660 Route des Lucioles, Sophia Antipolis, F-06560, Valbonne, France.
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93
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Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review. J Clin Med 2020; 9:jcm9123905. [PMID: 33271929 PMCID: PMC7761005 DOI: 10.3390/jcm9123905] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/02/2023] Open
Abstract
Treatment of giant cell myocarditis (GCM) can require bridging to orthotopic heart transplantation (OHT) or recovery with mechanical circulatory support (MCS). Since the roles of MCS and immunotherapy are not well-defined in GCM, we sought to analyze outcomes of patients with GCM who required MCS. A systematic search was performed in June 2019 to identify all studies of biopsy-proven GCM requiring MCS after 2009. We identified 27 studies with 43 patients. Patient-level data were extracted for analysis. Median patient age was 45 (interquartile range (IQR): 32-57) years. 42.1% (16/38) were female. 34.9% (15/43) presented in acute heart failure. 20.9% (9/43) presented in cardiogenic shock. Biventricular (BiVAD) MCS was required in 76.7% (33/43) of cases. Of the 62.8% (27/43) of patients who received immunotherapy, 81.5% (22/27) used steroids combined with at least one other immunosuppressant. Cyclosporine was the most common non-steroidal agent, used in 40.7% (11/27) of regimens. Immunosuppression was initiated before MCS in 59.3% (16/27) of cases, after MCS in 29.6% (8/27), and not specified in 11.1% (3/27). Immunosuppression started prior to MCS was associated with significantly better survival than MCS alone (p = 0.006); 60.5% (26/43) of patients received bridge-to-transplant MCS; 39.5% (17/43) received bridge-to-recovery MCS; 58.5% (24/41) underwent OHT a median of 104 (58-255) days from diagnosis. GCM recurrence after OHT was reported in 8.3% (2/24) of transplanted cases. BiVAD predominates in mechanically supported patients with GCM. Survival and bridge to recovery appear better in patients on immunosuppression, especially if initiated before MCS.
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94
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Baghel V, Kaushik P, Seth S, Patel C. Somatostatin analogue scintigraphy in myocardial inflammation: An interesting image. J Nucl Cardiol 2020; 27:2436-2437. [PMID: 31933155 DOI: 10.1007/s12350-019-02023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Vivek Baghel
- Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Kaushik
- Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Seth
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Patel
- Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
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95
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Acute Myocarditis Related to COVID-19: Comparison to SARS and MERS. SN COMPREHENSIVE CLINICAL MEDICINE 2020; 2:2684-2690. [PMID: 33235977 PMCID: PMC7677600 DOI: 10.1007/s42399-020-00563-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/02/2022]
Abstract
Myocardial involvement has been described during previous SARS and MERS outbreaks. Infection by SARS-CoV-2 (COVID-19) can range from asymptomatic to life-threatening multi-system disease. Heart involvement most commonly occurs during severe COVID-19 infection. Myocardial injury, based on elevated levels of myocardial enzymes, has been noted in up to 30% of patients with COVID-19 infection and could be a marker for worse prognosis. A few cases of possible myocarditis due to SARS-CoV-2 have been described, providing variable degree of evidence of direct myocardial involvement. We reviewed in detail those cases in comparison to relevant literature on SARS and MERS and attempted to draw initial conclusions in regard to clinical presentation, treatment and prognosis.
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96
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Fernando A, Guragai N, Vasudev R, Pullatt R, Randhawa P. A Rare Case of Myocarditis Mimicking ST-Elevation Myocardial Infarction. Cureus 2020; 12:e11671. [PMID: 33391909 PMCID: PMC7769724 DOI: 10.7759/cureus.11671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Myocarditis is caused by acute injury and inflammation of cardiac myocytes and is most commonly caused by a viral infection. Myocarditis remains a rare diagnosis and manifests with a wide spectrum of non-specific symptoms that include chest pain, dyspnea, and palpitations associated with electrocardiographic abnormalities that resemble that of ST-elevation myocardial infarction (STEMI). Therefore, clinical diagnosis is often challenging and is often misdiagnosed. We present a case of a 22-year-old male who presented with left-sided non-radiating chest pain associated with shortness of breath, elevated troponin of 3.2 ng/ml (<0.03 ng/ml). Electrocardiogram (ECG) and cardiac echocardiogram revealed ST-segment elevations in the anterolateral leads and an ejection fraction of 35%, respectively. The patient was initially suspected of having a STEMI; however, cardiac catheterization revealed non-obstructed coronary arteries. Due to elevated inflammatory markers, the patient was then started on colchicine for suspected myocarditis and had complete resolution of symptoms one week after. This case highlights that a high index of clinical suspicion and prompt diagnosis is necessary to prevent any delays in appropriate therapy for myocarditis.
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Affiliation(s)
- Ashen Fernando
- Cardiology, St. George's University School of Medicine, True Blue, GRD
| | - Nirmal Guragai
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
| | - Rahul Vasudev
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
| | - Raja Pullatt
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
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Ziegler JP, Batalis NI, Fulcher JW, Ward ME. Giant cell myocarditis causing sudden death in a patient with sarcoidosis. Autops Case Rep 2020; 10:e2020238. [PMID: 33344333 PMCID: PMC7703129 DOI: 10.4322/acr.2020.238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Giant cell myocarditis (GCM) is a rare and rapidly fatal cardiovascular condition most often seen in young adults. It is characterized microscopically by myocardial necrosis with multinucleated giant cells in the absence of well-defined granulomas. This disorder has typically been attributed to manifest as heart failure, but in some individuals, GCM may present as sudden cardiac death. Herein, we present a fatal case of GCM in a 36-year-old male with a history of autoimmune disorders. The decedent presented to the emergency room due to vomiting and was treated for nausea due to suspected dehydration. He was discharged that night and found dead on his bathroom floor the following day. Postmortem examination revealed psoriasis and granulomatous lesions in the lungs consistent with sarcoidosis, further supporting circumstantial evidence existing between GCM and autoimmune disorders. Additionally, this case provides an opportunity to distinguish GCM from the distinct clinical entity of cardiac sarcoidosis (CS), especially in the setting of systemic sarcoidosis. We hope to raise awareness of this rare disease process and its potential to cause sudden cardiac death so that it may be considered in a differential diagnosis as immunosuppression and early cardiac transplantation largely determine the prognosis.
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Affiliation(s)
- John P Ziegler
- Medical University of South Carolina, Charleston, SC, USA
| | - Nicholas I Batalis
- Medical University of South Carolina, Department of Pathology, Charleston, SC, USA
| | | | - Michael E Ward
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA.,Office of the Medical Examiner, Greenville County, SC, USA
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98
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Wang H, Zhao B, Yang H, Qian T, Han B, Jia H, An J, Zhao J, Wang X, Wang C. Identifying myocardial injuries in "normal-appearing" myocardium in pediatric patients with clinically suspected myocarditis using mapping techniques. PeerJ 2020; 8:e10252. [PMID: 33194425 PMCID: PMC7648451 DOI: 10.7717/peerj.10252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/06/2020] [Indexed: 11/20/2022] Open
Abstract
Background Mapping techniques using cardiac magnetic resonance imaging have significantly improved the diagnostic accuracy for myocarditis with focal myocardial injuries. The aim of our study was to determine whether T1 and T2 mapping techniques could identify diffuse myocardial injuries in "normal-appearing" myocardium in pediatric patients with clinically suspected myocarditis and to evaluate the associations between diffuse myocardial injuries and cardiac function parameters. Methods Forty-six subjects were included in this study: 20 acute myocarditis patients, 11 subacute/chronic myocarditis patients and 15 control children. T2 values, native T1 values and the extracellular volume (ECV) of "normal-appearing" myocardium were compared among the three groups of patients. Associations between diffuse myocardial injuries and cardiac function parameters were also evaluated. Results The ECV of "normal-appearing" myocardium was significantly higher in the subacute/chronic myocarditis group than in the control group (30.1 ± 0.9 vs 27.0 ± 0.6, P =0.004). No significant differences in T1 and T2 values between the acute myocarditis and control groups were found. In the subacute/chronic myocarditis group, a significant association between ECV and left ventricle ejection fraction was found (P=0.03). Conclusions Diffuse myocardial injuries are likely to occur in subacute/chronic myocarditis patients with prolonged inflammatory responses. Mapping techniques have great value for the diagnosis and monitoring of myocarditis.
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Affiliation(s)
- Haipeng Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
| | - Bin Zhao
- Shandong Medical Imaging Research Institute Affiliated to Shandong University, Ji'nan, China
| | - Huan Yang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
| | - Tianyi Qian
- Siemens Healthcare, MR Collaborations NE Asia, Beijing, China
| | - Bo Han
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
| | - Haipeng Jia
- Department of Radiology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Jing An
- Siemens SSMR, APPL, Beijing, China
| | - Junyu Zhao
- Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Ji'nan, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
| | - Cuiyan Wang
- Shandong Medical Imaging Research Institute Affiliated to Shandong University, Ji'nan, China
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DEMİR HA, BİLDİK F, KADİ G. Focal Myocarditis Mimicking Subendocardial Ischaemia: a Case Report. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2020. [DOI: 10.33706/jemcr.805411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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100
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Quagliariello V, Bonelli A, Caronna A, Conforti G, Iovine M, Carbone A, Berretta M, Botti G, Maurea N. SARS-CoV-2 Infection and Cardioncology: From Cardiometabolic Risk Factors to Outcomes in Cancer Patients. Cancers (Basel) 2020; 12:E3316. [PMID: 33182653 PMCID: PMC7697868 DOI: 10.3390/cancers12113316] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease-2019 (COVID-19) is a highly transmissible viral illness caused by SARS-CoV-2, which has been defined by the World Health Organization as a pandemic, considering its remarkable transmission speed worldwide. SARS-CoV-2 interacts with angiotensin-converting enzyme 2 and TMPRSS2, which is a serine protease both expressed in lungs, the gastro-intestinal tract, and cardiac myocytes. Patients with COVID-19 experienced adverse cardiac events (hypertension, venous thromboembolism, arrhythmia, myocardial injury, fulminant myocarditis), and patients with previous cardiovascular disease have a higher risk of death. Cancer patients are extremely vulnerable with a high risk of viral infection and more negative prognosis than healthy people, and the magnitude of effects depends on the type of cancer, recent chemotherapy, radiotherapy, or surgery and other concomitant comorbidities (diabetes, cardiovascular diseases, metabolic syndrome). Patients with active cancer or those treated with cardiotoxic therapies may have heart damages exacerbated by SARS-CoV-2 infection than non-cancer patients. We highlight the cardiovascular side effects of COVID-19 focusing on the main outcomes in cancer patients in updated perspective and retrospective studies. We focus on the main cardio-metabolic risk factors in non-cancer and cancer patients and provide recommendations aimed to reduce cardiovascular events, morbidity, and mortality.
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Affiliation(s)
- Vincenzo Quagliariello
- Division of Cardiology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (A.B.); (A.C.); (G.C.); (M.I.); (A.C.)
| | - Annamaria Bonelli
- Division of Cardiology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (A.B.); (A.C.); (G.C.); (M.I.); (A.C.)
| | - Antonietta Caronna
- Division of Cardiology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (A.B.); (A.C.); (G.C.); (M.I.); (A.C.)
| | - Gabriele Conforti
- Division of Cardiology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (A.B.); (A.C.); (G.C.); (M.I.); (A.C.)
| | - Martina Iovine
- Division of Cardiology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (A.B.); (A.C.); (G.C.); (M.I.); (A.C.)
| | - Andreina Carbone
- Division of Cardiology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (A.B.); (A.C.); (G.C.); (M.I.); (A.C.)
| | - Massimiliano Berretta
- Department of Medical Oncology-Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy;
| | - Gerardo Botti
- Scientific Direction, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy;
| | - Nicola Maurea
- Division of Cardiology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (A.B.); (A.C.); (G.C.); (M.I.); (A.C.)
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