- Ventricular arrhythmias and myocardial inflammation: Long-term follow-up of patients with suspected myocarditis. [Journal Article]
- IJInt J Cardiol 2018 Aug 09
- CONCLUSIONS: Nearly one third of patients with suspected myocarditis require an ICD due to impaired LVEF or occurrence of VA. Half of these patients experienced VA with adequate ICD therapy.
- Clozapine-Induced Myocarditis or Acute Coronary Syndrome? Optical Coherence Tomography to the Rescue. [Journal Article]
- CRCase Rep Cardiol 2018; 2018:5026107
- Chest pain and troponin elevation may be due to an acute coronary syndrome, myocarditis, acute cardiomyopathy, or other less common conditions. Management differs depending on the aetiology, and the ...
Chest pain and troponin elevation may be due to an acute coronary syndrome, myocarditis, acute cardiomyopathy, or other less common conditions. Management differs depending on the aetiology, and the pathophysiologic diagnosis has direct implications on treatment and patient outcomes. History and clinical examination is supplemented by selected investigations including the electrocardiogram, chest X-ray, echocardiography, coronary angiography, and even myocardial perfusion scintigraphy or cardiac magnetic resonance imaging. Intravascular imaging can provide important insights into the underlying mechanism of acute coronary syndromes, especially when angiography is ambiguous.
- A Rare Case of an Azygos Lobe in the Right Lung of a 40-year-old Male. [Journal Article]
- CCureus 2018 Jun 11; 10(6):e2780
- The azygos lobe is a rare anatomical variant, most often encountered in the right lung. Its etiology is related to a defect of the migration of the azygos vein during the embryonic development. Here,...
The azygos lobe is a rare anatomical variant, most often encountered in the right lung. Its etiology is related to a defect of the migration of the azygos vein during the embryonic development. Here, we describe a rare case of an azygos lobe of the right lung, diagnosed incidentally on a computed tomography (CT) scan in a 40-year-old male patient who presented with chest pain, shortness of breath, and fever. The initial differential diagnosis included acute myocardial infarction, aortic dissection, and myocarditis. Chest CT with contrast matter demonstrated a peculiar finding in the right lung which was recognized as an azygos vein passing through the upper lobe and separating an azygos lobe with its mesoazygos. The azygos lobe may be rarely associated with neoplastic processes or spontaneous pneumothorax and its differential diagnosis on imaging studies includes various conditions. Knowledge of this variation is important to avoid misdiagnosis or complications during thoracic surgery.
- The unique role of cardiovascular magnetic resonance imaging in acute myocarditis. [Review]
- FF1000Res 2018; 7
- This article addresses the specific diagnostic information provided by cardiovascular magnetic resonance (CMR) in patients with suspected acute myocarditis. It gives an overview of the current eviden...
This article addresses the specific diagnostic information provided by cardiovascular magnetic resonance (CMR) in patients with suspected acute myocarditis. It gives an overview of the current evidence of the ability of CMR to detect myocardial inflammation and discusses the added value as well as its limitations in clinical settings. Because of the large variety of symptoms and the limited specificity of other non-invasive procedures, the identification of myocardial inflammation is of paramount importance. Because of its accuracy in imaging ventricular volumes and function and its unique ability to visualize myocardial edema, scar, and other tissue abnormalities, CMR has emerged as the prime non-invasive diagnostic tool in patients with acute myocarditis. The presence of myocardial inflammation is not specific to viral myocarditis or other forms of acute myocardial injury, and the regional distribution within the myocardium helps differentiate acute myocarditis from other diseases. The currently recommended diagnostic criteria (Lake Louise Criteria) include markers for hyperemia/capillary leak, edema, and inflammatory scarring. Their diagnostic accuracy of close to 80% is satisfactory to rule in myocarditis, yet the negative predictive value is less than 70%. Novel CMR techniques, especially T1 and T2 mapping, have been shown to further improve the diagnostic utility.
- Longitudinal 18F-FDG PET imaging in a rat model of autoimmune myocarditis. [Journal Article]
- EHEur Heart J Cardiovasc Imaging 2018 Aug 08
- CONCLUSIONS: 18F-FDG PET imaging can provide non-invasive serial monitoring of cardiac inflammation in a rat model of acute myocarditis.
- Immune checkpoint inhibitor-related myositis and myocarditis in patients with cancer. [Journal Article]
- NeurNeurology 2018 Aug 08
- CONCLUSIONS: irMyositis presents with remarkably homogeneous and unique clinicopathologic features, expanding the nosologic spectrum of inflammatory myopathies in patients with cancer. ICI withdrawal and treatment with corticosteroids improve outcome.
- Cardiac MRI Texture Analysis of T1 and T2 Maps in Patients with Infarctlike Acute Myocarditis. [Journal Article]
- RRadiology 2018 Aug 07; :180411
- Purpose To assess the diagnostic potential of texture analysis applied to T1 and T2 maps obtained with cardiac MRI for the diagnosis of acute infarctlike myocarditis. Materials and Methods This prosp...
Purpose To assess the diagnostic potential of texture analysis applied to T1 and T2 maps obtained with cardiac MRI for the diagnosis of acute infarctlike myocarditis. Materials and Methods This prospective study from August 2012 to May 2015 included 39 participants (overall mean age ± standard deviation, 34.7 years ± 12.2 [range, 18-63 years]; mean age of women, 46.1 years ± 10.8 [range, 24-63 years]; mean age of men, 29.8 years ± 9.2 [range, 18-56 years]) from the Magnetic Resonance Imaging in Myocarditis (MyoRacer) trial with clinical suspicion of acute myocarditis and infarctlike presentation. Participants underwent biventricular endomyocardial biopsy, cardiac catheterization, and cardiac MRI at 1.5 T, in which native T1 and T2 mapping as well as Lake Louise criteria (LLC) were assessed. Texture analysis was applied on T1 and T2 maps by using a freely available software package. Stepwise dimension reduction and texture feature selection was performed for selecting features enabling the diagnosis of myocarditis by using endomyocardial biopsy as the reference standard. Results Endomyocardial biopsy confirmed the diagnosis of acute myocarditis in 26 patients, whereas 13 participants had no signs of acute inflammation. Mean T1 and T2 values and LLC showed a low diagnostic performance, with area under the curve in receiver operating curve analyses as follows: 0.65 (95% confidence interval [CI]: 0.45, 0.85) for T1, 0.67 (95% CI: 0.49, 0.85) for T2, and 0.62 (95% CI: 0.42, 0.79) for LLC. Combining the texture features T2 run-length nonuniformity and gray-level nonuniformity resulted in higher diagnostic performance with an area under the curve of 0.88 (95% CI: 0.73, 1.00) (P < .001) and a sensitivity and specificity of 89% [95% CI: 81%, 93%] and 92% [95% CI: 77%, 93%], respectively. Conclusion Texture analysis of T2 maps shows high sensitivity and specificity for the diagnosis of acute infarctlike myocarditis.
- Mechanical Unloading by Fulminant Myocarditis: LV-IMPELLA, ECMELLA, BI-PELLA, and PROPELLA Concepts. [Journal Article]
- JCJ Cardiovasc Transl Res 2018 Aug 06
- Mechanical circulatory support (MCS) is often required to stabilize patients with acute fulminant myocarditis with cardiogenic shock. This review gives an overview of the successful use of left-sided...
Mechanical circulatory support (MCS) is often required to stabilize patients with acute fulminant myocarditis with cardiogenic shock. This review gives an overview of the successful use of left-sided Impella in the setting of fulminant myocarditis and cardiogenic shock as the sole means of MCS as well as in combination with right ventricular (RV) support devices including extracorporeal life support (ECLS) (ECMELLA) or an Impella RP (BI-PELLA). It further provides evidence from endomyocardial biopsies that in addition to giving adequate support, LV unloading by Impella exhibits disease-modifying effects important for myocardial recovery (i.e., bridge-to-recovery) achieved by this newly termed "prolonged Impella" (PROPELLA) concept in which LV-IMPELLA 5.0, implanted via an axillary approach, provides support in awake, mobilized patients for several weeks. Finally, this review addresses the question of how to define the appropriate time point for weaning strategies and for changing or discontinuing unloading in fulminant myocarditis.
- Retroperitoneal Paraganglioma-Induced Cardiogenic Shock Rescued by Preoperative Arterial Embolization. [Journal Article]
- CRCase Rep Crit Care 2018; 2018:4058046
- CONCLUSIONS: Paraganglioma-induced myocarditis is rare but can be dramatic. Management requires appropriate and immediate hemodynamic support. Embolization may be an alternative to stabilize the patient prior to surgery.
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- Association of left atrial pressure with left atrial volume and N-terminal prohormone brain natriuretic peptide in children with cardiomyopathy. [Journal Article]
- CYCardiol Young 2018 Jul 31; :1-5
- CONCLUSIONS: Left atrial volume measured non-invasively by echocardiography can be used as a surrogate for left atrial pressure in assessing diastolic dysfunction of the left ventricle in children with cardiomyopathy. The larger the size of the left atrium, worse is the diastolic function of the left ventricle.