1
|
Gallo A, Massaro MG, Camilli S, Di Francesco S, Gerardino L, Verrecchia E, Sicignano LL, Landi F, Manna R, Montalto M. Interleukin-1 Blockers in Recurrent and Acute Pericarditis: State of the Art and Future Directions. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:241. [PMID: 38399529 PMCID: PMC10890577 DOI: 10.3390/medicina60020241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
Diseases of the pericardium encompass a spectrum of conditions, including acute and recurrent pericarditis, where inflammation plays a pivotal role in the pathogenesis and clinical manifestations. Anti-inflammatory therapy indeed forms the cornerstone of treating these conditions: NSAIDs, colchicine, and corticosteroids (as a second-line treatment) are recommended by current guidelines. However, these medications come with several contraindications and are not devoid of adverse effects. In recent years, there has been an increased focus on the role of the inflammasome and potential therapeutic targets. Recurrent pericarditis also shares numerous characteristics with other autoinflammatory diseases, in which interleukin-1 antagonists have already been employed with good efficacy and safety. The objective of this review is to summarize the available studies on the use of anti-IL-1 drugs both in acute and recurrent pericarditis.
Collapse
Affiliation(s)
- Antonella Gallo
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
| | - Maria Grazia Massaro
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sara Camilli
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Silvino Di Francesco
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Laura Gerardino
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
| | - Elena Verrecchia
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ludovico Luca Sicignano
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
| | - Francesco Landi
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Raffaele Manna
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Massimo Montalto
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
2
|
Dell’Aversana F, Tedeschi C, Comune R, Gallo L, Ferrandino G, Basco E, Tamburrini S, Sica G, Masala S, Scaglione M, Liguori C. Advanced Cardiac Imaging and Women's Chest Pain: A Question of Gender. Diagnostics (Basel) 2023; 13:2611. [PMID: 37568974 PMCID: PMC10416986 DOI: 10.3390/diagnostics13152611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Awareness of gender differences in cardiovascular disease (CVD) has increased: both the different impact of traditional cardiovascular risk factors on women and the existence of sex-specific risk factors have been demonstrated. Therefore, it is essential to recognize typical aspects of ischemic heart disease (IHD) in women, who usually show a lower prevalence of obstructive coronary artery disease (CAD) as a cause of acute coronary syndrome (ACS). It is also important to know how to recognize pathologies that can cause acute chest pain with a higher incidence in women, such as spontaneous coronary artery dissection (SCAD) and myocardial infarction with non-obstructive coronary arteries (MINOCA). Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance imaging (CMR) gained a pivotal role in the context of cardiac emergencies. Thus, the aim of our review is to investigate the most frequent scenarios in women with acute chest pain and how advanced cardiac imaging can help in the management and diagnosis of ACS.
Collapse
Affiliation(s)
- Federica Dell’Aversana
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy
| | - Carlo Tedeschi
- Operational Unit of Cardiology, Presidio Sanitario Intermedio Napoli Est, ASL-Napoli 1 Centro, 80144 Napoli, Italy;
| | - Rosita Comune
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy
| | - Luigi Gallo
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy
| | - Giovanni Ferrandino
- Department of Radiology, Ospedale del Mare-ASL Napoli 1, 80147 Napoli, Italy; (G.F.)
| | - Emilia Basco
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare-ASL Napoli 1, 80147 Napoli, Italy; (G.F.)
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital Azienda dei Colli, 80131 Napoli, Italy
| | - Salvatore Masala
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Mariano Scaglione
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
- Department of Radiology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Carlo Liguori
- Department of Radiology, Ospedale del Mare-ASL Napoli 1, 80147 Napoli, Italy; (G.F.)
| |
Collapse
|
3
|
Bizzi E, Picchi C, Mastrangelo G, Imazio M, Brucato A. Recent advances in pericarditis. Eur J Intern Med 2022; 95:24-31. [PMID: 34556390 DOI: 10.1016/j.ejim.2021.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/27/2021] [Accepted: 09/04/2021] [Indexed: 12/15/2022]
Abstract
Pericardial diseases are an heterogeneous group of entities, ranging from acute pericarditis to asymptomatic pericardial effusions. New advances in understanding the processes underlying them have been made. In 2020 a prospective study defined the reference intervals of the component of normal pericardial fluid, that was found to be rich in nucleated cells, proteins, albumin and LDH, at levels compatible with the inflammatory exudates of other biological fluids such as pleural or peritoneal fluid; Light's criteria should not be used to evaluate it. Recently we also analyzed systematically large chronic idiopathic non-inflammatory pericardial effusions, observing that a non-invasive wait-and-see approach may be the best choice in clinical practice in oligosymptomatic cases. Concerning acute recurrent pericarditis (RP), an innovative interaction between cardiologists, internists and pediatric rheumatologists led to the intuition of a pivotal role of IL-1 in recurrent pericarditis characterized by an evident inflammatory recurrent phenotype, and recent data have shown the striking efficacy of anakinra and rilonacept in these patients. The proper selection of the patient is important; the ideal candidate for anti-IL-1 therapy is the patient with RP with high levels of serum C-reactive protein, high fever, neutrophil leukocitosis, pleuropulmonary involvement, frequent exacerbations and resistant to conventional therapy. On the contrary, anti-IL-1 drugs are not indicated in patients with pericardial effusion whose cause is not attributable to inflammatory phenomena. Finally, many patients with RP are women of childbearing age, and the possibility for these women to become pregnant must be addressed by multidisciplinary teams.
Collapse
Affiliation(s)
- Emanuele Bizzi
- Internal Medicine Department, Fatebenefratelli Hospital, Piazzale Principessa Clotilde 3, 20121, Milano, Italy.
| | - Chiara Picchi
- Internal Medicine Department, Fatebenefratelli Hospital, Piazzale Principessa Clotilde 3, 20121, Milano, Italy.
| | - Greta Mastrangelo
- Department of Pediatrics, Fatebenefratelli Hospital, Piazzale Principessa Clotilde 3, 20121, Milano, Italy.
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy
| | - Antonio Brucato
- University of Milano, Department of biomedical and clinical sciences "Luigi Sacco", Fatebenefratelli Hospital, Piazzale Principessa Clotilde 3, 20121, Milano, Italy.
| |
Collapse
|
4
|
Li M, Yuan J, Lv G, Brown J, Jiang X, Lu ZK. Myocarditis and Pericarditis following COVID-19 Vaccination: Inequalities in Age and Vaccine Types. J Pers Med 2021; 11:jpm11111106. [PMID: 34834458 PMCID: PMC8624452 DOI: 10.3390/jpm11111106] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
An increasing number of myocarditis/pericarditis incidences has been reported after coronavirus disease-19 (COVID-19) vaccination in adolescents and young adults. This study was designed to investigate the incidence rate of-and risk for-myocarditis and pericarditis following COVID-19 vaccination in the United States according to age and vaccine type. This study used the Vaccine Adverse Events Reporting System (VAERS) from 11 December 2020 to 13 August 2021. A population-based data mining approach was performed based on the reporting odds ratio (ROR). Adverse events of myocarditis and pericarditis following COVID-19 vaccination were rare, with an incidence rate of 5.98 (95% CI = 5.73-6.24) cases per million doses administered. The incidence rate was higher in adolescents and after the administration of the second dose of messenger RNA (mRNA) vaccines. Overall, two mRNA vaccines were significantly associated with increased risks for myocarditis/pericarditis (mRNA-1273 (Moderna): ROR = 2.91, 95% CI = 2.21-3.83; BNT162b2 (Pfizer-BioNTech): ROR = 5.37, 95% CI = 4.10-7.04) compared to all other vaccines from VAERS. The viral vector vaccine of Ad26.COV2.S (Janssen) was not associated with signals of myocarditis/pericarditis (ROR = 1.39; 95% CI = 0.99-1.97). This study found increased risks for myocarditis/pericarditis following mRNA COVID-19 vaccines. For patients at high risk for myocarditis/pericarditis or with myocardial injuries, the viral vector vaccine may be an alternative for consideration.
Collapse
Affiliation(s)
- Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN 38103, USA;
| | - Jing Yuan
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai 201203, China;
| | - Gang Lv
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100091, China;
| | - Jacob Brown
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA;
| | - Xiangxiang Jiang
- School of Public Health, Nanjing Medical University, Nanjing 210029, China;
| | - Zhiqiang Kevin Lu
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA;
- Correspondence:
| |
Collapse
|