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Liang YC, Chang CH, Lin MT, Kao FY, Huang SK, Wu MH. Shock and unresponsiveness to repeated courses of intravenous immunoglobulin in Kawasaki disease: a nationwide database study. Pediatr Res 2020; 87:961-966. [PMID: 31711068 DOI: 10.1038/s41390-019-0668-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/09/2019] [Accepted: 10/13/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND We aimed to investigate the clinical implications of unresponsiveness to single or repeated courses intravenous immunoglobulin (IVIG) and Kawasaki disease (KD) shock syndrome in patients with KD in an era of a single brand of IVIG. METHODS Data were collected from National Health Insurance database 2010-2013. Characteristics of the KD patients were analyzed, including age, gender, shock, and associated coronary aneurysms. RESULTS There were 3043 KD patients (male: 1872) identified. Among them, 46 (1.51%) had KDSS, 261 patients (8.5%) had IVIG unresponsiveness, and 225 patients (7.4%) developed coronary aneurysms. Moreover, 51 patients did not respond to the second course IVIG therapy, i.e., re-IVIG unresponsiveness. KDSS was associated with the occurrence of IVIG unresponsiveness (P < 10-4) and re-IVIG unresponsiveness (P = 0.02). In addition to male gender and KD shock syndrome, IVIG unresponsiveness (OR: 2.18, 95% CI: 1.48-3.22, P = 0.001) and re-IVIG unresponsiveness (OR: 2.87, 95% CI: 1.40-5.89, P = 0.004) were both independent risk factors for coronary aneurysms. CONCLUSIONS In a nationwide KD cohort, both IVIG unresponsiveness and re-IVIG unresponsiveness increase the risk of coronary aneurysms. Such observation addresses the importance of refining the treatment for IVIG unresponsiveness, at least in those with KD shock syndrome.
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Affiliation(s)
- Yun-Chieh Liang
- Clinical Trial Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
| | - Feng-Yu Kao
- Taiwan Bureau of National Health Insurance, Taipei, Taiwan
| | - San-Kuei Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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52
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The Role of Cardiovascular Magnetic Resonance in Inflammatory Arthropathies and Systemic Rheumatic Diseases. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-0346-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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53
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Simon R, Perel-Winkler A, Bokhari S, Fazlollahi L, Nickerson K. Myocarditis in Giant Cell Arteritis Diagnosed With Fluorine 18-Labeled Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography: Case Report and Review of the Literature. J Clin Rheumatol 2020; 26:e37-e40. [PMID: 32073529 DOI: 10.1097/rhu.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Rachel Simon
- Department of Medicine, Columbia University Medical, Center-New York Presbyterian Hospital, New York, NY Department of Rheumatology, Columbia University Medical, Center-New York Presbyterian Hospital, New York, NY Department of Cardiology, Columbia University Medical, Center-New York Presbyterian Hospital, New York, NY Department of Pathology, Columbia University Medical, Center-New York Presbyterian Hospital, New York, NY Department of Rheumatology, Columbia University Medical, Center-New York Presbyterian Hospital, New York, NY
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54
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Usefulness of Myocardial Strain and Twist for Early Detection of Myocardial Dysfunction in Patients With Autoimmune Diseases. Am J Cardiol 2020; 125:475-481. [PMID: 31784053 DOI: 10.1016/j.amjcard.2019.10.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/26/2019] [Accepted: 10/30/2019] [Indexed: 12/23/2022]
Abstract
Cardiac involvement in autoimmune diseases (AD) is common but underdiagnosed due to a lack of sensitive imaging methods. We aim to evaluate the characteristics of left ventricular (LV) systolic dysfunction in patients with AD using deformational parameters from 2-dimensional speckle-tracking echocardiography (STE). We retrospectively enrolled 86 AD patients and 71 healthy controls. All subjects underwent transthoracic echocardiography and STE to analyze LV strain and twist. A twist-radial displacement loop was constructed to investigate the relation between LV contractility and dimension. In AD patients, 68 had preserved LV ejection fraction (EF ≥ 50%), and 18 had reduced LVEF (EF < 50%). The patients with preserved LVEF exhibited significantly lower values of global longitudinal, circumferential, and radial strain than controls (-19.11 ± 4.18 vs -21.49 ± 2.53%, -25.17 ± 5.04% vs -27.37 ± 2.87%, 17.68 ± 5.69% vs 21.17 ± 6.44%, respectively; all p <0.01) and a marked attenuation in peak twist (14.24 ± 5.57 vs 18.10 ± 5.97, p <0.01) attributed to impaired apical rotation (9.03 ± 5.17 vs 12.79 ± 5.99, p <0.01). AD patients were more likely to present with abnormal loop types with flat ascending slope and delayed peak twist time. In conclusion, abnormal strain and twist precede deterioration in LVEF, suggesting early myocardial involvement in AD. STE can be used as a good alternative for early detection of myocardial dysfunction in AD patients.
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55
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Ikonomidis I, Makavos G, Katsimbri P, Boumpas DT, Parissis J, Iliodromitis E. Imaging Risk in Multisystem Inflammatory Diseases. JACC Cardiovasc Imaging 2019; 12:2517-2537. [DOI: 10.1016/j.jcmg.2018.06.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/29/2018] [Accepted: 06/28/2018] [Indexed: 11/17/2022]
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56
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Sanghera C, Wong LM, Panahi M, Sintou A, Hasham M, Sattler S. Cardiac phenotype in mouse models of systemic autoimmunity. Dis Model Mech 2019; 12:dmm036947. [PMID: 30858306 PMCID: PMC6451423 DOI: 10.1242/dmm.036947] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients suffering from systemic autoimmune diseases are at significant risk of cardiovascular complications. This can be due to systemically increased levels of inflammation leading to accelerated atherosclerosis, or due to direct damage to the tissues and cells of the heart. Cardiac complications include an increased risk of myocardial infarction, myocarditis and dilated cardiomyopathy, valve disease, endothelial dysfunction, excessive fibrosis, and bona fide autoimmune-mediated tissue damage by autoantibodies or auto-reactive cells. There is, however, still a considerable need to better understand how to diagnose and treat cardiac complications in autoimmune patients. A range of inducible and spontaneous mouse models of systemic autoimmune diseases is available for mechanistic and therapeutic studies. For this Review, we systematically collated information on the cardiac phenotype in the most common inducible, spontaneous and engineered mouse models of systemic lupus erythematosus, rheumatoid arthritis and systemic sclerosis. We also highlight selected lesser-known models of interest to provide researchers with a decision framework to choose the most suitable model for their study of heart involvement in systemic autoimmunity.
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Affiliation(s)
- Chandan Sanghera
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
| | - Lok Man Wong
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
| | - Mona Panahi
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
| | - Amalia Sintou
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
| | - Muneer Hasham
- The Jackson Laboratory, 600 Main Street, Bar Harbor, ME 04609, USA
| | - Susanne Sattler
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
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57
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Braun J, Krüger K, Manger B, Schneider M, Specker C, Trappe HJ. Cardiovascular Comorbidity in Inflammatory Rheumatological Conditions. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:197-203. [PMID: 28407841 DOI: 10.3238/arztebl.2017.0197] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 05/03/2016] [Accepted: 01/18/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Approximately 1.5 million adults in Germany suffer from an inflammatory rheumatological condition. The most common among these are rheumatoid arthritis and spondyloarthritis-above all axial spondyloarthritis, including ankylosing spondylitis (Bekhterev's disease) and psoriatic arthritis. These systemic inflammatory diseases often affect the heart as well. METHODS This review is based on pertinent articles retrieved by a selective literature search, on current European guidelines, and on the authors' clinical experience. RESULTS Rheumatic inflammation of cardiac structures can manifest itself as pericarditis, myocarditis, or endocarditis. The heart valves and the intracardiac conduction system can be affected as well, leading to AV block. Functional sequelae, e.g., congestive heart failure, can arise as a consequence of any inflammatory rheumatic disease. The long-term mortality of rheumatic diseases is elevated predominantly because of the increased risk for cardiovascular comorbidities. The cardiovascular risk profile should therefore be re-evaluated regularly (e.g., at 5-year intervals) in cooperation with the patient's primary care physician. The cardiovascular manifestations of rheumatic disease, such as pericarditis, myocarditis, and vasculitis, are treated initially with high-dose glucocorticoids and then over the long term with maintenance drugs such as methotrexate and azathioprine. Biological agents are sometimes used as well. CONCLUSION In patients with inflammatory rheumatic diseases, the elevated cardiovascular risk should be kept in mind and preventive measures should be initiated early. This subject should be further studied in controlled trials so that the treatment options for patients with cardiac involvement can be evaluated.
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Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne; Rheumazentrum München, Munich; Department of Medicine 3, Universitätsklinikum Erlangen; Department of Rheumatology, Hiller Research Center Rheumatology, University Hospital Düsseldorf; Department of Rheumatology and Clinical Immunology, St. Josef Krankenhaus, Essen University Hospital; Department of Cardiology, Marien-Hospital Herne, University Hospitals of the Ruhr University of Bochum
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58
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Patel AR, Kramer CM. Role of Cardiac Magnetic Resonance in the Diagnosis and Prognosis of Nonischemic Cardiomyopathy. JACC Cardiovasc Imaging 2018; 10:1180-1193. [PMID: 28982571 DOI: 10.1016/j.jcmg.2017.08.005] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/04/2017] [Accepted: 08/10/2017] [Indexed: 12/11/2022]
Abstract
Cardiac magnetic resonance (CMR) is a valuable tool for the evaluation of patients with, or at risk for, heart failure and has a growing impact on diagnosis, clinical management, and decision making. Through its ability to characterize the myocardium by using multiple different imaging parameters, it provides insight into the etiology of the underlying heart failure and its prognosis. CMR is widely accepted as the reference standard for quantifying chamber size and ejection fraction. Additionally, tissue characterization techniques such as late gadolinium enhancement (LGE) and other quantitative parameters such as T1 mapping, both native and with measurement of extracellular volume fraction; T2 mapping; and T2* mapping have been validated against histological findings in a wide range of clinical scenarios. In particular, the pattern of LGE in the myocardium can help determine the underlying etiology of the heart failure. The presence and extent of LGE determine prognosis in many of the nonischemic cardiomyopathies. The use of CMR should increase as its utility in characterization and assessment of prognosis in cardiomyopathies is increasingly recognized.
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Affiliation(s)
- Amit R Patel
- Department of Medicine and Radiology, University of Chicago, Chicago, Illinois
| | - Christopher M Kramer
- Departments of Medicine and Radiology and the Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia.
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59
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Broncano J, Vargas D, Bhalla S, Cummings KW, Raptis CA, Luna A. CT and MR Imaging of Cardiothoracic Vasculitis. Radiographics 2018; 38:997-1021. [PMID: 29883266 DOI: 10.1148/rg.2018170136] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The term vasculitis includes a variable group of entities in which the common characteristic is inflammation of the walls of blood vessels occurring at some time during the course of the disease. The vasculitides can be divided into primary and secondary vasculitides, depending on the etiology and according to the size of the vessel affected. Both primary vasculitis and secondary vasculitis are associated with cardiac morbidity that is often subclinical. Cardiac involvement is associated with prognostic implications and higher rates of related mortality. Vasculitis of cardiac structures and the assessment of disease extent are important for appropriate management and selection of treatment. Although echocardiography, radionuclide imaging, and catheter-directed coronary angiography remain the cornerstones of cardiac imaging, cardiac computed tomography and magnetic resonance imaging can offer a 360° assessment of cardiac anatomy, function, and complications secondary to vasculitis. Postoperative complications, which are more frequent in patients with active disease, can also be depicted with those imaging modalities. A multidisciplinary approach is important to yield an appropriate estimate of the disease activity and extent and, therefore, to enable better treatment selection and monitoring. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Jordi Broncano
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Daniel Vargas
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Kristopher W Cummings
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Constantine A Raptis
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Antonio Luna
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
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60
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Rastogi U, Sergie Z, Pinney S, Moss N. Recurrence of eosinophilic granulomatosis with polyangitis after orthotopic heart transplant. Am J Transplant 2018; 18:1544-1547. [PMID: 29392845 DOI: 10.1111/ajt.14679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 12/26/2017] [Accepted: 01/21/2018] [Indexed: 01/25/2023]
Abstract
Eosinophilic granulomatosis with polyangitis (EGPA), previously referred to as Churg-Strauss syndrome, is a necrotizing small vessel vasculitis associated with eosinophilic infiltrates and extravascular granulomas. We report a case of a Caucasian woman successfully bridged to heart transplantation with a continuous flow left ventricular assist device (LVAD) who survived recurrence of EGPA in the allograft.
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Affiliation(s)
- Ujjwal Rastogi
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ziad Sergie
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sean Pinney
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Noah Moss
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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61
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Tiosano S, Adler Y, Azrielant S, Yavne Y, Gendelman O, Ben-Ami Shor D, Comaneshter D, Shalom G, Cohen AD, Amital H. Pericarditis among giant cell arteritis patients: From myth to reality. Clin Cardiol 2018; 41:623-627. [PMID: 29746000 DOI: 10.1002/clc.22927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Giant cell arteritis (GCA) is an inflammatory disease of unknown etiology affecting adults age > 50 years. GCA (also known as temporal arteritis) is a vasculitis of large and medium-size vessels that involves the extracranial branches of the carotid artery. Common manifestations include constitutional symptoms, headache, jaw claudication, scalp tenderness, and vision loss. Cardiac involvement in GCA is considered to be as low as 5%, and < 30 cases of pericarditis among GCA patients have been reported in the literature. The aim of this study was to evaluate the association between GCA and pericarditis by conducting a cross-sectional study utilizing the database of the largest healthcare provider in Israel. HYPOTHESIS GCA is associated with pericarditis. METHODS The proportion of past documentation of pericarditis among patients diagnosed with GCA was compared with that of their age- and sex-matched controls. Univariate analysis was performed using the χ2 and t tests; multivariate analysis was performed using logistic regression. RESULTS The study included 4329 GCA patients and 21 611 controls. GCA patients had higher rates of cardiovascular risk factors. Pericarditis was observed in 53 GCA patients and 72 controls (1.22% vs 0.33%, respectively; P < 0.001), significantly higher among GCA patients in comparison with controls. A significant interaction was found between GCA, pericarditis, and young age (<70 years). CONCLUSIONS The study showed an independent association between GCA and pericarditis, especially among young patients. Proper screening should be applied whenever a suspicion arises as to the existence of comorbidity in patients with either disease.
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Affiliation(s)
- Shmuel Tiosano
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yehuda Adler
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Management, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Shir Azrielant
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yarden Yavne
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Gendelman
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dana Ben-Ami Shor
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Guy Shalom
- Department of Dermatology and Venereology, Soroka Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Howard Amital
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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62
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Towards the Clinical Management of Cardiac Involvement in Systemic Inflammatory Conditions—a Central Role for CMR. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9451-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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63
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Covey HL, Connolly DJ. Pericardial effusion associated with systemic inflammatory disease in seven dogs (January 2006 - January 2012). J Vet Cardiol 2018; 20:123-128. [PMID: 29478903 DOI: 10.1016/j.jvc.2017.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 12/27/2022]
Abstract
Pericardial effusion (PE) is reported in dogs as a consequence of neoplasia, primary cardiac disease or as an idiopathic condition. We describe seven dogs with systemic inflammatory disease, PE without tamponade and increased cardiac troponin I concentrations. Echocardiographic findings and adjunctive testing did not identify other known causes of PE. Resolution of the PE was documented in five of seven dogs in which follow-up echocardiography was performed, often after anti-inflammatory therapy. Resolution of PE was associated with normalisation of cardiac troponin I levels. Clinical signs had not recurred in six dogs with follow-up for more than 12 months and up to 7 years. These findings suggest an association between systemic inflammation and PE in dogs.
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Affiliation(s)
- Heather L Covey
- Clinical Science and Services, Royal Veterinary College, Hatfield, AL9 7TA, UK.
| | - David J Connolly
- Clinical Science and Services, Royal Veterinary College, Hatfield, AL9 7TA, UK
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64
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Atzeni F, Corda M, Gianturco L, Porcu M, Sarzi-Puttini P, Turiel M. Cardiovascular Imaging Techniques in Systemic Rheumatic Diseases. Front Med (Lausanne) 2018; 5:26. [PMID: 29497612 PMCID: PMC5819573 DOI: 10.3389/fmed.2018.00026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/25/2018] [Indexed: 01/20/2023] Open
Abstract
The risk of cardiovascular (CV) events and mortality is significantly higher in patients with systemic rheumatic diseases than in the general population. Although CV involvement in such patients is highly heterogeneous and may affect various structures of the heart, it can now be diagnosed earlier and promptly treated. Various types of assessments are employed for the evaluation of CV risk such as transthoracic or transesophageal echocardiography, magnetic resonance imaging (MRI), and computed tomography (CT) to investigate valve abnormalities, pericardial disease, and ventricular wall motion defects. The diameter of coronary arteries can be assessed using invasive quantitative coronarography or intravascular ultrasound, and coronary flow reserve can be assessed using non-invasive transesophageal or transthoracic ultrasonography (US), MRI, CT, or positron emission tomography (PET) after endothelium-dependent vasodilation. Finally, peripheral circulation can be measured invasively using strain-gauge plethysmography in an arm after the arterial infusion of an endothelium-dependent vasodilator or non-invasively by means of US or MRI measurements of flow-mediated vasodilation of the brachial artery. All of the above are reliable methods of investigating CV involvement, but more recently, introduced use of speckle tracking echocardiography and 3-dimensional US are diagnostically more accurate.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, University of Messina, Messina, Italy
| | - Marco Corda
- Cardiology Unit, Brotzu Hospital, Cagliari, Italy
| | - Luigi Gianturco
- Cardiology Unit, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | | | | | - Maurizio Turiel
- Cardiology Unit, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
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65
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Hasham MG, Baxan N, Stuckey DJ, Branca J, Perkins B, Dent O, Duffy T, Hameed TS, Stella SE, Bellahcene M, Schneider MD, Harding SE, Rosenthal N, Sattler S. Systemic autoimmunity induced by the TLR7/8 agonist Resiquimod causes myocarditis and dilated cardiomyopathy in a new mouse model of autoimmune heart disease. Dis Model Mech 2017; 10:259-270. [PMID: 28250051 PMCID: PMC5374321 DOI: 10.1242/dmm.027409] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/18/2017] [Indexed: 12/21/2022] Open
Abstract
Systemic autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) show significant heart involvement and cardiovascular morbidity, which can be due to systemically increased levels of inflammation or direct autoreactivity targeting cardiac tissue. Despite high clinical relevance, cardiac damage secondary to systemic autoimmunity lacks inducible rodent models. Here, we characterise immune-mediated cardiac tissue damage in a new model of SLE induced by topical application of the Toll-like receptor 7/8 (TLR7/8) agonist Resiquimod. We observe a cardiac phenotype reminiscent of autoimmune-mediated dilated cardiomyopathy, and identify auto-antibodies as major contributors to cardiac tissue damage. Resiquimod-induced heart disease is a highly relevant mouse model for mechanistic and therapeutic studies aiming to protect the heart during autoimmunity. Summary: A novel mouse model of autoimmune-mediated heart damage to study the underlying mechanisms and test therapeutic options for systemic autoimmunity.
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Affiliation(s)
- Muneer G Hasham
- The Jackson Laboratory, 600 Main Street, Bar Harbor, ME 04609, USA
| | - Nicoleta Baxan
- Biological Imaging Centre, Department of Medicine, Imperial College London, London W12 0NN, UK
| | - Daniel J Stuckey
- Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London WC1E 6DD, UK
| | - Jane Branca
- The Jackson Laboratory, 600 Main Street, Bar Harbor, ME 04609, USA
| | - Bryant Perkins
- The Jackson Laboratory, 600 Main Street, Bar Harbor, ME 04609, USA
| | - Oliver Dent
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK
| | - Ted Duffy
- The Jackson Laboratory, 600 Main Street, Bar Harbor, ME 04609, USA
| | - Tolani S Hameed
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK
| | - Sarah E Stella
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK
| | - Mohammed Bellahcene
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK
| | - Michael D Schneider
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK
| | - Sian E Harding
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK
| | - Nadia Rosenthal
- The Jackson Laboratory, 600 Main Street, Bar Harbor, ME 04609, USA.,National Heart and Lung Institute, Imperial College London, London W12 0NN, UK
| | - Susanne Sattler
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK
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66
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Angina in granulomatosis with polyangiitis: A case report. Exp Ther Med 2017; 14:3569-3572. [PMID: 29042949 PMCID: PMC5639335 DOI: 10.3892/etm.2017.4946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/07/2017] [Indexed: 11/05/2022] Open
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Hur JH, Chun EJ, Kwag HJ, Yoo JY, Kim HY, Kim JJ, Lee KW. CT Features of Vasculitides Based on the 2012 International Chapel Hill Consensus Conference Revised Classification. Korean J Radiol 2017; 18:786-798. [PMID: 28860896 PMCID: PMC5552462 DOI: 10.3348/kjr.2017.18.5.786] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/14/2017] [Indexed: 12/26/2022] Open
Abstract
Vasculitis, characterized by inflammation of vessel walls, is comprised of heterogeneous clinicopathological entities, and thus poses a diagnostic challenge. The most widely used approach for classifying vasculitides is based on the International Chapel Hill Consensus Conference (CHCC) nomenclature system. Based on the recently revised CHCC 2012, we propose computed tomography (CT) features of vasculitides and a differential diagnosis based on location and morphological characteristics. Finally, vasculitis mimics should be differentiated, because erroneous application of immunosuppressive drugs on vasculitis mimics may be ineffective, even deteriorating. This article presents the utility of CT in the diagnosis and differential diagnosis of vasculitides.
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Affiliation(s)
- Jee Hye Hur
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Hyon Joo Kwag
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Jin Young Yoo
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Hae Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Jeong Jae Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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68
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Granulomatosis with Polyangiitis with Myocarditis and Ventricular Tachycardia. Case Rep Med 2017; 2017:6501738. [PMID: 28912820 PMCID: PMC5585673 DOI: 10.1155/2017/6501738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/06/2017] [Indexed: 12/27/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA), previously known as Wegener's granulomatosis, is a pulmonary-renal syndrome affecting small and medium sized blood vessels. The disease has a prevalence in studies ranging from 3 to 15.7 cases per 100,000, with a noted increasing incidence and prevalence in more recent studies. Pulmonary manifestations include hemorrhage, lung cavitary lesions, and pulmonary fibrosis. Within the kidney, GPA is known to cause rapidly progressive pauci-immune crescentic glomerulonephritis. Rare and severe cardiovascular manifestations include pericarditis, arrhythmias, myocarditis, and aortic valve disease. Our patient is a 43-year-old female with typical pulmonary and renal lesions from GPA and also acute myocarditis, multiple episodes of ventricular tachycardia, and a severe reactive thrombocytosis.
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69
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Pugnet G, Gouya H, Puéchal X, Terrier B, Kahan A, Legmann P, Guillevin L, Vignaux O. Cardiac involvement in granulomatosis with polyangiitis: a magnetic resonance imaging study of 31 consecutive patients. Rheumatology (Oxford) 2017; 56:947-956. [PMID: 28339663 DOI: 10.1093/rheumatology/kew490] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives Specific cardiac involvement in granulomatosis with polyangiitis (GPA) is probably underestimated since many of these conditions are subclinical. The objective of this study was to assess the prevalence and patterns of cardiac abnormalities detected by cardiac MRI (CMRI) in patients with GPA. Methods Thirty-one consecutive patients with newly diagnosed or relapsing GPA underwent CMRI to assess morphological, functional, perfusion at rest and delayed enhancement abnormalities. Results At least one abnormality was observed on CMRI for 19 of 31 patients (61%). Four patients (13%) had an impaired left ventricle ejection fraction (LVEF). LV regional wall motion abnormalities were found in 11 patients (35%). Late gadolinium enhancement (LGE) was detected in 10 of 31 patients (32%). LGE was mostly nodular ( n = 9). Myocardial early contrast enhancement was detected in 5 of the 31 patients (16%), which was systematically associated with LGE in the same territory. CMRI detected pericarditis in eight patients (26%). GPA with <18 months duration was associated with a higher LVEF ( P = 0.03), fewer CMRI abnormalities ( P = 0.04) and less LV hypokinesia ( P = 0.04) than GPA with a longer duration. Patients with recent-onset GPA had a higher LVEF ( P = 0.01) and less LV hypokinesia ( P = 0.006) than patients experiencing a relapse ( P = 0.02). Conclusion CMR is an accurate technique for detecting heart involvement in GPA. This unique non-invasive technique may provide information with important clinical implications for the accurate early assessment of cardiac lesions in GPA patients and for detecting cumulative, irreversible damage. It may also have prognostic implications.
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Affiliation(s)
- Grégory Pugnet
- Service de Médecine Interne, Centre National de Référence Vascularites Nécrosantes et Sclérodermie Systémique, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris.,Service de Médecine Interne, Hôpital Purpan, Toulouse
| | | | - Xavier Puéchal
- Service de Médecine Interne, Centre National de Référence Vascularites Nécrosantes et Sclérodermie Systémique, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Benjamin Terrier
- Service de Médecine Interne, Centre National de Référence Vascularites Nécrosantes et Sclérodermie Systémique, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - André Kahan
- Service de Rhumatologie A, Hôpital Cochin, AP-HP, Paris, France
| | | | - Loïc Guillevin
- Service de Médecine Interne, Centre National de Référence Vascularites Nécrosantes et Sclérodermie Systémique, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
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70
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Deteriorated Systolic Blood Pressure Recovery and Heart Rate Recovery After Graded Exercise in Children With Familial Mediterranean Fever. Arch Rheumatol 2017; 32:244-249. [PMID: 30375532 DOI: 10.5606/archrheumatol.2017.6071] [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: 05/16/2016] [Accepted: 10/28/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate if cardiac involvement may occur in children with familial Mediterranean fever (FMF) without cardiovascular symptoms by using heart rate recovery (HRR) and systolic blood pressure recovery (SBPR) parameters. Patients and methods A total of 50 FMF patients (26 males, 24 females; mean age 151±33.4 month; range 60 to 216 month) and 30 healthy controls (18 males, 12 females; mean age 143±43.9 month; range 84 to 228 month) were included in the study. All patients were evaluated by echocardiography. All patients underwent a maximal graded exercise stress test. HRR and SBPR parameters were calculated. Results There was a significant decrease in HRR1 value in FMF group (p=0.03). SBPR1 and SPBR2 values were higher in FMF group compared to control group (0.96±0.12 vs 0.88±0.12 and 0.95±0.09 vs 0.91±0.11, respectively); and the high SBPR1 value was statistically significant (p=0.02). FMF presence had a negative correlation with HRR1 (r= -0.26, p=0.03) and a positive correlation with SBPR1 (r=0.29, p=0.02). There was a negative correlation of M694V homozygous mutation with HRR1 and HRR2 values (r= -0.43, p=0.004, r=-0.42, p=0.005). Conclusion Cardiac involvement may occur in FMF patients without cardiovascular symptoms. Impaired SBPR and decreased HRR response may indicate increased cardiovascular risk in these patients despite normal exercise stress test results.
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71
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Saeed M, Liu H, Liang CH, Wilson MW. Magnetic resonance imaging for characterizing myocardial diseases. Int J Cardiovasc Imaging 2017; 33:1395-1414. [PMID: 28364177 DOI: 10.1007/s10554-017-1127-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/23/2017] [Indexed: 12/21/2022]
Abstract
The National Institute of Health defined cardiomyopathy as diseases of the heart muscle. These myocardial diseases have different etiology, structure and treatment. This review highlights the key imaging features of different myocardial diseases. It provides information on myocardial structure/orientation, perfusion, function and viability in diseases related to cardiomyopathy. The standard cardiac magnetic resonance imaging (MRI) sequences can reveal insight on left ventricular (LV) mass, volumes and regional contractile function in all types of cardiomyopathy diseases. Contrast enhanced MRI sequences allow visualization of different infarct patterns and sizes. Enhancement of myocardial inflammation and infarct (location, transmurality and pattern) on contrast enhanced MRI have been used to highlight the key differences in myocardial diseases, predict recovery of function and healing. The common feature in many forms of cardiomyopathy is the presence of diffuse-fibrosis. Currently, imaging sequences generating the most interest in cardiomyopathy include myocardial strain analysis, tissue mapping (T1, T2, T2*) and extracellular volume (ECV) estimation techniques. MRI sequences have the potential to decode the etiology by showing various patterns of infarct and diffuse fibrosis in myocarditis, amyloidosis, sarcoidosis, hypertrophic cardiomyopathy due to aortic stenosis, restrictive cardiomyopathy, arrythmogenic right ventricular dysplasia and hypertension. Integrated PET/MRI system may add in the future more information for the diagnosis and progression of cardiomyopathy diseases. With the promise of high spatial/temporal resolution and 3D coverage, MRI will be an indispensible tool in diagnosis and monitoring the benefits of new therapies designed to treat myocardial diseases.
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Affiliation(s)
- Maythem Saeed
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry Street, Suite 350, Campus Box 0946, San Francisco, CA, 94107-5705, USA.
| | - Hui Liu
- Department of Radiology, Guangdong General Hospital, Guangzhou, China
| | - Chang-Hong Liang
- Department of Radiology, Guangdong General Hospital, Guangzhou, China
| | - Mark W Wilson
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry Street, Suite 350, Campus Box 0946, San Francisco, CA, 94107-5705, USA
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72
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Francis W, Aziz Eid Al Kuwari MA, Ghareep AN, Peyrou J, Szmigielski W. A Rare Right Ventricular Involvement of Eosinophilic Granulomatosis Demonstrated by Cardiac MRI. Pol J Radiol 2017; 81:598-601. [PMID: 28058073 PMCID: PMC5181521 DOI: 10.12659/pjr.898964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 05/10/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis with a prevalence rate of seven per million. Cardiac involvement was reported in 20-50%, yet with improved diagnostic methods, the frequency of cardiac involvement is expected to be even higher. It can result in significant morbidity and mortality, accounting for about 50% of death. Cardiac magnetic resonance (CMR) imaging is used to evaluate the myocardium, valves, coronary arteries, pericardium, also to assess cardiac structure and function. Perfusion study allows tissue characterisation with a suggestive pattern of late gadolinium enhancement. CASE REPORT We report a rare case of EGPA in a 54-year-old male patient who presented with fever, sore throat and dizziness. Echocardiography showed a filling defect at the apex of the right ventricle (RV). CMR findings suggested the diagnosis of EGPA by demonstrating an impressive lesion at RV apex with the typical 3-layer appearance and thrombus formation. Post-gadolinium subendocardial hyperenhancement suggested focal involvement at the inferolateral wall of the left ventricle. Computed Tomography (CT) was done to rule out calcific or soft plaques of the coronary arteries, small vessel vasculitis and small aneurysm. CT scan showed a low-attenuation lesion at the inner wall of the right ventricle. In the lungs, bilateral interstitial changes and bilateral cystic bronchiectases were found. Under appropriate treatment, the patient improved clinically. CONCLUSIONS It is of crucial importance to perform full cardiac imaging that includes CMR even in asymptomatic patients with suspected EGPA, since early identification of cardiac involvement may allow to apply appropriate therapy and full recovery of the patient.
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Affiliation(s)
- Willington Francis
- Department of Clinical Imaging, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Abdel-Naser Ghareep
- Department of Clinical Imaging, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Jérôme Peyrou
- Department of Cardiac Imaging, Bordeaux University Hospital, Haut-Lévêque Heart Hospital, Pessac, France
| | - Wojciech Szmigielski
- Department of Clinical Imaging, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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Greulich S, Mayr A, Kitterer D, Latus J, Henes J, Steubing H, Kaesemann P, Patrascu A, Greiser A, Groeninger S, Braun N, Alscher MD, Sechtem U, Mahrholdt H. T1 and T2 mapping for evaluation of myocardial involvement in patients with ANCA-associated vasculitides. J Cardiovasc Magn Reson 2017; 19:6. [PMID: 28077133 PMCID: PMC5225624 DOI: 10.1186/s12968-016-0315-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/09/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Myocardial involvement in AAV patients might be silent, presenting with no or nonspecific symptoms, normal ECG, and preserved left-ventricular ejection fraction (LV-EF). Since up to 50% of deaths in these patients may be due to myocardial involvement, a reliable diagnostic tool is warranted. In contrast to LGE-CMR, which has its strengths in detecting focal inflammatory or fibrotic processes, recent mapping techniques are able to detect even subtle, diffuse inflammatory or fibrotic processes. Our study sought to investigate ANCA (antineutrophil cytoplasmic antibody) associated vasculitides (AAV) patients for myocardial involvement by a cardiovascular magnetic resonance (CMR) protocol, including late gadolinium enhancement (LGE) and mapping sequences. METHODS Thirty seven AAV patients were prospectively enrolled and underwent CMR imaging. Twenty healthy volunteers served as controls. RESULTS Mean LV-EF was 64%; LGE prevalence of the AAV patients was 43%. AAV patients had higher median native T1 (988 vs. 952 ms, p < 0.001), lower post-contrast T1 (488 vs. 524 ms, p = 0.03), expanded extracellular volume (ECV) (27.5 vs. 24.5%, p < 0.001), and higher T2 (53 vs. 49 ms, p < 0.001) compared to controls, with most parameters independent of the LGE status. Native T1 and T2 in AAV patients showed the highest prevalence of abnormally increased values beyond the 95% percentile of controls. CONCLUSION AAV patients demonstrated increased T1, ECV, and T2 values, with native T1 and T2 showing the highest prevalence of values beyond the 95% percentile of normal. Since these findings seem to be independent of LGE, mapping techniques may provide complementary information to LGE-CMR in the assessment of myocardial involvement in patients with AAV.
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Affiliation(s)
- Simon Greulich
- Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Agnes Mayr
- Division of Radiology, University Hospital Innsbruck, Innsbruck, Austria
| | - Daniel Kitterer
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany
| | - Joerg Latus
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany
| | - Joerg Henes
- Center for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases, University Hospital Tuebingen, Tuebingen, Germany
| | - Hannah Steubing
- Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Philipp Kaesemann
- Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Alexandru Patrascu
- Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | | | | | - Niko Braun
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany
| | - M. Dominik Alscher
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany
| | - Udo Sechtem
- Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
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Greulich S, Kitterer D, Kurmann R, Henes J, Latus J, Gloekler S, Wahl A, Buss SJ, Katus HA, Bobbo M, Lombardi M, Backes M, Steubing H, Schepat P, Braun N, Alscher MD, Sechtem U, Mahrholdt H. Cardiac involvement in patients with rheumatic disorders: Data of the RHEU-M(A)R study. Int J Cardiol 2016; 224:37-49. [DOI: 10.1016/j.ijcard.2016.08.298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/19/2016] [Indexed: 01/08/2023]
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75
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Approach to giant cell arteritis and recent evidence on its relation with cardiovascular risk. A review. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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76
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Hinojar R, Foote L, Sangle S, Marber M, Mayr M, Carr-White G, D'Cruz D, Nagel E, Puntmann VO. Native T1 and T2 mapping by CMR in lupus myocarditis: Disease recognition and response to treatment. Int J Cardiol 2016; 222:717-726. [DOI: 10.1016/j.ijcard.2016.07.182] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/28/2016] [Indexed: 11/16/2022]
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77
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Andersen JK, Oma I, Prayson RA, Kvelstad IL, Almdahl SM, Fagerland MW, Hollan I. Inflammatory cell infiltrates in the heart of patients with coronary artery disease with and without inflammatory rheumatic disease: a biopsy study. Arthritis Res Ther 2016; 18:232. [PMID: 27729056 PMCID: PMC5059899 DOI: 10.1186/s13075-016-1136-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background The cause of premature cardiovascular disease (CVD) in inflammatory rheumatic diseases (IRDs) has not been fully elucidated. As inflammation may play a role, we wanted to compare the occurrence and extent of inflammatory cell infiltrates (ICIs), small vessel vasculitis, and the amount of adipose tissue and collagen in cardiac biopsies taken from patients with coronary artery disease with and without IRDs. Methods From among the Feiring Heart Biopsy Study subjects, we selected patients undergoing coronary artery bypass grafting from whom paraffin-embedded, formalin-fixed specimens from the right atrium were available. The sample comprised 48 patients with IRD and 40 non-IRD patients. Hematoxylin and eosin staining was used to examine the presence and location of ICIs and vasculitis, and Lendrum (Martius yellow, scarlet, and blue) staining was carried out for collagen and adipose tissue. Results Epicardial ICIs were found in 27 (56 %) patients with IRD and 24 (60 %) non-IRD patients. There were no significant differences between patients with IRD and non-IRD patients in the amount of cardiac ICIs and adipose tissue, but patients with IRD had more collagen in the myocardium than non-IRD patients. Small vessel vasculitis was not observed in any cardiac specimen. Patients with epicardial ICIs were, on average, 7 years younger than those without. Conclusions Our results do not support the notion that inflammation in cardiac peri-, epi-, and myocardium plays a more important role in CVD of patients with IRD than non-IRD patients. The increased amount of collagen in the myocardium of patients with IRD suggests differences in extracellular matrix composition and/or mass, which might play a role in cardiac remodeling, and represent targets for novel therapies against heart failure.
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Affiliation(s)
- Jacqueline K Andersen
- Department of Health, Technology and Society, Norwegian University of Science and Technology (NTNU), Teknologiveien 22, 2815, Gjøvik, Norway.
| | - Ingvild Oma
- Department of Pathology, Innlandet Hospital Trust, Lillehammer, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Richard A Prayson
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Sven Martin Almdahl
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Ivana Hollan
- Hospital for Rheumatic Diseases, Lillehammer, Norway.,Department of Research, Innlandet Hospital Trust, Brumunddal, Norway.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Gerster M, Peker E, Nagel E, Puntmann VO. Deciphering cardiac involvement in systemic inflammatory diseases: noninvasive tissue characterisation using cardiac magnetic resonance is key to improved patients’ care. Expert Rev Cardiovasc Ther 2016; 14:1283-1295. [DOI: 10.1080/14779072.2016.1226130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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79
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The Assessment of Tp-e Interval and Tp-e/QT Ratio in Patients With Systemic Sclerosis. Arch Rheumatol 2016; 31:139-144. [PMID: 29900933 DOI: 10.5606/archrheumatol.2016.5753] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/26/2015] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate ventricular repolarization using T-peak to T-end (Tp-e) intervals and Tp-e/QT ratios in patients with systemic sclerosis (SSc). Patients and methods Totally 65 patients (8 males, 57 females; mean age 49.8 years; range 20 to 77 years) with SSc and 63 control subjects (8 males, 55 females; mean age 49.3 years; range 20 to 77 years) were enrolled. Tp-e intervals, Tp-e/QT, and Tp-e/corrected QT (QTc) ratios were measured from the 12-lead electrocardiogram. Results Tp-e intervals, QT intervals, QTc intervals, Tp-e/QT, and Tp-e/QTc ratios were significantly higher in patients with SSc than control subjects (all p<0.01). There was no difference between patients with diffuse and limited cutaneous SSc in terms of electrocardiogram and echocardiographic findings. Correlation analysis revealed no correlation between Tp-e intervals, Tp-e/QT, and Tp-e/QTc ratios with disease duration and anti-Sjögren's syndrome antigen A antibody levels in patients with SSc (all p>0.05). Conclusion Our study showed that Tp-e intervals, Tp-e/QT, and Tp-e/QTc ratios were increased in patients with SSc than control subjects. The increased frequency of ventricular arrhythmias can be clarified by increased indexes of ventricular repolarization parameters in patients with SSc.
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80
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The Pericardium and Its Diseases. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00015-x] [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: 11/19/2022] Open
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81
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Hazebroek M, Kemna M, Schalla S, Sanders-van Wijk S, Gerretsen S, Dennert R, Merken J, Kuznetsova T, Staessen J, Brunner-La Rocca H, van Paassen P, Cohen Tervaert J, Heymans S. Prevalence and prognostic relevance of cardiac involvement in ANCA-associated vasculitis: Eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis. Int J Cardiol 2015. [DOI: 10.1016/j.ijcard.2015.06.087] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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82
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Comparison of Echocardiographic Variables Between Systemic Lupus Erythematosus Patients and a Control Group. ACTA ACUST UNITED AC 2015. [DOI: 10.5812/acvi.30009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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83
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Teixeira PC, Ferber P, Vuilleumier N, Cutler P. Biomarkers for cardiovascular risk assessment in autoimmune diseases. Proteomics Clin Appl 2015; 9:48-57. [DOI: 10.1002/prca.201400125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/30/2014] [Accepted: 12/15/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Priscila Camillo Teixeira
- Pharma Research and Early Development; Roche Innovation Center Basel; Basel; Switzerland
- Division of Laboratory Medicine; Department of Genetics and Laboratory Medicine; Geneva University Hospitals; Geneva; Switzerland
| | - Philippe Ferber
- Pharma Research and Early Development; Roche Innovation Center Basel; Basel; Switzerland
| | - Nicolas Vuilleumier
- Division of Laboratory Medicine; Department of Genetics and Laboratory Medicine; Geneva University Hospitals; Geneva; Switzerland
| | - Paul Cutler
- Pharma Research and Early Development; Roche Innovation Center Basel; Basel; Switzerland
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84
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Martínez Zapico A, Caminal Montero L, Costas Sueiras C, Álvarez Pichel I. Myocarditis and Adult onset Still disease. Rev Clin Esp 2015; 215:244-5. [PMID: 25640255 DOI: 10.1016/j.rce.2014.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/21/2014] [Indexed: 11/15/2022]
Affiliation(s)
- A Martínez Zapico
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - L Caminal Montero
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - C Costas Sueiras
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - I Álvarez Pichel
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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85
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Abstract
Churg-Strauss angiitis is a rare vasculitic disorder affecting small- and medium-sized blood vessels. It is clinically characterized by the presence of a wide spectrum of multisystem organ involvement, with allergic rhinitis, asthma and peripheral blood eosinophilia as the most typical manifestations. The authors describe 2 cases of Churg-Strauss angiitis from an urban community of Southern Louisiana, exhibiting an atypical presentation with myocardial ischemia and cerebrovascular complications. Epidemiology, pathophysiology and clinical overview are presented. The therapeutic management is also discussed.
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86
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Akyuz S, Zengin A, Arugaslan E, Yazici S, Onuk T, Ceylan US, Gungor B, Gurkan U, Kemaloglu Oz T, Kasikcioglu H, Cam N. Echo-guided pericardiocentesis in patients with clinically significant pericardial effusion. Outcomes over a 10-year period. Herz 2014; 40 Suppl 2:153-9. [PMID: 25491665 DOI: 10.1007/s00059-014-4187-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/06/2014] [Accepted: 11/07/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND The purpose of the present study is to evaluate current echocardiographically (echo)-guided pericardiocentesis practice with regard to procedural success, complication rate, etiological causes, and outcomes of patients with clinically significant pericardial effusion. PATIENTS AND METHODS Patients who underwent echo-guided pericardiocentesis between January 2004 and February 2014 were identified using an institutional code for the procedure. Other complementary data were obtained by interviewing patients or their relatives (directly or by telephone) and by searching the social security death index. RESULTS A total of 301 patients were identified. The pericardium was approached via the subcostal (85 %) or apical (15 %) route under echo guidance in all procedures. The success rate was 97 %, with an intervention-requiring complication rate of 1.3 %. No patient died from complications. The most common etiology was malignancy (n = 84, 28 %). Patients were followed-up for a median of 35 months. Median survival for patients with malignant effusion was 5.9 months compared with 54 months for those with nonmalignant effusion. CONCLUSIONS Echo-guided pericardiocentesis has a high success and low complication rate in current practice. Among etiologies, malignancy remains the most common cause of clinically significant pericardial effusion and is associated with a poor prognosis.
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Affiliation(s)
- S Akyuz
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tibbiye cad. No:13, Istanbul, Turkey,
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87
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Cincin A, Sunbul M, Kivrak T, Atas H, Sari I, Tigen K, Kani T, Akin H, Imeryuz N, Basaran Y. Evaluation of cardiac function by two-dimensional speckle tracking echocardiography in ulcerative colitis patients. Dig Dis Sci 2014; 59:3004-11. [PMID: 25023227 DOI: 10.1007/s10620-014-3274-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 06/27/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE Although ulcerative colitis (UC) shows obvious similarities with other autoimmune diseases, cardiac consequences have not adequately introduced. The aim of our study was to evaluate left ventricular (LV) function in UC patients by using novel echocardiographic parameters. RESULTS Forty-five UC patients (mean age 37, 18 female) and 90 age- and sex-matched healthy volunteers (mean age 40, 38 female) included in the study. The mean disease activity score according to partial Mayo score was 2.16 ± 2.13. Mean global longitudinal strain (GLS) and global longitudinal strain rate (GLSR) measurements were significantly lower (-21.16 ± 2.71 vs. -23.36 ± 3.34; p < 0.001 and -1.33 ± 0.24 vs. -1.43 ± 0.24; p = 0.037, respectively), whereas global circumferential (-22.67 ± 3.66 vs. -23.37 ± 3.99; p = 0.140) and global radial strain (43.07 ± 8.58 vs. 44.12 ± 9.32; p = 0.545) measurements of the LV were similar in patients with UC compared with controls. The correlation coefficient (r) between GLS and partial Mayo score was -0.578 (p < 0.001). CONCLUSION Our study suggests that systolic cardiac deformation values are impaired in UC patients. Reduced GLS and GLSR might be an early indicator of cardiac involvement in this population.
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Affiliation(s)
- Altug Cincin
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey,
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88
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Biomarkers in cardiology--part 1--in heart failure and specific cardiomyopathies. Arq Bras Cardiol 2014; 103:451-9. [PMID: 25590924 PMCID: PMC4290735 DOI: 10.5935/abc.20140184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/30/2014] [Indexed: 02/02/2023] Open
Abstract
Cardiovascular diseases are the leading causes of mortality and morbidity in Brazil.
The primary and secondary preventions of those diseases are a priority for the health
system and require multiple approaches to increase their effectiveness. Biomarkers
are tools used to more accurately identify high-risk individuals, to speed the
diagnosis, and to aid in treatment and prognosis determination. This review aims to
highlight the importance of biomarkers in clinical cardiology practice, and to raise
relevant points of their use and the promises for the coming years. This document was
divided into two parts, and this first one discusses the use of biomarkers in
specific cardiomyopathies and heart failure.
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89
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Kaya H, Süner A, Köroğlu S, Akçay A, Türkbeyler İH, Köleoğlu M. Heart rate variability in familial Mediterranean fever patients. Eur J Rheumatol 2014; 1:58-61. [PMID: 27708876 DOI: 10.5152/eurjrheumatol.2014.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 03/27/2014] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Familial Mediterranean fever (FMF) is an autosomal recessive autoimmune disease, presenting with the attacks of fever and inflammation of serous membranes. One of the leading causes of death in autoimmune rheumatologic diseases is cardiovascular events. The purpose of this study is to evaluate the effects of FMF on the autonomic nerve and cardiovascular systems by measuring the indices of heart rate variability (HRV). MATERIAL AND METHODS Thirty FMF patients and the same number of healthy volunteers were enrolled to the study. Standard deviation of all R-R intervals (SDNN), the square root of the sum of the square of the differences between successive R-R intervals (RMSSD), standard deviation of 5-minute mean values of R-R interval (SDANN), low frequency (LF), and high frequency (HF) were measured. RESULTS Time domain indices (SDNN, SDANN, and RMSSD) were: 124.67±40.79, 129.87±36.43 (p=0.605); 11.43±38.41, 11.23±38.98 (p=0.984); and 33.43±17.39, 38.17±12.8 (p=0.235) for FMF patients and controls, respectively, and similar in both groups. Frequency domain indices (HF, LF, and LF/HF) were: 290.41±290.25, 322.20±222.54 (p=0.639); 596.16±334.07, 805.80±471.00 (p=0.051); and 3.57±2.57, 3.05±1.40 (p=0.338) for FMF patients and controls, respectively, and similar in both groups. CONCLUSION The HRV parameters were similar in both groups. However, studies including larger populations and using different methods are required to clarify if autonomic dysfunction exists in patients with FMF.
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Affiliation(s)
- Hakan Kaya
- Department of Cardiology, Adıyaman University Faculty of Medicine, Adıyaman, Turkey
| | - Arif Süner
- Department of Cardiology, Adıyaman University Faculty of Medicine, Adıyaman, Turkey
| | - Sedat Köroğlu
- Department of Cardiology, Afşin State Hospital, Kahramanmaraş, Turkey
| | - Ahmet Akçay
- Department of Cardiology, Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | | | - Murat Köleoğlu
- Department of Cardiology, Avicenna Hospital, İstanbul, Turkey
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90
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Fidanci K, Gulgun M, Demirkaya E, Acikel C, Kilic A, Gok F, Ozen S. Assessment of autonomic functions in children with familial Mediterranean fever by using heart rate variability measurements. Int J Rheum Dis 2014; 20:2086-2092. [PMID: 24860912 DOI: 10.1111/1756-185x.12401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study is to analyze possible autonomic nerve system alterations and assess the efficacy of heart rate variability (HRV) analysis in anticipation of cardiovascular risks in pediatric patients with familial Mediterranean fever (FMF). METHOD In this study, cardiac autonomic functions were investigated in children with FMF by analyzing HRV and its other probable cardiac effects by echocardiography. We studied 70 pediatric patients with FMF and 50 healthy controls. RESULTS The time-domain parameters of HRV were compared between the FMF and control groups. SDNN (standard deviation of all NN intervals) was significantly decreased in patients with FMF as compared to control subjects. The other time-domain parameters of HRV and the frequency-domain parameters of HRV were similar in both groups. Frequency-dependent HRV parameters were similar in both groups, as were conventional echocardiographic parameters. CONCLUSION HRV is a convenient and reliable technique for evaluation of autonomic functions. There are only a few studies on the assessment of autonomic functions by means of HRV in adult FMF patients but not in pediatric patients. Further studies are required to assess whether there is autonomic dysfunction in children with FMF.
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Affiliation(s)
- Kursat Fidanci
- Department of Pediatric Cardiology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Mustafa Gulgun
- Department of Pediatric Cardiology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Erkan Demirkaya
- Department of Pediatric Rheumatology, Gulhane Military Medical Faculty, Ankara, Turkey.,FMF Arthritis Vasculitis and Orphan Disease Research in Pediatric Rheumatology (FAVOR), Gulhane Military Medical Faculty, Ankara, Turkey
| | - Cengizhan Acikel
- FMF Arthritis Vasculitis and Orphan Disease Research in Pediatric Rheumatology (FAVOR), Gulhane Military Medical Faculty, Ankara, Turkey.,Department of Biostatistics, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Ayhan Kilic
- Department of Pediatric Cardiology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Faysal Gok
- Department of Pediatric Rheumatology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
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91
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Imbalzano E, Lo Gullo A, Costantino R, Tomasello C, Giugno V, Saitta A. Coronary vasculitis in granulomatosis with polyangiitis. Int J Cardiol 2014; 173:593-5. [PMID: 24698240 DOI: 10.1016/j.ijcard.2014.03.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- E Imbalzano
- Department of Internal Medicine, University of Messina, Italy.
| | - A Lo Gullo
- Department of Internal Medicine, University of Messina, Italy
| | - R Costantino
- Department of Internal Medicine, University of Messina, Italy
| | - C Tomasello
- Department of Internal Medicine, University of Messina, Italy
| | - V Giugno
- U.O. of Internal Medicine, Hospital of Locri, Italy
| | - A Saitta
- Department of Internal Medicine, University of Messina, Italy
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92
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Fatal acute necrotizing eosinophilic myocarditis temporally related to use of adalimumab in a patient with relapsing polychondritis. J Clin Rheumatol 2014; 19:386-9. [PMID: 24048108 DOI: 10.1097/rhu.0b013e3182a701cb] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tumor necrosis factor α (TNF-α) antagonists are being increasingly used as maintenance therapies for rheumatic diseases, and therefore knowledge of their adverse effects is important. We report a case of fatal acute necrotizing eosinophilic myocarditis temporally related to use of a second course of the TNF-α antagonist, adalimumab. A 51-year-old woman with relapsing polychondritis took adalimumab 2 weeks before presenting with acute myocarditis. Within hours of presentation to the emergency department, she had cardiac arrest due to fulminant heart failure. Autopsy demonstrated necrotizing eosinophilic myocarditis. This is a rare cause of fulminant heart failure. This is the first report of a TNF-α antagonist potentially associated with acute necrotizing eosinophilic myocarditis.
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93
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Mavrogeni S, Sfikakis PP, Gialafos E, Bratis K, Karabela G, Stavropoulos E, Spiliotis G, Sfendouraki E, Panopoulos S, Bournia V, Kolovou G, Kitas GD. Cardiac tissue characterization and the diagnostic value of cardiovascular magnetic resonance in systemic connective tissue diseases. Arthritis Care Res (Hoboken) 2014; 66:104-12. [PMID: 24106233 DOI: 10.1002/acr.22181] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 09/10/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Accurate diagnosis of cardiovascular involvement in connective tissue diseases (CTDs) remains challenging. We hypothesized that cardiovascular magnetic resonance (CMR) demonstrates cardiac lesions in symptomatic CTD patients with normal echocardiography. METHODS CMR from 246 CTD patients with typical cardiac symptoms (TCS; n = 146, group A) or atypical cardiac symptoms (ATCS; n = 100, group B) was retrospectively evaluated. Group A included 9 patients with inflammatory myopathy (IM), 35 with sarcoidosis, 30 with systemic sclerosis (SSc), 14 with systemic lupus erythematosus (SLE), 10 with rheumatoid arthritis (RA), and 48 with small vessel vasculitis. Group B included 25 patients with RA, 20 with SLE, 20 with sarcoidosis, 15 with SSc, 10 with IM, and 10 with small vessel vasculitis. CMR was performed by 1.5T; left ventricular ejection fraction, T2 ratio (edema imaging), and late gadolinium enhancement (LGE; fibrosis imaging) were evaluated. Acute and chronic lesions were characterized as LGE positive plus T2 ratio >2 and T2 ratio ≤2, respectively. According to LGE, lesions were characterized as diffuse subendocardial, subepicardial, and subendocardial/transmural due to vasculitis, myocarditis, and myocardial infarction, respectively. A stress study by dobutamine echocardiography or stress, nuclear, or adenosine CMR was performed in CTD patients with negative rest CMR. RESULTS Abnormal CMR was identified in 32% (27% chronic) and 15% (12% chronic) of patients with TCS and ATCS, respectively. Lesions due to vasculitis, myocarditis, and myocardial infarction were evident in 27.4%, 62.6%, and 9.6% of CTD patients, respectively. Stress studies in CTD patients with negative CMR revealed coronary artery disease in 20%. CONCLUSION CMR in symptomatic CTD patients with normal echocardiography can assess disease acuity and identify vasculitis, myocarditis, and myocardial infarction.
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94
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Zenone T, Puget M. Pericardial effusion and giant cell arteritis. Rheumatol Int 2014; 34:1465-9. [DOI: 10.1007/s00296-014-2958-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/29/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Thierry Zenone
- Unit of Internal Medicine, Department of Medicine, Centre Hospitalier General, 179 boulevard Marechal Juin, 26953, Valence Cedex 9, France,
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95
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Burkard T, Pfister O, Rickli H, Follath F, Hack D, Zaker R, Pittl U, Handschin R, Pfisterer M, Brunner-La Rocca HP. Prognostic impact of systemic inflammatory diseases in elderly patients with congestive heart failure. QJM 2014; 107:131-8. [PMID: 24131549 DOI: 10.1093/qjmed/hct205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS Inflammation is part of the pathophysiology of congestive heart failure (CHF). However, little is known about the impact of the presence of systemic inflammatory disease (SID), defined as inflammatory syndrome with constitutional symptoms and involvement of at least two organs as co-morbidity on the clinical course and prognosis of patients with CHF. METHODS AND RESULTS This is an analysis of all 622 patients included in TIME-CHF. After an 18 months follow-up, outcomes of patients with and without SID were compared. Primary endpoint was all-cause hospitalization free survival. Secondary endpoints were overall survival and CHF hospitalization free survival. At baseline, 38 patients had history of SID (6.1%). These patients had higher N-terminal pro brain natriuretic peptide and worse renal function than patients without SID. SID was a risk factor for adverse outcome [primary endpoint: hazard ratio (HR) = 1.73 (95% confidence interval: 1.18-2.55, P = 0.005); survival: HR = 2.60 (1.49-4.55, P = 0.001); CHF hospitalization free survival: HR = 2.3 (1.45-3.65, P < 0.001)]. In multivariate models, SID remained the strongest independent risk factor for survival and CHF hospitalization free survival. CONCLUSION In elderly patients with CHF, SID is independently accompanied with adverse outcome. Given the increasing prevalence of SID in the elderly population, these findings are clinically important for both risk stratification and patient management.
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Affiliation(s)
- T Burkard
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
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96
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Leroy S, Gaudebout N, Lanteme P, Seve P. [Recurrent pericarditis as an initial manifestation of Wegener's granulomatosis]. Ann Cardiol Angeiol (Paris) 2014; 63:48-50. [PMID: 21683940 DOI: 10.1016/j.ancard.2011.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 05/01/2011] [Indexed: 05/30/2023]
Abstract
Recurrent pericarditis occur in around a quarter of patients after a first episode of acute pericarditis. Most of the cases are idiopathic or viral pericarditis or post-pericardial injury syndromes. Recurrent pericarditis are most likely to occur in patients with known systemic lupus erythematosus or rheumatoid arthritis but are rare in other systemic auto-immune diseases. We report here an unusual case of a patient with a 5-year history of four acute myopericarditis revealing Wegener's granulomatosis. Clinicians should consider the possibility of Wegener's granulomatosis in case of recurrent pericarditis and look for features suggestive of granulomatous disease affecting the upper and lower respiratory tract. In this setting, antineutrophil cytoplasmic autoantibodies (ANCA) testing and/or biopsy of involved organs appear of particular interest to confirm the diagnosis.
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Affiliation(s)
- S Leroy
- Service de médecine interne, hôpital de la Croix-Rousse, 103, boulevard de la Croix-Rousse, 69317 Lyon cedex 04, France; Université Claude-Bernard, Lyon 1, Lyon, France
| | - N Gaudebout
- Service de cardiologie, centre hospitalier de la Croix-Rousse, 93, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Université Claude-Bernard, Lyon 1, Lyon, France
| | - P Lanteme
- Service de cardiologie, centre hospitalier de la Croix-Rousse, 93, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Université Claude-Bernard, Lyon 1, Lyon, France
| | - P Seve
- Service de médecine interne, hôpital de la Croix-Rousse, 103, boulevard de la Croix-Rousse, 69317 Lyon cedex 04, France; Université Claude-Bernard, Lyon 1, Lyon, France.
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97
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Huang BT, Yao HM, Huang H. Left Ventricular Remodeling and Dysfunction in Systemic Lupus Erythematosus: A Three-Dimensional Speckle Tracking Study. Echocardiography 2014; 31:1085-94. [PMID: 24446690 DOI: 10.1111/echo.12515] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Bao-Tao Huang
- Department of Cardiology; West China Hospital; Sichuan University; Chengdu China
| | - Hong-Mei Yao
- Department of Cardiology; West China Hospital; Sichuan University; Chengdu China
| | - He Huang
- Department of Cardiology; West China Hospital; Sichuan University; Chengdu China
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98
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Michaud K, Grabherr S, Shiferaw K, Doenz F, Augsburger M, Mangin P. Acute coronary syndrome after levamisole-adultered cocaine abuse. J Forensic Leg Med 2014; 21:48-52. [DOI: 10.1016/j.jflm.2013.10.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 09/28/2013] [Accepted: 10/27/2013] [Indexed: 12/17/2022]
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99
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Abo-Haded HM, Barakat TS, Hafez MM. Myocardial performance in children with autoimmune hepatitis: Doppler tissue imaging study. Eur J Pediatr 2013; 172:1511-9. [PMID: 23812510 DOI: 10.1007/s00431-013-2073-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/11/2013] [Indexed: 01/09/2023]
Abstract
Autoimmune hepatitis (AIH) is a member of autoimmune diseases family which can increase risk of cardiovascular morbidity and mortality. This study aimed to assess subclinical impact of AIH on global myocardial performance in affected children using Doppler tissue imaging (DTI) and to correlate it with total serum immunoglobulin-G (IgG). Thirty children with AIH (mean age = 12.67 ± 2.9 years) was included as the study group and 20 age- and sex-matched healthy children (mean age = 11.93 ± 2.66 years) as the control group. Conventional two-dimensional echocardiography was performed to both groups and DTI were used to determine right ventricular (RV) and left ventricular (LV) Tei indexes. Total serum IgG levels at initial diagnosis of AIH were correlated to the cardiac functions of AIH patients. RV and LV Tei indexes were significantly higher in AIH group (mean ± SD: 0.46 ± 0.088 vs. 0.26 ± 0.01, P < 0.0001 and 0.45 ± 0.086 vs. 0.31 ± 0.02, P < 0.0001, respectively). Also, total IgG concentrations were correlated positively with the LV Tei index (r = 0.69, P < 0.0001) and with the RV Tei index (r = 0.61, P < 0.0003) and correlated negatively with the mitral systolic (Sm) velocity (r = -0.76, P < 0.0001) and with tricuspid systolic (Sm) velocity (r = -0.66, P < 0.0001). On the other hand, fractional shortening did not correlate with serum IgG concentrations (r = -0.04, P = 0.821). In conclusion, the DTI technique appears to be more sensitive than conventional echocardiography in the early detection of myocardial dysfunction in AIH children.
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MESH Headings
- Adolescent
- Biomarkers/blood
- Case-Control Studies
- Child
- Cross-Sectional Studies
- Echocardiography, Doppler, Pulsed
- Female
- Hepatitis, Autoimmune/blood
- Hepatitis, Autoimmune/complications
- Hepatitis, Autoimmune/diagnostic imaging
- Hepatitis, Autoimmune/immunology
- Humans
- Immunoglobulin G/blood
- Male
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
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Affiliation(s)
- Hany M Abo-Haded
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt,
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100
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Peñataro JS, De Mingo A, Del Río A, Martínez JA, Heras M, Regueiro A. Myopericarditis and severe myocardial dysfunction as the initial manifestation of systemic lupus erythematosus. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 1:253-5. [PMID: 24062915 DOI: 10.1177/2048872612455122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 06/27/2012] [Indexed: 11/17/2022]
Abstract
Pericarditis is the most frequent cardiac manifestation of systemic lupus erythematosus (SLE). However, a large pericardial effusion as the initial manifestation of the disease is infrequent, especially when it is associated with myocardial damage. We describe an unusual case of a young female with pleuropericarditis and severe myocardial dysfunction as the initial manifestation of SLE.
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Affiliation(s)
- Joaquín S Peñataro
- Clinical Pharmacology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
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