Myocardial Injury and Altered Gene Expression Associated With SARS-CoV-2 Infection or mRNA Vaccination

SARS CoV-2 enters host cells via its Spike protein moiety binding to the essential cardiac enzyme angiotensin-converting enzyme (ACE) 2, followed by internalization. COVID-19 mRNA vaccines are RNA sequences that are translated into Spike protein, which follows the same ACE2-binding route as the intact virion. In model systems, isolated Spike protein can produce cell damage and altered gene expression, and myocardial injury or myocarditis can occur during COVID-19 or after mRNA vaccination. We investigated 7 COVID-19 and 6 post-mRNA vaccination patients with myocardial injury and found nearly identical alterations in gene expression that would predispose to inflammation, coagulopathy, and myocardial dysfunction.

Left ventricular vortex analysis by high-frame rate blood speckle tracking echocardiography in healthy children and in congenital heart disease

Background

High-frame rate blood speckle tracking (BST) echocardiography is a new technique for the assessment of intracardiac flow. The purpose of this study was to evaluate the characteristics of left ventricular (LV) vortices in healthy children and in those with congenital heart disease (CHD).

Methods

Characteristics of LV vortices were analyses based on 4-chamber BST images from 118 healthy children (median age 6.84 years, range 0.01-17 years) and 43 children with CHD (median age 0.99 years, range 0.01-14 years). Both groups were compared after propensity matching. Multiple linear regression was used to identify factors that independently influence vortex characteristics.

Results

Feasibility of vortex imaging was 93.7% for healthy children and 95.6% for CHD. After propensity matching, there were no overall significant differences in vortex distance to apex, distance to interventricular septum (IVS), height, width, sphericity index, or area. However, multiple regression analysis revealed significant associations of LV morphology with vortex characteristics. Furthermore, CHD involving LV volume overload and CHD involving LV pressure overload were both associated with vortices localized closer to the IVS.

Conclusions

LV vortex analysis using high-frame rate BST echocardiography is feasible in healthy children and in those with CHD. As they are associated with LV morphology and are modified in some types of CHD, vortices might yield diagnostic and prognostic value. Future studies are warranted to establish applications of vortex imaging in the clinical setting.

Cardiac Sarcoidosis Initially Diagnosed as Spontaneous Coronary Artery Dissection

We present the case of a woman who developed presumed spontaneous coronary artery dissection of a septal branch. She later developed high-grade atrioventricular block that led to a diagnosis of cardiac sarcoidosis involving the interventricular septum. This case illustrates a rare and challenging presentation of cardiac sarcoidosis. (Level of Difficulty: Beginner.)

First Follow-Up of Cardiac Amyloidosis Treated by Tafamidis, Evaluated by Absolute Quantification in Bone Scintigraphy

Assessment of absolute myocardial hydroxydimethylene diphosphonate–technetium-99m uptake using standardized uptake value with a single-photon emission computed tomography–computed tomography cadmium zinc telluride camera (Discovery NM/CT 670CZT, GE Healthcare, Chicago, Illinois) in a patient with cardiac transthyretin-related amyloidosis treated with tafamidis showed a decrease in hydroxydimethylene diphosphonate cardiac uptake. This imaging technique should be helpful in monitoring therapy and evaluating prognosis. (Level of Difficulty: Intermediate.)

Left Ventricular Intramyocardial Dissecting Hematomas

Intramyocardial dissection is a rare complication of myocardial infarction, trauma, and percutaneous intervention. It is usually caused by hemorrhagic dissection among the spiral myocardial fibers. We hereby report the case of a patient with left ventricular intramyocardial dissection who presented with acute decompensated heart failure. (Level of Difficulty: Advanced.)

Dynamic Augmentation of Left Ventricle and Mitral Valve Function With an Implantable Soft Robotic Device

Left ventricular failure is strongly associated with secondary mitral valve regurgitation. Implantable soft robotic devices are an emerging technology that enables augmentation of a native function of a target tissue. We demonstrate the ability of a novel soft robotic ventricular assist device to dynamically augment left ventricular contraction, provide native pulsatile flow, simultaneously reshape the mitral valve apparatus, and eliminate the associated regurgitation in an Short-term large animal model of acute left ventricular systolic dysfunction.

Coronary Artery and Pulmonary Artery Fistula: Rare Congenital Coronary Artery Fistula

Coronary artery fistula is a rare condition that can be congenital or acquired. Most patients with these anomalies remain asymptomatic, but symptoms and complications may develop with increasing age. We discuss the clinical presentation, diagnostic work-up, and management options for this condition. (Level of Difficulty: Intermediate.)

Progressive Thinning of the Basal Interventricular Septum by Giant Cell Myocarditis

We describe a patient with ventricular tachycardia and complete atrioventricular block. Remarkable thinning of the basal interventricular septum preceded left ventricular dysfunction. Endomyocardial biopsy demonstrated giant cell myocarditis. The patient received combined immunosuppressive therapy and a cardioverter-defibrillator. Eligibility screening for heart transplantation was initiated. (Level of Difficulty: Advanced.)

Two Hearts at Risk: Emergency Alcohol Septal Ablation in a Pregnant Woman With Decompensated HOCM

Hypertrophic obstructive cardiomyopathy (HOCM) increases the risk for mother and fetus during pregnancy. Alcohol septal ablation (ASA) is an established procedure in nonpregnant patients with HOCM. In this report, we present a case of a 29-year-old woman in her 29th gestational week with decompensated HOCM undergoing a successful ASA. (Level of Difficulty: Advanced.).

Coordination of changes in expression and phosphorylation of eukaryotic elongation factor 2 (eEF2) and eEF2 kinase in hypertrophied cardiomyocytes

Eukaryotic elongation factor 2 (eEF2) kinase (eEF2K) is one of the Ca²⁺/calmodulin-dependent protein kinases. Activated eEF2K phosphorylates its specific substrate, eEF2, which results in inhibition of protein translation. We have recently shown that protein expression of eEF2K was specifically increased in hypertrophied left ventricles (LV) from spontaneously hypertensive rats (SHR). However, phosphorylation state of eEF2K and eEF2 in hypertrophied LV is not determined. In the present study, we examined expression and phosphorylation of eEF2K and eEF2 in LV from SHR as well as the pressure overload (transverse aortic constriction: TAC)- and isoproterenol (ISO)-induced cardiac hypertrophy model. In LV from TAC mice, eEF2K expression was increased as determined by Western blotting. In LV from TAC mice and SHR, eEF2K phosphorylation at Ser366 (inactive site) was decreased. Consistently, eEF2 phosphorylation at Thr56 was increased. In LV from ISO rats, while eEF2K phosphorylation was decreased, eEF2K expression and eEF2 phosphorylation were not different as determined by Western blotting. In the results obtained from immunohistochemistry, however, total eEF2K and phosphorylated eEF2 (at Thr56) localized to cardiomyocytes were increased in LV cardiomyocytes from ISO rats. Accordingly, the increased expression and the decreased phosphorylation of eEF2K and the increased phosphorylation of eEF2 in hypertrophied LV were common to all models in this study. The present results thus suggest that cardiac hypertrophy may be regulated at least partly via eEF2K-eEF2 signaling pathway.

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eEF2 kinase (eEF2K) is a unique Ca²⁺/calmodulin-dependent protein kinase.

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eEF2K expression increased but phosphorylation decreased in cardiac hypertrophy.

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eEF2 phosphorylation increased in cardiac hypertrophy.

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Expression and phosphorylation state of eEF2K/eEF2 was common to hypertrophy model.

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eEF2K/eEF2 signaling might affect the pathogenesis of cardiac hypertrophy.

Arterial stiffness in metabolic syndrome

Arterial stiffness is increasingly recognized as an important determinant of cardiovascular risk and may be directly involved in the process of atherosclerosis. As atherosclerosis leads to increased arterial resistance and decrease the flow propagation speed within the arterial lumen, a similar decrease in aortic flow propagation with increased downstream resistance is detected, so aortic flow propagation velocity AVP was evaluated in many studies as a new parameter of aortic stiffness.

Aim

To measure arterial stiffness using the new parameter AVP and compare it to flow mediated dilatation FMD as a parameter of endothelial dysfunction in patients with metabolic syndrome MS.

Methods

AVP (assessed by transthoracic echocardiography) and FMD (assessed by brachial artery reactivity test) were measured in 100 patients with MS (Group 1) and were compared to 14 normal subjects (Group 2).

Results

Patients with MS had significantly lower values of AVP as compared to the normal subjects; 36 ± 5 cm/s vs 57 ± 5, p < 0.05, and lower FMD; 6% ± 1 vs 17 ± 3 p < 0.05 as well, there was significant correlations between AVP and FMD (r = 0.89, p < 0.001).

Conclusion

Transthoracic echocardiographic determination of AVP is a simple practical method and correlates well with FMD in patients with MS.