51
|
Santacruz JC, Mantilla MJ, Rueda I, Rodríguez-Salas G, Pulido S, Londono J. Perimyocarditis With Acute Heart Failure as the First Manifestation of Systemic Lupus Erythematosus. Cureus 2022; 14:e26707. [PMID: 35959185 PMCID: PMC9360625 DOI: 10.7759/cureus.26707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 11/30/2022] Open
Abstract
Cardiac abnormalities are common in patients with systemic lupus erythematosus (SLE). However, many of them tend to be mild or asymptomatic and can be recognized by non-invasive studies such as transthoracic echocardiography and cardiac magnetic resonance imaging (CMR). However, heart failure secondary to perimyocarditis as the initial manifestation of SLE remains an extremely rare form of presentation. Below, we present the case of an adult female patient who initially consulted due to symptoms of acute dyspnea, atypical chest pain, and edema of the lower limbs, who underwent a chest X-ray as part of the initial studies, which described an increase in the cardiac silhouette associated with diffuse opacities in both lung fields. The admission electrocardiogram only showed sinus tachycardia and nonspecific alterations of the T wave, with an initial report of frankly elevated cardiac biomarkers compatible with acute myocardial injury together with the positivity of specific antibodies for SLE.
Collapse
|
52
|
Montera MW, Marcondes-Braga FG, Simões MV, Moura LAZ, Fernandes F, Mangine S, Oliveira Júnior ACD, Souza ALADAGD, Ianni BM, Rochitte CE, Mesquita CT, de Azevedo Filho CF, Freitas DCDA, Melo DTPD, Bocchi EA, Horowitz ESK, Mesquita ET, Oliveira GH, Villacorta H, Rossi Neto JM, Barbosa JMB, Figueiredo Neto JAD, Luiz LF, Hajjar LA, Beck-da-Silva L, Campos LADA, Danzmann LC, Bittencourt MI, Garcia MI, Avila MS, Clausell NO, Oliveira NAD, Silvestre OM, Souza OFD, Mourilhe-Rocha R, Kalil Filho R, Al-Kindi SG, Rassi S, Alves SMM, Ferreira SMA, Rizk SI, Mattos TAC, Barzilai V, Martins WDA, Schultheiss HP. Brazilian Society of Cardiology Guideline on Myocarditis - 2022. Arq Bras Cardiol 2022; 119:143-211. [PMID: 35830116 PMCID: PMC9352123 DOI: 10.36660/abc.20220412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Fabiana G Marcondes-Braga
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Marcus Vinícius Simões
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Fabio Fernandes
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Sandrigo Mangine
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Bárbara Maria Ianni
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | - Claudio Tinoco Mesquita
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil.,Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil.,Hospital Vitória, Rio de Janeiro, RJ - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Evandro Tinoco Mesquita
- Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil.,Centro de Ensino e Treinamento Edson de Godoy Bueno / UHG, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Ludhmila Abrahão Hajjar
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil.,Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Luis Beck-da-Silva
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | - Marcelo Imbroise Bittencourt
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brasil.,Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ - Brasil
| | - Marcelo Iorio Garcia
- Hospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | - Monica Samuel Avila
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University,Cleveland, Ohio - EUA
| | | | - Silvia Marinho Martins Alves
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil.,Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | - Silvia Moreira Ayub Ferreira
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Stéphanie Itala Rizk
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital Sírio Libanês, São Paulo, SP - Brasil
| | | | - Vitor Barzilai
- Instituto de Cardiologia do Distrito Federal, Brasília, DF - Brasil
| | - Wolney de Andrade Martins
- Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil.,DASA Complexo Hospitalar de Niterói, Niterói, RJ - Brasil
| | | |
Collapse
|
53
|
Casian M, Jurcut C, Dima A, Mihai A, Stanciu S, Jurcut R. Cardiovascular Disease in Primary Sjögren's Syndrome: Raising Clinicians' Awareness. Front Immunol 2022; 13:865373. [PMID: 35757738 PMCID: PMC9219550 DOI: 10.3389/fimmu.2022.865373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022] Open
Abstract
In the ever evolving landscape of systemic immune mediated diseases, an increased awareness regarding the associated cardiovascular system impairment has been noted in recent years. Even though primary Sjögren’s Syndrome (pSS) is one of the most frequent autoimmune diseases affecting middle-aged individuals, the cardiovascular profile of this specific population is far less studied, at least compared to other autoimmune diseases. Traditional cardiovascular risk factors and disease specific risk factors are inextricably intertwined in this particular case. Therefore, the cardiovascular risk profile in pSS is a multifaceted issue, sometimes difficult to assess. Furthermore, in the era of multimodality imaging, the diagnosis of subclinical myocardial and vascular damage is possible, with recent data pointing that the prevalence of such involvement is higher in pSS than in the general population. Nevertheless, when approaching patients with pSS in terms of cardiovascular diseases, clinicians are often faced with the difficult task of translating data from the literature into their everyday practice. The present review aims to synthesize the existing evidence on pSS associated cardiovascular changes in a clinically relevant manner.
Collapse
Affiliation(s)
- Mihnea Casian
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,2nd Internal Medicine Department, Central Military University Emergency Hospital, Bucharest, Romania
| | - Ciprian Jurcut
- 2nd Internal Medicine Department, Central Military University Emergency Hospital, Bucharest, Romania
| | - Alina Dima
- Department of Rheumatology, Colentina Clinical Hospital, Bucharest, Romania
| | - Ancuta Mihai
- 2nd Internal Medicine Department, Central Military University Emergency Hospital, Bucharest, Romania.,Rheumatology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Silviu Stanciu
- Cardiac Noninvasive Laboratory, Central Military University Emergency Hospital, Bucharest, Romania.,Internal Medicine Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Ruxandra Jurcut
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Department of Cardiology, Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| |
Collapse
|
54
|
Mondal S, Barman P, Vignesh P. Cardiovascular Abnormalities in Juvenile Dermatomyositis: A Scoping Review for the Clinical Rheumatologists. Front Med (Lausanne) 2022; 9:827539. [PMID: 35814777 PMCID: PMC9263083 DOI: 10.3389/fmed.2022.827539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Juvenile dermatomyositis (JDM) is a common form of inflammatory myositis in children. Vasculopathy and endothelial dysfunction play significant roles in the pathogenesis of JDM. Cardiac involvement in JDM is often underestimated, and it may be a potential indicator of poor prognosis. Cardiac dysfunction in JDM can occur both in the acute and chronic stages of the disease. Amongst the acute complications, acute congestive heart failure (CHF), myocarditis, arrhythmia, and complete heart block are common. However, these remain unrecognized due to a lack of overt clinical manifestations. Increased rates of cardiovascular abnormalities have been noted with anti-SRP and anti-Jo 1 auto-antibody positivity. Long-term follow-up studies in JDM have shown an increased prevalence of hypertension, atherosclerosis, coronary artery disease, and metabolic syndrome in adolescence and adulthood. Monitoring of body-mass index, blood pressure, and laboratory evaluation of fasting glucose and lipid profile may help in identifying metabolic syndrome in children with JDM. Steroid-sparing agents, daily exercise, and a healthy diet may reduce such long-term cardiac morbidities. Current use of multimodality imaging such as stress-echocardiography, contrast-enhanced echocardiography, cardiac magnetic resonance imaging, and positron emission tomography has increased the diagnostic yield of subclinical heart disease during acute and chronic stages of JDM. This review elaborates on different aspects of cardiac dysfunction in JDM. It also emphasizes the importance of cardiac screening in long-term follow-up of children with JDM.
Collapse
|
55
|
Khatib M, Elbaz-Greener G, Nitzan O, Soboh S, Peretz A, Hazanov E, Kinany W, Halahla Y, Grosman-Rimon L, Houle H, Amir O, Carasso S. Unmasking Myocardial Dysfunction in Patients Hospitalized for Community-Acquired Pneumonia Using a 4-Chamber 3-Dimensional Volume/Strain Analysis. J Digit Imaging 2022; 35:1654-1661. [PMID: 35705794 PMCID: PMC9200371 DOI: 10.1007/s10278-022-00665-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Lower respiratory infection was reported as the most common fatal infectious disease. Community-acquired pneumonia (CAP) and myocardial injury are associated; yet, true prevalence of myocardial injury is probably underestimated. We assessed the rate and severity of myocardial dysfunction in patients with CAP. Admitted patients diagnosed with CAP were prospectively recruited. All the patients had C-reactive protein (CRP), brain natriuretic peptide (BNP), and high-sensitivity cardiac troponin (hs-cTnl) tests added to their routine workup. 2D/3D Doppler echocardiography was done on a Siemens Acuson SC2000 machine ≤ 24 h of diagnosis. 3D datasets were blindly analyzed for 4-chamber volumes/strains using EchobuildR 3D-Volume Analysis prototype software, v3.0 2019, Siemens-Medical Solutions. Volume/strain parameters were correlated with admission clinical and laboratory findings. The cohort included 34 patients, median age 60 years (95% CI 55-72). The cohort included 18 (53%) patients had hypertension, 9 (25%) had diabetes mellitus, 7 (21%) were smokers, 7 (21%) had previous myocardial infarction, 4 (12%) had chronic renal failure, and 1 (3%) was on hemodialysis treatment. 2D/Doppler echocardiography findings showed normal ventricular size/function (LVEF 63 ± 9%), mild LV hypertrophy (104 ± 36 g/m2), and LA enlargement (41 ± 6 mm). 3D volumes/strains suggested bi-atrial and right ventricular dysfunction (global longitudinal strain RVGLS = - 8 ± 4%). Left ventricular strain was normal (LVGLS = - 18 ± 5%) and correlated with BNP (r = 0.40, p = 0.024). The patients with LVGLS > - 17% had higher admission blood pressure and lower SaO2 (144 ± 33 vs. 121 ± 20, systolic, mmHg, p = 0.02, and 89 ± 4 vs. 94 ± 4%, p = 0.006, respectively). hs-cTnl and CRP were not different. Using novel 3D volume/strain software in CAP patients, we demonstrated diffuse global myocardial dysfunction involving several chambers. The patients with worse LV GLS had lower SaO2 and higher blood pressure at presentation. LV GLS correlated with maximal BNP level and did not correlate with inflammation or myocardial damage markers.
Collapse
Affiliation(s)
- Moayad Khatib
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Lower Galilee, Tiberias, Israel
| | - Gabby Elbaz-Greener
- Hebrew University of Jerusalem, Jerusalem, Israel
- Cardiovascular Institute, Hadassah Medical Center, Jerusalem, Israel
| | - Orna Nitzan
- Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, POB 1589, 8 Henrietta Szold Street, Safed, Israel, 1311502
| | - Soboh Soboh
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Lower Galilee, Tiberias, Israel
- Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel
| | - Avi Peretz
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, POB 1589, 8 Henrietta Szold Street, Safed, Israel, 1311502
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Israel
| | - Evgeni Hazanov
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Lower Galilee, Tiberias, Israel
| | - Wadia Kinany
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Lower Galilee, Tiberias, Israel
| | - Yusra Halahla
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Lower Galilee, Tiberias, Israel
| | - Liza Grosman-Rimon
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Lower Galilee, Tiberias, Israel
| | - Helene Houle
- Siemens Medical Solutions USA, Mountain View, CA, USA
| | - Offer Amir
- Hebrew University of Jerusalem, Jerusalem, Israel.
- Cardiovascular Institute, Hadassah Medical Center, Jerusalem, Israel.
| | - Shemy Carasso
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Lower Galilee, Tiberias, Israel.
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, POB 1589, 8 Henrietta Szold Street, Safed, Israel, 1311502.
- Non-Invasive Cardiac Imaging Cardiovascular Institute, The Baruch Padeh Medical Center, Poriya, Lower Galilee, Israel, 15208.
| |
Collapse
|
56
|
Using multi-parametric quantitative MRI to screen for cardiac involvement in patients with idiopathic inflammatory myopathy. Sci Rep 2022; 12:9819. [PMID: 35701509 PMCID: PMC9198094 DOI: 10.1038/s41598-022-13858-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/30/2022] [Indexed: 11/08/2022] Open
Abstract
Idiopathic inflammatory myopathies (IIM) is a group of heterogeneous autoimmune systemic diseases, which not only involve skeletal muscle but also myocardium. Cardiac involvement in IIM, which eventually develops into heart failure, is difficult to identify by conventional examinations at early stage. The aim of this study was to investigate if multi-parametric cardiac magnetic resonance (CMR) imaging can screen for early cardiac involvement in IIM, compared with clinical score (Myositis Disease Activity Assessment Tool, MDAAT). Forty-nine patients of IIM, and 25 healthy control subjects with comparable age-range and sex-ratio were enrolled in this study. All subjects underwent CMR examination, and multi-slice short-axis and 4-chamber cine MRI were acquired to evaluate biventricular global circumferential strain (GCS) and global longitudinal strain (GLS). Native T1 and T2 mapping were performed, and post-contrast T1 mapping and LGE were acquired after administration of contrast. A CMR score was developed from native T1 mean and T2 mean for the identification of cardiac involvement in the IIM cohort. Using contingency tables MDAAT and CMR were compared and statistically analyzed using McNemar test. McNemar’s test revealed no significant difference between CMR score and MDAAT (p = 0.454). CMR score had potential to screen for early cardiac involvement in IIM patients, compared to MDAAT.
Collapse
|
57
|
Manchanda AS, Kwan AC, Ishimori M, Thomson LEJ, Li D, Berman DS, Bairey Merz CN, Jefferies C, Wei J. Coronary Microvascular Dysfunction in Patients With Systemic Lupus Erythematosus and Chest Pain. Front Cardiovasc Med 2022; 9:867155. [PMID: 35498009 PMCID: PMC9053571 DOI: 10.3389/fcvm.2022.867155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/28/2022] [Indexed: 01/19/2023] Open
Abstract
Chest pain is a common symptom in patients with systemic lupus erythematosus, an autoimmune disease that is associated with increased cardiovascular morbidity and mortality. While chest pain mechanisms can be multifactorial and often attributed to non-coronary or non-cardiac cardiac etiologies, emerging evidence suggests that ischemia with no obstructive coronary arteries (INOCA) is a prevalent condition in patients with chest pain and no obstructive coronary artery disease. Coronary microvascular dysfunction is reported in approximately half of SLE patients with suspected INOCA. In this mini review, we highlight the cardiovascular risk assessment, mechanisms of INOCA, and diagnostic approach for patients with SLE and suspected CMD.
Collapse
Affiliation(s)
- Ashley S. Manchanda
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Alan C. Kwan
- Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Imaging, Mark Taper Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Mariko Ishimori
- Division of Rheumatology and Department of Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Louise E. J. Thomson
- Department of Imaging, Mark Taper Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Daniel S. Berman
- Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Imaging, Mark Taper Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - C. Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Caroline Jefferies
- Division of Rheumatology and Department of Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- *Correspondence: Janet Wei
| |
Collapse
|
58
|
Baritussio A, Schiavo A, Basso C, Giordani AS, Cheng CY, Pontara E, Cattini MG, Bison E, Gallo N, De Gaspari M, Carturan E, Thiene G, Tarantini G, Plebani M, Rizzo S, Gregori D, Iliceto S, Marcolongo R, Caforio ALP. Predictors of relapse, death or heart transplantation in myocarditis before the introduction of immunosuppression: negative prognostic impact of female gender, fulminant onset, lower ejection fraction and serum autoantibodies. Eur J Heart Fail 2022; 24:1033-1044. [PMID: 35377503 DOI: 10.1002/ejhf.2496] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS Outcome predictors in myocarditis are not well defined; we aimed at identifying predictors of death, heart transplantation (HTx) and relapse before the introduction of immunosuppression. METHODS AND RESULTS From 1992 to 2012 we consecutively included 466 patients (68% male, 37±17 years, single centre recruitment, median follow-up 50 months), 216 with clinically suspected and 250 with biopsy (Bx)-proven myocarditis. Serum anti heart (AHA) and antiintercalated disk (AIDA) auto-antibodies were measured by indirect immunofluorescence. We performed univariable and multivariable analysis of clinical and diagnostic features at diagnosis. Survival free from death or HTx at 10 years was 83% in the whole group and was lower in Bx- proven vs. clinically suspected myocarditis (76% vs 94% respectively, p<0.001). Female gender (hazard ratio (HR) 2.7, 95% Confidence Intervals (CI) 1.1-6.5), fulminant presentation (HR 13.77, CI 9.7-261.73), high-titre organ-specific AHA (HR 4.2, CI 1.2-14.7) and anti-nuclear antibodies (ANA) (HR 5.2, CI 2.1-12.8) were independent predictors of death or HTx; higher echocardiographic left ventricular ejection fraction (LVEF) at diagnosis was protective, with a 0.93 times risk reduction for each 1% LVEF increase (CI 0.89-0.96). History of myocarditis at diagnosis (HR 8.5, CI 3.5-20.7) was independent predictor of myocarditis relapse at follow-up; older age was protective (HR 0.95, CI 0.91-0.99). Predictors of death, HTx and relapse did not differ in Bx-proven vs. clinically suspected myocarditis. CONCLUSIONS Young age and a previous myocarditis were independent relapse predictors; female gender, fulminant onset, lower LVEF at presentation and high-titre organ-specific AHA and ANA were independent predictors of death and HTx, suggesting that autoimmune features predict worse prognosis.
Collapse
Affiliation(s)
- Anna Baritussio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alessandro Schiavo
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Cristina Basso
- Cardiac Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea Silvio Giordani
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Chun-Yan Cheng
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Elena Pontara
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Maria Grazia Cattini
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Elisa Bison
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Nicoletta Gallo
- Department of Laboratory Medicine, University of Padua, Padua, Italy
| | - Monica De Gaspari
- Cardiac Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Elisa Carturan
- Cardiac Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gaetano Thiene
- Cardiac Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Tarantini
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University of Padua, Padua, Italy
| | - Stefania Rizzo
- Cardiac Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Dario Gregori
- Statistics, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Renzo Marcolongo
- Haematology and Clinical Immunology, Department of Medicine, University of Padua, Padua, Italy
| | - Alida Linda Patrizia Caforio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| |
Collapse
|
59
|
Tsang D, Malladi CL, Patel K, Bajaj P. Seronegative immune-mediated necrotising myopathy complicated by fulminant myocarditis resulting in cardiogenic shock and cardiac arrest. BMJ Case Rep 2022; 15:e248535. [PMID: 35379682 PMCID: PMC8981287 DOI: 10.1136/bcr-2021-248535] [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] [Accepted: 03/21/2022] [Indexed: 11/03/2022] Open
Abstract
A woman in her late 30s recently diagnosed with viral myopericarditis presented with 1 month of worsening fatigue, diffuse myalgias and chest pain radiating to her back. While undergoing work-up for chest wall myositis, she rapidly decompensated, developing heart failure and acute hypoxaemic respiratory failure. Her clinical course was complicated by cardiac arrest and severe cardiogenic shock requiring intra-aortic balloon pump support.
Collapse
Affiliation(s)
- Darren Tsang
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Komal Patel
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Puneet Bajaj
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
60
|
Castillo AV, Ivsic T. Overview of pediatric myocarditis and pericarditis. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
61
|
Pancarditis as the Clinical Presentation of Eosinophilic Granulomatosis with Polyangiitis: A Multimodality Approach to Diagnosis. CARDIOGENETICS 2022. [DOI: 10.3390/cardiogenetics12020014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Eosinophilic pancarditis (EP) is a rare, often unrecognized condition caused by endomyocardial infiltration of eosinophil granulocytes (referred as eosinophilic myocarditis, EM) associated with pericardial involvement. EM has a variable clinical presentation, ranging from asymptomatic cases to acute cardiogenic shock requiring mechanical circulatory support (MCS) or chronic restrictive cardiomyopathy at high risk of progression to dilated cardiomyopathy (DCM). EP is associated with high in-hospital mortality, particularly when associated to endomyocardial thrombosis, coronary arteries vasculitis or severe left ventricular systolic dysfunction. To date, there is a lack of consensus about the optimal diagnostic algorithm and clinical management of patients with biopsy-proven EP. The differential diagnosis includes hypersensitivity myocarditis, eosinophil granulomatosis with polyangiitis (EGPA), hypereosinophilic syndrome, parasitic infections, pregnancy-related hypereosinophilia, malignancies, drug overdose (particularly clozapine) and Omenn syndrome (OMIM 603554). To our knowledge, we report the first case of pancarditis associated to eosinophilic granulomatosis with polyangiitis (EGPA) with negative anti-neutrophil cytoplasmic antibodies (ANCA). Treatment with steroids and azathioprine was promptly started. Six months later, the patient developed a relapse: treatment with subcutaneous mepolizumab was added on the top of standard therapy, with prompt disease activity remission. This case highlights the role of a multimodality approach for the diagnosis of cardiac involvement associated to systemic immune disorders.
Collapse
|
62
|
Chen JH, Ikwuanusi IA, Bommu VJL, Patel V, Aujla H, Kaushik V, Cheriyath P. COVID-19 Vaccine-Related Myocarditis: A Descriptive Study of 40 Case Reports. Cureus 2022; 14:e21740. [PMID: 35251812 PMCID: PMC8887934 DOI: 10.7759/cureus.21740] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 12/21/2022] Open
Abstract
After the surging rise in the Coronavirus disease 2019 (COVID-19) pandemic, the Food and Drug Administration (FDA) approved emergency approval of vaccinations to prevent life-threatening complications of COVID-19 infection. These vaccines are BNT162b2, mRNA-1273. Later, the FDA also approved JNJ-78436735. COVID-19 vaccination does not have major side effects, but there are some concerning adverse events reported right after vaccination. Myocarditis is one of them. Based on our analysis of 40 case reports, we are presenting the epidemiology and clinical picture of myocarditis related to the COVID-19 vaccine. Based on our analysis, we found that the majority of cases were seen in males with 90% predominance, and these cases were seen in the age group of 29.13 years old (mean, SD of 14.39 years). In 65% of cases, patients took the BNT162b2 vaccine; 30% of cases were reported with the mRNA-1273 vaccine; and 5% of cases with JNJ-78436735. Of all the cases, 80% of them are reported after the second dose of the vaccine with either Moderna or Pfizer. The characteristics of COVID-19 vaccine-related myocarditis were analyzed in this study. We identified several findings, ranging from age, gender, type of vaccination, presentation of symptoms, and diagnosis modality. This depicts the picture of COVID-19 vaccine-related myocarditis and what physicians should expect when dealing with the disease. Our analysis showed that more cases were reported after receiving the BNT162b2 vaccine compared to mRNA-1273 and JNJ-78436735 vaccines. Further research needs to be conducted to analyze the underlying cause of this association.
Collapse
Affiliation(s)
- Jia Hong Chen
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | | | | | - Vraj Patel
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | | | - Vishrut Kaushik
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Pramil Cheriyath
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| |
Collapse
|
63
|
Emerging Role of Cardiac Magnetic Resonance Imaging in Diagnosing Myocarditis: A Blunder or The Way To Get the Problem Sorted? J Thorac Imaging 2022; 37:W12-W27. [PMID: 35191862 DOI: 10.1097/rti.0000000000000634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acute myocarditis is a disease affecting the myocardial tissue, which is caused by infections, rheumatic diseases, especially sarcoidosis, or certain therapies. Its diagnosis may be difficult, owing to its variable clinical presentation. In this setting, cardiac magnetic resonance plays a pivotal role in detecting myocardial inflammation through qualitative, semiquantitative, and quantitative parameters, in particular with the new quantitative techniques such as T1 and T2 mapping, combined or not with late gadolinium enhancement evaluation. This is in accordance with the revised Lake Louise criteria. In this review, the emerging role of the new cutting-edge cardiac magnetic resonance imaging techniques in diagnosing myocarditis is extensively presented.
Collapse
|
64
|
Tymińska A, Ozierański K, Skwarek A, Kapłon-Cieślicka A, Baritussio A, Grabowski M, Marcolongo R, Caforio ALP. Personalized Management of Myocarditis and Inflammatory Cardiomyopathy in Clinical Practice. J Pers Med 2022; 12:jpm12020183. [PMID: 35207671 PMCID: PMC8874629 DOI: 10.3390/jpm12020183] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023] Open
Abstract
Myocarditis is an inflammatory heart disease induced by infectious and non-infectious causes frequently triggering immune-mediated pathologic mechanisms leading to myocardial damage and dysfunction. In approximately half of the patients, acute myocarditis resolves spontaneously while in the remaining cases, it may evolve into serious complications including inflammatory cardiomyopathy, arrhythmias, death, or heart transplantation. Due to the large variability in clinical presentation, unpredictable course of the disease, and lack of established causative treatment, myocarditis represents a challenging diagnosis in modern cardiology. Moreover, an increase in the incidence of myocarditis and inflammatory cardiomyopathy has been observed in recent years. However, there is a growing potential of available non-invasive diagnostic methods (biomarkers, serum anti-heart autoantibodies (AHA), microRNAs, speckle tracking echocardiography, cardiac magnetic resonance T1 and T2 tissue mapping, positron emission tomography), which may refine the diagnostic workup and/or noninvasive follow-up. Personalized management should include the use of endomyocardial biopsy and AHA, which may allow the etiopathogenetic subsets of myocarditis (infectious, non-infectious, and/or immune-mediated) to be distinguished and implementation of disease-specific therapies. In this review, we summarize current knowledge on myocarditis and inflammatory cardiomyopathy, and outline some practical diagnostic, therapeutic, and follow-up algorithms to facilitate comprehensive individualized management of these patients.
Collapse
Affiliation(s)
- Agata Tymińska
- First Department of Cardiology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland; (A.T.); (A.S.); (A.K.-C.); (M.G.)
| | - Krzysztof Ozierański
- First Department of Cardiology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland; (A.T.); (A.S.); (A.K.-C.); (M.G.)
- Correspondence: ; Tel.: +48-22-599-29-58; Fax: +48-22-599-19-57
| | - Aleksandra Skwarek
- First Department of Cardiology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland; (A.T.); (A.S.); (A.K.-C.); (M.G.)
| | - Agnieszka Kapłon-Cieślicka
- First Department of Cardiology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland; (A.T.); (A.S.); (A.K.-C.); (M.G.)
| | - Anna Baritussio
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 2-35128 Padova, Italy; (A.B.); (R.M.); (A.L.C.)
| | - Marcin Grabowski
- First Department of Cardiology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland; (A.T.); (A.S.); (A.K.-C.); (M.G.)
| | - Renzo Marcolongo
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 2-35128 Padova, Italy; (A.B.); (R.M.); (A.L.C.)
| | - Alida LP Caforio
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 2-35128 Padova, Italy; (A.B.); (R.M.); (A.L.C.)
| |
Collapse
|
65
|
Cheng CY, Baritussio A, Giordani AS, Iliceto S, Marcolongo R, Caforio ALP. Myocarditis in systemic immune-mediated diseases: Prevalence, characteristics and prognosis. A systematic review. Autoimmun Rev 2022; 21:103037. [PMID: 34995763 DOI: 10.1016/j.autrev.2022.103037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/02/2022] [Indexed: 12/17/2022]
Abstract
Many systemic immune-mediated diseases (SIDs) may involve the heart and present as myocarditis with different histopathological pictures, i.e. lymphocytic, eosinophilic, granulomatous, and clinical features, ranging from a completely asymptomatic patient to life-threatening cardiogenic shock or arrhythmias. Myocarditis can be part of some SIDs, such as sarcoidosis, systemic lupus erythematosus, systemic sclerosis, antiphospholipid syndrome, dermato-polymyositis, eosinophilic granulomatosis with polyangiitis and other vasculitis syndromes, but also of some organ-based immune-mediated diseases with systemic expression, such as chronic inflammatory bowel diseases. The aim of this review is to describe the prevalence, main clinical characteristics and prognosis of myocarditis associated with SIDs.
Collapse
Affiliation(s)
- Chun-Yan Cheng
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Anna Baritussio
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Andrea Silvio Giordani
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Renzo Marcolongo
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alida L P Caforio
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| |
Collapse
|
66
|
Binaghi G, Cossa S, Pasqualucci D, Piras M, Porcu M. An Unusual Case of Acute Heart Failure: Myositis With Cardiac Involvement as the First Clinical Manifestation of a Possible Connective Tissue Disease. J Clin Rheumatol 2021; 27:S670-S671. [PMID: 33298809 DOI: 10.1097/rhu.0000000000001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | - Martina Piras
- Internal Medicine, Ospedale G. Brotzu, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | | |
Collapse
|
67
|
Caforio ALP, De Luca G, Baritussio A, Seguso M, Gallo N, Bison E, Cattini MG, Pontara E, Gargani L, Pepe A, Campochiaro C, Plebani M, Iliceto S, Peretto G, Esposito A, Tofani L, Moggi-Pignone A, Dagna L, Marcolongo R, Matucci-Cerinic M, Bruni C. Serum Organ-Specific Anti-Heart and Anti-Intercalated Disk Autoantibodies as New Autoimmune Markers of Cardiac Involvement in Systemic Sclerosis: Frequency, Clinical and Prognostic Correlates. Diagnostics (Basel) 2021; 11:2165. [PMID: 34829512 PMCID: PMC8625508 DOI: 10.3390/diagnostics11112165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/09/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Heart involvement (HInv) in systemic sclerosis (SSc) may relate to myocarditis and is associated with poor prognosis. Serum anti-heart (AHA) and anti-intercalated disk autoantibodies (AIDA) are organ and disease-specific markers of isolated autoimmune myocarditis. We assessed frequencies, clinical correlates, and prognostic impacts of AHA and AIDA in SSc. METHODS The study included consecutive SSc patients (n = 116, aged 53 ± 13 years, 83.6% females, median disease duration 7 years) with clinically suspected heart involvement (symptoms, abnormal ECG, abnormal troponin I or natriuretic peptides, and abnormal echocardiography). All SSc patients underwent CMR. Serum AHA and AIDA were measured by indirect immunofluorescence in SSc and in control groups of non-inflammatory cardiac disease (NICD) (n = 160), ischemic heart failure (IHF) (n = 141), and normal blood donors (NBD) (n = 270). AHA and AIDA status in SSc was correlated with baseline clinical, diagnostic features, and outcome. RESULTS The frequency of AHA was higher in SSc (57/116, 49%, p < 0.00001) than in NICD (2/160, 1%), IHF (2/141, 1%), or NBD (7/270, 2.5%). The frequency of AIDA was higher (65/116, 56%, p < 0.00001) in SSc than in NICD (6/160, 3.75%), IHF (3/141, 2%), or NBD (1/270, 0.37%). AHAs were associated with interstitial lung disease (p = 0.04), history of chest pain (p = 0.026), abnormal troponin (p = 0.006), AIDA (p = 0.000), and current immunosuppression (p = 0.01). AHAs were associated with death (p = 0.02) and overall cardiac events during follow-up (p = 0.017). CONCLUSIONS The high frequencies of AHA and AIDA suggest a high burden of underdiagnosed autoimmune HInv in SSc. In keeping with the negative prognostic impact of HInv in SSc, AHAs were associated with dismal prognosis.
Collapse
Affiliation(s)
- Alida Linda Patrizia Caforio
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (A.B.); (E.B.); (M.G.C.); (E.P.); (S.I.)
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.D.L.); (C.C.); (L.D.); (M.M.-C.)
| | - Anna Baritussio
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (A.B.); (E.B.); (M.G.C.); (E.P.); (S.I.)
| | - Mara Seguso
- Department of Laboratory Medicine, University of Padua, 35122 Padua, Italy; (M.S.); (N.G.); (M.P.)
| | - Nicoletta Gallo
- Department of Laboratory Medicine, University of Padua, 35122 Padua, Italy; (M.S.); (N.G.); (M.P.)
| | - Elisa Bison
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (A.B.); (E.B.); (M.G.C.); (E.P.); (S.I.)
| | - Maria Grazia Cattini
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (A.B.); (E.B.); (M.G.C.); (E.P.); (S.I.)
| | - Elena Pontara
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (A.B.); (E.B.); (M.G.C.); (E.P.); (S.I.)
| | - Luna Gargani
- Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy;
| | - Alessia Pepe
- Department of Medicine, Institute of Radiology, University of Padova, 35122 Padova, Italy;
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.D.L.); (C.C.); (L.D.); (M.M.-C.)
| | - Mario Plebani
- Department of Laboratory Medicine, University of Padua, 35122 Padua, Italy; (M.S.); (N.G.); (M.P.)
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (A.B.); (E.B.); (M.G.C.); (E.P.); (S.I.)
| | - Giovanni Peretto
- Unit of Arrhythmology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Expirimental Imaging Center, IRCCS San Raffaele Scientific Institute, Ospedale San Raffaele University, 20132 Milan, Italy;
| | - Lorenzo Tofani
- Division of Rheumatology, Department of Experimental and Clinical Medicine, Department of Geriatric Medicine AOUC, University of Florence, 50121 Florence, Italy; (L.T.); (C.B.)
| | - Alberto Moggi-Pignone
- Division of Internal Medicine Unit IV AOUC, Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy;
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.D.L.); (C.C.); (L.D.); (M.M.-C.)
| | - Renzo Marcolongo
- Haematology and Clinical Immunology, Department of Medicine, University of Padua, 35122 Padua, Italy;
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.D.L.); (C.C.); (L.D.); (M.M.-C.)
- Division of Rheumatology, Department of Experimental and Clinical Medicine, Department of Geriatric Medicine AOUC, University of Florence, 50121 Florence, Italy; (L.T.); (C.B.)
| | - Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, Department of Geriatric Medicine AOUC, University of Florence, 50121 Florence, Italy; (L.T.); (C.B.)
| |
Collapse
|
68
|
Diagnostic biomarkers of dilated cardiomyopathy. Immunobiology 2021; 226:152153. [PMID: 34784575 DOI: 10.1016/j.imbio.2021.152153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is a condition involving dilation of cardiac chambers, which results in contraction impairment. Besides invasive and non-invasive diagnostic procedures, cardiac biomarkers are of great importance in both diagnosis and prognosis of the disease. These biomarkers are categorized into three groups based on their site; cardiomyocyte biomarkers, microenvironmental biomarkers and macroenvironmental biomarkers. AIMS In this review, an overview of characteristics, epidemiology, etiology and clinical manifestations of DCM is provided. In addition, the most important biomarkers, of all three categories, and their diagnostic and prognostic values are discussed. CONCLUSION Considering the association of DCM with conditions such as infections and autoimmunity, which are prevalent among the population, introducing efficient diagnostic tools is of high value for the early detection of DCM to prevent its severe complications. The three discussed classes of biomarkers are potential candidates for the detection of DCM. However, further studies are necessary in this regard.
Collapse
|
69
|
Schmitt P, Demoulin R, Poyet R, Capilla E, Rohel G, Pons F, Jégo C, Sidibe S, Druelle A, Brocq FX, Dutasta F, Cellarier GR. Acute Myocarditis after COVID-19 vaccination: A case report. Rev Med Interne 2021; 42:797-800. [PMID: 34740463 PMCID: PMC8523482 DOI: 10.1016/j.revmed.2021.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/05/2021] [Accepted: 10/10/2021] [Indexed: 01/05/2023]
Abstract
Introduction The etiology of myocarditis often remains undetermined. A large variety of infectious agents, systemic diseases, drugs, and toxins can cause the disease. We report the case of a 19-year-old man who developed myocarditis three days after Pfizer-BioNTech COVID-19 booster vaccination. Case report A 19-year-old man, presenting with troponin-positive acute chest pain, was referred to our department. He had received the Pfizer-BioNTech COVID-19 vaccine three days prior to his admission. The diagnosis of acute myocarditis was confirmed by cardiovascular magnetic resonance imaging. Patient hemodynamic status remained stable during hospitalization. The left ventricular ejection fraction was preserved during hospital stay and at one-month follow-up. We found no evidence for another infectious or autoimmune etiology. Conclusion Although imputability of the vaccine cannot be formally established on the basis of this case report, the findings raise the possibility of an association between mRNA COVID-19 vaccination and acute myocarditis.
Collapse
Affiliation(s)
- P Schmitt
- Department of Cardiology, HIA Sainte Anne Military Hospital, Toulon, France.
| | - R Demoulin
- Department of Cardiology, HIA Laveran Military Hospital, Marseille, France
| | - R Poyet
- Department of Cardiology, HIA Sainte Anne Military Hospital, Toulon, France
| | - E Capilla
- Department of Cardiology, HIA Sainte Anne Military Hospital, Toulon, France
| | - G Rohel
- Department of Cardiology, HIA Sainte Anne Military Hospital, Toulon, France
| | - F Pons
- Department of Cardiology, HIA Sainte Anne Military Hospital, Toulon, France
| | - C Jégo
- Department of Cardiology, HIA Sainte Anne Military Hospital, Toulon, France
| | - S Sidibe
- Department of Cardiology, HIA Sainte Anne Military Hospital, Toulon, France
| | - A Druelle
- Diving and Hyperbaric Medicine Department, HIA Sainte Anne Military Hospital, Toulon, France
| | - F-X Brocq
- Flight Crew Medical Expertise Center, HIA Sainte Anne Military Hospital, Toulon, France
| | - F Dutasta
- Department of Internal Medicine, HIA Sainte-Anne, Toulon, France
| | - G R Cellarier
- Department of Cardiology, HIA Sainte Anne Military Hospital, Toulon, France
| |
Collapse
|
70
|
Patrignani A, Schicchi N, Calcagnoli F, Falchetti E, Ciampani N, Argalia G, Mariani A. Acute myocarditis following Comirnaty vaccination in a healthy man with previous SARS-CoV-2 infection. Radiol Case Rep 2021; 16:3321-3325. [PMID: 34367386 PMCID: PMC8326008 DOI: 10.1016/j.radcr.2021.07.082] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 01/07/2023] Open
Abstract
Myopericarditis following mRNA Covid-19 vaccination has recently been reported to health authorities in a lot of countries. They can occur in very rare cases after either the Moderna (mRNA-1273 - Spikevax) or Pfizer-BioNTech (BNT162b2 - Comirnaty) vaccination. Cases predominately occur in younger adult men within 14 days following the second dose. In this article, we present a 56 year-old man with no prior medical history, whit the exception of a mild Covid-19 infection 4 months earlier, who experienced an episode of acute epigastric pain, profuse sweating, tachycardia, hypotension 4 days after the first dose of BNT162b2 vaccine. Troponin I level was elevated. Chest X-ray, electrocardiogram, echocardiogram, coronary angiography didn't show significant abnormalities. Cardiac Magnetic Resonance showed a pattern of acute myocarditis. The condition appeared to be self-limited and the patient recovered without specific therapy. No report of acute myocarditis was observed in the BNT162b2 and mRNA-1273 trials and very rare cases, in comparison to given doses, have been reported to pharmacovigilance systems worldwide. Further surveillance and evaluation of this side effect are warranted to establish the correct balance of benefits and risks of Covid-19 mRNA vaccines, above all in children and younger people (categories with the higher reactogenicity and the lower risk of Covid-19 complications). At the present time the benefits of Covid-19 vaccination significantly exceed possible risks.
Collapse
Affiliation(s)
- Anna Patrignani
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
| | - Nicolò Schicchi
- Radiology Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Marche, Italy
| | - Francesca Calcagnoli
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
| | - Elena Falchetti
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
| | - Nino Ciampani
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
| | - Giulio Argalia
- Radiology Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Marche, Italy
| | - Antonio Mariani
- Cardiology Department, Senigallia Hospital, ASUR Area Vasta 2, Via Cellini n°1, 60019, Senigallia (AN), Marche, Italy
| |
Collapse
|
71
|
Goldman BI, Choung HY, Sainvil M, Miller CW. The spectrum of macrophage-predominant inflammatory myocardial disease presenting as fulminant heart failure. Cardiovasc Pathol 2021; 57:107393. [PMID: 34699976 DOI: 10.1016/j.carpath.2021.107393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/29/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Endomyocardial biopsy results are integral for diagnosis and management of myocarditis. Current diagnostic classifications of myocarditis are based on the microscopic and immunochemical characterization of inflammation do not include monocyte/macrophage-predominant (i.e. "histiocytic") myocarditis as a histologic subtype. METHODS Endomyocardial biopsies from 6 patients with sudden heart failure were reviewed by 3 cardiac pathologists. Routine stains and immunostains to identify T cells and monocytes/macrophages, complement C4d, and endothelium were applied. Electron microscopy was performed in 2 cases. RESULTS The 6 patients included 2 with diagnoses of systemic lupus erythematosus (SLE) and 4 without known disease. Microscopy showed space-occupying inflammation in 2 cases and interstitial inflammation in 4. No giant cell myocarditis or eosinophilic myocarditis was found. Immunostains showed infiltration predominantly by macrophages and/or monocytes with markedly fewer T cells. In 4 of 6 cases necrotic cells were immunopositive for complement C4d. Monocytes we identified immunochemically within the microvasculature in 5 cases and by electron microscopy in 2. Patients with SLE had microvascular C4d positivity or interstitial/sarcolemmal staining. Clinical outcomes ranged from spontaneous resolution to persistent heart failure requiring an internal cardioverter/defibrillator. CONCLUSIONS (1) Heart failure with CD68 predominant inflammation ("histiocytic" myocardial inflammatory disease, HMID) occurs with variable clinical presentation and outcome; (2) HMID may be primary or secondary; (3) some cases of HMID show features suggestive of antibody and/or complement mediated myocardial injury, and (4) HMID is a diagnosis distinct from those in classification systems currently in use.
Collapse
|
72
|
Li B, Lento PA, Pan S. Inflammatory Cardiomyopathy: Case-based Review on Clinical Presentation, Diagnosis, and Management. Cardiol Rev 2021; 29:230-237. [PMID: 33165090 DOI: 10.1097/crd.0000000000000369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inflammatory cardiomyopathy is a broad term encompassing any disease leading to myocardial inflammation with associated cardiac dysfunction. While endomyocardial biopsy remains the gold standard for diagnosis, noninvasive imaging techniques, such as cardiac magnetic resonance imaging and positron emission tomography, have become powerful tools to facilitate the identification of underlying myocardial inflammation. This review presents a series of clinical cases with some common etiologies of inflammatory cardiomyopathy, including diagnosis and management.
Collapse
Affiliation(s)
- Boyangzi Li
- From the Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Patrick A Lento
- Department of Pathology, New York Medical College, Valhalla, NY
| | - Stephen Pan
- Department of Medicine, Division of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| |
Collapse
|
73
|
Frustaci A, Francone M, Verardo R, Scialla R, Bagnato G, Alfarano M, Chimenti C, Frustaci E, Sansone L, Russo M. Pemphigus-associated cardiomyopathy: report of autoimmune myocarditis and review of literature. ESC Heart Fail 2021; 8:3690-3695. [PMID: 34432378 PMCID: PMC8497363 DOI: 10.1002/ehf2.13474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/11/2021] [Accepted: 06/01/2021] [Indexed: 01/05/2023] Open
Abstract
Pemphigus is a rare disease characterized by bullous lesions of the skin and mucous membranes. The aetiology is autoimmune and related to the formation of IgG autoantibodies against desmogleins, which are structural proteins of desmosomes that ensure the stability of contacts between cells. Cardiac involvement in patients with pemphigus is poorly documented. We report the data in the literature on this topic and a case of pemphigus-associated autoimmune myocarditis with damage of intercalated disc responding to immunosuppressive therapy. The occurrence of cardiomyopathy with left ventricular dysfunction in patients affected by pemphigus should be appropriately screened with endomyocardial biopsy as it could be the myocardial extension of a potentially reversible autoimmune disorder.
Collapse
Affiliation(s)
- Andrea Frustaci
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University, Viale del Policlinico 155, Rome, 00161, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
| | - Romina Verardo
- Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy
| | - Rossella Scialla
- Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy
| | - Giulia Bagnato
- Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy
| | - Maria Alfarano
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University, Viale del Policlinico 155, Rome, 00161, Italy
| | - Cristina Chimenti
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University, Viale del Policlinico 155, Rome, 00161, Italy
| | - Emanuela Frustaci
- Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy
| | - Luigi Sansone
- Laboratory of Molecular and Cellular Pathology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Matteo Russo
- MEBIC Consortium, San Raffaele Open University and IRCCS San Raffaele Pisana, Rome, Italy
| |
Collapse
|
74
|
Puzanov I, Subramanian P, Yatsynovich YV, Jacobs DM, Chilbert MR, Sharma UC, Ito F, Feuerstein SG, Stefanovic F, Switzer B, Hicar MD, Curtis AB, Spangenthal EJ, Dy GK, Ernstoff MS, Vachhani P, Page BJ, Agrawal N, Khunger A, Kapoor A, Hattoum A, Jerome SJ. Clinical characteristics, time course, treatment and outcomes of patients with immune checkpoint inhibitor-associated myocarditis. J Immunother Cancer 2021; 9:jitc-2021-002553. [PMID: 34162715 PMCID: PMC8231054 DOI: 10.1136/jitc-2021-002553] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICI) have emerged as a front-line therapy for a variety of solid tumors. With the widespread use of these agents, immune-associated toxicities are increasingly being recognized, including fatal myocarditis. There are limited data on the outcomes and prognostic utility of biomarkers associated with ICI-associated myocarditis. Our objective was to examine the associations between clinical biomarkers of cardiomyocyte damage and mortality in patients with cancer treated with ICIs. Methods We retrospectively studied 23 patients who developed symptomatic and asymptomatic troponin elevations while receiving ICI therapy at a National Cancer Institute-designated comprehensive cancer center. We obtained serial ECGs, troponin I, and creatine kinase-MD (CK-MB), in addition to other conventional clinical biomarkers, and compared covariates between survivors and non-survivors. Results Among patients with myocarditis, higher troponin I (p=0.037) and CK-MB (p=0.034) levels on presentation correlated with progression to severe myocarditis. Higher troponin I (p=0.016), CK (p=0.013), and CK-MB (p=0.034) levels were associated with increased mortality, while the presence of advanced atrioventricular block on presentation (p=0.088) trended toward increased mortality. Weekly troponin monitoring lead to earlier hospitalization for potential myocarditis (p=0.022) and was associated with decreased time to steroid initiation (p=0.053) and improved outcomes. Conclusions Routine troponin surveillance may be helpful in predicting mortality in ICI-treated patients with cancer in the early phase of ICI therapy initiation. Early detection of troponin elevation is associated with earlier intervention and improved outcomes in ICI-associated myocarditis. The recommended assessment and diagnostic studies guiding treatment decisions are presented.
Collapse
Affiliation(s)
- Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | | | - Yan V Yatsynovich
- Department of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - David M Jacobs
- CPL Associates, Buffalo, New York, USA.,Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
| | - Maya R Chilbert
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
| | - Umesh C Sharma
- Department of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Fumito Ito
- Center for Immunotherapy, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.,Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Steven G Feuerstein
- CPL Associates, Buffalo, New York, USA.,Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
| | - Filip Stefanovic
- CPL Associates, Buffalo, New York, USA.,Department of Biomedical Engineering, University at Buffalo School of Engineering and Applied Sciences, Buffalo, New York, USA
| | - Benjamin Switzer
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Mark D Hicar
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Anne B Curtis
- Department of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Edward J Spangenthal
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Grace K Dy
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Marc S Ernstoff
- Division of Cancer Treatment and Diagnosis/Developmental Therapeutics Program, National Cancer Institute, Rockville, Maryland, USA
| | - Pankit Vachhani
- Department of Medicine, Division of Hematology and Oncology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Brian J Page
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Nikhil Agrawal
- Department of Cardiovascular Medicine, The University of Texas at Houston/MD Anderson Cancer Center, Houston, Texas, USA
| | - Arjun Khunger
- Department of Internal Medicine, Memorial Hospital West, Pembroke Pines, Florida, USA
| | - Ankita Kapoor
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Alexander Hattoum
- Department of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Schentag J Jerome
- CPL Associates, Buffalo, New York, USA.,Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
| |
Collapse
|
75
|
Serum Anti-Heart and Anti-Intercalated Disk Autoantibodies: Novel Autoimmune Markers in Cardiac Sarcoidosis. J Clin Med 2021; 10:jcm10112476. [PMID: 34199661 PMCID: PMC8199734 DOI: 10.3390/jcm10112476] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Sarcoidosis is an immune-mediated disease. Cardiac involvement, a granulomatous form of myocarditis, is under-recognized and prognostically relevant. Anti-heart autoantibodies (AHAs) and anti-intercalated disk autoantibodies (AIDAs) are autoimmune markers in nonsarcoidosis myocarditis forms. Objective: The aim was to assess serum AHAs and AIDAs as autoimmune markers in cardiac sarcoidosis. Methods: This is a cross-sectional study on AHA and AIDA frequency in: 29 patients (aged 46 ± 12, 20 male) with biopsy-proven extracardiac sarcoidosis and biopsy-proven or clinically suspected and confirmed by 18-fluorodeoxyglucose positron emission tomography and/or cardiovascular magnetic resonance (CMR) cardiac involvement; 30 patients (aged 44 ± 11, 12 male) with biopsy-proven extracardiac sarcoidosis without cardiac involvement (no cardiac symptoms, normal 12-lead electrocardiogram, echocardiography and CMR), and control patients with noninflammatory cardiac disease (NICD) (n = 160), ischemic heart failure (IHF) (n = 141) and normal blood donors (NBDs) (n = 270). Sarcoidosis patients were recruited in two recruiting tertiary centers in the USA and Italy. AHAs and AIDAs were detected by indirect immunofluorescence on the human myocardium and skeletal muscle. Results: AHA and AIDA frequencies were higher in sarcoidosis with cardiac involvement (86%; 62%) than in sarcoidosis without cardiac involvement (0%; 0%), NICD (8%; 4%), IHF (7%; 2%) and NBD (9%; 0%) (p = 0.0001; p = 0.0001, respectively). Sensitivity and specificity for cardiac sarcoidosis were 86% and 92% for positive AHAs and 62% and 98% for positive AIDAs, respectively. AIDAs in cardiac sarcoidosis were associated with a higher number of involved organs (p = 0.04). Conclusions: Serum AHAs and AIDAs provide novel noninvasive diagnostic autoimmune markers for cardiac sarcoidosis.
Collapse
|
76
|
Caforio ALP. Myocarditis: endomyocardial biopsy and circulating anti-heart autoantibodies are key to diagnosis and personalized etiology-directed treatment. Eur Heart J 2021; 42:1618-1620. [PMID: 33538808 DOI: 10.1093/eurheartj/ehab024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Alida L P Caforio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| |
Collapse
|
77
|
Abu Mouch S, Roguin A, Hellou E, Ishai A, Shoshan U, Mahamid L, Zoabi M, Aisman M, Goldschmid N, Berar Yanay N. Myocarditis following COVID-19 mRNA vaccination. Vaccine 2021; 39:3790-3793. [PMID: 34092429 PMCID: PMC8162819 DOI: 10.1016/j.vaccine.2021.05.087] [Citation(s) in RCA: 194] [Impact Index Per Article: 64.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/02/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
Background Clinical trials of the BNT162b2 vaccine, revealed efficacy and safety. We report six cases of myocarditis, which occurred shortly after BNT162b2 vaccination. Methods Patients were identified upon presentation to the emergency department with symptoms of chest pain/discomfort. In all study patients, we excluded past and current COVID-19. Routine clinical and laboratory investigations for common etiologies of myocarditis were performed. Laboratory tests also included troponin and C-reactive protein levels. The diagnosis of myocarditis was established after cardiac MRI. Findings Five patients presented after the second and one after the first dose of the vaccine. All patients were males with a median age of 23 years. Myocarditis was diagnosed in all patients, there was no evidence of COVID-19 infection. Laboratory assays excluded concomitant infection; autoimmune disorder was considered unlikely. All patients responded to the BNT162b2 vaccine. The clinical course was mild in all six patients. Interpretation Our report of myocarditis after BNT162b2 vaccination may be possibly considered as an adverse reaction following immunization. We believe our information should be interpreted with caution and further surveillance is warranted.
Collapse
Affiliation(s)
- Saif Abu Mouch
- Department of Internal Medicine B, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel.
| | - Ariel Roguin
- Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Elias Hellou
- Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Amorina Ishai
- Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; Department of Imaging, Hillel Yaffe Medical Center, Hadera, Israel
| | - Uri Shoshan
- Department of Internal Medicine B, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel
| | - Lamis Mahamid
- Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; Infectious Disease Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Marwan Zoabi
- Department of Internal Medicine B, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel
| | - Marina Aisman
- Department of Internal Medicine B, Hillel Yaffe Medical Center, Hadera, Israel
| | - Nimrod Goldschmid
- Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel
| | - Noa Berar Yanay
- Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; Department of Nephrology, Hillel Yaffe Medical Center, Hadera, Israel
| |
Collapse
|
78
|
Verdonschot JAJ, Merlo M, Dominguez F, Wang P, Henkens MTHM, Adriaens ME, Hazebroek MR, Masè M, Escobar LE, Cobas-Paz R, Derks KWJ, van den Wijngaard A, Krapels IPC, Brunner HG, Sinagra G, Garcia-Pavia P, Heymans SRB. Phenotypic clustering of dilated cardiomyopathy patients highlights important pathophysiological differences. Eur Heart J 2021; 42:162-174. [PMID: 33156912 PMCID: PMC7813623 DOI: 10.1093/eurheartj/ehaa841] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/05/2020] [Accepted: 09/25/2020] [Indexed: 01/05/2023] Open
Abstract
AIMS The dilated cardiomyopathy (DCM) phenotype is the result of combined genetic and acquired triggers. Until now, clinical decision-making in DCM has mainly been based on ejection fraction (EF) and NYHA classification, not considering the DCM heterogenicity. The present study aimed to identify patient subgroups by phenotypic clustering integrating aetiologies, comorbidities, and cardiac function along cardiac transcript levels, to unveil pathophysiological differences between DCM subgroups. METHODS AND RESULTS We included 795 consecutive DCM patients from the Maastricht Cardiomyopathy Registry who underwent in-depth phenotyping, comprising extensive clinical data on aetiology and comorbodities, imaging and endomyocardial biopsies. Four mutually exclusive and clinically distinct phenogroups (PG) were identified based upon unsupervised hierarchical clustering of principal components: [PG1] mild systolic dysfunction, [PG2] auto-immune, [PG3] genetic and arrhythmias, and [PG4] severe systolic dysfunction. RNA-sequencing of cardiac samples (n = 91) revealed a distinct underlying molecular profile per PG: pro-inflammatory (PG2, auto-immune), pro-fibrotic (PG3; arrhythmia), and metabolic (PG4, low EF) gene expression. Furthermore, event-free survival differed among the four phenogroups, also when corrected for well-known clinical predictors. Decision tree modelling identified four clinical parameters (auto-immune disease, EF, atrial fibrillation, and kidney function) by which every DCM patient from two independent DCM cohorts could be placed in one of the four phenogroups with corresponding outcome (n = 789; Spain, n = 352 and Italy, n = 437), showing a feasible applicability of the phenogrouping. CONCLUSION The present study identified four different DCM phenogroups associated with significant differences in clinical presentation, underlying molecular profiles and outcome, paving the way for a more personalized treatment approach.
Collapse
Affiliation(s)
- Job A J Verdonschot
- Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Fernando Dominguez
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Ping Wang
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michiel T H M Henkens
- Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Michiel E Adriaens
- Maastricht Centre for Systems Biology, Maastricht University, Maastricht, The Netherlands
| | - Mark R Hazebroek
- Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Marco Masè
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Luis E Escobar
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Rafael Cobas-Paz
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Kasper W J Derks
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arthur van den Wijngaard
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ingrid P C Krapels
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Han G Brunner
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen.,GROW Institute for Developmental Biology and Cancer, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Pablo Garcia-Pavia
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain.,Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcon, Spain
| | - Stephane R B Heymans
- Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands.,Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, KU Leuven, Belgium.,The Netherlands Heart Institute, Nl-HI, Utrecht, The Netherlands
| |
Collapse
|
79
|
Fragoulis GE, Soulaidopoulos S, Sfikakis PP, Dimitroulas T, D Kitas G. Effect of Biologics on Cardiovascular Inflammation: Mechanistic Insights and Risk Reduction. J Inflamm Res 2021; 14:1915-1931. [PMID: 34017189 PMCID: PMC8131071 DOI: 10.2147/jir.s282691] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022] Open
Abstract
It is increasingly recognized that atherosclerosis and consequently cardiovascular disease (CVD) are closely linked with inflammatory processes. The latter is in the center of the pathogenic mechanism underlying autoimmune rheumatic diseases (ARD). It follows then, that optimal control of inflammation in ARDs may lead to a decrease of the accompanied CVD risk. Major trials (eg, CANTOS, CIRT), aimed at examining the possible benefits of immunomodulatory treatments in CVD, demonstrated conflicting results. On the other hand, substantial evidence is accumulating about the possible beneficial effects of biologic disease modifying antirheumatic drugs (bDMARDs) in patients with ARDs, particularly those with rheumatoid arthritis (RA). It seems that bDMARDs (some more than others) alter the lipid profile in RA patients but do not adversely affect, in most cases, the TC/HDL ratio. Favorable effects are noted for arterial stiffness and endothelial function. This is reflected in the lower risk for CVD events, seen in observational studies of RA patients treated with bDMARDs. It should be stressed that more data exist for the TNF-inhibitors than for other bDMARDs, such as tocilizumab, abatacept and rituximab. As regards the spondyloarthropathies (SpA), data are less robust. For TNF-inhibitors, effects appear to be on par with those seen in RA but no conclusions can be drawn for newer biologic drugs used in SpA (eg, IL-17 blockers). Finally, there is accumulating evidence for a beneficial effect of immunosuppressive treatment in cardiac inflammation and function in several ARDs. Introduction of newer therapeutic options in clinical practice seem to have a positive impact on CVD in the setting of ARD. This is probably due to better control of inflammation, but direct improvement in vascular pathology is also a valid hypothesis. Most data are derived from observational studies and, therefore, randomized controlled trials are needed to assess the possible favorable effect of bDMARDs on CVD outcomes.
Collapse
Affiliation(s)
- George E Fragoulis
- Rheumatology Unit, Joint Rheumatology Program, Medical School, First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, 115 27, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, 115 27, Greece
| | - Petros P Sfikakis
- Rheumatology Unit, Joint Rheumatology Program, Medical School, First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, 115 27, Greece
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 546 41, Greece
| | - George D Kitas
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS FT, Dudley, DY1 2HQ, UK.,Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, M13 9PT, UK
| |
Collapse
|
80
|
Ederhy S, Salem JE, Dercle L, Hasan AS, Chauvet-Droit M, Nhan P, Ammari S, Pinna B, Redheuil A, Boussouar S, Champiat S, Soulat-Dufour L, Cohen A. Role of Cardiac Imaging in the Diagnosis of Immune Checkpoints Inhibitors Related Myocarditis. Front Oncol 2021; 11:640985. [PMID: 34055610 PMCID: PMC8158154 DOI: 10.3389/fonc.2021.640985] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/24/2021] [Indexed: 11/13/2022] Open
Abstract
Immune checkpoint inhibitors (ICI) have constituted a paradigm shift in the management of patients with cancer. Their administration is associated with a new spectrum of immune-related toxicities that can affect any organ. In patients treated with ICI, cardiovascular toxicities, particularly myocarditis, occur with a low incidence (<1%) but with a high fatality rate (30-50%). ICI-related myocarditis has been attributed to an immune infiltration, comprising of T-cells that are positive for CD3+, CD4+, CD8+, and macrophages that are positive for CD68. The diagnosis remains challenging and is made based on clinical syndrome, an electrocardiogram (ECG), biomarker data, and imaging criteria. In most clinical scenarios, endomyocardial biopsy plays a pivotal role in diagnosis, while cardiac magnetic resonance imaging (cMRI) has limitations that should be acknowledged. In this review, we discuss the role of medical imaging in optimizing the management of ICI related myocarditis, including diagnosis, prognostication, and treatment decisions.
Collapse
Affiliation(s)
- Stéphane Ederhy
- Department of Cardiology, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
- UNICO-GRECO APHP.Sorbonne Cardio-Oncology Program, Sorbonne Université, Paris, France
| | - Joe-Elie Salem
- UNICO-GRECO APHP.Sorbonne Cardio-Oncology Program, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM CIC-1901, AP-HP.Sorbonne, Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France
- Unité INSERM UMRS-ICAN 1166, Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, Sorbonne Universités, Paris, France
- Division of Medicine and Pharmacology, Cardio-oncology program, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Laurent Dercle
- Department of Radiology, New York Presbyterian, Columbia University Irving Medical Center, New York, NY, United States
| | - Abrar Saqif Hasan
- Department of Internal Medicine, Montefiore/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Marion Chauvet-Droit
- Department of Cardiology, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Pascal Nhan
- Department of Cardiology, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Samy Ammari
- Radiology Department, Gustave Roussy Cancer Campus, Villejuif, France
- BIOMAPS, UMR1281, INSERM.CEA.CNRS, Université Paris-Saclay, Paris, France
| | - Bruno Pinna
- UNICO-GRECO APHP.Sorbonne Cardio-Oncology Program, Sorbonne Université, Paris, France
| | - Alban Redheuil
- LIB Biomedical Imaging Laboratory INSERM, CNRS, ICT Cardiothoracic Imaging Unit & Radiology Department, ICAN Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, Paris, France
| | - Samia Boussouar
- LIB Biomedical Imaging Laboratory INSERM, CNRS, ICT Cardiothoracic Imaging Unit & Radiology Department, ICAN Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, Paris, France
| | - Stephane Champiat
- Drug Development Department (DITEP), Institut Gustave Roussy, Villejuif, France
| | - Laurie Soulat-Dufour
- Department of Cardiology, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Ariel Cohen
- Department of Cardiology, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
- UNICO-GRECO APHP.Sorbonne Cardio-Oncology Program, Sorbonne Université, Paris, France
| |
Collapse
|
81
|
Kotit S, Yacoub M. Cardiovascular adverse events in pregnancy: A global perspective. Glob Cardiol Sci Pract 2021; 2021:e202105. [PMID: 34036091 PMCID: PMC8133785 DOI: 10.21542/gcsp.2021.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022] Open
Abstract
Pregnant women with heart disease are vulnerable to many adverse cardiovascular events (AE). AEs during and after pregnancy continue to be important causes of maternal mortality and morbidity worldwide, with huge variations in burden in different countries and regions. These AEs are classified as having direct or indirect causes, depending on whether they are directly caused by pregnancy or due to some pre-existing disease and/or non-obstetric cause, respectively. The risks continue throughout pregnancy and even after childbirth. Apart from immediate complications during pregnancy, there is increasing evidence of a significant link between several events and the risk of cardiovascular disease (CVD) later in life. A significant number of pregnancy-related deaths caused by cardiovascular disease are preventable. This prevention can be realized through increasing awareness of cardiovascular AE in pregnancy, coupled with the application of strategies for prevention and treatment. Knowledge of the risks associated with CVD and pregnancy is of extreme importance in that regard. We discuss the global distribution of cardiovascular maternal mortality, adverse events during and after pregnancy, their predictors and risk stratification. In addition, we enumerate possible solutions, particularly the role of cardio-obstetric clinics.
Collapse
|
82
|
Méndez Eirín E, Suárez Ouréns Y, Guerra Vázquez JL. Cardiac manifestations of rheumatic diseases. Med Clin (Barc) 2021; 156:615-621. [PMID: 33836859 DOI: 10.1016/j.medcli.2021.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
Abstract
Autoimmune rheumatic diseases are inflammatory disorders that can involve multiple organs, including the heart. The high risk of cardiovascular pathology in these patients is not only due to traditional cardiovascular risk factors, but also to chronic inflammation and autoimmunity. All cardiac structures may be affected during the course of systemic autoimmune diseases (valves, the conduction system, the myocardium, endocardium and pericardium, and coronary arteries), and the cardiac complications have a variety of clinical manifestations. As these are all associated with an unfavourable prognosis, it is essential to detect subclinical cardiac involvement in asymptomatic systemic autoimmune disease patients and begin adequate management and treatment early. In this review, we examine the multiple cardiovascular manifestations in patients with rheumatological disorders and available management strategies.
Collapse
Affiliation(s)
- Elizabet Méndez Eirín
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, España.
| | - Yago Suárez Ouréns
- Servicio de Traumatología, Complejo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España
| | - José Luis Guerra Vázquez
- Servicio de Reumatología, Complejo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España
| |
Collapse
|
83
|
Saramet EE, Cojocaru DC, Ungurianu S, Negru RD, Ancuta C. QT Interval Prolongation in Patients with Systemic Sclerosis-Are the Holter ECG Recordings a Better Option for QT Interval Evaluation? ACTA ACUST UNITED AC 2021; 57:medicina57030295. [PMID: 33809849 PMCID: PMC8004093 DOI: 10.3390/medicina57030295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/06/2021] [Accepted: 03/17/2021] [Indexed: 11/19/2022]
Abstract
Background and Objectives: Cardiac involvement in systemic sclerosis has important consequences on patient survival. Myocardial fibrosis and microcirculation involvement can generate arrhythmic complications, which can be associated with a higher death risk. QT interval prolongation is considered as a risk factor for ectopic ventricular events and can be evaluated using standard short ECG recordings or 24-h Holter ECG recordings. Materials and Methods: 39 patients with systemic sclerosis were submitted to a standard ECG recording at admission and 24-h Holter ECG monitoring. Results: QT interval values resulted from Holter ECG monitoring are higher than the values generated by the short-term ECG recordings. Holter ECG monitoring permits the detection of ventricular ectopy in patients with no events on standard ECG. Conclusions: In patients with systemic sclerosis, 24-h Holter ECG recordings can realize a more precise evaluation of the extent of QTc interval prolongation and ventricular ectopic events associated with myocardial involvement.
Collapse
Affiliation(s)
- Elena E. Saramet
- Department of Internal Medicine, Gr T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (E.E.S.); (D.-C.C.); (C.A.)
| | - Doina-Clementina Cojocaru
- Department of Internal Medicine, Gr T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (E.E.S.); (D.-C.C.); (C.A.)
| | - Sorin Ungurianu
- Department of Surgery, Dunarea de Jos University, 800008 Galati, Romania;
| | - Robert D. Negru
- Department of Internal Medicine, Gr T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (E.E.S.); (D.-C.C.); (C.A.)
- Correspondence:
| | - Codrina Ancuta
- Department of Internal Medicine, Gr T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (E.E.S.); (D.-C.C.); (C.A.)
| |
Collapse
|
84
|
Moslehi J, Lichtman AH, Sharpe AH, Galluzzi L, Kitsis RN. Immune checkpoint inhibitor-associated myocarditis: manifestations and mechanisms. J Clin Invest 2021; 131:145186. [PMID: 33645548 DOI: 10.1172/jci145186] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have transformed the treatment of various cancers, including malignancies once considered untreatable. These agents, however, are associated with inflammation and tissue damage in multiple organs. Myocarditis has emerged as a serious ICI-associated toxicity, because, while seemingly infrequent, it is often fulminant and lethal. The underlying basis of ICI-associated myocarditis is not completely understood. While the importance of T cells is clear, the inciting antigens, why they are recognized, and the mechanisms leading to cardiac cell injury remain poorly characterized. These issues underscore the need for basic and clinical studies to define pathogenesis, identify predictive biomarkers, improve diagnostic strategies, and develop effective treatments. An improved understanding of ICI-associated myocarditis will provide insights into the equilibrium between the immune and cardiovascular systems.
Collapse
Affiliation(s)
- Javid Moslehi
- Division of Cardiovascular Medicine and Division of Oncology, Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew H Lichtman
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Arlene H Sharpe
- Department of Immunology and Blavatnik Institute, Harvard Medical School, Boston, Massachusetts, USA.,Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lorenzo Galluzzi
- Department of Radiation Oncology, Sandra and Edward Meyer Cancer Center, Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, New York, USA.,Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA.,Université de Paris, Paris, France
| | - Richard N Kitsis
- Departments of Medicine and Cell Biology, Wilf Family Cardiovascular Research Institute, and Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
85
|
Schulze-Bahr E, Dettmeyer RB, Klingel K, Kauferstein S, Wolf C, Baba HA, Bohle RM, Gebauer R, Milting H, Schmidt U, Meder B, Rieß O, Paul T, Bajanowski T, Schunkert H. Postmortale molekulargenetische Untersuchungen (molekulare Autopsie) bei kardiovaskulären und bei ungeklärten Todesfällen. KARDIOLOGE 2021. [DOI: 10.1007/s12181-020-00438-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
86
|
Marcolongo R, Rizzo S, Cerutti A, Reffo E, Castaldi B, Baritussio A, Basso C, Di Salvo G, Caforio AL. The multiple faces of autoimmune/immune-mediated myocarditis in children: a biopsy-proven case series treated with immunosuppressive therapy. ESC Heart Fail 2021; 8:1604-1609. [PMID: 33452872 PMCID: PMC8006650 DOI: 10.1002/ehf2.13163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 12/23/2022] Open
Abstract
The role of immunosuppressive therapy (IT) in paediatric autoimmune/immune‐mediated myocarditis remains poorly defined. To explore its role, we present a series of three consecutive paediatric patients with biopsy‐proven, virus negative, autoimmune/immune‐mediated myocarditis, with distinct clinical and pathological features, who have been successfully treated with IT, a 14‐year‐old boy with Loeffler's fibroblastic parietal endomyocarditis, a 6‐year‐old child with celiac disease with chronic active lymphocytic myocarditis, and a 13‐year‐old boy with long‐standing heart failure and active lymphocytic myocarditis. Patients started IT and entered follow‐up between July 2017 and September 2019; the first patient completed IT. IT was associated with a substantial and sustained recovery of cardiac function in our patients, regardless of their heterogeneous clinical and pathological features. Combination IT was well tolerated and enabled tapering and weaning off steroids.
Collapse
Affiliation(s)
- Renzo Marcolongo
- Hematology and Clinical Immunology, Department of MedicineUniversity of PadovaPadovaItaly
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Alessia Cerutti
- Pediatric Cardiology, Department of Woman and Child HealthUniversity of PadovaPadovaItaly
| | - Elena Reffo
- Pediatric Cardiology, Department of Woman and Child HealthUniversity of PadovaPadovaItaly
| | - Biagio Castaldi
- Pediatric Cardiology, Department of Woman and Child HealthUniversity of PadovaPadovaItaly
| | - Anna Baritussio
- Division of Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Giovanni Di Salvo
- Pediatric Cardiology, Department of Woman and Child HealthUniversity of PadovaPadovaItaly
| | - Alida L.P. Caforio
- Division of Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| |
Collapse
|
87
|
Clinical Outcomes of Myocarditis after Moderate-Dose Steroid Therapy in Systemic Sclerosis: A Pilot Study. Int J Rheumatol 2021; 2020:8884442. [PMID: 33414828 PMCID: PMC7769651 DOI: 10.1155/2020/8884442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/26/2020] [Accepted: 12/08/2020] [Indexed: 12/02/2022] Open
Abstract
Background Myocarditis is reported in systemic sclerosis (SSc); however, treatment options and outcomes are limited. Our objective was to define cardiac outcomes after moderate-dose steroid therapy in SSc patients with myocarditis. Method An open-label study was conducted among SSc patients with myocarditis—as defined by cardiovascular magnetic resonance (CMR), disease onset <5 years, and a NYHA functional class ≥II. All enrolled patients received prednisolone (30 mg/d) which would be tapered off by week 24, and CMR was followed up at the end of treatment. Results A total of 20 SSc patients were enrolled which 12 patients completed the study. At week 24, 8 of the 12 cases experienced improvement of myocarditis. Compared to those with no improvement, these 8 patients had significantly longer disease duration (p = 0.03), higher heart rate at baseline (p = 0.049) and week 24 (p = 0.04), lower left ventricular (LV) and right ventricular (RV) stroke volume at baseline (p = 0.002 and p = 0.01) and week 24 (p = 0.01 and p = 0.02), and lower LV and RV cardiac output at week 24 (p = 0.01 and p = 0.01). Four cases died during follow-up (3 due to cardiac complications, 1 due to renal crisis). The two who died from heart failure had very high NT-prohormone-brain natriuretic peptide (NT-proBNP) and impaired LV ejection fraction (LVEF), and the one who died from arrhythmia had very high sensitivity of cardiac Troponin-T (hs-cTnT). Conclusions Moderate-dose steroid therapy may improve myocarditis in SSc. A proportion of patients died due to cardiac complications during treatment, particularly those with high hs-cTnT, high NT-proBNP, and impaired LVEF. This trial is registered with NCT03607071.
Collapse
|
88
|
Abstract
Purpose of Review Immune checkpoint inhibitors, such as monoclonal antibodies targeting CTLA-4, PD-1, and PD-L1, have improved the outcome of many malignancies, but serious immune-related cardiovascular adverse events have been observed. Patients’ risk factors for these toxicities are currently being investigated. Recent Findings Interfering with the CTLA-4 and PD-1 axes can bring to several immune-related adverse events, including cardiotoxic events such as autoimmune myocarditis, pericarditis, and vasculitis, suggesting that these molecules play an important role in preventing autoimmunity. Summary Risk factors (such as pre-existing cardiovascular conditions, previous and concomitant cardiotoxic treatments, underlying autoimmune diseases, tumor-related factors, simultaneous immune-related toxic effects, and genetic factors) should be always recognized for the correct management of these toxicities.
Collapse
|
89
|
Mangion K, Morrow A, Bagot C, Bayes H, Blyth KG, Church C, Corcoran D, Delles C, Gillespie L, Grieve D, Ho A, Kean S, Lang NN, Lennie V, Lowe DJ, Kellman P, Macfarlane PW, McConnachie A, Roditi G, Sykes R, Touyz RM, Sattar N, Wereski R, Wright S, Berry C. The Chief Scientist Office Cardiovascular and Pulmonary Imaging in SARS Coronavirus disease-19 (CISCO-19) study. Cardiovasc Res 2020; 116:2185-2196. [PMID: 32702087 PMCID: PMC7454350 DOI: 10.1093/cvr/cvaa209] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND COVID-19 is typically a primary respiratory illness with multisystem involvement. The prevalence and clinical significance of cardiovascular and multisystem involvement in COVID-19 remain unclear. METHODS This is a prospective, observational, multicentre, longitudinal, cohort study with minimal selection criteria and a near-consecutive approach to screening. Patients who have received hospital care for COVID-19 will be enrolled within 28 days of discharge. Myocardial injury will be diagnosed according to the peak troponin I in relation to the upper reference limit (URL, 99th centile) (Abbott Architect troponin I assay; sex-specific URL, male: >34 ng/L; female: >16 ng/L). Multisystem, multimodality imaging will be undertaken during the convalescent phase at 28 days post-discharge (Visit 2). Imaging of the heart, lung, and kidneys will include multiparametric, stress perfusion, cardiovascular magnetic resonance imaging, and computed tomography coronary angiography. Health and well-being will be assessed in the longer term. The primary outcome is the proportion of patients with a diagnosis of myocardial inflammation. CONCLUSION CISCO-19 will provide detailed insights into cardiovascular and multisystem involvement of COVID-19. Our study will inform the rationale and design of novel therapeutic and management strategies for affected patients. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04403607.
Collapse
Affiliation(s)
- Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Andrew Morrow
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Hannah Bayes
- Department of Respiratory Medicine, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Colin Church
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Christian Delles
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Douglas Grieve
- Department of Respiratory Medicine, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Sharon Kean
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ninian N Lang
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Vera Lennie
- Department of Cardiology, University Hospital Ayr, Ayrshire and Arran Health Board, Ayr, UK
| | - David J Lowe
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Peter W Macfarlane
- Electrocardiography Core Laboratory, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Alex McConnachie
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Giles Roditi
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Robert Sykes
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Rhian M Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ryan Wereski
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- Department of Cardiology, University Hospital Ayr, Ayrshire and Arran Health Board, Ayr, UK
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Sylvia Wright
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Respiratory Medicine, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| |
Collapse
|
90
|
Donal E, Delgado V, Bucciarelli-Ducci C, Galli E, Haugaa KH, Charron P, Voigt JU, Cardim N, Masci PG, Galderisi M, Gaemperli O, Gimelli A, Pinto YM, Lancellotti P, Habib G, Elliott P, Edvardsen T, Cosyns B, Popescu BA. Multimodality imaging in the diagnosis, risk stratification, and management of patients with dilated cardiomyopathies: an expert consensus document from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2020; 20:1075-1093. [PMID: 31504368 DOI: 10.1093/ehjci/jez178] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/19/2019] [Indexed: 12/12/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is defined by the presence of left ventricular or biventricular dilatation and systolic dysfunction in the absence of abnormal loading conditions or coronary artery disease sufficient to explain these changes. This is a heterogeneous disease frequently having a genetic background. Imaging is important for the diagnosis, the prognostic assessment and for guiding therapy. A multimodality imaging approach provides a comprehensive evaluation of all the issues related to this disease. The present document aims to provide recommendations for the use of multimodality imaging according to the clinical question. Selection of one or another imaging technique should be based on the clinical condition and context. Techniques are presented with the aim to underscore what is 'clinically relevant' and what are the tools that 'can be used'. There remain some gaps in evidence on the impact of multimodality imaging on the management and the treatment of DCM patients where ongoing research is important.
Collapse
Affiliation(s)
- Erwan Donal
- Service de Cardiologie et CIC-IT INSERM 1414, CHU Pontchaillou, 2 rue Henri Le Guilloux, Rennes, France.,LTSI, Université de Rennes 1, INSERM, UMR, Rennes, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden RC, The Netherlands
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, University of Bristol, University Hospitals Bristol NHS Foundation Trust, Malborough St, Bristol, UK
| | - Elena Galli
- Service de Cardiologie et CIC-IT INSERM 1414, CHU Pontchaillou, 2 rue Henri Le Guilloux, Rennes, France.,LTSI, Université de Rennes 1, INSERM, UMR, Rennes, France
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway
| | - Philippe Charron
- Centre de Référence pour les Maladies Cardiaques Héréditaires, APHP, ICAN, Hôpital de la Pitié Salpêtrière, Paris, France.,Université Versailles Saint Quentin & AP-HP, CESP, INSERM U1018, Service de Génétique, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Nuno Cardim
- Cardiology Department, Hospital da Luz, Av. Lusíada, n° 100, Lisbon, Portugal
| | - P G Masci
- HeartClinic, Hirslanden Hospital Zurich, Witellikerstrasse 32, CH Zurich, Switzerland
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Oliver Gaemperli
- HeartClinic, Hirslanden Hospital Zurich, Witellikerstrasse 32, CH Zurich, Switzerland
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, Pisa, Italy
| | - Yigal M Pinto
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, B Liège, Belgium
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, Boulevard Jean Moulin, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Boulevard Jean Moulin, Marseille, France
| | - Perry Elliott
- Institute of Cardiovascular Science, University College London, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Thor Edvardsen
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway
| | - Bernard Cosyns
- Centrum voor Hart en Vaatziekten (CHVZ), Unversitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussel, Belgium
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"- Euroecolab, Emergency Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, Sector 2, Bucharest, Romania
| | | |
Collapse
|
91
|
Efficacy of immunosuppressive therapy in myocarditis: A 30-year systematic review and meta analysis. Autoimmun Rev 2020; 20:102710. [PMID: 33197576 DOI: 10.1016/j.autrev.2020.102710] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/01/2020] [Indexed: 12/20/2022]
Abstract
AIMS Myocarditis is an inflammation of the heart muscle, due to infectious, toxic or autoimmune causes. Literature reported controversial results in relation to the effect of immunosuppression (IS)/immunomodulation (IM). We aimed at assessing the effect of IS/IM by meta analysis. METHODS AND RESULTS Using the P.R.I.S.M.A. approach, two researchers searched for relevant studies on PubMed, Embase, and the Central Registry of Controlled Trials of the Cochrane Library. Proposed MeSH terms were: "immunotherapy OR immune therapy OR immune modeling OR Immunosuppressive Agents" AND "combination OR combined with OR plus" AND "myocarditis OR cardiomyopathies OR inflammatory cardiomyopathy". The language was restricted to English. Reference lists of included articles and those relevant to the topic were hand searched for the identification of additional, potentially relevant articles. The cutoff date was from 1987 until 30th Nov 2019. Reported survival or mortality events or change of left ventricular ejection fraction (LVEF) after IS/IT were primary outcomes of the study; in addition, improvement of New York Heart Association class, follow-up biopsy (Bx) findings, viral genome clearance on Bx and recurrence of myocarditis were recorded if reported. Statistical analysis was conducted using Review Manager 5.3; 5452 studies were screened, of these 73 were assessed for eligibility, including 8 randomized control studies, 26 retrospective studies, 2 prospective studies and 1 case control study, 34 case reports and 2 case series. In prospective studies, the difference in mortality between the IS and control groups tended to be lower in the combined IS groups (12.5% vs. 18.2%) (95% CI of odds ratio 0.7(0.3, 1.64)) and the pooled difference of the increase of LVEF between the IS and control groups tended to be higher in the combined IS groups (95% CI 7.26 (-2.29, 16.81)). In retrospective studies, the difference of survival between the IS and control group was significantly in favor of IS (95%CI Hazard ratio 0.82(0.69, 0.96)). CONCLUSIONS A tailored IS may be considered in myocarditis, depending on the phase of the disease, and the type of underlying autoimmune or immune-mediated form.
Collapse
|
92
|
Valente T, Pignatiello M, Sica G, Bocchini G, Rea G, Cappabianca S, Scaglione M. Hemopericardium in the acute clinical setting: Are we ready for a tailored management approach on the basis of MDCT findings? LA RADIOLOGIA MEDICA 2020; 126:527-543. [PMID: 33136215 DOI: 10.1007/s11547-020-01303-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
The clinical spectrum of pericardial effusions varies from innocuous serous fluid to life-threatening hemopericardium. A misdiagnosis may be made by similar clinical presentation of acute chest pain/hypotension. Echocardiography is the first-line test for diagnosis of pericardial effusion and its etiology, but sometimes there are different drawbacks to the correct cardiovascular ultrasound diagnosis. Radiologists are reporting an increasing amount of thoracic Multidetector CT examinations at the emergency department. Multidetector CT has now become an established and complementary method for cardiac imaging, and diseases of the pericardium can now be quickly identified with increasing certainty. The aim of this review is to discuss the hemopericardium key Multidetector CT features in acute clinical setting which indicate the need to proceed with predominantly medical or surgical treatment, however, being able to identify forms of bleeding pericardial effusion for which only "a watch and wait strategy" and/or deferred treatment is indicated. In the emergency care setting, radiologists must be aware of different findings of hemopericardium in order to address a tailored and timely management approach.
Collapse
Affiliation(s)
- Tullio Valente
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy.
| | - Maria Pignatiello
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Giacomo Sica
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Giorgio Bocchini
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Gaetano Rea
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Mariano Scaglione
- Department of Diagnostic Imaging, Pineta Grande Hospital, Castelvolturno, Italy
- Department of Radiology, Tesside University, Middlesbrough, UK
- James Cook University Hospital, Middlesbrough, UK
| |
Collapse
|
93
|
Chimenti C, Alfarano M, Toto F, Fanisio F, Verardo R, Galea N, Agati L, Frustaci A. Myocarditis and intramural coronary vasculitis in polyarteritis nodosa: an unusual treatable form of heart failure. ESC Heart Fail 2020; 7:4357-4360. [PMID: 33094911 PMCID: PMC7754977 DOI: 10.1002/ehf2.13012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/30/2020] [Accepted: 08/26/2020] [Indexed: 11/09/2022] Open
Abstract
We describe an uncommon cardiac presentation of polyarteritis nodosa. A 68-year-old woman, with a history of fatigue, weight loss, and myalgia of the lower extremities, was admitted for congestive heart failure. Coronary arteries were normal. Endomyocardial biopsy showed active lymphocytic myocarditis with associated intramural small vessels necrotizing vasculitis. The overexpression of TLR-4 and the negativity for myocardial viruses suggested an immune mediated mechanism of cardiac damage. These histologic findings associated to weight loss >4 kg not due to dieting or other factors, myalgias, and polyneuropathy, were consistent with the diagnosis of polyarteritis nodosa. Immunosuppressive treatment, consisting of cyclophosphamide and prednisolone, led to a significant improvement of cardiac function. Polyarteritis nodosa can be the cause of unexplained heart failure due to myocarditis and intramural vessels vasculitis. Its recognition is crucial to obtain a cardiac recovery with a tailored immunosuppressive treatment.
Collapse
Affiliation(s)
- Cristina Chimenti
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University, Viale del Policlinico 155, Rome, 00161, Italy.,Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy
| | - Maria Alfarano
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University, Viale del Policlinico 155, Rome, 00161, Italy
| | - Federica Toto
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University, Viale del Policlinico 155, Rome, 00161, Italy
| | - Francesca Fanisio
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University, Viale del Policlinico 155, Rome, 00161, Italy
| | - Romina Verardo
- Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy
| | - Nicola Galea
- Department of Experimental Medicine, La Sapienza University, Rome, Italy
| | - Luciano Agati
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University, Viale del Policlinico 155, Rome, 00161, Italy
| | - Andrea Frustaci
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University, Viale del Policlinico 155, Rome, 00161, Italy.,Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy
| |
Collapse
|
94
|
Pudil R, Mueller C, Čelutkienė J, Henriksen PA, Lenihan D, Dent S, Barac A, Stanway S, Moslehi J, Suter TM, Ky B, Štěrba M, Cardinale D, Cohen‐Solal A, Tocchetti CG, Farmakis D, Bergler‐Klein J, Anker MS, Von Haehling S, Belenkov Y, Iakobishvili Z, Maack C, Ciardiello F, Ruschitzka F, Coats AJ, Seferovic P, Lainscak M, Piepoli MF, Chioncel O, Bax J, Hulot J, Skouri H, Hägler‐Laube ES, Asteggiano R, Fernandez TL, Boer RA, Lyon AR. Role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies: a position statement from the
Cardio‐Oncology Study Group
of the
Heart Failure Association
and the
Cardio‐Oncology Council of the European Society of Cardiology. Eur J Heart Fail 2020; 22:1966-1983. [DOI: 10.1002/ejhf.2017] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/14/2020] [Accepted: 09/25/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Radek Pudil
- 1st Department Medicine – Cardioangiology Charles University Prague, Medical Faculty and University Hospital Hradec Kralove Prague Czech Republic
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology University Hospital Basel, University of Basel Basel Switzerland
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Vilnius Lithuania
- State Research Institute Centre For Innovative Medicine Vilnius Lithuania
| | | | - Dan Lenihan
- Cardio‐Oncology Center of Excellence Washington University in St Louis St Louis MO USA
| | - Susan Dent
- Duke Cancer Institute Duke University Durham NC USA
| | - Ana Barac
- MedStar Heart and Vascular Institute Georgetown University Washington DC USA
| | | | - Javid Moslehi
- Cardio‐Oncology Program, Department of Medicine Vanderbilt University Medical Center Nashville TN USA
| | - Thomas M. Suter
- Department of Cardiology Bern University Hospital, Inselspital, University of Bern Bern Switzerland
| | - Bonnie Ky
- University of Pennsylvania Philadelphia PA USA
| | - Martin Štěrba
- Department of Pharmacology Faculty of Medicine in Hradec Kralove, Charles University Hradec Kralove Czech Republic
| | - Daniela Cardinale
- Cardioncology Unit European Institute of Oncology, IRCCS Milan Italy
| | - Alain Cohen‐Solal
- UMR‐S 942, Paris University, Cardiology Department, Lariboisiere Hospital, AP‐HP Paris France
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Research (CIRCET) ‘Federico II’ University Naples Italy
| | - Dimitrios Farmakis
- University of Cyprus Medical School Nicosia Cyprus
- Cardio‐Oncology Clinic, Heart Failure Unit, ‘Attikon’ University Hospital Athens Greece
- National and Kapodistrian University of Athens Medical School Athens Greece
| | | | - Markus S. Anker
- Division of Cardiology and Metabolism, Department of Cardiology Charité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research), partner site Berlin and Department of Cardiology, Charité Campus Benjamin Franklin Berlin Germany
| | - Stephan Von Haehling
- Department of Cardiology and Pneumology University of Goettingen Medical Center Goettingen Germany
- German Center for Cardiovascular Research (DZHK), partner site Goettingen Goettingen Germany
| | | | - Zaza Iakobishvili
- Department of Community Cardiology Tel Aviv Jaffa District, Clalit Health Fund and Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Christoph Maack
- Comprehensive Heart Failure Center University Clinic Würzburg Würzburg Germany
| | - Fortunato Ciardiello
- Department of Precision Medicine ‘Luigi Vanvitelli’ University of Campania Naples Italy
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Andrew J.S. Coats
- University of Warwick Warwick UK
- Pharmacology Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana Rome Italy
| | - Petar Seferovic
- Faculty of Medicine and Serbian Academy of Sciences and Arts University of Belgrade Belgrade Serbia
| | | | - Massimo F. Piepoli
- Cardiac Department ‘Guglielmo da Saliceto’ Polichirurgico Hospital AUSL Piacenza Piacenza Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’ Bucharest Romania
- University of Medicine Carol Davila Bucharest Romania
| | - Jereon Bax
- Department of Cardiology Leiden University Medical Centre Leiden The Netherlands
| | - Jean‐Sebastien Hulot
- Université de Paris CIC1418, Paris Cardiovascular Research Center, INSERM Paris France
| | - Hadi Skouri
- Cardiology Division, Internal Medicine Department at American University of Beirut Medical Center Beirut Lebanon
| | | | | | - Teresa Lopez Fernandez
- Cardiology Service Cardio‐Oncology Unit, La Paz University Hospital and IdiPAz Research Institute, Ciber CV Madrid Spain
| | - Rudolf A. Boer
- Department of Cardiology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Alexander R. Lyon
- Cardio‐Oncology Service Royal Brompton Hospital and Imperial College London London UK
| |
Collapse
|
95
|
Abstract
Inflammatory cardiomyopathy, characterized by inflammatory cell infiltration into the myocardium and a high risk of deteriorating cardiac function, has a heterogeneous aetiology. Inflammatory cardiomyopathy is predominantly mediated by viral infection, but can also be induced by bacterial, protozoal or fungal infections as well as a wide variety of toxic substances and drugs and systemic immune-mediated diseases. Despite extensive research, inflammatory cardiomyopathy complicated by left ventricular dysfunction, heart failure or arrhythmia is associated with a poor prognosis. At present, the reason why some patients recover without residual myocardial injury whereas others develop dilated cardiomyopathy is unclear. The relative roles of the pathogen, host genomics and environmental factors in disease progression and healing are still under discussion, including which viruses are active inducers and which are only bystanders. As a consequence, treatment strategies are not well established. In this Review, we summarize and evaluate the available evidence on the pathogenesis, diagnosis and treatment of myocarditis and inflammatory cardiomyopathy, with a special focus on virus-induced and virus-associated myocarditis. Furthermore, we identify knowledge gaps, appraise the available experimental models and propose future directions for the field. The current knowledge and open questions regarding the cardiovascular effects associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are also discussed. This Review is the result of scientific cooperation of members of the Heart Failure Association of the ESC, the Heart Failure Society of America and the Japanese Heart Failure Society.
Collapse
|
96
|
Diniz MDFR, Kozu KT, Elias AM, Lianza AC, Sawamura KSS, Menezes CRB, Ferreira JCDOA, Silva CA, Leal GN. Echocardiographic study of juvenile dermatomyositis patients: new insights from speckle-tracking-derived strain. Clin Rheumatol 2020; 40:1497-1505. [PMID: 32989504 DOI: 10.1007/s10067-020-05418-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/09/2020] [Accepted: 09/17/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study aimed to investigate subclinical left ventricle (LV) systolic dysfunction in juvenile dermatomyositis (JDM) using two-dimensional speckle-tracking echocardiography (2DST). Possible associations between LV deformation impairment and disease activity/cumulative damage were also evaluated. METHODS Thirty-five consecutive JDM patients without cardiac symptoms and 35 healthy volunteers were enrolled. Clinical data were collected from medical records, and echocardiograms were performed by a pediatric cardiologist, unaware of patients' conditions. RESULTS Patients and controls had similar age (12.6 ± 0.7 vs.12.5 ± 0.6; p = 0.97) and gender (11F:24M vs.11F:24M; p = 1.0). Median of JDM duration was 4.6 (0.04-17.6) years, and only 6/35 (17%) had active disease (disease activity score (DAS > 3)). Conventional echocardiogram revealed preserved LV ejection fraction (EF) (≥ 55%) in all individuals. In JDM, 2DST identified reduction of LV longitudinal [-22(-17.2 to -27.9) % vs. -23(-20.8 to -27.4) %; p = 0.028)] and circumferential -23.9 ± 2.8% vs. -26.7 ± 2.9%; p = 0.0002) strain. Lower longitudinal strain was associated with DAS >3 -19.9(-17.2 to -26.5)% vs. -22.1-18.9 to -27.9)%; p = 0.046], MDI extent > 0 [-19(-17.2 to -22.5)% vs. -22.1-19.2 to -27.9)%; p = 0.0008], MDI severity > 0 [-19(-17.2 to -22.1)% vs. -22.3(-20.3 to -27.9)%; p = 0.0001] and calcinosis[-20.6(-17.2 to -23)% vs. -22.3(-20.3 to -27.9)%; p = 0.03]. Lower circumferential strain was associated with MDI extent > 0 (-22.1 ± 3.87% vs. -24.4 ± 2.3%; p = 0.039), MDI severity > 0 (-21.7 ± 3% vs. 24.7 ± 2.3%; p = 0.004) and calcinosis (-22.5 ± 3.3% vs. -24.8 ± 2.1%; p = 0.02). There was a negative correlation between longitudinal strain and cumulative dose of prednisone (r = -0.44; p = 0.009) and methotrexate (r = -0.33; p = 0.0008). CONCLUSIONS LV 2DST detected early systolic myocardial compromise in asymptomatic pediatric JDM patients, with preserved EF. Longitudinal strain impairment was associated with disease activity and cumulative damage, whereas circumferential strain impairment was associated exclusively with cumulative damage. KEY POINTS • Serious cardiac involvement is rare but has been associated with death in juvenile dermatomyositis. • Two-dimensional speckle tracking stands out for the identification of subclinical myocardial compromise in juvenile dermatomyositis. • Longitudinal strain impairment is associated with disease activity and cumulative damage, whereas circumferential strain impairment is associated exclusively with cumulative damage.
Collapse
Affiliation(s)
- Maria de Fátima Rodrigues Diniz
- Pediatric Echocardiography Laboratory, Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Katia Tomie Kozu
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Maluf Elias
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alessandro Cavalcanti Lianza
- Pediatric Echocardiography Laboratory, Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Karen Saori Shiraishi Sawamura
- Pediatric Echocardiography Laboratory, Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carolina Rocha Brito Menezes
- Pediatric Echocardiography Laboratory, Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Clovis Artur Silva
- Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gabriela Nunes Leal
- Pediatric Echocardiography Laboratory, Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
97
|
Kersten J, Güleroglu AM, Rosenbohm A, Buckert D, Ludolph AC, Hackenbroch C, Beer M, Bernhardt P. Myocardial involvement and deformation abnormalities in idiopathic inflammatory myopathy assessed by CMR feature tracking. Int J Cardiovasc Imaging 2020; 37:597-603. [PMID: 32944886 PMCID: PMC7900063 DOI: 10.1007/s10554-020-02020-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/04/2020] [Indexed: 01/30/2023]
Abstract
Background Cardiac involvement has been described in idiopathic inflammatory myopathies (IIM), including non-specific ECG and echocardiographic findings. Aim of our study was to evaluate myocardial deformation parameters in IIM and to correlate them with late gadolinium enhancement (LGE) findings using cardiac magnetic resonance imaging (CMR). Methods
Forty-seven consecutive patients with histologically proven IIM were included into our study. Twenty-five healthy volunteers were used as a control group. All patients and controls underwent CMR examination using a 1.5 T scanner including functional cine and LGE imaging. After a mean follow-up of 234.7 ± 79.5 days a second CMR examination was performed in IIM patients. Results In comparison to healthy volunteers, IIM patients had lower left ventricular mass and left ventricular global radial, circumferential and longitudinal strain. There was no significant difference in left ventricular ejection fraction. Patients with LGE (N = 28) had lower left ventricular ejection fraction (p = 0.016), global right and left ventricular longitudinal strain (p = 0.014 and p = 0.005) and global left ventricular diastolic longitudinal strain rate (p = 0.001) compared to patients without LGE (N = 19). In IIM patients, a significant decrease of left ventricular ejection fraction, left ventricular mass and all measured deformation parameters was observed between baseline and follow-up CMR. Conclusion Cardiac involvement in IIM is frequent. Impairment of systolic and diastolic deformation parameters and a worsening over time can be observed. CMR is a useful tool for cardiac diagnostic work-up of these patients.
Collapse
Affiliation(s)
- Johannes Kersten
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. .,University Hospital of Ulm, Albert-Einstein-Allee 23, Ulm, Germany.
| | | | - Angela Rosenbohm
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Dominik Buckert
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | | | - Carsten Hackenbroch
- Department of Radiology, Armed Forces Military Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | | |
Collapse
|
98
|
Makavos G, Varoudi M, Papangelopoulou K, Kapniari E, Plotas P, Ikonomidis I, Papadavid E. Echocardiography in Autoimmune Rheumatic Diseases for Diagnosis and Prognosis of Cardiovascular Complications. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:medicina56090445. [PMID: 32883041 PMCID: PMC7558642 DOI: 10.3390/medicina56090445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 12/23/2022]
Abstract
Autoimmune rheumatic diseases are systemic diseases frequently affecting the heart and vessels. The main cardiovascular complications are pericarditis, myocarditis, valvular disease, obstructive coronary artery disease and coronary microcirculatory dysfunction, cardiac failure and pulmonary hypertension. Echocardiography, including transthoracic two and three-dimensional echocardiography, Doppler imaging, myocardial deformation and transesophageal echo, is an established and widely available imaging technique for the identification of cardiovascular manifestations that are crucial for prognosis in rheumatic diseases. Echocardiography is also important for monitoring the impact of drug treatment on cardiac function, coronary microcirculatory function, valvular function and pulmonary artery pressures. In this article we summarize established and evolving knowledge on the role of echocardiography for diagnosis and prognosis of cardiovascular abnormalities in rheumatic diseases.
Collapse
Affiliation(s)
- George Makavos
- Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (M.V.); (K.P.); (P.P.); (I.I.)
- Correspondence: ; Tel.: +30-210-5832187
| | - Maria Varoudi
- Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (M.V.); (K.P.); (P.P.); (I.I.)
| | - Konstantina Papangelopoulou
- Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (M.V.); (K.P.); (P.P.); (I.I.)
| | - Eirini Kapniari
- Second Department of Dermatology and Venereology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.K.); (E.P.)
| | - Panagiotis Plotas
- Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (M.V.); (K.P.); (P.P.); (I.I.)
| | - Ignatios Ikonomidis
- Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (M.V.); (K.P.); (P.P.); (I.I.)
| | - Evangelia Papadavid
- Second Department of Dermatology and Venereology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.K.); (E.P.)
| |
Collapse
|
99
|
Merlo M, Masè M, Cannatà A, Zaffalon D, Lardieri G, Limongelli G, Imazio M, Canepa M, Castelletti S, Bauce B, Biagini E, Livi U, Severini GM, Dal Ferro M, Marra MP, Basso C, Autore C, Sinagra G. Management of nonischemic-dilated cardiomyopathies in clinical practice: a position paper of the working group on myocardial and pericardial diseases of Italian Society of Cardiology. J Cardiovasc Med (Hagerstown) 2020; 21:927-943. [PMID: 32740436 DOI: 10.2459/jcm.0000000000001050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
: Nonischemic-dilated cardiomyopathy (NIDCM) is an entity that gathers extremely heterogeneous diseases. This awareness, although leading to continuous improvement in survival, has increased the complexity of NIDCM patients' management. Even though the endorsed 'red-flags' approach helps clinicians in pursuing an accurate etiological definition in clinical practice, it is not clear when and how peripheral centers should interact with referral centers with specific expertise in challenging scenarios (e.g. postmyocarditis and genetically determined dilated cardiomyopathy) and with easier access to second-line diagnostic tools and therapies. This position paper will summarize each step in NIDCM management, highlighting the multiple interactions between peripheral and referral centers, from first-line diagnostic workup and therapy to advanced heart failure management and long-term follow-up.
Collapse
Affiliation(s)
- Marco Merlo
- Cardiothoracovascular Department , Center for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste
| | - Marco Masè
- Cardiothoracovascular Department , Center for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste
| | - Antonio Cannatà
- Cardiothoracovascular Department , Center for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste
| | - Denise Zaffalon
- Cardiothoracovascular Department , Center for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste
| | - Gerardina Lardieri
- Cardiology Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Hospital of Gorizia and Monfalcone
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, Inherited and Rare Heart Disease, Vanvitelli Cardiology, University of Campania Luigi Vanvitelli, Caserta
| | - Massimo Imazio
- University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Torino
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino - IRCCS Italian Cardiovascular Network.,Department of Internal Medicine, University of Genova, Genova
| | - Silvia Castelletti
- IRCCS Istituto Auxologico Italiano, Center for Cardiac Arrhythmias of Genetic Origin, Milan
| | - Barbara Bauce
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova
| | - Elena Biagini
- Azienda Ospedaliero - Universitaria, Policlinico di Sant'Orsola, Cardiology Unit, Cardio-Thoracic-Vascular Department, Bologna, Italy
| | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, Udine
| | | | - Matteo Dal Ferro
- Cardiothoracovascular Department , Center for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova
| | - Camillo Autore
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department , Center for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste
| |
Collapse
|
100
|
Criado PR, Pagliari C, Carneiro FRO, Quaresma JAS. Lessons from dermatology about inflammatory responses in Covid-19. Rev Med Virol 2020; 30:e2130. [PMID: 32656939 PMCID: PMC7404593 DOI: 10.1002/rmv.2130] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023]
Abstract
The SARS‐Cov‐2 is a single‐stranded RNA virus composed of 16 non‐structural proteins (NSP 1‐16) with specific roles in the replication of coronaviruses. NSP3 has the property to block host innate immune response and to promote cytokine expression. NSP5 can inhibit interferon (IFN) signalling and NSP16 prevents MAD5 recognition, depressing the innate immunity. Dendritic cells, monocytes, and macrophages are the first cell lineage against viruses' infections. The IFN type I is the danger signal for the human body during this clinical setting. Protective immune responses to viral infection are initiated by innate immune sensors that survey extracellular and intracellular space for foreign nucleic acids. In Covid‐19 the pathogenesis is not yet fully understood, but viral and host factors seem to play a key role. Important points in severe Covid‐19 are characterized by an upregulated innate immune response, hypercoagulopathy state, pulmonary tissue damage, neurological and/or gastrointestinal tract involvement, and fatal outcome in severe cases of macrophage activation syndrome, which produce a ‘cytokine storm’. These systemic conditions share polymorphous cutaneous lesions where innate immune system is involved in the histopathological findings with acute respiratory distress syndrome, hypercoagulability, hyperferritinemia, increased serum levels of D‐dimer, lactic dehydrogenase, reactive‐C‐protein and serum A amyloid. It is described that several polymorphous cutaneous lesions similar to erythema pernio, urticarial rashes, diffuse or disseminated erythema, livedo racemosa, blue toe syndrome, retiform purpura, vesicles lesions, and purpuric exanthema or exanthema with clinical aspects of symmetrical drug‐related intertriginous and flexural exanthema. This review describes the complexity of Covid‐19, its pathophysiological and clinical aspects.
Collapse
Affiliation(s)
- Paulo Ricardo Criado
- Dermatology Department, Centro Universitário Saúde ABC, Santo André, Brazil.,Dermatology Department, Faculdade de Medicina, Centro Universitário Saúde ABC, Santo André, Brazil
| | - Carla Pagliari
- Pathology Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | |
Collapse
|