Vaccine-carditis study: Spanish multicenter registry of inflammatory heart disease after COVID-19 vaccination

INTRODUCTION AND OBJECTIVES

Vaccines against SARS-CoV-2 have been a major scientific and medical achievement in the control of the COVID-19 pandemic. However, very infrequent cases of inflammatory heart disease have been described as adverse events, leading to uncertainty in the scientific community and in the general population.

METHODS

The Vaccine-Carditis Registry has included all cases of myocarditis and pericarditis diagnosed within 30 days after COVID-19 vaccination since August 1, 2021 in 29 centers throughout the Spanish territory. The definitions of myocarditis (probable or confirmed) and pericarditis followed the consensus of the Centers for Disease Control and the Clinical Practice Guidelines of the European Society of Cardiology. A comprehensive analysis of clinical characteristics and 3-month evolution is presented.

RESULTS

From August 1, 2021, to March 10, 2022, 139 cases of myocarditis or pericarditis were recorded (81.3% male, median age 28 years). Most cases were detected in the 1st week after administration of an mRNA vaccine, the majority after the second dose. The most common presentation was mixed inflammatory disease (myocarditis and pericarditis). 11% had left ventricular systolic dysfunction, 4% had right ventricular systolic dysfunction, and 21% had pericardial effusion. In cardiac magnetic resonance studies, left ventricular inferolateral involvement was the most frequent pattern (58%). More than 90% of cases had a benign clinical course. After a 3-month follow-up, the incidence of adverse events was 12.78% (1.44% mortality).

CONCLUSIONS

In our setting, inflammatory heart disease after vaccination against SARS-CoV-2 predominantly affects young men in the 1st week after the second dose of RNA-m vaccine and presents a favorable clinical course in most cases.

An Infrequent Complication of VT Ablation: Should We Perform Delayed Routine Imaging After Steam Pops?

Catheter ablation has become the cornerstone of the treatment of ventricular arrythmias. Nevertheless, it is crucial to recognize the adverse effects of such treatment. We present a case of an incidental diagnosis of ventricular pseudoaneurysms after catheter ablation for treatment of drug-refractory nonsustained runs of ventricular tachycardia. (Level of Difficulty: Advanced.)

Immediate improvement of left ventricular mechanics following transcatheter aortic valve replacement

BACKGROUND

Left ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has become a widespread technique for patients with severe AS considered inoperable or high risk for traditional open-surgery. This procedure could have a positive impact in LV mechanics. The aim of this study was to evaluate the immediate effect of TAVR on LV function recovery, as assessed by myocardial deformation parameters.

METHODS

One-hundred twelve consecutive patients (81.4 ± 6.4 years, 50% female) from 10 centres in Europe with severe AS who successfully underwent TAVR with either a self-expanding CoreValve (Medtronic, Minneapolis, MN) or a mechanically expanded Lotus valve (Boston Scientific, Natick, MA) were enrolled in a prospective multi-center study. A complete echocardiographic examination was performed at baseline and immediately before discharge, including the assessment of LV strain using standard two-dimensional images.

RESULTS

Echocardiographic examination with global longitudinal strain (GLS) quantification could be obtained in 92 patients, because of echocardiographic and logistic reasons. Between examinations, a modest statistically significant improvement in GLS could be seen (GLS% -15.00 ± 4.80 at baseline;-16.15 ± 4.97 at discharge, p = 0.028). In a stratified analysis, only women showed a significant improvement in GLS and a trend towards greater improvement in GLS according to severity of systolic dysfunction as measured by LV ejection fraction could be noted.

CONCLUSIONS

Immediate improvement in GLS was appreciated after TAVR procedure. Whether this finding continues to be noted in a more prolonged follow-up and its clinical implications need to be assessed in further studies.

Confirmation of cross-fertilization using molecular markers in ornamental passion flower hybrids

Several interspecific Passiflora hybrids are produced in the northern hemisphere for the ornamental plant market. In Brazil, production of passion flower hybrids is limited to the introgression of genes into the main cultivated species, yellow passion fruit, to be used as rootstocks. Confirmation of hybridization in the initial developmental stage is important for breeding perennial and sub-perennial plants, such as passion flowers, reducing time and costs in plant stock maintenance. In order to obtain F₁ hybrids with ornamental potential, four species of Passiflora (P. alata, P. gardneri, P. gibertii, and P. watsoniana) from the Active Germplasm Bank at UESC were hybridized. Flower buds, in pre-anthesis, of the genitors were previously protected, and the female buds were emasculated. To confirm hybridization, the genomic DNA of the genitor species and the supposed hybrids was extracted and RAPD primers were used to obtain molecular markers and select passion flower interspecific hybrids. Eight primers were used to confirm hybrids derived from P. gardneri with P. alata, P. watsoniana with P. alata, P. watsoniana with P. gardneri, and P. gardneri with P. gibertii; 75, 50, 45, and 46% of the informative bands, respectively, confirmed the hybrid nature of these plants. The RAPD technique was effective in the early identification of hybrids; this will be useful for development of hybrid Passiflora progeny.

Reproducibility of ambulatory blood pressure monitoring in hemodialysis patients

Ambulatory blood pressure monitoring (ABPM) has been increasingly used in hemodialysis (HD) practice and research; however, no study has evaluated the reproducibility of ABPM in this population. To address this question, we performed 48-hour interdialytic ABPM on 21 HD patients (mean age, 53 +/- 16 years; 7 women) on two different occasions 68 +/- 34 days (range, 30 to 154 days) apart. To qualify for the protocol, patients had to be at the same dry weight and on the same vasoactive drug regimen at both monitoring periods. BP was analyzed according to three different methods: isolated pre-HD and post-HD values, average pre-HD and post-HD values for the five HD sessions surrounding each monitoring period, and 48-hour interdialytic ABPM. Reproducibility was determined by analysis of the SD of the differences (SDD) between the two monitoring periods and the coefficient of variation of each method of BP determination. Our results show better reproducibility of ABPM (SDD, 10.6/6.6 mm Hg; coefficient of variation, 7.5%/8.1%) compared with isolated pre-HD BP (SDD, 24.4/11.3 mm Hg; coefficient of variation, 16.7%/14.1%) or post-HD BP (SDD, 16.8/14.5 mm Hg; coefficient of variation, 11.7%/17.8%), and averaged pre-HD BP (SDD, 14.7/7.2 mm Hg; coefficient of variation, 10.1%/9.1%) or post-HD BP (SDD, 12.4/8.7 mm Hg; coefficient of variation, 8.9%/11.1%). The reproducibility of the decrease in BP during sleep was poor, with up to 43% of the subjects changing dipping category within or between interdialytic periods. We conclude that ABPM is the most accurate method to study BP in HD patients over time. However, variability is significant, and there is poor reproducibility of the nocturnal decline in BP.

Thrombosis of the internal carotid artery secondary to soft palate injury in children and childhood. Report of two cases

Trauma to the soft palate is a uncommon event during childhood. Stroke following intraoral trauma is also rare, but has been well documented by the current literature as a potentially serious complication. In this article, we report 2 cases of posttraumatic internal carotid artery thrombosis depicted by imaging studies. We discuss pathogenesis, and the literature is reviewed.

Effect of high-salt intake on blood pressure and vascular reactivity of diabetic rats

The etiopathogenesis of diabetes mellitus (DM)-associated hypertension is not known. Sodium and an increased vascular reactivity to vasopressor agents have been implicated in the pathogenesis of this disease in humans. The aim of the present study was to experimentally evaluate the possible role of salt intake and changes in vascular reactivity in the pathogenesis of DM-associated hypertension. Male Wistar rats, weighing 180 to 200 g, rendered diabetic by streptozotocin (65 mg/kg) and maintained moderately hyperglycemic with insulin were submitted to high-salt intake (tap water replaced with 1.0% NaCl) for 8 weeks (D+salt rats, N = 8). Mean arterial pressure and reactivity of the isolated aorta to norepinephrine and angiotensin II were then determined. Diabetic rats on normal-salt intake (group D+nl, N = 6) or normal-salt intake (group non-D+nl, N = 8) were used as controls. Mean blood pressure was significantly higher in D+salt rats (123 +/- 3 mmHg) compared with the D+nl (113 +/- 3 mmHg), non-D+salt (111 +/- 2 mmHg) and non-D+nl (105 +/- 2 mmHg) groups. Mean blood pressure was also significantly higher in diabetic rats on normal-salt intake compared with control rats on normal-salt intake. Vascular reactivity of the aorta to norepinephrine was increased only in diabetic rats on high-salt intake. No modification in reactivity was detected with regard to the reactivity to angiotensin II. We conclude that high-salt intake increases blood pressure in diabetic rats and that increased aorta vascular reactivity to norepinephrine might be involved in the blood pressure alteration.