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Journal of the American Heart... Jan 2020
Review
Topics: Animals; Antineoplastic Agents, Immunological; Biopsy; Cardiac Imaging Techniques; Cardiotoxicity; Electrocardiography; Heart; Heart Disease Risk Factors; Humans; Molecular Targeted Therapy; Myocarditis; Myocardium; Neoplasms; Prognosis; Risk Assessment
PubMed: 31960755
DOI: 10.1161/JAHA.119.013757 -
Journal of the American College of... Nov 2017Eosinophilic myocarditis (EM) is an acute life-threatening inflammatory disease of the heart. Neither large case series nor clinical trials on this specific myocarditis...
BACKGROUND
Eosinophilic myocarditis (EM) is an acute life-threatening inflammatory disease of the heart. Neither large case series nor clinical trials on this specific myocarditis have been reported.
OBJECTIVES
Based on a systematic revision of all published histologically proven cases, this study aimed to describe the clinical presentation, treatment, and outcome of EM.
METHODS
The study screened 443 manuscripts in MEDLINE and EMBASE on cases of EM published until June 2017. The authors identified 264 patients and included in the main analysis 179 patients admitted to hospital with histologically proven EM.
RESULTS
Median age was 41 years (interquartile range: 27 to 53 years) with similar prevalence in both sexes; pediatric cases (≤16 years of age) accounted for 10.1%. The main symptom at presentation was dyspnea (59.4%), with peripheral eosinophilia observed in 75.9%. Median left ventricular ejection fraction at presentation was 35% (interquartile range: 25% to 50%). The disorders most frequently associated with EM were hypersensitivity and eosinophilic granulomatosis with polyangiitis, which accounted for 34.1% and 12.8% of cases, respectively, whereas idiopathic or undefined forms accounted for 35.7% of cases. Steroids were administered in 77.7% of patients. A temporary mechanical circulatory support (n = 30) was instituted in 16.8% of patients. In-hospital death was 22.3% (n = 40), with the highest occurrence in the hypersensitivity form (36.1%; p = 0.026).
CONCLUSIONS
EM has a poor prognosis during the acute phase, despite a publication bias that could have led to an overestimation of mortality. Associated conditions are identified in approximately 65% of cases. Specific trials and multicenter registries are needed to provide evidence-based treatments to improve in-hospital outcome.
Topics: Adult; Coronary Angiography; Eosinophilia; Female; Humans; Male; Middle Aged; Myocarditis; Treatment Outcome
PubMed: 29096807
DOI: 10.1016/j.jacc.2017.09.023 -
Journal of the American College of... Apr 2009Cardiovascular magnetic resonance (CMR) has become the primary tool for noninvasive assessment of myocardial inflammation in patients with suspected myocarditis. The...
Cardiovascular magnetic resonance (CMR) has become the primary tool for noninvasive assessment of myocardial inflammation in patients with suspected myocarditis. The International Consensus Group on CMR Diagnosis of Myocarditis was founded in 2006 to achieve consensus among CMR experts and develop recommendations on the current state-of-the-art use of CMR for myocarditis. The recommendations include indications for CMR in patients with suspected myocarditis, CMR protocol standards, terminology for reporting CMR findings, and diagnostic CMR criteria for myocarditis (i.e., "Lake Louise Criteria").
Topics: Canada; Consensus; Humans; Inflammation; Magnetic Resonance Angiography; Models, Cardiovascular; Myocarditis; Myocardium; Risk Factors; Societies, Medical
PubMed: 19389557
DOI: 10.1016/j.jacc.2009.02.007 -
Circulation Journal : Official Journal... Apr 2023
Topics: Humans; Myocarditis
PubMed: 36908170
DOI: 10.1253/circj.CJ-22-0696 -
Annals of Noninvasive Electrocardiology... May 2020Acute myocarditis represents a challenging diagnosis as there is no pathognomonic clinical presentation. In patients with myocarditis, electrocardiogram (ECG) can... (Review)
Review
BACKGROUND
Acute myocarditis represents a challenging diagnosis as there is no pathognomonic clinical presentation. In patients with myocarditis, electrocardiogram (ECG) can display a variety of non-specific abnormalities. Nevertheless, ECG is widely used as an initial screening tool for myocarditis.
METHODS
We researched all possible ECG alterations during acute myocarditis evaluating prevalence, physiopathology, correlation with clinical presentation patterns, role in differential diagnosis, and prognostic yield.
RESULTS
The most common ECG abnormality in myocarditis is sinus tachycardia associated with nonspecific ST/T-wave changes. The presence of PR segment depression both in precordial and limb leads, a PR segment depression in leads with ST segment elevation, a PR segment elevation in aVR lead or a ST elevation with pericarditis pattern favor generally diagnosis of perimyocarditis rather than myocardial infarction. In patients with acute myocarditis, features associated with a poorer prognosis are: pathological Q wave, wide QRS complex, QRS/T angle ≥ 100°, prolonged QT interval, high-degree atrioventricular block and malignant ventricular tachyarrhythmia. On the contrary, ST elevation with a typical early repolarization pattern is associated with a better prognosis.
CONCLUSIONS
ECG alterations in acute myocarditis could be very useful in clinical practice for a patient-tailored approach in order to decide appropriate therapy, length of hospitalization, and frequency of followup.
Topics: Acute Disease; Electrocardiography; Humans; Myocarditis; Prognosis
PubMed: 31778001
DOI: 10.1111/anec.12726 -
Medicina Clinica Nov 2022SARS-CoV-2 is currently causing a persistent COVID-19 pandemic, which poses a risk of causing long-term cardiovascular sequels in the population. The viral mechanism of... (Review)
Review
SARS-CoV-2 is currently causing a persistent COVID-19 pandemic, which poses a risk of causing long-term cardiovascular sequels in the population. The viral mechanism of cell infection through the angiotensin 2 converter enzyme receptor and the limited antiviral innate immune response are the suspected causes for a more frequent cardiovascular damage in SARS-CoV-2 infection. Knowledge of the appearance during acute infection of other cardiac conditions beyond the classical myocarditis and pericarditis, the long-term cardiac manifestations (persistent COVID-19), and the increased incidence of myocarditis and pericarditis after vaccination is of special interest in order to offer our patients best practices based on current scientific evidence.
Topics: Humans; SARS-CoV-2; Pandemics; COVID-19; Angiotensin-Converting Enzyme 2; Myocarditis; Pericarditis
PubMed: 35945062
DOI: 10.1016/j.medcli.2022.07.002 -
International Journal of Cardiology Mar 2024Gene therapy is a technique to correct genetic abnormalities, through introduction of a functional gene or through direct genome editing. Adeno-associated virus... (Review)
Review
Gene therapy is a technique to correct genetic abnormalities, through introduction of a functional gene or through direct genome editing. Adeno-associated virus (AAV)-mediated gene replacement shows promise for targeted therapies in treatment of inherited cardiomyopathies and is the most used approach in clinical trials. However, immune responses from the host to the virus and gene product pose delivery and safety challenges. This review explores the immunological reactions to AAV-based gene therapy, their potential toxic effects, with a focus on myocarditis, and future directions for gene therapy.
Topics: Humans; Myocarditis; Genetic Therapy; Genetic Vectors; Dependovirus
PubMed: 38030043
DOI: 10.1016/j.ijcard.2023.131617 -
Frontiers in Bioscience (Landmark... Feb 2022Cardiovascular complications (especially myocarditis) related to COVID-19 viral infection are not well understood, nor do they possess a well recognized diagnostic... (Review)
Review
Cardiovascular complications (especially myocarditis) related to COVID-19 viral infection are not well understood, nor do they possess a well recognized diagnostic protocol as most of our information regarding this issue was derived from case reports. In this article we extract data from all published case reports in the second half of 2020 to summarize the theories of pathogenesis and explore the value of each diagnostic test including clinical, lab, ECG, ECHO, cardiac MRI and endomyocardial biopsy. These tests provide information that explain the mechanism of development of myocarditis that further paves the way for better management.
Topics: COVID-19; Heart; Humans; Myocarditis; SARS-CoV-2
PubMed: 35227016
DOI: 10.31083/j.fbl2702073 -
Hellenic Journal of Cardiology : HJC =... 2021Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2, is currently in a pandemic outbreak and has become a global health issue.... (Review)
Review
Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2, is currently in a pandemic outbreak and has become a global health issue. In addition to the primarily involvement of the respiratory system, myocarditis is considered an important and fatal lesion in patients with COVID-19. However, effective therapeutic methods are currently lacking. The cholinergic anti-inflammatory pathway (CAP) has been demonstrated to suppress pro-inflammatory cytokine production and control inflammation in sepsis and other medical conditions. Therefore, the CAP may be a potential and effective therapeutic method for COVID-19-related myocarditis. This article reviews the relationship between COVID-19-related myocarditis and the CAP and discusses the CAP as a potential therapeutic modality in the treatment of COVID-19-related myocarditis.
Topics: COVID-19; Humans; Myocarditis; Neuroimmunomodulation; Pandemics; SARS-CoV-2
PubMed: 33301863
DOI: 10.1016/j.hjc.2020.12.004 -
Archives of Cardiovascular Diseases Oct 2019Myocarditis encompasses a wide range of myocardial inflammatory diseases, including acute myocarditis, chronic myocarditis and inflammatory cardiomyopathies, and... (Review)
Review
Myocarditis encompasses a wide range of myocardial inflammatory diseases, including acute myocarditis, chronic myocarditis and inflammatory cardiomyopathies, and myocardial inflammation associated with other cardiomyopathies. Because of this heterogeneity in clinical presentation, and the infrequent use of endomyocardial biopsy, cardiac imaging has gradually acquired a key role in the non-invasive detection of myocardial inflammation, the assessment of aetiology and the management of specific therapies. This article summarizes the issue of myocarditis and myocardial inflammation in clinical practice, and reviews the role of different non-invasive imaging techniques in the exploration of myocardial inflammation.
Topics: Cardiac Imaging Techniques; Cardiomyopathies; Humans; Myocarditis; Predictive Value of Tests; Prognosis; Reproducibility of Results
PubMed: 31494082
DOI: 10.1016/j.acvd.2019.05.007