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Madea B, Doberentz E. Cardiovascular-related death in infancy and childhood: a clinicopathological study of two referral institutions in England. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00881-w. [PMID: 39196446 DOI: 10.1007/s12024-024-00881-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2024] [Indexed: 08/29/2024]
Affiliation(s)
- Burkhard Madea
- Institute of Forensic Medicine, University Hospital Bonn, Bonn, Germany
- Institute of Forensic Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Doberentz
- Institute of Forensic Medicine, Medical University of Innsbruck, Innsbruck, Austria.
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Madea B, Duval I, Doberentz E. Sudden death of a 12-year-old boy with severe myocardial fibrosis due to inapparent chronic myocarditis. Forensic Sci Med Pathol 2024; 20:742-745. [PMID: 37450168 DOI: 10.1007/s12024-023-00670-x] [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] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
Sudden death due to unknown cardiac disease in children is an unusual occurrence. An apparently healthy 12-year-old boy without any physical restrictions collapsed suddenly and died despite cardiopulmonary resuscitation. The main autopsy finding was extensive scarring of the myocardium, especially the interventricular septum. This extensive scarring was exceptional for the young age. Histologically, replacement-type fibrosis with patchy lymphomonocytic infiltrate and infiltration by macrophages were observed. The case was diagnosed as chronic myocarditis, which may have progressed to dilated cardiomyopathy with inflammation or inflammatory cardiomyopathy.
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Affiliation(s)
- B Madea
- Institute of Legal Medicine, University Hospital Bonn, Stiftsplatz 12, Bonn, 53111, Germany
| | - I Duval
- Institute of Legal Medicine, University Hospital Bonn, Stiftsplatz 12, Bonn, 53111, Germany
| | - E Doberentz
- Institute of Legal Medicine, Medical University of Innsbruck, Müllerstr. 44, Innsbruck, 6020, Austria.
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Palaskas NL, Segura A, Lelenwa L, Siddiqui BA, Subudhi SK, Lopez-Mattei J, Durand JB, Deswal A, Zhao B, Maximilian Buja L, Iliescu C. Immune checkpoint inhibitor myocarditis: elucidating the spectrum of disease through endomyocardial biopsy. Eur J Heart Fail 2021; 23:1725-1735. [PMID: 34114291 DOI: 10.1002/ejhf.2265] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS Although immune checkpoint inhibitor (ICI) myocarditis carries a high reported mortality, increasing reports of smoldering myocarditis suggest a clinical spectrum of disease. Endomyocardial biopsy (EMB) remains the gold standard for diagnosis of ICI myocarditis, but different pathologic diagnostic criteria exist. The objective of this study was to classify the spectrum of ICI myocarditis and myocardial inflammation by pathology findings on EMB and correlate this with clinical outcomes. METHODS AND RESULTS All patients who had EMB at MD Anderson Cancer Center between January 2018 and August 2019 for suspected ICI myocarditis were retrospectively reviewed. A grading system (Grades 0-2) based on the degree of inflammatory infiltrate was developed by pathologists. Cardiovascular outcomes and treatment were compared between grades of pathology. We identified 28 patients who had EMB for suspected ICI myocarditis, of which 18 were positive for myocarditis/inflammation. There were four deaths (two in Grade 2 and two in Grade 1), but only one was attributable to myocarditis. Grade 2 patients had no myocarditis-associated deaths despite having the highest troponin T values (median 2063 pg/mL). Four patients with Grade 1 myocardial inflammation continued ICI without any immunomodulation, and all were alive without adverse cardiovascular events at follow-up. CONCLUSION We defined an EMB grading system for ICI myocarditis encompassing a spectrum of histologic findings of inflammatory infiltrates. A subset of low-grade myocardial inflammation patients were able to continue ICI without immunosuppressive therapy. Further studies are needed to identify low-risk patients who can be safely treated with ICI.
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Affiliation(s)
- Nicolas L Palaskas
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Laura Lelenwa
- University of Texas Health Science Center, Houston, TX, USA
| | - Bilal A Siddiqui
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sumit K Subudhi
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean B Durand
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bihong Zhao
- University of Texas Health Science Center, Houston, TX, USA
| | | | - Cezar Iliescu
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Buja LM, Ottaviani G, Ilic M, Zhao B, Lelenwa LC, Segura AM, Bai Y, Chen A, Akkanti B, Hussain R, Nathan S, Petrovic M, Radovancevic R, Gregoric ID, Kar B. Clinicopathological manifestations of myocarditis in a heart failure population. Cardiovasc Pathol 2019; 45:107190. [PMID: 31896440 DOI: 10.1016/j.carpath.2019.107190] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022] Open
Abstract
Myocarditis continues to present challenges in diagnosis and management. The goal of this study is to determine the occurrence and manifestations of myocarditis in a heart failure (HF) population. The analyzed patients had acute or persistent HF and were referred over a 6-year period to a quaternary HF center for advanced HF therapies including mechanical circulatory support, left ventricular assist device (LVAD) implantation, and/or heart transplantation. The histopathological diagnosis of myocarditis was made based on the presence of an inflammatory infiltrate of the myocardium, typically with associated cardiomyocyte (CMC) damage, combined as indicated with immunohistochemical and molecular biology characterization. The pathological findings were correlated with a panel of clinical parameters and clinical course of the patients. Myocarditis was identified in 36 patients, with initial diagnoses made in 10 (40%) of 25 by endomyocardial biopsy (EMB), 1 by atrial biopsy (maze procedure), 7 (2.1%) of 331 at LVAD implantation, and 18 (7.8%) of 229 in the explanted heart. There were 20 cases of lymphocytic myocarditis, 4 cases of giant cell myocarditis, 3 cases of eosinophilic myocarditis, and 9 cases of lymphohistocytic with granulomas myocarditis - cardiac sarcoidosis. EMB was performed in 25 patients and was positive in 10 (40%) of cases. Myocarditis was found in 23 explanted hearts including 18 cases de novo and 5 cases with a previously positive specimen. Of the 23 explanted hearts, 21 were nonischemic cardiomyopathy and 2 were ischemic cardiomyopathy. Our findings show that, in patients presenting to a quaternary medical center, myocarditis can be manifest as acute HF as well as a complicating factor in chronic HF.
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Affiliation(s)
- Louis Maximilian Buja
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Cardiovascular Pathology Research Laboratory, Texas Heart Institute, CHI St. Luke's Hospital, Houston, TX, USA.
| | - Giulia Ottaviani
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Lino Rossi Research Center, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Milica Ilic
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Laura C Lelenwa
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Ana Maria Segura
- Cardiovascular Pathology Research Laboratory, Texas Heart Institute, CHI St. Luke's Hospital, Houston, TX, USA
| | - Yu Bai
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Alice Chen
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Bindu Akkanti
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Rahat Hussain
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Sriram Nathan
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Marija Petrovic
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Rajko Radovancevic
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Igor D Gregoric
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Biswajit Kar
- Center for Advanced Heart Failure, Cardiopulmonary Support and Transplantation Program, Memorial Hermann Heart & Vascular Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
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Petkov DI, Liu DX, Allers C, Didier PJ, Didier ES, Kuroda MJ. Characterization of heart macrophages in rhesus macaques as a model to study cardiovascular disease in humans. J Leukoc Biol 2019; 106:1241-1255. [PMID: 31287581 DOI: 10.1002/jlb.1a0119-017r] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 12/24/2022] Open
Abstract
Rhesus macaques are physiologically similar to humans and, thus, have served as useful animal models of human diseases including cardiovascular disease. The purpose of this study was to characterize the distribution, composition, and phenotype of macrophages in heart tissues of very young (fetus: 0.5 years, n = 6), young adult (2-12 years, n = 12), and older adult (13-24 years, n = 9) rhesus macaques using histopathology and immunofluorescence microscopy. Results demonstrated that macrophages were uniformly distributed throughout the heart in animals of all age groups and were more prevalent than CD3-positve T-cells and CD20-positive B-cells. Macrophages comprised approximately 2% of heart tissue cells in the younger animals and increased to a mean of nearly 4% in the older adults. CD163-positive macrophages predominated over HAM56-positive and CD206-positive macrophages, and were detected at significantly higher percentage in the animals between 13 and 24 years of age, as well as in heart tissues exhibiting severe histopathology or inflammation in animals of all age groups. In vivo dextran labeling and retention indicated that approximately half of the macrophages were longer lived in healthy adult heart tissues and may comprise the tissue-resident population of macrophages. These results provide a basis for continued studies to examine the specific functional roles of macrophage subpopulations in heart tissues during homeostasis and in cardiovascular disease for then developing intervention strategies.
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Affiliation(s)
- Daniel I Petkov
- Division of Immunology, Tulane National Primate Research Center, Covington, Louisiana, USA.,Charles River Laboratories Edinburgh, Ltd., Tranent, United Kingdom
| | - David X Liu
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana, USA.,Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, Maryland, USA
| | - Carolina Allers
- Division of Immunology, Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Peter J Didier
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Elizabeth S Didier
- Division of Microbiology, Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Marcelo J Kuroda
- Division of Immunology, Tulane National Primate Research Center, Covington, Louisiana, USA
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