- Clinical Presentation and Outcome in a Contemporary Cohort of Patients with Acute Myocarditis: The Multicenter Lombardy Registry. [Journal Article]
- CircCirculation 2018 May 15
- Background -There is controversy regarding outcome of patients with acute myocarditis (AM), and lack of data on how patients admitted with suspected AM are managed. We report characteristics, in-hos...
Background -There is controversy regarding outcome of patients with acute myocarditis (AM), and lack of data on how patients admitted with suspected AM are managed. We report characteristics, in-hospital management and long-term outcome of patients with AM based on a retrospective multi-center registry from 19 Italian hospitals. Methods -A total of 684 patients with suspected AM and recent onset of symptoms (<30 days) were screened between May 2001 and February 2017. Patients >70 years and those older than 50 years without coronary angiography were excluded. The final study population comprised 443 patients (median age 34 years, 19.4% female) with AM diagnosed either by endomyocardial biopsy (EMB) or increased troponin plus edema and late gadolinium enhancement at cardiac magnetic resonance (CMR). Results -At presentation, 118 patients (26.6%) had either left ventricular (LV) ejection fraction (EF) <50%, sustained ventricular arrhythmias (VA) or a low cardiac output syndrome (LCOS) whilst 325 (73.4%) had no such complications. EMB was performed in 56/443 (12.6%), and a baseline CMR was performed in 415/443 (93.7%) of patients. Cardiac mortality plus heart transplant (HTx) at 1 and 5 years were 3.0% and 4.1%. Cardiac mortality plus HTx were 11.3% and 14.7% in patients with complicated presentation and 0% in uncomplicated cases (Log-rank p<0.0001). Major AM-related cardiac events after the acute phase (post-discharge death and HTx, sustained VA treated with electrical shock or ablation, symptomatic heart failure needing device implantation) occurred in 2.8% at 5-year follow up, with a higher incidence in patients with complicated forms (10.8% vs. 0% in uncomplicated AM, Log-rank p<0.0001). Beta adrenoceptor blockers were the most frequently employed medications both in complicated (61.9%) and in uncomplicated forms (53.8%, p=0.18). After a median time of 196 days, 200 patients had follow-up CMR and 8/55 (14.5%) with complications at presentation had LVEF<50% compared with 1/145 (0.7%) of those with uncomplicated presentation. Conclusions -In this contemporary study, overall serious adverse events after AM were lower than previously reported. However, patients with LVEF<50%, VA or LCOS at presentation were at higher risk compared with uncomplicated cases that had a benign prognosis and low risk of subsequent LV systolic dysfunction.
- Evaluation of MinION nanopore sequencing for rapid enterovirus genotyping. [Journal Article]
- VRVirus Res 2018 May 12; 252:8-12
- Enteroviruses (EV) are associated with a range of serious infections, including aseptic meningitis, hand foot and mouth disease, myocarditis, acute flaccid paralysis and encephalitis. Improved method...
Enteroviruses (EV) are associated with a range of serious infections, including aseptic meningitis, hand foot and mouth disease, myocarditis, acute flaccid paralysis and encephalitis. Improved methods for assessing EV genotypic diversity could assist molecular epidemiology studies, clinical diagnosis and environmental surveillance. We report new methods for EV genome amplification, and subsequent genotyping using the miniaturised MinION sequencing device. Importantly, this next-generation sequencer enabled correct strain-level assignment of identity for the EV-A71 isolate assessed, where strains with up to 99.7% similarity were discriminated. In addition, an accurate consensus sequence was produced for EV-A71 isolate RNA, with 99.3-99.6% similarity to the reference sequence. Thus, the long nanopore reads enabled rapid whole genome sequencing and strain level identification of EV- A71 isolate RNA. We also demonstrated potential for using MinION sequencing for direct detection of EV in water samples, which may have application for diversity analysis, water quality monitoring, and environmental surveillance.
- Fatal Myopericarditis Following an Influenza A (H3N2) Infection. [Journal Article]
- AJAm J Case Rep 2018 May 08; 19:540-544
- CONCLUSIONS: Pericardial effusion myopericarditis may occur during influenza virus infection in young individuals, even those with no known predisposing factors. Physicians need to be aware that acute myopericarditis can be a fatal complication of recent influenza virus infection in all patients with instable hemodynamics. Early diagnosis and treatment could reduce, in some cases, the risk of severe cardiac events. However, this sudden and fatal outcome was difficult to predict in a healthy young female with no known risk factors.
- NF-κB-mediated metabolic remodelling in the inflamed heart in acute viral myocarditis. [Journal Article]
- BBBiochim Biophys Acta 2018 May 03
- Acute viral myocarditis (VM), characterised by leukocyte infiltration and dysfunction of the heart, is an important cause of sudden cardiac death in young adults. Unfortunately, to date, the patholog...
Acute viral myocarditis (VM), characterised by leukocyte infiltration and dysfunction of the heart, is an important cause of sudden cardiac death in young adults. Unfortunately, to date, the pathological mechanisms underlying cardiac failure in VM remain incompletely understood. In the current study, we investigated if acute VM leads to cardiac metabolic rewiring and if this process is driven by local inflammation. Transcriptomic analysis of cardiac biopsies from myocarditis patients and a mouse model of VM revealed prominent reductions in the expression of a multitude of genes involved in mitochondrial oxidative energy metabolism. In mice, this coincided with reductions in high-energy phosphate and NAD levels, as determined by Imaging Mass Spectrometry, as well as marked decreases in the activity, protein abundance and mRNA levels of various enzymes and key regulators of cardiac oxidative metabolism. Indicative of fulminant cardiac inflammation, NF-κB signalling and inflammatory cytokine expression were potently induced in the heart during human and mouse VM. In cultured cardiomyocytes, cytokine-mediated NF-κB activation impaired cardiomyocyte oxidative gene expression, likely by interfering with the PGC-1 (peroxisome proliferator-activated receptor (PPAR)-γ co-activator) signalling network, the key regulatory pathway controlling cardiomyocyte oxidative metabolism. In conclusion, we provide evidence that acute VM is associated with extensive cardiac metabolic remodelling and our data support a mechanism whereby cytokines secreted primarily from infiltrating leukocytes activate NF-κB signalling in cardiomyocytes thereby inhibiting the transcriptional activity of the PGC-1 network and consequently modulating myocardial energy metabolism.
- Transient myocardial thickening in a Bartonella henselae-positive cat. [Journal Article]
- JVJ Vet Cardiol 2018 May 02
- A 3-year-old castrated male domestic shorthair presented to the Cornell University Hospital for Animals for acute onset respiratory distress. Thoracic radiographs, echocardiogram, and electrocardiogr...
A 3-year-old castrated male domestic shorthair presented to the Cornell University Hospital for Animals for acute onset respiratory distress. Thoracic radiographs, echocardiogram, and electrocardiogram (ECG) revealed left-sided congestive heart failure, myocardial thickening with left atrial dilation, and sinus rhythm conducted with a left bundle branch block, respectively. Cardiac troponin I was elevated and continued to increase over 36 h (1.9 ng/mL, 3.1 ng/mL, and 3.5 ng/mL, sequentially every 12 h). The cat tested positive for Bartonella henselae and was treated with azithromycin (30 mg/kg by mouth (PO) every 24 h for 30 days), along with furosemide (1 mg/kg PO every 24 h), benazepril (0.4 mg/kg PO every 24 h), pimobendan (0.23 mg/kg PO every 12 h), and clopidogrel (18.75 mg PO every 24 h). Reevaluation at 6 weeks revealed normal respiratory rate on physical examination, normal cardiac structures and function on echocardiogram, resolution of left bundle branch block on ECG, and normal cardiac troponin I levels (0.06 ng/mL). All medications were discontinued at this time, and the cat continued to do well 5 months after reevaluation. Here, we report a case of transient myocardial thickening in a cat that was also positive for B.henselae.
- Scleroderma Renal Crisis: A Reversible Cause of Left Ventricular Dysfunction. [Journal Article]
- RCReumatol Clin 2018 May 02
- We report a case of acute left ventricular dysfunction due to myocarditis, in the setting of a scleroderma renal crisis. The case is particularly intriguing for the favorable outcome of both symptoms...
We report a case of acute left ventricular dysfunction due to myocarditis, in the setting of a scleroderma renal crisis. The case is particularly intriguing for the favorable outcome of both symptoms and heart function following immunosuppressive therapy. We also highlight the changes observed over time with image techniques as well as in electrocardiograms.
- [MINOCA in Iceland. Acute coronary syndrome in patients with normal or nonobstructive coronary arteries]. [Journal Article]
- LLaeknabladid 2018 Mai; 104(5):237-242
- CONCLUSIONS: The proportion of MINOCA in Iceland is 13.2% of patients admitted for acute coronary syndromes. Plaque erosion / rupture was considered a likely cause in one third of patients with other causes beeing evenly distributed with approximately half that frequency. Identification of the underlying cause of MINOCA would become more accurate with a consistent use of cardiac magnetic resonance imaging in these patients as it provided a definitive diagnosis in all of those -studied.
- Personalized medicine in inflammatory cardiomyopathy. [Journal Article]
- PMPer Med 2018; 15(2):127-136
- Inflammatory cardiomyopathy is the result of persistent myocardial inflammation which can arise from both infectious or noninfectious causes. While most patients with acute myocarditis recover, up to...
Inflammatory cardiomyopathy is the result of persistent myocardial inflammation which can arise from both infectious or noninfectious causes. While most patients with acute myocarditis recover, up to 20% develop inflammatory cardiomyopathy with chronic heart failure. The interaction between host factors and factors of the agent that triggered myocardial inflammation must be considered to fully understand the individual mechanism of disease. Several inflammatory biomarkers, histology, immunohistochemistry, advanced imaging technologies as well as molecular high-throughput sequencing techniques help to identify disease pathways and to establish a comprehensive, individualized treatment approach, which can include anti-inflammatory medication, antiviral drugs and heart failure therapy. This might help to prevent transition from acute inflammation to persistent heart failure and to restore cardiac function.
- Sudden unexpected cardio-respiratory arrest after venipuncture in children. [Journal Article]
- KJKorean J Pediatr 2018; 61(4):108-113
- CONCLUSIONS: Cardiorespiratory arrest after venipuncture is unpredictable and the probable cause of most cases is a vasovagal reaction. Medical personnel must be aware of the risk of unexpected cardiorespiratory arrest during routine intravenous procedures.
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- Clinical Profile and Outcome of Paraphenylene Diamine Poisoning. [Journal Article]
- JCJ Coll Physicians Surg Pak 2018; 28(5):374-377
- CONCLUSIONS: Paraphenylene diamine is an emerging domestic poison in Pakistan, with a high morbidity and mortality.