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Goldberg JF, Spinner JA, Soslow JH. Myocarditis in children 2024, new themes and continued questions. Curr Opin Cardiol 2024; 39:315-322. [PMID: 38661130 DOI: 10.1097/hco.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW While pediatric myocarditis incidence has increased since the coronavirus disease 2019 (COVID-19) pandemic, there remain questions regarding diagnosis, risk stratification, and optimal therapy. This review highlights recent publications and continued unanswered questions related to myocarditis in children. RECENT FINDINGS Emergence from the COVID-19 era has allowed more accurate description of the incidence and prognosis of myocarditis adjacent to COVID-19 infection and vaccine administration as well that of multi-system inflammatory disease in children (MIS-C). As cardiac magnetic resonance technology has shown increased availability and evidence in pediatric myocarditis, it is important to understand conclusions from adult imaging studies and define the use of this imaging biomarker in children. Precision medicine has begun to allow real-time molecular evaluations to help diagnose and risk-stratify cardiovascular diseases, with emerging evidence of these modalities in myocarditis. SUMMARY Recent information regarding COVID-19 associated myocarditis, cardiac magnetic resonance, and molecular biomarkers may help clinicians caring for children with myocarditis and identify needs for future investigations.
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Srivastava A, Nalroad Sundararaj S, Bhatia J, Singh Arya D. Understanding long COVID myocarditis: A comprehensive review. Cytokine 2024; 178:156584. [PMID: 38508059 DOI: 10.1016/j.cyto.2024.156584] [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: 12/29/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
Infectious diseases are a cause of major concern in this twenty-first century. There have been reports of various outbreaks like severe acute respiratory syndrome (SARS) in 2003, swine flu in 2009, Zika virus disease in 2015, and Middle East Respiratory Syndrome (MERS) in 2012, since the start of this millennium. In addition to these outbreaks, the latest infectious disease to result in an outbreak is the SARS-CoV-2 infection. A viral infection recognized as a respiratory illness at the time of emergence, SARS-CoV-2 has wreaked havoc worldwide because of its long-lasting implications like heart failure, sepsis, organ failure, etc., and its significant impact on the global economy. Besides the acute illness, it also leads to symptoms months later which is called long COVID or post-COVID-19 condition. Due to its ever-increasing prevalence, it has been a significant challenge to treat the affected individuals and manage the complications as well. Myocarditis, a long-term complication of coronavirus disease 2019 (COVID-19) is an inflammatory condition involving the myocardium of the heart, which could even be fatal in the long term in cases of progression to ventricular dysfunction and heart failure. Thus, it is imperative to diagnose early and treat this condition in the affected individuals. At present, there are numerous studies which are in progress, investigating patients with COVID-19-related myocarditis and the treatment strategies. This review focuses primarily on myocarditis, a life-threatening complication of COVID-19 illness, and endeavors to elucidate the pathogenesis, biomarkers, and management of long COVID myocarditis along with pipeline drugs in detail.
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Affiliation(s)
- Arti Srivastava
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | | | - Jagriti Bhatia
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Dharamvir Singh Arya
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
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Eckstein J, Skeries V, Pöhler G, Babazade N, Kaireit T, Gutberlet M, Kornemann N, Hellms S, Pfeil A, Bucher AM, Hansmann G, Beerbaum P, Hansen G, Wacker F, Vogel-Claussen J, Wetzke M, Renz DM. Multiparametric Cardiovascular MRI Assessment of Post-COVID Syndrome in Children in Comparison to Matched Healthy Individuals. Invest Radiol 2024; 59:472-478. [PMID: 38117123 DOI: 10.1097/rli.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Post-COVID syndrome (PCS) can adversely affect the quality of life of patients and their families. In particular, the degree of cardiac impairment in children with PCS is unknown. OBJECTIVE The aim of this study was to identify potential cardiac inflammatory sequelae in children with PCS compared with healthy controls. METHODS This single-center, prospective, intraindividual, observational study assesses cardiac function, global and segment-based strains, and tissue characterization in 29 age- and sex-matched children with PCS and healthy children using a 3 T magnetic resonance imaging (MRI). RESULTS Cardiac MRI was carried out over 36.4 ± 24.9 weeks post-COVID infection. The study cohort has an average age of 14.0 ± 2.8 years, for which the majority of individuals experience from fatigue, concentration disorders, dyspnea, dizziness, and muscle ache. Children with PSC in contrast to the control group exhibited elevated heart rate (83.7 ± 18.1 beats per minute vs 75.2 ± 11.2 beats per minute, P = 0.019), increased indexed right ventricular end-diastolic volume (95.2 ± 19.2 mlm -2 vs 82.0 ± 21.5 mlm -2 , P = 0.018) and end-systolic volume (40.3 ± 7.9 mlm -2 vs 34.8 ± 6.2 mlm -2 , P = 0.005), and elevated basal and midventricular T1 and T2 relaxation times ( P < 0.001 to P = 0.013). Based on the updated Lake Louise Criteria, myocardial inflammation is present in 20 (69%) children with PCS. No statistically significant difference was observed for global strains. CONCLUSIONS Cardiac MRI revealed altered right ventricular volumetrics and elevated T1 and T2 mapping values in children with PCS, suggestive for a diffuse myocardial inflammation, which may be useful for the diagnostic workup of PCS in children.
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Affiliation(s)
- Jan Eckstein
- From the Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (J.E., G.P., N.B., T.K., M.G., N.K., S.H., F.W., J.V.-C., D.M.R.); Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany (V.S., G.H., M.W.); Department of Internal Medicine III, University Hospital Jena, Jena, Germany (A.P.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (A.M.B.); and Clinic for Pediatric Cardiology and Intensive Care, Hannover Medical School, Hannover, Germany (G.H., P.B.)
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Mirabel M, Eslami A, Thibault C, Oudard S, Mousseaux E, Wahbi K, Fabre E, Terrier B, Marijon E, Villefaillot A, Fayol A, Dragon-Durey MA, Le Louet AL, Bruno RM, Soulat G, Hulot JS. Adverse myocardial and vascular side effects of immune checkpoint inhibitors: a prospective multimodal cardiovascular assessment. Clin Res Cardiol 2024:10.1007/s00392-024-02462-x. [PMID: 38806821 DOI: 10.1007/s00392-024-02462-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) can induce cardiovascular toxicities. OBJECTIVES To prospectively assess the incidence of major cardiovascular events (MACE) on ICIs in solid cancer patients: myocarditis, pericarditis, acute coronary syndrome, heart failure, high-degree conduction abnormalities or sustained ventricular arrhythmias, or cardiovascular death at 6 weeks (early MACE), including asymptomatic clinical changes by an independent adjudication committee using current recommended diagnostic criteria. The secondary objective was the incidence of the above-mentioned events adding atrial fibrillation (AF) at 6 months (late MACE). RESULTS Participants underwent pre-ICIs and repeated multimodality cardiac imaging (echocardiogram, cardiac magnetic resonance (CMR)), serum biomarkers (ultrasensitive troponin I), and rhythm surveillance (ambulatory ECG monitoring) at 6 weeks and 6 months. Forty-nine patients (38 (77.6%) male; mean age 64.3 (SD 11.0) years old) were included (June 2020-December 2021). Early MACE were observed in 9 (18.4%) patients at mean 40.1 (SD 5.9) days, with heart failure (HF) in 5 (10.2%), ventricular arrhythmias, or new conduction disorders in 4 (8.2%) patients. History of AF (HR 4.49 (CI 1.11-18.14), P = 0.035) predicted early MACE. At 6 months follow-up, 18 MACE were observed in 15/49 (31%) patients, with 6 (12.2%) HF events, 5 (10.2%) significant ventricular arrhythmias, or conduction disorders, and 4 (8.2%) AF. There was a significant decline in LVEF (P < 0.001) in patients with no MACE (P = 0.003) or HF (P = 0.0028). Higher creatinine at inclusion (HR 0.99 [0.98-1.00], P = 0.006) predicted HF on multivariate analysis. There were no significant T1 or T2 mapping changes in our study cohort on repeated CMR. CONCLUSIONS Cardiotoxicity on ICIs is more frequent than previously described when using a thorough detection strategy, consisting mainly in HF and asymptomatic rhythm disorders.
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Affiliation(s)
- Mariana Mirabel
- Cardiology, Institut Mutualiste Montsouris, 42 bd Jourdan, 75014, Paris, France.
- Université Paris Cité, INSERM, PARCC, F-75015, Paris, France.
| | - Assié Eslami
- Cardiology, DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Constance Thibault
- Oncology, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Stéphane Oudard
- Université Paris Cité, INSERM, PARCC, F-75015, Paris, France
- Oncology, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Elie Mousseaux
- Université Paris Cité, INSERM, PARCC, F-75015, Paris, France
- Radiology, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Karim Wahbi
- Université Paris Cité, INSERM, PARCC, F-75015, Paris, France
- Cardiology, DMU CARTE, AP-HP, Hôpital Cochin, F-75014, Paris, France
| | - Elizabeth Fabre
- Université Paris Cité, INSERM, PARCC, F-75015, Paris, France
- Thoracic Oncology, AP-HP, CARPEM Cancer Institute, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | | | - Eloi Marijon
- Université Paris Cité, INSERM, PARCC, F-75015, Paris, France
- Oncology, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Aurélie Villefaillot
- Unité de Recherche Clinique, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Antoine Fayol
- Cardiology, DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | | | - Agnès Lillo Le Louet
- Pharmacovigilance, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | | | - Gilles Soulat
- Université Paris Cité, INSERM, PARCC, F-75015, Paris, France
- Radiology, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Jean Sébastien Hulot
- Université Paris Cité, INSERM, PARCC, F-75015, Paris, France
- CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
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Bohbot Y, Pezel T. Acute myocarditis: An urgent need for evidence-based recommendations. Arch Cardiovasc Dis 2024:S1875-2136(24)00188-8. [PMID: 38797640 DOI: 10.1016/j.acvd.2024.05.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules-Verne University of Picardie, 80025 Amiens, France; MIRACL.ai laboratory (Multimodality Imaging for Research and Analysis Core Laboratory and Artificial Intelligence), University Hospital of Lariboisière, AP-HP, 75010 Paris, France.
| | - Théo Pezel
- MIRACL.ai laboratory (Multimodality Imaging for Research and Analysis Core Laboratory and Artificial Intelligence), University Hospital of Lariboisière, AP-HP, 75010 Paris, France; Department of Cardiology, University Hospital of Lariboisière, AP-HP, Université Paris Cité, 75010 Paris, France; MASCOT-UMRS 942, Inserm, University Hospital of Lariboisière, AP-HP, 75010 Paris, France
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Palaskas NL, Ali HJ, Koutroumpakis E, Ganatra S, Deswal A. Cardiovascular toxicity of immune therapies for cancer. BMJ 2024; 385:e075859. [PMID: 38749554 DOI: 10.1136/bmj-2023-075859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
In addition to conventional chemoradiation and targeted cancer therapy, the use of immune based therapies, specifically immune checkpoint inhibitors (ICIs) and chimeric antigen receptor T cell therapy (CAR-T), has increased exponentially across a wide spectrum of cancers. This has been paralleled by recognition of off-target immune related adverse events that can affect almost any organ system including the cardiovascular system. The use of ICIs has been associated with myocarditis, a less common but highly fatal adverse effect, pericarditis and pericardial effusions, vasculitis, thromboembolism, and potentially accelerated atherosclerosis. CAR-T resulting in a systemic cytokine release syndrome has been associated with myriad cardiovascular consequences including arrhythmias, myocardial infarction, and heart failure. This review summarizes the current state of knowledge regarding adverse cardiovascular effects associated with ICIs and CAR-T.
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Affiliation(s)
| | - Hyeon-Ju Ali
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sarju Ganatra
- Lahey Hospital and Medical Center, Burlington, MA 01805
| | - Anita Deswal
- University of Texas MD Anderson Cancer Center, Houston, TX, USA 01805
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Badwan O, Berglund F, Rosenzveig A, Persits I, Gharaibeh A, Kumar A, Agrawal A, Sul L, Chan N, Wang TKM, Hanna M, Klein AL. Pericardial Disease in Cardiac Amyloidosis. Am J Cardiol 2024:S0002-9149(24)00360-6. [PMID: 38740164 DOI: 10.1016/j.amjcard.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
In patients with cardiac amyloidosis, pericardial involvement is common, with up to half of patients presenting with pericardial effusions. The pathophysiological mechanisms of pericardial pathology in cardiac amyloidosis include chronic elevations in right-sided filling pressures, myocardial and pericardial inflammation due to cytotoxic effects of amyloid deposits, and renal involvement with subsequent uremia and hypoalbuminemia. The pericardial effusions are typically small; however, several cases of life-threatening cardiac tamponade with hemorrhagic effusions have been described as a presenting clinical scenario. Constrictive pericarditis can also occur due to amyloidosis and its identification presents a clinical challenge in patients with cardiac amyloidosis who concurrently manifest signs of restrictive cardiomyopathy. Multimodality imaging, including echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, is useful in the evaluation and management of this patient population. The recognition of pericardial effusion is important in the risk stratification of patients with cardiac amyloidosis as its presence confers a poor prognosis. However, specific treatment aimed at the effusions themselves is seldom indicated. Cardiac tamponade and constrictive pericarditis may necessitate pericardiocentesis and pericardiectomy, respectively.
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Affiliation(s)
- Osamah Badwan
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Felix Berglund
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell, and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Akiva Rosenzveig
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ian Persits
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ahmad Gharaibeh
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ashwin Kumar
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell, and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ankit Agrawal
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell, and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lidiya Sul
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicholas Chan
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell, and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mazen Hanna
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell, and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell, and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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Cronin M, Lowery A, Kerin M, Wijns W, Soliman O. Risk Prediction, Diagnosis and Management of a Breast Cancer Patient with Treatment-Related Cardiovascular Toxicity: An Essential Overview. Cancers (Basel) 2024; 16:1845. [PMID: 38791923 PMCID: PMC11120055 DOI: 10.3390/cancers16101845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Breast cancer is amongst the most common invasive cancers in adults. There are established relationships between anti-cancer treatments for breast cancer and cardiovascular side effects. In recent years, novel anti-cancer treatments have been established, as well as the availability of multi-modal cardiac imaging and the sophistication of treatment for cardiac disease. This review provides an in-depth overview regarding the interface of breast cancer and cancer therapy-related cardiovascular toxicity. Specifically, it reviews the pathophysiology of breast cancer, the method of action in therapy-related cardiovascular toxicity from anti-cancer treatment, the use of echocardiography, cardiac CT, MRI, or nuclear medicine as diagnostics, and the current evidence-based treatments available. It is intended to be an all-encompassing review for clinicians caring for patients in this situation.
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Affiliation(s)
- Michael Cronin
- School of Medicine, University of Galway, H91 V4AY Galway, Ireland
| | - Aoife Lowery
- Precision Cardio-Oncology Research Enterprise (P-CORE), H91 TK33 Galway, Ireland
- CURAM Centre for Medical Devices, H91 TK33 Galway, Ireland
| | - Michael Kerin
- Precision Cardio-Oncology Research Enterprise (P-CORE), H91 TK33 Galway, Ireland
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 V4AY Galway, Ireland
| | - William Wijns
- School of Medicine, University of Galway, H91 V4AY Galway, Ireland
- Precision Cardio-Oncology Research Enterprise (P-CORE), H91 TK33 Galway, Ireland
- CURAM Centre for Medical Devices, H91 TK33 Galway, Ireland
| | - Osama Soliman
- School of Medicine, University of Galway, H91 V4AY Galway, Ireland
- Precision Cardio-Oncology Research Enterprise (P-CORE), H91 TK33 Galway, Ireland
- CURAM Centre for Medical Devices, H91 TK33 Galway, Ireland
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 V4AY Galway, Ireland
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Bouleti C, Servoz C, Alos B, Carsten E, Jacquier A, Ternacle J, Deux JF, Tea V, Mousseaux E, Garcia R, Bonnet G, Huttin O, Akodad M, Bejan-Angoulvant T, Lattuca B, Redheuil A, Glatt N, Angoulvant D, Ou P. Rationale and design of the French cohort of acute myocarditis diagnosed by cardiac magnetic resonance imaging (MyocarditIRM). Arch Cardiovasc Dis 2024:S1875-2136(24)00071-8. [PMID: 38797639 DOI: 10.1016/j.acvd.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Acute myocarditis usually presents as chest pain with rising troponin and normal coronary arteries. Despite frequent favourable evolution at the acute phase, it is associated with heart failure and ventricular rhythm disorders, and is considered the leading cause of sudden cardiac death in young, apparently healthy, adults. There are no specific recommendations for acute myocarditis diagnosis and management, only expert consensus, given the lack of large databases. AIM The main objective is to describe the contemporary presentation of acute myocarditis, its management and in-hospital outcomes. Secondary objectives are to investigate survival and event-free survival for up to 10years of follow-up, the determinants of prognosis, the modalities of treatment and follow-up and the gaps between expert consensus and real-life management. METHODS MyocarditIRM is a prospective multicentre cohort that enrolled 803 consecutive patients with acute myocarditis in 49 participating centres in France between 01 May 2016 and 28 February 2019. The diagnosis of acute myocarditis was acknowledged by cardiac magnetic resonance, using the Lake Louise Criteria. Exclusion criteria were age<18years, lack of health coverage, contraindication to cardiac magnetic resonance and refusal to participate. Detailed information was collected prospectively, starting at admission. Cardiac magnetic resonance imaging (diagnosis and follow-up) is analysed centrally by the certified core laboratory IHU ICAN. Ten years of follow-up for each patient is ensured by linking with the French National Health Database, and includes information on death, hospital admissions, major clinical events and drug consumption. CONCLUSION This prospective cohort with long-term follow-up represents the largest database on acute myocarditis worldwide, and will improve knowledge about its presentation, management and outcomes.
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Affiliation(s)
- Claire Bouleti
- University of Poitiers, Clinical Investigation Centre (Inserm 1402), Cardiology Department, Poitiers Hospital, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - Clement Servoz
- Cardiology Department, University Hospital of Toulouse, 31300 Toulouse, France
| | - Benjamin Alos
- University of Poitiers, Clinical Investigation Centre (Inserm 1402), Cardiology Department, Poitiers Hospital, 2, rue de la Milétrie, 86000 Poitiers, France
| | - Ehmer Carsten
- Radiology Department, Bichat University Hospital, AP-HP, 75018 Paris, France
| | - Alexis Jacquier
- Radiology Department, University Hospital of Marseille, AP-HM, 13005 Marseille, France
| | - Julien Ternacle
- Cardiology Department, Mondor University Hospital, AP-HP, 94000 Créteil, France
| | - Jean-François Deux
- Radiology Department, Mondor University Hospital, AP-HP, 94000 Créteil, France; Radiology Department, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Victoria Tea
- Cardiology Department, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Elie Mousseaux
- Radiology Department, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France; Inserm PARCC, Université Paris-Cité, 75015 Paris, France
| | - Rodrigue Garcia
- University of Poitiers, Clinical Investigation Centre (Inserm 1402), Cardiology Department, Poitiers Hospital, 2, rue de la Milétrie, 86000 Poitiers, France
| | - Guillaume Bonnet
- Cardiology Department, University Hospital of Marseille, AP-HM, 13005 Marseille, France
| | - Olivier Huttin
- Cardiology Department, University Hospital of Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - Mariama Akodad
- Cardiology Department, Jacques-Cartier Private Hospital, 91300 Massy, France
| | - Theodora Bejan-Angoulvant
- Medical Pharmacology Department, CHRU de Tours, 37000 Tours, France; UMR Inserm 1327 ISCHEMIA "Membrane Signalling and Inflammation in Reperfusion Injuries", Tours University, 37000 Tours, France
| | - Benoit Lattuca
- Cardiology Department, University Hospital of Nîmes, 30900 Nîmes, France
| | - Alban Redheuil
- Radiology Department, La Pitié-Salpêtrière University Hospital, AP-HP, IHU ICAN, 75013 Paris, France
| | | | - Denis Angoulvant
- UMR Inserm 1327 ISCHEMIA "Membrane Signalling and Inflammation in Reperfusion Injuries", Tours University, 37000 Tours, France; Cardiology Department, CHRU de Tours, 37000 Tours, France
| | - Phalla Ou
- Radiology Department, Bichat University Hospital, AP-HP, 75018 Paris, France
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Markousis-Mavrogenis G, Pepe A, Lupi A, Apostolou D, Argyriou P, Velitsista S, Vartela V, Quaia E, Mavrogeni SI. Combined brain-heart MRI identifies cardiac and white matter lesions in patients with systemic lupus erythematosus and/or antiphospholipid syndrome: A pilot study. Eur J Radiol 2024; 176:111500. [PMID: 38772161 DOI: 10.1016/j.ejrad.2024.111500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/19/2024] [Accepted: 05/06/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Antiphospholipid syndrome (APS) can occur primarily (PAPS) or secondary to another autoimmune disease (SAPS), most commonly systemic lupus erythematosus (SLE). Recently, we reported that subclinical brain involvement was highly prevalent in patients with autoimmune diseases, including SLE. We aimed to investigate whether patients with SLE, PAPS or SAPS and cardiac symptoms showed differences in cardiac/brain involvement based on combined brain-heart magnetic resonance imaging (MRI). METHODS We prospectively recruited 15 patients with SAPS (86 % with SLE) and 3 patients with PAPS and compared their MRI findings to those of 13 patients with SLE from our previous publication. All patients underwent routine cardiovascular/neurological examination and standard echocardiography. RESULTS No patients had abnormalities in routine clinical workup/echocardiography. The vast majority had white matter hyperintensities (WMHs) and all had evidence of myocardial fibrosis and/or inflammation. Patients with SAPS had a lower median WMH number [1.00 (1.00, 2.00)] than those with PAPS [3.00 (2.50, 3.00)] or SLE [2.00 (2.00, 3.00)] (p = 0.010). Subcortical and deep WM were highly prevalent. Periventricular WMHs were more frequent in patients with SLE [6 (46.2 %)] or PAPS [2 (66.7 %)] (p = 0.023). Higher lesion burdens (1 WMH vs. 2 WMHs vs. ≥ WMHs) were associated with the presence of cardiac fibrosis [3 (33.3 %) vs. 10 (83.3) vs. 7 (77.8), p = 0.039] and affected the deep and periventricular WM (p < 0.001 for both). CONCLUSION In patients with PAPS, SAPS or SLE, cardiac symptoms and normal routine workup, combined brain-heart MRI identified abnormalities in both organs in the majority of patients. Combined brain-heart MRI offers excellent diagnostic value, but its incorporation into routine clinical practice should be further investigated. Clinical relevance statement Combined brain-heart magnetic resonance imaging in antiphospholipid syndrome may help to assess the presence of abnormalities in both organs.
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Affiliation(s)
- George Markousis-Mavrogenis
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy
| | - Amalia Lupi
- Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy
| | | | | | | | - Vasiliki Vartela
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy
| | - Sophie I Mavrogeni
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece; Onassis Cardiac Surgery Center, 17674 Athens, Greece.
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11
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Shi X, Zhang Z, Yin F, Liu W, Wang Y, Zhou X, Xu Y, Chen X, Zhu X. Cardiac magnetic resonance imaging (MRI) for detecting acute myocardial injury of fulminant myocarditis survivors after extracorporeal membrane oxygenation (ECMO) treatment in adults. Clin Radiol 2024:S0009-9260(24)00243-5. [PMID: 38797607 DOI: 10.1016/j.crad.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/13/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024]
Abstract
AIMS To detect the acute myocardial injury in fulminant myocarditis (FM) survivors after extracorporeal membrane oxygenation (ECMO) and to demonstrate its significant differences from non-FM patients by cardiac magnetic resonance (CMR). MATERIALS AND METHODS This retrospective study enrolled 59 patients with acute myocarditis (AM), including 35 non-FM patients, 24 FM patients, and 54 controls. The peak value of cardiac troponin T (cTnT) was recorded. Tissue parameters, including native T1, extracellular volume (ECV), late gadolinium-enhancement (LGE)%, and T2 by CMR were assessed. RESULTS The mean age was 35 ± 14 years, and 45.8% of the population were males in the AM group. Patients had higher levels of peak cTnT, peak NT-proBNP and peak C-reactive protein in the FM group (all p<0.05). Comparing with non-FM, the values of T1-based imaging parameters were significantly higher in the FM group (all p<0.05). In contrast, no difference was observed among the two groups in terms of T2 value (p=0.707). The septal area was more frequently involved in FM survivors after ECMO treatment, both in T1 and T2-based images. In addition, the cubic relationship was the relative best fit of LGE% against logcTnT and indicated that cTnT value exceeding 300ng/L exhibited a rapid upward trend of LGE%. CONCLUSION Comparing to non-FM, higher myocardial necrosis and fibrosis but similar edema determined by T1 and T2 based imaging was found in FM survivors after ECMO treatment. Furthermore, the inter-ventricular septal area was more frequently involved by acute myocardial injury in FM survivors after ECMO treatment. In addition, LGE% showed an overall increasing trend with cTnT values elevating with rapidly increasing with cTnT exceeding 300 ng/L.
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Affiliation(s)
- X Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
| | - Z Zhang
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
| | - F Yin
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
| | - W Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Y Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - X Zhou
- MR Collaboration, Siemens Healthineers, Shanghai, China
| | - Y Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - X Chen
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
| | - X Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
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12
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Károlyi M, Polacin M, Kolossváry M, Sokolska JM, Matziris I, Weber L, Alkadhi H, Manka R. Comparative analysis of late gadolinium enhancement assessment techniques for monitoring fibrotic changes in myocarditis follow-up. Eur Radiol 2024:10.1007/s00330-024-10756-x. [PMID: 38703188 DOI: 10.1007/s00330-024-10756-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/05/2024] [Accepted: 03/11/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To compare the repeatability and interrelation of various late gadolinium enhancement (LGE) assessment techniques for monitoring fibrotic changes in myocarditis follow-up. MATERIALS AND METHODS LGE extent change between baseline and 3-month cardiovascular magnetic resonance (CMR) was compared in patients with acute myocarditis using the full width at half maximum (FWHM), gray-scale thresholds at 5 and 6 standard deviations (SD5 and SD6), visual assessment with threshold (VAT) and full manual (FM) techniques. In addition, visual presence score (VPS), visual transmurality score (VTS), and a simplified visual change score (VCS) were assessed. Intraclass-correlation (ICC) was used to evaluate repeatability, and methods were compared using Spearman's correlation. RESULTS Forty-seven patients (38 male, median age: 27 [IQR: 21; 38] years) were included. LGE extent change differed among quantitative techniques (p < 0.01), with variability in the proportion of patients showing LGE change during follow-up (FWHM: 62%, SD5: 74%, SD6: 66%, VAT: 43%, FM: 60%, VPS: 53%, VTS: 77%, VCS: 89%). Repeatability was highest with FWHM (ICC: 0.97) and lowest with SD5 (ICC: 0.89). Semiquantitative scoring had slightly lower values (VPS ICC: 0.81; VTS ICC: 0.71). VCS repeatability was excellent (ICC: 0.93). VPS and VTS correlated with quantitative techniques, while VCS was positively associated with VPS, VTS, VAT, and FM, but not with FWHM, SD5, and SD6. CONCLUSION FWHM offers the least observer-dependent LGE follow-up after myocarditis. VPS, VTS, and VCS are practical alternatives, showing reliable correlations with quantitative methods. Classification of patients exhibiting either stable or changing LGE relies on the assessment technique. CLINICAL RELEVANCE STATEMENT This study shows that LGE monitoring in myocarditis is technique-dependent; the FWHM method yields the most consistent fibrotic tracking results, with scoring-based techniques as reliable alternatives. KEY POINTS Recognition of fibrotic changes during myocarditis follow-up is significantly influenced by the choice of the quantification technique employed. The FWHM technique ensures highly repeatable tracking of myocarditis-related LGE changes. Segment-based visual scoring and the simplified visual change score offer practical, reproducible alternatives in resource-limited settings.
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Affiliation(s)
- Mihály Károlyi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Malgorzata Polacin
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, Budapest, Hungary
- Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Justyna M Sokolska
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ioannis Matziris
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lucas Weber
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Robert Manka
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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13
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Sakhi H, Reverdito G, Soulat G, Mousseaux E. Cardiovascular magnetic resonance in the identification of extra-cardiac causes of myocarditis: a case series. Eur Heart J Case Rep 2024; 8:ytae232. [PMID: 38774772 PMCID: PMC11106581 DOI: 10.1093/ehjcr/ytae232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 04/20/2024] [Accepted: 05/03/2024] [Indexed: 05/24/2024]
Abstract
Background Myocarditis is challenging to diagnose due to its varied presentations. Endomyocardial biopsy is the gold standard for diagnosis, but its invasive nature has led to alternative non-invasive modalities, notably cardiovascular magnetic resonance (CMR). Identifying the precise aetiology of myocarditis is crucial for effective treatment, yet extra-cardiac causes are often overlooked. In this paper, we spotlight the underexplored role of CMR in diagnosing extra-cardiac aetiologies, utilizing three insightful cases for illustration. Case summary The first case is a 31-year-old patient with myocarditis secondary to a pyogenic liver abscess, identified through CMR, who improved after abscess drainage. The second case involves a 54-year-old patient with myocarditis attributed to adult T-cell leukaemia-lymphoma, with the loco-regional thickening process identified thanks to CMR. This patient had an unfavourable disease progression due to the underlying malignancy. The third case concerns a 23-year-old patient suffering from myocarditis associated with pneumonia, again illustrated effectively through CMR imaging, who recovered after antibiotic treatment. Discussion These cases underline the overlooked potential of CMR in diagnosing extra-cardiac aetiologies of myocarditis, even though such causes are rare. Despite current guidelines recognizing the importance of identifying the aetiology of myocarditis, they do not explicitly address the role of CMR in diagnosing extra-cardiac aetiologies. This article, therefore, proposes that future guidelines could emphasize the utility of CMR in exploring these causes, potentially leading to more accurate diagnoses and improved patient outcomes. It also advocates for a comprehensive, multidisciplinary approach to myocarditis diagnosis, encouraging vigilance for potential loco-regional causes, and calls for further research in this area.
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Affiliation(s)
- Hichem Sakhi
- AP-HP, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - Guillaume Reverdito
- AP-HP, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris, France
- Institut National de la Santé et de la Recherche Médicale, PARCC, Paris, France
- Université de Paris-Cité, 75015 Paris, France
| | - Gilles Soulat
- AP-HP, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris, France
- Institut National de la Santé et de la Recherche Médicale, PARCC, Paris, France
- Université de Paris-Cité, 75015 Paris, France
| | - Elie Mousseaux
- AP-HP, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris, France
- Institut National de la Santé et de la Recherche Médicale, PARCC, Paris, France
- Université de Paris-Cité, 75015 Paris, France
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14
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Latchupatula L, Benayon M, Yang L, Ganame J, Tandon V. COVID-19 mRNA Vaccination-Induced Myopericarditis in an Otherwise Healthy Young Male: An Evidence-Based Approach to Differentiating From Perimyocarditis. Cureus 2024; 16:e59999. [PMID: 38736762 PMCID: PMC11081880 DOI: 10.7759/cureus.59999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 05/14/2024] Open
Abstract
A 29-year-old male, otherwise healthy with no past medical history, presented to the hospital after a two-day history of pleuritic chest pain with a fever. He had received his first dose of the mRNA-1273 coronavirus disease (COVID-19) vaccine (Moderna) two months prior without any adverse reactions. He received his second dose approximately 24 hours before symptom onset and hospital presentation. Work-up was unremarkable for respiratory, autoimmune, and rheumatological etiologies. The patient was found to have electrocardiogram features and symptoms in keeping with pericarditis, C-reactive protein elevation, and a peak high-sensitivity troponin level of 9,992 ng/L suggestive of a component of myocarditis. A dilemma arose regarding whether this patient should be diagnosed with perimyocarditis or myopericarditis, terms often used interchangeably without proper reference to the primary pathology, which can ultimately affect management. A subsequent echocardiogram was unremarkable, with a normal left ventricular systolic function, but cardiac resonance imaging revealed myocardial edema suggestive of myocarditis. Without convincing evidence for an alternative explanation after an extensive work-up of ischemic, autoimmune, rheumatological, and infectious etiologies, this patient was diagnosed with COVID-19 mRNA vaccine-induced myopericarditis. The patient fully recovered after receiving a treatment course of ibuprofen and colchicine. This case explores how the diagnosis of COVID-19 vaccine-induced myopericarditis was made and treated using an evidence-based approach, highlighting its differentiation from perimyocarditis.
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Affiliation(s)
| | - Myles Benayon
- Internal Medicine, McMaster University, Hamilton, CAN
| | - Laurie Yang
- Medical School, McMaster University, Hamilton, CAN
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15
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Liu C, Long Q, Yang H, Yang H, Tang Y, Liu B, Zhou Z, Yuan J. Sacubitril/Valsartan inhibits M1 type macrophages polarization in acute myocarditis by targeting C-type natriuretic peptide. Biomed Pharmacother 2024; 174:116535. [PMID: 38581923 DOI: 10.1016/j.biopha.2024.116535] [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: 12/20/2023] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 04/08/2024] Open
Abstract
Studies have shown that Sacubitril/valsartan (Sac/Val) can reduce myocardial inflammation in myocarditis mice, in addition to its the recommended treatment of heart failure. However, the underlying mechanisms of Sac/Val in myocarditis remain unclear. C-type natriuretic peptide (CNP), one of the targeting natriuretic peptides of Sac/Val, was recently reported to exert cardio-protective and anti-inflammatory effects in cardiovascular systems. Here, we focused on circulating levels of CNP in patients with acute myocarditis (AMC) and whether Sac/Val modulates inflammation by targeting CNP in experimental autoimmune myocarditis (EAM) mice as well as LPS-induced RAW 264.7 cells and bone marrow derived macrophages (BMDMs) models. Circulating CNP levels were higher in AMC patients compared to healthy controls, and these levels positively correlated with the elevated inflammatory cytokines IL-6 and monocyte count. In EAM mice, Sac/Val alleviated myocardial inflammation while augmenting circulating CNP levels rather than BNP and ANP, accompanied by reduction in intracardial M1 macrophage infiltration and expression of inflammatory cytokines IL-1β, TNF-α, and IL-6. Furthermore, Sac/Val inhibited CNP degradation and directly blunted M1 macrophage polarization in LPS-induced RAW 264.7 cells and BMDMs. Mechanistically, the effects might be mediated by the NPR-C/cAMP/JNK/c-Jun signaling pathway apart from NPR-B/cGMP/NF-κB pathway. In conclusion, Sac/Val exerts a protective effect in myocarditis by increasing CNP concentration and inhibiting M1 macrophages polarization.
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Affiliation(s)
- Changhu Liu
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provincial Engineering Research Center of Immunological Diagnosis and Therapy for Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qi Long
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provincial Engineering Research Center of Immunological Diagnosis and Therapy for Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Han Yang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provincial Engineering Research Center of Immunological Diagnosis and Therapy for Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hongmin Yang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provincial Engineering Research Center of Immunological Diagnosis and Therapy for Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yaohan Tang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provincial Engineering Research Center of Immunological Diagnosis and Therapy for Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Bingjun Liu
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provincial Engineering Research Center of Immunological Diagnosis and Therapy for Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zihua Zhou
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provincial Engineering Research Center of Immunological Diagnosis and Therapy for Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Jing Yuan
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provincial Engineering Research Center of Immunological Diagnosis and Therapy for Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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16
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Conte E, Pizzamiglio F, Dessanai MA, Guarnieri G, Ardizzone V, Schillaci M, Dello Russo A, Casella M, Mushtaq S, Melotti E, Marchetti D, Volpato V, Drago G, Gigante C, Sforza C, Bartorelli AL, Pepi M, Pontone G, Tondo C, Andreini D. Prevalence and prognosis of structural heart disease among athletes with negative T waves and normal transthoracic echocardiography. Clin Res Cardiol 2024; 113:706-715. [PMID: 37582977 DOI: 10.1007/s00392-023-02282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION The aim of the present study was to evaluate the prevalence and prognosis of structural heart disease (SHD) among competitive athletes with negative T waves without pathological findings at transthoracic echocardiogram. METHODS From a prospective register of 450 athletes consecutively evaluated during a second-level cardiological examination, we retrospectively identified all subjects with the following inclusion criteria: (1) not previously known cardiovascular disease; (2) negative T waves in leads other than V1-V2; (3) normal transthoracic echocardiogram. Patients underwent cardiac MRI and CT. The primary endpoint was the diagnosis of definite SHD after multimodality imaging evaluation. A follow-up was collected for a combined end-point of sudden death, resuscitated sudden cardiac death and hospitalization for any cardiovascular causes. RESULTS A total of 55 competitive athletes were finally enrolled (50 males, 90%) with a mean age of 27.5 ± 14.1 years. Among the population enrolled 16 (29.1%) athletes had a final diagnosis of SHD. At multivariate analysis, only deep negative T waves remained statistically significant [OR (95% CI) 7.81 (1.24-49.08), p = 0.0285]. Contemporary identification of deep negative T waves and complex arrhythmias in the same patients appeared to have an incremental diagnostic value. No events were collected at 49.3 ± 12.3 months of follow-up. CONCLUSIONS In a cohort of athletes with negative T waves at ECG, cardiac MRI (and selected use of cardiac CT) enabled the identification of 16 (29.1%) subjects with SHD despite normal transthoracic echocardiography. Deep negative T waves and complex ventricular arrhythmias were the only clinical characteristic associated with SHD diagnosis.
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Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Milan, Italy.
- Department of Biomedical Science for Health, University of Milan, Milan, Italy.
| | | | | | | | | | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti" Ancona, Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti" Ancona, Ancona, Italy
| | | | | | | | | | | | | | - Chiarella Sforza
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | | | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Claudio Tondo
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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17
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Jiang J, Shu H, Wang DW, Hui R, Li C, Ran X, Wang H, Zhang J, Nie S, Cui G, Xiang D, Shao Q, Xu S, Zhou N, Li Y, Gao W, Chen Y, Bian Y, Wang G, Xia L, Wang Y, Zhao C, Zhang Z, Zhao Y, Wang J, Chen S, Jiang H, Chen J, Du X, Chen M, Sun Y, Li S, Ding H, Ma X, Zeng H, Lin L, Zhou S, Ma L, Tao L, Chen J, Zhou Y, Guo X. Chinese Society of Cardiology guidelines on the diagnosis and treatment of adult fulminant myocarditis. SCIENCE CHINA. LIFE SCIENCES 2024; 67:913-939. [PMID: 38332216 DOI: 10.1007/s11427-023-2421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/25/2023] [Indexed: 02/10/2024]
Abstract
Fulminant myocarditis is an acute diffuse inflammatory disease of myocardium. It is characterized by acute onset, rapid progress and high risk of death. Its pathogenesis involves excessive immune activation of the innate immune system and formation of inflammatory storm. According to China's practical experience, the adoption of the "life support-based comprehensive treatment regimen" (with mechanical circulation support and immunomodulation therapy as the core) can significantly improve the survival rate and long-term prognosis. Special emphasis is placed on very early identification,very early diagnosis,very early prediction and very early treatment.
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Affiliation(s)
- Jiangang Jiang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hongyang Shu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dao Wen Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Rutai Hui
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Chenze Li
- Zhongnan Hospital of Wuhan University, Wuhan, 430062, China
| | - Xiao Ran
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jing Zhang
- Fuwai Huazhong Cardiovascular Hospital, Zhengzhou, 450003, China
| | - Shaoping Nie
- Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Guanglin Cui
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dingcheng Xiang
- Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China
| | - Qun Shao
- Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Shengyong Xu
- Union Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ning Zhou
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuming Li
- Taida Hospital, Tianjin, 300457, China
| | - Wei Gao
- Peking University Third Hospital, Beijing, 100191, China
| | - Yuguo Chen
- Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Yuan Bian
- Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Guoping Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Liming Xia
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yan Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chunxia Zhao
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhiren Zhang
- Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Yuhua Zhao
- Kanghua Hospital, Dongguan, Guangzhou, 523080, China
| | - Jianan Wang
- Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Shaoliang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Hong Jiang
- Renmin Hospital of Wuhan University, Wuhan, 430060, Wuhan, China
| | - Jing Chen
- Renmin Hospital of Wuhan University, Wuhan, 430060, Wuhan, China
| | - Xianjin Du
- Renmin Hospital of Wuhan University, Wuhan, 430060, Wuhan, China
| | - Mao Chen
- West China Hospital, Sichuan University, Chengdu, 610044, China
| | - Yinxian Sun
- First Hospital of China Medical University, Shenyang, 110002, China
| | - Sheng Li
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hu Ding
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xueping Ma
- General Hospital of Ningxia Medical University, Yinchuan, 750003, China
| | - Hesong Zeng
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Li Lin
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shenghua Zhou
- The Second Xiangya Hospital, Central South University, Changsha, 410012, China
| | - Likun Ma
- The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230002, China
| | - Ling Tao
- The First Affiliated Hospital of Air Force Medical University, Xi'an, 710032, China
| | - Juan Chen
- Central Hospital of Wuhan City, Wuhan, 430014, China
| | - Yiwu Zhou
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaomei Guo
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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18
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Wang YRJ, Yang K, Wen Y, Wang P, Hu Y, Lai Y, Wang Y, Zhao K, Tang S, Zhang A, Zhan H, Lu M, Chen X, Yang S, Dong Z, Wang Y, Liu H, Zhao L, Huang L, Li Y, Wu L, Chen Z, Luo Y, Liu D, Zhao P, Lin K, Wu JC, Zhao S. Screening and diagnosis of cardiovascular disease using artificial intelligence-enabled cardiac magnetic resonance imaging. Nat Med 2024; 30:1471-1480. [PMID: 38740996 PMCID: PMC11108784 DOI: 10.1038/s41591-024-02971-2] [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: 07/19/2023] [Accepted: 04/03/2024] [Indexed: 05/16/2024]
Abstract
Cardiac magnetic resonance imaging (CMR) is the gold standard for cardiac function assessment and plays a crucial role in diagnosing cardiovascular disease (CVD). However, its widespread application has been limited by the heavy resource burden of CMR interpretation. Here, to address this challenge, we developed and validated computerized CMR interpretation for screening and diagnosis of 11 types of CVD in 9,719 patients. We propose a two-stage paradigm consisting of noninvasive cine-based CVD screening followed by cine and late gadolinium enhancement-based diagnosis. The screening and diagnostic models achieved high performance (area under the curve of 0.988 ± 0.3% and 0.991 ± 0.0%, respectively) in both internal and external datasets. Furthermore, the diagnostic model outperformed cardiologists in diagnosing pulmonary arterial hypertension, demonstrating the ability of artificial intelligence-enabled CMR to detect previously unidentified CMR features. This proof-of-concept study holds the potential to substantially advance the efficiency and scalability of CMR interpretation, thereby improving CVD screening and diagnosis.
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Affiliation(s)
| | - Kai Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Wen
- Changhong AI Research (CHAIR), Sichuan Changhong Electronics Holding Group, Mianyang, China
| | - Pengcheng Wang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Yuepeng Hu
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Yongfan Lai
- School of Engineering, University of Science and Technology of China, Hefei, China
| | - Yufeng Wang
- Department of Computer Science, Stony Brook University, New York, NY, USA
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| | - Siyi Tang
- School of Medicine, Stanford University, Stanford, CA, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Angela Zhang
- School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, School of Medicine (Division of Cardiology), Stanford University, Stanford, CA, USA
| | - Huayi Zhan
- Changhong AI Research (CHAIR), Sichuan Changhong Electronics Holding Group, Mianyang, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiuyu Chen
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujuan Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhixiang Dong
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yining Wang
- Peking Union Medical College Hospital, Beijing, China
| | - Hui Liu
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Lei Zhao
- Beijing Anzhen Hospital, Beijing, China
| | | | - Yunling Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Zixian Chen
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Yi Luo
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Dongbo Liu
- Changhong AI Research (CHAIR), Sichuan Changhong Electronics Holding Group, Mianyang, China
| | - Pengbo Zhao
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, USA
| | - Keldon Lin
- Mayo Clinic Alix School of Medicine, Phoenix, AZ, USA
| | - Joseph C Wu
- School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, School of Medicine (Division of Cardiology), Stanford University, Stanford, CA, USA
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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19
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Amelotti N, Brusamolino M, Mapelli M, Contini M, Baggiano A, Fazzari F, Pontone G, Agostoni P. Case report: acute myocarditis in two patients with coronary artery disease presenting with chest pain-thinking outside the box. Eur Heart J Case Rep 2024; 8:ytae220. [PMID: 38736997 PMCID: PMC11087877 DOI: 10.1093/ehjcr/ytae220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024]
Abstract
Background In a subset of patients, acute myocarditis (AM) may mimic acute myocardial infarction, with a similar clinical presentation characterized by chest pain, electrocardiogram (ECG) changes consistent with acute coronary syndromes (ACS), and serum markers increment. Case summary We present two cases of infarct-like myocarditis in patients with known coronary artery disease (CAD), in which the discrepancy between transthoracic echocardiogram findings, ECG, and angiography prompted us to look beyond the simplest diagnosis. In these cases, making a prompt and correct diagnosis is pivotal to address adequate therapy and establish a correct prognosis. Discussion The right diagnosis can avoid unnecessary coronary revascularizations and subsequent antiplatelet therapy that may be associated with an increased haemorrhagic risk. Moreover, it allows setting up guideline-directed therapy for myocarditis, proper follow-up, as well as recommending abstention from physical activity.
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Affiliation(s)
- Nicola Amelotti
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Matteo Brusamolino
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Mauro Contini
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Andrea Baggiano
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Fabio Fazzari
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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20
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Gulhane A, Soriano B, Stanescu L, Schauer J, Ferguson M, Romberg E, Bhutta S, Otto R, Caris E, Mallenahalli S, Portman M, Litt H, Buddhe S. Objective Comparison of Clinical and Cardiac Magnetic Resonance Biomarkers in Adolescents Presenting With Acute Chest Pain and Elevated Troponins Pre-COVID and Post-COVID Vaccination. J Magn Reson Imaging 2024; 59:1867-1873. [PMID: 37622988 DOI: 10.1002/jmri.28971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Affiliation(s)
- Avanti Gulhane
- Department of Cardiothoracic Radiology, University of Washington, Seattle, Washington, USA
| | - Brian Soriano
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Luana Stanescu
- Department of Pediatric Radiology, University of Washington, Seattle, Washington, USA
| | - Jenna Schauer
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Mark Ferguson
- Department of Pediatric Radiology, University of Washington, Seattle, Washington, USA
| | - Erin Romberg
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Sadaf Bhutta
- Department of Pediatric Radiology, University of Washington, Seattle, Washington, USA
| | - Randolph Otto
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Elizabeth Caris
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Sathish Mallenahalli
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Michael Portman
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sujatha Buddhe
- Department of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
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21
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Mokart D, Vieillard-Baron A, Gilon D. What intensivists need to know on cardiac dysfunction in critically ill cancer patients. Intensive Care Med 2024; 50:766-772. [PMID: 38573404 DOI: 10.1007/s00134-024-07373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/25/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Djamel Mokart
- Medical and Surgical ICU, Département d'Anesthésie Réanimation, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille Cedex 09, France.
| | - Antoine Vieillard-Baron
- Medical and Surgical ICU, University Hospital Ambroise Pare, GHU Paris-Saclay, APHP, Boulogne-Billancourt, France
- Inserm U1018, CESP, Université Versailles Saint-Quentin en Yvelines, Guyancourt, France
| | - Dan Gilon
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University, Jerusalem, Israel
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22
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Techasatian W, Gozun M, Vo K, Yokoyama J, Nagamine T, Shah P, Vu K, Zhang J, Nishimura Y. Eosinophilic myocarditis: systematic review. Heart 2024; 110:687-693. [PMID: 37963727 DOI: 10.1136/heartjnl-2023-323225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE In clinical practice, patients with eosinophilic myocarditis (EM) may forgo the gold standard diagnostic procedure, endomyocardial biopsy (EMB), although it is highly recommended in guidelines. This systematic review aims to summarise current approaches in diagnosing and treating EM with a particular emphasis on the utilisation and value of alternative diagnostic methods. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we searched MEDLINE and EMBASE for all peer-reviewed articles using the keywords "eosinophilic myocarditis" from their inception to 10 September 2022. RESULTS We included 239 articles, including 8 observational studies and 274 cases, in this review. The median patient age was 45 years. Initial presentations were non-specific, including dyspnoea (50.0%) and chest pain (39.4%). The aetiologies of EM were variable with the most common being idiopathic (28.8%) and eosinophilic granulomatosis polyangiitis (19.3%); others included drug-induced (13.1%) and hypereosinophilic syndrome (12.8%). 82.4% received an EM diagnosis by EMB while 17.6% were diagnosed based on clinical reasoning and cardiac MRI (CMR). CMR-diagnosed patients exhibited a better risk profile at diagnosis, particularly higher left ventricular ejection fraction and less need for inotropic or mechanical circulatory supports. Glucocorticoids were the primary treatment with variability in dosages and regimens. CONCLUSION EMB is the mainstay for diagnostic testing for EM. CMR is potentially helpful for screening in appropriate clinical scenarios. Regarding treatment, there is no consensus regarding the optimal dosage of corticosteroids. Large clinical trials are warranted to further explore the utility of CMR in the diagnosis of EM and steroid regimen in treating EM.
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Affiliation(s)
| | - Maan Gozun
- Department of Medicine, UH Mānoa JABSOM, Honolulu, Hawaii, USA
| | - Kristine Vo
- Department of Medicine, UH Mānoa JABSOM, Honolulu, Hawaii, USA
| | | | - Todd Nagamine
- Department of Medicine, UH Mānoa JABSOM, Honolulu, Hawaii, USA
| | - Parthav Shah
- Department of Medicine, UH Mānoa JABSOM, Honolulu, Hawaii, USA
| | - Kimberly Vu
- Queen's Heart Institute, Queen's Medical Center, Honolulu, Hawaii, USA
| | - James Zhang
- Queen's Heart Institute, Queen's Medical Center, Honolulu, Hawaii, USA
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23
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Gao P, Li X, He Z, Zhang H, Zhang Z, Liu Z. Lethal Immune Myocarditis and Myasthenia Gravis Due to Anti-PD-1 Treatment for a Bladder Cancer Patient: A Case Report and Possible Treatment Inspiration. Int Med Case Rep J 2024; 17:359-365. [PMID: 38651079 PMCID: PMC11034559 DOI: 10.2147/imcrj.s449525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
Immune checkpoint inhibitors (ICI) have become a new hope for many patients with advanced cancer by blocking tumor immune escape. Bladder cancer is a common malignant tumor of the urinary tract epithelium that often relapses and metastasizes after surgery, chemotherapy, and radiotherapy. Immunotherapy has dramatically improved patient survival rates and clinical benefits as a new, potentially effective therapy. However, avoidance of various immune-related adverse events (irAEs) remains an implausible idea. ICI-induced myocarditis is different from viral myocarditis, and mortality is still high with the current treatment. We report the case of an 82-year-old female patient with ICI-induced fulminant myocarditis and myasthenia gravis. Although she actively accepted the current mainstream treatment for immune-related myocarditis and myasthenia, she died of heart and respiratory failure. Analyzing and reporting the patient's disease development process and the changes in related indicators may help peers gain a deeper understanding of immune-related adverse events and reduce the mortality of immune-related myocarditis.
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Affiliation(s)
- Pan Gao
- Department of Urology, Second People’s Hospital of Yichang, Yichang, Hubei Province, People’s Republic of China
- Department of Urology, Second People’s Hospital of China Three Gorges University, Yichang, Hubei Province, People’s Republic of China
| | - Xinyu Li
- Department of Urology, Second People’s Hospital of Yichang, Yichang, Hubei Province, People’s Republic of China
- Department of Urology, Second People’s Hospital of China Three Gorges University, Yichang, Hubei Province, People’s Republic of China
| | - Ziqiu He
- Department of Urology, Second People’s Hospital of Yichang, Yichang, Hubei Province, People’s Republic of China
- Department of Urology, Second People’s Hospital of China Three Gorges University, Yichang, Hubei Province, People’s Republic of China
| | - Hongbo Zhang
- Department of Urology, Second People’s Hospital of Yichang, Yichang, Hubei Province, People’s Republic of China
- Department of Urology, Second People’s Hospital of China Three Gorges University, Yichang, Hubei Province, People’s Republic of China
| | - Zhi Zhang
- Department of Urology, Second People’s Hospital of Yichang, Yichang, Hubei Province, People’s Republic of China
- Department of Urology, Second People’s Hospital of China Three Gorges University, Yichang, Hubei Province, People’s Republic of China
| | - Zonglai Liu
- Department of Urology, Second People’s Hospital of Yichang, Yichang, Hubei Province, People’s Republic of China
- Department of Urology, Second People’s Hospital of China Three Gorges University, Yichang, Hubei Province, People’s Republic of China
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24
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Costa C, Moniati F. The Epidemiology of COVID-19 Vaccine-Induced Myocarditis. Adv Med 2024; 2024:4470326. [PMID: 38681683 PMCID: PMC11045291 DOI: 10.1155/2024/4470326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/26/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Background In December 2019, the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) led to the COVID-19 pandemic, with millions of deaths worldwide. Vaccine breakthroughs in late 2020 resulted in the authorization of COVID-19 vaccines. While these vaccines have demonstrated efficacy, evidence from vaccine safety monitoring systems around the globe supported a causal association between COVID-19 vaccines, in particular those using mRNA technology, i.e., Moderna's mRNA-1273 and Pfizer-BioNTech's BNT162b2, and myocarditis. Objective This paper aims to investigate the epidemiology of mRNA COVID-19 vaccine-induced myocarditis, including age, ethnicity, and gender associations with these vaccines. It also discusses the immunopathophysiological mechanisms of mRNA COVID-19 vaccine-associated myocarditis and outlines principles of diagnosis, clinical presentation, and management. Methods A literature review was conducted using PubMed, Embase, and Queen Mary University of London Library Services databases. Search terms included "myocarditis," "coronavirus disease 2019," "SARS-CoV-2," "mRNA Covid-19 vaccines," "Covid vaccine-associated myocarditis," "epidemiology," "potential mechanisms," "myocarditis diagnosis," and "myocarditis management." Results While the definite mechanism of mRNA COVID-19 vaccine-associated myocarditis remains ambiguous, potential mechanisms include molecular mimicry of spike proteins and activation of the adaptive immune response with dysregulated cytokine expression. Male predominance in COVID-19 vaccine-induced myocarditis may be attributed to sex hormones, variations in inflammatory reactions, coagulation states based on gender, and female-specific protective factors. Moreover, an analysis of diagnostic and management strategies reveals a lack of consensus on acute patient presentation management. Conclusion In contrast to viral infections that stand as the predominant etiological factor for myocarditis with more severe consequences, the mRNA COVID-19 vaccination elicits a mild and self-limiting manifestation of the condition. There is currently insufficient evidence to confirm the definite underlying mechanism of COVID-19 vaccine-associated myocarditis. Further research is needed to develop preventive and therapeutic solutions in this context.
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Affiliation(s)
| | - Foteini Moniati
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
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25
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Tsang HW, Kwan MYW, Chua GT, Tsao SSL, Wong JSC, Tung KTS, Chan GCF, To KKW, Wong ICK, Leung WH, Ip P. The central role of natural killer cells in mediating acute myocarditis after mRNA COVID-19 vaccination. MED 2024; 5:335-347.e3. [PMID: 38521068 DOI: 10.1016/j.medj.2024.02.008] [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: 11/03/2023] [Revised: 01/26/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Vaccine-related acute myocarditis is recognized as a rare and specific vaccine complication following mRNA-based COVID-19 vaccinations. The precise mechanisms remain unclear. We hypothesized that natural killer (NK) cells play a central role in its pathogenesis. METHODS Samples from 60 adolescents with vaccine-related myocarditis were analyzed, including pro-inflammatory cytokines, cardiac troponin T, genotyping, and immunophenotyping of the corresponding activation subsets of NK cells, monocytes, and T cells. Results were compared with samples from 10 vaccinated individuals without myocarditis and 10 healthy controls. FINDINGS Phenotypically, high levels of serum cytokines pivotal for NK cells, including interleukin-1β (IL-1β), interferon α2 (IFN-α2), IL-12, and IFN-γ, were observed in post-vaccination patients with myocarditis, who also had high percentage of CD57+ NK cells in blood, which in turn correlated positively with elevated levels of cardiac troponin T. Abundance of the CD57+ NK subset was particularly prominent in males and in those after the second dose of vaccination. Genotypically, killer cell immunoglobulin-like receptor (KIR) KIR2DL5B(-)/KIR2DS3(+)/KIR2DS5(-)/KIR2DS4del(+) was a risk haplotype, in addition to single-nucleotide polymorphisms related to the NK cell-specific expression quantitative trait loci DNAM-1 and FuT11, which also correlated with cardiac troponin T levels in post-vaccination patients with myocarditis. CONCLUSION Collectively, these data suggest that NK cell activation by mRNA COVID-19 vaccine contributed to the pathogenesis of acute myocarditis in genetically and epidemiologically vulnerable subjects. FUNDING This work was funded by the Hong Kong Collaborative Research Fund (CRF) 2020/21 and the CRF Coronavirus and Novel Infectious Diseases Research Exercises (reference no. C7149-20G).
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Affiliation(s)
- Hing Wai Tsang
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mike Yat Wah Kwan
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Gilbert T Chua
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sabrina Siu Ling Tsao
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Joshua Sung Chih Wong
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital Authority, Hong Kong SAR, China
| | - Keith Tsz Suen Tung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Godfrey Chi Fung Chan
- Paediatric Haematology & Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Kelvin Kai Wang To
- Department of Microbiology, Li Ka Shing Faculty of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; School of Pharmacy, Medical Sciences Division, Macau University of Science and Technology, Macau SAR, China; School of Pharmacy, Aston University, Birmingham B4 7ET, England
| | - Wing Hang Leung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China.
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26
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Nedeljkovic-Arsenovic O, Ristić A, Đorđević N, Tomić M, Krljanac G, Maksimović R. Cardiac Magnetic Resonance Imaging as a Risk Stratification Tool in COVID-19 Myocarditis. Diagnostics (Basel) 2024; 14:790. [PMID: 38667436 PMCID: PMC11049213 DOI: 10.3390/diagnostics14080790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 04/28/2024] Open
Abstract
The aim of this retrospective study was to identify myocardial injury after COVID-19 inflammation and explore whether myocardial damage could be a possible cause of the persistent symptoms following COVID-19 infection in previously healthy individuals. This study included 139 patients who were enrolled between January and June 2021, with a mean age of 46.7 ± 15.2 years, of whom 68 were men and 71 were women without known cardiac or pulmonary diseases. All patients underwent clinical work-up, laboratory analysis, cardiac ultrasound, and CMR on a 1.5 T scanner using a recommended protocol for morphological and functional assessment before and after contrast media application with multi-parametric sequences. In 39% of patients, late gadolinium enhancement (LGE) was found as a sign of myocarditis. Fibrinogen was statistically significantly higher in patients with LGE than in those without LGE (4.3 ± 0.23 vs. 3.2 ± 0.14 g/L, p < 0.05, respectively), as well as D-dimer (1.8 ± 0.3 vs. 0.8 ± 0.1 mg/L FEU). Also, troponin was statistically significantly higher in patients with myocardial LGE (13.1 ± 0.4 ng/L) compared to those with normal myocardium (4.9 ± 0.3 ng/L, p < 0.001). We demonstrated chest pain, fatigue, and elevated troponin to be independent predictors for LGE. Septal LGE was shown to be a predictor for arrhythmias. The use of CMR is a potential risk stratification tool in evaluating outcomes following COVID-19 myocarditis.
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Affiliation(s)
- Olga Nedeljkovic-Arsenovic
- Department of Magnetic Resonance Imaging, Centre for Radiology, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia;
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia;
| | - Arsen Ristić
- Clinic for Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (A.R.); (N.Đ.); (M.T.)
| | - Nemanja Đorđević
- Clinic for Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (A.R.); (N.Đ.); (M.T.)
| | - Milenko Tomić
- Clinic for Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (A.R.); (N.Đ.); (M.T.)
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia;
- Clinic for Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (A.R.); (N.Đ.); (M.T.)
| | - Ruzica Maksimović
- Department of Magnetic Resonance Imaging, Centre for Radiology, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia;
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia;
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27
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Cacciatore C, Baudet M, Jean E, Presente S, Para M, Sonneville R, Arangalage D, Ait Abdallah N, Sicre de Fontbrune F, Prata PH, Crichi B, Hervier B, Parquet N, Soulat G, Mousseaux E, Burt RK, Farge D. Extracorporeal membrane oxygenation (ECMO) during aplasia: A bridge towards myopericarditis recovery after autologous hematopoietic stem cell transplant for systemic sclerosis and recent Coronarovirus disease (COVID-19) vaccination. Curr Res Transl Med 2024; 72:103449. [PMID: 38636307 DOI: 10.1016/j.retram.2024.103449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
Systemic sclerosis (SSc) is a rare autoimmune disease (AD), characterised by early diffuse vasculopathy, activation of the immune response and progressive skin and internal organ fibrosis. In severe progressive diffuse SSc (dSSc), autologous hematopoietic stem cell transplantation (aHSCT) improves survival, despite its own risk of complications and transplant related mortality (TRM). We present herein the case of a dSSc patient undergoing aHSCT with low dose cyclophosphamide conditioning and sudden acute myopericarditis and cardiogenic shock, four weeks after a second mRNA SARS-CoV-2 vaccine (Pfizer) injection. Four days of extracorporeal membrane oxygenation (ECMO) support during the aplasia period, allowed to observe full cardiac function recovery and progressive SSc rehabilitation with sustained disease response at 30 months follow-up. This report illustrates, for the first time to our knowledge, that ECMO can be indicated despite aplasia during aHSCT and successfully used as a bridge towards heart function recovery in highly selected and fragile AD patients. We review the factors that may contribute to endothelial and myocardial stunning and acute reversible cardiac failure in SSc and aggravate intrinsic endothelial injury during the aHSCT procedure. These classically include: cyclophosphamide drug toxicity, viral infections and autoimmune activation with disease flair per se. In the COVID-19 pandemic times, acute myocarditis due to recent viral infection or mRNA vaccine per se, must also be considered.
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Affiliation(s)
- Carlotta Cacciatore
- Unité de Médecine Interne (UF04): CRMR MATHEC, Maladies Auto-immunes et Thérapie Cellulaire, Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France, AP-HP, Hôpital St-Louis, F-75010 Paris, France; Université Paris Cité, IRSL, Recherche Clinique en hématologie, immunologie et transplantation, URP3518, F-75010 Paris, France
| | - Mathilde Baudet
- Department of Cardiology, Hospital Saint-Louis, Paris, France
| | - Estelle Jean
- Département de Médecine Interne, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France; Centre de référence des syndromes drépanocytaires majeurs, thalassémies et autres pathologies rares du globule rouge et de l'érythropoïèse, Assistance Publique des hôpitaux de Marseille, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Simona Presente
- Medical and Infectious Diseases ICU, APHP, Bichat Hospital, Paris, France
| | - Marylou Para
- Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France; Laboratory of Vascular Translational Science, University of Paris-Cité, UMR 1148 Paris, France
| | - Romain Sonneville
- Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France; Laboratory of Vascular Translational Science, University of Paris-Cité, UMR 1148 Paris, France
| | - Dimitri Arangalage
- Cardiology Department, AP-HP, Bichat Hospital and Université de Paris-Cité, Paris, France
| | - Nassim Ait Abdallah
- Service de Médecine Interne 2, maladies auto-immunes et systémiques, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | | | | | - Benjamin Crichi
- Unité de Médecine interne (UF07), AP-HP, Hôpital St-Louis, F-75010 Paris, France
| | - Baptiste Hervier
- Unité de Médecine interne (UF07), AP-HP, Hôpital St-Louis, F-75010 Paris, France
| | - Nathalie Parquet
- Unité d'Aphérèse Thérapeutique, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Gilles Soulat
- Radiologie, Hôpital Européen Georges Pompidou, APHP, INSERM 970, Université de Paris-Cité, France
| | - Elie Mousseaux
- Radiologie, Hôpital Européen Georges Pompidou, APHP, INSERM 970, Université de Paris-Cité, France
| | - Richard K Burt
- Scripps Health, La Jolla USA,; Genani Corporation, Chicago, USA
| | - Dominique Farge
- Unité de Médecine Interne (UF04): CRMR MATHEC, Maladies Auto-immunes et Thérapie Cellulaire, Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France, AP-HP, Hôpital St-Louis, F-75010 Paris, France; Université Paris Cité, IRSL, Recherche Clinique en hématologie, immunologie et transplantation, URP3518, F-75010 Paris, France; Department of Medicine, McGill University, H3A 1A1, Montreal, Canada.
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Fabiani I, Chianca M, Aimo A, Emdin M, Dent S, Fedele A, Cipolla CM, Cardinale DM. Use of new and emerging cancer drugs: what the cardiologist needs to know. Eur Heart J 2024:ehae161. [PMID: 38591670 DOI: 10.1093/eurheartj/ehae161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
The last decade has witnessed a paradigm shift in cancer therapy, from non-specific cytotoxic chemotherapies to agents targeting specific molecular mechanisms. Nonetheless, cardiovascular toxicity of cancer therapies remains an important concern. This is particularly relevant given the significant improvement in survival of solid and haematological cancers achieved in the last decades. Cardio-oncology is a subspecialty of medicine focusing on the identification and prevention of cancer therapy-related cardiovascular toxicity (CTR-CVT). This review will examine the new definition of CTR-CVT and guiding principles for baseline cardiovascular assessment and risk stratification before cancer therapy, providing take-home messages for non-specialized cardiologists.
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Affiliation(s)
- Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - Michela Chianca
- Interdisciplinary Center for Health Science, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Aimo
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
- Interdisciplinary Center for Health Science, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Michele Emdin
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
- Interdisciplinary Center for Health Science, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Susan Dent
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Antonella Fedele
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Carlo Maria Cipolla
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Daniela Maria Cardinale
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
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Netea SA, Biesbroek G, Groenink M, Planken RNN, de Winter RJ, Blom NA, Kuijpers TW, Kuipers IM. Long-term global longitudinal strain abnormalities in paediatric patients after multisystem inflammatory syndrome in children correlate with cardiac troponin T: a single-centre cohort study. Cardiol Young 2024:1-10. [PMID: 38584315 DOI: 10.1017/s1047951124000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children is an inflammatory syndrome related to severe acute respiratory syndrome coronavirus 2 with a high risk of cardiovascular complications (vasoplegia, cardiac shock). We investigated the cardiac outcomes in multisystem inflammatory syndrome in children, focusing on the identification of predictors for late cardiac function impairment. METHODS Clinical characteristics, conventional echocardiography (left ventricle ejection fraction, fractional shortening), 4-chamber left ventricular global longitudinal strain, and cardiac MRI of multisystem inflammatory syndrome in children patients (n = 48) were collected during admission, 6 weeks, 6 months, >12-≤18 months, and >18-≤24 months post-onset. Paired over-time patterns were assessed and multivariable regression analyses were performed to identify predictors for late global longitudinal strain impairment. RESULTS In total, 81.3% of patients had acute cardiac dysfunction (left ventricle ejection fraction <50% and/or fractional shortening <28%). The left ventricle ejection fraction and fractional shortening reached a plateau level ≤6 weeks, while the global longitudinal strain continued to decrease in the first 6 months post-onset (median -17.3%, P < 0.001 [versus acute]). At 6 months, 35.7% of the patients still had an abnormal global longitudinal strain, which persisted in 5/9 patients that underwent echocardiography >12-≤18 months post-onset and in 3/3 patients >18-≤24 months post-onset. In a multivariable analysis, soluble troponin T (>62.0 ng/L [median]) was associated with reduced global longitudinal strain at 6 months. Our cardiac MRI findings indicated acute myocardial involvement (increased T1/T2 value) in 77.8% (7/9), which recovered quickly without signs of fibrosis on convalescent cardiac MRIs. CONCLUSIONS Late global longitudinal strain impairment is seen in some multisystem inflammatory syndrome in children patients up to one-year post-onset. Careful cardiac follow-up in patients with elevated troponin in the acute phase and patients with persistent abnormal global longitudinal strain is warranted until resolution of the global longitudinal strain since the long-term implications of such abnormalities are still unclear.
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Affiliation(s)
- Stejara A Netea
- Emma Children's Hospital, Paediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Amsterdam, The Netherlands
| | - Giske Biesbroek
- Emma Children's Hospital, Paediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Amsterdam, The Netherlands
| | - Maarten Groenink
- Department of Radiology, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - R N Nils Planken
- Department of Radiology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Nico A Blom
- Emma Children's Hospital, Paediatric Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Pediatric Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Taco W Kuijpers
- Emma Children's Hospital, Paediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Molecular Haematology, Sanquin Research Institute, Amsterdam, The Netherlands
| | - Irene M Kuipers
- Emma Children's Hospital, Paediatric Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
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Khachatoorian Y, Fuisz A, Frishman WH, Aronow WS, Ranjan P. The Significance of Parametric Mapping in Advanced Cardiac Imaging. Cardiol Rev 2024:00045415-990000000-00243. [PMID: 38595125 DOI: 10.1097/crd.0000000000000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Cardiac magnetic resonance imaging has witnessed a transformative shift with the integration of parametric mapping techniques, such as T1 and T2 mapping and extracellular volume fraction. These techniques play a crucial role in advancing our understanding of cardiac function and structure, providing unique insights into myocardial tissue properties. Native T1 mapping is particularly valuable, correlating with histopathological fibrosis and serving as a marker for various cardiac pathologies. Extracellular volume fraction, an early indicator of myocardial remodeling, predicts adverse outcomes in heart failure. Elevated T2 relaxation time in cardiac MRI indicates myocardial edema, enabling noninvasive and early detection in conditions like myocarditis. These techniques offer precise insights into myocardial properties, enhancing the accuracy of diagnosis and prognosis across a spectrum of cardiac conditions, including myocardial infarction, autoimmune diseases, myocarditis, and sarcoidosis. Emphasizing the significance of these techniques in myocardial tissue analysis, the review provides a comprehensive overview of their applications and contributions to our understanding of cardiac diseases.
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Affiliation(s)
- Yeraz Khachatoorian
- From the Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
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Rav-Acha M, Shah K, Hasin T, Gumuser E, Tovia-Brodie O, Shauer A, Konstantino Y, Yair E, Wolak A, Sinai E, Ziv-Baran T, Amsalem I, Michowitz Y, Glikson M, Heist K, Ng CY. Incidence and Predictors for Recurrence of Ventricular Arrhythmia Presenting During Acute Myocarditis: A Multicenter Study. JACC Clin Electrophysiol 2024:S2405-500X(24)00173-7. [PMID: 38661603 DOI: 10.1016/j.jacep.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Management of acute myocarditis (AM) patients experiencing ventricular arrhythmia (VA) during acute illness is controversial, especially regarding early implantable cardioverter-defibrillator (ICD) implantation. OBJECTIVES The purpose of this study was to evaluate the prevalence of and find predictors for long-term sustained VA recurrence and overall mortality among AM patients with VA. METHODS This was a multicenter retrospective analysis of AM patients (verified by cardiac magnetic resonance imaging or myocardial biopsy) with documented VA during the acute illness ("initial VA"). Patients with history of myocardial infarction, heart failure, or VA were excluded. The study endpoint was a composite of sustained VA and overall mortality during follow-up. RESULTS The study included 69 AM patients with initial VA: sustained monomorphic ventricular tachycardia (MMVT) (n = 25), sustained polymorphic ventricular tachycardia (VT)/ventricular fibrillation (n = 13), and nonsustained VT (n = 31). Age was 44 ± 13 years, and 23 of 69 (33.3%) were women. During median follow-up of 5.5 years, 27 of 69 (39%) patients reached the composite endpoint including sustained VA (n = 24) and death (n = 11). Initial MMVT, predischarge left ventricular dysfunction (left ventricular ejection fraction <50%), and anteroseptal delayed enhancement on cardiac magnetic resonance imaging were significantly associated with the composite endpoint. On multivariable analysis, initial MMVT (HR: 5.17; 95% CI: 1.81-14.6; P = 0.001) and predischarge LV dysfunction (HR: 4.57; 95% CI: 1.83-11.5; P = 0.005) were independently associated with the composite endpoint. Using these 2 predictors, we could delineate subgroups with low (∼4%), medium (∼42%), and high (∼82%) 10-year incidence of composite endpoint. CONCLUSIONS AM patients presenting with VA have high incidence of sustained VA recurrence and mortality posthospitalization. Initial MMVT and predischarge LV dysfunction are independently associated with VA recurrence and mortality. Implantable cardioverter-defibrillator implantation may be considered in such high-risk patients.
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Affiliation(s)
- Moshe Rav-Acha
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel.
| | - Kushal Shah
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Tal Hasin
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Ezra Gumuser
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Oholi Tovia-Brodie
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Ayelet Shauer
- Cardiology Dept. Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Yuval Konstantino
- Cardiology Department, Soroka Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | - Eyal Yair
- Bar-Ilan University, Tek-Aviv, Israel
| | - Arik Wolak
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Eden Sinai
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Tomer Ziv-Baran
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itzak Amsalem
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Yoav Michowitz
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Michael Glikson
- Integrated Heart Center, Shaare Zedek Hospital, Hebrew University, Jerusalem, Israel
| | - Kevin Heist
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Chee Yuan Ng
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
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Suzuki K, Akiyama M, Saito S, Kaneko Y. Successful high-dose glucocorticoid therapy for anti-mitochondrial antibody-positive myocarditis arising during tocilizumab and low-dose glucocorticoid therapy for rheumatoid arthritis. Immunol Med 2024:1-5. [PMID: 38578159 DOI: 10.1080/25785826.2024.2336689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
Anti-mitochondrial antibody (AMA)-positive myopathy, a recently identified condition with significant cardiac involvement, poses a serious challenge in treatment consensus due to its extreme rarity. While several studies demonstrate the efficacy of high-dose prednisolone in managing this disease, the current literature lacks substantial evidence regarding the effectiveness of biologic therapy or low-dose prednisolone for remission induction. Here, we present a case of AMA-positive myocarditis that emerged during rheumatoid arthritis treatment with tocilizumab (TCZ) and low-dose prednisolone (PSL). Successfully, intensive immunosuppressive therapy with high-dose PSL proved effective in stabilizing this condition. Our case highlights the necessity of a robust immunosuppressive approach, favoring high-dose PSL over the combination of low-dose PSL and TCZ in this disease.
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Affiliation(s)
- Koji Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Akiyama
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shuntaro Saito
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Miljoen H, Favere K, Van De Heyning C, Corteville B, Dausin C, Herbots L, Teulingkx T, Bekhuis Y, Lyssens M, Bogaert J, Heidbuchel H, Claessen G. Low rates of myocardial fibrosis and ventricular arrhythmias in recreational athletes after SARS-CoV-2 infection. Front Cardiovasc Med 2024; 11:1372028. [PMID: 38628312 PMCID: PMC11018940 DOI: 10.3389/fcvm.2024.1372028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/26/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction High rates of cardiac involvement were reported in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. This led to anxiety in the athletic population. The current study was set up to assess the prevalence of myocardial fibrosis and ventricular arrhythmias in recreational athletes with the recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Consecutive adult recreational athletes (≥18 years old, ≥4 h of mixed type or endurance sports/week) underwent systematic cardiac evaluation after a prior confirmed COVID-19 infection. Evaluation included clinical history, electrocardiogram (ECG), 5-day Holter monitoring, and cardiac magnetic resonance (CMR) imaging with simultaneous measurement of high-sensitive cardiac Troponin I. Data from asymptomatic or mildly symptomatic athletes (Group 1) were compared with those with moderate to severe symptoms (Groups 2-3). Furthermore, a comparison with a historical control group of athletes without COVID-19 (Master@Heart) was made. Results In total, 35 athletes (18 Group 1, 10 female, 36.9 ± 2.2 years, mean 143 ± 20 days following diagnosis) were evaluated. The baseline characteristics for the Group 1 and Groups 2-3 athletes were similar. None of the athletes showed overt myocarditis on CMR based on the updated Lake Louise criteria for diagnosis of myocarditis. The prevalence of non-ischemic late gadolinium enhancement [1 (6%) Group 1 vs. 2 (12%) Groups 2-3; p = 0.603] or ventricular arrhythmias [1 Group 1 athlete showed non-sustained ventricular tachycardia (vs. 0 in Groups 2-3: p = 1.000)] were not statistically different between the groups. When the male athletes were compared with the Master@Heart athletes, again no differences regarding these criteria were found. Conclusion In our series of recreational athletes with prior confirmed COVID-19, we found no evidence of ongoing myocarditis, and no more detection of fibrosis or ventricular arrhythmias than in a comparable athletic pre-COVID cohort. This points to a much lower cardiac involvement of COVID-19 in athletes than originally suggested.
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Affiliation(s)
- Hielko Miljoen
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
| | - Kasper Favere
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Caroline Van De Heyning
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
| | - Ben Corteville
- Department of Cardiology, Jan Palfijn Hospital, Ghent, Belgium
| | - Christophe Dausin
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Lieven Herbots
- Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Youri Bekhuis
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Leuven University Hospitals, Leuven, Belgium
- Department of Cardiovascular Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Malou Lyssens
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Guido Claessen
- Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Gröschel J, Grassow L, van Dijck P, Bhoyroo Y, Blaszczyk E, Schulz-Menger J. Trajectories of functional and structural myocardial parameters in post-COVID-19 syndrome-insights from mid-term follow-up by cardiovascular magnetic resonance. Front Cardiovasc Med 2024; 11:1357349. [PMID: 38628318 PMCID: PMC11018885 DOI: 10.3389/fcvm.2024.1357349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Myocardial tissue alterations in patients with post-Coronavirus disease 2019 syndrome (PCS) are often subtle and mild. Reports vary in the prevalence of non-ischemic and ischemic injuries as well as the extent of ongoing myocardial inflammation. The exact relevance of these myocardial alterations is not fully understood. This study aimed at describing the trajectories of myocardial alterations in PCS patients by mid-term follow-up with cardiovascular magnetic resonance (CMR). Methods This study entails a retrospective analysis of symptomatic PCS patients referred for follow-up CMR between August 2020 and May 2023 due to mildly affected or reduced left or right ventricular function (LV and RV, respectively) and structural myocardial alterations, e.g., focal and diffuse fibrosis, on baseline scans. Follow-up CMR protocol consisted of cine images and full coverage native T1 and T2 mapping. Baseline and follow-up scans were compared using t-tests or Wilcoxon tests. Post-hoc analysis was carried out in a subgroup based on the change of LV stroke volume (SV) between scans. Results In total, 43 patients [median age (interquartile range) 46 (37-56) years, 33 women] received follow-ups 347 (167-651) days after initial diagnosis. A decrease in symptoms was recorded on follow-ups (p < 0.03) with 23 patients being asymptomatic at follow-ups [symptomatic at baseline 43/43 (100%) vs. symptomatic at follow-up 21/43 (49%), p < 0.001]. Functional improvement was noted for LV-SV [83.3 (72.7-95.0) vs. 84.0 (77.0-100.3) ml; p = 0.045], global radial [25.3% (23.4%-27.9%) vs. 27.4% (24.4%-33.1%); p < 0.001], and circumferential strains [-16.5% (-17.5% to -15.6%) vs. -17.2% (-19.5% to -16.1%); p < 0.001]. In total, 17 patients had an LV-SV change >10% on follow-up scans (5 with a decrease and 12 with an increase), with LV-SV, RV-SV, and global longitudinal strain being discriminatory variables on baseline scans (p = 0.01, 0.02, and 0.04, respectively). T1- or T2-analysis revealed no changes, remaining within normal limits. Conclusion Symptomatic load as well as blood pressures decreased on follow-up. CMR did not detect significant changes in tissue parameters; however, volumetric, specifically LV-SV, and deformation indexes improved during mid-term follow-up.
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Affiliation(s)
- Jan Gröschel
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute Berlin, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
| | - Leonhard Grassow
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Phillip van Dijck
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
- Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute Berlin, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
| | - Yashraj Bhoyroo
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
| | - Edyta Blaszczyk
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jeanette Schulz-Menger
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Kakarla S, Abhilash SP, Valakkada J, Namboodiri N. Feasibility of cardiac magnetic resonance imaging in temporary permanent pacemaker implants in pediatric myocarditis and complete atrioventricular block. J Arrhythm 2024; 40:385-389. [PMID: 38586858 PMCID: PMC10995590 DOI: 10.1002/joa3.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/29/2024] [Accepted: 02/14/2024] [Indexed: 04/09/2024] Open
Abstract
Background Diagnosing myocarditis in children presenting with complete AV block (CAVB) is challenging. Temporary permanent pacing support using standard transvenous active fixation lead can be inserted percutaneously until recovery. However, access to cardiac magnetic resonance (CMR) imaging may be limited due to safety concerns. Cases We report three cases where CMR was performed using temporary permanent pacemaker in situ. We evaluated the effect of device artefacts on image quality and examined any instances of device malfunction. Conclusion In children with CAVB and myocarditis, a temporary permanent pacemaker can provide reliable pacing until recovery, and CMR can be safely performed with the implanted pacemaker without compromising image quality.
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Affiliation(s)
- Saikiran Kakarla
- Division of Cardiac Electrophysiology and Pacing, Department of CardiologySree Chitra Tirunal Institute for Medical Sciences and TechnologyThiruvananthapuramKeralaIndia
| | - Sreevilasam P. Abhilash
- Division of Cardiac Electrophysiology and Pacing, Department of CardiologySree Chitra Tirunal Institute for Medical Sciences and TechnologyThiruvananthapuramKeralaIndia
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional RadiologySree Chitra Tirunal Institute for Medical Sciences and TechnologyThiruvananthapuramKeralaIndia
| | - Narayanan Namboodiri
- Division of Cardiac Electrophysiology and Pacing, Department of CardiologySree Chitra Tirunal Institute for Medical Sciences and TechnologyThiruvananthapuramKeralaIndia
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36
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Popa OA, Amzulescu M, Bugeac C, Tomescu L, Slavu IM, Gheorghita V, Andrei R, Tulin A. Cardiovascular Magnetic Resonance Imaging in Myocardial Disease. Cureus 2024; 16:e58688. [PMID: 38774162 PMCID: PMC11107957 DOI: 10.7759/cureus.58688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/24/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) is the central non-invasive imaging investigation for the evaluation of myocardial disease. It is the well-established gold standard for measuring cardiac chamber volumes, systolic function, and left ventricular mass, and it brings unique information for therapeutic decisions. In addition, its tissue characterization capability, through T1, T2, and T2* mapping, as well as early and late gadolinium enhancement (LGE) sequences, allows to differentiate in many cases among ischemic, inflammatory, and infiltrative heart disease and permits the quantification of myocardial fibrosis, providing valuable diagnostic and prognostic information. This review aims to highlight the main CMR features of different cardiomyopathies.
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Affiliation(s)
- Oana-Andreea Popa
- Cardiology, Agrippa Ionescu Emergency Clinical Hospital, Bucharest, ROU
| | - Mihaela Amzulescu
- Cardiology, Centre Hospitalier Universitaire (CHU) Saint Pierre, Bruxelles, BEL
| | - Claudia Bugeac
- Radiology, Agrippa Ionescu Emergency Clinical Hospital, Bucharest, ROU
| | - Luminita Tomescu
- Radiology, Agrippa Ionescu Emergency Clinical Hospital, Bucharest, ROU
| | - Iulian M Slavu
- Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Valeriu Gheorghita
- Infectious Disease, Agrippa Ionescu Emergency Clinical Hospital, Bucharest, ROU
| | - Rosu Andrei
- Cardiology, Agrippa Ionescu Emergency Clinical Hospital, Bucharest, ROU
| | - Adrian Tulin
- Clinic of General Surgery, Agrippa Ionescu Emergency Clinical Hospital, Bucharest, ROU
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Emrich T, Wintersperger BJ, Greco FD, Suchá D, Natale L, Paar MH, Francone M. ESR Essentials: ten steps to cardiac MR-practice recommendations by ESCR. Eur Radiol 2024; 34:2140-2151. [PMID: 38379017 DOI: 10.1007/s00330-024-10605-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 02/22/2024]
Abstract
Cardiovascular MR imaging has become an indispensable noninvasive tool in diagnosing and monitoring a broad range of cardiovascular diseases. Key to its clinical success and efficiency are appropriate clinical indication triage, technical expertise, patient safety, standardized preparation and execution, quality assurance, efficient post-processing, structured reporting, and communication and clinical integration of findings. Technological advancements are driving faster, more accessible, and cost-effective approaches. This ESR Essentials article presents a ten-step guide for implementing a cardiovascular MR program, covering indication assessments, optimized imaging, post-processing, and detailed reporting. Future goals include streamlined protocols, improved tissue characterization, and automation for greater standardization and efficiency. CLINICAL RELEVANCE STATEMENT The growing clinical role of cardiovascular MR in risk assessment, diagnosis, and treatment planning highlights the necessity for radiologists to achieve expertise in this modality, advancing precision medicine and healthcare efficiency. KEY POINTS • Cardiovascular MR is essential in diagnosing and monitoring many acute and chronic cardiovascular pathologies. • Features such as technical expertise, quality assurance, patient safety, and optimized tailored imaging protocols, among others, are essential for a successful cardiovascular MR program. • Ongoing technological advances will push rapid multi-parametric cardiovascular MR, thus improving accessibility, patient comfort, and cost-effectiveness. KEY POINTS • Cardiovascular MR is essential in diagnosing and monitoring a wide array of cardiovascular pathologies (Level of Evidence: High). • A successful cardiovascular MR program depends on standardization (Level of Evidence: Low). • Future developments will increase the efficiency and accessibility of cardiovascular MR (Level of Evidence: Low).
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Affiliation(s)
- Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
| | - Bernd J Wintersperger
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- University Medical Imaging Toronto, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Fabio Domenico Greco
- Department of Clinical Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Cardiovascular Magnetic Resonance Unit, Bristol Heart Institute, Bristol, UK
| | - Dominika Suchá
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luigi Natale
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, Rome, Italy
| | - Maja Hrabak Paar
- Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- IRCCS Humanitas Research Hospital, Milan, Italy.
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38
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Soma T, Kinjo T, Goto S, Sasaki S, Tomita H. Complete remission of giant cell myocarditis by prednisolone monotherapy: A case with mild inflammation demonstrated by mismatch between T2-high intensity areas and late gadolinium enhancement. J Cardiol Cases 2024; 29:182-185. [PMID: 38646085 PMCID: PMC11031667 DOI: 10.1016/j.jccase.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 04/23/2024] Open
Abstract
Giant cell myocarditis (GCM) is a potentially lethal subtype of myocarditis. Herein, we report a case of a 22-year-old woman with GCM who was successfully treated with prednisolone monotherapy. The patient had a fever and shortness of breath and was referred to our hospital. Laboratory test results revealed elevated troponin I levels. Cardiac magnetic resonance (CMR) showed high intensity in the inferoseptal segment of the left ventricle on T2-weighted short tau inversion recovery imaging without late gadolinium enhancement (LGE), suggesting predominant edema rather than necrosis. The patient was diagnosed with GCM based on an endomyocardial biopsy, which revealed lymphocyte infiltration and multinucleated giant cells in the absence of granuloma formation. Subsequently, the patient received intravenous methylprednisolone at 1000 mg/day for 3 days followed by oral prednisolone at 30 mg/day, which normalized troponin levels. Follow-up CMR revealed improved cardiac inflammation; therefore, the patient was discharged without prescribing another immunosuppressive agent. Prednisolone was tapered and terminated three years after discharge. The patient went one year without medication and had no recurrence of GCM on follow-up. This case highlights the presence of mild GCM, successfully treated by steroid monotherapy, in which the mismatch between high-intensity T2 areas and LGE suggests mild inflammation. Learning objective Giant cell myocarditis (GCM) is potentially lethal and usually requires multiple immunosuppressive agents. Here, we report a patient with GCM with preserved left ventricular ejection fraction. Cardiac magnetic resonance revealed focal high T2 signal intensity areas without late gadolinium enhancement, indicating myocardial edema without necrosis. The patient remained in remission with prednisolone monotherapy for 2 years. Our report indicates that "mild" GCM may be treated with prednisolone monotherapy.
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Affiliation(s)
- Takanobu Soma
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiko Kinjo
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shintaro Goto
- Department of Pathology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Sasaki
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Cardiac Remote Management System, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Cardiac Remote Management System, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of the Advanced Therapeutics for Cardiovascular Diseases, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Sedoud B, Barone-Rochette G. [Myocardial Infarction with no obstructive coronary arteries: Imaging plays a central role]. Rev Med Interne 2024; 45:200-209. [PMID: 38160097 DOI: 10.1016/j.revmed.2023.10.455] [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: 06/21/2023] [Revised: 08/16/2023] [Accepted: 10/08/2023] [Indexed: 01/03/2024]
Abstract
Myocardial infarction with non-obstructive coronary lesion (MINOCA) represents a non-negligible percentage of the proportion of myocardial infarctions (≈6%). Moreover, the long-term prognosis is poor, with an annual mortality rate of 2%. This high mortality rate may be explained by the fact that MINOCA represents a heterogeneous group, and the diagnosis of pathology is poorly understood. It is essential to be aware of this clinical presentation, and to follow the different diagnostic strategies, in order to identify the etiological mechanism, and thus set up a suitable treatment. Many tools are available to support diagnosis, notably in the fields of imaging, the principal contributors being coronary angiography, coronary physiology and pharmacological testing, as well as endo-coronary imaging and cardiac MRI. This review will provide an update on the definition, epidemiology, diagnostic strategies and treatment options for patients with MINOCA.
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Affiliation(s)
- B Sedoud
- Department of cardiology, university hospital, Grenoble-Alpes, France
| | - G Barone-Rochette
- Department of cardiology, university hospital, Grenoble-Alpes, France; Université Grenoble-Alpes, Inserm, CHU Grenoble-Alpes, LRB, 38000 Grenoble, France; French Clinical Research Infrastructure Network, Paris, France.
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40
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Hao Y, Wang X, Du Z, Liu C, Zhang M, Kuai H, Wang W, Wang Z, Liu Z, Yang J. Prevalence and impact of viral myocarditis in patients with severe fever with thrombocytopenia syndrome. J Med Virol 2024; 96:e29612. [PMID: 38639291 DOI: 10.1002/jmv.29612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
To explore the association and impact between viral myocarditis and mortality in patients with severe fever with thrombocytopenia syndrome. A dynamic analysis was conducted between fatal group and nonfatal group regarding the daily epidemiology data, clinical symptoms, and electrocardiogram (ECG), echocardiogram, and laboratory findings. Outcomes of patients with and without viral myocarditis were compared. The association between viral myocarditis and mortality was analyzed. Among 183 severe fever with thrombocytopenia syndrome patients, 32 were in the fatal group and 151 in the nonfatal group; there were 26 (81.25%) with viral myocarditis in the fatal group, 66 (43.70%) with viral myocarditis in the nonfatal group (p < 0.001), 79.35% of patients had abnormal ECG results. The abnormal rate of ECG in the fatal group was 100%, and in the nonfatal group was 74.83%. Univariate analysis found that the number of risk factors gradually increased on Day 7 of the disease course and reached the peak on Day 10. Combined with the dynamic analysis of the disease course, alanine aminotransferase, aspartate aminotransferase, creatine kinase, creatine kinase fraction, lactate dehydrogenase, hydroxybutyrate dehydrogenase, neutrophil count, serum creatinine, Na, Ca, carbon dioxide combining power, amylase, lipase, activated partial thromboplastin time and thrombin time had statistically significant impact on prognosis. The incidence of fever with thrombocytopenia syndrome combined with viral myocarditis is high, especially in the fatal group of patients. Viral myocarditis is closely related to prognosis and is an early risk factor. The time point for changes in myocarditis is Day 7 of the course of the disease.
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Affiliation(s)
- Yao Hao
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Xiaoyi Wang
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Zhixiang Du
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Cuicui Liu
- Department of Infectious Diseases, Anqing Municipal Hospital, Anqing, Anhui, People's Republic of China
| | - Mingfang Zhang
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Huifen Kuai
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Wenjie Wang
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Zijian Wang
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Zhenjun Liu
- Department of Infectious Diseases, Anqing Municipal Hospital, Anqing, Anhui, People's Republic of China
| | - Jianghua Yang
- Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
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Trivieri MG, Robson PM, Vergani V, LaRocca G, Romero-Daza AM, Abgral R, Devesa A, Azoulay LD, Karakatsanis NA, Parikh A, Panagiota C, Palmisano A, DePalo L, Chang HL, Rothstein JH, Fayad RA, Miller MA, Fuster V, Narula J, Dweck MR, Morgenthau A, Jacobi A, Padilla M, Kovacic JC, Fayad ZA. Hybrid Magnetic Resonance Positron Emission Tomography Is Associated With Cardiac-Related Outcomes in Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2024; 17:411-424. [PMID: 38300202 DOI: 10.1016/j.jcmg.2023.11.010] [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: 03/01/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Imaging with late gadolinium enhancement (LGE) magnetic resonance (MR) and 18F-fluorodeoxyglucose (18F-FDG) PET allows complementary assessment of myocardial injury and disease activity and has shown promise for improved characterization of active cardiac sarcoidosis (CS) based on the combined positive imaging outcome, MR(+)PET(+). OBJECTIVES This study aims to evaluate qualitative and quantitative assessments of hybrid MR/PET imaging in CS and to evaluate its association with cardiac-related outcomes. METHODS A total of 148 patients with suspected CS underwent hybrid MR/PET imaging. Patients were classified based on the presence/absence of LGE (MR+/MR-), presence/absence of 18F-FDG (PET+/PET-), and pattern of 18F-FDG uptake (focal/diffuse) into the following categories: MR(+)PET(+)FOCAL, MR(+)PET(+)DIFFUSE, MR(+)PET(-), MR(-)PET(+)FOCAL, MR(-)PET(+)DIFFUSE, MR(-)PET(-). Further analysis classified MR positivity based on %LGE exceeding 5.7% as MR(+/-)5.7%. Quantitative values of standard uptake value, target-to-background ratio, target-to-normal-myocardium ratio (TNMRmax), and T2 were measured. The primary clinical endpoint was met by the occurrence of cardiac arrest, ventricular tachycardia, or secondary prevention implantable cardioverter-defibrillator (ICD) before the end of the study. The secondary endpoint was met by any of the primary endpoint criteria plus heart failure or heart block. MR/PET imaging results were compared between those meeting or not meeting the clinical endpoints. RESULTS Patients designated MR(+)5.7%PET(+)FOCAL had increased odds of meeting the primary clinical endpoint compared to those with all other imaging classifications (unadjusted OR: 9.2 [95% CI: 3.0-28.7]; P = 0.0001), which was higher than the odds based on MR or PET alone. TNMRmax achieved an area under the receiver-operating characteristic curve of 0.90 for separating MR(+)PET(+)FOCAL from non-MR(+)PET(+)FOCAL, and 0.77 for separating those reaching the clinical endpoint from those not reaching the clinical endpoint. CONCLUSIONS Hybrid MR/PET image-based classification of CS was statistically associated with clinical outcomes in CS. TNMRmax had modest sensitivity and specificity for quantifying the imaging-based classification MR(+)PET(+)FOCAL and was associated with outcomes. Use of combined MR and PET image-based classification may have use in prognostication and treatment management in CS.
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Affiliation(s)
- Maria Giovanna Trivieri
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Philip M Robson
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vittoria Vergani
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Gina LaRocca
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Ronan Abgral
- Department of Nuclear Medicine, University Hospital of Brest, European University of Brittany, Brest, France
| | - Ana Devesa
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Levi-Dan Azoulay
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Nicolas A Karakatsanis
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Radiopharmaceutical Sciences, Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Aditya Parikh
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christia Panagiota
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anna Palmisano
- Experimental Imaging Center, Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Louis DePalo
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Helena L Chang
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph H Rothstein
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rima A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Valentin Fuster
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jagat Narula
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Adam Morgenthau
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam Jacobi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maria Padilla
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jason C Kovacic
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Victor Chang Cardiac Research Institute and St Vincent's Clinical School, University of NSW, Darlinghurst, New South Wales, Australia
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Park JH, Kim KH. COVID-19 Vaccination-Related Myocarditis: What We Learned From Our Experience and What We Need to Do in The Future. Korean Circ J 2024; 54:54.e35. [PMID: 38654456 DOI: 10.4070/kcj.2024.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 04/26/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has led to a global health crisis with substantial mortality and morbidity. To combat the COVID-19 pandemic, various vaccines have been developed, but unexpected serious adverse events including vaccine-induced thrombotic thrombocytopenia, carditis, and thromboembolic events have been reported and became a huddle for COVID-19 vaccination. Vaccine-related myocarditis (VRM) is a rare but significant adverse event associated primarily with mRNA vaccines. This review explores the incidence, risk factors, clinical presentation, pathogenesis, management strategies, and outcomes associated with VRM. The incidence of VRM is notably higher in male adolescents and young adults, especially after the second dose of mRNA vaccines. The pathogenesis appears to involve an immune-mediated process, but the precise mechanism remains mostly unknown so far. Most studies have suggested that VRM is mild and self-limiting, and responds well to conventional treatment. However, a recent nationwide study in Korea warns that severe cases, including fulminant myocarditis or death, are not uncommon in patients with COVID-19 VRM. The long-term cardiovascular consequences of VRM have not been well understood and warrant further investigation. This review also briefly addresses the critical balance between the substantial benefits of COVID-19 vaccination and the rare risks of VRM in the coming endemic era. It emphasizes the need for continued surveillance, research to understand the underlying mechanisms, and strategies to mitigate risk. Filling these knowledge gaps would be vital to refining vaccination recommendations and improving patient care in the evolving COVID-19 pandemic landscape.
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Affiliation(s)
- Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University, Daejeon, Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea.
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Bernhard B, Joss P, Greisser N, Stark AW, Schütze J, Shiri I, Safarkhanlo Y, Fischer K, Guensch DP, Bastiaansen JAM, Pavlicek M, Benz DC, Kwong RY, Gräni C. Prognostic value of visual and quantitative CMR regional myocardial function in patients with suspected myocarditis. Int J Cardiovasc Imaging 2024; 40:907-920. [PMID: 38427272 PMCID: PMC11052711 DOI: 10.1007/s10554-024-03059-1] [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: 11/22/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
According to updated Lake-Louise Criteria, impaired regional myocardial function serves as a supportive criterion in diagnosing myocarditis. This study aimed to assess visual regional wall motional abnormalities (RWMA) and novel quantitative regional longitudinal peak strain (RLS) for risk stratification in the clinical setting of myocarditis. In patients undergoing CMR and meeting clinical criteria for suspected myocarditis global longitudinal strain (GLS), late gadolinium enhancement (LGE), RWMA and RLS were assessed in the anterior, septal, inferior, and lateral regions and correlated to the occurrence of major adverse cardiac events (MACE), including heart failure hospitalization, sustained ventricular tachycardia, recurrent myocarditis, and all-cause death. In 690 consecutive patients (age: 48.0 ± 16.0 years; 37.7% female) with suspected myocarditis impaired RLS was correlated with RWMA and LV-GLS but not with the presence of LGE. At median follow up of 3.8 years, MACE occurred in 116 (16.8%) patients. Both, RWMA and RLS in anterior-, septal-, inferior-, and lateral- locations were univariately associated with outcomes (all p < 0.001), but not after adjusting for clinical characteristics and LV-GLS. In the subgroup of patients with normal LV function, RWMA were not predictive of outcomes, whereas septal RLS had incremental and independent prognostic value over clinical characteristics (HRadjusted = 1.132, 95% CI 1.020-1.256; p = 0.020). RWMA and RLS can be used to assess regional impairment of myocardial function in myocarditis but are of limited prognostic value in the overall population. However, in the subgroup of patients with normal LV function, septal RLS represents a distinctive marker of regional LV dysfunction, offering potential for risk-stratification.
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Affiliation(s)
- Benedikt Bernhard
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Philippe Joss
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Noah Greisser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anselm W Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan Schütze
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Isaac Shiri
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasaman Safarkhanlo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Jessica A M Bastiaansen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Translation Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Maryam Pavlicek
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik C Benz
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Cardiology, University Hospital Bern, Freiburgstrasse, CH - 3010, Bern, Switzerland.
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Antonopoulos AS, Xintarakou A, Protonotarios A, Lazaros G, Miliou A, Tsioufis K, Vlachopoulos C. Imagenetics for Precision Medicine in Dilated Cardiomyopathy. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2024; 17:e004301. [PMID: 38415367 DOI: 10.1161/circgen.123.004301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Dilated cardiomyopathy (DCM) is a common heart muscle disorder of nonischemic etiology associated with heart failure development and the risk of malignant ventricular arrhythmias and sudden cardiac death. A tailored approach to risk stratification and prevention of sudden cardiac death is required in genetic DCM given its variable presentation and phenotypic severity. Currently, advances in cardiogenetics have shed light on disease mechanisms, the complex genetic architecture of DCM, polygenic contributors to disease susceptibility and the role of environmental triggers. Parallel advances in imaging have also enhanced disease recognition and the identification of the wide spectrum of phenotypes falling under the DCM umbrella. Genotype-phenotype associations have been also established for specific subtypes of DCM, such as DSP (desmoplakin) or FLNC (filamin-C) cardiomyopathy but overall, they remain elusive and not readily identifiable. Also, despite the accumulated knowledge on disease mechanisms, certain aspects remain still unclear, such as which patients with DCM are at risk for disease progression or remission after treatment. Imagenetics, that is, the combination of imaging and genetics, is expected to further advance research in the field and contribute to precision medicine in DCM management and treatment. In the present article, we review the existing literature in the field, summarize the established knowledge and emerging data on the value of genetics and imaging in establishing genotype-phenotype associations in DCM and in clinical decision making for DCM patients.
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Affiliation(s)
- Alexios S Antonopoulos
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (A.S.A., A.X., G.L., A.M., K.T., C.V.)
| | - Anastasia Xintarakou
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (A.S.A., A.X., G.L., A.M., K.T., C.V.)
| | - Alexandros Protonotarios
- Institute of Cardiovascular Science, University College London, United Kingdom (A.P.)
- Inherited Cardiovascular Disease Unit, St Bartholomew's Hospital, London, United Kingdom (A.P.)
| | - George Lazaros
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (A.S.A., A.X., G.L., A.M., K.T., C.V.)
| | - Antigoni Miliou
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (A.S.A., A.X., G.L., A.M., K.T., C.V.)
| | - Konstantinos Tsioufis
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (A.S.A., A.X., G.L., A.M., K.T., C.V.)
| | - Charalambos Vlachopoulos
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (A.S.A., A.X., G.L., A.M., K.T., C.V.)
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Scheel PJ, Cartella I, Murray B, Gilotra NA, Ammirati E. Role of genetics in inflammatory cardiomyopathy. Int J Cardiol 2024; 400:131777. [PMID: 38218248 DOI: 10.1016/j.ijcard.2024.131777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
Traditional cardiomyopathy paradigms segregate inflammatory etiologies from those caused by genetic variants. An identified or presumed trigger is implicated in acute myocarditis or chronic inflammatory cardiomyopathy but growing evidence suggests a significant proportion of patients have an underlying cardiomyopathy-associated genetic variant often even when a clear inflammatory trigger is identified. Recognizing a possible genetic contribution to inflammatory cardiomyopathy may have major downstream implications for both the patient and family. The presenting features of myocarditis (i.e. chest pain, arrhythmia, and/or heart failure) may provide insight into diagnostic considerations. One example is isolated cardiac sarcoidosis, a distinct inflammatory cardiomyopathy that carries diagnostic challenges and clinical overlap; genetic testing has increasingly reclassified cases of isolated cardiac sarcoidosis as genetic cardiomyopathy, notably altering management. On the other side, inflammatory presentations of genetic cardiomyopathies are likewise underappreciated and a growing area of investigation. Inflammation plays an important role in the pathogenesis of several familial cardiomyopathies, especially arrhythmogenic phenotypes. Given these clinical scenarios, and the implications on clinical decision making such as initiation of immunosuppression, sudden cardiac death prevention, and family screening, it is important to recognize when genetics may be playing a role.
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Affiliation(s)
- Paul J Scheel
- Division of Cardiology, Department of Medicine, Johns Hopkins University, USA.
| | - Iside Cartella
- De Gasperis Cardio Center, Transplant Center, Niguarda Hospital, Milano, Italy; Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University, USA
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University, USA
| | - Enrico Ammirati
- De Gasperis Cardio Center, Transplant Center, Niguarda Hospital, Milano, Italy; Department of Health Sciences, University of Milano-Bicocca, Monza, Italy.
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Galizia MS, Attili AK, Truesdell WR, Smith ED, Helms AS, Sulaiman AMA, Madamanchi C, Agarwal PP. Imaging Features of Arrhythmogenic Cardiomyopathies. Radiographics 2024; 44:e230154. [PMID: 38512728 PMCID: PMC10995833 DOI: 10.1148/rg.230154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 03/23/2024]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetic disease characterized by replacement of ventricular myocardium with fibrofatty tissue, predisposing the patient to ventricular arrhythmias and/or sudden cardiac death. Most cases of ACM are associated with pathogenic variants in genes that encode desmosomal proteins, an important cell-to-cell adhesion complex present in both the heart and skin tissue. Although ACM was first described as a disease predominantly of the right ventricle, it is now acknowledged that it can also primarily involve the left ventricle or both ventricles. The original right-dominant phenotype is traditionally diagnosed using the 2010 task force criteria, a multifactorial algorithm divided into major and minor criteria consisting of structural criteria based on two-dimensional echocardiographic, cardiac MRI, or right ventricular angiographic findings; tissue characterization based on endomyocardial biopsy results; repolarization and depolarization abnormalities based on electrocardiographic findings; arrhythmic features; and family history. Shortfalls in the task force criteria due to the modern understanding of the disease have led to development of the Padua criteria, which include updated criteria for diagnosis of the right-dominant phenotype and new criteria for diagnosis of the left-predominant and biventricular phenotypes. In addition to incorporating cardiac MRI findings of ventricular dilatation, systolic dysfunction, and regional wall motion abnormalities, the new Padua criteria emphasize late gadolinium enhancement at cardiac MRI as a key feature in diagnosis and imaging-based tissue characterization. Conditions to consider in the differential diagnosis of the right-dominant phenotype include various other causes of right ventricular dilatation such as left-to-right shunts and variants of normal right ventricular anatomy that can be misinterpreted as abnormalities. The left-dominant phenotype can mimic myocarditis at imaging and clinical examination. Additional considerations for the differential diagnosis of ACM, particularly for the left-dominant phenotype, include sarcoidosis and dilated cardiomyopathy. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Mauricio S. Galizia
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Anil K. Attili
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - William R. Truesdell
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Eric D. Smith
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Adam S. Helms
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Abdulbaset M. A. Sulaiman
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Chaitanya Madamanchi
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Prachi P. Agarwal
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
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Scharinger B, Boxhammer E, Rezar R, Hecht S, Wernly S, Widhalm T, Lichtenauer M, Hoppe UC, Hergan K, Wernly B, Strohmer B, Kaufmann R. Cardiac MRI after Sudden Cardiac Arrest: A Systematic Review. Radiol Cardiothorac Imaging 2024; 6:e230216. [PMID: 38634744 PMCID: PMC11056749 DOI: 10.1148/ryct.230216] [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: 06/20/2023] [Revised: 01/08/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
Purpose To perform a systematic review to assess the diagnostic and prognostic value of cardiac MRI after sudden cardiac arrest (SCA). Materials and Methods PubMed and Cochrane Library databases were systematically searched for studies investigating cardiac MRI after SCA in adult patients (≥18 years of age). The time frame of the encompassed studies spans from January 2012 to January 2023. The study protocol was preregistered in OSF Registries (www.osf.io/nxaev), and the systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the included studies was evaluated using the Newcastle-Ottawa quality assessment scale. Results Fourteen studies involving 1367 individuals, 1257 (91.9%) of whom underwent cardiac MRI, were included. Inconsistent findings were reported on the diagnostic value of cardiac MRI-specific findings. The included studies demonstrated the following main findings: (a) cardiac MRI led to a new or alternative diagnosis in patients with SCA; (b) cardiac MRI identified pathologic or arrhythmogenic substrates; (c) cardiac MRI helped detect myocardial edema (potentially reversible); (d) cardiac MRI provided evidence for the occurrence of adverse events; and (e) functional markers or ventricular dimensions were considered prognostically relevant in a few studies. Relevant challenges in this systematic review were the lack of comparators and reference standards relative to cardiac MRI as the index test and patient selection bias. Conclusion Cardiac MRI following SCA can contribute to the diagnostic process and offer supplementary information essential for treatment planning. Limitations of the review include studies with insufficient comparators and potential bias in patient selection. Systematic review registration link: osf.io/nxaev Keywords: Cardiac MRI, Cardiovascular Disease, Cardiomyopathy, Ischemia, Myocardial Edema, Sudden Cardiac Arrest © RSNA, 2024.
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Affiliation(s)
| | | | - Richard Rezar
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Stefan Hecht
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Sarah Wernly
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Tobias Widhalm
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Michael Lichtenauer
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Uta C. Hoppe
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Klaus Hergan
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Bernhard Wernly
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Bernhard Strohmer
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Reinhard Kaufmann
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
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Kato S, Kitai T, Utsunomiya D, Azuma M, Fukui K, Hagiwara E, Ogura T, Ishibashi Y, Okada T, Kitakata H, Shiraishi Y, Torii S, Ohashi K, Takamatsu K, Yokoyama A, Hirata KI, Matsue Y, Node K. Myocardial Injury by COVID-19 Infection Assessed by Cardiovascular Magnetic Resonance Imaging - A Prospective Multicenter Study. Circ J 2024:CJ-23-0729. [PMID: 38556299 DOI: 10.1253/circj.cj-23-0729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND This prospective multicenter study assessed the prevalence of myocardial injury in patients with COVID-19 using cardiac magnetic resonance imaging (CMR).Methods and Results: We prospectively screened 505 patients with moderate to severe COVID-19 disease from 7 hospitals in Japan. Of these patients, 31 (mean [±SD] age 63.5±10.4 years, 23 [74%] male) suspected of myocardial injury, based on elevated serum troponin or B-type natriuretic peptide concentrations either upon admission or 3 months after discharge, underwent CMR 3 months after discharge. The primary endpoint was the presence of myocardial injury, defined by any of the following: (1) contrast enhancement in the left or right ventricle myocardium on late gadolinium enhancement CMR; (2) left or right ventricular dysfunction (defined as <50% and <45%, respectively); and (3) pericardial thickening on contrast enhancement. The mean (±SD) duration between diagnosis and CMR was 117±16 days. The primary endpoint was observed in 13 of 31 individuals (42%), with 8 (26%) satisfying the modified Lake Louise Criteria for the diagnosis of acute myocarditis. CONCLUSIONS This study revealed a high incidence of myocardial injury identified by CMR in patients with moderate to severe COVID-19 and abnormal findings for cardiac biomarkers.
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Affiliation(s)
- Shingo Kato
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine
| | - Takeshi Kitai
- Department of Cardiology, National Cerebral and Cardiovascular Center
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine
| | - Mai Azuma
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Taiji Okada
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Hiroki Kitakata
- Department of Cardiology, Keio University School of Medicine
| | | | - Shunsuke Torii
- Department of Cardiology, National Center for Global Health and Medicine
| | - Koichi Ohashi
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital
| | - Kazufumi Takamatsu
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University
| | - Akihito Yokoyama
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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Almeida AG, Grapsa J, Gimelli A, Bucciarelli-Ducci C, Gerber B, Ajmone-Marsan N, Bernard A, Donal E, Dweck MR, Haugaa KH, Hristova K, Maceira A, Mandoli GE, Mulvagh S, Morrone D, Plonska-Gosciniak E, Sade LE, Shivalkar B, Schulz-Menger J, Shaw L, Sitges M, von Kemp B, Pinto FJ, Edvardsen T, Petersen SE, Cosyns B. Cardiovascular multimodality imaging in women: a scientific statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology. Eur Heart J Cardiovasc Imaging 2024; 25:e116-e136. [PMID: 38198766 DOI: 10.1093/ehjci/jeae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
Cardiovascular diseases (CVD) represent an important cause of mortality and morbidity in women. It is now recognized that there are sex differences regarding the prevalence and the clinical significance of the traditional cardiovascular (CV) risk factors as well as the pathology underlying a range of CVDs. Unfortunately, women have been under-represented in most CVD imaging studies and trials regarding diagnosis, prognosis, and therapeutics. There is therefore a clear need for further investigation of how CVD affects women along their life span. Multimodality CV imaging plays a key role in the diagnosis of CVD in women as well as in prognosis, decision-making, and monitoring of therapeutics and interventions. However, multimodality imaging in women requires specific consideration given the differences in CVD between the sexes. These differences relate to physiological changes that only women experience (e.g. pregnancy and menopause) as well as variation in the underlying pathophysiology of CVD and also differences in the prevalence of certain conditions such as connective tissue disorders, Takotsubo, and spontaneous coronary artery dissection, which are all more common in women. This scientific statement on CV multimodality in women, an initiative of the European Association of Cardiovascular Imaging of the European Society of Cardiology, reviews the role of multimodality CV imaging in the diagnosis, management, and risk stratification of CVD, as well as highlights important gaps in our knowledge that require further investigation.
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Affiliation(s)
- Ana G Almeida
- Heart and Vessels Department, University Hospital Santa Maria, CAML, CCUL, Faculty of Medicine of Lisbon University, Lisbon, Portugal
| | - Julia Grapsa
- Cardiology Department, Guys and St Thomas NHS Trust, London, UK
| | - Alessia Gimelli
- Imaging Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Chiara Bucciarelli-Ducci
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Hospitals, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Bernhard Gerber
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, UCLouvain, Brussels, Belgium
- Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvain, Brussels, Belgium
| | - Nina Ajmone-Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne Bernard
- EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France
- Service de Cardiologie, CHRU de Tours, Tours, France
| | - Erwan Donal
- CHU Rennes, Inserm, LTSI-UMR 1099, University of Rennes, Rennes, France
| | - Marc R Dweck
- Centre for Cardiovascular Science, Chancellors Building, Little France Crescent, Edinburgh, UK
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Krassimira Hristova
- Center for Cardiovascular Diseases, Faculty of Medicine, Sofia University, Sofia, Bulgaria
| | - Alicia Maceira
- Ascires Biomedical Group, Valencia, Spain
- Department of Medicine, Health Sciences School, UCH-CEU University, Valencia, Spain
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Sharon Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, NS, Canada
| | - Doralisa Morrone
- Division of Cardiology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | - Leyla Elif Sade
- Cardiology Department, University of Baskent, Ankara, Turkey
- UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jeanette Schulz-Menger
- Charité ECRC Medical Faculty of the Humboldt University Berlin and Helios-Clinics, Berlin, Germany
- DZHK, Partner site Berlin, Berlin, Germany
| | - Leslee Shaw
- Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institut Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- CIBERCV, Barcelona, Spain
| | - Berlinde von Kemp
- Cardiology, Centrum voor Hart en Vaatziekten (CHVZ), Universitair Ziejkenhuis Brussel (UZB), Vrij Universiteit Brussel (VUB), Brussels, Belgium
| | - Fausto J Pinto
- Heart and Vessels Department, University Hospital Santa Maria, CAML, CCUL, Faculty of Medicine of Lisbon University, Lisbon, Portugal
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Bernard Cosyns
- Cardiology, Centrum voor Hart en Vaatziekten (CHVZ), Universitair Ziejkenhuis Brussel (UZB), Vrij Universiteit Brussel (VUB), Brussels, Belgium
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50
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Alrayyashi M, Uddin M, Bdiwi M, Afonso L. Immune checkpoint inhibitor-induced myopericarditis. BMJ Case Rep 2024; 17:e259497. [PMID: 38514163 PMCID: PMC10961502 DOI: 10.1136/bcr-2023-259497] [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] [Indexed: 03/23/2024] Open
Abstract
A woman in her 30s with a medical history of metastatic rectal adenocarcinoma, currently on pembrolizumab, which started a few weeks ago, was admitted for abdominal pain. During the hospital stay, she experienced sharp chest pain. Troponin was 1885 ng/mL which peaked at 7338 ng/mL. ECG was unremarkable. The echocardiogram showed an Ejection fraction (EF) of 55%-60% and basal-inferior wall hypokinesis. Left heart catheterisation showed no coronary abnormalities. Cardiac MRI showed a non-coronary area of focal T1 and T2 hyperintense signal and transmural delayed gadolinium enhancement in the mid-basal inferior/inferoseptal wall consistent with myocardial damage. Pericardium showed increased thickness and adhesions at the right ventricular outflow tract consistent with pericarditis. Steroid therapy was initiated, and a marked clinical response was achieved. Immune checkpoint inhibitor-induced myocarditis and pericarditis is a rare complication associated with a high mortality rate, if untreated. Diagnosis requires a multidisciplinary approach, and early detection is critical to preventing a fatal outcome.
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Affiliation(s)
- Mohamed Alrayyashi
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mohammed Uddin
- Cardiology, Wayne State University, Warren, Michigan, USA
| | - Mustafa Bdiwi
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Luis Afonso
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
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