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Heart Failure Reviews Jan 2022Myocardial inflammation in COVID-19 has been documented. Its pathogenesis is not fully elucidated, but the two main theories foresee a direct role of ACE2 receptor and a... (Review)
Review
Myocardial inflammation in COVID-19 has been documented. Its pathogenesis is not fully elucidated, but the two main theories foresee a direct role of ACE2 receptor and a hyperimmune response, which may also lead to isolated presentation of COVID-19-mediated myocarditis. The frequency and prognostic impact of COVID-19-mediated myocarditis is unknown. This review aims to summarise current evidence on this topic. We performed a systematic review of MEDLINE and Cochrane Library (1/12/19-30/09/20). We also searched clinicaltrials.gov for unpublished studies testing therapies with potential implication for COVID-19-mediated cardiovascular complication. Eligible studies had laboratory confirmed COVID-19 and a clinical and/or histological diagnosis of myocarditis by ESC or WHO/ISFC criteria. Reports of 38 cases were included (26 male patients, 24 aged < 50 years). The first histologically proven case was a virus-negative lymphocytic myocarditis; however, biopsy evidence of myocarditis secondary to SARS-CoV-2 cardiotropism has been recently demonstrated. Histological data was found in 12 cases (8 EMB and 4 autopsies) and CMR was the main imaging modality to confirm a diagnosis of myocarditis (25 patients). There was a substantial variability in biventricular systolic function during the acute episode and in therapeutic regimen used. Five patients died in hospital. Cause-effect relationship between SARS-CoV-2 infection and myocarditis is difficult to demonstrate. However, current evidence demonstrates myocardial inflammation with or without direct cardiomyocyte damage, suggesting different pathophysiology mechanisms responsible of COVID-mediated myocarditis. Established clinical approaches should be pursued until future evidence support different actions. Large multicentre registries are advisable to elucidate further.
Topics: COVID-19; Humans; Male; Myocarditis; Myocytes, Cardiac; Registries; SARS-CoV-2
PubMed: 33761041
DOI: 10.1007/s10741-021-10087-9 -
The British Journal of Radiology Sep 2020In this review, we describe the technical aspects of artificial intelligence (AI) in cardiac imaging, starting with radiomics, basic algorithms of deep learning and...
In this review, we describe the technical aspects of artificial intelligence (AI) in cardiac imaging, starting with radiomics, basic algorithms of deep learning and application tasks of algorithms, until recently the availability of the public database. Subsequently, we conducted a systematic literature search for recently published clinically relevant studies on AI in cardiac imaging. As a result, 24 and 14 studies using CT and MRI, respectively, were included and summarized. From these studies, it can be concluded that AI is widely applied in cardiac applications in the clinic, including coronary calcium scoring, coronary CT angiography, fractional flow reserve CT, plaque analysis, left ventricular myocardium analysis, diagnosis of myocardial infarction, prognosis of coronary artery disease, assessment of cardiac function, and diagnosis and prognosis of cardiomyopathy. These advancements show that AI has a promising prospect in cardiac imaging.
Topics: Adipose Tissue; Algorithms; Artificial Intelligence; Cardiomyopathies; Computed Tomography Angiography; Coronary Disease; Coronary Stenosis; Databases, Factual; Deep Learning; Fractional Flow Reserve, Myocardial; Heart; Heart Ventricles; Humans; Magnetic Resonance Imaging; Myocardial Infarction; Prognosis; Vascular Calcification
PubMed: 32017605
DOI: 10.1259/bjr.20190812 -
Heart (British Cardiac Society) Apr 2024In clinical practice, patients with eosinophilic myocarditis (EM) may forgo the gold standard diagnostic procedure, endomyocardial biopsy (EMB), although it is highly...
OBJECTIVE
In clinical practice, patients with eosinophilic myocarditis (EM) may forgo the gold standard diagnostic procedure, endomyocardial biopsy (EMB), although it is highly recommended in guidelines. This systematic review aims to summarise current approaches in diagnosing and treating EM with a particular emphasis on the utilisation and value of alternative diagnostic methods.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we searched MEDLINE and EMBASE for all peer-reviewed articles using the keywords "eosinophilic myocarditis" from their inception to 10 September 2022.
RESULTS
We included 239 articles, including 8 observational studies and 274 cases, in this review. The median patient age was 45 years. Initial presentations were non-specific, including dyspnoea (50.0%) and chest pain (39.4%). The aetiologies of EM were variable with the most common being idiopathic (28.8%) and eosinophilic granulomatosis polyangiitis (19.3%); others included drug-induced (13.1%) and hypereosinophilic syndrome (12.8%). 82.4% received an EM diagnosis by EMB while 17.6% were diagnosed based on clinical reasoning and cardiac MRI (CMR). CMR-diagnosed patients exhibited a better risk profile at diagnosis, particularly higher left ventricular ejection fraction and less need for inotropic or mechanical circulatory supports. Glucocorticoids were the primary treatment with variability in dosages and regimens.
CONCLUSION
EMB is the mainstay for diagnostic testing for EM. CMR is potentially helpful for screening in appropriate clinical scenarios. Regarding treatment, there is no consensus regarding the optimal dosage of corticosteroids. Large clinical trials are warranted to further explore the utility of CMR in the diagnosis of EM and steroid regimen in treating EM.
Topics: Humans; Myocarditis; Eosinophilia; Biopsy; Myocardium
PubMed: 37963727
DOI: 10.1136/heartjnl-2023-323225 -
Current Problems in Cardiology Aug 2023Cysticercosis is a parasitic tissue infection caused by larval cysts of the tapeworm Taenia solium. These larval cysts infect brain, muscle, or other tissue, and are a... (Review)
Review
Cysticercosis is a parasitic tissue infection caused by larval cysts of the tapeworm Taenia solium. These larval cysts infect brain, muscle, or other tissue, and are a major cause of adult-onset seizures in most low-income countries with tropical climate. Prevalence it's around 50 million people. Although cardiovascular system is not the most affected, this disease can also be associated with multiple and randomly distributed cysts in the subpericardium, subendocardium and myocardium in up to 25% of infected patients. Most cardiac cysticercosis' cases are asymptomatic, but it can manifest with ventricular arrhythmias and conduction disorders. Area Covered: The "Neglected Tropical Diseases and other Infectious Diseases affecting the Heart" (NET-Heart project) is an initiative by the Emerging Leaders group of the Interamerican Society of Cardiology to systematically review all these endemic conditions affecting the heart. A systematic review was conducted following preferred reporting items for systematic review and meta-analysis guidelines and including articles published in MEDLINE, ScienceDirect, PubMed and LILACS databases. A total of 41 papers were included in this review. Expert Opinion: In the areas of greatest prevalence, unhealthiness and poverty favor the development of this disease, which highlights the need to establish global health policies that reduce morbidity and mortality, economic losses of the affected population, and health costs related to hospitalizations for cardiovascular involvement. Authors provide an algorithm to evaluate the possibility of Cysticercosis' cardiovascular complications.
Topics: Animals; Adult; Humans; Cysticercosis; Taenia solium; Prevalence; Cardiac Conduction System Disease; Heart Diseases
PubMed: 35395330
DOI: 10.1016/j.cpcardiol.2022.101195 -
Clinical Anatomy (New York, N.Y.) Jul 2021Myocardial bridges are anatomical entities characterized by myocardium covering segments of coronary arteries. In some patients, the presence of a myocardial bridge is... (Meta-Analysis)
Meta-Analysis
Myocardial bridges are anatomical entities characterized by myocardium covering segments of coronary arteries. In some patients, the presence of a myocardial bridge is benign and is only incidentally found on autopsy. In other patients, however, myocardial bridges can lead to compression of the coronary artery during systolic contraction and delayed diastolic relaxation, resulting in myocardial ischemia. This ischemia in turn can lead to myocardial infarction, ventricular arrhythmias and sudden cardiac death. Myocardial bridges have also been linked to an increased incidence of atherosclerosis, which has been attributed to increased shear stress and the presence of vasoactive factors. Other studies however, demonstrated the protective roles of myocardial bridges. In this study, using systematic review and a meta-analytical approach we investigate the prevalence and morphology of myocardial bridges in both clinical imaging and cadaveric dissections. We also discuss the pathophysiology, clinical significance, and management of these anatomical entities.
Topics: Animals; Cadaver; Humans; Myocardial Bridging; Prevalence
PubMed: 33078444
DOI: 10.1002/ca.23697 -
Fortschritte Der Neurologie-Psychiatrie Nov 2018Tako-Tsubo Cardiomyopathy (TTC) is an acute, reversible disease of the myocardium. It seems to be caused by an excess of epinephrine, norepinephrine and dopamine....
BACKGROUND
Tako-Tsubo Cardiomyopathy (TTC) is an acute, reversible disease of the myocardium. It seems to be caused by an excess of epinephrine, norepinephrine and dopamine. Psychological or physiological stress is considered as a risk factor. Several cases of Tako-Tsubo cardiomyopathy in the context of seizures and electroconvulsive therapy have been reported.
METHODS
We describe the case of a 63-year-old patient who developed TTC during a second series of ECT applications with etomidate anaesthesia and continued antidepressant medication with tranylcypromine. Potential pathophysiological correlations are discussed on the basis of the available literature. Given the increased risk of TTC recurrence, the question on reinitiation of ECT treatment after remission of the heart disease is also addressed.
RESULTS
At least in theory, depressive disorders, ECT applications with seizures, the application of the anaesthetic etomidate, as well as tranylcypromine treatment may all be causally related to the development of TTC. Etomidate is known to interfere with cortisol synthesis, resulting in sympathomimetic and pro-inflammatory effects. To date, 19 cases of TTC in conjunction with ECT applications have been published. As in our patient, ECT was reinitiated successfully without complications in eight of them.
DISCUSSION
ECT-related TTC seems to be caused by multiple factors. Circumstantial evidence in our case as well as published data does not support the conclusion that a single risk factor can be held responsible for the development of TTC. Based on theoretical considerations and preliminary findings on a potential role of a relative cortisol deficit, future studies should be encouraged to provide relevant evidence. If careful risk-benefit considerations are done and specific precautions are taken, previous TTC does not exclude reinitiation of ECT.
Topics: Electroconvulsive Therapy; Etomidate; Humans; Hypnotics and Sedatives; Male; Middle Aged; Recurrence; Risk Factors; Takotsubo Cardiomyopathy
PubMed: 30654402
DOI: 10.1055/a-0653-7063 -
Journal of Immunology (Baltimore, Md. :... May 2023The mammalian heart is characterized by the presence of striated myocytes, which allow continuous rhythmic contraction from early embryonic development until the last...
The mammalian heart is characterized by the presence of striated myocytes, which allow continuous rhythmic contraction from early embryonic development until the last moments of life. However, the myocardium contains a significant contingent of leukocytes from every major class. This leukocyte pool includes both resident and nonresident immune cells. Over recent decades, it has become increasingly apparent that the heart is intimately sensitive to immune signaling and that myocardial leukocytes exhibit an array of critical functions, both in homeostasis and in the context of cardiac adaptation to injury. Here, we systematically review current knowledge of all major leukocyte classes in the heart, discussing their functions in health and disease. We also highlight the connection between the myocardium, immune cells, lymphoid organs, and both local and systemic immune responses.
Topics: Animals; Myocytes, Cardiac; Myocardium; Leukocytes; Signal Transduction; Mammals
PubMed: 37068299
DOI: 10.4049/jimmunol.2200924 -
Cells Nov 2023There is an increasing recognition of the crucial role of the right ventricle (RV) in determining the functional status and prognosis in multiple conditions. In the past... (Review)
Review
There is an increasing recognition of the crucial role of the right ventricle (RV) in determining the functional status and prognosis in multiple conditions. In the past decade, the epigenetic regulation (DNA methylation, histone modification, and non-coding RNAs) of gene expression has been raised as a critical determinant of RV development, RV physiological function, and RV pathological dysfunction. We thus aimed to perform an up-to-date review of the literature, gathering knowledge on the epigenetic modifications associated with RV function/dysfunction. Therefore, we conducted a systematic review of studies assessing the contribution of epigenetic modifications to RV development and/or the progression of RV dysfunction regardless of the causal pathology. English literature published on PubMed, between the inception of the study and 1 January 2023, was evaluated. Two authors independently evaluated whether studies met eligibility criteria before study results were extracted. Amongst the 817 studies screened, 109 studies were included in this review, including 69 that used human samples (e.g., RV myocardium, blood). While 37 proposed an epigenetic-based therapeutic intervention to improve RV function, none involved a clinical trial and 70 are descriptive. Surprisingly, we observed a substantial discrepancy between studies investigating the expression (up or down) and/or the contribution of the same epigenetic modifications on RV function or development. This exhaustive review of the literature summarizes the relevant epigenetic studies focusing on RV in human or preclinical setting.
Topics: Humans; Heart Ventricles; Epigenesis, Genetic; Ventricular Dysfunction, Right; Myocardium; Ventricular Function, Right
PubMed: 38067121
DOI: 10.3390/cells12232693 -
Cardiovascular Pathology : the Official... 2023While primary cardiac tumors are rare, it has been increasingly recognized due to improvement in screening measures. However, the hamartoma of mature cardiac myocytes... (Review)
Review
BACKGROUND
While primary cardiac tumors are rare, it has been increasingly recognized due to improvement in screening measures. However, the hamartoma of mature cardiac myocytes has been underrecognized compared to other cardiac tumors, such as cardiac myxomas and papillary fibroelastomas, and is still potentially associated with critical consequences such as sudden death. This systematic review aims to summarize the evidence regarding the hamartoma of mature cardiac myocytes and characterize the presentations and symptoms for clinicians.
METHODS
Following the PRISMA statement, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including "hamartoma of mature cardiac myocytes" from their inception to January 2, 2023.
RESULTS
We included 25 articles, including 34 cases, in this systematic review. Patients with hamartoma of mature cardiac myocytes commonly presented with nonspecific symptoms such as dyspnea (35.3%), although a few presented with sudden death and syncope. The left ventricle was the common site of origin (41.2%), followed by the right atrium and ventricle. Surgery was commonly pursued for diagnosis and treatment, while a few required cardiac transplants (8.8%), and 29.4% were diagnosed with autopsy or expired.
CONCLUSION
Hamartoma of mature cardiac myocytes is a potentially underrecognized primary cardiac tumor associated with treatable yet potentially critical consequences. Given the challenges of differentiating it from malignancy such as angiosarcoma, multimodal imaging needs to be utilized to pursue a diagnosis. Future studies are warranted to develop a noninvasive diagnosis mode for cardiac tumor.
Topics: Humans; Myocytes, Cardiac; Heart Neoplasms; Heart Ventricles; Hamartoma; Death, Sudden
PubMed: 37031829
DOI: 10.1016/j.carpath.2023.107538 -
JACC. Cardiovascular Imaging May 2022This systematic review and meta-analysis investigated the association of diabetes and glycemic control with myocardial fibrosis (MF). (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This systematic review and meta-analysis investigated the association of diabetes and glycemic control with myocardial fibrosis (MF).
BACKGROUND
MF is associated with an increased risk of heart failure, coronary artery disease, arrhythmias, and death. Diabetes may influence the development of MF, but evidence is inconsistent.
METHODS
The authors searched EMBASE, Medline Ovid, Cochrane CENTRAL, Web of Science, and Google Scholar for observational and interventional studies investigating the association of diabetes, glycemic control, and antidiabetic medication with MF assessed by histology and cardiac magnetic resonance (ie, extracellular volume fraction [ECV%] and T time).
RESULTS
A total of 32 studies (88% exclusively on type 2 diabetes) involving 5,053 participants were included in the systematic review. Meta-analyses showed that diabetes was associated with a higher degree of MF assessed by histological collagen volume fraction (n = 6 studies; mean difference: 5.80; 95% CI: 2.00-9.59) and ECV% (13 studies; mean difference: 2.09; 95% CI: 0.92-3.27), but not by native or postcontrast T time. Higher glycosylated hemoglobin levels were associated with higher degrees of MF.
CONCLUSIONS
Diabetes is associated with higher degree of MF assessed by histology and ECV% but not by T time. In patients with diabetes, worse glycemic control was associated with higher MF degrees. These findings mostly apply to type 2 diabetes and warrant further investigation into whether these associations are causal and which medications could attenuate MF in patients with diabetes.
Topics: Cardiomyopathies; Diabetes Mellitus, Type 2; Fibrosis; Humans; Magnetic Resonance Imaging, Cine; Myocardium; Predictive Value of Tests
PubMed: 35512952
DOI: 10.1016/j.jcmg.2021.12.008