1
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Göbel S, Braun AS, Hahad O, von Henning U, Brandt M, Keller K, Gaida MM, Gori T, Schultheiss HP, Escher F, Münzel T, Wenzel P. Etiologies and predictors of mortality in an all-comer population of patients with non-ischemic heart failure. Clin Res Cardiol 2024; 113:737-749. [PMID: 38224373 PMCID: PMC11026225 DOI: 10.1007/s00392-023-02354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Despite progress in diagnosis and therapy of heart failure (HF), etiology and risk stratification remain elusive in many patients. METHODS The My Biopsy HF Study (German clinical trials register number: DRKS22178) is a retrospective monocentric study investigating an all-comer population of patients with unexplained HF based on a thorough workup including endomyocardial biopsy (EMB). RESULTS 655 patients (70.9% men, median age 55 [45/66] years) with non-ischemic, non-valvular HF were included in the analyses. 489 patients were diagnosed with HF with reduced ejection fraction (HFrEF), 52 patients with HF with mildly reduced ejection fraction (HFmrEF) and 114 patients with HF with preserved ejection fraction (HFpEF). After a median follow-up of 4.6 (2.5/6.6) years, 94 deaths were enumerated (HFrEF: 68; HFmrEF: 8; HFpEF: 18), equating to mortality rates of 3.3% and 11.6% for patients with HFrEF, 7.7% and 15.4% for patients with HFmrEF and 5.3% and 11.4% for patients with HFpEF after 1 and 5 years, respectively. In EMB, we detected a variety of putative etiologies of HF, including incidental cardiac amyloidosis (CA, 5.8%). In multivariate logistic regression analysis adjusting for age, sex and comorbidities only CA, age and NYHA functional class III + IV remained independently associated with all-cause mortality (CA: HRperui 3.13, 95% CI 1.5-6.51; p = 0.002). CONCLUSIONS In an all-comer population of patients presenting with HF of unknown etiology, incidental finding of CA stands out to be independently associated with all-cause mortality. Our findings suggest that prospective trials would be helpful to test the added value of a systematic and holistic work-up of HF of unknown etiology.
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Affiliation(s)
- S Göbel
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - A S Braun
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - O Hahad
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - U von Henning
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - M Brandt
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - K Keller
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - M M Gaida
- Institute of Pathology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Mainz, Germany
- TRON, Translational Oncology at the University Medical Center Mainz, Mainz, Germany
| | - T Gori
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - F Escher
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - T Münzel
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - P Wenzel
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
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2
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Affiliation(s)
- Heinz-Peter Schultheiss
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Moltkestrasse 31, D-12203 Berlin, Germany
| | - Felicitas Escher
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
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3
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Baumeier C, Harms D, Aleshcheva G, Gross U, Escher F, Schultheiss HP. Advancing Precision Medicine in Myocarditis: Current Status and Future Perspectives in Endomyocardial Biopsy-Based Diagnostics and Therapeutic Approaches. J Clin Med 2023; 12:5050. [PMID: 37568452 PMCID: PMC10419903 DOI: 10.3390/jcm12155050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
The diagnosis and specific and causal treatment of myocarditis and inflammatory cardiomyopathy remain a major clinical challenge. Despite the rapid development of new imaging techniques, endomyocardial biopsies remain the gold standard for accurate diagnosis of inflammatory myocardial disease. With the introduction and continued development of immunohistochemical inflammation diagnostics in combination with viral nucleic acid testing, myocarditis diagnostics have improved significantly since their introduction. Together with new technologies such as miRNA and gene expression profiling, quantification of specific immune cell markers, and determination of viral activity, diagnostic accuracy and patient prognosis will continue to improve in the future. In this review, we summarize the current knowledge on the pathogenesis and diagnosis of myocarditis and inflammatory cardiomyopathies and highlight future perspectives for more in-depth and specialized biopsy diagnostics and precision, personalized medicine approaches.
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Affiliation(s)
- Christian Baumeier
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (D.H.); (G.A.); (U.G.); (H.-P.S.)
| | - Dominik Harms
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (D.H.); (G.A.); (U.G.); (H.-P.S.)
- Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
| | - Ganna Aleshcheva
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (D.H.); (G.A.); (U.G.); (H.-P.S.)
| | - Ulrich Gross
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (D.H.); (G.A.); (U.G.); (H.-P.S.)
| | - Felicitas Escher
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, 13353 Berlin, Germany;
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
| | - Heinz-Peter Schultheiss
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (D.H.); (G.A.); (U.G.); (H.-P.S.)
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Makrutzki-Zlotek K, Escher F, Karadeniz Z, Aleshcheva G, Pietsch H, Küchler K, Schultheiss HP, Heidecker B, Poller W, Landmesser U, Scheibenbogen C, Thevathasan T, Skurk C. FOXO3A acts as immune response modulator in human virus-negative inflammatory cardiomyopathy. Heart 2023; 109:846-856. [PMID: 36702542 DOI: 10.1136/heartjnl-2022-321732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/02/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Inflammatory cardiomyopathy is characterised by inflammatory infiltrates leading to cardiac injury, left ventricular (LV) dilatation and reduced LV ejection fraction (LVEF). Several viral pathogens and autoimmune phenomena may cause cardiac inflammation.The effects of the gain of function FOXO3A single-nucleotide polymorphism (SNP) rs12212067 on inflammation and outcome were studied in a cohort of patients with inflammatory dilated cardiomyopathy (DCMi) in relation to cardiac viral presence. METHODS Distribution of the SNP was determined in virus-positive and virus-negative DCMi patients and in control subjects without myocardial pathology. Baseline and outcome data were compared in 221 virus-negative patients with detection of cardiac inflammation and reduced LVEF according to their carrier status of the SNP. RESULTS Distribution of SNP rs12212067 did not differ between virus-positive (n=22, 19.3%), virus-negative (n=45, 20.4 %) and control patients (n=18, 23.4 %), indicating the absence of susceptibility for viral infection or inflammation per se (p=0.199). Patients in the virus-negative DCMi group were characterised by reduced LVEF 35.5% (95% CI) 33.5 to 37.4) and increased LVEDD (LV end-diastolic diameter) 59.8 mm (95% CI 58.5 to 61.2). Within the group, SNP and non-SNP carriers had similarly impaired LVEF 39.2% (95% CI 34.3% to 44.0%) vs 34.5% (95% CI 32.4 to 36.5), p=0.083, and increased LVEDD 58.9 mm (95% CI 56.3 to 61.5) vs 60.1 mm (95% CI 58.6 to 61.6), p=0.702, respectively. The number of inflammatory infiltrates was not different in both SNP groups at baseline. Outcome after 6 months showed a significant improvement in LVEF and clinical symptoms in SNP rs12212067 carriers 50.9% (95% CI 45.4 to 56.3) versus non-SNP carriers 41.7% (95% CI 39.2 to 44.2), p≤0.01. The improvement in clinical symptoms and LVEF was associated with a significant reduction in cardiac inflammation (ΔCD45RO+ p≤0.05; ΔMac-1+ p≤0.05; ΔLFA-1+ p≤0.01; ΔCD54+ p≤0.01) in the SNP cohort versus non-SNP cohort, respectively. Subgroup analyses identified ΔMac-1+, ΔLFA-1+, ΔCD3+ and Δperforin+ as predictors for improvement in cardiac function in SNP-positive patients. CONCLUSION FOXO3A might act as modulator of the cardiac immune response, diminishing cardiac inflammation and injury in pathogen-negative DCMi.
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Affiliation(s)
- Kamila Makrutzki-Zlotek
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
| | - Felicitas Escher
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Campus Virchow-Klinikum, Berlin, Germany.,DZHK, German Center for Cardiovascular Research, Berlin, Germany.,IKDT, Institute for Cardiac Diagnostics and Therapy, Berlin, Germany
| | - Zehra Karadeniz
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
| | - Ganna Aleshcheva
- IKDT, Institute for Cardiac Diagnostics and Therapy, Berlin, Germany
| | - Heiko Pietsch
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Campus Virchow-Klinikum, Berlin, Germany.,IKDT, Institute for Cardiac Diagnostics and Therapy, Berlin, Germany
| | - Konstanze Küchler
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany
| | | | - Bettina Heidecker
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany.,Institute of Medical Informatics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Poller
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany.,Institute of Medical Informatics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany.,Institute of Medical Informatics, Charité Universitätsmedizin Berlin, Berlin, Germany.,BIH, Berlin Institute of Health at Charité, Berlin, Germany
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité Universitätsmedizin Berlin - Campus Virchow-Klinikum, Berlin, Germany
| | - Tharusan Thevathasan
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany.,DZHK, German Center for Cardiovascular Research, Berlin, Germany.,Institute of Medical Informatics, Charité Universitätsmedizin Berlin, Berlin, Germany.,BIH, Berlin Institute of Health at Charité, Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Berlin, Germany .,DZHK, German Center for Cardiovascular Research, Berlin, Germany
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Baumeier C, Aleshcheva G, Schultheiss HP, Escher F. The cardioprotective role of PAI-1 in human inflammatory cardiomyopathy. J Mol Cell Cardiol 2022. [DOI: 10.1016/j.yjmcc.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Zweck E, Scheiber D, Schultheiss HP, Kuss O, Kelm M, Roden M, Westenfeld R, Szendroedi J. Impaired Myocardial Mitochondrial Respiration in Humans With Prediabetes: A Footprint of Prediabetic Cardiomyopathy. Circulation 2022; 146:1189-1191. [PMID: 36214134 DOI: 10.1161/circulationaha.122.058995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Elric Zweck
- Institute for Clinical Diabetology (E.Z., D.S., M.R., J.S.), German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine University, Düsseldorf.,Institute for Biometrics and Epidemiology (O.K.), German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine University, Düsseldorf.,Division of Cardiology, Pulmonology and Vascular Medicine (E.Z., D.S., M.K., R.W.), Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Daniel Scheiber
- Institute for Clinical Diabetology (E.Z., D.S., M.R., J.S.), German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine University, Düsseldorf.,Institute for Biometrics and Epidemiology (O.K.), German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine University, Düsseldorf.,Division of Cardiology, Pulmonology and Vascular Medicine (E.Z., D.S., M.K., R.W.), Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Oliver Kuss
- Institute for Biometrics and Epidemiology (O.K.), German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine University, Düsseldorf
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine (E.Z., D.S., M.K., R.W.), Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,Cardiovascular Research Institute Düsseldorf (M.K., M.R.), Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology (E.Z., D.S., M.R., J.S.), German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine University, Düsseldorf.,German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg (E.Z., D.S., M.R., J.S.).,Cardiovascular Research Institute Düsseldorf (M.K., M.R.), Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,Division of Endocrinology and Diabetology (M.R.), Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine (E.Z., D.S., M.K., R.W.), Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology (E.Z., D.S., M.R., J.S.), German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine University, Düsseldorf.,German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg (E.Z., D.S., M.R., J.S.).,Department of Internal Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg; Institute for Diabetes and Cancer; and Joint Heidelberg-IDC Translational Diabetes Program, Helmholtz Center Munich, München-Neuherberg, Germany (J.S.)
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7
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Zweck E, Scheiber D, Schultheiss HP, Kelm M, Roden M, Szendroedi J, Westenfeld R. Prediabetes relates to impaired mitochondrial function in human ventricular myocardium. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
With the growing prevalence of prediabetes in developed countries, complications of this predecessor of diabetes mellitus type 2 become increasingly important for medical research and practice. Prediabetes is defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) and may also incorporate elevated hemoglobin A1. While overt type 2 diabetes is a well-established risk factor and can even be the cause of cardiac failure, this is not yet proven for prediabetes. Mitochondrial impairment is a key pathomechanism in heart failure, but it remains uncertain, whether prediabetes impairs myocardial energy metabolism in humans just as type 2 diabetes does.
Purpose
We aimed to scrutinize the impact of prediabetes on myocardial mitochondrial metabolism and cardiac function.
Methods
We included 50 heart transplant recipients with normal glucose tolerance (GT, n=25), prediabetes (n=8, 3 IFG and 5 IGT) or type 2 diabetes mellitus (T2DM, n=17), who had received a healthy donor heart from a non-diabetic donor. In this cohort, the impact of the recipients' metabolism should be displayed in the donor heart after transplantation. We performed oral glucose tolerance tests to assess the diabetes status, and cardiac magnetic resonance imaging to assess cardiac systolic and diastolic function, circulating biomarkers of oxidative stress in serum samples (thiobarbituric acid reactive substances (TBARS) and redox potential), as well as global T2 relaxation times as a marker of myocardial inflammation. In transcatheter endomyocardial biopsies, we assessed myocardial mitochondrial oxidative capacity using high-resolution respirometry and myocardial mRNA expression of nuclear factor kappa B p105 subunit (NFKB1).
Results
GT and IFG/IGT patients exhibited comparable demographic and clinical characteristics, whereas T2DM had higher BMI, glycemia, triglycerides and creatine kinase (all p<0.05). None of systolic (p=0.99), diastolic cardiac function (p=0.81), myocardial NFKB1 expression (p=0.74), circulating oxidative stress markers (p=0.94 and 0.95) or cardiac T2 relaxation times (p=0.99) were altered in IFG/IGT compared to GT, but diastolic strainrate was impaired (p=0.03) and circulating oxidative stress (TBARS: p=0.03, redox potential: p=0.04) were higher in T2DM than in GT. However, myocardial mitochondrial function stood out to be already impaired in IFG/IGT to a similar extend as in T2DM. This particularly applied to substrates of mitochondrial complex I (GT vs. IFG/IGT vs. T2DM: 126±7 vs. 89±12 vs. 93±6 pmol s–1 mg–1. p=0.02) and II (188±13 vs. 123±17 vs. 138±11 pmol s–1 mg–1. p=0.02). Intrinsic uncoupling was not altered in IFG/IGT but tended to be higher in T2DM (leak control ratio: 0.49±0.02 vs. 0.46±0.06 vs. 0.57±0.04 [arbirary units]).
Conclusion
Our findings point towards mitochondrial impairment as a predecessor of overt heart failure in prediabetes and may represent an early footprint of prediabetic cardiomyopathy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Zweck
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - D Scheiber
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Dusseldorf , Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT) , Berlin , Germany
| | - M Kelm
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Dusseldorf , Germany
| | - M Roden
- German Diabetes Center, Leibniz Center for Diabetes Research, Institute for Clinical Diabetology , Dusseldorf , Germany
| | - J Szendroedi
- German Diabetes Center, Leibniz Center for Diabetes Research, Institute for Clinical Diabetology , Dusseldorf , Germany
| | - R Westenfeld
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Dusseldorf , Germany
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Affiliation(s)
- Heinz-Peter Schultheiss
- Department of Cardiology Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Moltkestr. 31, D-12203, Berlin, Germany
| | - Felicitas Escher
- Department of Cardiology Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Moltkestr. 31, D-12203, Berlin, Germany.,Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité-Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
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9
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Montera MW, Marcondes-Braga FG, Simões MV, Moura LAZ, Fernandes F, Mangine S, Oliveira Júnior ACD, Souza ALADAGD, Ianni BM, Rochitte CE, Mesquita CT, de Azevedo Filho CF, Freitas DCDA, Melo DTPD, Bocchi EA, Horowitz ESK, Mesquita ET, Oliveira GH, Villacorta H, Rossi Neto JM, Barbosa JMB, Figueiredo Neto JAD, Luiz LF, Hajjar LA, Beck-da-Silva L, Campos LADA, Danzmann LC, Bittencourt MI, Garcia MI, Avila MS, Clausell NO, Oliveira NAD, Silvestre OM, Souza OFD, Mourilhe-Rocha R, Kalil Filho R, Al-Kindi SG, Rassi S, Alves SMM, Ferreira SMA, Rizk SI, Mattos TAC, Barzilai V, Martins WDA, Schultheiss HP. Brazilian Society of Cardiology Guideline on Myocarditis - 2022. Arq Bras Cardiol 2022; 119:143-211. [PMID: 35830116 PMCID: PMC9352123 DOI: 10.36660/abc.20220412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Fabiana G Marcondes-Braga
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Marcus Vinícius Simões
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Fabio Fernandes
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Sandrigo Mangine
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Bárbara Maria Ianni
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | - Claudio Tinoco Mesquita
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil.,Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil.,Hospital Vitória, Rio de Janeiro, RJ - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Evandro Tinoco Mesquita
- Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil.,Centro de Ensino e Treinamento Edson de Godoy Bueno / UHG, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Ludhmila Abrahão Hajjar
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil.,Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Luis Beck-da-Silva
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | - Marcelo Imbroise Bittencourt
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brasil.,Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ - Brasil
| | - Marcelo Iorio Garcia
- Hospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | - Monica Samuel Avila
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University,Cleveland, Ohio - EUA
| | | | - Silvia Marinho Martins Alves
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil.,Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | - Silvia Moreira Ayub Ferreira
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Stéphanie Itala Rizk
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital Sírio Libanês, São Paulo, SP - Brasil
| | | | - Vitor Barzilai
- Instituto de Cardiologia do Distrito Federal, Brasília, DF - Brasil
| | - Wolney de Andrade Martins
- Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil.,DASA Complexo Hospitalar de Niterói, Niterói, RJ - Brasil
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10
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Hirsch VG, Schallhorn S, Zwadlo C, Diekmann J, Länger F, Jonigk DD, Kempf T, Schultheiss HP, Bauersachs J. Giant Cell Myocarditis after First Dose of BNT162b2 - a Case Report. Eur J Heart Fail 2022; 24:1319-1322. [PMID: 35733299 PMCID: PMC9350328 DOI: 10.1002/ejhf.2590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/27/2022] [Accepted: 06/19/2022] [Indexed: 11/10/2022] Open
Abstract
Herein we report the case of a young man, admitted to the Department of Cardiology and Angiology at Hannover Medical School with shortness of breath and elevated troponin. Few weeks earlier the patient received the first dose of BioNTech's mRNA vaccine (Comirnaty, BNT162b2). After diagnostic work‐up revealed giant cell myocarditis, the patient received immunosuppressive therapy. In the present context of myocarditis after mRNA vaccination we discuss this rare aetiology and the patient's treatment strategy in the light of current recommendations.
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Affiliation(s)
- V G Hirsch
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - S Schallhorn
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - C Zwadlo
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - J Diekmann
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - F Länger
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - D D Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - T Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany
| | - J Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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11
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Baumeier C, Aleshcheva G, Harms D, Gross U, Hamm C, Assmus B, Westenfeld R, Kelm M, Rammos S, Wenzel P, Münzel T, Elsässer A, Gailani M, Perings C, Bourakkadi A, Flesch M, Kempf T, Bauersachs J, Escher F, Schultheiss HP. Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series. Int J Mol Sci 2022; 23:ijms23136940. [PMID: 35805941 PMCID: PMC9266869 DOI: 10.3390/ijms23136940] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/20/2022] [Accepted: 06/21/2022] [Indexed: 12/11/2022] Open
Abstract
Myocarditis in response to COVID-19 vaccination has been reported since early 2021. In particular, young male individuals have been identified to exhibit an increased risk of myocardial inflammation following the administration of mRNA-based vaccines. Even though the first epidemiological analyses and numerous case reports investigated potential relationships, endomyocardial biopsy (EMB)-proven cases are limited. Here, we present a comprehensive histopathological analysis of EMBs from 15 patients with reduced ejection fraction (LVEF = 30 (14–39)%) and the clinical suspicion of myocarditis following vaccination with Comirnaty® (Pfizer-BioNTech) (n = 11), Vaxzevria® (AstraZenica) (n = 2) and Janssen® (Johnson & Johnson) (n = 2). Immunohistochemical EMB analyses reveal myocardial inflammation in 14 of 15 patients, with the histopathological diagnosis of active myocarditis according the Dallas criteria (n = 2), severe giant cell myocarditis (n = 2) and inflammatory cardiomyopathy (n = 10). Importantly, infectious causes have been excluded in all patients. The SARS-CoV-2 spike protein has been detected sparsely on cardiomyocytes of nine patients, and differential analysis of inflammatory markers such as CD4+ and CD8+ T cells suggests that the inflammatory response triggered by the vaccine may be of autoimmunological origin. Although a definitive causal relationship between COVID-19 vaccination and the occurrence of myocardial inflammation cannot be demonstrated in this study, data suggest a temporal connection. The expression of SARS-CoV-2 spike protein within the heart and the dominance of CD4+ lymphocytic infiltrates indicate an autoimmunological response to the vaccination.
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Affiliation(s)
- Christian Baumeier
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (D.H.); (U.G.); (F.E.); (H.-P.S.)
- Correspondence: ; Tel.: +49-30-8441-5543
| | - Ganna Aleshcheva
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (D.H.); (U.G.); (F.E.); (H.-P.S.)
| | - Dominik Harms
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (D.H.); (U.G.); (F.E.); (H.-P.S.)
| | - Ulrich Gross
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (D.H.); (U.G.); (F.E.); (H.-P.S.)
| | - Christian Hamm
- Kerckhoff Heart Center, Department of Cardiology, 61231 Bad Nauheim, Germany;
- Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, 35391 Gießen, Germany;
| | - Birgit Assmus
- Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, 35391 Gießen, Germany;
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (R.W.); (M.K.)
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (R.W.); (M.K.)
| | - Spyros Rammos
- Onassis Cardiac Surgery Center, 176 74 Athens, Greece;
| | - Philip Wenzel
- Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany; (P.W.); (T.M.)
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany; (P.W.); (T.M.)
| | - Albrecht Elsässer
- Department of Cardiology, Klinikum Oldenburg, 26133 Oldenburg, Germany;
| | | | - Christian Perings
- Department of Cardiology, St. Marien-Hospital, 44534 Lünen, Germany;
| | - Alae Bourakkadi
- Department of Internal Medicine, Cardiology, Geriatrics and Palliative Medicine, Gemeinschaftsklinikum Mittelrhein gGmbH, 56727 Mayen, Germany;
| | - Markus Flesch
- Department of Cardiology, Marienkrankenhaus gGmbH, 59494 Soest, Germany;
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany; (T.K.); (J.B.)
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany; (T.K.); (J.B.)
| | - Felicitas Escher
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (D.H.); (U.G.); (F.E.); (H.-P.S.)
- Department of Cardiology, Campus Virchow-Klinikum, Charité University Medicine Berlin, 13353 Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
| | - Heinz-Peter Schultheiss
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (D.H.); (U.G.); (F.E.); (H.-P.S.)
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12
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Poller W, Escher F, Haas J, Heidecker B, Schultheiss HP, Attanasio P, Skurk C, Haghikia A, Meder B, Klaassen S. Missense Variant E1295K of Sodium Channel SCN5A Associated With Recurrent Ventricular Fibrillation and Myocardial Inflammation. JACC Case Rep 2022; 4:280-286. [PMID: 35257103 PMCID: PMC8897185 DOI: 10.1016/j.jaccas.2022.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/14/2022] [Indexed: 12/21/2022]
Abstract
SCN5A was considered an exclusively cardiac expressed ion channel but discovered to also act as a novel innate immune sensor. We report on a young SCN5A variant carrier with recurrent ventricular fibrillation and massive myocardial inflammation whose peculiar clinical course is highly suggestive of such a dual role of SCN5A. (Level of Difficulty: Advanced.)
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Key Words
- CAD, coronary artery disease
- CMP, cardiomyopathy
- DCM, dilated cardiomyopathy
- EMB, endomyocardial biopsy
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- LVMi, left ventricular mass index
- MRI, magnetic resonance imaging
- PBMC, peripheral blood mononuclear cells
- PCR, polymerase chain reaction
- RT-PCR, reverse transcriptase polymerase chain reaction
- SCD, sudden cardiac death
- SCN5A, sodium voltage-gated channel alpha subunit 5
- VES, ventricular extrasystole
- VF, ventricular fibrillation
- VT, ventricular tachycardia
- inflammation
- innate immune response
- ion channel diseases
- ion channel functions
- variant screening
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Affiliation(s)
- Wolfgang Poller
- Department of Cardiology, Campus Benjamin Franklin, Charité Centrum 11, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Felicitas Escher
- Department of Cardiology, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Institute for Clinical Diagnostics and Therapy (IKDT), Berlin, Germany
| | - Jan Haas
- Department of Cardiology, University Hospital Heidelberg, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Heidelberg, Germany
| | - Bettina Heidecker
- Department of Cardiology, Campus Benjamin Franklin, Charité Centrum 11, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | | | - Philipp Attanasio
- Department of Cardiology, Campus Benjamin Franklin, Charité Centrum 11, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Campus Benjamin Franklin, Charité Centrum 11, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Arash Haghikia
- Department of Cardiology, Campus Benjamin Franklin, Charité Centrum 11, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Benjamin Meder
- Department of Cardiology, University Hospital Heidelberg, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Heidelberg, Germany.,Department of Genetics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sabine Klaassen
- German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Department of Pediatric Cardiology, Charité-Universitätsmedizen, Berlin, Germany.,Experimental and Clinical Research Center (ECRC), Berlin, Germany
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13
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Escher F, Aleshcheva G, Pietsch H, Baumeier C, Gross UM, Schrage BN, Westermann D, Bock CT, Schultheiss HP. Transcriptional Active Parvovirus B19 Infection Predicts Adverse Long-Term Outcome in Patients with Non-Ischemic Cardiomyopathy. Biomedicines 2021; 9:biomedicines9121898. [PMID: 34944716 PMCID: PMC8698988 DOI: 10.3390/biomedicines9121898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/22/2021] [Accepted: 12/10/2021] [Indexed: 12/11/2022] Open
Abstract
Parvovirus B19 (B19V) is the predominant cardiotropic virus currently found in endomyocardial biopsies (EMBs). However, direct evidence showing a causal relationship between B19V and progression of inflammatory cardiomyopathy are still missing. The aim of this study was to analyze the impact of transcriptionally active cardiotropic B19V infection determined by viral RNA expression upon long-term outcomes in a large cohort of adult patients with non-ischemic cardiomyopathy in a retrospective analysis from a prospective observational cohort. In total, the analyzed study group comprised 871 consecutive B19V-positive patients (mean age 50.0 ± 15.0 years) with non-ischemic cardiomyopathy who underwent EMB. B19V-positivity was ascertained by routine diagnosis of viral genomes in EMBs. Molecular analysis of EMB revealed positive B19V transcriptional activity in n = 165 patients (18.9%). Primary endpoint was all-cause mortality in the overall cohort. The patients were followed up to 60 months. On the Cox regression analysis, B19V transcriptional activity was predictive of a worse prognosis compared to those without actively replicating B19V (p = 0.01). Moreover, multivariable analysis revealed transcriptional active B19V combined with inflammation [hazard ratio 4.013, 95% confidence interval 1.515–10.629 (p = 0.005)] as the strongest predictor of impaired survival even after adjustment for age and baseline LVEF (p = 0.005) and independently of viral load. The study demonstrates for the first time the pathogenic clinical importance of B19V with transcriptional activity in a large cohort of patients. Transcriptionally active B19V infection is an unfavourable prognostic trigger of adverse outcome. Our findings are of high clinical relevance, indicating that advanced diagnostic differentiation of B19V positive patients is of high prognostic importance.
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Affiliation(s)
- Felicitas Escher
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (H.P.); (C.B.); (U.M.G.); (H.-P.S.)
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 13353 Berlin, Germany
- Correspondence:
| | - Ganna Aleshcheva
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (H.P.); (C.B.); (U.M.G.); (H.-P.S.)
| | - Heiko Pietsch
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (H.P.); (C.B.); (U.M.G.); (H.-P.S.)
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 13353 Berlin, Germany
| | - Christian Baumeier
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (H.P.); (C.B.); (U.M.G.); (H.-P.S.)
| | - Ulrich M. Gross
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (H.P.); (C.B.); (U.M.G.); (H.-P.S.)
| | - Benedikt Norbert Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, 20246 Hamburg, Germany; (B.N.S.); (D.W.)
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, 20246 Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, 20246 Hamburg, Germany; (B.N.S.); (D.W.)
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, 20246 Hamburg, Germany
| | - Claus-Thomas Bock
- Department of Infectious Diseases, Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Robert Koch Institute, 13353 Berlin, Germany;
- Institute of Tropical Medicine, University of Tuebingen, 72074 Tuebingen, Germany
| | - Heinz-Peter Schultheiss
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (G.A.); (H.P.); (C.B.); (U.M.G.); (H.-P.S.)
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14
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Schultheiss HP, Baumeier C, Aleshcheva G, Bock CT, Escher F. Viral Myocarditis-From Pathophysiology to Treatment. J Clin Med 2021; 10:jcm10225240. [PMID: 34830522 PMCID: PMC8623269 DOI: 10.3390/jcm10225240] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 12/17/2022] Open
Abstract
The diagnosis of acute and chronic myocarditis remains a challenge for clinicians. Characterization of this disease has been hampered by its diverse etiologies and heterogeneous clinical presentations. Most cases of myocarditis are caused by infectious agents. Despite successful research in the last few years, the pathophysiology of viral myocarditis and its sequelae leading to severe heart failure with a poor prognosis is not fully understood and represents a significant public health issue globally. Most likely, at a certain point, besides viral persistence, several etiological types merge into a common pathogenic autoimmune process leading to chronic inflammation and tissue remodeling, ultimately resulting in the clinical phenotype of dilated cardiomyopathy. Understanding the underlying molecular mechanisms is necessary to assess the prognosis of patients and is fundamental to appropriate specific and personalized therapeutic strategies. To reach this clinical prerequisite, there is the need for advanced diagnostic tools, including an endomyocardial biopsy and guidelines to optimize the management of this disease. The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has currently led to the worst pandemic in a century and has awakened a special sensitivity throughout the world to viral infections. This work aims to summarize the pathophysiology of viral myocarditis, advanced diagnostic methods and the current state of treatment options.
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Affiliation(s)
| | - Christian Baumeier
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany
| | - Ganna Aleshcheva
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany
| | - C-Thomas Bock
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
- Institute of Tropical Medicine, University of Tuebingen, 72074 Tuebingen, Germany
| | - Felicitas Escher
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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15
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Koenig T, Kempf T, Schultheiss HP, Cornberg M, Bauersachs J, Schäfer A. Fulminant parvovirus B19 myocarditis after chemotherapy: full recovery after antiviral therapy with tenofovir. Clin Res Cardiol 2021; 111:233-236. [PMID: 34669016 PMCID: PMC8816788 DOI: 10.1007/s00392-021-01955-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Tobias Koenig
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Andreas Schäfer
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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16
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Bräuninger H, Stoffers B, Fitzek ADE, Meißner K, Aleshcheva G, Schweizer M, Weimann J, Rotter B, Warnke S, Edler C, Braun F, Roedl K, Scherschel K, Escher F, Kluge S, Huber TB, Ondruschka B, Schultheiss HP, Kirchhof P, Blankenberg S, Püschel K, Westermann D, Lindner D. Cardiac SARS-CoV-2 infection is associated with pro-inflammatory transcriptomic alterations within the heart. Cardiovasc Res 2021; 118:542-555. [PMID: 34647998 PMCID: PMC8803085 DOI: 10.1093/cvr/cvab322] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022] Open
Abstract
Aims Cardiac involvement in COVID-19 is associated with adverse outcome. However, it is unclear whether cell-specific consequences are associated with cardiac SARS-CoV-2 infection. Therefore, we investigated heart tissue utilizing in situ hybridization, immunohistochemistry, and RNA-sequencing in consecutive autopsy cases to quantify virus load and characterize cardiac involvement in COVID-19. Methods and results In this study, 95 SARS-CoV-2-positive autopsy cases were included. A relevant SARS-CoV-2 virus load in the cardiac tissue was detected in 41/95 deceased (43%). Massive analysis of cDNA ends (MACE)-RNA-sequencing was performed to identify molecular pathomechanisms caused by the infection of the heart. A signature matrix was generated based on the single-cell dataset ‘Heart Cell Atlas’ and used for digital cytometry on the MACE-RNA-sequencing data. Thus, immune cell fractions were estimated and revealed no difference in immune cell numbers in cases with and without cardiac infection. This result was confirmed by quantitative immunohistological diagnosis. MACE-RNA-sequencing revealed 19 differentially expressed genes (DEGs) with a q-value <0.05 (e.g. up: IFI44L, IFT3, TRIM25; down: NPPB, MB, MYPN). The upregulated DEGs were linked to interferon pathways and originate predominantly from endothelial cells. In contrast, the downregulated DEGs originate predominately from cardiomyocytes. Immunofluorescent staining showed viral protein in cells positive for the endothelial marker ICAM1 but rarely in cardiomyocytes. The Gene Ontology (GO) term analysis revealed that downregulated GO terms were linked to cardiomyocyte structure, whereas upregulated GO terms were linked to anti-virus immune response. Conclusion This study reveals that cardiac infection induced transcriptomic alterations mainly linked to immune response and destruction of cardiomyocytes. While endothelial cells are primarily targeted by the virus, we suggest cardiomyocyte destruction by paracrine effects. Increased pro-inflammatory gene expression was detected in SARS-CoV-2-infected cardiac tissue but no increased SARS-CoV-2 associated immune cell infiltration was observed.
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Affiliation(s)
- Hanna Bräuninger
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Hamburg/Kiel, Lübeck, /
| | - Bastian Stoffers
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Hamburg/Kiel, Lübeck, /
| | - Antonia D E Fitzek
- Institute of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Germany
| | - Kira Meißner
- Institute of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Germany
| | | | - Michaela Schweizer
- Department of Electron Microscopy, Centre for Molecular Neurobiology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Germany
| | - Björn Rotter
- GenXPro GmbH, Frankfurter Innovationszentrum, Biotechnologie (FIZ), Frankfurt am Main, Germany
| | - Svenja Warnke
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Germany
| | - Carolin Edler
- Institute of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Germany
| | - Fabian Braun
- III. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Germany
| | - Kevin Roedl
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Germany
| | - Katharina Scherschel
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Germany.,Division of Cardiology (cNEP), EVK Düsseldorf, Germany.,Institute of Neural and Sensory Physiology, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | - Felicitas Escher
- Institute for Cardiac Diagnostics and Therapy, Berlin, Germany.,Department of Cardiology, Charité-Universitaetsmedizin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Germany
| | - Tobias B Huber
- III. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Germany
| | | | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Hamburg/Kiel, Lübeck, /.,Institute of Cardiovascular Sciences, University of Birmingham, UK
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Hamburg/Kiel, Lübeck, /
| | - Klaus Püschel
- Institute of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Hamburg/Kiel, Lübeck, /
| | - Diana Lindner
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Hamburg/Kiel, Lübeck, /
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17
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Baumeier C, Escher F, Pietsch H, Aleshcheva G, Schultheiss HP. Plasminogen activator inhibitor-1 (PAI-1) is anti-fibrogenic in human inflammatory cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Preclinical data indicate that plasminogen activator inhibitor-1 (PAI-1) is cardioprotective by repressing cardiac fibrosis through TGF-β and plasminogen mediated pathways. In addition it is linked to the recruitment and polarization of non-classical M2 macrophages in cancer.
Purpose
The role of cardiac PAI-1 in fibrogenesis and macrophage polarization is investigated in patients with dilated cardiomyopathy (DCM) and inflammatory dilated cardiomyopathy (DCMi).
Methods
We retrospectively analyzed endomyocardial biopsies (EMBs) of patients with DCM (n=27) and DCMi (n=149) for PAI-1 expression, number of activated myofibroblasts and M1/M2 macrophage polarization.
Results
Patients with high-grade DCMi (DCMi-high, CD3+ lymphocytes >30 cells/mm2) had significantly increased PAI-1 levels compared to DCM and low grade DCMi patients (DCMi-low, CD3+ lymphocytes = 14 - 30 cells/mm2) (15.5±0.4% vs. 1.0±0.1% and 4.0±0.1%, p≤0.001). Elevated PAI-1 expression in DCMi-high subjects was accompanied by a reduced number of alpha smooth muscle actin (α-SMA) positive myofibroblasts and an increased number of CD16+ CD68+ M2 macrophages, indicating anti-fibrogenic and M2 macrophage-favoring properties of PAI-1 in DCMi.
Conclusion
Our findings give evidence that elevated expression of PAI-1 suppresses cardiac fibrosis and promotes M2 macrophage polarization. Thus, PAI-1 could serve as a potential prognostic biomarker of cardiac fibrosis and inflammation, as well as possible therapeutic target in inflammatory cardiomyopathies.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ERA-Net on Cardiovascular Diseases (ERA-CVD) of the German Research Foundation (DFG)Transregional Collaborative Research Center “Inflammatory Cardiomyopathy-Molecular Pathogenesis and Therapy”
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Affiliation(s)
- C Baumeier
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - F Escher
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - H Pietsch
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - G Aleshcheva
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
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18
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Schultheiss HP, Baumeier C, Pietsch H, Bock CT, Poller W, Escher F. Cardiovascular consequences of viral infections: from COVID to other viral diseases. Cardiovasc Res 2021; 117:2610-2623. [PMID: 34609508 PMCID: PMC8500164 DOI: 10.1093/cvr/cvab315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/28/2021] [Indexed: 12/15/2022] Open
Abstract
Infection of the heart muscle with cardiotropic viruses is one of the major aetiologies of myocarditis and acute and chronic inflammatory cardiomyopathy (DCMi). However, viral myocarditis and subsequent dilated cardiomyopathy is still a challenging disease to diagnose and to treat and is therefore a significant public health issue globally. Advances in clinical examination and thorough molecular genetic analysis of intramyocardial viruses and their activation status have incrementally improved our understanding of molecular pathogenesis and pathophysiology of viral infections of the heart muscle. To date, several cardiotropic viruses have been implicated as causes of myocarditis and DCMi. These include, among others, classical cardiotropic enteroviruses (Coxsackieviruses B), the most commonly detected parvovirus B19, and human herpes virus 6. A newcomer is the respiratory virus that has triggered the worst pandemic in a century, SARS-CoV-2, whose involvement and impact in viral cardiovascular disease is under scrutiny. Despite extensive research into the pathomechanisms of viral infections of the cardiovascular system, our knowledge regarding their treatment and management is still incomplete. Accordingly, in this review, we aim to explore and summarize the current knowledge and available evidence on viral infections of the heart. We focus on diagnostics, clinical relevance and cardiovascular consequences, pathophysiology, and current and novel treatment strategies.
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Affiliation(s)
| | - Christian Baumeier
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany
| | - Heiko Pietsch
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany.,Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany, partner site
| | - C Thomas Bock
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, 13353 Germany.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Wolfgang Poller
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany, partner site.,Department of Cardiology, Campus Benjamin Franklin.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Felicitas Escher
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany.,Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany, partner site
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19
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Scheiber D, Zweck E, Albermann S, Jelenik T, Spieker M, Bönner F, Horn P, Schultheiss HP, Aleshcheva G, Escher F, Boeken U, Akhyari P, Roden M, Kelm M, Szendroedi J, Westenfeld R. Human myocardial mitochondrial oxidative capacity is impaired in mild acute heart transplant rejection. ESC Heart Fail 2021; 8:4674-4684. [PMID: 34490749 PMCID: PMC8712779 DOI: 10.1002/ehf2.13607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Acute cellular rejection (ACR) following heart transplantation (HTX) is associated with long‐term graft loss and increased mortality. Disturbed mitochondrial bioenergetics have been identified as pathophysiological drivers in heart failure, but their role in ACR remains unclear. We aimed to prove functional disturbances of myocardial bioenergetics in human heart transplant recipients with mild ACR by assessing myocardial mitochondrial respiration using high‐resolution respirometry, digital image analysis of myocardial inflammatory cell infiltration, and clinical assessment of HTX patients. We hypothesized that (i) mild ACR is associated with impaired myocardial mitochondrial respiration and (ii) myocardial inflammation, systemic oxidative stress, and myocardial oedema relate to impaired mitochondrial respiration and myocardial dysfunction. Methods and results We classified 35 HTX recipients undergoing endomyocardial biopsy according International Society for Heart and Lung Transplantation criteria to have no (0R) or mild (1R) ACR. Additionally, we quantified immune cell infiltration by immunohistochemistry and digital image analysis. We analysed mitochondrial substrate utilization in myocardial fibres by high‐resolution respirometry and performed cardiovascular magnetic resonance (CMR). ACR (1R) was diagnosed in 12 patients (34%), while the remaining 23 patients revealed no signs of ACR (0R). Underlying cardiomyopathies (dilated cardiomyopathy 50% vs. 65%; P = 0.77), comorbidities (type 2 diabetes mellitus: 50% vs. 35%, P = 0.57; chronic kidney disease stage 5: 8% vs. 9%, P > 0.99; arterial hypertension: 59% vs. 30%, P = 0.35), medications (tacrolimus: 100% vs. 91%, P = 0.54; mycophenolate mofetil: 92% vs. 91%, P > 0.99; prednisolone: 92% vs. 96%, P > 0.99) and time post‐transplantation (21.5 ± 26.0 months vs. 29.4 ± 26.4 months, P = 0.40) were similar between groups. Mitochondrial respiration was reduced by 40% in ACR (1R) compared with ACR (0R) (77.8 ± 23.0 vs. 128.0 ± 33.0; P < 0.0001). Quantitative assessment of myocardial CD3+‐lymphocyte infiltration identified ACR (1R) with a cut‐off of >14 CD3+‐lymphocytes/mm2 (100% sensitivity, 82% specificity; P < 0.0001). Myocardial CD3+ infiltration (r = −0.41, P < 0.05), systemic oxidative stress (thiobarbituric acid reactive substances; r = −0.42, P < 0.01) and myocardial oedema depicted by global CMR derived T2 time (r = −0.62, P < 0.01) correlated with lower oxidative capacity and overt cardiac dysfunction (global longitudinal strain; r = −0.63, P < 0.01). Conclusions Mild ACR with inflammatory cell infiltration associates with impaired mitochondrial bioenergetics in cardiomyocytes. Our findings may help to identify novel checkpoints in cardiac immune metabolism as potential therapeutic targets in post‐transplant care.
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Affiliation(s)
- Daniel Scheiber
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Moorenstraße 5, Düsseldorf, 40225, Germany.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany
| | - Elric Zweck
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Moorenstraße 5, Düsseldorf, 40225, Germany.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany
| | - Sophie Albermann
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Moorenstraße 5, Düsseldorf, 40225, Germany.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany
| | - Tomas Jelenik
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany
| | - Maximilian Spieker
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Florian Bönner
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Moorenstraße 5, Düsseldorf, 40225, Germany
| | | | - Ganna Aleshcheva
- Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - Felicitas Escher
- Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich-Heine University, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Moorenstraße 5, Düsseldorf, 40225, Germany.,Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,Department of Internal Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany.,Institute for Diabetes and Cancer (IDC) & Joint Heidelberg-IDC Translational Diabetes Program, Helmholtz Center Munich, Neuherberg, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Moorenstraße 5, Düsseldorf, 40225, Germany
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20
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Yergöz F, Friebel J, Kränkel N, Rauch-Kroehnert U, Schultheiss HP, Landmesser U, Dörner A. Adenine Nucleotide Translocase 1 Expression Modulates the Immune Response in Ischemic Hearts. Cells 2021; 10:cells10082130. [PMID: 34440901 PMCID: PMC8393693 DOI: 10.3390/cells10082130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Adenine nucleotide translocase 1 (ANT1) transfers ATP and ADP over the mitochondrial inner membrane and thus supplies the cell with energy. This study analyzed the role of ANT1 in the immune response of ischemic heart tissue. Ischemic ANT1 overexpressing hearts experienced a shift toward an anti-inflammatory immune response. The shift was characterized by low interleukin (IL)-1β expression and M1 macrophage infiltration, whereas M2 macrophage infiltration and levels of IL-10, IL-4, and transforming growth factor (TGFβ) were increased. The modulated immune response correlated with high mitochondrial integrity, reduced oxidative stress, low left ventricular end-diastolic heart pressure, and a high survival rate. Isolated ANT1-transgenic (ANT1-TG) cardiomyocytes expressed low levels of pro-inflammatory cytokines such as IL-1α, tumor necrosis factor α, and TGFβ. However, they showed increased expression and cellular release of anti-inflammatory immunomodulators such as vascular endothelial growth factor. The secretome from ANT1-TG cardiomyocytes initiated stress resistance when applied to ischemic wild-type cardiomyocytes and endothelial cells. It additionally prevented macrophages from expressing pro-inflammatory cytokines. Additionally, ANT1 expression correlated with genes that are related to cytokine and growth factor pathways in hearts of patients with ischemic cardiomyopathy. In conclusion, ANT1-TG cardiomyocytes secrete soluble factors that influence ischemic cardiac cells and initiate an anti-inflammatory immune response in ischemic hearts.
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Affiliation(s)
- Fatih Yergöz
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12200 Berlin, Germany; (F.Y.); (J.F.); (N.K.); (U.R.-K.); (U.L.)
- Institute of Health Center for Regenerative Therapies (BCRT), Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Julian Friebel
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12200 Berlin, Germany; (F.Y.); (J.F.); (N.K.); (U.R.-K.); (U.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Nicolle Kränkel
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12200 Berlin, Germany; (F.Y.); (J.F.); (N.K.); (U.R.-K.); (U.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Ursula Rauch-Kroehnert
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12200 Berlin, Germany; (F.Y.); (J.F.); (N.K.); (U.R.-K.); (U.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | | | - Ulf Landmesser
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12200 Berlin, Germany; (F.Y.); (J.F.); (N.K.); (U.R.-K.); (U.L.)
- Institute of Health Center for Regenerative Therapies (BCRT), Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Andrea Dörner
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12200 Berlin, Germany; (F.Y.); (J.F.); (N.K.); (U.R.-K.); (U.L.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-513-727
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21
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Aswad A, Aimola G, Wight D, Roychoudhury P, Zimmermann C, Hill J, Lassner D, Xie H, Huang ML, Parrish NF, Schultheiss HP, Venturini C, Lager S, Smith GCS, Charnock-Jones DS, Breuer J, Greninger AL, Kaufer BB. Evolutionary History of Endogenous Human Herpesvirus 6 Reflects Human Migration out of Africa. Mol Biol Evol 2021; 38:96-107. [PMID: 32722766 PMCID: PMC7782865 DOI: 10.1093/molbev/msaa190] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Human herpesvirus 6A and 6B (HHV-6) can integrate into the germline, and as a result, ∼70 million people harbor the genome of one of these viruses in every cell of their body. Until now, it has been largely unknown if 1) these integrations are ancient, 2) if they still occur, and 3) whether circulating virus strains differ from integrated ones. Here, we used next-generation sequencing and mining of public human genome data sets to generate the largest and most diverse collection of circulating and integrated HHV-6 genomes studied to date. In genomes of geographically dispersed, only distantly related people, we identified clades of integrated viruses that originated from a single ancestral event, confirming this with fluorescent in situ hybridization to directly observe the integration locus. In contrast to HHV-6B, circulating and integrated HHV-6A sequences form distinct clades, arguing against ongoing integration of circulating HHV-6A or “reactivation” of integrated HHV-6A. Taken together, our study provides the first comprehensive picture of the evolution of HHV-6, and reveals that integration of heritable HHV-6 has occurred since the time of, if not before, human migrations out of Africa.
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Affiliation(s)
- Amr Aswad
- Institut für Virologie, Freie Universität Berlin, Berlin, Germany
| | - Giulia Aimola
- Institut für Virologie, Freie Universität Berlin, Berlin, Germany
| | - Darren Wight
- Institut für Virologie, Freie Universität Berlin, Berlin, Germany
| | - Pavitra Roychoudhury
- Department of Laboratory Medicine, University of Washington, Seattle, WA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Centre, Seattle, WA
| | | | - Joshua Hill
- Department of Laboratory Medicine, University of Washington, Seattle, WA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Centre, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Dirk Lassner
- HighTech Center, Vinmec Hospital, Hanoi, Vietnam.,Institut Kardiale Diagnostik und Therapie, Berlin, Germany
| | - Hong Xie
- Department of Laboratory Medicine, University of Washington, Seattle, WA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Centre, Seattle, WA
| | - Meei-Li Huang
- Department of Laboratory Medicine, University of Washington, Seattle, WA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Centre, Seattle, WA
| | - Nicholas F Parrish
- Genome Immunobiology RIKEN Hakubi Research Team, RIKEN Cluster for Pioneering Research, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | | | - Cristina Venturini
- Division of Infection and Immunity, UCL Research Department of Infection, UCL, London, United Kingdom
| | - Susanne Lager
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Obstetrics and Gynaecology, Cambridge University, United Kingdom
| | - Gordon C S Smith
- Department of Obstetrics and Gynaecology, Cambridge University, United Kingdom
| | | | - Judith Breuer
- Division of Infection and Immunity, UCL Research Department of Infection, UCL, London, United Kingdom
| | - Alexander L Greninger
- Department of Laboratory Medicine, University of Washington, Seattle, WA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Centre, Seattle, WA
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22
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Zweck E, Scheiber D, Jelenik T, Bönner F, Horn P, Pesta D, Schultheiss HP, Boeken U, Akhyari P, Lichtenberg A, Kelm M, Roden M, Westenfeld R, Szendroedi J. Exposure to Type 2 Diabetes Provokes Mitochondrial Impairment in Apparently Healthy Human Hearts. Diabetes Care 2021; 44:e82-e84. [PMID: 33972315 PMCID: PMC8132329 DOI: 10.2337/dc20-2255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/24/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Elric Zweck
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Partner Düsseldorf, Germany.,Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Daniel Scheiber
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Partner Düsseldorf, Germany.,Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Tomas Jelenik
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Partner Düsseldorf, Germany
| | - Florian Bönner
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Dominik Pesta
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Partner Düsseldorf, Germany
| | | | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Partner Düsseldorf, Germany.,Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine University, Düsseldorf, Germany .,German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Partner Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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23
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Schwuchow-Thonke S, Göbel S, Emrich T, Schmitt VH, Fueting F, Klank C, Escher F, Schultheiss HP, Münzel T, Keller K, Wenzel P. Increased C reactive protein, cardiac troponin I and GLS are associated with myocardial inflammation in patients with non-ischemic heart failure. Sci Rep 2021; 11:3008. [PMID: 33542341 PMCID: PMC7862434 DOI: 10.1038/s41598-021-82592-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 01/18/2021] [Indexed: 11/09/2022] Open
Abstract
Inflammatory cardiomyopathy diagnosed by endomyocardial biopsy (EMB) is common in non-ischemic heart failure (HF) and might be associated with adverse outcome. We aimed to identify markers predicting myocardial inflammation in HF. We screened 517 patients with symptomatic non-ischemic HF who underwent EMB; 397 patients (median age 54 [IQR 43/64], 28.7% females) were included in this study. 230 patients were diagnosed with myocardial inflammation, defined as ≥ 7.0 CD3+ lymphocytes/mm2 and/or ≥ 35.0 Mac1 macrophages/mm2 and were compared to 167 inflammation negative patients. Patients with myocardial inflammation were more often smokers (52.4% vs. 39.8%, p = 0.013) and had higher C-reactive protein (CRP) levels (5.4 mg/dl vs. 3.7 mg/dl, p = 0.003). In logistic regression models CRP ≥ 8.15 mg/dl (OR 1.985 [95%CI 1.160–3.397]; p = 0.012) and Troponin I (TnI) ≥ 136.5 pg/ml (OR 3.011 [1.215–7.464]; p = 0.017) were independently associated with myocardial inflammation, whereas no association was found for elevated brain natriuretic peptide (OR 1.811 [0.873–3.757]; p = 0.111). In prognostic performance calculation the highest positive predictive value (90%) was detected for the combination of Global longitudinal strain (GLS) ≥ -13.95% and TnI ≥ 136.5 pg/ml (0.90 (0.74–0.96)). Elevated CRP, TnI and GLS in combination with TnI can be useful to detect myocardial inflammation. Smoking seems to predispose for myocardial inflammation.
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Affiliation(s)
- S Schwuchow-Thonke
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - S Göbel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - T Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Mainz, Germany
| | - V H Schmitt
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - F Fueting
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - C Klank
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - F Escher
- Departement of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
| | - H P Schultheiss
- Institut Kardiale Diagnostik Und Therapie (IKDT), Moltkestrasse 31, 12203, Berlin, Germany
| | - T Münzel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - K Keller
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - P Wenzel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany. .,Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.
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24
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Pietsch H, Escher F, Aleshcheva G, Lassner D, Bock CT, Schultheiss HP. Detection of parvovirus mRNAs as markers for viral activity in endomyocardial biopsy-based diagnosis of patients with unexplained heart failure. Sci Rep 2020; 10:22354. [PMID: 33339949 PMCID: PMC7749156 DOI: 10.1038/s41598-020-78597-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 11/22/2020] [Indexed: 12/16/2022] Open
Abstract
Erythroparvovirus (B19V) genomes have been detected in various organs of infected individuals including endothelial cells of the heart muscle. However, the role of B19V as a causative pathogen of myocardial damage is still unknown. The majority of reports focus on the presence of viral DNA ignoring proof of viral RNAs as important markers for viral activity. During this study, we established (RT-) qPCR to characterize expression of B19V RNAs (NS1 and VP1/2) in endomyocardial biopsies (EMBs) of 576 patients with unexplained heart failure. 403/576 (70%) EMBs were positive for B19V DNA. B19V mRNAs NS1 and/or VP1/2, indicating viral activity, could be detected in 38.5% of B19V DNA positive samples using the newly established B19V RT-PCRs. 22.1% of samples were characterized by only NS1 mRNA detection while 6.0% revealed only VP1/2 mRNA expression. Detection of both intermediates was successful in 10.4% of samples. Applying the molecular testing, our study revealed that a high proportion (38.5%) of B19V DNA positive EMBs was characterized by viral transcriptional activity. Further prospective studies will evaluate relevance of viral transcription intermediates as a diagnostic marker to differentiate between latent B19V infection and clinically relevant transcriptionally active B19V-infection of the heart muscle.
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Affiliation(s)
- Heiko Pietsch
- IKDT Institute of Cardiac Diagnostics and Therapy GmbH, Moltkestrasse 31, 12203, Berlin, Germany.,Department of Cardiology, Campus Rudolf Virchow, Charité-University Medicine Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Felicitas Escher
- IKDT Institute of Cardiac Diagnostics and Therapy GmbH, Moltkestrasse 31, 12203, Berlin, Germany.,Department of Cardiology, Campus Rudolf Virchow, Charité-University Medicine Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Ganna Aleshcheva
- IKDT Institute of Cardiac Diagnostics and Therapy GmbH, Moltkestrasse 31, 12203, Berlin, Germany
| | - Dirk Lassner
- IKDT Institute of Cardiac Diagnostics and Therapy GmbH, Moltkestrasse 31, 12203, Berlin, Germany
| | - Claus-Thomas Bock
- IKDT Institute of Cardiac Diagnostics and Therapy GmbH, Moltkestrasse 31, 12203, Berlin, Germany
| | - Heinz-Peter Schultheiss
- IKDT Institute of Cardiac Diagnostics and Therapy GmbH, Moltkestrasse 31, 12203, Berlin, Germany.
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25
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Lindner D, Fitzek A, Bräuninger H, Aleshcheva G, Edler C, Meissner K, Scherschel K, Kirchhof P, Escher F, Schultheiss HP, Blankenberg S, Püschel K, Westermann D. Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases. JAMA Cardiol 2020; 5:1281-1285. [PMID: 32730555 DOI: 10.1001/jamacardio.2020.3551] [Citation(s) in RCA: 537] [Impact Index Per Article: 134.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be documented in various tissues, but the frequency of cardiac involvement as well as possible consequences are unknown. Objective To evaluate the presence of SARS-CoV-2 in the myocardial tissue from autopsy cases and to document a possible cardiac response to that infection. Design, Setting, and Participants This cohort study used data from consecutive autopsy cases from Germany between April 8 and April 18, 2020. All patients had tested positive for SARS-CoV-2 in pharyngeal swab tests. Exposures Patients who died of coronavirus disease 2019. Main Outcomes and Measures Incidence of SARS-CoV-2 positivity in cardiac tissue as well as CD3+, CD45+, and CD68+ cells in the myocardium and gene expression of tumor necrosis growth factor α, interferon γ, chemokine ligand 5, as well as interleukin-6, -8, and -18. Results Cardiac tissue from 39 consecutive autopsy cases were included. The median (interquartile range) age of patients was 85 (78-89) years, and 23 (59.0%) were women. SARS-CoV-2 could be documented in 24 of 39 patients (61.5%). Viral load above 1000 copies per μg RNA could be documented in 16 of 39 patients (41.0%). A cytokine response panel consisting of 6 proinflammatory genes was increased in those 16 patients compared with 15 patients without any SARS-CoV-2 in the heart. Comparison of 15 patients without cardiac infection with 16 patients with more than 1000 copies revealed no inflammatory cell infiltrates or differences in leukocyte numbers per high power field. Conclusions and Relevance In this analysis of autopsy cases, viral presence within the myocardium could be documented. While a response to this infection could be reported in cases with higher virus load vs no virus infection, this was not associated with an influx of inflammatory cells. Future investigations should focus on evaluating the long-term consequences of this cardiac involvement.
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Affiliation(s)
- Diana Lindner
- Department of Cardiology, University Heart and Vascular Centre, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany
| | - Antonia Fitzek
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Bräuninger
- Department of Cardiology, University Heart and Vascular Centre, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany
| | | | - Caroline Edler
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kira Meissner
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Scherschel
- Department of Cardiology, University Heart and Vascular Centre, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Centre, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany
| | - Felicitas Escher
- Institute for Cardiac Diagnostics and Therapy, Berlin, Germany.,Department of Cardiology, Charité Campus Virchow-Klinikum, University Medicine Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | | | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Centre, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Centre, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany
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26
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Aleshcheva G, Pietsch H, Escher F, Schultheiss HP. MicroRNA profiling as a novel diagnostic tool for identification of patients with inflammatory and/or virally induced cardiomyopathies. ESC Heart Fail 2020; 8:408-422. [PMID: 33215881 PMCID: PMC7835602 DOI: 10.1002/ehf2.13090] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 10/07/2020] [Accepted: 10/22/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS MicroRNAs (miRNAs) might be used as prospective biomarkers for the identification of unexplained heart failure caused by a viral and/or inflammatory process. The aim of this study was to identify and to evaluate prognostic miRNAs in serum of patients with inflammatory heart diseases diagnosed by endomyocardial biopsies. METHODS AND RESULTS After TaqMan® OpenArray® screening of 754 unique circulating miRNAs in serum of biopsy-proven patients [184 patients with inflammatory and/or virally induced myocardial diseases (DCMi), 25 patients with dilated cardiomyopathy (DCM), and 25 healthy donors], we identified seven miRNAs of interest (P < 0.05). These data have been verified by single qRT-PCR assays in other biopsy-proven patients (159 patients with viral and/or inflammatory myocardial diseases, 46 patients with DCM, and 60 healthy donors). The expression of let-7f, miR-197, miR-223, miR-93, and miR-379 allowed us to differentiate between patients with a virus and/or inflammation and healthy donors (P < 0.05) with the specificity over 93%. Based on the expression of miR-21 and miR-30a-5p, we could sort out patients with DCM from all other study groups (P < 0.05) with the specificity over 95%. CONCLUSIONS This miRNA profile provides for the first time a new non-invasive diagnostic perspective to identify patients with intramyocardial inflammation and/or viral persistence only from single serum sample, independently of prescribed therapy and time of symptoms onset. It allows the early finding of those patients relevant for myocardial biopsy for exact diagnosis and further proscription of causal aetiology-driven specific treatment.
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Affiliation(s)
- Ganna Aleshcheva
- Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, 12203, Germany
| | - Heiko Pietsch
- Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, 12203, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Felicitas Escher
- Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, 12203, Germany.,Department of Cardiology, Campus Virchow, Charité - University Hospital Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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27
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Ammirati E, Frigerio M, Adler ED, Basso C, Birnie DH, Brambatti M, Friedrich MG, Klingel K, Lehtonen J, Moslehi JJ, Pedrotti P, Rimoldi OE, Schultheiss HP, Tschöpe C, Cooper LT, Camici PG. Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document. Circ Heart Fail 2020; 13:e007405. [PMID: 33176455 PMCID: PMC7673642 DOI: 10.1161/circheartfailure.120.007405] [Citation(s) in RCA: 305] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Myocarditis is an inflammatory disease of the heart that may occur because of infections, immune system activation, or exposure to drugs. The diagnosis of myocarditis has changed due to the introduction of cardiac magnetic resonance imaging. We present an expert consensus document aimed to summarize the common terminology related to myocarditis meanwhile highlighting some areas of controversies and uncertainties and the unmet clinical needs. In fact, controversies persist regarding mechanisms that determine the transition from the initial trigger to myocardial inflammation and from acute myocardial damage to chronic ventricular dysfunction. It is still uncertain which viruses (besides enteroviruses) cause direct tissue damage, act as triggers for immune-mediated damage, or both. Regarding terminology, myocarditis can be characterized according to etiology, phase, and severity of the disease, predominant symptoms, and pathological findings. Clinically, acute myocarditis (AM) implies a short time elapsed from the onset of symptoms and diagnosis (generally <1 month). In contrast, chronic inflammatory cardiomyopathy indicates myocardial inflammation with established dilated cardiomyopathy or hypokinetic nondilated phenotype, which in the advanced stages evolves into fibrosis without detectable inflammation. Suggested diagnostic and treatment recommendations for AM and chronic inflammatory cardiomyopathy are mainly based on expert opinion given the lack of well-designed contemporary clinical studies in the field. We will provide a shared and practical approach to patient diagnosis and management, underlying differences between the European and US scientific statements on this topic. We explain the role of histology that defines subtypes of myocarditis and its prognostic and therapeutic implications.
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Affiliation(s)
- Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.F., P.P.)
| | - Maria Frigerio
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.F., P.P.)
| | - Eric D. Adler
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla (E.D.A., M.B.)
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy (C.B.)
| | - David H. Birnie
- University of Ottawa Heart Institute, Ontario, Canada (D.H.B.)
| | - Michela Brambatti
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla (E.D.A., M.B.)
- IONIS Pharmaceuticals, Carlsbad, CA (M.B.)
| | - Matthias G. Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada (M.G.F.)
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Germany (K.K.)
| | - Jukka Lehtonen
- Heart and Lung Center, Helsinki University Hospital, Finland (J.L.)
| | - Javid J. Moslehi
- Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (J.J.M.)
| | - Patrizia Pedrotti
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.F., P.P.)
| | | | | | - Carsten Tschöpe
- Institute of Health Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany (C.T.)
- Department of Cardiology, Charité–University Medicine Berlin, Campus Virchow Klinikum, Germany (C.T.)
| | - Leslie T. Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (L.T.C.)
| | - Paolo G. Camici
- Vita Salute University and San Raffaele Hospital, Milano, Italy (P.G.C.)
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28
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Hudowenz O, Klemm P, Lange U, Rolf A, Schultheiss HP, Hamm C, Müller-Ladner U, Wegner F. Case report of severe PCR-confirmed COVID-19 myocarditis in a European patient manifesting in mid January 2020. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33437916 PMCID: PMC7665439 DOI: 10.1093/ehjcr/ytaa286] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 04/28/2020] [Accepted: 07/29/2020] [Indexed: 02/06/2023]
Abstract
Background Viral genesis is the most common cause of myocarditis. COVID-19-associated myocarditis seems to be a notable extrapulmonary manifestation, which may result in the need for a different treatment. There has been no positive polymerase chain reaction (PCR) testing of SARS-CoV-2 in heart specimens, thus far. Case summary A 48-year-old male patient presented with fever, dyspnoea, and haemoptysis. Laboratory findings showed highly elevated inflammatory and cardiac damage markers. Thoracic computed tomography (CT) revealed bilateral, patchy peripheral ground-glass opacities with a crazy-paving pattern, focal consolidations, and mild pleural effusions. Cardiac imaging with echocardiography and magnetic resonance imaging (MRI) detected a reduced biventricular function. MRI additionally showed myocardial oedema and late gadolinium enhancement. Lung and heart biopsies were performed, revealing alveolitis with necrosis and acute lymphocytic myocarditis. Testing for usual cardiotropic viruses was negative, and no aspects of vasculitis or granuloma could be found. Due to fulfilling the criteria, the patient was diagnosed with rheumatic vasculitis. Treatment with cyclophosphamide and steroids was initiated. Later, the patient reported a history of travel to Tyrol in mid January. Consequently, PCR testing for SARS-CoV-2 was performed, which was positive in the heart specimen. Immunosuppressive treatment was discontinued. During a follow-up visit at the end of April, the patient's recovery was stable. Discussion In COVID-19 infections, myocardial inflammation can be present as an extrapulmonary manifestation. Positive PCR testing confirms myocardial invasion of the virus. Imaging and laboratory studies correlate with the histopathological findings, and thus should be performed in COVID-19 patients who are suspicious for myocarditis. Supportive treatment with steroids may be useful in these patients.
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Affiliation(s)
- Ole Hudowenz
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim, Germany
| | - Philipp Klemm
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim, Germany
| | - Uwe Lange
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim, Germany
| | - Andreas Rolf
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim, Germany
| | | | - Christian Hamm
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim, Germany
| | - Franz Wegner
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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29
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Pietsch H, Escher F, Aleshcheva G, Baumeier C, Morawietz L, Elsaesser A, Schultheiss HP. Proof of SARS-CoV-2 genomes in endomyocardial biopsy with latency after acute infection. Int J Infect Dis 2020; 102:70-72. [PMID: 33045427 PMCID: PMC7546659 DOI: 10.1016/j.ijid.2020.10.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023] Open
Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has reached pandemic levels. Cardiovascular complications in COVID-19 have been reported frequently, however evidence for a causal relationship has not been established. This report describes the detection of SARS-CoV-2 viral genomes in a patient with symptoms of heart failure, in whom endomyocardial biopsy was investigated following a latency period of 4 weeks after the onset of pulmonary symptoms. The viral infection was accompanied by myocardial inflammation indicating an infection of the heart muscle.
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Affiliation(s)
- Heiko Pietsch
- Institute for Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany; Charité - University Medicine Berlin, Department of Cardiology, CVK, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Felicitas Escher
- Institute for Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany; Charité - University Medicine Berlin, Department of Cardiology, CVK, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Ganna Aleshcheva
- Institute for Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany
| | - Christian Baumeier
- Institute for Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany
| | - Lars Morawietz
- Institute for Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany
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30
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Wenzel P, Kopp S, Göbel S, Jansen T, Geyer M, Hahn F, Kreitner KF, Escher F, Schultheiss HP, Münzel T. Evidence of SARS-CoV-2 mRNA in endomyocardial biopsies of patients with clinically suspected myocarditis tested negative for COVID-19 in nasopharyngeal swab. Cardiovasc Res 2020; 116:1661-1663. [PMID: 32562489 PMCID: PMC7337685 DOI: 10.1093/cvr/cvaa160] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/22/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Philip Wenzel
- Center for Cardiology - Cardiology I, University Medical Center, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
| | - Sabrina Kopp
- Center for Cardiology - Cardiology I, University Medical Center, Mainz, Germany
| | - Sebastian Göbel
- Center for Cardiology - Cardiology I, University Medical Center, Mainz, Germany
| | - Thomas Jansen
- Center for Cardiology - Cardiology I, University Medical Center, Mainz, Germany
| | - Martin Geyer
- Center for Cardiology - Cardiology I, University Medical Center, Mainz, Germany
| | - Felix Hahn
- Center for Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
| | - Karl-Friedrich Kreitner
- Center for Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
| | - Felicitas Escher
- IKDT Institut Kardiale Diagnostik und Therapie GmbH, Moltkestraße 31, D-12203, Berlin, Germany.,Charité - University Medicine Berlin, Department of Cardiology, Campus Virchow-Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Heinz-Peter Schultheiss
- IKDT Institut Kardiale Diagnostik und Therapie GmbH, Moltkestraße 31, D-12203, Berlin, Germany
| | - Thomas Münzel
- Center for Cardiology - Cardiology I, University Medical Center, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
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31
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Emrich T, Hahn F, Fleischmann D, Halfmann MC, Düber C, Varga-Szemes A, Escher F, Pefani E, Münzel T, Schultheiss HP, Kreitner KF, Wenzel P. T1 and T2 mapping to detect chronic inflammation in cardiac magnetic resonance imaging in heart failure with reduced ejection fraction. ESC Heart Fail 2020; 7:2544-2552. [PMID: 32790159 PMCID: PMC7524213 DOI: 10.1002/ehf2.12830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/20/2020] [Accepted: 05/23/2020] [Indexed: 12/19/2022] Open
Abstract
Aims The purpose of this retrospective single‐centre study was to evaluate the non‐invasive detection of endomyocardial biopsy (EMB)‐established chronic myocardial inflammation in patients with heart failure with reduced ejection fraction (HFrEF) using T1 and T2 mapping. Methods and results The study population consisted of 52 retrospectively identified HFrEF patients who underwent EMB and cardiac magnetic resonance imaging at 3 Tesla. EMB was defined according to the position statement of the European Society of Cardiology and served as reference to identify inflammation in all patients. A control group of healthy volunteers with prior cardiac magnetic resonance imaging studies (n = 58) was also identified. Global and segmental T1 and T2 values as well as septal measurements and tissue heterogeneity parameters were calculated. Out of the 52 patients with HFrEF, 33 patients had myocardial inflammation detected by EMB, while 19 patients were EMB negative for inflammation. Mean left ventricular ejection fraction was 31% in both groups (P = 0.97). Global T1 and T2 values in HFrEF patients were significantly higher compared with healthy controls (T1 1275 ± 69 ms vs. 1,175 ± 44 ms, P < 0.001; T2 40.0 ± 3.4 ms vs. 37.9 ± 1.6 ms, P < 0.001). The distribution of T1 and T2 values between patients with and without EMB‐proven chronic myocardial inflammation was not statistically different when regarding global (T1 1292 ± 71 ms vs. 1266 ± 67 ms, P = 0.26; T2 40.0 ± 2.6 ms vs. 40.0 ± 3.9 ms, P = 1.0), septal (T1 1299 ± 63 ms vs. 1289 ± 76 ms, P = 0.76; T2 40.1 ± 3.5 ms vs 40.0 ± 6.4 ms, P = 0.49) or maximum segmental values (T1 1414 ± 111 ms vs. 1363 ± 88 ms, P = 0.15; T2 47.3 ± 5.2 ms vs. 48.8 ± 11.8 ms, P = 0.53). Mean absolute deviation of segmental T1 and T2 values and log‐transformed pixel‐wise standard deviation as parameters of tissue heterogeneity did not reveal statistical significant differences between inflammation‐positive and inflammation‐negative HFrEF patients (all P > 0.4). Conclusions Conventionally performed quantitative T1 and T2 mapping values significantly correlated with prevalence of HFrEF but did not discriminate HFrEF patients with or without chronic myocardial inflammation in our cohort. This suggests that EMB is the preferred method to detect chronic myocardial inflammation in HFrEF.
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Affiliation(s)
- Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
| | - David Fleischmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Felicitas Escher
- IKDT Institut Kardiale Diagnostik und Therapie GmbH, Berlin, Germany.,Department of Cardiology, Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Evgenia Pefani
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany.,Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | | | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
| | - Philip Wenzel
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany.,Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
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32
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Tschöpe C, Van Linthout S, Jäger S, Arndt R, Trippel T, Müller I, Elsanhoury A, Rutschow S, Anker SD, Schultheiss HP, Pauschinger M, Spillmann F, Pappritz K. Modulation of the acute defence reaction by eplerenone prevents cardiac disease progression in viral myocarditis. ESC Heart Fail 2020; 7:2838-2852. [PMID: 32662949 PMCID: PMC7405199 DOI: 10.1002/ehf2.12887] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/04/2020] [Accepted: 06/24/2020] [Indexed: 12/19/2022] Open
Abstract
Aims Left ventricular (LV) dysfunction in viral myocarditis is attributed to myocardial inflammation and fibrosis, inducing acute and long‐time cardiac damage. Interventions are not established. On the basis of the link between inflammation, fibrosis, aldosterone, and extracellular matrix regulation, we aimed to investigate the effect of an early intervention with the mineralocorticoid receptor antagonist (MRA) eplerenone on cardiac remodelling in a murine model of persistent coxsackievirus B3 (CVB3)‐induced myocarditis. Methods and results SWR/J mice were infected with 5 × 104 plaque‐forming units of CVB3 (Nancy strain) and daily treated either with eplerenone (200 mg/kg body weight) or with placebo starting from Day 1. At Day 8 or 28 post infection, mice were haemodynamically characterized and subsequently sacrificed for immunohistological and molecular biology analyses. Eplerenone did not influence CVB3 load. Already at Day 8, 1.8‐fold (P < 0.05), 1.4‐fold (P < 0.05), 3.2‐fold (P < 0.01), and 2.1‐fold (P < 0.001) reduction in LV intercellular adhesion molecule 1 expression, presence of monocytes/macrophages, oxidative stress, and apoptosis, respectively, was observed in eplerenone‐treated vs. untreated CVB3‐infected mice. In vitro, eplerenone led to 1.4‐fold (P < 0.01) and 1.2‐fold (P < 0.01) less CVB3‐induced cardiomyocyte oxidative stress and apoptosis. Furthermore, collagen production was 1.1‐fold (P < 0.05) decreased in cardiac fibroblasts cultured with medium of eplerenone‐treated vs. untreated CVB3‐infected HL‐1 cardiomyocytes. These ameliorations were in vivo translated into prevention of cardiac fibrosis, as shown by 1.4‐fold (P < 0.01) and 2.1‐fold (P < 0.001) lower collagen content in the LV of eplerenone‐treated vs. untreated CVB3‐infected mice at Days 8 and 28, respectively. This resulted in an early and long‐lasting improvement of LV dimension and function, as indicated by reduced LV end‐systolic volume and end‐diastolic volume, and an increase in LV contractility (dP/dtmax) and LV relaxation (dP/dtmin), respectively (P < 0.05). Conclusions Early intervention with the MRA eplerenone modulates the acute host and defence reaction and prevents cardiac disease progression in experimental CVB3‐induced myocarditis without aggravation of viral load. The findings advocate for an initiation of therapy of viral myocarditis as early as possible, even before the onset of inflammation‐induced myocardial dysfunction. This may also have implications for coronavirus disease‐19 therapy.
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Affiliation(s)
- Carsten Tschöpe
- Berlin Institute of Health Center for Regenerative Therapies and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany.,Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Sophie Van Linthout
- Berlin Institute of Health Center for Regenerative Therapies and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
| | - Sebastian Jäger
- Department of Cardiology, Alexianer Hospital Hedwigshöhe, Berlin, Germany
| | - Robert Arndt
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Berlin, Germany
| | - Tobias Trippel
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Irene Müller
- Berlin Institute of Health Center for Regenerative Therapies and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
| | - Ahmed Elsanhoury
- Berlin Institute of Health Center for Regenerative Therapies and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
| | - Susanne Rutschow
- Department of Cardiology, Angiology Johanniter-Kliniken, Stendal, Germany
| | - Stefan D Anker
- Berlin Institute of Health Center for Regenerative Therapies and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany.,Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | | | - Matthias Pauschinger
- Department of Cardiology, Paracelsus University, Klinikum Nürnberg, Nürnberg, Germany
| | - Frank Spillmann
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Kathleen Pappritz
- Berlin Institute of Health Center for Regenerative Therapies and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
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Escher F, Pietsch H, Aleshcheva G, Bock T, Baumeier C, Elsaesser A, Wenzel P, Hamm C, Westenfeld R, Schultheiss M, Gross U, Morawietz L, Schultheiss HP. Detection of viral SARS-CoV-2 genomes and histopathological changes in endomyocardial biopsies. ESC Heart Fail 2020; 7:2440-2447. [PMID: 32529795 PMCID: PMC7307078 DOI: 10.1002/ehf2.12805] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/11/2022] Open
Abstract
Aims Since December 2019, the novel coronavirus SARS‐CoV‐2 has spread rapidly throughout China and keeps the world in suspense. Cardiovascular complications with myocarditis and embolism due to COVID‐19 have been reported. SARS‐CoV‐2 genome detection in the heart muscle has not been demonstrated so far, and the underlying pathophysiological mechanisms remain to be investigated. Methods and results Endomyocardial biopsies (EMBs) of 104 patients (mean age: 57.90 ± 16.37 years; left ventricular ejection fraction: 33.7 ± 14.6%, sex: n = 79 male/25 female) with suspected myocarditis or unexplained heart failure were analysed. EMB analysis included histology, immunohistochemistry, and detection of SARS‐CoV‐2 genomes by real‐time reverse transcription polymerase chain reaction in the IKDT Berlin, Germany. Among 104 EMBs investigated, five were confirmed with SARS‐CoV‐2 infected by reverse real‐time transcriptase polymerase chain reaction. We describe patients of different history of symptoms and time duration. Additionally, we investigated histopathological changes in myocardial tissue showing that the inflammatory process in EMBs seemed to permeate vascular wall leading to small arterial obliteration and damage. Conclusions This is the first report that established the evidence of SARS‐CoV‐2 genomes detection in EMBs. In these patients, myocardial injury ischaemia may play a role, which could explain the ubiquitous troponin increases. EMB‐based identification of the cause of myocardial injury may contribute to explain the different evolution of complicated SARS‐CoV‐2‐infection and to design future specific and personalized treatment strategies.
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Affiliation(s)
- Felicitas Escher
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany.,Department of Cardiology, Campus Virchow - Klinikum, Charité - University Medicine Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Heiko Pietsch
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany.,Department of Cardiology, Campus Virchow - Klinikum, Charité - University Medicine Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Ganna Aleshcheva
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany
| | - Thomas Bock
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Christian Baumeier
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany
| | | | - Philip Wenzel
- Center for Cardiology - Cardiology I, University Medical Center, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
| | - Christian Hamm
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim, Germany
| | - Ralph Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Germany
| | - Maximilian Schultheiss
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ulrich Gross
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany
| | - Lars Morawietz
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, Berlin, Germany
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Casagrande M, Fitzek A, Püschel K, Aleshcheva G, Schultheiss HP, Berneking L, Spitzer MS, Schultheiss M. Detection of SARS-CoV-2 in Human Retinal Biopsies of Deceased COVID-19 Patients. Ocul Immunol Inflamm 2020; 28:721-725. [PMID: 32469258 DOI: 10.1080/09273948.2020.1770301] [Citation(s) in RCA: 196] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To report the presence of viral ribonucleic acid (RNA) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in human retina in deceased patients with confirmed novel coronavirus disease 2019 (COVID-19). PATIENTS AND METHODS Fourteen eyes of 14 deceased patients with confirmed COVID-19 disease were enucleated during autopsy. A sample of human retina was secured and fixed in RNAlater™. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) was performed to detect three different viral RNA sequences (RdRp-gene, E-gene and Orf1 gene) of SARS-CoV-2. RESULTS In three out of 14 eyes SARS-CoV-2 viral RNA was detected in the retina of deceased COVID-19 patients. As analysis for three different sequences (RdRp-gene, E-gene and Orf1 gene) revealed positive results in RT-PCR, the existence of SARS-CoV-2 viral RNA in human retina is proven according to the standards of the World-Health-Organization. CONCLUSION Viral RNA of SARS-CoV-2 is detectable in the retina of COVID-19 patients.
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Affiliation(s)
- Maria Casagrande
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE) , Hamburg, Germany
| | - Antonia Fitzek
- Institute of Forensic Medicine, University Medical Center Hamburg-Eppendorf (UKE) , Hamburg, Germany
| | - Klaus Püschel
- Institute of Forensic Medicine, University Medical Center Hamburg-Eppendorf (UKE) , Hamburg, Germany
| | | | | | - Laura Berneking
- Institute for Medical Microbiology, Virology and Hygiene, Medical Center Hamburg-Eppendorf (UKE) , Hamburg, Germany
| | - Martin S Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE) , Hamburg, Germany
| | - Maximilian Schultheiss
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE) , Hamburg, Germany
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Poller W, Haas J, Klingel K, Kühnisch J, Gast M, Kaya Z, Escher F, Kayvanpour E, Degener F, Opgen-Rhein B, Berger F, Mochmann HC, Skurk C, Heidecker B, Schultheiss HP, Monserrat L, Meder B, Landmesser U, Klaassen S. Familial Recurrent Myocarditis Triggered by Exercise in Patients With a Truncating Variant of the Desmoplakin Gene. J Am Heart Assoc 2020; 9:e015289. [PMID: 32410525 PMCID: PMC7660888 DOI: 10.1161/jaha.119.015289] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Variants of the desmosomal protein desmoplakin are associated with arrhythmogenic cardiomyopathy, an important cause of ventricular arrhythmias in children and young adults. Disease penetrance of desmoplakin variants is incomplete and variant carriers may display noncardiac, dermatologic phenotypes. We describe a novel cardiac phenotype associated with a truncating desmoplakin variant, likely causing mechanical instability of myocardial desmosomes. Methods and Results In 2 young brothers with recurrent myocarditis triggered by physical exercise, screening of 218 cardiomyopathy‐related genes identified the heterozygous truncating variant p.Arg1458Ter in desmoplakin. Screening for infections yielded no evidence of viral or nonviral infections. Myosin and troponin I autoantibodies were detected at high titers. Immunohistology failed to detect any residual DSP protein in endomyocardial biopsies, and none of the histologic criteria of arrhythmogenic cardiomyopathy were fulfilled. Cardiac magnetic resonance imaging revealed no features associated with right ventricular arrhythmogenic cardiomyopathy, but multifocal subepicardial late gadolinium enhancement was present in the left ventricles of both brothers. Screening of adult cardiomyopathy cohorts for truncating variants identified the rare genetic variants p.Gln307Ter, p.Tyr1391Ter, and p.Tyr1512Ter, suggesting that over subsequent decades critical genetic/exogenous modifiers drive pathogenesis from desmoplakin truncations toward different end points. Conclusions The described novel phenotype of familial recurrent myocarditis associated with a desmoplakin truncation in adolescents likely represents a serendipitously revealed subtype of arrhythmogenic cardiomyopathy. It may be caused by a distinctive adverse effect of the variant desmoplakin upon the mechanical stability of myocardial desmosomes. Variant screening is advisable to allow early detection of patients with similar phenotypes.
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Affiliation(s)
- Wolfgang Poller
- Department of Cardiology Campus Benjamin Franklin Universitätsmedizin Berlin Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT) Universitätsmedizin Berlin Germany.,German Center for Cardiovascular Research (DZHK) partner site Berlin Germany
| | - Jan Haas
- German Center for Cardiovascular Research (DZHK) partner site Heidelberg Germany.,Department of Cardiology University Hospital Heidelberg Mannheim Germany
| | - Karin Klingel
- Institute for Pathology and Neuropathology Department of Pathology University Hospital Tübingen Germany
| | - Jirko Kühnisch
- German Center for Cardiovascular Research (DZHK) partner site Berlin Germany.,Experimental and Clinical Research Center (ECRC) Universitätsmedizin Berlin Germany
| | - Martina Gast
- Department of Cardiology Campus Benjamin Franklin Universitätsmedizin Berlin Germany
| | - Ziya Kaya
- German Center for Cardiovascular Research (DZHK) partner site Heidelberg Germany.,Department of Cardiology University Hospital Heidelberg Mannheim Germany
| | - Felicitas Escher
- Department of Cardiology Campus Virchow Klinikum Universitätsmedizin Berlin Germany.,Institute for Clinical Diagnostics and Therapy (IKDT) Berlin Germany
| | - Elham Kayvanpour
- German Center for Cardiovascular Research (DZHK) partner site Heidelberg Germany.,Department of Cardiology University Hospital Heidelberg Mannheim Germany
| | - Franziska Degener
- German Center for Cardiovascular Research (DZHK) partner site Berlin Germany.,German Heart Center (DHZB) Berlin Germany
| | - Bernd Opgen-Rhein
- Department of Pediatric Cardiology Universitätsmedizin Berlin Germany
| | - Felix Berger
- German Center for Cardiovascular Research (DZHK) partner site Berlin Germany.,German Heart Center (DHZB) Berlin Germany.,Department of Pediatric Cardiology Universitätsmedizin Berlin Germany
| | | | - Carsten Skurk
- Department of Cardiology Campus Benjamin Franklin Universitätsmedizin Berlin Germany
| | - Bettina Heidecker
- Department of Cardiology Campus Benjamin Franklin Universitätsmedizin Berlin Germany
| | | | | | - Benjamin Meder
- German Center for Cardiovascular Research (DZHK) partner site Heidelberg Germany.,Department of Cardiology University Hospital Heidelberg Mannheim Germany.,Department of Genetics Stanford University School of Medicine Palo Alto CA
| | - Ulf Landmesser
- Department of Cardiology Campus Benjamin Franklin Universitätsmedizin Berlin Germany.,German Center for Cardiovascular Research (DZHK) partner site Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Sabine Klaassen
- German Center for Cardiovascular Research (DZHK) partner site Berlin Germany.,Experimental and Clinical Research Center (ECRC) Universitätsmedizin Berlin Germany.,Department of Pediatric Cardiology Universitätsmedizin Berlin Germany
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36
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Schultheiss M, Voykov B, Klemm M, Gross U, Schultheiss HP, Spitzer MS, Casagrande M. Scleral Inflammation around Collector Channels in Eyes with Primary Open-Angle Glaucoma. Ocul Immunol Inflamm 2020; 29:1338-1344. [DOI: 10.1080/09273948.2020.1746355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Maximilian Schultheiss
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Bogomil Voykov
- Centre of Ophthalmology, University Eye Hospital Tübingen, Tübingen, Germany
| | - Maren Klemm
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ulrich Gross
- Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | | | - Martin S. Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Maria Casagrande
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Coronado MJ, Bruno KA, Blauwet LA, Tschöpe C, Cunningham MW, Pankuweit S, van Linthout S, Jeon ES, McNamara DM, Krejčí J, Bienertová-Vašků J, Douglass EJ, Abston ED, Bucek A, Frisancho JA, Greenaway MS, Hill AR, Schultheiss HP, Cooper LT, Fairweather D. Elevated Sera sST2 Is Associated With Heart Failure in Men ≤50 Years Old With Myocarditis. J Am Heart Assoc 2020; 8:e008968. [PMID: 30638108 PMCID: PMC6497352 DOI: 10.1161/jaha.118.008968] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Myocarditis is an important cause of acute and chronic heart failure. Men with myocarditis have worse recovery and an increased need for transplantation compared with women, but the reason for the sex difference remains unclear. Elevated sera soluble (s)ST2 predicts mortality from acute and chronic heart failure, but has not been studied in myocarditis patients. Methods and Results Adults with a diagnosis of clinically suspected myocarditis (n=303, 78% male) were identified according to the 2013 European Society of Cardiology position statement. Sera sST2 levels were examined by ELISA in humans and mice and correlated with heart function according to sex and age. Sera sST2 levels were higher in healthy men (P=8×10−6) and men with myocarditis (P=0.004) compared with women. sST2 levels were elevated in patients with myocarditis and New York Heart Association class III‐IV heart failure (P=0.002), predominantly in men (P=0.0003). Sera sST2 levels were associated with New York Heart Association class in men with myocarditis who were ≤50 years old (r=0.231, P=0.0006), but not in women (r=0.172, P=0.57). Sera sST2 levels were also significantly higher in male mice with myocarditis (P=0.005) where levels were associated with cardiac inflammation. Gonadectomy with hormone replacement showed that testosterone (P<0.001), but not estradiol (P=0.32), increased sera sST2 levels in male mice with myocarditis. Conclusions We show in a well‐characterized subset of heart failure patients with clinically suspected and biopsy‐confirmed myocarditis that elevated sera sST2 is associated with an increased risk of heart failure based on New York Heart Association class in men ≤50 years old.
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Affiliation(s)
- Michael J Coronado
- 1 Department of Environmental Health Sciences Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Katelyn A Bruno
- 1 Department of Environmental Health Sciences Johns Hopkins Bloomberg School of Public Health Baltimore MD.,2 Department of Cardiovascular Medicine Mayo Clinic Jacksonville FL
| | - Lori A Blauwet
- 3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Carsten Tschöpe
- 4 Department of Cardiology and Berlin-Brandenburg Center for Regenerative Medicine Campus Virchow Klinikum Charite- Universitaetsmedizin Berlin Berlin Germany
| | - Madeleine W Cunningham
- 5 Department of Microbiology and Immunology University of Oklahoma Health Sciences Center Oklahoma City OK
| | - Sabine Pankuweit
- 6 Department of Internal Medicine and Cardiology University Hospital Giessen and Marburg Marburg Germany
| | - Sophie van Linthout
- 4 Department of Cardiology and Berlin-Brandenburg Center for Regenerative Medicine Campus Virchow Klinikum Charite- Universitaetsmedizin Berlin Berlin Germany
| | | | | | - Jan Krejčí
- 9 Department of Cardiovascular Diseases St. Anne's University Hospital and Masaryk University Brno Czech Republic
| | - Julie Bienertová-Vašků
- 10 Department of Pathological Physiology and the Research Center for the Toxic Compounds in the Environment Faculty of Sciences Masaryk University Brno Czech Republic
| | - Erika J Douglass
- 1 Department of Environmental Health Sciences Johns Hopkins Bloomberg School of Public Health Baltimore MD.,2 Department of Cardiovascular Medicine Mayo Clinic Jacksonville FL
| | - Eric D Abston
- 1 Department of Environmental Health Sciences Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Adriana Bucek
- 1 Department of Environmental Health Sciences Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - J Augusto Frisancho
- 1 Department of Environmental Health Sciences Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Merci S Greenaway
- 1 Department of Environmental Health Sciences Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Anneliese R Hill
- 2 Department of Cardiovascular Medicine Mayo Clinic Jacksonville FL
| | | | - Leslie T Cooper
- 2 Department of Cardiovascular Medicine Mayo Clinic Jacksonville FL
| | - DeLisa Fairweather
- 1 Department of Environmental Health Sciences Johns Hopkins Bloomberg School of Public Health Baltimore MD.,2 Department of Cardiovascular Medicine Mayo Clinic Jacksonville FL
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Loebel M, Holzhauser L, Hartwig JA, Shukla PC, Savvatis K, Jenke A, Gast M, Escher F, Becker SC, Bauer S, Stroux A, Beling A, Kespohl M, Pinkert S, Fechner H, Kuehl U, Lassner D, Poller W, Schultheiss HP, Zeller T, Blankenberg S, Papageorgiou AP, Heymans S, Landmesser U, Scheibenbogen C, Skurk C. The forkhead transcription factor Foxo3 negatively regulates natural killer cell function and viral clearance in myocarditis. Eur Heart J 2019; 39:876-887. [PMID: 29136142 DOI: 10.1093/eurheartj/ehx624] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 10/09/2017] [Indexed: 02/05/2023] Open
Abstract
Aims Foxo3 is a transcription factor involved in cell metabolism, survival, and inflammatory disease. However, mechanistic insight in Foxo3 effects is still limited. Here, we investigated the role of Foxo3 on natural killer (NK) cell responses and its effects in viral myocarditis. Methods and results Effects of Foxo3 on viral load and immune responses were investigated in a model of coxsackie virus B3 myocarditis in wild-type (WT) and Foxo3 deficient mice. Reduced immune cell infiltration, viral titres, and pro-inflammatory cytokines in cardiac tissue were observed in Foxo3-/- mice 7 days post-infection (p.i.). Viral titres were also attenuated in hearts of Foxo3-/- mice at Day 3 while interferon-γ (IFNγ) and NKp46 expression were up-regulated suggesting early viral control by enhanced NK cell activity. CD69 expression of NK cells, frequencies of CD11b+CD27+ effector NK cells and cytotoxicity of Foxo3-/- mice was enhanced compared to WT littermates. Moreover, microRNA-155 expression, essential in NK cell activation, was elevated in Foxo3-/- NK cells while its inhibition led to diminished IFNγ production. Healthy humans carrying the longevity-associated FOXO3 single nucleotide polymorphism (SNP) rs12212067 exhibited reduced IFNγ and cytotoxic degranulation of NK cells. Viral inflammatory cardiomyopathy (viral CMI) patients with this SNP showed a poorer outcome due to less efficient virus control. Conclusion Our results implicate Foxo3 in regulating NK cell function and suggest Foxo3 playing an important role in the antiviral innate immunity. Thus, enhanced FOXO3 activity such as in the polymorphism rs12212067 may be protective in chronic inflammation such as cancer and cardiovascular disease but disadvantageous to control acute viral infection.
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Affiliation(s)
- Madlen Loebel
- Institute of Medical Immunology, Charité, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Luise Holzhauser
- Department of Cardiology, University of Chicago, 5841S Maryland Avenue, Chicago, IL 60637, USA
| | - Jelka A Hartwig
- Institute of Medical Immunology, Charité, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Praphulla C Shukla
- Department of Cardiology, Charité, CBF, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Konstantinos Savvatis
- Department of Cardiology, Charité, CBF, Hindenburgdamm 30, 12200 Berlin, Germany.,Department of Cardiology, St-Bartholomew's Hospital, West Smithfield, London EC1A7BE, UK
| | - Alexander Jenke
- Department of Cardiology, Charité, CBF, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Martina Gast
- Department of Cardiology, Charité, CBF, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Felicitas Escher
- Department of Cardiology, Charité, CBF, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Sonya C Becker
- Institute of Medical Immunology, Charité, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sandra Bauer
- Institute of Medical Immunology, Charité, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Andrea Stroux
- Department of Biometry and Clinical Epidemiology, Charité, CBF, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Antje Beling
- Institute of Biochemistry, Charité, Chariteplatz 1, 10117 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Oudenarder Strasse 16, 13347 Berlin, Germany
| | - Meike Kespohl
- Institute of Biochemistry, Charité, Chariteplatz 1, 10117 Berlin, Germany
| | - Sandra Pinkert
- Department of Biochemistry, University of Technology, Gustav-meyer Allee 25, 13355 Berlin, Germany
| | - Henry Fechner
- Department of Biochemistry, University of Technology, Gustav-meyer Allee 25, 13355 Berlin, Germany
| | - Uwe Kuehl
- Department of Cardiology, Charité, CBF, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Dirk Lassner
- Institute for Cardiac Diagnostics and Therapy (IKDT), Molthestrasse 31, 12203 Berlin, Germany
| | - Wolfgang Poller
- Department of Cardiology, Charité, CBF, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Heinz-Peter Schultheiss
- Institute for Cardiac Diagnostics and Therapy (IKDT), Molthestrasse 31, 12203 Berlin, Germany
| | - Tanja Zeller
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Germany-DZHK, Partner Site Hamburg/Lübeck/Kiel, Martinistrasse 52, 20246 Hamburg, Germany
| | - Stefan Blankenberg
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Germany-DZHK, Partner Site Hamburg/Lübeck/Kiel, Martinistrasse 52, 20246 Hamburg, Germany
| | - Anna-Pia Papageorgiou
- Cardiovascular Research Institute, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, NL, Netherlands
| | - Stephane Heymans
- Cardiovascular Research Institute, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, NL, Netherlands
| | - Ulf Landmesser
- Department of Cardiology, Charité, CBF, Hindenburgdamm 30, 12200 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Oudenarder Strasse 16, 13347 Berlin, Germany
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité, Augustenburger Platz 1, 13353 Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Südstrasse 2, 13353 Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Charité, CBF, Hindenburgdamm 30, 12200 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Oudenarder Strasse 16, 13347 Berlin, Germany
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Poller W, Skurk C, Escher F, Manes C, Elgeti T, Schultheiss HP, Taupitz M, Landmesser U. Multimodality Imaging Reveals Divergent Responses of Left and Right Heart to Treatment in Cardiac Amyloidosis. JACC Case Rep 2019; 1:360-366. [PMID: 34316826 PMCID: PMC8289130 DOI: 10.1016/j.jaccas.2019.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/30/2022]
Abstract
Cardiac amyloidosis is associated with very high morbidity and mortality. Only if treated early, cardiac amyloidosis responds well to therapy, and early recognition with a full differential diagnostic workup including multimodality imaging is therefore critical at first presentation. Closely meshed clinical monitoring and imaging are indispensable to ensure optimal individualized treatment. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Wolfgang Poller
- Department of Cardiology, Campus Benjamin Franklin, Charite-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Site Berlin, Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Campus Benjamin Franklin, Charite-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Site Berlin, Berlin, Germany
| | - Felicitas Escher
- German Center for Cardiovascular Research, Site Berlin, Berlin, Germany.,Department of Cardiology, Campus Virchow-Klinikum, Charite-Universitätsmedizin Berlin, Berlin, Germany.,Institute for Cardiac Diagnostics and Therapy, Berlin, Germany
| | - Costantina Manes
- Department of Cardiology, Campus Benjamin Franklin, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Elgeti
- Institute for Radiology, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Matthias Taupitz
- Institute for Radiology, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin, Charite-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Site Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
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Escher F, Agirbasli M, Lassner D, Aleshcheva G, Schultheiss HP. P6450Plasminogen activator inhibitor type-1 (PAI-1) expression relates to the presence of myocardial inflammation in patients with nonischemic cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Plasminogen activator inhibitor type-1 (PAI-1) is an important inhibitor of the fibrinolytic pathway and an acute phase reactant in response to inflammatory cytokines, resulting in thrombosis, arteriosclerosis, and tissue fibrosis. It has been identified as a potential biomarker for coronary artery disease and metabolic syndrom. However, so far, nothing is known about its importance in nonischemic cardiomyopathy.
Aims
To analyzed PAI-1 expression in patients with different forms of cardiomyopathies and evaluate possible influence of PAI-1-dependent pathomechanisms in patients with intramyocardial inflammation.
Methods and results
In this study, endomyocardial biopsies (EMBs) from 309 patients (mean age 48.0±13.9 years) with different forms of cardiomyopathies were enrolled, including 123 patients with dilated cardiomyopathy (DCM) (mean LVEF 28.01±9.06%) and 186 patients with EMB-proven virus-negative inflammatory cardiomyopathy (DCMi) (mean LVEF 31.76±14.14%). 10 patients (mean LVEF 60.50±4.76%) without viral or inflammation in EMB served as controls. Hemodynamic parameters were measured by catheterization and echocardiography. EMBs were performed at first admission after exclusion of ischemic of valvular heart disease. In EMBs PAI-1 was assessed by immunohistology including digital imaging analysis. PAI-1 expression was significantly higher in patients with DCMi in contrast to DCM patients and controls (0.517±2.20 vs. 0.187±0.598 vs. 0.023±0.032% Area Fraction; p=0.0002). PAI-expression correlates significantly with lymphocytic infiltrates (for CD3 r=0.56, p<0.0001, and LFA-1 r=0.59, p<0.0001). This was found to be independent of hemodynamic parameters, and age.
Conclusion
Myocardial inflammation is associated with a significant increase in PAI-1 expression in DCMi independently of the hemodynamic conditions. This new pathophysiological axis could be a potiential therapeutic target in future treatment stategies in DCMi.
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Affiliation(s)
- F Escher
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - M Agirbasli
- Medeniyet University, Cardiology, Istanbul, Turkey
| | - D Lassner
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - G Aleshcheva
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
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Escher F, Pietsch HP, Gross UG, Lassner DL, Schultheiss HP. 2425Evaluation of myocardial gene expression profiling for superior diagnosis of idiopathic giant cell myocarditis in a large cohort of patients with acute cardiac decompensation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Idiopathic giant cell myocarditis (IGCM) diagnostics is based on differential patterns of inflammatory cell infiltration, and multinucleated giant cells (GCs) in histological sections of endomyocardial biopsies (EMBs). However, the sampling error is high for the detection of focally GCs by histopathology. We report on a clinical evaluation of a recently published method for improved differential diagnosis of this frequently fatal disease by myocardial gene expression profiling.
Objective
This is to improve the diagnostics of IGCM by gene expression profiling, and to demonstrate the feasibility of this method in clinical practice in a large cohort of patients.
Methods
In this multicenter study, EMBs of n=427 patients with clinically acute cardiac decompensation and suspected acute myocarditis were screened (mean age 47.03±15.69 years). In each patient, EMBs were analyzed by histology, immunohistology, molecular virology, and gene expression profiling.
Results
Out of the total of n=427 patient samples examined, GCs could be detected in 26 cases (6.0%) by histology. An established myocardial gene profile – consisting of 27 genes – was revealed resulting in a specified profile of 5 genes (chemokine receptor 5 (CCR5), chemokine receptor 6 (CCR6); carnitine palmitoyltransferase I (CPT1), toll-like receptor 8 (TLR8), and chemokine (C-C motif) ligand 20 (CCL20)) which identified histologically proven IGCM with high specificity in 25 of the 26 patients (96.2%). Applying this newly established profiling on the remaining patient samples, additional n=31 (7.3%) patients were identified for IGCM without any histological proof of myocardial GCs.
Conclusions
Myocardial gene expression profiling is a reliable method in clinical practice to predict IGCM even without direct histological proof of GCs in EMB section. The gene profiling is of high clinical relevance to overcome the sampling error of purely histological examination, and to control the effectiveness of the therapy. The data clearly show the importance to take EMB in unexplained acute decompensation to get a diagnosis and improve the prognosis.
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Affiliation(s)
- F Escher
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - H P Pietsch
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - U G Gross
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - D L Lassner
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
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Feig MA, Pop C, Bhardwaj G, Sappa PK, Dörr M, Ameling S, Weitmann K, Nauck M, Lehnert K, Beug D, Kühl U, Schultheiss HP, Völker U, Felix SB, Hammer E. Global plasma protein profiling reveals DCM characteristic protein signatures. J Proteomics 2019; 209:103508. [DOI: 10.1016/j.jprot.2019.103508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/07/2019] [Accepted: 08/26/2019] [Indexed: 12/28/2022]
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Safak E, Ince H, Gkouvatsou L, Schultheiss HP, Ortak J, Caglayan E, Oener A, D'Ancona G. Pacing-induced cardiomyopathy in chronic right ventricular apical pacing: a midterm follow-up study. Eur J Med Res 2019; 24:23. [PMID: 31331388 PMCID: PMC6643303 DOI: 10.1186/s40001-019-0386-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background Data concerning the effect of chronic right ventricular pacing in patients with normal left ventricular ejection fraction (LVEF%) are contradictory. The aim of this study is to evaluate the prevalence of pacing-induced cardiomyopathy (PICM) at midterm follow-up after permanent pacemaker implantation (PPM). Methods A series of 170 patients were submitted to PPM within our facility. Inclusion criteria were the absence of structural heart disease and a preserved LVEF% (> 45%) at the time of PPM. A midterm clinical and echocardiographic follow-up was performed, and data were collected and analyzed retrospectively. PICM was defined as follow-up LVEF ≤ 45%, dyskinesia during RV pacing, and the absence of other known causes of cardiomyopathy.
Results At a median echocardiographic follow-up of 24.5 months (IQR 10.0–43.0 months), the overall mean LVEF% decreased from a preimplantation value of 66.7% (± 8.6%) to 63.2% (± 10.6%) (p < 0.0001). PICM occurred in 11 patients (6.5%). Patients developing PICM had a significantly lower preimplantation LVEF% (58.4 ± 8.0% vs. 67.3 ± 8.4%; p = 0.005), a trend for higher right ventricular pacing time rate (0.7 ± 0.3 vs. 0.5 ± 0.4; p = 0.1), a significantly lower rate of PPM indication for sick sinus syndrome (SSS) (18.2% vs. 61.0%; p = 0.009), and significantly higher rate of second-grade cardiac conduction block (36.4% vs. 11.3%; p = 0.03). At multivariate logistic regression, only preimplantation LVEF% (OR = 0.88; CI 0.80–0.96; p = 0.006) and the presence of SSS (OR = 0.1; CI 0.03–0.9; p = 0.04) were independently related (inverse relationship) to follow-up PICM. Conclusions In this selected PPM patient cohort with preserved LVEF%, the rate of PICM at midterm follow-up is relatively low, but its occurrence seems to be related to baseline LVEF% and PPM indication category.
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Affiliation(s)
- Erdal Safak
- Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany. .,Rostock University Medical Center, Rostock, Germany. .,Department of Cardiology, Vivantes - Netzwerk für Gesundheit GmbH, Klinikum Am Urban, Dieffenbachstraße 1, 10967, Berlin, Germany.
| | - Hüseyin Ince
- Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany
| | | | | | - Jasmin Ortak
- Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany
| | | | - Alper Oener
- Rostock University Medical Center, Rostock, Germany
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Schmidt-Lucke C, Zobel T, Escher F, Tschöpe C, Lassner D, Kühl U, Gubbe K, Volk HD, Schultheiss HP. Human Parvovirus B19 (B19V) Up-regulates CXCR4 Surface Expression of Circulating Angiogenic Cells: Implications for Cardiac Ischemia in B19V Cardiomyopathy. J Infect Dis 2019; 217:456-465. [PMID: 28961998 DOI: 10.1093/infdis/jix309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/04/2017] [Indexed: 01/09/2023] Open
Abstract
Background Human parvovirus B19 (B19V) infection and damage of circulating angiogenic cells (CAC) results in dysfunctional endogenous vascular repair (DEVR) with secondary end-organ damage. Trafficking of CAC is regulated by SDF-1α and the respective receptor CXCR4. We thus tested the hypothesis of a deregulated CXCR4/SDF-1α axis in symptomatic B19V-cardiomyopathy. Methods CAC were infected in vitro with B19V and transfected with B19V-components. Read-out were: CXCR4-expression and migratory capacity at increasing doses of SDF-1α. In 31 patients with chronic B19V-cardiomyopathy compared to 20 controls read-outs were from blood: migratory capacity, CXCR4 expression on CAC, serum SDF-1α; from cardiac biopsies: SDF-1α mRNA, HIF-1α mRNA, microvascular density, resident cardiac stem cells (CSC), transcardiac gradients of CAC. Results In vitro B19V-infected CAC showed up-regulation of surface CXCR4 with increased migratory capacity further enhanced by elevated SDF-1α concentrations. Overexpression of the B19V capsid protein VP2 was associated with this effect. Chronic B19V-cardiomyopathy patients showed increased numbers of ischaemia mobilised CAC but DEVR as well as diminished numbers of CAC after transcardiac passage. Cardiac microvascular density and CSC were significantly reduced in B19V-cardiomyopathy. Conclusions We thus conclude that B19V infection has a direct VP2-mediated negative impact on trafficking of CAC in the presence of impaired cardiac regeneration.
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Affiliation(s)
- Caroline Schmidt-Lucke
- Department of Cardiology and Pneumology, Charité-University Medicine.,Berlin-Brandenburg Center for Regenerative Therapies, Charité-University Medicine.,Medico-academic Consultings (MEDIACC)
| | - Thomas Zobel
- Department of Cardiology and Pneumology, Charité-University Medicine
| | - Felicitas Escher
- Department of Cardiology and Pneumology, Charité-University Medicine.,Institut für Kardiale Diagnostik und Therapie, Berlin
| | - Carsten Tschöpe
- Department of Cardiology and Pneumology, Charité-University Medicine.,Berlin-Brandenburg Center for Regenerative Therapies, Charité-University Medicine
| | - Dirk Lassner
- Institut für Kardiale Diagnostik und Therapie, Berlin
| | - Uwe Kühl
- Department of Cardiology and Pneumology, Charité-University Medicine
| | - Knut Gubbe
- Institute of Transfusion Medicine and Immunohematology, German Red Cross, Plauen
| | - Hans-Dieter Volk
- Berlin-Brandenburg Center for Regenerative Therapies, Charité-University Medicine.,Institute of Medical Immunology, Charité-University Medicine, Berlin, Germany
| | - Heinz-Peter Schultheiss
- Department of Cardiology and Pneumology, Charité-University Medicine.,Institut für Kardiale Diagnostik und Therapie, Berlin
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Schultheiss HP, Fairweather D, Caforio ALP, Escher F, Hershberger RE, Lipshultz SE, Liu PP, Matsumori A, Mazzanti A, McMurray J, Priori SG. Dilated cardiomyopathy. Nat Rev Dis Primers 2019; 5:32. [PMID: 31073128 PMCID: PMC7096917 DOI: 10.1038/s41572-019-0084-1] [Citation(s) in RCA: 302] [Impact Index Per Article: 60.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Dilated cardiomyopathy (DCM) is a clinical diagnosis characterized by left ventricular or biventricular dilation and impaired contraction that is not explained by abnormal loading conditions (for example, hypertension and valvular heart disease) or coronary artery disease. Mutations in several genes can cause DCM, including genes encoding structural components of the sarcomere and desmosome. Nongenetic forms of DCM can result from different aetiologies, including inflammation of the myocardium due to an infection (mostly viral); exposure to drugs, toxins or allergens; and systemic endocrine or autoimmune diseases. The heterogeneous aetiology and clinical presentation of DCM make a correct and timely diagnosis challenging. Echocardiography and other imaging techniques are required to assess ventricular dysfunction and adverse myocardial remodelling, and immunological and histological analyses of an endomyocardial biopsy sample are indicated when inflammation or infection is suspected. As DCM eventually leads to impaired contractility, standard approaches to prevent or treat heart failure are the first-line treatment for patients with DCM. Cardiac resynchronization therapy and implantable cardioverter-defibrillators may be required to prevent life-threatening arrhythmias. In addition, identifying the probable cause of DCM helps tailor specific therapies to improve prognosis. An improved aetiology-driven personalized approach to clinical care will benefit patients with DCM, as will new diagnostic tools, such as serum biomarkers, that enable early diagnosis and treatment.
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Affiliation(s)
- Heinz-Peter Schultheiss
- Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany. .,Department of Cardiology, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
| | - DeLisa Fairweather
- Mayo Clinic, Department of Cardiovascular Medicine, Jacksonville, FL, USA.
| | - Alida L. P. Caforio
- 0000 0004 1757 3470grid.5608.bDivision of Cardiology, Department of Cardiological Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Felicitas Escher
- grid.486773.9Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany ,0000 0001 2218 4662grid.6363.0Department of Cardiology, Charité–Universitaetsmedizin Berlin, Berlin, Germany ,0000 0004 5937 5237grid.452396.fDZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Ray E. Hershberger
- 0000 0001 2285 7943grid.261331.4Divisions of Human Genetics and Cardiovascular Medicine in the Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH USA
| | - Steven E. Lipshultz
- 0000 0004 1936 9887grid.273335.3Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY USA ,0000 0000 9958 7286grid.413993.5Oishei Children’s Hospital, Buffalo, NY USA ,Roswell Park Comprehensive Cancer Center, Buffalo, NY USA
| | - Peter P. Liu
- 0000 0001 2182 2255grid.28046.38University of Ottawa Heart Institute, Ottawa, Ontario Canada
| | - Akira Matsumori
- grid.410835.bClinical Research Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Andrea Mazzanti
- 0000 0004 1762 5736grid.8982.bDepartment of Molecular Medicine, University of Pavia, Pavia, Italy ,Department of Molecular Cardiology, IRCCS ICS Maugeri, Pavia, Italy
| | - John McMurray
- 0000 0001 2193 314Xgrid.8756.cBritish Heart Foundation (BHF) Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Silvia G. Priori
- 0000 0004 1762 5736grid.8982.bDepartment of Molecular Medicine, University of Pavia, Pavia, Italy ,Department of Molecular Cardiology, IRCCS ICS Maugeri, Pavia, Italy
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Lassner D, Siegismund CS, Kühl U, Rohde M, Stroux A, Escher F, Schultheiss HP. CCR5del32 genotype in human enteroviral cardiomyopathy leads to spontaneous virus clearance and improved outcome compared to wildtype CCR5. J Transl Med 2018; 16:249. [PMID: 30180856 PMCID: PMC6123922 DOI: 10.1186/s12967-018-1610-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/14/2018] [Indexed: 12/31/2022] Open
Abstract
Background Enteroviral cardiomyopathy is a life-threatening disease, and detection of enterovirus (EV) RNA in the initial endomyocardial biopsy is associated with adverse prognosis and increased mortality. Some patients with EV infection may spontaneously eliminate the virus and recover, whereas those with virus persistence deteriorate and progress to heart failure. Interferon-beta (IFN-β) therapy eliminates the virus, resulting in increased survival of treated patients. CCR5 is expressed on antigen-presenting cells (both macrophages and dendritic cells) and immune effector cells (T-lymphocytes with memory/effector phenotype and natural killer cells). Its 32-bp deletion (CCR5del32) is the most frequent human coding sequence mutation. This study addresses the correlation of CCR5 polymorphism to the clinical course of EV infection and the necessity for IFN-β treatment. Methods We examined 97 consecutive patients with chronic/inflammatory cardiomyopathy and biopsy-proven EV infection and reliable information on clinical outcomes by CCr5 genotyping. These data were evaluated in relation to virus persistence in follow-up biopsies and survival rates over a 15-year period. Results Genotyping revealed a strong correlation between the CCR5del32 genotype and spontaneous virus clearance with improved outcomes. All patients with CCR5del32 eliminated EV spontaneously and none of them died within the observed period. In the group of untreated CCR5 wildtype patients, 33% died (Kaplan–Meier log-rank p = 0.010). However, CCR5 wildtype individuals treated with IFN-β are more likely to survive than without therapy (Kaplan–Meier log-rank p = 0.004) in identical proportions to individuals with the CCR5del32 genotype. Conclusions These data suggest that CCR5 genotyping is a novel predictive genetic marker for the clinical course of human EV cardiomyopathies. Hereby clinicians can identify those EV positive individuals who will eliminate the virus spontaneously based on CCR5 phenotype and those patients with CCR5 wildtype genotype who would be eligible for immediate antiviral IFN-β treatment to minimize irreversible cardiac damage. Electronic supplementary material The online version of this article (10.1186/s12967-018-1610-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dirk Lassner
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany.
| | | | - Uwe Kühl
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany.,Department of Cardiology, Campus Virchow, Charité-University Hospital Berlin, Berlin, Germany
| | - Maria Rohde
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - Andrea Stroux
- Institute of Biometry and Clinical Epidemiology, Campus Benjamin Franklin, Charité-University Hospital and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Felicitas Escher
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany.,Department of Cardiology, Campus Virchow, Charité-University Hospital Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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Escher F, Kuehl U, Lassner D, Pieske B, Poller W, Schultheiss HP. P4532High cytotoxic cells infiltration and male gender predict adverse long-term mortality in patients with inflammatory cardiomyopathy (CMi). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Escher
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - U Kuehl
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - D Lassner
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - B Pieske
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - W Poller
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
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Escher F, Siegismuns CS, Lassner D, Gross U, Linke R, Schultheiss HP. P683Intramyocardial inflammation correlates with poor prognosis in patients with cardiac AL amyloidosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Escher
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - C S Siegismuns
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - D Lassner
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - U Gross
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - R Linke
- amYmed, Reference Center of Amyloid Diseases, Martinsried, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
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Jenke A, Schur R, Röger C, Karadeniz Z, Grüger M, Holzhauser L, Savvatis K, Poller W, Schultheiss HP, Landmesser U, Skurk C. Adiponectin attenuates profibrotic extracellular matrix remodeling following cardiac injury by up-regulating matrix metalloproteinase 9 expression in mice. Physiol Rep 2018; 5:5/24/e13523. [PMID: 29263115 PMCID: PMC5742698 DOI: 10.14814/phy2.13523] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/05/2017] [Indexed: 01/25/2023] Open
Abstract
Adiponectin (APN) is a multifunctional adipocytokine that inhibits myocardial fibrosis, dilatation, and left ventricular (LV) dysfunction after myocardial infarction (MI). Coxsackievirus B3 (CVB3) myocarditis is associated with intense extracellular matrix (ECM) remodeling which might progress to dilated cardiomyopathy. Here, we investigated in experimental CVB3 myocarditis whether APN inhibits adverse ECM remodeling following cardiac injury by affecting matrix metalloproteinase (MMP) expression. Cardiac injury was induced by CVB3 infection in APN knockout (APN-KO) and wild-type (WT) mice. Expression and activity of MMPs was quantified by qRT-PCR and zymography, respectively. Activation of protein kinases was assessed by immunoblot. In cardiac myocytes and fibroblasts APN up-regulates MMP-9 expression via activation of 5' adenosine monophosphate-activated protein kinase (AMPK) and extracellular signal-regulated kinase (ERK)1/2 which function as master regulators of inflammation-induced MMP-9 expression. Correspondingly, APN further increased up-regulation of MMP-9 expression triggered by tumor necrosis factor (TNF)α, lipopolysaccharide (LPS) and R-848 in cardiac fibroblasts. In vivo, compared to WT mice cardiac MMP-9 activity and serum levels of carboxy-terminal telopeptide of type I collagen (ICTP) were attenuated in APN-KO mice in subacute (day 7 p.i.) CVB3 myocarditis. Moreover, on day 3 and day 7 post CVB3 infection splenic MMP-9 expression was diminished in APN-KO mice correlating with attenuated myocardial immune cell infiltration in subacute CVB3 myocarditis. These results indicate that APN attenuates adverse cardiac remodeling following cardiac injury by up-regulating MMP-9 expression in cardiac and immune cells. Thus, APN mediates intensified collagen cleavage that might explain inhibition of LV fibrosis and dysfunction.
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Affiliation(s)
- Alexander Jenke
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Robert Schur
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Carsten Röger
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Zehra Karadeniz
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Mathias Grüger
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Luise Holzhauser
- Department of Internal Medicine, Albert-Einstein College of Medicine, Bronx, New York
| | - Kostas Savvatis
- Department of Cardiology, Barts Heart Centre Barts Health NHS Trust, London, United Kingdom
| | - Wolfgang Poller
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Heinz-Peter Schultheiss
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany .,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
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Sotiriou E, Heiner S, Jansen T, Brandt M, Schmidt KH, Kreitner KF, Emrich T, Schultheiss HP, Schulz E, Münzel T, Wenzel P. Therapeutic implications of a combined diagnostic workup including endomyocardial biopsy in an all-comer population of patients with heart failure: a retrospective analysis. ESC Heart Fail 2018; 5:630-641. [PMID: 29745463 PMCID: PMC6073026 DOI: 10.1002/ehf2.12296] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/14/2018] [Accepted: 03/29/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Aetiology of heart failure (HF) often remains obscure. We therefore evaluated the usefulness of a combined diagnostic approach including cardiac magnetic resonance imaging (CMRI) and endomyocardial biopsy (EMB) to assess the cause of unexplained cardiomyopathy underlying HF. METHODS AND RESULTS We retrospectively investigated 100 consecutive patients (36% women, mean age 53.6 ± 18.8 years) presenting with unexplained cardiomyopathy (HF with reduced ejection fraction or left ventricular hypertrophy; excluding ischaemic and valvular heart disease; left ventricular ejection fraction 31.6 ± 13.9%, Left ventricular end-diastolic pressure 18.2 ± 9.3 mmHg, heart rate 89 ± 26.6 b.p.m.; mean ± SEM) at the University Medical Center Mainz. We performed electrocardiography, echocardiography, CMRI, and cardiac catheterization with EMB analysed at a Food and Drug Administration-approved reference centre in 100%, 94%, 69%, and 100% of patients, respectively. On the basis of CMRI findings, electrocardiography, echocardiography, and medical history, the exact cause of cardiomyopathy remained uncertain in 37 of 69 cases (53.6%). In EMB, 25% of patients had viral replication, 23% had inflammation defined as lymphocytic infiltrations without active virus replication, 1% had giant cell myocarditis, and 1% had eosinophilic myocarditis. After diagnostic workup including EMB findings, the cause of cardiomyopathy remained unidentified in 14% of the cases, classified as idiopathic dilated cardiomyopathy or hypertrophic cardiomyopathy in 10% or 4%, respectively. EMB helped to discuss a causal treatment strategy of HF involving immunosuppression or antiviral treatment in 53% of patients, which was opted for in 12% of the patients. CONCLUSIONS A comprehensive workup including imaging and EMB in an all-comer population of patients with HF may help physicians to improve diagnostics of unexplained cardiomyopathy in the majority of cases.
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Affiliation(s)
- Efthymios Sotiriou
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Thomas Jansen
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Moritz Brandt
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Berlin, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Kai Helge Schmidt
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Karl-Friedrich Kreitner
- Clinic for Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Tilman Emrich
- Clinic for Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Heinz-Peter Schultheiss
- IKDT Institut Kardiale Diagnostik und Therapie GmbH, Moltkestraße 31, 12203, Berlin, Germany
| | - Eberhard Schulz
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Berlin, Germany
| | - Philip Wenzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Berlin, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
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