1
|
Wan Y, He S, Wang S, Xu T, Qi M, Gan P. Efficacy and Safety of Interleukin-1 Inhibitors in the Management of Patients with Recurrent Pericarditis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Cardiovasc Drugs 2024; 24:537-545. [PMID: 38809412 DOI: 10.1007/s40256-024-00653-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The efficacy and safety of interleukin-1 (IL-1) inhibitors in patients with recurrent pericarditis (RP) remain to be determined. OBJECTIVE We aimed to conduct a meta-analysis to investigate the impact of IL-1 inhibitors on patients suffering from RP. METHODS The Cochrane Library, PubMed, EMBASE, ClinicalTrials.gov, and Web of Science databases were systematically searched to identify articles investigating the effects of IL-1 inhibitors in patients with RP up until January 2024. Relevant data on study characteristics and results were selected based on predefined criteria. The results were combined using a random effects model. RESULTS The study included a total of 102 patients from three open-label randomized controlled trials. Overall, the use of IL-1 inhibitors, in comparison to placebo, demonstrated a significant reduction in the risk of pericarditis recurrence [risk ratio (RR) 0.13; 95% confident interval (CI) 0.05-0.30; p < 0.05; I2 = 0%]. However, the administration of IL-1 inhibitors may lead to certain adverse events (AEs), including infections and injection-site reactions. The risk of AEs is significantly higher with IL-1 inhibitors compared with placebo (RR 1.88; 95% CI 1.30-2.72; p < 0.05; I2 = 0%). Nevertheless, the occurrence of serious AEs among patients was relatively rare, and no fatalities were reported. CONCLUSION This meta-analysis showed that IL-1 inhibitors can effectively reduce the risk of recurrence in patients with RP and are relatively safe. REGISTRATION PROSPERO identifier number CRD42023492904.
Collapse
Affiliation(s)
- Yong Wan
- Department of Endocrinology, Hangzhou Linping Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Shuai He
- Department of Hand and Foot Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Shasha Wang
- Department of Intensive Care Rehabilitation, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Tingli Xu
- Department of Intensive Care Rehabilitation, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Minfang Qi
- Department of Intensive Care Rehabilitation, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Pengcheng Gan
- Department of Intensive Care Rehabilitation, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China.
| |
Collapse
|
2
|
Nayfeh M, DiGregorio H, Saad JM, Al-Mallah M, Al Rifai M. The Emerging Specialty of Cardio-Rheumatology. Curr Atheroscler Rep 2024:10.1007/s11883-024-01221-7. [PMID: 38913292 DOI: 10.1007/s11883-024-01221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE OF REVIEW In this review, we aimed to summarize the different aspects of the field of cardio-rheumatology, the role of the cardio-rheumatologist, and future research in the field. RECENT FINDINGS Cardio-rheumatology is an emerging subspecialty within cardiology that focuses on addressing the intricate relationship between systemic inflammation and cardiovascular diseases. It involves understanding the cardiovascular impact of immune-mediated inflammatory diseases on the heart and vascular system. A cardio-rheumatologist's role is multifaceted. First, they should understand the cardiac manifestations of rheumatological diseases. They should also be knowledgeable about the different immunotherapies available and side effects. Additionally, they should know how to utilize imaging modalities, either for diagnosis, prognosis, or treatment monitoring. This field is constantly evolving with new research on both treatment and imaging of the effects of inflammation on the cardiovascular system.
Collapse
Affiliation(s)
- Malek Nayfeh
- Houston Methodist Academic Institute, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | | | | | - Mouaz Al-Mallah
- Houston Methodist Academic Institute, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Mahmoud Al Rifai
- Houston Methodist Academic Institute, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
- Weill Cornell Medicine, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
| |
Collapse
|
3
|
Weiss T, Itelman E, Lotan D, Segev A, Freimark D, Arad M, Wasserstrum Y. Pericarditis recurrence is associated with milder electrocardiographic, echocardiographic, and laboratory findings. Intern Emerg Med 2024; 19:1035-1039. [PMID: 38551753 PMCID: PMC11186859 DOI: 10.1007/s11739-024-03579-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/05/2024] [Indexed: 06/20/2024]
Abstract
Recurrent pericarditis (RP) complicates approximately 30% of acute pericarditis (AP) cases. We sought to compare the prevalence and severity of objective findings seen in patients with RP. A retrospective single-center study during 2010-2019, including 765 patients diagnosed with AP. Clinical, electrocardiographic, echocardiographic, and laboratory findings were extracted from the local electronic health records. Recurrence during follow-up was documented in 134 patients (17.5%), with a median time to recurrence of 101 (± 59-251) days. The median age was 60 years (IQR 45-72), 68% were male. Most patients were defined as having idiopathic\viral pericarditis (64%). The clinical manifestation during the recurrent event of pericarditis was less prominent or attenuated when compared to the initial event-ECG signs (ST elevation 12% vs. 26%; p = 0.006, Knuckle sign 13% vs. 33%; p < 0.001, ST larger in lead L2 than L3 4% vs. 19%; p < 0.001), pericardial effusion moderate and above (11% vs. 30%; p = 0.02), and inflammatory markers (mean peak CRP levels 66 mg/l vs. 97 mg/l; p < 0.001). Similar results were seen in the subgroup of patients defined as having idiopathic\viral pericarditis. Up to 20% of patients who did not have ECG signs or a significant pericardial effusion in their 1st event demonstrated these findings during the recurrence, though still to a lesser extent compared with those who had these signs in their 1st event. The objective findings of AP are less pronounced during recurrent events. Future studies should focus on the role of advanced biomarkers and imaging in defining true RP events.
Collapse
Affiliation(s)
- Tal Weiss
- Leviev Heart Center, Sheba Medical Center, 2 Derech Sheba St, Tel-Ha'shomer, 52662, Ramat Gan, Israel.
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Edward Itelman
- Cardiology Division, Rabin Medical Center, Petach-Tikva, Israel
| | - Dor Lotan
- Columbia University, New-York City, NY, USA
| | - Amitai Segev
- Leviev Heart Center, Sheba Medical Center, 2 Derech Sheba St, Tel-Ha'shomer, 52662, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Dov Freimark
- Leviev Heart Center, Sheba Medical Center, 2 Derech Sheba St, Tel-Ha'shomer, 52662, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michael Arad
- Leviev Heart Center, Sheba Medical Center, 2 Derech Sheba St, Tel-Ha'shomer, 52662, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yishay Wasserstrum
- Leviev Heart Center, Sheba Medical Center, 2 Derech Sheba St, Tel-Ha'shomer, 52662, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Chong A, Stanton T, Taylor A, Prior D, La Gerche A, Anderson B, Scalia G, Cooke J, Dahiya A, To A, Davis M, Mottram P, Moir S, Playford D, Mahadavan D, Thomas L, Wahi S. 2024 CSANZ Position Statement on Indications, Assessment and Monitoring of Structural and Valvular Heart Disease With Transthoracic Echocardiography in Adults. Heart Lung Circ 2024; 33:773-827. [PMID: 38749800 DOI: 10.1016/j.hlc.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 08/22/2023] [Accepted: 11/01/2023] [Indexed: 06/25/2024]
Abstract
Transthoracic echocardiography (TTE) is the most widely available and utilised imaging modality for the screening, diagnosis, and serial monitoring of all abnormalities related to cardiac structure or function. The primary objectives of this document are to provide (1) a guiding framework for treating clinicians of the acceptable indications for the initial and serial TTE assessments of the commonly encountered cardiovascular conditions in adults, and (2) the minimum required standard for TTE examinations and reporting for imaging service providers. The main areas covered within this Position Statement pertain to the TTE assessment of the left and right ventricles, valvular heart diseases, pericardial diseases, aortic diseases, infective endocarditis, cardiac masses, pulmonary hypertension, and cardiovascular diseases associated with cancer treatments or cardio-oncology. Facilitating the optimal use and performance of high quality TTEs will prevent the over or under-utilisation of this resource and unnecessary downstream testing due to suboptimal or incomplete studies.
Collapse
Affiliation(s)
- Adrian Chong
- Department of Cardiology, Princess Alexandra Hospital, Mater Hospital Brisbane, University of Queensland, Brisbane, Qld, Australia
| | - Tony Stanton
- Sunshine Coast University Hospital, School of Health University of Sunshine Coast, School of Medicine and Dentistry Griffith University, Birtinya, Qld, Australia
| | - Andrew Taylor
- Department of Cardiology, Royal Melbourne Hospital, Alfred Hospital, Melbourne, Vic, Australia
| | - David Prior
- Albury Wodonga Health, Albury, NSW, Australia
| | - Andre La Gerche
- St Vincent's Hospital, Baker Heart and Diabetes Institute, University of Melbourne, Melbourne, Vic, Australia
| | - Bonita Anderson
- Cardiac Sciences Unit, The Prince Charles Hospital, Queensland University of Technology, Brisbane, Qld, Australia
| | - Gregory Scalia
- The Prince Charles Hospital, University of Queensland, Brisbane, Qld, Australia
| | - Jennifer Cooke
- Department of Cardiology, Eastern Health, Monash University, Melbourne, Vic, Australia
| | - Arun Dahiya
- Department of Cardiology, Princess Alexandra Hospital, Logan Hospital, Griffith University, Brisbane, Qld, Australia
| | - Andrew To
- Department of Cardiology, Health New Zealand Waitemata, Auckland, New Zealand
| | | | - Philip Mottram
- Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | - Stuart Moir
- Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | | | - Devan Mahadavan
- Department of Cardiology, Queen Elizabeth Hospital, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Westmead Clinical School University of Sydney, South West Clinical School University of New South Wales, Sydney, NSW, Australia
| | - Sudhir Wahi
- Department of Cardiology, Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia.
| |
Collapse
|
5
|
Thomas GK, Bonaventura A, Vecchié A, van Tassell B, Imazio M, Klein A, Luis SA, Abbate A. Interleukin-1 Blockers for the Treatment of Recurrent Pericarditis: Pathophysiology, Patient-Reported Outcomes, and Perspectives. J Cardiovasc Pharmacol 2024; 83:503-510. [PMID: 37163222 DOI: 10.1097/fjc.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/14/2023] [Indexed: 05/11/2023]
Abstract
ABSTRACT Recurrent pericarditis (RP) is the most troublesome complication of acute pericarditis reflecting an unresolving inflammation of the pericardial sac around the heart and associated with significant morbidity. Recent studies have shown interleukin-1 (IL-1) signaling to be central to the pathophysiology of cases of RP with evidence of activation of systemic inflammation. We herein review the literature and clinical trials discussing the utility of IL-1 blockade for RP. The early experience of IL-1 blockade with anakinra (Kineret) and its favorable safety profile paved the way for the clinical development of rilonacept (Arcalyst) and subsequent approval by the US FDA for RP. In patients with RP who have become colchicine-resistant and glucocorticoid-dependent, IL-1 blockade with rilonacept or anakinra effectively treats recurrences and prevents future flares and significantly improves quality of life.
Collapse
Affiliation(s)
- Georgia K Thomas
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Aldo Bonaventura
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy
| | | | - Benjamin van Tassell
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Massimo Imazio
- Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Allan Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Sushil Allen Luis
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Rochester, MN
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center and Division of Cardiology, Department of Internal Medicine, Heart and Vascular Center, University of Virginia, Charlottesville, VA
| |
Collapse
|
6
|
Li Z, Min XW, He PG, Zhang CH. Chest pain with diffuse ST segment elevation. BMJ 2024; 385:e078403. [PMID: 38697642 DOI: 10.1136/bmj-2023-078403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
- Zhi Li
- Department of Cardiology, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, China
| | - Xin-Wen Min
- Department of Cardiology, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, China
| | - Pei-Gen He
- Department of Cardiology, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, China
| | - Chuan-Hai Zhang
- Department of Cardiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, China
| |
Collapse
|
7
|
Zhang RS, Weber BN, Araiza-Garaygordobil D, Garshick MS. Colchicine for the Prevention of Cardiovascular Disease: Potential Global Implementation. Curr Cardiol Rep 2024; 26:423-434. [PMID: 38573553 PMCID: PMC11196186 DOI: 10.1007/s11886-024-02049-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Targeting traditional cardiovascular risk factors is effective in reducing recurrent cardiovascular events, yet the presence of residual cardiovascular risk due to underlying systemic inflammation is a largely unaddressed opportunity. This review aims to comprehensively assess the evolving role of colchicine as a therapeutic approach targeting residual inflammatory risk in the context of those with coronary artery disease (CAD). RECENT FINDINGS Inflammation plays a significant role in promoting atherosclerosis, and targeting anti-inflammatory pathways has the potential to decrease cardiovascular events. Low-dose colchicine (0.5 mg/day orally), when added to guideline-directed medical care for CAD, safely decreases major adverse cardiovascular events (MACE) by 31% in stable atherosclerosis patients and 23% in those after recent myocardial infarctions. Meta-analyses of recent randomized control trials further support both the efficacy and safety of colchicine, particularly when added to other standard cardiovascular therapies, including statin therapy. The European Society of Cardiology and other national guidelines endorse the use of low-dose colchicine in patients across the spectrum of CAD. Recently, colchicine was FDA-approved in the United States as the first anti-inflammatory therapy for the reduction of cardiovascular events. In a period of a rising incidence of CAD across the globe, colchicine represents a unique opportunity to decrease MACE due to its large magnitude of benefits and general affordability. However, challenges with drug interactions must be addressed, especially in those regions where HIV, hepatitis, and tuberculosis are prevalent. Colchicine is safe and effective at reducing cardiovascular events across a broad spectrum of coronary syndromes. The ability to simultaneously target traditional risk factors and mitigate residual inflammatory risk marks a substantial advancement in cardiovascular prevention strategies, heralding a new era in the global battle against CAD.
Collapse
Affiliation(s)
- Robert S Zhang
- Leon H. Charney Division of Cardiology and Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Brittany N Weber
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Michael S Garshick
- Leon H. Charney Division of Cardiology and Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, New York, NY, 10016, USA.
| |
Collapse
|
8
|
Buckley LF, Libby P. Colchicine's Role in Cardiovascular Disease Management. Arterioscler Thromb Vasc Biol 2024; 44:1031-1041. [PMID: 38511324 PMCID: PMC11047118 DOI: 10.1161/atvbaha.124.319851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Colchicine-an anti-inflammatory alkaloid-has assumed an important role in the management of cardiovascular inflammation ≈3500 years after its first medicinal use in ancient Egypt. Primarily used in high doses for the treatment of acute gout flares during the 20th century, research in the early 21st century demonstrated that low-dose colchicine effectively treats acute gout attacks, lowers the risk of recurrent pericarditis, and can add to secondary prevention of major adverse cardiovascular events. As the first Food and Drug Administration-approved targeted anti-inflammatory cardiovascular therapy, colchicine currently has a unique role in the management of atherosclerotic cardiovascular disease. The safe use of colchicine requires careful monitoring for drug-drug interactions, changes in kidney and liver function, and counseling regarding gastrointestinal upset. Future research should elucidate the mechanisms of anti-inflammatory effects of colchicine relevant to atherosclerosis, the potential role of colchicine in primary prevention, in other cardiometabolic conditions, colchicine's safety in cardiovascular patients, and opportunities for individualizing colchicine therapy using clinical and molecular diagnostics.
Collapse
Affiliation(s)
- Leo F. Buckley
- Department of Pharmacy, Brigham and Women’s Hospital, Boston MA
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA
| |
Collapse
|
9
|
McBenedict B, Ahmed YA, Reda Elmahdi R, Yusuf WH, Netto JGM, Valentim G, Abrahão A, Lima Pessôa B, Mesquita ET. Pericardial Diseases Mortality Trends in Brazil From 2000 to 2022. Cureus 2024; 16:e57949. [PMID: 38738132 PMCID: PMC11084855 DOI: 10.7759/cureus.57949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Background Pericardial diseases manifest in various clinical forms, including acute pericarditis, constrictive pericarditis, pericardial effusion, and cardiac tamponade, with acute pericarditis being the most prevalent. These conditions significantly contribute to mortality rates. Therefore, this article aimed to analyze mortality trends in the Brazilian population based on age and sex, shedding light on the impact of pericardial diseases on public health outcomes. Methods This is a retrospective time-series analysis of pericardial disease mortality rates in Brazil (2000-2022). Data was obtained from the Department of Informatics of the Unified Health System (DATASUS), and the 10th edition of the International Classification of Diseases (ICD-10) codes: I30, I31, and I32 were included for analysis. We gathered population and demographic data categorized by age range and sex from the Brazilian Institute of Geography and Statistics (IBGE). Subsequently, we computed the age-standardized mortality rate per 100,000 individuals and assessed the annual percentage changes (APCs) and average annual percentage changes (AAPCs) using joinpoint regression, along with their corresponding 95% confidence intervals (CIs). Results In terms of mortality trends based on sex, overall mortality rates remained stable for males and combined sexes over the study period. However, there was a notable increase in mortality rates among females (AAPC=1.18), particularly between 2020 and 2022, with a significant APC of 27.55. Analyzing pericardial diseases across different age groups (20 to 80 years and above), it wasobserved that mortality rates significantly increased in the 70-79 and 80 years and above age groups throughout the study period (AAPC=1.0339 and AAPC=3.4587, respectively). These two age groups experienced the highest significant rise in mortality between 2020 and 2022. Other age groups did not exhibit a significant change in AAPC. Conclusions This comprehensive analysis spanning two decades (2000-2022), examined the mortality trends of pericardial diseases in Brazil and revealed relative stability overall. Males exhibited an overall higher mortality number due to pericardial diseases; however, females showed the most significant increase in mortality trend throughout the whole period. In the first segment (2000-2015), mortality rose across all cohorts, which was attributed to substandard healthcare facilities and infectious diseases like tuberculosis. The second segment (2016-2020) saw a decline in mortality, likely due to improved healthcare, particularly the increased availability of echocardiograms. However, the third segment (2020-2022) witnessed a sharp rise in mortality, coinciding with the COVID-19 pandemic, with post-COVID-19 symptoms, particularly pericarditis. Pericarditis-related death rates declined compared to pericardial effusion, and mortality rates correlated directly with age, with older cohorts experiencing higher mortality due to increased comorbidities, and decline in health and immunocompetency.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ana Abrahão
- Public Health, Fluminense Federal University, Niterói, BRA
| | | | | |
Collapse
|
10
|
Albertson TE, Hansen C, Bihari S, Gayed J, Xu X, Simón-Campos JA, Dever ME, Cardona JF, Mitha E, Baker JB, Keep G, Oladipupo I, Mensa FJ, Feng Y, Ma H, Koury K, Mather S, Ianos CA, Anderson AS, Türeci Ö, Şahin U, Gruber WC, Gurtman A, Sabharwal C, Kitchin N. Serum Troponin I Assessments in 5- to 30-Year-Olds After BNT162b2 Vaccination. Infect Dis Ther 2024; 13:699-714. [PMID: 38489117 PMCID: PMC11058143 DOI: 10.1007/s40121-024-00927-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/19/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Rare myocarditis and pericarditis cases have occurred in coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccine recipients. Troponin levels, a potential marker of myocardial injury, were assessed in healthy participants before and after BNT162b2 vaccination. METHODS Vaccine-experienced 12- to 30-year-olds in phase 3 crossover C4591031 Substudy B (NCT04955626) who had two or three prior BNT162b2 30-μg doses were randomized to receive BNT162b2 30 μg followed by placebo, or placebo followed by BNT162b2 30 µg, 1 month apart. A participant subset, previously unvaccinated against COVID-19, in the phase 3 C4591007 study (NCT04816643) received up to three vaccinations (BNT162b2 10 μg or placebo [5- to 11-year-olds]) or open-label BNT162b2 30 μg (12- to 15-year-olds). Blood samples collected pre-vaccination, 4 days post-vaccination, and 1-month post-vaccination (C4591031 Substudy B only) were analyzed. Frequencies of elevated troponin I levels (male, > 35 ng/l; female, > 17 ng/l) were assessed. RESULTS Percentages of 12- to 30-year-olds (n = 1485) in C4591031 Substudy B with elevated troponin levels following BNT162b2 or placebo receipt were 0.5% and 0.8% before vaccination, 0.7% and 1.0% at day 4, and 0.7% and 0.5% at 1 month, respectively. In Study C4591007 (n = 1265), elevated troponin I levels were observed in 0.2, 0.4, and 0.2% of 5- to 11-year-old BNT162b2 recipients at baseline and 4 days post-dose 2 and 3, respectively; corresponding values in 12- to 15-year-olds were 0.4, 0.4, and 0.7%. No 5- to 11-year-old placebo recipients had elevated troponin levels. No myocarditis or pericarditis cases or deaths were reported. CONCLUSIONS Among 5- to < 30-year-olds in both studies, troponin levels were rarely elevated (≤ 1.0%) and similar before and post-vaccination; troponin levels were also similar between BNT162b2 and placebo in 12- to 30-year-old and 5- to 11-year-old recipients in the respective studies. No myocarditis or pericarditis cases were reported. These findings did not provide evidence that BNT162b2 causes troponin elevations. No utility of routine measurement of troponin levels in asymptomatic BNT162b2 recipients was identified.
Collapse
Affiliation(s)
| | - Caitlin Hansen
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Smiti Bihari
- Vaccine Research and Development, Pfizer Ltd, Hurley, UK
| | - Juleen Gayed
- Vaccine Research and Development, Pfizer Ltd, Hurley, UK.
| | - Xia Xu
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - J Abraham Simón-Campos
- Faculty of Medicine, Köhler and Milstein Research/Autonomous University of Yucatan, Mérida, Yucatan, Mexico
| | | | - Jose F Cardona
- Indago Research and Health Center, Inc, Hialeah, FL, USA
| | - Essack Mitha
- Newtown Clinical Research, Johannesburg, South Africa
| | | | - Georgina Keep
- Vaccine Research and Development, Pfizer Ltd, Hurley, UK
| | | | | | - Ye Feng
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Hua Ma
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Kenneth Koury
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Susan Mather
- Worldwide Safety, Safety Surveillance and Risk Management, Pfizer Inc, Collegeville, PA, USA
| | | | | | | | | | - William C Gruber
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | | | - Charu Sabharwal
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | | |
Collapse
|
11
|
Kasim SM, Hussain S, Alsharhan MA, Al-Najjar FJK. Acute pericarditis as the presenting symptom of a case of oesophageal carcinoma. BMJ Case Rep 2024; 17:e259116. [PMID: 38508607 PMCID: PMC10952961 DOI: 10.1136/bcr-2023-259116] [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] [Indexed: 03/22/2024] Open
Abstract
Oesophageal carcinoma is a globally prevalent form of cancer. Patients with advanced disease often experience progressive dysphagia and weight loss as initial symptoms, but pericarditis is an uncommon presentation. This study describes a young man who presented with pericarditis and was diagnosed with oesophageal squamous cell carcinoma. The patient's diagnosis came after presenting with intermittent chest pain. His diagnostic tests included an ECG showing ST elevation, echocardiography showing pericardial effusion and elevated inflammatory markers. His imaging tests revealed a neoplastic lesion in the lower oesophagus with metastases. He was initially treated as a case of pericarditis, followed by palliative chemotherapy for his cancer. Pericarditis, as the initial presentation of oesophageal carcinoma, is rare. There have only been 19 cases reported and published in the literature. Treatment depends on the stage of the disease. This case emphasises the importance of considering malignancy in unusual presentations of pericarditis, especially in young patients.
Collapse
Affiliation(s)
- Sarah Mohd Kasim
- Emergency Medicine, Rashid Hospital Trauma Center, Dubai Health, Dubai, UAE
| | - Sara Hussain
- Department of Emergency medicine, Monash Health, Victoria, Victoria, Australia
| | | | | |
Collapse
|
12
|
Cau R, Pisu F, Muscogiuri G, Sironi S, Suri JS, Pontone G, Salgado R, Saba L. Atrial and ventricular strain using cardiovascular magnetic resonance in the prediction of outcomes of pericarditis patients: a pilot study. Eur Radiol 2024:10.1007/s00330-024-10677-9. [PMID: 38467940 DOI: 10.1007/s00330-024-10677-9] [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: 01/07/2024] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE Our study aimed to explore with cardiovascular magnetic resonance (CMR) the impact of left atrial (LA) and left ventricular (LV) myocardial strain in patients with acute pericarditis and to investigate their possible prognostic significance in adverse outcomes. METHOD This retrospective study performed CMR scans in 36 consecutive patients with acute pericarditis (24 males, age 52 [23-52]). The primary endpoint was the combination of recurrent pericarditis, constrictive pericarditis, and surgery for pericardial diseases defined as pericardial events. Atrial and ventricular strain function were performed on conventional cine SSFP sequences. RESULTS After a median follow-up time of 16 months (interquartile range [13-24]), 12 patients with acute pericarditis reached the primary endpoint. In multivariable Cox regression analysis, LA reservoir and LA conduit strain parameters were all independent determinants of adverse pericardial diseases. Conversely, LV myocardial strain parameters did not remain an independent predictor of outcome. With receiving operating characteristics curve analysis, LA conduit and reservoir strain showed excellent predictive performance (area under the curve of 0.914 and 0.895, respectively) for outcome prediction at 12 months. CONCLUSION LA reservoir and conduit mechanisms on CMR are independently associated with a higher risk of adverse pericardial events. Including atrial strain parameters in the management of acute pericarditis may improve risk stratification. CLINICAL RELEVANCE STATEMENT Atrial strain could be a suitable non-invasive and non-contrast cardiovascular magnetic resonance parameter for predicting adverse pericardial complications in patients with acute pericarditis. KEY POINTS • Myocardial strain is a well-validated CMR parameter for risk stratification in cardiovascular diseases. • LA reservoir and conduit functions are significantly associated with adverse pericardial events. • Atrial strain may serve as an additional non-contrast CMR parameter for stratifying patients with acute pericarditis.
Collapse
Affiliation(s)
- Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554, Monserrato, 09045, Cagliari, Italy
| | - Francesco Pisu
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554, Monserrato, 09045, Cagliari, Italy
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Sandro Sironi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554, Monserrato, 09045, Cagliari, Italy.
| |
Collapse
|
13
|
Spotts PH, Zhou F. Myocarditis and Pericarditis. Prim Care 2024; 51:111-124. [PMID: 38278565 DOI: 10.1016/j.pop.2023.07.006] [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] [Indexed: 01/28/2024]
Abstract
Pericarditis typically presents with classic symptoms of acute sharp, retrosternal, and pleuritic chest pain. It can have several different underlying causes including viral, bacterial, and autoimmune etiologies. The mainstays of pericarditis treatment are nonsteroidal anti-inflammatory drugs and colchicine with glucocorticoids or other immunosuppressive drugs used for refractory cases and relapse. Myocarditis is an inflammatory disease of the cardiac muscle that is caused by a variety of infectious and noninfectious conditions. It mainly affects young adults (median age 30-45 years), and men more than women. The clinical manifestations of myocarditis are highly variable, so a high level of suspicion in the early stage of disease is important to facilitate diagnosis. The treatment of myocarditis includes nonspecific treatment aimed at complications such as heart failure and arrhythmia, as well as specific treatment aimed at underlying causes. Pericarditis and myocarditis associated with vaccine have been extremely rare before coronavirus disease 2019 (COVID-19). There is a small increase of incidence after COVID-19 messenger ribonucleic acid vaccine, but the relative risk for pericarditis and myocarditis due to severe acute respiratory syndrome coronavirus 2 infection is much higher. Therefore, vaccination against COVID-19 is currently recommended for everyone aged 6 years and older.
Collapse
Affiliation(s)
- Philip Hunter Spotts
- Department of Family Medicine & Community Health, Duke Student Health, Duke University, 305 Towerview Road, Second Floor, Durham, NC 27708, USA.
| | - Fan Zhou
- Department of Family Medicine & Community Health, Duke Student Health, Duke University, 305 Towerview Road, Second Floor, Durham, NC 27708, USA
| |
Collapse
|
14
|
Yan KL, Lee YJ, Baik AH. Acute radiation-induced pericarditis complicated by polymicrobial infectious pericarditis in a patient with mediastinal sarcoma: a case report. Eur Heart J Case Rep 2024; 8:ytae084. [PMID: 38405193 PMCID: PMC10894000 DOI: 10.1093/ehjcr/ytae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
Background Acute pericarditis is often caused by viral infections, autoimmune diseases, and radiation therapy (RT). Infectious pericarditis is rare and associated with high morbidity and mortality. We present a case of acute RT-induced pericarditis complicated by bacterial pericarditis and cardiac tamponade due to oesophageal bacterial translocation. Case summary A 65-year-old man with a recurrent mediastinal sarcoma complicated by oesophageal compression and recent oesophageal stenting presented with shortness of breath. Electrocardiogram showed diffuse ST elevations, and he was diagnosed with presumed RT-induced pericarditis. Despite anti-inflammatory therapy, he developed haemodynamic instability and clinical tamponade, with transthoracic echocardiogram showing a large circumferential pericardial effusion. He underwent emergent pericardiocentesis, and pericardial fluid cultures grew polymicrobial species. Anti-inflammatories were held, and he was started on broad spectrum intravenous antibiotics and antifungals. Due to clinical decompensation and repeat computed tomography imaging demonstrating worsening pericardial disease, he underwent pericardial irrigation and subxiphoid pericardial window. The patient died from hypoxaemic and hypercapnic respiratory failure. Autopsy revealed constrictive pericarditis and no bacterial organisms in the pericardium. Discussion Anti-inflammatories are standard treatment for viral and RT-induced pericarditis. Purulent, bacterial pericarditis is rare and an uncommon complication of RT-induced pericarditis. Polymicrobial infectious pericarditis is often refractory to intravenous antibiotics, requiring surgical intervention. This case highlights the importance of maintaining a high index of suspicion of various potential aetiologies of pericarditis in order to tailor medical and surgical therapies especially in high-risk, immunosuppressed cancer patients.
Collapse
Affiliation(s)
- Kimberly L Yan
- Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Yoo Jin Lee
- Department of Radiology, University of California, San Francisco, San Francisco, CAUSA
| | - Alan H Baik
- Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
- Division of Cardiology, Section of Cardio-Oncology and Immunology, University of California, San Francisco, 555 Mission Bay Blvd South, San Francisco, CA 94158, USA
| |
Collapse
|
15
|
Leppien EE, Pauling EE, Smith E, Wisniewski B, Carpenter A, Schwier NC. Pain management considerations in patients living with both pain syndromes and cardiovascular diseases and disorders. Pharmacotherapy 2024; 44:184-196. [PMID: 38049207 DOI: 10.1002/phar.2897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 12/06/2023]
Abstract
Concomitant pain syndromes and cardiovascular disease (CVD) and disorders are associated with significant morbidity, impaired quality of life, and neuropsychiatric disorders. There is an interplay between the mechanisms of pathophysiology of both CVD and pain syndromes. Patients with CVD (and/or disorders) as well as pain syndromes have an increased propensity for drug-drug/disease interactions. Therefore, an understanding of how to use pharmacotherapy to treat pain syndromes, in the context of patients who have diagnoses of CVD and/or disorders, is paramount to patients' success in achieving adequate pain control and appropriately managing CVD and/or disorders, all while decreasing the risk of adverse events (AEs) both from pharmacotherapy to treat pain and CVD (and/or disorders). Based on the appraisal of literature and authors' clinical expertise, it was determined that gabapentinoids, opioids, skeletal muscle relaxants, tricyclic antidepressants, clonidine, serotonin norepinephrine-reuptake inhibitors, dronabinol, carbamazepine, second-generation antipsychotics, non-steroidal anti-inflammatory drugs, aspirin, corticosteroids, and topical anesthetics have the most evidence for use in patients with CVD and/or disorders. However, the literature surrounding the use of pharmacotherapy for pain management is limited to retrospective studies and there is a lack of well-designed, prospective, randomized trials; this also includes head-to-head comparator studies. Unlike many CVD-related pharmacotherapy studies, data studying pain management in patients with CVD lacks standardized outcomes that are consistent among the pool of data. Overall, the decision to prescribe specific pain management therapies in patients with CVD and/or disorders should include assessment of pain severity, type of pain, drug-drug/disease interactions, adjuvant therapies required, and the risk or presence of AEs.
Collapse
Affiliation(s)
- Emily E Leppien
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, New York, USA
| | - Erin E Pauling
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, New York, USA
| | - Eric Smith
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, New York, USA
| | - Brady Wisniewski
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, New York, USA
| | - Abigayle Carpenter
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, New York, USA
| | - Nicholas C Schwier
- Office of Experiential Education & Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, New York, USA
| |
Collapse
|
16
|
Thorolfsdottir RB, Jonsdottir AB, Sveinbjornsson G, Aegisdottir HM, Oddsson A, Stefansson OA, Halldorsson GH, Saevarsdottir S, Thorleifsson G, Stefansdottir L, Pedersen OB, Sørensen E, Ghouse J, Raja AA, Zheng C, Silajdzija E, Rand SA, Erikstrup C, Ullum H, Mikkelsen C, Banasik K, Brunak S, Ivarsdottir EV, Sigurdsson A, Beyter D, Sturluson A, Einarsson H, Tragante V, Helgason H, Lund SH, Halldorsson BV, Sigurpalsdottir BD, Olafsson I, Arnar DO, Thorgeirsson G, Knowlton KU, Nadauld LD, Gretarsdottir S, Helgadottir A, Ostrowski SR, Gudbjartssson DF, Jonsdottir I, Bundgaard H, Holm H, Sulem P, Stefansson K. Variants at the Interleukin 1 Gene Locus and Pericarditis. JAMA Cardiol 2024; 9:165-172. [PMID: 38150231 PMCID: PMC10753444 DOI: 10.1001/jamacardio.2023.4820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/14/2023] [Indexed: 12/28/2023]
Abstract
Importance Recurrent pericarditis is a treatment challenge and often a debilitating condition. Drugs inhibiting interleukin 1 cytokines are a promising new treatment option, but their use is based on scarce biological evidence and clinical trials of modest sizes, and the contributions of innate and adaptive immune processes to the pathophysiology are incompletely understood. Objective To use human genomics, transcriptomics, and proteomics to shed light on the pathogenesis of pericarditis. Design, Setting, and Participants This was a meta-analysis of genome-wide association studies of pericarditis from 5 countries. Associations were examined between the pericarditis-associated variants and pericarditis subtypes (including recurrent pericarditis) and secondary phenotypes. To explore mechanisms, associations with messenger RNA expression (cis-eQTL), plasma protein levels (pQTL), and CpG methylation of DNA (ASM-QTL) were assessed. Data from Iceland (deCODE genetics, 1983-2020), Denmark (Copenhagen Hospital Biobank/Danish Blood Donor Study, 1977-2022), the UK (UK Biobank, 1953-2021), the US (Intermountain, 1996-2022), and Finland (FinnGen, 1970-2022) were included. Data were analyzed from September 2022 to August 2023. Exposure Genotype. Main Outcomes and Measures Pericarditis. Results In this genome-wide association study of 4894 individuals with pericarditis (mean [SD] age at diagnosis, 51.4 [17.9] years, 2734 [67.6%] male, excluding the FinnGen cohort), associations were identified with 2 independent common intergenic variants at the interleukin 1 locus on chromosome 2q14. The lead variant was rs12992780 (T) (effect allele frequency [EAF], 31%-40%; odds ratio [OR], 0.83; 95% CI, 0.79-0.87; P = 6.67 × 10-16), downstream of IL1B and the secondary variant rs7575402 (A or T) (EAF, 45%-55%; adjusted OR, 0.89; 95% CI, 0.85-0.93; adjusted P = 9.6 × 10-8). The lead variant rs12992780 had a smaller odds ratio for recurrent pericarditis (0.76) than the acute form (0.86) (P for heterogeneity = .03) and rs7575402 was associated with CpG methylation overlapping binding sites of 4 transcription factors known to regulate interleukin 1 production: PU.1 (encoded by SPI1), STAT1, STAT3, and CCAAT/enhancer-binding protein β (encoded by CEBPB). Conclusions and Relevance This study found an association between pericarditis and 2 independent sequence variants at the interleukin 1 gene locus. This finding has the potential to contribute to development of more targeted and personalized therapy of pericarditis with interleukin 1-blocking drugs.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Gisli H. Halldorsson
- deCODE genetics, Amgen, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Saedis Saevarsdottir
- deCODE genetics, Amgen, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Medicine, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Ole B. Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jonas Ghouse
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Laboratory for Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Chaoqun Zheng
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elvira Silajdzija
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Albertsen Rand
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Laboratory for Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Christina Mikkelsen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Karina Banasik
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Hafsteinn Einarsson
- deCODE genetics, Amgen, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Hannes Helgason
- deCODE genetics, Amgen, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Bjarni V. Halldorsson
- deCODE genetics, Amgen, Reykjavik, Iceland
- School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Brynja D. Sigurpalsdottir
- deCODE genetics, Amgen, Reykjavik, Iceland
- School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Isleifur Olafsson
- Department of Clinical Biochemistry, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
| | - David O. Arnar
- deCODE genetics, Amgen, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Medicine, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Kirk U. Knowlton
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah
- School of Medicine, University of Utah, Salt Lake City
| | - Lincoln D. Nadauld
- Precision Genomics, Intermountain Healthcare, Saint George, Utah
- School of Medicine, Stanford University, Stanford, California
| | | | | | - Sisse R. Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel F. Gudbjartssson
- deCODE genetics, Amgen, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Ingileif Jonsdottir
- deCODE genetics, Amgen, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Immunology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hilma Holm
- deCODE genetics, Amgen, Reykjavik, Iceland
| | | | - Kari Stefansson
- deCODE genetics, Amgen, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
17
|
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
|
18
|
Xia S, Li YF, Raschi E, Zhang BK, Noguchi Y, Sarangdhar M, Yan M, Ma JA. Disproportional signal of pericarditis with biological diseasemodifying antirheumatic drugs (bDMARDs) in patients with ankylosing spondylitis: a disproportionality analysis in the FAERS database. Front Pharmacol 2024; 15:1275814. [PMID: 38333008 PMCID: PMC10850349 DOI: 10.3389/fphar.2024.1275814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Objective: This study aimed to investigate the potential association between biological disease-modifying antirheumatic drugs (bDMARDs) and pericarditis and uncover relevant clinical characteristics in ankylosing spondylitis (AS). Methods: Reports of pericarditis recorded in the FDA Adverse Event Reporting System (FAERS) (January 2004-December 2022) were identified through the preferred term "pericarditis." Demographic and clinical characteristics were described, and disproportionality signals were assessed through the reporting odds ratio (ROR) and information component (IC). A significant signal was detected if the lower bound of IC (IC025) was more than zero. Results: We found 1,874 reports of pericarditis with bDMARDs (11.3% of cases with fatal outcomes). Adalimumab (IC025 3.24), infliximab (IC025 4.90), golimumab (IC025 5.40), certolizumab (IC025 5.43), etanercept (IC025 3.24), secukinumab (IC025 3.97), and ustekinumab (IC025 7.61) exhibit significant disproportionality signals compared to other medications in the FAERS database. After excluding pre-existing diseases and co-treated drugs that may increase the susceptibility of pericarditis, the disproportionality signal associated with infliximab, certolizumab, etanercept, secukinumab, and ustekinumab remained strong. Pericarditis cases associated with all bDMARDs were predominantly recorded in women aged 25-65 years. Conclusion: More reports of pericarditis were detected with AS patients on bDMARDs than with other drugs in the overall database. Further studies are warranted to investigate the underlying mechanisms and identify patient-related susceptibility factors, thus supporting timely diagnosis and safe(r) prescribing of bDMARDs.
Collapse
Affiliation(s)
- Shuang Xia
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Changsha, China
- Toxicology Counseling Center of Hunan Province, Changsha, China
| | - Yun-Fei Li
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Bi-Kui Zhang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Changsha, China
- Toxicology Counseling Center of Hunan Province, Changsha, China
| | - Yoshihiro Noguchi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Mayur Sarangdhar
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Miao Yan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- International Research Center for Precision Medicine, Transformative Technology and Software Services, Changsha, China
- Toxicology Counseling Center of Hunan Province, Changsha, China
| | - Jin-An Ma
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, China
| |
Collapse
|
19
|
Yamamoto H, Kume N, Hashimoto K, Isogai J, Kuwabara T, Noguchi M, Murayama H, Hashimoto T, Ogino H. Subacute hemorrhagic pericardial tamponade after COVID-19 infection mimicking carcinomatous pericarditis: a case report. Front Cardiovasc Med 2024; 10:1329952. [PMID: 38264260 PMCID: PMC10803410 DOI: 10.3389/fcvm.2023.1329952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/26/2023] [Indexed: 01/25/2024] Open
Abstract
Background Coronavirus disease (COVID-19)-associated acute pericarditis has recently received much attention owing to its high frequency associated with pericardial tamponade (PT), showing unfavorable prognosis. However, early diagnosis and treatment remain challenging in cases of non-specific signs and symptoms. Case presentation A 64-year-old man was admitted to our hospital for acute osteomyelitis of the toes and was properly treated with antimicrobial agents. Three days after admission, the patient developed mild COVID-19 without pneumonia, for which early anti-COVID-19 agents were initiated. Nevertheless, the patient developed hemorrhagic PT due to acute pericarditis 2 weeks later, which was confirmed by cardiac magnetic resonance, requiring an urgent pericardiocentesis. Although cytological analysis of the hemorrhagic pericardial fluid strongly suggested adenocarcinoma, the atypical cells were eventually proven to be mesothelial cells with reactive atypia. Furthermore, lymph nodes swelling with abnormal 2-[18F]-fluoro-2-deoxy-D-glucose accumulation on imaging were suggestive of malignancy. However, biopsy examination revealed multiple non-caseating granulomas in the lymph node, unlikely due to malignancy. Eventually, the temporal association of the preceding COVID-19 with the occurrence of subacute PT without other identifiable cause led to a final diagnosis of COVID-19-associated acute pericarditis. With anti-inflammatory and corticosteroids treatment, the patient's symptoms involving the pericardial structure and function were completely resolved along with improvements in size of the affected lymphadenopathies. Conclusions We encountered a unique case of COVID-19-associated acute pericarditis exhibiting hemorrhagic PT. This case underscores the residual risk of delayed pericardial involvement even in patients with mild COVID-19 who receive early treatment, and the recognition that COVID-19 may cause various cytomorphological and histological features. Additionally, the importance of considering this rare entity as a cause of hemorrhagic pericardial effusions should be highlighted.
Collapse
Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Nao Kume
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Katsuya Hashimoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Jun Isogai
- Division of Radiology, Asahi General Hospital, Asahi, Japan
| | - Takuya Kuwabara
- Department of Pathology, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Masayuki Noguchi
- Department of Pathology, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hiroyuki Murayama
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| |
Collapse
|
20
|
Booz GW. Journal of Cardiovascular Pharmacology Welcomes New Associates. J Cardiovasc Pharmacol 2024; 83:1-3. [PMID: 38090968 DOI: 10.1097/fjc.0000000000001522] [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: 01/06/2024]
Affiliation(s)
- George W Booz
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS
| |
Collapse
|
21
|
Gyöngyösi M, Hasimbegovic E, Han E, Zlabinger K, Spannbauer A, Riesenhuber M, Hamzaraj K, Bergler-Klein J, Hengstenberg C, Kammerlander A, Kastl S, Loewe C, Beitzke D. Improvement of Symptoms and Cardiac Magnetic Resonance Abnormalities in Patients with Post-Acute Sequelae of SARS-CoV-2 Cardiovascular Syndrome (PASC-CVS) after Guideline-Oriented Therapy. Biomedicines 2023; 11:3312. [PMID: 38137533 PMCID: PMC10742066 DOI: 10.3390/biomedicines11123312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiac magnetic resonance (CMR) studies reported CMR abnormalities in patients with mild-moderate SARS-CoV-2 infection, suggesting ongoing myocardial inflammation. Patients (n = 278, 43 ± 13 years, 70.5% female) with post-acute sequelae of SARS-CoV-2 cardiovascular syndrome (PASC-CVS) were included prospectively into the Vienna POSTCOV Registry between March 2021 and March 2023 (clinicaltrials.gov NCT05398952). Clinical, laboratory, and CMR findings were recorded. Patients with abnormal CMR results were classified into isolated chronic pericardial (with/without pleural) effusion, isolated cardiac function impairment, or both (myopericarditis) groups. Medical treatment included a nonsteroidal anti-inflammatory agent (NSAID) for pericardial effusion and a condition-adapted maximal dose of heart failure (HF) treatment. Three months after medical therapy, clinical assessment and CMR were repeated in 82 patients. Laboratory analyses revealed normal hematological, inflammatory, coagulation, and cardiac biomarkers. CMR abnormalities were found in 155 patients (55.8%). Condition-adapted HF treatment led to a significant increase in the left ventricular ejection fraction (LVEF) in patients with initially reduced LVEF (from 49 ± 5% to 56 ± 4%, p = 0.009, n = 25). Low-moderate doses of NSAIDs for 3 months significantly reduced pericardial effusion (from 4/3;5.75/mm to 2/0;3/mm, median/interquartile ranges/p < 0.001, n = 51). Clinical symptoms improved markedly with a decrease in CMR abnormalities, which might be attributed to the maintenance of NSAID and HF medical treatment for PASC-CVS.
Collapse
Affiliation(s)
- Mariann Gyöngyösi
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Ena Hasimbegovic
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Emilie Han
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Katrin Zlabinger
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Andreas Spannbauer
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Martin Riesenhuber
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Kevin Hamzaraj
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Jutta Bergler-Klein
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Christian Hengstenberg
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Andreas Kammerlander
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Stefan Kastl
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Christian Loewe
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (C.L.); (D.B.)
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (C.L.); (D.B.)
| |
Collapse
|
22
|
Moros D, Zaki A, Tong MZY. Surgical Approaches for Pericardial Diseases: What Is New? Curr Cardiol Rep 2023; 25:1705-1713. [PMID: 37938424 DOI: 10.1007/s11886-023-01986-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the evolving techniques and approaches for pericardiectomy, with a focus on the use of cardiopulmonary bypass (CPB) and the extent of radical pericardial resection. The review aims to highlight the benefits and considerations associated with these modifications in radical pericardiectomy. RECENT FINDINGS Recent studies have demonstrated that the use of CPB during pericardiectomy does not increase procedural risk or negatively impact survival. In fact, it has been shown to contribute to a more radical resection and improve postoperative outcomes, which is associated with less recurrence and better survival. The review emphasizes the importance of radical pericardiectomy and the use of CPB in achieving successful outcomes. Radical resection of the pericardium, facilitated by CPB, helps minimize the risk of recurrent constrictions and the need for reinterventions. The findings highlight the correlation between postoperative outcomes and survival, further supporting the use of CPB.
Collapse
Affiliation(s)
- David Moros
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Anthony Zaki
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Michael Zhen-Yu Tong
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| |
Collapse
|
23
|
Chang Q, Wu D, Xu Z. Further Analysis Needed of Migrating Localized ST-Segment Elevation or Was It Lead Reversal? JAMA Intern Med 2023; 183:1412. [PMID: 37902724 DOI: 10.1001/jamainternmed.2023.5683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- Qinghua Chang
- Department of Cardiology of the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Dongdong Wu
- Department of Cardiology of the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Zhaolong Xu
- Department of Cardiology of the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
| |
Collapse
|
24
|
Weber BN, Garshick M, Abbate A, Youngstein T, Stewart G, Bohula E, Plein S, Mukherjee M. Acute cardiovascular complications of immune-mediated systemic inflammatory diseases. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:792-801. [PMID: 37603839 PMCID: PMC11004858 DOI: 10.1093/ehjacc/zuad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Abstract
Immune-mediated systemic inflammatory conditions (IMIDs) are associated with an increased risk of atherosclerosis and adverse cardiovascular (CV) events secondary to pathogenic inflammation and derangements in the innate and adaptive immune responses inherent to the underlying rheumatic diseases. As the intersection of cardio-rheumatology continues to expand, a multi-disciplinary approach must be considered to optimize clinical outcomes and long-term survival. This review will highlight acute cardiac manifestations of systemic inflammatory diseases and propose a clinically relevant framework for diagnosis, management, and the role of integrated multimodality imaging.
Collapse
Affiliation(s)
- Brittany N Weber
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Michael Garshick
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center, and Division of Cardiology, University of Virginia, Charlottesville, VA, USA
| | - Taryn Youngstein
- Department of Rheumatology, Imperial College NHS Healthcare Trust, London, UK
| | - Garrick Stewart
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Erin Bohula
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
25
|
Kaur G, Sabatine MS, Schaefer IM, Sun YP, Loscalzo J. Encased in Peril. N Engl J Med 2023; 389:1709-1716. [PMID: 37913509 DOI: 10.1056/nejmcps2306031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
- Gurleen Kaur
- From the Department of Medicine (G.K., M.S.S., Y.-P.S., J.L.), TIMI Study Group, Division of Cardiovascular Medicine (M.S.S.), and the Department of Pathology (I.-M.S.), Brigham and Women's Hospital, Boston
| | - Marc S Sabatine
- From the Department of Medicine (G.K., M.S.S., Y.-P.S., J.L.), TIMI Study Group, Division of Cardiovascular Medicine (M.S.S.), and the Department of Pathology (I.-M.S.), Brigham and Women's Hospital, Boston
| | - Inga-Marie Schaefer
- From the Department of Medicine (G.K., M.S.S., Y.-P.S., J.L.), TIMI Study Group, Division of Cardiovascular Medicine (M.S.S.), and the Department of Pathology (I.-M.S.), Brigham and Women's Hospital, Boston
| | - Yee-Ping Sun
- From the Department of Medicine (G.K., M.S.S., Y.-P.S., J.L.), TIMI Study Group, Division of Cardiovascular Medicine (M.S.S.), and the Department of Pathology (I.-M.S.), Brigham and Women's Hospital, Boston
| | - Joseph Loscalzo
- From the Department of Medicine (G.K., M.S.S., Y.-P.S., J.L.), TIMI Study Group, Division of Cardiovascular Medicine (M.S.S.), and the Department of Pathology (I.-M.S.), Brigham and Women's Hospital, Boston
| |
Collapse
|
26
|
Cinteza E, Stefan D, Iancu MA, Ioan A, Vasile CM, Vatasescu R, Cochino A. Autoinflammatory Recurrent Pericarditis Associated with a New NLRP12 Mutation in a Male Adolescent. Life (Basel) 2023; 13:2131. [PMID: 38004271 PMCID: PMC10672620 DOI: 10.3390/life13112131] [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: 10/04/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Idiopathic recurrent pericarditis (IRP) can be the hallmark of an autoinflammatory syndrome with recurrent attacks of chest pain and symptom-free intervals following an acute episode. The recurrence rate may be 35% in the pediatric population, frequently with less severe manifestations than at the first episode. Pericarditis can be the sole clinical manifestation or may be part of a systemic autoinflammatory disease (SAID), especially in the case of a recurrence. Familial Mediterranean Fever (FMF), Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS), Mevalonate-Kinase Deficiency (MKD), nucleotide-binding oligomerization domain 2 (NOD2)-associated autoinflammatory syndrome, and others are closely related to IRP based on similar clinical manifestations and treatment responses to anti-interleukin 1 (IL-1) agents, such as anakinra, and should therefore be excluded in patients with IRP. A newly described SAID, an autosomal dominant disorder known as NLRP12-AID (nucleotide-binding leucine-rich repeat-containing receptor 12-related autoinflammatory disease) is caused by heterozygous mutations in the NLRP12 gene and most commonly affects children. Fewer than 40 pediatric patients with NLRP12-AID have been described in the medical literature, with none presenting with RP. We report a case of relapsing pericarditis responsive to anti-IL-1 therapy in a male adolescent who carried a missense mutation in the NLRP12 gene potentially causative of the excessive activation of inflammatory pathways. This is a unique case in the medical literature that associates recurrent pericarditis in an adolescent presumed to be related to the missense mutation in the NLRP12 gene. The role of the NLRP12 inflammasome in generating and maintaining recurrent pericardial inflammation should be considered.
Collapse
Affiliation(s)
- Eliza Cinteza
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.); (A.C.)
- Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 41451 Bucharest, Romania;
| | - Dan Stefan
- Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 41451 Bucharest, Romania;
| | - Mihaela Adela Iancu
- Department of Internal, Family and Occupational Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andreea Ioan
- Department of Pediatrics, “Alessandrescu Rusescu” National Institute for Mother and Child Health, 020395 Bucharest, Romania;
| | - Corina Maria Vasile
- Pediatric and Adult Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, 3300 Bordeaux, France;
| | - Radu Vatasescu
- Cardio-Thoracic Department, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
- Department of Cardiology, Clinic Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Alexis Cochino
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.); (A.C.)
- Department of Pediatrics, “Alessandrescu Rusescu” National Institute for Mother and Child Health, 020395 Bucharest, Romania;
| |
Collapse
|
27
|
Li P, Shi A, Lu X, Li C, Cai P, Teng C, Liu B, Wu L, Liu Q, Wang B. Incidence and Impact of Acute Pericarditis in Hospitalized Patients With COVID-19. J Am Heart Assoc 2023; 12:e028970. [PMID: 37815025 PMCID: PMC10757531 DOI: 10.1161/jaha.122.028970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/06/2023] [Indexed: 10/11/2023]
Abstract
Background Acute pericarditis (AP) is considered a cardiovascular complication in patients with COVID-19. We aimed to ass-ess the incidence, associated complications, and clinical impact of AP on hospitalized patients with COVID-19. Methods and Results In this retrospective cohort study, International Classification of Diseases, Tenthth Revision, Clinical Modification (ICD-10) codes were used to identify patients with COVID-19 with or without AP in the National Inpatient Sample 2020 database. We compared outcomes between AP and non-AP groups before and after propensity-score matching for patient and hospital demographics and relevant comorbidities. A total of 211 619 patients with a primary diagnosis of COVID-19 were identified, including 983 (0.46%) patients who had a secondary diagnosis of AP. Before matching, patients with COVID-19 with AP were younger (59.93±19.24 years old versus 64.29±16.82 years old) and more likely to have anemia (40.5% versus 19.9%), cancer (6.7% versus 3.6%), and chronic kidney disease (29.3% versus 19.6%) (all P<0.05). After matching, patients with COVID-19 with AP (n=980), when compared with the matched non-AP group (n=2936), had higher rates of mortality (21.3% versus 11.1%, P<0.001), cardiac arrest (5.0% versus 2.6%, P<0.001), cardiogenic shock (4.2% versus 0.5%, P<0.001), ventricular arrhythmia (4.7% versus 1.9%, P<0.001), acute kidney injury (38.3% versus 28.9%, P<0.001), acute congestive heart failure (14.3% versus 4.8%, P<0.001), and longer length of stay (7.00±10.00 days versus 5.00±7.00 days, P<0.001) and higher total charges ($75066.5±$130831.3 versus $44824.0±$63660.5, P<0.001). Conclusions In hospitalized patients with COVID-19, AP is a rare but severe in-hospital complication and is associated with worse in-hospital outcomes.
Collapse
Affiliation(s)
- Pengyang Li
- Division of Cardiology, Pauley Heart CenterVirginia Commonwealth UniversityRichmondVAUSA
| | - Ao Shi
- Faculty of MedicineSt. George University of LondonLondonUnited Kingdom
- University of Nicosia Medical SchoolUniversity of NicosiaCyprus
| | - Xiaojia Lu
- Department of CardiologyThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Chenlin Li
- Department of CardiologyThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Peng Cai
- Department of Mathematical SciencesWorcester Polytechnic InstituteWorcesterMAUSA
| | - Catherine Teng
- Division of Cardiology, Department of MedicineUniversity of Texas San AntonioSan AntonioTXUSA
| | - Bolun Liu
- Department of Hospital Internal MedicineMayo Clinic Health SystemMankatoMNUSA
| | - Lingling Wu
- Department of MedicineEastern Carolina University Health Medical CenterGreenvilleNCUSA
| | - Qi Liu
- Wafic Said Molecular Cardiology Research LaboratoryThe Texas Heart InstituteHoustonTXUSA
| | - Bin Wang
- Department of CardiologyThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
- Clinical Research CenterThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| |
Collapse
|
28
|
Aikawa H, Fujino M, Murai K, Iwai T, Sawada K, Matama H, Miura H, Honda S, Yoneda S, Takagi K, Otsuka F, Kataoka Y, Asaumi Y, Tahara Y, Ogata S, Nishimura K, Tsujita K, Noguchi T. In-hospital adverse events and recurrence in hospitalized patients with acute pericarditis. J Cardiol 2023; 82:268-273. [PMID: 36906259 DOI: 10.1016/j.jjcc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/04/2023] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Acute pericarditis occasionally requires invasive treatment, and may recur after discharge. However, there are no studies on acute pericarditis in Japan, and its clinical characteristics and prognosis are unknown. METHODS This was a single-center, retrospective cohort study of clinical characteristics, invasive procedures, mortality, and recurrence in patients with acute pericarditis hospitalized from 2010 to 2022. The primary in-hospital outcome was adverse events (AEs), a composite of all-cause mortality and cardiac tamponade. The primary outcome in the long-term analysis was hospitalization for recurrent pericarditis. RESULTS The median age of all 65 patients was 65.0 years [interquartile range (IQR), 48.0-76.0 years], and 49 (75.3 %) were male. The etiology of acute pericarditis was idiopathic in 55 patients (84.6 %), collagenous in 5 (7.6 %), bacterial in 1 (1.5 %), malignant in 3 (4.6 %), and related to previous open-heart surgery in 1 (1.5 %). Of the 8 patients (12.3 %) with in-hospital AE, 1 (1.5 %) died during hospitalization and 7 (10.8 %) developed cardiac tamponade. Patients with AE were less likely to have chest pain (p = 0.011) but were more likely to have symptoms lasting 72 h after treatment (p = 0.006), heart failure (p < 0.001), and higher levels of C-reactive protein (p = 0.040) and B-type natriuretic peptide (p = 0.032). All patients complicated with cardiac tamponade were treated with pericardial drainage or pericardiotomy. We analyzed 57 patients for recurrent pericarditis after excluding 8 patients: 1 with in-hospital death, 3 with malignant pericarditis, 1 with bacterial pericarditis, and 3 lost to follow-up. During a median follow-up of 2.5 years (IQR 1.3-3.0 years), 6 patients (10.5 %) had recurrences requiring hospitalization. The recurrence rate of pericarditis was not associated with colchicine treatment or aspirin dose or titration. CONCLUSIONS In acute pericarditis requiring hospitalization, in-hospital AE and recurrence were each observed in >10 % of patients. Further large studies on treatment are warranted.
Collapse
Affiliation(s)
- Hirohiko Aikawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan.
| | - Kota Murai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Matama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Shuichi Yoneda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, NCVC, Suita, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, NCVC, Suita, Osaka, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
29
|
Maqbool KU, Arsh H, Kumar D, Veena F, Punshi AK, Payal F, Kumar S, Kumar S, Rani D, Malik J. Cardiovascular Manifestations of Human Monkeypox Virus: An Updated Review. Curr Probl Cardiol 2023; 48:101869. [PMID: 37302648 PMCID: PMC10251728 DOI: 10.1016/j.cpcardiol.2023.101869] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023]
Abstract
Cardiovascular manifestations in human monkeypox virus (MPXV) infection has gained increasing recognition as significant complications with both social and clinical implications. Myocarditis, viral pericarditis, heart failure, and arrhythmias can occur, leading to adverse effects on individuals' health and quality of life. Understanding the detailed pathophysiology of these cardiovascular manifestations is essential for improved diagnosis and management. The social implications of these cardiovascular complications are multifaceted, ranging from public health concerns and the impact on individuals' quality of life to psychological distress and social stigma. Clinically, diagnosing, and managing these complications present challenges, requiring a multidisciplinary approach and specialized care. The burden on healthcare resources necessitates preparedness and resource allocation to effectively address these complications. We delve into the pathophysiological mechanisms involved, including viral-induced cardiac damage, immune response, and inflammatory processes. Additionally, we explore the types of cardiovascular manifestations and their clinical presentations. Addressing cardiovascular manifestations' social and clinical implications in MPXV infection requires a comprehensive approach involving healthcare professionals, public health authorities, and communities. By prioritizing research, enhancing diagnosis and treatment strategies, and promoting preventive measures, we can mitigate the impact of these complications, improve patient care, and protect public health.
Collapse
Affiliation(s)
| | - Hina Arsh
- Department of Medicine, THQ Hospital, Pasrur, Pakistan
| | - Deepak Kumar
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Fnu Veena
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | | | - Fnu Payal
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto University, Larkana, Pakistan
| | - Sameet Kumar
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto University, Larkana, Pakistan
| | - Saroop Kumar
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Deepa Rani
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto University, Larkana, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Research, Cardiovascular Analytics Group, Islamabad, Pakistan.
| |
Collapse
|
30
|
Restelli D, Carerj ML, Bella GD, Zito C, Poleggi C, D’Angelo T, Donato R, Ascenti G, Blandino A, Micari A, Mazziotti S, Minutoli F, Baldari S, Carerj S. Constrictive Pericarditis: An Update on Noninvasive Multimodal Diagnosis. J Cardiovasc Echogr 2023; 33:161-170. [PMID: 38486689 PMCID: PMC10936705 DOI: 10.4103/jcecho.jcecho_61_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/28/2023] [Accepted: 10/29/2023] [Indexed: 03/17/2024] Open
Abstract
Constrictive pericarditis (CP) is a rare condition that can affect the pericardium after every pericardial disease process and has been described even after SARS-CoV-2 infection or vaccine. In CP, the affected pericardium, usually the inner layer, is noncompliant, constraining the heart to a fixed maximum volume and impairing the diastolic function. This leads to several clinical features, that, however, can be pleomorphic. In its difficult diagnostic workup, noninvasive multimodal imaging plays a central role, providing important morphological and functional data, like the enhanced ventricular interdependence and the dissociation between intrathoracic and intracardiac pressures. An early and proper diagnosis is crucial to set an appropriate therapy, changing the prognosis of patients affected by CP. In this review, we cover in detail the main elements of each imaging technique, after a reminder of pathophysiology useful for understanding the diagnostic findings.
Collapse
Affiliation(s)
- Davide Restelli
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Maria Ludovica Carerj
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Cristina Poleggi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Tommaso D’Angelo
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Rocco Donato
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Antonio Micari
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Fabio Minutoli
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| |
Collapse
|
31
|
Ambrogetti R, Taha O, Awan B, Memon A, Sunmboye KO. Pericarditis of Polyarteritis Nodosa. Cureus 2023; 15:e46717. [PMID: 37822689 PMCID: PMC10564263 DOI: 10.7759/cureus.46717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 10/13/2023] Open
Abstract
Polyarteritis nodosa (PAN) is a rare systemic vasculitis characterised by necrotising inflammation of medium-sized arteries. PAN can affect patients of any age, gender, or ethnic background. Its highest incidence is in the fifth-sixth decade of life, with a slight male-to-female predilection. PAN can be idiopathic or secondary to a multitude of systemic conditions, such as infection, haematological malignancy, or autoinflammatory disorders. PAN has a broad spectrum of possible clinical manifestations the most common being constitutional symptoms, such as fever and myalgia. While cardiac involvement is well-described and is a common cause of mortality, it is exceedingly uncommon as the initial presentation. Below, we describe a case of a female in her 60s who presented with pericarditis as the first manifestation of PAN.
Collapse
Affiliation(s)
- Robert Ambrogetti
- Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Omer Taha
- Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Baseer Awan
- Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Ahsan Memon
- Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Kehinde O Sunmboye
- Health Sciences, University of Leicester, Leicester, GBR
- Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, GBR
| |
Collapse
|
32
|
Lazaros G, Vlachakis PK, Theofilis P, Dasoula FE, Imazio M, Lazarou E, Vlachopoulos C, Tsioufis C. D-dimer as a diagnostic and prognostic plasma biomarker in patients with a first episode of acute pericarditis. Eur J Intern Med 2023; 116:58-64. [PMID: 37357033 DOI: 10.1016/j.ejim.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES The impact of plasma biomarkers on diagnosis and prognosis of patients with acute pericarditis (AP) has been poorly investigated. This study aims to assess the diagnostic and prognostic role of d-dimer (DD), an easily obtainable biomarker, in patients with AP. PATIENTS AND METHODS This is a prospective clinical study enrolling 265 consecutive patients hospitalized between September 2010 and May 2019 with a first episode of AP. At baseline, demographics, clinical features, laboratory and imaging findings were recorded. All patients were followed-up for a minimum of 18 months. Endpoints included cardiac tamponade, new-onset atrial fibrillation, pericardial drainage, recurrent/constrictive pericarditis and death. RESULTS DD was measured in 165 out of 265 patients (62.3%, median levels 1456 ng/mL) Among them, 121 patients (73.3%) presented with elevated age-adjusted DD levels. Patients with elevated DD depicted a higher rate of pleural (69.4%, vs 38.6%, p<0.001) and pericardial effusions (89.3% vs 72.7%, p = 0.009). Elevated DD correlated with admission (rho=0.37) and peak (rho=0.36) C-reactive protein values. Patients with elevated DD depicted a trend towards a greater prevalence of pericardial tamponade vs those without (14.9% vs 4.5% respectively, p = 0.07). In the 43.8% of patients with elevated DD who underwent computed tomography pulmonary angiography (CTPA), no case of pulmonary embolism or aortic syndrome was unveiled. CONCLUSION DD elevation is detected in the majority of AP cases at presentation and may herald cardiac tamponade. In patients with chest pain not attributable to alternative causes, elevated DD denotes an inflammatory condition and should not prompt unnecessary investigations, such as CTPA.
Collapse
Affiliation(s)
- George Lazaros
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece.
| | - Panagiotis K Vlachakis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Panagiotis Theofilis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Foteini E Dasoula
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Udine, Italy
| | - Emilia Lazarou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Charalambos Vlachopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Costas Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| |
Collapse
|
33
|
Goyal S, Khidhir A, Burwinkel MD. Atypical Presentation of Acute Pericarditis Secondary to Allogeneic Hematopoietic Stem Cell Transplantation: A Case Report. Cureus 2023; 15:e44868. [PMID: 37818511 PMCID: PMC10561524 DOI: 10.7759/cureus.44868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/12/2023] Open
Abstract
Cardiotoxicity linked with hematopoietic stem cell transplantation (HSCT) is a well-described phenomenon associated with an increased mortality risk; however, the majority of cardiac events present over 100 days following transfusion and are often attributed to graft-versus-host disease or pre-treatment conditioning by chemotherapy with or without radiation therapy. Here, we present the case of a 60-year-old female with a medical history of chronic lymphocytic leukemia complicated by a myelodysplastic syndrome that progressed to acute myeloid leukemia who developed chest pain immediately following an allogeneic HSCT. Electrocardiogram showed dynamic ST-depressions in leads V3-5 without evidence of reciprocal changes. Transthoracic echocardiography revealed pericardial effusion without signs of tamponade. The patient was thought to have acute pericarditis and was subsequently treated with high-dose intravenous methylprednisolone with a taper for two weeks. Her symptoms promptly subsided, and the pericardial effusion resolved on repeat echocardiography, which confirmed the diagnosis. Acute pericarditis is a rarely described complication of HSCT that is fatal if left untreated and prompts urgent management. This atypical case of acute pericarditis in the early post-transplant phase highlights the importance of cardiac stratification in patients with active malignancy undergoing treatment. It would suggest a potential benefit in closely monitoring high-risk individuals who have a history of coronary artery disease, smoking, or pericarditis in the pre-engraftment phase of transplantation.
Collapse
Affiliation(s)
- Sourabh Goyal
- Department of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Angela Khidhir
- Department of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Matthew D Burwinkel
- Department of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| |
Collapse
|
34
|
Xiao Y, Zhou R. Migrating Localized ST-Segment Elevation With Ongoing Chest Pain. JAMA Intern Med 2023; 183:1005-1006. [PMID: 37399032 DOI: 10.1001/jamainternmed.2023.1723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
A patient in their 60s presented with a 6-hour history of sudden-onset worsening chest pain associated with shortness of breath and diaphoresis. What is your diagnosis?
Collapse
Affiliation(s)
- Yunling Xiao
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, PR China
| | - Ruihai Zhou
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
35
|
Osawa T, Tajiri K. Neoplastic Cardiac Tamponade. Intern Med 2023; 62:2447-2448. [PMID: 36642525 PMCID: PMC10518545 DOI: 10.2169/internalmedicine.1294-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Takumi Osawa
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kazuko Tajiri
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Japan
- Department of Cardiology, National Cancer Center Hospital East, Japan
| |
Collapse
|
36
|
Lazaros G, Imazio M, Tsioufis P, Lazarou E, Vlachopoulos C, Tsioufis C. Chronic Pericardial Effusion: Causes and Management. Can J Cardiol 2023; 39:1121-1131. [PMID: 36773704 DOI: 10.1016/j.cjca.2023.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/10/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Chronic pericardial effusion is a common pericardial syndrome whose approach has been well standardised in recent years. The main challenge associated with this condition is the progression (sometimes unheralded) to cardiac tamponade. Pericardial effusions may present either as an isolated finding or in the context of a specific etiology including autoimmune, neoplastic, or metabolic disease. Among investigations used during diagnostic work-up, echocardiography is of paramount importance for the diagnosis, sizing, and serial evaluation of the hemodynamic impact of effusions on heart diastolic function. In an individualised manner, advanced imaging including computed tomography and cardiac magnetic resonance imaging should be performed, especially if baseline tests are inconclusive. Triage of these patients according to the most recent 2015 European Society of Cardiology Guidelines for the diagnosis and management of pericardial diseases should take into account the presence of hemodynamic compromise as well as suspicion of malignant or purulent pericarditis as first step, C-reactive protein serum level measurement as second step, investigations for a specific condition known to be associated with pericardial effusion as third step, and finally the size and the duration of the effusion. Treatment depends on the evaluation of the above-mentioned parameters and should ideally be tailored to the individual patient. Prognosis of chronic pericardial effusions depends largely on the underlying etiology. According to novel data, the prognosis of individuals with idiopathic, chronic (> 3 months), large (> 2 cm), asymptomatic pericardial effusions is usually benign and a watchful waiting strategy seems more reasonable and cost-effective than routine drainage as previously recommended.
Collapse
Affiliation(s)
- George Lazaros
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Udine, Italy
| | - Panagiotis Tsioufis
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilia Lazarou
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
37
|
Imazio M, Mardigyan V, Andreis A, Franchin L, De Biasio M, Collini V. New Developments in the Management of Recurrent Pericarditis. Can J Cardiol 2023; 39:1103-1110. [PMID: 37075863 DOI: 10.1016/j.cjca.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023] Open
Abstract
Recurrent pericarditis is a common and troublesome complication that affects 15%-30% of patients with a previous episode of pericarditis. However, the pathogenesis of these recurrences is not well understood, and most cases remain idiopathic. Recent advances in medical therapy, including the use of colchicine and anti-interleukin-1 agents like anakinra and rilonacept, have suggested an autoinflammatory rather than an autoimmune mechanism for recurrences with an inflammatory phenotype. As a result, a more personalized approach to treatment is now recommended. Patients with an inflammatory phenotype (fever and elevated C-reactive protein level) should receive colchicine and anti-interleukin-1 agents as first-line therapy, whereas those without systemic inflammation should receive low to moderate doses of corticosteroids (eg, prednisone 0.2-0.5 mg/kg/d as an initial dose) and consider azathioprine and intravenous human immunoglobulins in the case of corticosteroid failure. Tapering of corticosteroids should be slow after achieving clinical remission. In this article, we review the new developments in the management of recurrent pericarditis.
Collapse
Affiliation(s)
- Massimo Imazio
- Cardiology and Cardiothoracic Department, University Hospital Santa Maria della Misericordia, and Department of Medicine, University of Udine, Udine, Italy.
| | - Vartan Mardigyan
- Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada
| | - Alessandro Andreis
- University Cardiology, Cardiovascular Department, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Luca Franchin
- Cardiology and Cardiothoracic Department, University Hospital Santa Maria della Misericordia, and Department of Medicine, University of Udine, Udine, Italy
| | - Marzia De Biasio
- Cardiology and Cardiothoracic Department, University Hospital Santa Maria della Misericordia, and Department of Medicine, University of Udine, Udine, Italy
| | - Valentino Collini
- Cardiology and Cardiothoracic Department, University Hospital Santa Maria della Misericordia, and Department of Medicine, University of Udine, Udine, Italy
| |
Collapse
|
38
|
Moodie TR, Taylor J, Shepple B. A Case of Cutibacterium acnes Pericardial Effusion After Coronary Artery Bypass Surgery. Cureus 2023; 15:e43095. [PMID: 37680428 PMCID: PMC10482544 DOI: 10.7759/cureus.43095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Cutibacterium acnes is a gram-positive, anaerobic rod commonly found on the skin and mucosal membrane. It is mostly associated with its role in acne formation, but here we present a case of purulent pericarditis secondary to C. acnes after coronary artery bypass graft surgery (CABG). A 58-year-old male presented for CABG after a coronary angiogram showed severe multivessel disease. The procedure was performed successfully. He had minimal complications until postop day seven, when he developed a fever and hypoxia. The transthoracic echo (TTE) was largely unrevealing. Due to further declining status the following day, a transesophageal echo (TEE) was performed and revealed a loculated pericardial effusion not visualized on TTE. This was subsequently drained, and fluid cultures grew C. acnes. The patient received five weeks of antibiotic therapy, which improved his condition.
Collapse
Affiliation(s)
| | - John Taylor
- Cardiology, University of Tennessee Medical Center, Knoxville, USA
| | - Benjamin Shepple
- Cardiology, University of Tennessee Medical Center, Knoxville, USA
| |
Collapse
|
39
|
Reddy P, Kane GC, Oh JK, Luis SA. The Evolving Etiologic and Epidemiologic Portrait of Pericardial Disease. Can J Cardiol 2023; 39:1047-1058. [PMID: 37217161 DOI: 10.1016/j.cjca.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Abstract
Pericardial disease includes a variety of conditions, including inflammatory pericarditis, pericardial effusions, constrictive pericarditis, pericardial cysts, and primary and secondary pericardial neoplasms. The true incidence of this varied condition is not well established, and the causes vary greatly across the world. This review aims to describe the changing pattern of epidemiology of pericardial disease and to provide an overview of causative etiologies. Idiopathic pericarditis (assumed most often to be viral) remains the most common etiology for pericardial disease globally, with tuberculous pericarditis being most common in developing countries. Other important etiologies include fungal, autoimmune, autoinflammatory, neoplastic (both benign and malignant), immunotherapy-related, radiation therapy-induced, metabolic, postcardiac injury, postoperative, and postprocedural causes. Improved understanding of the immune pathophysiological pathways has led to identification and reclassification of some idiopathic pericarditis cases into autoinflammatory etiologies, including immunoglobulin G (IgG)4-related pericarditis, tumour necrosis factor receptor-associated periodic syndrome (TRAPS), and familial Mediterranean fever in the current era. Contemporary advances in percutaneous cardiac interventions and the recent COVID-19 pandemic have also resulted in changes in the epidemiology of pericardial diseases. Further research is needed to improve our understanding of the etiologies of pericarditis, using the assistance of contemporary advanced imaging techniques and laboratory testing. Careful consideration of the range of potential causes and local epidemiologic patterns of causality are important for the optimization of diagnostic and therapeutic approaches.
Collapse
Affiliation(s)
- Prajwal Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| |
Collapse
|
40
|
Ibrahim R, Ferng J, Pineda JRE, Lee K. A case report of self-audible pericardial rub secondary to acute pericarditis from post-pericardiotomy syndrome (pericardial rub tinnitus). Eur Heart J Case Rep 2023; 7:ytad333. [PMID: 37547373 PMCID: PMC10398423 DOI: 10.1093/ehjcr/ytad333] [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: 01/18/2023] [Revised: 02/27/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
Background Pericarditis is a common pericardial disorder that is frequently accompanied by a pericardial friction rub, which can be detected during a physical examination. Although patients' awareness of cardiac murmurs and vascular bruits has been extensively reported, there are no reports on patients' self-awareness of a pericardial friction rub. Case summary We present the first case of a patient with acute pericarditis associated with objective self-awareness of a pericardial friction rub, which we recorded with an electronic stethoscope and confirmed the sound with the patient. The patient had a recent history of three-vessel coronary artery bypass grafting and presented with a progressively worsening, rhythmic, and 'sandpaper-scratching' sound in both ears. The sound was more pronounced in the left lateral decubitus position. The symptom resolved with colchicine therapy and was associated with concomitant resolution of the pericardial friction rub. Discussion This is the first documented case of a patient demonstrating objective self-awareness of a pericardial rub resulting from acute pericarditis associated with post-pericardiotomy syndrome. Tinnitus refers to the perception of an auditory sensation that can be subjective or objective, depending on whether it is heard only by the individual or can also be heard by an observer. While objective tinnitus caused by cardiovascular conditions has been previously reported, no cases have attributed the pericardial friction rub as the underlying cause. Therefore, we suggest using the term pericardial rub tinnitus to describe this unique phenomenon.
Collapse
Affiliation(s)
| | - Jonathan Ferng
- Department of Medicine, University of Arizona–Banner University Medical Center, 6th Floor, Room 6336, 1501 N. Campbell Ave., Tucson, AZ 85719, USA
| | - J R Exequiel Pineda
- Department of Cardiology, Sarver Heart Center, University of Arizona–Banner University Medical Center, 1625 N, Campbell Ave., Tucson, AZ 85719, USA
| | | |
Collapse
|
41
|
Antonopoulos AS, Vrettos A, Androulakis E, Kamperou C, Vlachopoulos C, Tsioufis K, Mohiaddin R, Lazaros G. Cardiac magnetic resonance imaging of pericardial diseases: a comprehensive guide. Eur Heart J Cardiovasc Imaging 2023; 24:983-998. [PMID: 37207354 DOI: 10.1093/ehjci/jead092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Indexed: 05/21/2023] Open
Abstract
Cardiac magnetic resonance (CMR) imaging has been established as a valuable diagnostic tool in the assessment of pericardial diseases by providing information on cardiac anatomy and function, surrounding extra-cardiac structures, pericardial thickening and effusion, characterization of pericardial effusion, and the presence of active pericardial inflammation from the same scan. In addition, CMR imaging has excellent diagnostic accuracy for the non-invasive detection of constrictive physiology evading the need for invasive catheterization in most instances. Growing evidence in the field suggests that pericardial enhancement on CMR is not only diagnostic of pericarditis but also has prognostic value for pericarditis recurrence, although such evidence is derived from small patient cohorts. CMR findings could also be used to guide treatment de-escalation or up-titration in recurrent pericarditis and selecting patients most likely to benefit from novel treatments such as anakinra and rilonacept. This article is an overview of the CMR applications in pericardial syndromes as a primer for reporting physicians. We sought to provide a summary of the clinical protocols used and an interpretation of the major CMR findings in the setting of pericardial diseases. We also discuss points that are less well clear and delineate the strengths and weak points of CMR in pericardial diseases.
Collapse
Affiliation(s)
- Alexios S Antonopoulos
- 1st Cardiology Department, Hipporkration Hospital, National and Kapodistrian University of Athens, 114 Vas Sofias Avenue 11527 Athens Greece
- Clinical, Experimental Surgery & Translational Research Center, Biomedical Research Foundation of the Academy of Athens, 4 Soranou Efesiou Street, 11527, AthensGreece
| | - Apostolos Vrettos
- Department of Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Emmanouil Androulakis
- CMR Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Chelsea, London
| | - Christina Kamperou
- 1st Cardiology Department, Hipporkration Hospital, National and Kapodistrian University of Athens, 114 Vas Sofias Avenue 11527 Athens Greece
| | - Charalambos Vlachopoulos
- 1st Cardiology Department, Hipporkration Hospital, National and Kapodistrian University of Athens, 114 Vas Sofias Avenue 11527 Athens Greece
| | - Konstantinos Tsioufis
- 1st Cardiology Department, Hipporkration Hospital, National and Kapodistrian University of Athens, 114 Vas Sofias Avenue 11527 Athens Greece
| | - Raad Mohiaddin
- CMR Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Chelsea, London
| | - George Lazaros
- 1st Cardiology Department, Hipporkration Hospital, National and Kapodistrian University of Athens, 114 Vas Sofias Avenue 11527 Athens Greece
| |
Collapse
|
42
|
Myachikova VY, Maslyanskiy AL, Moiseeva OM, Vinogradova OV, Gleykina EV, Lavrovsky Y, Abbate A, Grishin SA, Egorova AN, Schedrova ML, Samsonov MY. Treatment of Idiopathic Recurrent Pericarditis With Goflikicept: Phase II/III Study Results. J Am Coll Cardiol 2023; 82:30-40. [PMID: 37380301 DOI: 10.1016/j.jacc.2023.04.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Idiopathic recurrent pericarditis (IRP) is a rare autoinflammatory disease. Interleukin (IL)-1α and IL-1β are the pivotal cytokines in the pathophysiology of acute pericarditis and its recurrence. We created a phase II/III study with a new IL-1 inhibitor-goflikicept in IRP. OBJECTIVES This study sought to evaluate the efficacy and safety of goflikicept treatment in patients with IRP. METHODS We conducted a 2-center open-label study of goflikicept in patients with IRP with and without recurrence at time of enrollment. The study consisted of 4 periods: screening, run-in (open-label treatment period), randomized withdrawal, and follow-up. Patients with clinical response to goflikicept in the run-in period were randomized (1:1) to a placebo-controlled withdrawal period, where the time to first pericarditis recurrence (primary endpoint) was evaluated. RESULTS We enrolled 22 patients, and 20 of these patients were randomized. Reduction of C-reactive protein level accompanied by reduction of chest pain and pericardial effusion compared to baseline was demonstrated during the run-in period. Recurrence of pericarditis occurred in 9 of 10 patients in the placebo group, and there were no recurrence events in goflikicept group within 24 weeks after randomization (P < 0.001). A total of 122 adverse events were reported in 21 patients (95.5%), with no deaths and no new safety signals identified for goflikicept. CONCLUSIONS Treatment with goflikicept prevented recurrences and maintained IRP remission with a favorable risk-benefit ratio. Goflikicept reduced the risk of recurrence compared with placebo. (Study to Evaluate the Efficacy and Safety of RPH-104 Treatment in Patients With Idiopathic Recurrent Pericarditis; NCT04692766).
Collapse
Affiliation(s)
- Valentina Yu Myachikova
- World-Class Research Center for Personalized Medicine, Rare and Genetically Determined Diseases, Research Laboratory of Autoimmune and Autoinflammatory Diseases, St Petersburg, Russia; Almazov National Medical Research Center, Rheumatology and Immunopathology Research Laboratory, St Petersburg, Russia.
| | - Alexey L Maslyanskiy
- Almazov National Medical Research Center, Rheumatology and Immunopathology Research Laboratory, St Petersburg, Russia; Saint Petersburg State University, Scientific, Clinical and Educational Center of Gastroenterology and Hepatology, St Petersburg, Russia
| | - Olga M Moiseeva
- Almazov National Medical Research Center, Noncoronary Heart Disease Research Department, St Petersburg, Russia
| | - Oksana V Vinogradova
- State Autonomous Healthcare Institution "Orenburg Regional Clinical Hospital," Regional Vascular Center, Orenburg, Russia
| | - Ekaterina V Gleykina
- State Autonomous Healthcare Institution "Orenburg Regional Clinical Hospital," Cardiology Department No. 2, Orenburg, Russia
| | | | - Antonio Abbate
- Berne Cardiovascular Research Center and Division of Cardiology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | | | | | | | | |
Collapse
|
43
|
Goel A, Bandyopadhyay D, Malik AH, Gupta R, Frishman WH, Aronow WS. Rilonacept and Other Interleukin-1 Inhibitors in the Treatment of Recurrent Pericarditis. Cardiol Rev 2023; 31:225-229. [PMID: 36398320 DOI: 10.1097/crd.0000000000000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pericarditis is the commonest form of pericardial disease. Unfortunately, despite optimal treatment, approximately 15-30% of patients with acute pericarditis have recurrence. Many of these patients are refractory to colchicine, and become corticosteroid-dependent. Recurrent pericarditis severely impairs quality of life, and is associated with significant morbidity. Inflammasome formation and overproduction of interleukin (IL)-1 have been found to drive the systemic inflammatory response in recurrent autoinflammatory pericarditis. Several IL-1 inhibitors have been evaluated for their usefulness as therapeutic options. Rilonacept is a dimeric fusion protein that functions as a soluble decoy receptor that binds to both IL-1α and IL-1β, thereby inhibiting the IL-1 pathway. It is safe and efficacious in the treatment of recurrent pericarditis in the RHAPSODY II and III trials. Anakinra is a recombinant IL-1 receptor antagonist that blocks the action of circulating IL-1α and IL-1β. It has also been shown to be safe and efficacious in the AIRTRIP and IRAP studies. Canakinumab is a selective human monoclonal antibody against IL-1β, and data on its use in recurrent pericarditis is scarce. Several questions regarding IL-1 inhibitor therapy, such as the duration of treatment and the recommended tapering protocols, as well as their use in special populations like pregnant or lactating women, remain unanswered and need to be addressed in future studies.
Collapse
Affiliation(s)
- Akshay Goel
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| | | | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Rahul Gupta
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - William H Frishman
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| |
Collapse
|
44
|
Sayad R, Siddiq A, Hashim A, Elsaeidy AS. Can the current monkeypox affect the heart? A systematic review of case series and case report. BMC Cardiovasc Disord 2023; 23:328. [PMID: 37380955 PMCID: PMC10308700 DOI: 10.1186/s12872-023-03351-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Monkeypox is a zoonotic viral infection first reported in May 2022. Monkeypox cases present with prodromal symptoms, rash, and/or systemic complications. This study systematically reviews the monkeypox cases presented with any cardiac complications. METHODS A systematic literature search was done to locate papers that discuss any cardiac complications associated with monkeypox; then, data were analyzed qualitatively. RESULTS Nine articles, including the 13 cases that reported cardiac complications of the disease, were included in the review. Five cases previously had sex with men, and two cases had unprotected intercourse, which reveals the importance of the sexual route in disease transmission. All cases have a wide spectrum of cardiac complications, such as acute myocarditis, pericarditis, pericardial effusion, and myopericarditis. CONCLUSION This study clarifies the potential for cardiac complications in monkeypox cases and provides avenues for future research to determine the underlying mechanism. Also, we found that the cases with pericarditis were treated with colchicine, and those with myocarditis were treated with supportive care or cardioprotective treatment (Bisoprolol and Ramipril). Furthermore, Tecovirimat is used as an antiviral drug for 14 days.
Collapse
Affiliation(s)
- Reem Sayad
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Ahmed Hashim
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | |
Collapse
|
45
|
Massaro MG, Gallo A, Montalto M, Manna R. Treatment of recurrent pericarditis in elderly. Eur J Intern Med 2023; 112:133-135. [PMID: 36805820 DOI: 10.1016/j.ejim.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023]
Affiliation(s)
- Maria Grazia Massaro
- Institute of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiology, Italy
| | - Antonella Gallo
- Department of Geriatric Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiology, Italy
| | - Massimo Montalto
- Department of Geriatric Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Periodic Fever and Rare Diseases Research Centre, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Cardiology, Italy
| | - Raffaele Manna
- Institute of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Periodic Fever and Rare Diseases Research Centre, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Cardiology, Italy.
| |
Collapse
|
46
|
Schneider A, Jhawar N, Balistreri L, Chirila R, Berianu F. A Rare Case of Cardiac Tamponade in a Patient With Anti-RNA Polymerase III Scleroderma. Cureus 2023; 15:e38533. [PMID: 37273403 PMCID: PMC10239203 DOI: 10.7759/cureus.38533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Scleroderma is a chronic, progressive autoimmune disease that often presents with multiorgan involvement. Cardiac manifestations are common and include microvascular coronary artery disease, conduction abnormalities, autonomic insufficiency, and pericardial effusions. Although rare, pericardial effusions may progress and lead to cardiac tamponade. Patients diagnosed with scleroderma can be further prognosticated based on the presence of serologic scleroderma-specific antibodies. The anti-RNA polymerase III autoantibody (anti-RNAP3) is associated with an aggressive subtype of scleroderma. Looking at the current literature, no association has been reported between anti-RNAP3 and the development of cardiac tamponade in patients with underlying scleroderma. We discuss a unique case of a patient with scleroderma who was found to be anti-RNAP3 positive and signs of cardiac tamponade. This case illustrates the importance of an expeditious diagnosis and timely interventions to treat cardiac tamponade. Additionally, we share a rare but important association between anti-RNAP3 and the formation of tamponade physiology in scleroderma.
Collapse
|
47
|
Onggo S, Chang R, Singh A, Lopez K, Chen L, Hah M. Pericarditis Associated With Aripiprazole: A Case Report. J Clin Psychopharmacol 2023; 43:295-296. [PMID: 37068012 DOI: 10.1097/jcp.0000000000001686] [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: 04/18/2023]
|
48
|
Saeed S, Mohamed Ali A, Wasim D, Saeed N, Lunde T, Solheim E, Vegsundvåg J, Imazio M. Natural Course of Electrocardiogram Changes and the Value of Multimodality Imaging in Acute Pericarditis. Cardiology 2023; 148:219-227. [PMID: 36948161 DOI: 10.1159/000530207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND ECG is the initial diagnostic tool that in combination with typical symptoms often raises the suspicion of pericarditis. Echocardiography remains the first-line imaging modality for assessment of pericardial diseases, particularly effusion/tamponade, constrictive physiology, and assessment of regional wall motion abnormalities as differential diagnoses. However, cardiac CT and cardiac magnetic resonance may be necessary in complicated cases and to identify pericardial inflammation in specific settings (atypical presentation, new onset constriction), as well as myocardial involvement and monitoring the disease activity. SUMMARY In acute pericarditis, the most commonly used ECG criteria recommended by international guidelines are the widespread ST-segment elevation or PR depression. However, the classic ECG pattern of widespread ST-segment elevation or PR depression can be seen in less than 60% of patients. In addition, ECG changes are often temporally dynamic, evolve rapidly during the course of disease, and may be influenced by a number of factors such as disease severity, time (stage) of presentation, degree of myocardial involvement, and the treatment initiated. Overall, temporal dynamic changes on ECG during acute pericarditis or myopericarditis have received limited attention. Hence, the aim of this brief clinical review was to increase awareness about the various ECG changes observed during the course of acute pericarditis. KEY MESSAGES ECG may be normal at presentation or for days after the index episode of chest pain, but serial ECGs can reveal specific patterns of temporally dynamic ST elevation in patients with pericarditis or myopericarditis, particularly during new episodes of chest pain.
Collapse
Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Abukar Mohamed Ali
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Daanyaal Wasim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Nasir Saeed
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Torbjørn Lunde
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eivind Solheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria Della Misericordia", ASUFC, Udine, Italy
| |
Collapse
|
49
|
Kosmopoulos M, Liatsou Ε, Theochari C, Stavropoulos A, Chatzopoulou D, Mylonas KS, Georgiopoulos G, Schizas D. Updates on the Global Prevalence and Etiology of Constrictive Pericarditis: A Systematic Review. Cardiol Rev 2023; Publish Ahead of Print:00045415-990000000-00075. [PMID: 36883817 DOI: 10.1097/crd.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Constrictive pericarditis is a rare disease with poorly understood epidemiology. A systematic literature search was adopted to assess the region- and period-specific traits of constrictive pericarditis through Pubmed, EMBASE, and Scopus. Case reports and studies including less than 20 patients were excluded. The risk of bias was assessed through the Study Quality Assessment Tools developed by the National Heart Lung Blood Institute by 4 reviewers. Patient demographics, disease etiology, and mortality were the primary assessed outcomes. One hundred thirty studies with 11,325 patients have been included in this systematic review and meta-analysis. The age at diagnosis of constrictive pericarditis has markedly increased after 1990. Patients from Africa and Asia are considerably younger compared with those from Europe and North America. Moreover, there are differences in etiology, as tuberculosis remains the dominant cause of constrictive pericarditis in Africa and Asia but has been surpassed by history of previous chest surgery in North America and Europe. The human immunodeficiency virus affects 29.1% of patients from Africa diagnosed with constrictive pericarditis, a feature that is not observed on any other continent. The early mortality rate after hospitalization has improved. The variances of age at diagnosis and etiology of constrictive pericarditis should be considered by the clinician during the work-up of cardiac and pericardial diseases. An underlying human immunodeficiency virus infection complicates a significant portion of constrictive pericarditis cases in Africa. Early mortality has improved across the world but remains high.
Collapse
Affiliation(s)
- Marinos Kosmopoulos
- From the Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Εfstathia Liatsou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Christina Theochari
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Thoracic Diseases General Hospital Sotiria, Athens, Greece
| | - Amalia Stavropoulos
- Department of Medicine, Internal Medicine, North Bristol NHS Trust, Bristol, United Kingdom
| | - Despoina Chatzopoulou
- Department of Surgery, General Surgery, Frimley Health NHS Trust, Frimley, Surrey, United Kingdom
| | | | - Georgios Georgiopoulos
- Department of Therapeutics, National and Kapodistrian University of Athens - Faculty of Medicine, Alexandra Hospital
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| |
Collapse
|
50
|
Shahid R, Jin J, Hope K, Tunuguntla H, Amdani S. Pediatric Pericarditis: Update. Curr Cardiol Rep 2023; 25:157-170. [PMID: 36749541 PMCID: PMC9903287 DOI: 10.1007/s11886-023-01839-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW While there have now been a variety of large reviews on adult pericarditis, this detailed review specifically focuses on the epidemiology, clinical presentation, diagnosis, and management of pediatric pericarditis. We have tried to highlight most pediatric studies conducted on this topic, with special inclusion of important adult studies that have shaped our understanding of and management for acute and recurrent pericarditis. RECENT FINDINGS We find that the etiology of pediatric pericarditis differs from adult patients with pericarditis and has evolved over the years. Also, with the current COVID-19 pandemic, it is important for pediatric clinicians to be aware of pericardial involvement both due to the infection and from vaccination. Oftentimes, pericarditis maybe the only cardiac involvement in children with COVID-19, and so caregivers should maintain a high index of suspicion when they encounter children with pericarditis. Large-scale contemporary epidemiological data regarding incidence and prevalence of both acute and recurrent pericarditis is lacking in pediatrics, and future studies should focus on highlighting this important research gap. Most of the current management strategies for pediatric pericarditis are from experiences gathered from adult data. Pediatric multicenter trials are warranted to understand the best management strategy for those with acute and recurrent pericarditis. CASE VIGNETTE A 6-year-old child with a past history of pericarditis almost 2 months ago comes in with a 2-day history of chest pain and fever. Per mother, he stopped his steroids about 2 weeks ago, and for the last 2 days has had a temperature of 102F and has been complaining of sharp mid-sternal chest pain that gets worse when he lies down and is relieved when he sits up and leans forward. On examination, he is tachycardic (heart rate 160 bpm), with normal blood pressure for age. He appears to be in pain (5/10), and on auscultation has a pericardial friction rub. His lab studies are notable for elevated white blood cell count and inflammatory markers (CRP and ESR). His electrocardiogram reveals sinus tachycardia and diffuse ST-elevation in all precordial leads. His echocardiogram demonstrates normal biventricular function and a trace pericardial effusion. His cardiac MRI confirms recurrent pericarditis. He is started on indomethacin and colchicine. He has complete resolution of his symptoms by day 3 of admission and is discharged with close follow-up.
Collapse
Affiliation(s)
- Rida Shahid
- grid.239578.20000 0001 0675 4725Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, OH USA
| | - Justin Jin
- grid.413808.60000 0004 0388 2248Division of Pediatric Cardiology, Northwestern Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Kyle Hope
- grid.39382.330000 0001 2160 926XLillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Hari Tunuguntla
- grid.39382.330000 0001 2160 926XLillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Shahnawaz Amdani
- grid.239578.20000 0001 0675 4725Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, OH USA
| |
Collapse
|