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Mannarino S, Lanna M, Calcaterra V, Carzaniga T, Casiraghi L, Lai A, Gabrieli A, Bergna A, Fini G, Bianchi S, De Amici M, Zehender G, Bellini T, Buscaglia M, Zuccotti G. Fetal Myocarditis Associated With Maternal SARS-CoV-2 Infection. Pediatr Infect Dis J 2024; 43:454-456. [PMID: 38190639 DOI: 10.1097/inf.0000000000004245] [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: 01/10/2024]
Abstract
We report the first case of significant fetal myocardial involvement associated with maternal SARS-CoV-2 infection, in which restoration of cardiac function at birth was noted. The demonstration of previous infection was supported by the quantification of humoral response in child and mother, in particular the presence of anti-N antibodies and through the detection of specific antibodies against the BA.4/5 variant.
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Affiliation(s)
- Savina Mannarino
- From the Pediatric Cardiology Unit, Buzzi Children's Hospital, Milan, Italy
| | - Mariano Lanna
- Fetal Therapy Unit "U. Nicolini"
- Department of Women, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Thomas Carzaniga
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Segrate, Italy
| | - Luca Casiraghi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Segrate, Italy
| | - Alessia Lai
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Arianna Gabrieli
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Annalisa Bergna
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Giulia Fini
- From the Pediatric Cardiology Unit, Buzzi Children's Hospital, Milan, Italy
| | - Silvia Bianchi
- Division of Neonatology, Buzzi Children's Hospital, Milan, Italy
| | - Mara De Amici
- Immuno-Allergology Laboratory, Clinical Chemistry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Tommaso Bellini
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Segrate, Italy
| | - Marco Buscaglia
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Segrate, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
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Arvinti B, Isar A. Improving Chest Monitoring through Magnetic Resonance Angiogram Image Contrast Enhancement. Life (Basel) 2023; 13:2160. [PMID: 38004300 PMCID: PMC10672579 DOI: 10.3390/life13112160] [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: 09/04/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Magnetic resonance angiography is a medical procedure used to offer an image of the blood vessels and organs of the body. Given the worldwide spread of cardiovascular diseases, more and more resources are invested in treating them. One of the most modern treatments involves the acquisition of images of the heart. Sometimes the contrast of these images is not satisfactory. Injecting invasive enhancement substances to obtain a better view of the cardiac route is not advisable. However, software algorithms can solve the problem. This study proposes and tests a local adaptive contrast-adjustment algorithm using the dual-tree complex wavelet transform. The method has been tested with medical data from a public database to allow comparisons to other methods. The selected algorithm further improved the contrast of images. The performances are given for evaluation, both visually (to help doctors make accurate diagnoses) and in parametric form (to show engineers which parts of the algorithm might need improvement). Compared to other contrast enhancement methods, the proposed wavelet algorithm shows good results and greater stability. Thus, we aim to avoid future pointless complications due to unnecessary contrast substances.
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Affiliation(s)
- Beatrice Arvinti
- Fundamentals of Physics for Engineers Department, “Politehnica” University Timisoara, Bd. Vasile Pârvan No. 2, 300223 Timisoara, Romania
| | - Alexandru Isar
- Faculty of Electronics, Telecommunications and Information Technologies, “Politehnica” University Timisoara, Bd. Vasile Pârvan No. 2, 300223 Timisoara, Romania;
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Mitrofanova L, Makarov I, Goncharova E, Makarova T, Starshinova A, Kudlay D, Shlaykhto E. High Risk of Heart Tumors after COVID-19. Life (Basel) 2023; 13:2087. [PMID: 37895467 PMCID: PMC10608002 DOI: 10.3390/life13102087] [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: 09/17/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
An emergence of evidence suggests that severe COVID-19 is associated with an increased risk of developing breast and gastrointestinal cancers. The aim of this research was to assess the risk of heart tumors development in patients who have had COVID-19. METHODS A comparative analysis of 173 heart tumors was conducted between 2016 and 2023. Immunohistochemical examination with antibodies against spike SARS-CoV-2 was performed on 21 heart tumors: 10 myxomas operated before 2020 (the control group), four cardiac myxomas, one proliferating myxoma, three papillary fibroelastomas, two myxofibrosarcomas, one chondrosarcoma resected in 2022-2023. Immunohistochemical analysis with antibodies against CD34 and CD68 was also conducted on the same 11 Post-COVID period heart tumors. Immunofluorescent examination with a cocktail of antibodies against spike SARS-CoV-2/CD34 and spike SARS-CoV-2/CD68 was performed in 2 cases out of 11 (proliferating myxoma and classic myxoma). RESULTS A 1.5-fold increase in the number of heart tumors by 2023 was observed, with a statistically significant increase in the number of myxomas. There was no correlation with vaccination, and no significant differences were found between patients from 2016-2019 and 2021-2023 in terms of gender, age, and cardiac rhythm dis-orders. Morphological examination revealed the expression of spike SARS-CoV-2 in tumor cells, endothelial cells, and macrophages in 10 out of 11 heart tumors. CONCLUSION The detection of SARS-CoV-2 persistence in endothelium and macrophages as well as in tumor cells of benign and malignant cardiac neoplasms, the increase in the number of these tumors, especially cardiac myxomas, after the pandemic by 2023 may indicate a trend toward an increased risk of cardiac neoplasms in COVID-19 patients, which re-quires further research on this issue and a search for new evidence.
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Affiliation(s)
- Lubov Mitrofanova
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (L.M.); (I.M.); (E.G.); (T.M.); (E.S.)
| | - Igor Makarov
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (L.M.); (I.M.); (E.G.); (T.M.); (E.S.)
| | - Ekaterina Goncharova
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (L.M.); (I.M.); (E.G.); (T.M.); (E.S.)
| | - Taiana Makarova
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (L.M.); (I.M.); (E.G.); (T.M.); (E.S.)
| | - Anna Starshinova
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (L.M.); (I.M.); (E.G.); (T.M.); (E.S.)
| | - Dmitry Kudlay
- Department of Pharmacology, I.M. Sechenov First Moscow State Medical University, 119992 Moscow, Russia;
- Institute of Immunology, 115478 Moscow, Russia
| | - Evgeny Shlaykhto
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia; (L.M.); (I.M.); (E.G.); (T.M.); (E.S.)
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Karev V, Starshinova AY, Glushkova A, Kudlay D, Starshinova A. Features of Myocarditis: Morphological Differential Diagnosis in Post-COVID-19 Children. Diagnostics (Basel) 2023; 13:2499. [PMID: 37568863 PMCID: PMC10417761 DOI: 10.3390/diagnostics13152499] [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: 06/23/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Myocarditis is characterized by dysfunction and destruction of cardiomyocytes, infiltrative inflammation, and development of fibrosis. Late diagnosis of myocarditis has been a serious global health problem, especially due to the spread of a new coronavirus infection. The aim of this review is to identify differences between myocarditis of viral etiology, including SARS-CoV-2 lesions, based on instrumental and pathomorphological findings. MATERIAL AND METHODS We analyzed publications covering the period from December 2019 to May 2023, published in publicly accessible international databases ("Medline", "PubMed", "Scopus"), with queries for the keywords "myocarditis", "children", "cardiovascular inflammation", "COVID-19", "SARS-CoV-2", "severe acute respiratory syndrome coronavirus 2", "differential diagnosis". RESULTS It was found that no unambiguous morphological criteria for the diagnosis of myocarditis coupled to SARS-CoV-2 lesions were identified. However, the detected histopathological changes such as virus-associated degeneration, apoptosis, cardiomyocyte necrosis, moderate interstitial hyperemia, myocardial tissue oedema, and capillary endothelial cell dysfunction were the major markers of SARS-CoV-2 infection. CONCLUSION It is necessary further reconsider morphological criteria to diagnose SARS-CoV-2-caused myocarditis, rather than solely relying on detecting viral RNA by PCR as the sole evidence-based criterion. Similar issues accompany diagnostics of myocardial lesions associated with other viral infections. Evidence for an etiological diagnosis of myocarditis can be provided by a comprehensive analysis of the diagnostic criteria obtained, confirming virus exposure, followed by development of distinct clinical symptoms, MRI and CT changes, and morphological criteria.
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Affiliation(s)
- Vadim Karev
- Children’s Clinical Research Center for Infectious Diseases, St. Petersburg 194100, Russia;
- Almazov National Medical Research Centre, St. Petersburg 197341, Russia
| | | | - Anzhela Glushkova
- Medical Faculty, Pavlov First Saint Petersburg State Medical University, St. Petersburg 197022, Russia;
| | - Dmitry Kudlay
- Department of Pharmacology, Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia;
- Institute of Immunology FMBA of Russia, Moscow 115478, Russia
| | - Anna Starshinova
- Almazov National Medical Research Centre, St. Petersburg 197341, Russia
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Makarov I, Mayrina S, Makarova T, Karonova T, Starshinova A, Kudlay D, Mitrofanova L. Morphological Changes in the Myocardium of Patients with Post-Acute Coronavirus Syndrome: A Study of Endomyocardial Biopsies. Diagnostics (Basel) 2023; 13:2212. [PMID: 37443606 DOI: 10.3390/diagnostics13132212] [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: 05/19/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
The clinical manifestation study of post-acute sequelae of SARS-CoV-2 infection (PASC) has shown a lack of knowledge regarding its morphology and pathogenesis. The aim of this research was to investigate morphological manifestations of PASC in the myocardium. MATERIALS AND METHODS The study included 38 patients requiring endomyocardial biopsy (EMB) during the post-acute phase of coronavirus infection and a control group including patients requiring EMB prior to the SARS-CoV-2 pandemic. The patients' clinical and laboratory data were analyzed. Histological examination and immunohistochemistry (IHC) of the myocardial tissue was conducted with antibodies to CD3, CD68, HLA-DR, MHC1, C1q, VP1 enteroviruses, spike protein SARS-CoV-2, Ang1, von Willebrand factor (VWF), and VEGF. The morphometric analysis included counting the mean number of inflammatory infiltrate cells per mm2 and evaluating the expression of SARS-CoV-2 spike protein, HLA-DR, MHC1, C1q, Ang1, VWF, and VEGF using a scoring system. If the expression of SARS-CoV-2 spike protein was >3 points, an additional IHC test with antibodies to ACE2, CD16 as well as RT-PCR testing of the myocardial tissue were performed. For two patients, immunofluorescence tests of the myocardial tissue were performed using antibody cocktails to SARS-CoV-2 spike protein/CD16, SARS-CoV-2 spike protein/CD68, CD80/CD163. The statistical data analysis was carried out using the Python programming language and libraries such as NumPy, SciPy, Pandas, and Matplotlib. RESULTS The study demonstrated a significant increase in the number of CD68+ macrophages in the myocardium of PASC patients compared to patients who did not have a history of COVID-19 (p = 0.014 and p = 0.007 for patients with and without myocarditis, respectively), predominantly due to M2 macrophages. An increase in the number of CD68+ macrophages was more frequently observed in patients with shorter intervals between the most recent positive SARS-CoV-2 PCR test and the time of performing the EMB (r = -0.33 and r = -0.61 for patients with and without myocarditis, respectively). The expression scores of Ang1, VEGF, VWF, and C1q in PASC patients did not significantly differ from those in EMB samples taken before 2019. CONCLUSION The myocardium of PASC patients demonstrated a significant increase in the number of CD68+ macrophages and a decrease in the expression of markers associated with angiopathy. No evidence of coronavirus-associated myocarditis was observed in any PASC patient.
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Affiliation(s)
- Igor Makarov
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
| | - Sofya Mayrina
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
| | - Taiana Makarova
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
| | - Tatiana Karonova
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
| | - Anna Starshinova
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
| | - Dmitry Kudlay
- Department of Pharmacology, Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia
- Institute of Immunology, 115478 Moscow, Russia
| | - Lubov Mitrofanova
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
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