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1.
Int J Biol Sci ; 18(7): 2703-2713, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35541905

RESUMO

Coronavirus disease 2019 (COVID-19), a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) had resulted in considerable morbidity and mortality. COVID-19 primarily posed a threat to the respiratory system and violated many different organs, including the heart, kidney, liver, and blood vessels with the development of the disease. Severe patients were often accompanied by cardiac injury, and once the heart gets damaged, the mortality of patients will significantly increase. The main clinical manifestations of cardiac injury range from myocarditis, heart failure (HF), arrhythmia, and Takotsubo cardiomyopathy (TCM). A high abundance of angiotensin-converting enzyme II (ACE2) on the membrane of cardiomyocytes makes it possible that the virus can directly attack cardiomyocytes as subsequently evidenced by the detection of spike protein and virus RNA in autopsy cardiac tissues. The secondary myocardial injury through systemic inflammatory and immune response also caused obvious cardiac damage. The pathological manifestations of heart tissue were diverse, varied from mild cardiomyocyte edema, myocardial hypertrophy, cardiomyocyte degeneration, and necrosis to severe myocarditis caused by lymphocyte and macrophage infiltration. However, the mechanism of heart injury was still unclear. Here, we summarized the clinical manifestations and mechanism of SARS-CoV2 mediated cardiac injury, providing a reference for cardiac treatment in critically ill patients.


Assuntos
COVID-19 , Traumatismos Cardíacos , Miocardite , Humanos , RNA Viral , SARS-CoV-2
2.
BMJ Case Rep ; 15(5)2022 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-35504665

RESUMO

Although the pathogenesis of fulminant myocarditis varies, it is usually recognised by symptoms such as chest pain or syncope, echographic findings such as abnormal left ventricular (LV) wall motion, elevated cardiac enzymes and arrhythmias. We encountered a case of acute myocarditis with syncope, electrocardiographic changes suggestive of coronary artery disease in the inferior wall with abnormal wall motion in the right ventricle, which eventually developed into fulminant disease. Multidetector CT showed a contrast effect localised to the right ventricle in the late-contrast phase, suggesting a right ventricular myocardial injury. Thereafter, the LV function rapidly decreased. Finally, mechanical circulatory support with extracorporeal membrane oxygenation and an intra-aortic balloon pump was needed. A myocardial biopsy of the right ventricular septum showed severe degenerative findings such as myocyte tearing and segmentation with infiltration of inflammatory cells including lymphocytes. After insertion of an Impella pump, the right ventricular function gradually improved.


Assuntos
Oxigenação por Membrana Extracorpórea , Coração Auxiliar , Miocardite , Ventrículos do Coração/diagnóstico por imagem , Coração Auxiliar/efeitos adversos , Humanos , Miocardite/diagnóstico , Síncope
3.
Open Heart ; 9(1)2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35534093

RESUMO

OBJECTIVE: To identify the most common transthoracic echocardiogram (TTE) parameters in patients hospitalised with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) and their association with myocardial injury and outcomes. METHODS: A retrospective, single-centre, observational, exploratory cohort study was performed at the height of the COVID-19 pandemic. All SARS-CoV-2 polymerase chain reaction (PCR) positive patients who underwent a TTE during their inpatient admission between 1 March 2020 and 31 October 2020 were analysed. The most frequent cardiovascular risk factor profile and echocardiographic features were investigated. RESULTS: A total of 87 patients met the eligibility criteria. A salient 41.4% (n=36) of our cohort succumbed to this devastating virus. More than half of our hospital population (58.6%) were admitted to the intensive care unit (ITU) and this was significantly associated with inpatient mortality (OR: 7.14, CI 2.53 to 20.19, p<0.001). Hypertension was the most common cardiovascular risk factor (51.7%) with no additional prominence in non-survivors (OR: 2.33, CI 0.97 to 5.61, p=0.059). Remarkably, 90.8% of our cohort demonstrated a preserved left ventricular ejection fraction, although 69.1% had elevated troponin levels. Only 1 patient (1.1%) was given a diagnostic label of myocarditis. A raised pulmonary artery systolic pressure (36.8%) andright ventricle (RV) dysfunction (26.4%) were the most common echocardiographic features. In particular, the presence of RV dysfunction was significantly related to adverse outcomes (OR: 2.97, CI 1.11 to 7.94, p<0.03). CONCLUSIONS: In this cohort of extremely unwell patients hospitalised with COVID-19 pneumonitis, the presence of RV dysfunction or admission to ITU was significantly associated with inpatient case fatality ratio. Moreover, COVID-19-induced myocarditis remains extremely rare.


Assuntos
COVID-19 , Miocardite , COVID-19/diagnóstico , Estudos de Coortes , Ecocardiografia , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Volume Sistólico , Função Ventricular Esquerda
5.
Am J Case Rep ; 23: e935577, 2022 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-35535009

RESUMO

BACKGROUND COVID-19 is a pandemic caused by a coronavirus that has only recently been discovered. The disorder is characterized by persistent respiratory system malfunction, which can range from modest difficulty breathing to potentially lethal complications such as acute respiratory distress syndrome. Additional organs are affected as a result of its presence. An adverse impact of COVID-19 infection is myocarditis, which is a condition that affects the heart muscle. CASE REPORT We describe the case of a 38-year-old woman who was hospitalized at University Medical Center Ho Chi Minh City following a 15-day fever, a 3-day bout of dyspnea, and a positive nasal PCR SAR-CoV-2 test. The Lake Louise criteria were used to determine that the patient had a high probability of having myocarditis. She was then treated with oxygen treatment, vasoconstrictor medicines, inotropic therapy, and cornerstone heart failure medications, and was discharged 2 weeks later after a complete recovery. CONCLUSIONS Myocarditis has been identified as a cause of death in COVID-19, although it is not known how common the ailment is in the general population. Early detection and complete treatment, which should include support for the cardiovascular system, are consequently critical for successful outcomes. Magnetic resonance imaging (MRI) of the cardiovascular system (cardiac MRI) is the most important noninvasive method for diagnosing myocarditis.


Assuntos
COVID-19 , Miocardite , Insuficiência Respiratória , Adulto , Feminino , Humanos , Miocardite/diagnóstico , Miocardite/etiologia , Pandemias , SARS-CoV-2
6.
Front Immunol ; 13: 843891, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35514979

RESUMO

Myocarditis is the common cause of sudden cardiac death, dilated cardiomyopathy (DCM) and heart failure (HF) in young adults. The most common type of myocarditis is viral myocarditis (VMC). Toll-like receptors (TLRs) are vital to identify pathogens in vivo. TLRs promote the differentiation of naive CD4+T cells to T helper (Th) cells, activate the immune response, and participate in the pathogenesis of autoimmune and allergic diseases. Although the pathogenesis of VMC is unclear, autoimmune responses have been confirmed to play a significant role; hence, it could be inferred that VMC is closely related to TLRs and Th responses. Some drugs have been found to improve the prognosis of VMC by regulating the immune response through activated TLRs. In this review, we discuss the role of TLRs and Th responses in VMC.


Assuntos
Cardiomiopatia Dilatada , Infecções por Coxsackievirus , Miocardite , Viroses , Cardiomiopatia Dilatada/patologia , Humanos , Linfócitos T Auxiliares-Indutores , Receptores Toll-Like
8.
Sci Rep ; 12(1): 7304, 2022 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-35508525

RESUMO

Viral myocarditis (VM) is an important cause of heart failure (HF) in children and adults. However, the molecular determinants involved in cardiac inflammation and cardiomyocyte necrosis remain poorly characterized, and cardioprotective molecules are currently missing. Here, we applied an in vivo method based on the functional selection (FunSel) of cardioprotective factors using AAV vectors for the unbiased identification of novel immunomodulatory molecules in a Coxsackievirus B3 (CVB3)-induced myocarditis mouse model. Two consecutive rounds of in vivo FunSel using an expression library of 60 cytokines were sufficient to identify five cardioprotective factors (IL9, IL3, IL4, IL13, IL15). The screening also revealed three cytokines (IL18, IL17b, and CCL11) that were counter-selected and likely to exert a detrimental effect. The pooled overexpression of the five most enriched cytokines using AAV9 vectors decreased inflammation and reduced cardiac dilatation, persisting at 1 month after treatment. Individual overexpression of IL9, the top ranking in our functional selection, markedly reduced cardiac inflammation and injury, concomitant with an increase of anti-inflammatory Th2-cells and a reduction of pro-inflammatory Th17- and Th22-cells at 14 days post-infection. AAV9-mediated FunSel cardiac screening identified IL9 and other four cytokines (IL3, IL4, IL13, and IL15) as cardioprotective factors in CVB3-induced VM in mice.


Assuntos
Infecções por Coxsackievirus , Miocardite , Animais , Citocinas/metabolismo , Modelos Animais de Doenças , Enterovirus Humano B , Inflamação , Interleucina-13 , Interleucina-15 , Interleucina-4 , Interleucina-9 , Camundongos , Camundongos Endogâmicos BALB C , Miocardite/genética
9.
Clin J Sport Med ; 32(3): 334-337, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35427244

RESUMO

OBJECTIVE: To evaluate the necessity of cardiac testing after a COVID-19 diagnosis as it relates to myocarditis in collegiate athletes. DESIGN: Cross-sectional retrospective case series. SETTING: National Collegiate Athletic Association Division I University. PATIENTS: One hundred sixty-five collegiate athletes diagnosed with COVID-19 by reverse transcriptase-polymerase chain reaction or immunoglobulin G antibody between August and December 2020 without exclusion. INTERVENTIONS: All participants underwent cardiac workup consisting of serum troponin, electrocardiogram, transthoracic echocardiogram, and cardiac magnetic resonance (CMR). All results were reviewed by team physicians and sports cardiologists. MAIN OUTCOME MEASURES: Prevalence of myocarditis and abnormality on cardiac testing after COVID-19 infection at a single institution. RESULTS: One (0.61% [95% CI, 0.02%-3.3%] asymptomatic athlete had CMR findings of an age-indeterminate myocardial injury with further cardiac testing being otherwise normal. No athlete had CMR abnormalities consistent with acute myocarditis by the modified Lake Louise Criteria. CONCLUSIONS: Occurrence of myocarditis was lower in this population compared with other studies. No student athlete was permanently disqualified from participation because of testing. A stratified, risk-based testing strategy with CMR may be more appropriate than a universal screening strategy.


Assuntos
COVID-19 , Miocardite , Esportes , Atletas , COVID-19/diagnóstico , Teste para COVID-19 , Estudos Transversais , Humanos , Miocardite/diagnóstico , Estudos Retrospectivos
10.
J Cardiothorac Surg ; 17(1): 72, 2022 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-35414115

RESUMO

BACKGROUND: Fulminant myocarditis (FM) is a form of severe inflammatory carditis with rapidly developing acute heart failure. CASE PRESENTATION: We report three cases of successful intensive treatment by Impella of FM without any complications. In all cases, impairment of microcirculation as measured by blood lactate level and the hemodynamic value as indicated by cardiac index were improved within 24-48 h and 7 days after Impella implantation, respectively. Interestingly, our data also suggested that treatment by Impella CP or 5.0 may lead to faster recovery of microcirculation and cardiac function than treatment by Impella 2.5. CONCLUSION: Our findings demonstrate that the appropriate selection of Impella devices guided by body surface area measurements may help to improve clinical outcomes of severe heart failure including FM.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Miocardite , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Hemodinâmica , Humanos , Miocardite/cirurgia , Choque Cardiogênico/etiologia , Resultado do Tratamento
11.
J Int Med Res ; 50(4): 3000605221093678, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35466750

RESUMO

Acute myocarditis is often secondary to an acute virus infection, which can be the first manifestation of upper respiratory tract symptoms, followed by chest tightness, shortness of breath, palpitations, chest pain and other non-specific symptoms. In severe cases, it can quickly progress to serious complications such as heart failure, shock and respiratory failure. Laboratory examinations can show an increase of myocardial injury markers, infection and inflammatory indicators. Cardiac ultrasound can detect the weakening of the myocardial contraction and valve regurgitation. On imaging, bilateral pulmonary oedema demonstrates symmetrical infiltration along the hilum of lung, called the "butterfly shadow". This current case report describes a patient with unilateral pulmonary oedema caused by myocarditis that was initially misdiagnosed and treated as pneumonia. The patient was subsequently treated with the application of extracorporeal membrane oxygenation and he made a full recovery. A review of this case highlights that when a patient's symptoms are not typical, a comprehensive examination and evaluation are required to avoid incorrect treatment.


Assuntos
Oxigenação por Membrana Extracorpórea , Miocardite , Edema Pulmonar , Choque , Dor no Peito , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Humanos , Masculino , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia
12.
J Investig Med High Impact Case Rep ; 10: 23247096221092291, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35466745

RESUMO

Viral infections are a common cause of acute myocarditis. However, vaccines including influenza and smallpox have also been rarely implicated. Recently, the coronavirus disease 2019 (COVID-19) vaccines have been associated with acute myocarditis. We describe a case of acute myocarditis in a 19-year-old male 2 days after the initial dose of the COVID-19 mRNA-1273 vaccine. He presented with chest pain radiating to his left arm and bilateral shoulders. COVID, influenza, coxsackie, respiratory syncytial virus polymerase chain reaction (PCR) tests were negative. Electrocardiogram revealed diffuse ST-segment elevation. Initial Troponin was 15.7 ng/mL. A coronary angiogram revealed patent coronary arteries and no wall motion abnormality. A transthoracic echocardiogram showed diffuse hypokinesis with an ejection fraction of 49%. Cardiac magnetic resonance scan was aborted after 2 attempts due to severe claustrophobia. His chest pain resolved following initiation of aspirin, tylenol, colchicine, lisinopril, and metoprolol.


Assuntos
COVID-19 , Influenza Humana , Miocardite , Adulto , Vacinas contra COVID-19/efeitos adversos , Dor no Peito/etiologia , Humanos , Influenza Humana/complicações , Masculino , Miocardite/complicações , Vacinação/efeitos adversos , Adulto Jovem
13.
MMW Fortschr Med ; 164(7): 22-23, 2022 04.
Artigo em Alemão | MEDLINE | ID: mdl-35391676
15.
J Immunother Cancer ; 10(4)2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35383117

RESUMO

Immune-checkpoint inhibitors (ICI) have revolutionized cancer therapy but are associated with infrequent but lethal myocarditis, for which management remains uncertain. Abatacept, a CTLA-4 fusion protein targeting CD86 on antigen presenting cells and leading to global T-cell anergy, has been described as a potential treatment in individual reports. Yet, abatacept treatment dosage, schedule and optimal combination with other immunosuppressive therapies are unclear. We describe a 25-year-old man who developed pembrolizumab (anti-PD1)-induced myocarditis 14 days after first injection for thymoma treatment, which deteriorated into cardiogenic shock, with sustained ventricular arrhythmia, requiring urgent extracorporeal life support implantation, despite prompt initiation of corticosteroids and mycophenolate-mofetil. Using a strategy of serial measurement ensuring with a target of >80% CD86 receptor occupancy on circulating monocytes, abatacept dose was adjusted and combined with ruxolitinib and methylprednisolone. This strategy resulted in high-dose of abatacept: 60 mg/kg in three doses (20 mg/kg each) within the first 10 days, followed by two doses. Clinical improvement occurred within 7 days, with resolution of systolic cardiac dysfunction, and ventricular arrhythmias resulting in successful discharge from hospital. We reversed a case of nearly lethal ICI-myocarditis, using specific patient-dose adjusted abatacept, which may serve as basis for personalized treatment of patients with severe ICI-adverse events. Trial registration number: NCT04294771.


Assuntos
Abatacepte , Inibidores de Checkpoint Imunológico , Miocardite , Pirazóis , Abatacepte/efeitos adversos , Abatacepte/uso terapêutico , Adulto , Humanos , Inibidores de Checkpoint Imunológico/efeitos adversos , Masculino , Miocardite/induzido quimicamente , Miocardite/tratamento farmacológico , Nitrilas , Pirazóis/efeitos adversos , Pirazóis/uso terapêutico , Pirimidinas
16.
Cardiol Rev ; 30(3): 145-157, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35384908

RESUMO

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 and was first reported in December 2019 in Wuhan, China. Since then, it caused a global pandemic with 212,324,054 confirmed cases and 4,440,840 deaths worldwide as of August 22, 2021. The disease spectrum of COVID-19 ranges from asymptomatic subclinical infection to clinical manifestations predominantly affecting the respiratory system. However, it is now evident that COVID-19 is a multiorgan disease with a broad spectrum of manifestations leading to multiple organ injuries including the cardiovascular system. We review studies that have shown that the relationship between cardiovascular diseases and COVID-19 is indeed bidirectional, implicating that preexisting cardiovascular comorbidities increase the morbidity and mortality of COVID-19, and newly emerging cardiac injuries occur in the settings of acute COVID-19 in patients with no preexisting cardiovascular disease. We present the most up-to-date literature summary to explore the incidence of new-onset cardiac complications of coronavirus and their role in predicting the severity of COVID-19. We review the association of elevated troponin with the severity of COVID-19 disease, which includes mild compared to severe disease, in nonintensive care unit compared to intensive care unit patients and in those discharged from the hospital compared to those who die. The role of serum troponin levels in predicting prognosis are compared in survivors and non-survivors. The association between COVID-19 disease and myocarditis, heart failure and coagulopathy are reviewed. Finally, an update on beneficial treatments is discussed.


Assuntos
COVID-19 , Doenças Cardiovasculares , Cardiopatias , Miocardite , COVID-19/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Cardiopatias/epidemiologia , Humanos , Pandemias , Troponina
17.
Vet Clin North Am Exot Anim Pract ; 25(2): 453-467, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35422262

RESUMO

Samples of 363 Psittacidae were included in this study with a focus on cardiovascular diseases. These were identified in 28.9% of the animals, with pericarditis and/or epicarditis and myocarditis representing approximately half of all lesions and bacteria being the most common infectious cause. Cardiac lymphoma was only seen in 5 birds, whereas degenerative vascular lesions were diagnosed in 26.7% of the cases. Histopathology in the context of clinical findings and complementary examination results is the most useful tool for the evaluation of cardiac diseases.


Assuntos
Sistema Cardiovascular , Miocardite , Papagaios , Pericardite , Animais , Sistema Cardiovascular/patologia , Miocardite/complicações , Miocardite/patologia , Miocardite/veterinária , Pericardite/etiologia , Pericardite/patologia , Pericardite/veterinária
18.
Ann Glob Health ; 88(1): 18, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35433282

RESUMO

Background: COVID-19 myocarditis is becoming increasingly appreciated as a complication of COVID-19. There are significant hurdles to formal diagnosis with endomyocardial biopsy or cardiac MRI, whether by resource limitations, patient instability, or isolation precautions. Therefore, further exploratory analysis is needed to clinically define the characteristics and spectrum of severity of COVID-19 myocarditis. Objectives: The aim of this study was to describe the clinical course, echocardiographic, and laboratory testing across suspected fulminant and non-fulminant clinically defined COVID-19 myocarditis. Methods: In a cross-sectional observational study of 19 patients with clinically defined COVID-19 myocarditis, we report presenting symptoms, clinical course, laboratory findings, and echocardiographic results stratified by non-fulminant and fulminant myocarditis. Student t-test and univariate logistic regression are used to compare laboratory findings across fulminant and non-fulminant cases. Findings: Among 19 patients, there was no prior history of coronary artery disease, atrial fibrillation, or heart failure; 21.1% of patients died; and 78.9% of cases required supplemental oxygen. A significantly higher geometric mean D-dimer and ferritin were observed in patients with fulminant compared to non-fulminant suspected myocarditis. 26.3% of cases had pericardial effusions. 10 out of the 16 with available echocardiographic data had normal left ventricular systolic function. Conclusions: In this study, we provide a practical clinical depiction of patients with clinical COVID-19 myocarditis across fulminant and non-fulminant cases. Statistically significant elevations in inflammatory markers in fulminant versus non-fulminant cases generate hypotheses regarding the role of systemic inflammation. While cardiac MRI and endomyocardial biopsy may not be accessible at scale in low- and middle-income countries, the present study offers a clinical definition of COVID-19 myocarditis and accessible laboratory findings to define severity.


Assuntos
COVID-19 , Miocardite , Estudos Transversais , Ecocardiografia , Humanos , Miocardite/complicações , Miocardite/diagnóstico por imagem , Cidade de Nova Iorque/epidemiologia
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