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Haberka M, Rajewska-Tabor J, Wojtowicz D, Jankowska A, Miszalski-Jamka K, Janus M, Dorniak K, Kulawiak-Gałąska D, Stasiow B, Rozmiarek S, Szurowska E, Elikowski W, Ławrynowicz M, Śpiewak M, Koziński M, Pyda M. A distinct septal pattern of late gadolinium enhancement specific for COVID-induced myocarditis: A multicenter cardiovascular magnetic resonance study. Kardiol Pol 2023:VM/OJS/J/93708. [PMID: 36871296 DOI: 10.33963/kp.a2023.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/15/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Coronavirus disease-19 (COVID-19) is a great medical challenge provoking acute respiratory distress, pulmonary manifestations, and cardiovascular (CV) consequences. AIMS This study compares cardiac injury in COVID-19 myocarditis patients with non-COVID myocarditis patients. METHODS Patients who recovered from COVID-19 were scheduled for cardiovascular magnetic resonance (CMR) owing to clinical myocarditis suspicion. The retrospective non-COVID-19 myocarditis (2018-2019) group was enrolled (n=221 patients). All patients underwent a contrast-enhanced CMR, conventional myocarditis protocol, and late gadolinium enhancement (LGE). The COVID study group included 552 patients with a mean (standard deviation [SD]) age 45.9 (12.6) years old. RESULTS CMR assessment confirmed a myocarditis-like LGE in 46% of the cases (68.5% of the segments with LGE <25% transmural extent), left ventricular (LV) dilatation in 10%, and systolic dysfunction in 16%. The COVID-myocarditis group showed a smaller median (interquartile range [IQR]) LV LGE (4.4% [2.9%-8.1%] vs. 5.9% [4.4%-11.8%]; P <0.001), lower LVEDV (144.6 [125.5-178] ml vs. 162.8 [136.6-194] ml; P <0.001), limited functional consequence (LVEF, 59% [54.1%-65%] vs. 58% [52%-63%]; P = 0.01), and a higher rate of pericarditis (13.6% vs. 6%; P = 0.03) compared to non-COVID myocarditis. The COVID-induced injury was more frequent in septal segments (2, 3, 14), and non-COVID myocarditis showed higher affinity to lateral wall segments (P <0.01). Neither obesity nor age was associated with LV injury or remodeling in subjects with COVID-myocarditis. CONCLUSIONS COVID-19-induced myocarditis is associated with minor LV injury with a significantly more frequent septal pattern and a higher pericarditis rate than non-COVID-19 myocarditis.
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Affiliation(s)
- Maciej Haberka
- Department of Cardiology, SHS, Medical University of Silesia, Katowice, Poland. .,Department of Cardiovascular Imaging, CMR unit, Upper Silesian Medical Centre of the Medical University of Silesia, Katowice, Poland.
| | - Justyna Rajewska-Tabor
- 1st Department of Cardiology, CMR unit, Poznan University of Medical Sciences, Poznań, Poland
| | - Dagmara Wojtowicz
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Gdynia, Poland
| | - Anna Jankowska
- Department of Cardiology, Cardinal Wyszynski Specialist Hospital, Lublin, Poland
| | | | - Magdalena Janus
- 1st Department of Cardiology, CMR unit, Poznan University of Medical Sciences, Poznań, Poland
| | - Karolina Dorniak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Bartłomiej Stasiow
- Department of Cardiovascular Imaging, CMR unit, Upper Silesian Medical Centre of the Medical University of Silesia, Katowice, Poland
| | - Szymon Rozmiarek
- 1st Department of Cardiology, CMR unit, Poznan University of Medical Sciences, Poznań, Poland
| | - Edyta Szurowska
- 2nd Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Waldemar Elikowski
- Infectious diseases hospital for COVID-19, Józef Strus Municipal Hospital, Poznań, Poland
| | - Marzena Ławrynowicz
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Gdynia, Poland
| | - Mateusz Śpiewak
- Magnetic Resonance Unit, Department of Radiology, National Institute of Cardiology, Warszawa, Poland
| | - Marek Koziński
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Gdynia, Poland
| | - Małgorzata Pyda
- 1st Department of Cardiology, CMR unit, Poznan University of Medical Sciences, Poznań, Poland
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Wojtowicz D, Dorniak K, Ławrynowicz M, Wąż P, Fijałkowska J, Kulawiak-Gałąska D, Rejszel-Baranowska J, Knut R, Haberka M, Szurowska E, Koziński M. Cardiac Magnetic Resonance Findings in Patients Recovered from COVID-19 Pneumonia and Presenting with Persistent Cardiac Symptoms: The TRICITY-CMR Trial. Biology (Basel) 2022; 11:biology11121848. [PMID: 36552357 PMCID: PMC9775441 DOI: 10.3390/biology11121848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/03/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
The prevalence and clinical consequences of coronavirus disease 2019 (COVID-19)-related non-ischemic cardiac injury are under investigation. The main purpose of this study was to determine the occurrence of non-ischemic cardiac injury using cardiac magnetic resonance (CMR) imaging in patients with persistent cardiac symptoms following recovery from COVID-19 pneumonia. We conducted a single-center, cross-sectional study. Between January 2021 and May 2021, we enrolled 121 patients with a recent COVID-19 infection and persistent cardiac symptoms. Study participants were divided into those who required hospitalization during the acute phase of SARS-CoV-2 infection (n = 58; 47.9%) and those non-hospitalized (n = 63; 52.1%). Non-ischemic cardiac injury (defined as the presence of late gadolinium enhancement (LGE) lesion and/or active myocarditis in CMR) was detected in over half of post-COVID-19 patients (n = 64; 52.9%). LGE lesions were present in 63 (52.1%) and active myocarditis in 10 (8.3%) post-COVID-19 study participants. The majority of LGE lesions were located in the left ventricle at inferior and inferolateral segments at the base. There were no significant differences in the occurrence of LGE lesions (35 (60.3%) vs. 28 (44.4%); p = 0.117) or active myocarditis (6 (10.3%) vs. 4 (6.3%); p = 0.517) between hospitalized and non-hospitalized post-COVID-19 patients. However, CMR imaging revealed lower right ventricular ejection fraction (RVEF; 49.5 (44; 54) vs. 53 (50; 58) %; p = 0.001) and more frequent presence of reduced RVEF (60.3% vs. 33.3%; p = 0.005) in the former subgroup. In conclusion, more than half of our patients presenting with cardiac symptoms after a recent recovery from COVID-19 pneumonia had CMR imaging abnormalities indicating non-ischemic cardiac injury. The most common finding was LGE, while active myocarditis was detected in the minority of patients. CMR imaging abnormalities were observed both in previously hospitalized and non-hospitalized post-COVID-19 patients. Further research is needed to determine the long-term cardiovascular consequences of COVID-19 infection and the optimal management of patients with suspected post-COVID-19 non-ischemic cardiac injury.
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Affiliation(s)
- Dagmara Wojtowicz
- Department of Cardiology and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Karolina Dorniak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Marzena Ławrynowicz
- Department of Cardiology and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland
| | - Piotr Wąż
- Department of Nuclear Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Jadwiga Fijałkowska
- Second Department of Radiology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | | | - Joanna Rejszel-Baranowska
- Department of Cardiology and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland
| | - Robert Knut
- Department of Cardiology and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland
| | - Maciej Haberka
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland
| | - Edyta Szurowska
- Second Department of Radiology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Marek Koziński
- Department of Cardiology and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland
- Correspondence: ; Tel.: +48-58-699-84-06
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Wachnicka-Truty R, Curyłło B, Wojtowicz D, Kulawiak-Gałąska D, Renke M, Sikorska K, Gruchała M, Koziński M. Life-threatening COVID-19 and aspergillosis co-infection in a heart transplant recipient: A cardiologist's nightmare. Cardiol J 2022; 29:351-354. [PMID: 35146731 PMCID: PMC9007474 DOI: 10.5603/cj.a2022.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Renata Wachnicka-Truty
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Bartosz Curyłło
- Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Dagmara Wojtowicz
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland
| | | | - Marcin Renke
- Department of Occupational, Metabolic and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Katarzyna Sikorska
- Department of Tropical and Parasitic Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Marcin Gruchała
- Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Marek Koziński
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland.
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Haberka M, Rajewska-Tabor J, Wojtowicz D, Jankowska A, Miszalski-Jamka K, Janus M, Dorniak K, Kulawiak-Gałąska D, Stasiow B, Rozmiarek S, Szurowska E, Elikowski W, Ławrynowicz M, Śpiewak M, Koziński M, Pyda M. Perimyocardial Injury Specific for SARS-CoV-2-Induced Myocarditis in Comparison With Non-COVID-19 Myocarditis: A Multicenter CMR Study. JACC Cardiovasc Imaging 2021; 15:705-707. [PMID: 34922867 PMCID: PMC8673438 DOI: 10.1016/j.jcmg.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/25/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
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Wojtowicz D, Dorniak K, Ławrynowicz M, Rejszel-Baranowska J, Fijałkowska J, Kulawiak-Gałąska D, Szurowska E, Koziński M. Spectrum of lesions visualized in cardiac magnetic resonance imaging in COVID-19-related myocarditis: Findings from a pilot study of the TRICITY-CMR trial. Cardiol J 2021; 28:976-978. [PMID: 34708861 PMCID: PMC8747819 DOI: 10.5603/cj.a2021.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/01/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Dagmara Wojtowicz
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Powstania Styczniowego 9B, 81-519 Gdynia, Poland.
| | - Karolina Dorniak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdańsk, University Clinical Centre in Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
| | - Marzena Ławrynowicz
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Powstania Styczniowego 9B, 81-519 Gdynia, Poland
| | - Joanna Rejszel-Baranowska
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Powstania Styczniowego 9B, 81-519 Gdynia, Poland
| | - Jadwiga Fijałkowska
- Department of Radiology II, Medical University of Gdańsk, University Clinical Centre in Gdańsk, Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland
| | - Dorota Kulawiak-Gałąska
- Department of Radiology II, Medical University of Gdańsk, University Clinical Centre in Gdańsk, Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland
| | - Edyta Szurowska
- Department of Radiology II, Medical University of Gdańsk, University Clinical Centre in Gdańsk, Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland
| | - Marek Koziński
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Powstania Styczniowego 9B, 81-519 Gdynia, Poland
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Wojtowicz D, Tomaszuk-Kazberuk A, Małyszko J, Koziński M. HEMATURIA AND OTHER KINDS OF BLEEDINGS ON NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION: AN UPDATED OVERVIEW ON OCCURRENCE, PATHOMECHANISMS AND MANAGEMENT. Wiad Lek 2020; 73:2528-2534. [PMID: 33454696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Non-vitamin K antagonist oral anticoagulants (NOACs) are currently recommended for oral anticoagulation in patients with non-valvular atrial fibrillation. In the setting, NOACs effectively prevent from stroke and systemic embolic events. In spite of the favorable safety profile of NOACs when compared with vitamin K antagonists, the use of any kind of anticoagulation is associated with an increased risk of bleeding. However, there is still a lack of direct comparisons of effectiveness and safety among NOACs. The results of indirect comparisons and meta-analyses suggest that the risk of various types of hemorrhagic complications differ among the particular NOACs. Management of bleeding in patients under NOAC therapy can be challenging because of limited availability of antidotes and the lack of routine laboratory test monitoring the NOAC anticoagulant effect. In case of life-threatening or critical site bleeding, reversal of NOAC anticoagulant activity is essential together with immediate implementation of causative treatment. Moreover, some patients on chronic NOAC therapy may require urgent surgery or invasive procedures. Specific reversal agents for NOACs have been developed, i.e. more widely available idarucizumab for the factor IIa inhibitor (dabigatran) and andexanet alfa for the factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) with limited availability. This review summarizes the occurrence and management of NOAC-related bleeding complications with a particular emphasis on hematuria.
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Affiliation(s)
- Dagmara Wojtowicz
- DEPARTMENT OF CARDIOLOGY AND INTERNAL DISEASES, INSTITUTE OF MARITIME AND TROPICAL MEDICINE IN GDYNIA, MEDICAL UNIVERSITY OF GDANSK, GDYNIA, POLAND
| | | | - Jolanta Małyszko
- DEPARTMENT OF NEPHROLOGY, DIALYSIS AND INTERNAL MEDICINE MEDICAL UNIVERSITY OF WARSAW, WARSAW, POLAND
| | - Marek Koziński
- DEPARTMENT OF CARDIOLOGY AND INTERNAL DISEASES, INSTITUTE OF MARITIME AND TROPICAL MEDICINE IN GDYNIA, MEDICAL UNIVERSITY OF GDANSK, GDYNIA, POLAND
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Abstract
A great deal of evolutionarily conserved information is contained in genomes and proteins. Enormous effort has been put into understanding protein structure and developing computational tools for protein folding, and many sophisticated approaches take structure and sequence homology into account. Several groups have applied statistical physics approaches to extracting information about proteins from sequences alone. Here, we develop a new method for sequence analysis based on first principles, in information theory, in statistical physics and in Bayesian analysis. We provide a complete derivation of our approach and we apply it to a variety of systems, to demonstrate its utility and its limitations. We show in some examples that phylogenetic alignments of amino-acid sequences of families of proteins imply the existence of a small number of modes that appear to be associated with correlated global variation. These modes are uncovered efficiently in our approach by computing a non-perturbative effective potential directly from the alignment. We show that this effective potential approaches a limiting form inversely with the logarithm of the number of sequences. Mapping symbol entropy flows along modes to underlying physical structures shows that these modes arise due to correlated compensatory adjustments. In the protein examples, these occur around functional binding pockets.
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Szwoch M, Wojtowicz D, Dorniak K, Walczak E, Raczak G, Fidziańska A. [Cardiac involvement in neuronal ceroid lipofuscinosis]. Kardiol Pol 2013; 71:855-7. [PMID: 24049028 DOI: 10.5603/kp.2013.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Indexed: 11/25/2022]
Abstract
We present a case of a 58-year-old female with neuropsychiatric symptoms, followed by recurrent episodes of atrial flagellation and symptoms of heart failure. Based on intraoperative myocardial biopsy, neuronal ceroid lipofuscinosis was diagnosed.
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Affiliation(s)
- Małgorzata Szwoch
- Klinika Kardiologii i Elektroterapii Serca, Uniwersytet Medyczny, Gdańsk.
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Wojtowicz D. [Clinical evaluation of nuva-fil material]. Protet Stomatol 1977; 27:179. [PMID: 335454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Wojtowicz D. [Prevention of dental caries in 1st molars using nuva-seal preparation]. Protet Stomatol 1977; 27:178. [PMID: 270179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Wojtowicz D. [The effect of the Elmex protective lacquer on the solubility of enamel in in-vitro studies]. Czas Stomatol 1974; 27:933-8. [PMID: 4528327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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