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Schreiber T, Grune J, Landmesser U, Attanasio P. Detection and modification of biomarkers of inflammation determining successful rhythm control in patients with atrial fibrillation. Biomarkers 2023; 28:681-691. [PMID: 37962292 DOI: 10.1080/1354750x.2023.2284122] [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: 03/17/2023] [Accepted: 11/12/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Multiple pathophysiological mechanisms are involved in the pathogenesis of atrial fibrillation (AF). Growing evidence suggests that both local and systemic inflammation plays a key role even in early stages and its progression towards persisting and permanent AF. Rhythm control therapy via pulmonary vein isolation or cardioversion is the cornerstone of AF therapy for most symptomatic patients, yet arrhythmia recurrence after treatment is still common, especially in patients with persistent AF. MATERIAL AND METHODS In this review, we summarize the current state of knowledge of biomarkers of inflammation with prognostic value in patients with atrial fibrillation as well as anti-inflammatory medication with potential benefits after rhythm control therapy. RESULTS AND DISCUSSION Both onset of AF, progression and arrhythmia recurrence after rhythm control therapy can be caused by local and systemic inflammation. Various inflammatory biomarkers have been established to predict treatment success. Furthermore, additional anti-inflammatory therapy may significantly improve success rates.
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Affiliation(s)
- Tobias Schreiber
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
| | - Jana Grune
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Philipp Attanasio
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
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2
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Wu L, Jiang Z, Meulendijks ER, Baylan U, Waas ISE, Bugiani M, Tuinman PR, Fronczek J, Heunks LMA, de Groot JR, van Rossum AC, Niessen HWM, Krijnen PAJ. Atrial inflammation and microvascular thrombogenicity are increased in deceased COVID-19 patients. Cardiovasc Pathol 2023; 64:107524. [PMID: 36649811 PMCID: PMC9839463 DOI: 10.1016/j.carpath.2023.107524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Histopathological studies have shown inflammation, cardiomyocyte injury, and microvascular thrombosis in the ventricular myocardium of patients with coronavirus disease 2019 (COVID-19). However, although atrial dysfunction is common in COVID-19, little is known about histopathological changes in the atria of the heart. We therefore analyzed inflammation, cardiomyocyte injury, and microvascular thrombogenicity in the atria of deceased patients with COVID-19. METHODS Atrial tissue was obtained from autopsied COVID-19 (n=16) patients and control patients (n=10) and analyzed using immunohistochemistry. The infiltration of CD45+ leukocytes, CD3+ T lymphocytes, CD68+ macrophages, MPO+ neutrophils, and Tryptase+ mast cells were quantified as well as cardiomyocyte damage and microvascular thrombosis. In addition, Tissue Factor (TF) and Factor XII (FXII) were quantified as markers of microvascular thrombogenicity. RESULTS The numbers of lymphocytes, macrophages, and neutrophils were significantly increased in the atrial myocardium and epicardial atrial adipose tissue of COVID-19 patients compared with the control group. This was accompanied by dispersed cardiomyocyte injury, the occasional presence of microvascular thrombosis, and an increased presence of TF and FXII in the microvascular endothelium. CONCLUSIONS Severe COVID-19 induces inflammation, cardiomyocyte injury, and microvascular thrombosis in the atria of the heart.
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Affiliation(s)
- Linghe Wu
- Department of Pathology, Amsterdam University Medical Centre (AUMC), Location VUmc, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, AUMC, Location VUmc, Amsterdam, The Netherlands; Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands.
| | - Zhu Jiang
- Department of Pathology, Amsterdam University Medical Centre (AUMC), Location VUmc, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, AUMC, Location VUmc, Amsterdam, The Netherlands; Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands
| | - Eva R Meulendijks
- Department of Cardiology, AUMC, location VUmc, Amsterdam, The Netherlands
| | - Umit Baylan
- Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands
| | - Ingeborg S E Waas
- Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands
| | - Marianna Bugiani
- Department of Pathology, Amsterdam University Medical Centre (AUMC), Location VUmc, Amsterdam, The Netherlands; Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, AUMC, location VUmc, Amsterdam, The Netherlands
| | - Judith Fronczek
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash Monash University, Southbank, Victoria, Australia
| | - Leo M A Heunks
- Department of Intensive Care Medicine, AUMC, location VUmc, Amsterdam, The Netherlands
| | - Joris R de Groot
- Department of Cardiology, AUMC, location VUmc, Amsterdam, The Netherlands
| | | | - Hans W M Niessen
- Department of Pathology, Amsterdam University Medical Centre (AUMC), Location VUmc, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, AUMC, Location VUmc, Amsterdam, The Netherlands; Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands; Department of Cardiac Surgery, AUMC, location VUmc, Amsterdam, The Netherlands
| | - Paul A J Krijnen
- Department of Pathology, Amsterdam University Medical Centre (AUMC), Location VUmc, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, AUMC, Location VUmc, Amsterdam, The Netherlands; Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands
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3
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Schneider JN, Jahnke C, Cavus E, Chevalier C, Bohnen S, Radunski UK, Riedl KA, Tahir E, Adam G, Kirchhof P, Blankenberg S, Lund GK, Müllerleile K. Feature tracking cardiovascular magnetic resonance reveals recovery of atrial function after acute myocarditis. Int J Cardiovasc Imaging 2022; 38:2003-2012. [PMID: 37726601 PMCID: PMC10509057 DOI: 10.1007/s10554-022-02576-1] [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: 11/21/2021] [Accepted: 02/17/2022] [Indexed: 11/24/2022]
Abstract
Follow-up after acute myocarditis is important to detect persisting myocardial dysfunction. However, recovery of atrial function has not been evaluated after acute myocarditis so far. Thirty-five patients with strictly defined acute myocarditis underwent cardiovascular magnetic resonance (CMR, 1.5 T) in the acute stage at baseline (BL) and at 3 months follow-up (FU). The study population included 13 patients with biopsy-proven "cardiomyopathy-like" myocarditis (CLM) and 22 patients with "infarct-like" (ILM) clinical presentation. CMR feature tracking (FT) was performed on conventional cine SSFP sequences. Median LA-GLS increased from 33.2 (14.5; 39.2) at BL to 37.0% (25.2; 44.1, P = 0.0018) at FU in the entire study population. Median LA-GLS also increased from 36.7 (26.5; 42.3) at BL to 41.3% (34.5; 44.8, P = 0.0262) at FU in the ILM subgroup and from 11.3 (6.4; 21.1) at BL to 21.4% (14.2; 30.7, P = 0.0186) at FU in the CLM subgroup. Median RA-GLS significantly increased from BL with 30.8 (22.5; 37.0) to FU with 33.7% (26.8; 45.4, P = 0.0027) in the entire study population. Median RA-GLS also significantly increased from 32.7 (25.8; 41.0) at BL to 35.8% (27.7; 48.0, P = 0.0495) at FU in the ILM subgroup and from 22.8 (13.1; 33.9) at BL to 31.0% (26.0; 40.8, P = 0.0266) at FU in the CLM subgroup. Our findings demonstrate recovery of LA and RA function by CMR-FT strain analyses in patients after acute myocarditis independent from clinical presentation. Monitoring of atrial strain could be an important tool for an individual assessment of healing after acute myocarditis.
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Affiliation(s)
- J N Schneider
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.
| | - C Jahnke
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - E Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - C Chevalier
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - S Bohnen
- Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | - U K Radunski
- Department of Cardiology, Regio Clinics Pinneberg and Elmshorn, Hamburg, Germany
| | - K A Riedl
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - E Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - S Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - G K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Müllerleile
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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4
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Mitrani RD, Dabas N, Alfadhli J, Lowery MH, Best TM, Hare JM, Myerburg RJ, Goldberger JJ. Long-term cardiac surveillance and outcomes of COVID-19 patients. Trends Cardiovasc Med 2022; 32:465-475. [PMID: 35718289 PMCID: PMC9212847 DOI: 10.1016/j.tcm.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022]
Abstract
Acute cardiac manifestions of COVID-19 have been well described, while chronic cardiac sequelae remain less clear. Various studies have shown conflicting data on the prevalence of new or worsening cardiovascular disease, myocarditis or cardiac dysrhythmias among patients recovered from COVID-19. Data are emerging that show that patients recovering from COVID-19 have an increased incidence of myocarditis and arrhythmias after recovery from COVID-19 compared with the control groups without COVID-19. The incidence of myocarditis after COVID-19 infection is low but is still significantly greater than the incidence of myocarditis from a COVID-19 vaccine. There have been several studies of athletes who underwent a variety of screening protocols prior to being cleared to return to exercise and competition. The data show possible, probable or definite myocarditis or cardiac injury among 0.4–3.0% of the athletes studied. Recent consensus statements suggest that athletes with full recovery and absence of cardiopulmonary symptoms may return to exercise and competition without cardiovascular testing. In conclusion, patients with COVID-19 may be expected to have an increased risk of cardiovascular disease, myocarditis or arrhythmias during the convalescent phase. Fortunately, the majority of patients, including athletes may return to their normal activity after recovery from COVID 19, in the absence of persisting cardiovascular symptoms.
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Affiliation(s)
- Raul D Mitrani
- Cardiovascular Division, Department of Medicine, University of Miami, 1120 NW 14th St., Suite 1124, Miami, FL 33136, United States
| | - Nitika Dabas
- Cardiovascular Division, Department of Medicine, University of Miami, 1120 NW 14th St., Suite 1124, Miami, FL 33136, United States
| | - Jarrah Alfadhli
- Cardiovascular Division, Department of Medicine, University of Miami, 1120 NW 14th St., Suite 1124, Miami, FL 33136, United States
| | - Maureen H Lowery
- Cardiovascular Division, Department of Medicine, University of Miami, 1120 NW 14th St., Suite 1124, Miami, FL 33136, United States
| | - Thomas M Best
- Department of Orthopedics, UHealth Sports Medicine Institute, United States
| | - Joshua M Hare
- Cardiovascular Division, Department of Medicine, University of Miami, 1120 NW 14th St., Suite 1124, Miami, FL 33136, United States; The Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, United States
| | - Robert J Myerburg
- Cardiovascular Division, Department of Medicine, University of Miami, 1120 NW 14th St., Suite 1124, Miami, FL 33136, United States
| | - Jeffrey J Goldberger
- Cardiovascular Division, Department of Medicine, University of Miami, 1120 NW 14th St., Suite 1124, Miami, FL 33136, United States.
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5
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Wu L, Fiet MD, Raaijmakers DR, Woudstra L, van Rossum AC, Niessen HWM, Krijnen PAJ. Transient atrial inflammation in a murine model of Coxsackievirus B3-induced myocarditis. Int J Exp Pathol 2022; 103:149-155. [PMID: 35363404 PMCID: PMC9264345 DOI: 10.1111/iep.12438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/21/2022] [Accepted: 03/06/2022] [Indexed: 12/02/2022] Open
Abstract
Atrial dysfunction is a relatively common complication of acute myocarditis, although its pathophysiology is unclear. There is limited information on myocarditis‐associated histological changes in the atria and how they develop in time. The aim of this study therefore was to investigate inflammation, fibrosis and viral genome in the atria in time after mild CVB3‐induced viral myocarditis (VM) in mice. C3H mice (n = 68) were infected with 105 PFU of Coxsackievirus B3 (CVB3) and were compared with uninfected mice (n = 10). Atrial tissue was obtained at days 4, 7, 10, 21, 35 or 49 post‐infection. Cellular infiltration of CD45+ lymphocytes, MAC3+ macrophages, Ly6G+ neutrophils and mast cells was quantified by (immuno)histochemical staining. The CVB3 RNA was determined by in situ hybridization, and fibrosis was evaluated by elastic van Gieson (EvG) staining. In the atria of VM mice, the numbers of lymphocytes on days 4 and 7 (p < .05) and days 10 (p < .01); macrophages on days 7 (p < .01) and 10 (p < .05); neutrophils on days 4 (p < .05); and mast cells on days 4 and 7 (p < .05) increased significantly compared with control mice and decreased thereafter to basal levels. No cardiomyocyte death was observed, and the CVB3 genome was detected in only one infected mouse on Day 4 post‐infection. No significant changes in the amount of atrial fibrosis were found between VM and control mice. A temporary increase in inflammation is induced in the atria in the acute phase of CVB3‐induced mild VM, which may facilitate the development of atrial arrhythmia and contractile dysfunction.
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Affiliation(s)
- Linghe Wu
- Department of Pathology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.,Department of Pathology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Mitchell D Fiet
- Department of Pathology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.,Department of Pathology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Daan R Raaijmakers
- Department of Pathology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Linde Woudstra
- Department of Reproductive Medicine, Reinier de Graaf Hospital, Voorburg, The Netherlands
| | - Albert C van Rossum
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Cardiac Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Hans W M Niessen
- Department of Pathology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.,Department of Pathology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Paul A J Krijnen
- Department of Pathology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.,Department of Pathology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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6
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The presence of cardiotropic viral genomes is not increased in atrial tissue of atrial fibrillation patients. Neth Heart J 2022; 30:377-382. [PMID: 35099775 PMCID: PMC9270523 DOI: 10.1007/s12471-022-01660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Infections with potentially cardiotropic viruses are associated with the development of atrial fibrillation (AF). However, whether direct viral infection of the atria is involved in the pathogenesis of AF is unclear. We have therefore analysed the presence of cardiotropic viral genomes in AF patients. Methods Samples of left atrial tissue were obtained from 50 AF patients (paroxysmal, n = 20; long-standing persistent/permanent, n = 30) during cardiac surgery and from autopsied control patients (n = 14). Herein, the presence of PVB19, EBV, CMV, HHV‑6, adenovirus and enterovirus genomes was determined by polymerase chain reaction. The densities of CD45+ and CD3+ cells and fibrosis in the atria were quantified by (immuno)histochemistry. Results Of the tested viruses only the PVB19 genome was detected in the atria of 10% of patients, paroxysmal AF (2 of 20) and long-standing persistent/permanent AF (3 of 30). Conversely, in 50% of controls (7 of 14) PVB19 genome was found. No significant association was found between PVB19 and CD45+ and CD3+ cells, or between the presence of PVB19 and fibrosis, in either control or AF patients. Conclusion The presence of viral genomes is not increased in the atria of AF patients. These results do not support an important role for viral infection of the atria in the pathogenesis of AF. Supplementary Information The online version of this article (10.1007/s12471-022-01660-4) contains supplementary material, which is available to authorized users.
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Lim CP, Chiam PTL, Lai HK, Koh YL. A rare case of isolated atrial myocarditis. Singapore Med J 2022; 62:610-614. [PMID: 35001133 DOI: 10.11622/smedj.2021227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Choon Pin Lim
- The Heart and Vascular Centre, Mount Elizabeth Novena Hospital, Singapore
| | | | - Hee Kit Lai
- Radiology Department, Mount Elizabeth Novena Hospital, Singapore
| | - Yin Ling Koh
- The Novena Medical Specialists, Mount Elizabeth Novena Hospital, Singapore
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8
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Wu L, Woudstra L, Dam TA, Germans T, van Rossum AC, Niessen HWM, Krijnen PAJ. Electrocardiographic changes are strongly correlated with the extent of cardiac inflammation in mice with Coxsackievirus B3-induced viral myocarditis. Cardiovasc Pathol 2021; 54:107367. [PMID: 34245872 DOI: 10.1016/j.carpath.2021.107367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/11/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Viral myocarditis (VM) can induce changes in myocardial electrical conduction and arrhythmia. However, their relationship with myocarditis-associated arrhythmic substrates in the heart such as inflammation and fibrosis is relatively unknown. This we have analyzed in the present study. METHODS C3H mice were infected with 1×105 plaque-forming units Coxsackievirus B3 (CVB3, n=68) and were compared with uninfected control mice (n=10). Electrocardiograms (ECGs) were recorded in all conscious mice shortly before sacrifice and included heart rate; P-R interval; QRS duration; QTc interval and R-peak amplitude of lead II and aVF. Mice were sacrificed at 4, 7, 10, 21, 35 or 49 days post-infection. Cardiac lesion size, calcification, fibrosis and cellular infiltration of CD45+ lymphocytes, MAC3+ macrophages, Ly6G+ neutrophils and mast cells were quantitatively determined in cross-sections of the ventricles. Putative relations between ECG changes and lesion size and/or cardiac inflammation were then analyzed. RESULTS Significant transient reductions in QRS duration and R-peak amplitude occurred between 4 and 14 days post-infection and returned to baseline values thereafter. The magnitude of these ECG changes strongly correlated to the extent of lymphocyte (days 7 and 14), macrophage (days 7 and 10) and neutrophil (days 7) infiltration. The ECG changes did not significantly correlate with lesion size and fibrosis. CONCLUSION VM induces transient changes in myocardial electrical conduction that are strongly related to cellular inflammation of the heart. These data show that even in mild VM, with relatively little cardiac damage, the inflammatory infiltrate can form an important arrhythmogenic substrate.
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Affiliation(s)
- Linghe Wu
- Department of Pathology, Amsterdam University Medical Centers, location VUmc and AMC, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - Linde Woudstra
- Department of Pathology, Amsterdam University Medical Centers, location VUmc and AMC, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Tariq A Dam
- Department of Pathology, Amsterdam University Medical Centers, location VUmc and AMC, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Tjeerd Germans
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Department of Cardiology, Amsterdam UMC, location VU Medical Center, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Department of Cardiology, Amsterdam UMC, location VU Medical Center, Amsterdam, The Netherlands
| | - Hans W M Niessen
- Department of Pathology, Amsterdam University Medical Centers, location VUmc and AMC, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Department of Cardiac Surgery, Amsterdam UMC, location VU Medical Center, Amsterdam, The Netherlands
| | - Paul A J Krijnen
- Department of Pathology, Amsterdam University Medical Centers, location VUmc and AMC, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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9
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Compagnucci P, Volpato G, Falanga U, Cipolletta L, Conti MA, Grifoni G, Ciliberti G, Stronati G, Fogante M, Bergonti M, Sommariva E, Guerra F, Giovagnoni A, Dello Russo A, Casella M. Myocardial Inflammation, Sports Practice, and Sudden Cardiac Death: 2021 Update. ACTA ACUST UNITED AC 2021; 57:medicina57030277. [PMID: 33802881 PMCID: PMC8002711 DOI: 10.3390/medicina57030277] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023]
Abstract
Myocardial inflammation is an important cause of cardiovascular morbidity and sudden cardiac death in athletes. The relationship between sports practice and myocardial inflammation is complex, and recent data from studies concerning cardiac magnetic resonance imaging and endomyocardial biopsy have substantially added to our understanding of the challenges encountered in the comprehensive care of athletes with myocarditis or inflammatory cardiomyopathy (ICM). In this review, we provide an overview of the current knowledge on the epidemiology, pathophysiology, diagnosis, and treatment of myocarditis, ICM, and myopericarditis/perimyocarditis in athletes, with a special emphasis on arrhythmias, patient-tailored therapies, and sports eligibility issues.
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Affiliation(s)
- Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
- Correspondence:
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Umberto Falanga
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Laura Cipolletta
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
| | - Manuel Antonio Conti
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
| | - Gino Grifoni
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
| | - Giuseppe Ciliberti
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Marco Fogante
- Department of Radiology, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60121 Ancona, Italy; (M.F.); (A.G.)
| | - Marco Bergonti
- Department of Clinical Sciences and Community Health, University of Milan, 20138 Milan, Italy;
| | - Elena Sommariva
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy;
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60121 Ancona, Italy; (M.F.); (A.G.)
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Biomedical Science and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy; (G.V.); (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (G.S.); (F.G.); (A.D.R.); (M.C.)
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, 60121 Ancona, Italy
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10
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Myocardial fibrosis after COVID-19 infection and severe sinus arrest episodes in an asymptomatic patient with mild sleep apnea syndrome: A case report and review of the literature. Respir Med Case Rep 2021; 32:101366. [PMID: 33619450 PMCID: PMC7889031 DOI: 10.1016/j.rmcr.2021.101366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/13/2021] [Indexed: 11/29/2022] Open
Abstract
COVID-19 infection is a new disease mainly affecting the respiratory system but is also accompanied by many extra-pulmonary manifestations. A case of a 47-year old male with unique myocardial fibrosis after COVID-19 infection involving the left ventricular wall, intraventricular septum and almost complete damage of interatrial septum, in combination with asymptomatic severe sinus arrest episodes related to mild obstructive sleep apnea syndrome is described here. Myocardial fibrosis may be a consequence of COVID-19 infection. Almost complete fibrosis of interatrial septum is a unique complication of COVID-19. Cardiac MRI is very useful in detecting myocardial complications. Severe sinus arrest episodes are very unusual in patients with mild OSA syndrome.
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11
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Prokudina ES, Kurbatov BK, Zavadovsky KV, Vrublevsky AV, Naryzhnaya NV, Lishmanov YB, Maslov LN, Oeltgen PR. Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis. Curr Cardiol Rev 2021; 17:188-203. [PMID: 31995013 PMCID: PMC8226199 DOI: 10.2174/1573403x16666200129114330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/02/2019] [Accepted: 12/12/2019] [Indexed: 12/15/2022] Open
Abstract
The purpose of the review is the analysis of clinical and experimental data on the etiology and pathogenesis of takotsubo syndrome (TS). TS is characterized by contractile dysfunction, which usually affects the apical region of the heart without obstruction of coronary artery, moderate increase in myocardial necrosis markers, prolonged QTc interval (in 50% of patients), sometimes elevation of ST segment (in 19% of patients), increase N-Terminal Pro-B-Type Natriuretic Peptide level, microvascular dysfunction, sometimes spasm of the epicardial coronary arteries (in 10% of patients), myocardial edema, and life-threatening ventricular arrhythmias (in 11% of patients). Stress cardiomyopathy is a rare disease, it is observed in 0.6 - 2.5% of patients with acute coronary syndrome. The occurrence of takotsubo syndrome is 9 times higher in women, who are aged 60-70 years old, than in men. The hospital mortality among patients with TS corresponds to 3.5% - 12%. Physical or emotional stress do not precede disease in all patients with TS. Most of patients with TS have neurological or mental illnesses. The level of catecholamines is increased in patients with TS, therefore, the occurrence of TS is associated with excessive activation of the adrenergic system. The negative inotropic effect of catecholamines is associated with the activation of β2 adrenergic receptors. An important role of the adrenergic system in the pathogenesis of TS is confirmed by studies which were performed using 125I-metaiodobenzylguanidine (125I -MIBG). TS causes edema and inflammation of the myocardium. The inflammatory response in TS is systemic. TS causes impaired coronary microcirculation and reduces coronary reserve. There is a reason to believe that an increase in blood viscosity may play an important role in the pathogenesis of microcirculatory dysfunction in patients with TS. Epicardial coronary artery spasm is not obligatory for the occurrence of TS. Cortisol, endothelin-1 and microRNAs are challengers for the role of TS triggers. A decrease in estrogen levels is a factor contributing to the onset of TS. The central nervous system appears to play an important role in the pathogenesis of TS.
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Affiliation(s)
| | | | | | | | | | | | - Leonid N. Maslov
- Address correspondence to this at the Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center of the RAS, Tomsk, Russia; E-mail:
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Shah SN, Varghese RGB, Theodore S. Histopathological changes in the right atrial appendages triggering atrial fibrillation: A tertiary care center study. INDIAN J PATHOL MICR 2021; 64:464-468. [PMID: 34341254 DOI: 10.4103/ijpm.ijpm_371_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Atrial fibrillation(AF) is as an abnormal irregular rhythm with chaotic generation of electrical signals in the atria of the heart. Various studies in the West have proved that atrial substrates, like isolated atrial amyloidosis can trigger the development of atrial fibrillation. In India, these structural changes have been analyzed on autopsied hearts. Aim To determine the role of Atrial Amyloid as a substrate for Atrial fibrillation in ante mortem hearts. Methods and Results Atrial appendages were obtained from seventy five patients undergoing open heart surgery at a tertiary care hospital in south India. They were stained with Hematoxylin &Eosin, Masson's Trichrome and Congo red stains and were examined for myocarditis, fibrosis and amyloidosis, respectively. 30 (40%) patients were in AF. Amyloid deposits were seen in 3 cases. All the three were in AF and had undergone mitral valve replacement (MVR) (P<0.05). 2 out of the 3 amyloid-positive cases showed active myocarditis and severe scarring but there was no statistically significant correlation between these factors. Conclusion Amyloid and myocarditis, independently act as an arrythmogenic substrates in the development of atrial fibrillation and are also increasingly associated with female gender and MVR. We hypothesize that the amyloid deposits are due to isolated atrial amyloidosis as they were seen only in young individuals. Some patients in sinus rhythm (SR) had large left atria and myocarditis and probably are at a higher risk for developing AF. Hence, follow-up of these patients is required for prevention of severe organ damage and timely therapeutic intervention.
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Affiliation(s)
- Saloni Naresh Shah
- Department of Histopathology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Renu G' Boy Varghese
- Department of Pathology, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
| | - Sanjay Theodore
- Department of Cardiovascular and Thoracic Surgery, Chettinad Health City, Chennai, Tamil Nadu, India
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13
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Prokudina ES, Kurbatov BK, Maslov LN. [Clinical Manifestation of Stressful Cardiomyopathy (Takotsubo Syndrome) and the Problem of Differential Diagnosis with Acute Myocardial Infarction]. ACTA ACUST UNITED AC 2020; 60:777. [PMID: 33487160 DOI: 10.18087/cardio.2020.11.n777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/28/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022]
Abstract
The presented data show that tacotsubo syndrome (TS) is characterized by the absence of coronary artery obstruction, cardiac contractile dysfunction, apical ballooning, and heart failure, and in some patients, ST-segment elevation and prolongation of the QTc interval. Every tenth patient with TS develops ventricular arrhythmias. Most of TS patients have elevated markers of necrosis (troponin I, troponin Т, and creatine kinase МВ (CK-МВ), which are considerably lower than in patients with acute myocardial infarction (AMI) with ST-segment elevation. The level of N-terminal pro-B-type natriuretic peptide (NT-proBNP), in contrast, is considerably higher in patients with TS than with AMI. Differential diagnosis of TS and AMI should be based on a multifaceted approach using coronary angiography, echocardiography, analysis of ECG, magnetic resonance imaging, single-photon emission computed tomography, and measurement of troponins, CK-MB, and NT-proBNP.
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Affiliation(s)
- E S Prokudina
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
| | - B K Kurbatov
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
| | - L N Maslov
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
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14
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Mitrani RD, Dabas N, Goldberger JJ. COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors. Heart Rhythm 2020; 17:1984-1990. [PMID: 32599178 PMCID: PMC7319645 DOI: 10.1016/j.hrthm.2020.06.026] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022]
Abstract
Up to 20%-30% of patients hospitalized with coronavirus disease 2019 (COVID-19) have evidence of myocardial involvement. Acute cardiac injury in patients hospitalized with COVID-19 is associated with higher morbidity and mortality. There are no data on how acute treatment of COVID-19 may affect the convalescent phase or long-term cardiac recovery and function. Myocarditis from other viral pathogens can evolve into overt or subclinical myocardial dysfunction, and sudden death has been described in the convalescent phase of viral myocarditis. This raises concerns for patients recovering from COVID-19. Some patients will have subclinical and possibly overt cardiovascular abnormalities. Patients with ostensibly recovered cardiac function may still be at risk of cardiomyopathy and cardiac arrhythmias. Screening for residual cardiac involvement in the convalescent phase for patients recovered from COVID-19-associated cardiac injury is needed. The type of testing and therapies for post COVID-19 myocardial dysfunction will need to be determined. Therefore, now is the time to plan for appropriate registries and clinical trials to properly assess these issues and prepare for long-term sequelae of "post-COVID-19 cardiac syndrome."
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Affiliation(s)
- Raul D Mitrani
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
| | - Nitika Dabas
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Jeffrey J Goldberger
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
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15
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Santilli RA, Grego E, Battaia S, Gianella P, Tursi M, Di Girolamo N, Biasato I, Perego M. Prevalence of selected cardiotropic pathogens in the myocardium of adult dogs with unexplained myocardial and rhythm disorders or with congenital heart disease. J Am Vet Med Assoc 2020; 255:1150-1160. [PMID: 31687895 DOI: 10.2460/javma.255.10.1150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the prevalence of nucleic acid from selected cardiotropic pathogens in endomyocardial biopsy samples from dogs with unexplained myocardial and rhythm disorders (UMRD) and compare prevalence with that for a group of control dogs with congenital heart disease (CHD). ANIMALS 47 client-owned dogs. PROCEDURES Right ventricular endomyocardial biopsy was performed in dogs with UMRD (dilated cardiomyopathy [n = 25], atrioventricular block [6], and nonfamilial ventricular [4] and supraventricular arrhythmias [2]) or CHD (10) that required right ventricular catheterization. Biopsy samples were evaluated histologically, and PCR assays were used for detection of nucleic acid from 12 pathogens. RESULTS 197 biopsy samples were collected from dogs with UMRD (n = 172) or CHD (25). At least 1 pathogen was detected in 21 of 37 (57%; 95% confidence interval [CI], 41% to 71%) dogs with UMRD, and canine coronavirus was detected in 1 of 10 (10%; 95% CI, 2% to 40%) dogs with CHD. Dogs with UMRD were significantly more likely than dogs with CHD to have pathogens detected in biopsy samples (OR, 11.8; 95% CI, 1.3 to 103.0). The most common pathogens in dogs with UMRD were canine distemper virus, canine coronavirus, canine parvovirus 2, and Bartonella spp. No pathogens were detected in available blood samples from dogs with pathogens detected in biopsy samples. CONCLUSIONS AND CLINICAL RELEVANCE Detection of nucleic acids from selected cardiotropic pathogens in myocardial tissue from dogs with UMRD suggested a possible association between the 2. Further studies are needed to explore whether this association is causative or clinically important. (J Am Vet Med Assoc 2019;255:1150-1160).
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Myocarditis in the Athlete: Arrhythmogenic Substrates, Clinical Manifestations, Management, and Eligibility Decisions. J Cardiovasc Transl Res 2020; 13:284-295. [PMID: 32270467 DOI: 10.1007/s12265-020-09996-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/24/2020] [Indexed: 12/26/2022]
Abstract
Myocarditis is as an important cause of sudden cardiac death (SCD) among athletes. The incidence of SCD ascribed to myocarditis did not change after the introduction of pre-participation screening in Italy, due to the transient nature of the disease and problems in the differential diagnosis with the athlete's heart. The arrhythmic burden and the underlying mechanisms differ between the acute and chronic setting, depending on the relative impact of acute inflammation versus post-inflammatory myocardial fibrosis. In the acute phase, ventricular arrhythmias vary from isolated ventricular ectopic beats to complex tachycardias that can lead to SCD. Atrioventricular blocks are typical of specific forms of myocarditis, and supraventricular arrhythmias may be observed in case of atrial inflammation. Athletes with acute myocarditis should be temporarily restricted from physical exercise, until complete recovery. However, ventricular tachycardia may also occur in the chronic phase in the context of post-inflammatory myocardial scar.
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Diagnostic Efficacy of Cardiac Scintigraphy with 99mTc-Pyrophosphate for Latent Myocardial Inflammation in Patients with Atrial Fibrillation. Cardiol Res Pract 2020; 2020:5983751. [PMID: 32211203 PMCID: PMC7057002 DOI: 10.1155/2020/5983751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives This work aimed to study the efficacy of hybrid 99mTc-Pyrophosphate SPECT/CT for diagnosis of latent inflammatory processes in the myocardium of patients with atrial fibrillation (AF). Methods The study comprised 34 patients aged 44 ± 9 years with AF of unknown etiology referred for radiofrequency ablation. The data were acquired using hybrid 99mTc-Pyrophosphate SPECT/CT. To evaluate and interpret the results of hybrid study and to determine localization of radiopharmaceutical accumulation, scintigraphic and CT images were fused. SPECT/CT results were compared with data of endomyocardial biopsy. Results Sensitivity, specificity, and accuracy of 99mTc-Pyrophosphate SPECT/CT in diagnosing myocarditis were 91%, 100%, and 94%, respectively. Proposed diagnostic criteria for myocarditis comprised intensity of the radiopharmaceutical accumulation in the myocardium and the ratios of focus/lung, focus/vertebral column, and focus/LV pool. Minimum cutoff values for the histologically verified myocarditis were >1.47 for focus/lung index, >0.11 for focus/vertebral column ratio, and >1.26 for focus/lung index. Conclusions SPECT/CT-based quantitative assessment of 99mTc-Pyrophosphate accumulation in the myocardium is a highly informative noninvasive method for diagnosis of inflammatory process in the heart in patients with AF of undefined etiology.
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Dabir D, Vollbrecht TM, Luetkens JA, Kuetting DLR, Isaak A, Feisst A, Fimmers R, Sprinkart AM, Schild HH, Thomas D. Multiparametric cardiovascular magnetic resonance imaging in acute myocarditis: a comparison of different measurement approaches. J Cardiovasc Magn Reson 2019; 21:54. [PMID: 31462282 PMCID: PMC6714458 DOI: 10.1186/s12968-019-0568-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/23/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Myocardial T1 and T2 mapping are reliable diagnostic markers for the detection and follow up of acute myocarditis. The aim of this study was to compare the diagnostic performance of current mapping measurement approaches to differentiate between myocarditis patients and healthy individuals. METHODS Fifty patients with clinically defined acute myocarditis and 30 healthy controls underwent cardiovascular magnetic resonance (CMR). Myocardial T1 relaxation times, T2 relaxation times, left ventricular (LV) function, T2 ratio, early gadolinium enhancement ratio, and presence of late gadolinium enhancement (LGE) were analysed. Native T1 and T2 relaxation times, as well as extracellular volume fraction (ECV) were measured for the entire LV myocardium (global), within the midventricular short axis slice (mSAX), within the midventricular septal wall (ConSept), and within the remote myocardium (remote). Receiver operating characteristics analysis was performed to compare diagnostic performance. RESULTS All measurement approaches revealed significantly higher native T1 and T2 relaxation times as well as ECV values in patients compared to healthy controls (p < 0.05 for all parameters). The global measurement approach showed highest diagnostic performance regarding all mapping parameters (AUCs, native T1: 0.903, T2: 0.847, ECV: 0.731). Direct comparison of the different measurement approaches revealed significant differences in diagnostic performance between the global and the remote approach regarding T1 relaxation times and ECV (p = 0.001 and p = 0.002 respectively). Further, the global measurement approach revealed significantly higher T1 relaxation times compared to the ConSept approach (AUCs: 0.903 vs. 0.783; p = 0.003) and nearly significant differences compared to the mSAX approach (AUC: 0.850; p = 0.051). T2 relaxation times showed no significant differences between all measurement approaches (p > 0.050 for all parameters). CONCLUSIONS Native T1 and T2 mapping allow for accurate detection of acute myocarditis irrespective of the measurement approach used. Even measurements performed exclusively within remote myocardium allow for reliable detection of acute myocarditis, demonstrating diffuse involvement of disease despite a mostly regional or patchy distribution pattern of visible pathologies. The global measurement approach provides the overall best diagnostic performance in acute myocarditis for both T1 and T2 mapping.
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Affiliation(s)
- Darius Dabir
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Thomas M. Vollbrecht
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Julian A. Luetkens
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Daniel L. R. Kuetting
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Alexander Isaak
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Andreas Feisst
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Rolf Fimmers
- Department of Medical Biometry, Computer Science, and Epidemiology (IMBIE), University of Bonn, Bonn, Germany
| | - Alois M. Sprinkart
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Hans H. Schild
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Daniel Thomas
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
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Sazonova SI, Ilushenkova JN, Batalov RE, Gusakova AM, Saranchina JV, Rogovskaya JV, Popov SV. Plasma markers of myocardial inflammation at isolated atrial fibrillation. J Arrhythm 2018; 34:493-500. [PMID: 30327694 PMCID: PMC6174480 DOI: 10.1002/joa3.12083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/02/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is one of the widest spread forms of arrhythmia, which is associated with the increased mortality and thromboembolic complications. To date, the involvement of renin-angiotensin-aldosterone system and immunomediators of inflammation into the mechanisms of development and maintenance of isolated AF is not clear. Specificity of their changes with respect to the latent myocarditis at AF is not proved. METHODS In 96 patients with persistent isolated atrial fibrillation (IsAF), scheduled for radiofrequency ablation and endomyocardial biopsy (EMB), and in 20 healthy volunteers (HVT), levels of plasma tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, IL-10, fatty acid-binding protein (FABP), neopterin, C-reactive protein (CRP) were determined by ELISA, level of aldosterone and the renin activity were determined by radioimmunoassay. Results were compared between the study and HVT groups and related to the EMB data. RESULTS Endomyocardial biopsy revealed lymphocytic myocarditis in 29%, immunohistochemical signs of viruses' persistence in the myocardium-in 43.8% of patient. We formed 4 subgroups: «myocarditis», «fibrosis», «virus positive», «virus negative». In the group «myocarditis», level of IL-6 was significantly higher than in group «fibrosis» (P < .01). ROC analysis showed its sensitivity 75%, specificity 75% (AUC = 0.759, Cutoff Value > 1.6 pg/mL, P < .01). In the group «virus positive», level of neopterin was significantly higher than in group «virus negative» (P < .01), with sensitivity 51%, specificity 84% (AUC = 0.675, Cutoff Value > 13.2 nmol/L, P < .01). CONCLUSION Levels of plasma IL-6 and neopterin may serve as a marker of latent viral myocarditis in IsAF.
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Affiliation(s)
- Svetlana Ivanovna Sazonova
- Cardiology Research InstituteTomsk National Research Medical CenterRussian Academy of ScienceTomskRussia
| | | | - Roman Efimovich Batalov
- Cardiology Research InstituteTomsk National Research Medical CenterRussian Academy of ScienceTomskRussia
| | - Anna Mihaylovna Gusakova
- Cardiology Research InstituteTomsk National Research Medical CenterRussian Academy of ScienceTomskRussia
| | | | | | - Sergey Valentinovich Popov
- Cardiology Research InstituteTomsk National Research Medical CenterRussian Academy of ScienceTomskRussia
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Xu M, Jiang T, Zhou Y, Yang X. Influence of echocardiographic measurements and renal impairments on the prognosis of fulminant myocarditis. Medicine (Baltimore) 2018; 97:e9812. [PMID: 29384884 PMCID: PMC5805456 DOI: 10.1097/md.0000000000009812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Fulminant myocarditis is a severe cardiac emergency that may lead to death if effective cardiopulmonary supports are not provided. This study aimed to evaluate the prognostic predictors in patients with fulminant myocarditis.We retrospectively analyzed the clinical characteristics, complications, laboratory findings, treatments, as well as electrocardiographic and echocardiographic data of 73 consecutive subjects diagnosed with fulminant myocarditis from June 2012 to June 2016. Logistic regression analysis was used to identify the independent predictive factors of nonsurvivor fulminant myocarditis.Ten patients and 63 patients were assigned to the nonsurvivor and survivor fulminant myocarditis groups, respectively. Patients in the nonsurvivor fulminant myocarditis group had higher heart rates; were more likely to develop clinical complications and supraventricular tachycardia (SVT); and had higher serum creatinine (Scr) level, and had higher white blood cell (WBC) counts, and lower abbreviated estimated glomerular filtration rates (eGFR) than the patients in the survivor fulminant myocarditis group. Moreover, we observed larger left atrium dimension (LAd), larger left ventricular end systolic dimensions, and lower left ventricular ejection fraction in the patients from the nonsurvivor fulminant myocarditis group than in those from the other group. A logistic regression model was constructed and demonstrated that eGFR and LAd were 2 independent predictors of mortality in patients with fulminant myocarditis.Higher heart rates, higher incidences of clinical complication, SVT, higher admission levels of Scr and eGFR, higher WBC counts, higher Scr and eGFR at stage of most severe renal damage, and abnormal echocardiographic findings were associated with high risk of mortality in patients with fulminant myocarditis. The major finding was that eGFR and LAd were independent predictors for in-hospital mortality in patients with fulminant myocarditis.
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Kasner M, Aleksandrov A, Escher F, Al-Saadi N, Makowski M, Spillmann F, Genger M, Schultheiss HP, Kühl U, Pieske B, Morris DA, Noutsias M, Tschöpe C. Multimodality imaging approach in the diagnosis of chronic myocarditis with preserved left ventricular ejection fraction (MCpEF): The role of 2D speckle-tracking echocardiography. Int J Cardiol 2017; 243:374-378. [PMID: 28536004 DOI: 10.1016/j.ijcard.2017.05.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 05/03/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Up to one third of patients with chronic myocarditis (MC) have preserved left ventricular (LV) ejection fraction (MCpEF). The purpose of this study was to evaluate the role of adding 2D speckle-tracking echocardiography (STE) to cardiac magnetic resonance imaging (cMRI) in the diagnosis of patients with MCpEF. METHODS AND RESULTS We analyzed 67 patients with suspected MCpEF who underwent endomyocardial biopsy (EMB). Thirty-two patients with confirmed chronic myocardial inflammation by EMB served as study group (MCpEF) and the remaining patients (n=35) served as control group. In all patients, 2D STE and cMRI were performed within 48h before EMB. Patients with MCpEF had significantly lower LV global longitudinal systolic strain (GLS) than controls (GLS: -17.01±2.42% vs. -19.39±3.81%, p<0.001; respectively). In line, an abnormal GLS had adequate diagnostic performance to detect MCpEF (sensitivity, specificity, and accuracy of 82%, 70%, and 76%, respectively), which was superior to cMRI based on the Lake-Louise criteria (sensitivity, specificity, and accuracy 54%, 71%, and 67%, respectively). In addition, adding GLS to the Lake-Louise criteria improved significantly the diagnostic performance of cMRI to detect MCpEF (sensitivity, specificity, and accuracy 96%, 55%, and 75%, respectively). CONCLUSION The findings of this study suggest that GLS using 2D STE could play an important role in the diagnostic evaluation of patients with suspected chronic myocarditis with preserved LV ejection fraction (MCpEF).
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Affiliation(s)
- Mario Kasner
- Department of Cardiology and Pulmonology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Aleksandar Aleksandrov
- Department of Cardiology and Pulmonology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Felicitas Escher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Nidal Al-Saadi
- Private Institute for Cardiovascular Medicine, Berlin, Germany
| | - Markus Makowski
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Frank Spillmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Martin Genger
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | | | - Uwe Kühl
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Center: Berlin, Germany
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Michel Noutsias
- Department of Internal Medicine I, Division of Cardiology, Pulmonology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Center: Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.
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Histopathological and Immunological Characteristics of Tachycardia-Induced Cardiomyopathy. J Am Coll Cardiol 2017; 69:2160-2172. [DOI: 10.1016/j.jacc.2017.02.049] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 12/17/2022]
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Smorodinova N, Bláha M, Melenovský V, Rozsívalová K, Přidal J, Ďurišová M, Pirk J, Kautzner J, Kučera T. Analysis of immune cell populations in atrial myocardium of patients with atrial fibrillation or sinus rhythm. PLoS One 2017; 12:e0172691. [PMID: 28225836 PMCID: PMC5321459 DOI: 10.1371/journal.pone.0172691] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/08/2017] [Indexed: 01/15/2023] Open
Abstract
Background Atrial fibrillation (AF) is the most common arrhythmia and despite obvious clinical importance remains its pathogenesis only partially explained. A relation between inflammation and AF has been suggested by findings of increased inflammatory markers in AF patients. Objective The goal of this study was to characterize morphologically and functionally CD45-positive inflammatory cell populations in atrial myocardium of patients with AF as compared to sinus rhythm (SR). Methods We examined 46 subjects (19 with AF, and 27 in SR) undergoing coronary bypass or valve surgery. Peroperative bioptic samples of the left and the right atrial tissue were examined using immunohistochemistry. Results The number of CD3+ T-lymphocytes and CD68-KP1+ cells were elevated in the left atrial myocardium of patients with AF compared to those in SR. Immune cell infiltration of LA was related to the rhythm, but not to age, body size, LA size, mitral regurgitation grade, type of surgery, systemic markers of inflammation or presence of diabetes or hypertension. Most of CD68-KP1+ cells corresponded to dendritic cell population based on their morphology and immunoreactivity for DC-SIGN. The numbers of mast cells and CD20+ B-lymphocytes did not differ between AF and SR patients. No foci of inflammation were detected in any sample. Conclusions An immunohistochemical analysis of samples from patients undergoing open heart surgery showed moderate and site-specific increase of inflammatory cells in the atrial myocardium of patients with AF compared to those in SR, with prevailing population of monocyte-macrophage lineage. These cells and their cytokine products may play a role in atrial remodeling and AF persistence.
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Affiliation(s)
- Natalia Smorodinova
- Institute of Histology and Embryology, The First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Bláha
- Institute for Clinical and Experimental Medicine-IKEM, Department of Cardiology, Prague, Czech Republic
| | - Vojtěch Melenovský
- Institute for Clinical and Experimental Medicine-IKEM, Department of Cardiology, Prague, Czech Republic
| | - Karolína Rozsívalová
- Institute of Histology and Embryology, The First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jaromír Přidal
- Institute of Histology and Embryology, The First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Mária Ďurišová
- Institute of Histology and Embryology, The First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Pirk
- Institute for Clinical and Experimental Medicine-IKEM, Department of Cardiovascular Surgery, Prague, Czech Republic
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine-IKEM, Department of Cardiology, Prague, Czech Republic
| | - Tomáš Kučera
- Institute of Histology and Embryology, The First Faculty of Medicine, Charles University, Prague, Czech Republic
- * E-mail:
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Sazonova SI, Ilyushenkova JN, Lishmanov YB, Batalov RE, Sazonov AE, Larionova LA, Nesterov EA, Varlamova NV, Rogovskaya JV, Shelkovnikova TA, Popov SV. Assessment of radiological techniques application possibility for non-invasive diagnostics of latent inflammatory processes in myocardium in patients with atrial fibrillation. Ann Nucl Med 2016; 30:738-748. [PMID: 27558361 DOI: 10.1007/s12149-016-1120-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
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Affiliation(s)
- Juerg Schwitter
- From the Division of Cardiology, Cardiovascular Department, University Hospital Lausanne, CHUV, and Cardiac MR Center of the University Hospital Lausanne, Switzerland
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