Tofacitinib for treatment in immune-mediated myocarditis: The first reported cases

Immune Mediated ◽

Ecg Abnormalities ◽

Effective Treatments

Introduction Immune checkpoint inhibitors (ICI) has demonstrated significant clinical benefit in advanced cancer. Despite favorable benefits, the use of ICI is accompanied by various side effects, which are inflammatory side effects potentially affecting any organ. Among which myocarditis is the most severe and has a relatively high mortality. However, there is no effective treatments, and many patients respond poorly to glucocorticoids and immunosuppressants. Therefore, it is urgent to explore effective treatments. Cases report Here we describe two patients with metastatic cancer who developed immune-mediated myocarditis after receiving anti-programmed cell death protein (PD)-1 antibody. The main clinical manifestations are dyspnea. All patients had an elevation of cardiac enzyme, a variety of atypical electrocardiographic (ECG) abnormalities and preserved left ventricular ejection fraction (LVEF). All our patients underwent cardiac MRI (CMRI) and suggested typical features of myocarditis, including myocardial oedema and delayed enhancement. Management and outcome: All patients were treated promptly with glucocorticoids, followed by other immunosuppressive treatments include plasma exchange and intravenous immunoglobulin (IVIG). However, no significant improvement was observed and we then administered tofacitinib 5 mg twice daily to treat the refractory myocarditis and the elevated levels of pro-inflammatory cytokines. All patients recovered and were discharged. No major adverse reaction was reported during tofacitinib therapy. Discussion To our knowledge, this is the first report in the world of patients with ICI-associated myocarditis treated with oral tofacitinib. Our results can at least provide a new option for clinical treatment of refractory myocarditis or other immune-related adverse events.

Myocarditis-associated necrotizing coronary vasculitis: incidence, cause, and outcome

European Heart Journal ◽

10.1093/eurheartj/ehaa973 ◽

2020 ◽

Author(s):

Andrea Frustaci ◽

Maria Alfarano ◽

Romina Verardo ◽

Chiara Agrati ◽

Rita Casetti ◽

...

Keyword(s):

Hospital Mortality ◽

Hypereosinophilic Syndrome ◽

Left Ventricular ◽

Response To Therapy ◽

Toll Like Receptor ◽

Toll Like Receptor 4 ◽

Immune Mediated ◽

Coronary Vasculitis

Abstract Aims Necrotizing coronary vasculitis (NCV) is a rare entity usually associated to myocarditis which incidence, cause, and response to therapy is unreported. Methods and results Among 1916 patients with biopsy-proven myocarditis, 30 had NCV. Endomyocardial samples were retrospectively investigated with immunohistochemistry for toll-like receptor 4 (TLR4) and real-time polymerase chain reaction (PCR) for viral genomes. Serum samples were processed for anti-heart autoantibodies (Abs), IL-1β, IL-6, IL-8, tumour necrosis factor (TNF)-α. Identification of an immunologic pathway (including virus-negativity, TLR4-, and Ab-positivity) was followed by immunosuppression. Myocarditis-NCV cohort was followed for 6 months with 2D-echo and/or cardiac magnetic resonance and compared with 60 Myocarditis patients and 30 controls. Increase in left ventricular ejection fraction ≥10% was classified as response to therapy. Control endomyocardial biopsy followed the end of treatment. Twenty-six Myocarditis-NCV patients presented with heart failure; four with electrical instability. Cause of Myocarditis-NCV included infectious agents (10%) and immune-mediated causes (chest trauma 3%; drug hypersensitivity 7%; hypereosinophilic syndrome 3%; primary autoimmune diseases 33%, idiopathic 44%). Abs were positive in immune-mediated Myocarditis-NCV and virus-negative Myocarditis; Myocarditis-NCV patients with Ab+ presented autoreactivity in vessel walls. Toll-like receptor 4 was overexpressed in immune-mediated forms and poorly detectable in viral. Interleukin-1β was significantly higher in Myocarditis-NCV than Myocarditis, the former presenting 24% in-hospital mortality compared with 1.5% of Myocarditis cohort. Immunosuppression induced improvement of cardiac function in 88% of Myocarditis-NCV and 86% of virus-negative Myocarditis patients. Conclusion Necrotizing coronary vasculitis is histologically detectable in 1.5% of Myocarditis. Necrotizing coronary vasculitis includes viral and immune-mediated causes. Intra-hospital mortality is 24%. The immunologic pathway is associated with beneficial response to immunosuppression.

Cardiac sarcoidosis: A review on the work-up and management

Open Medicine ◽

10.2478/s11536-012-0095-8 ◽

2013 ◽

Vol 8 (1) ◽

pp. 107-116

Author(s):

Boris Solun ◽

Dana Marcoviciu ◽

Yulia Belnik ◽

Tamar Azran ◽

Dror Dicker ◽

...

Keyword(s):

Sudden Death ◽

Cardiac Sarcoidosis ◽

Ventricular Tachyarrhythmia ◽

Clinical Manifestations ◽

Left Ventricular ◽

Diagnostic Tools ◽

Unknown Etiology ◽

Electrocardiographic Monitoring

AbstractSarcoidosis is a multisystem granulomatous disease of unknown etiology and with variable presentation. Skin, lymph nodes, lungs, eyes and the central nervous system are mostly involved. Cardiac sarcoidosis (CS) is a rare condition with clinical manifestations in about 5% of patients. Since it increases the risk of acute cardiac failure, ventricular arrhythmia, conduction disturbances and even sudden death, it aggravates markedly the prognosis. The early diagnosis of CS is difficult, requiring the use of diagnostic tools such as electrocardiographic monitoring, two-dimensional echocardiography, radionuclide scan, cardiac magnetic resonance imaging, positron emission tomography and endomyocardial biopsy. Once the diagnosis of CS is established, there is a need for early corticosteroids treatment, with or without immunosuppressive therapy, to prevent deterioration of cardiac function. In patients with refractory ventricular tachyarrhythmia, markedly reduced left ventricular ejection fraction and high risk of sudden death, prophylactic insertion of a pacemaker or implantable defibrillator is recommended. We had the opportunity to treat a patient with CS and to review the currently accepted diagnostic and treatment approach.

Left Ventricular Noncompaction—A Systematic Review of Risk Factors in the Pediatric Population

Journal of Clinical Medicine ◽

10.3390/jcm10061232 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1232

Author(s):

Katarzyna Łuczak-Woźniak ◽

Bożena Werner

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Magnetic Resonance ◽

Clinical Manifestations ◽

Left Ventricular ◽

Diagnostic Methods ◽

Left Ventricular Noncompaction ◽

Ventricular Noncompaction

Left ventricular noncompaction (LVNC) is a heterogeneous, often hereditary group of diseases, which may have diverse clinical manifestations. This article reviews the risk factors for unfavorable outcomes of LVNC in children, as well as discuss the diagnostic methods and the differences between pediatric and adult LVNC. Through a systematic review of the literature, a total of 1983 articles were outlined; 23 of them met the inclusion criteria. In echocardiography the following have been associated with adverse outcomes in children: Left ventricular ejection fraction, end-diastolic dimension, left ventricular posterior wall compaction, and decreased strains. T-wave abnormalities and increased spatial peak QRS-T angle in ECG, as well as arrhythmia, were observed in children at greater risk. Cardiac magnetic resonance is a valuable tool to identify those with systolic dysfunction and late gadolinium enhancement. Genetic testing appears to help identify children at risk, because mutations in particular genes have been associated with worse outcomes. ECG and imaging tests, such as echocardiography and magnetic resonance, help outline risk factors for unfavorable outcomes of LVNC in children and in identifying outpatients who require more attention. Refining the current diagnostic criteria is crucial to avoid inadequate restrain from physical activity.

Novel Oral Anti Coagulants (NOACs) as Anti Thrombotic on Atrial Fibrillation Patients

SCRIPTA SCORE Scientific Medical Journal ◽

10.32734/scripta.v1i2.1232 ◽

2020 ◽

Vol 1 (2) ◽

pp. 6

Author(s):

Abed Nego Okthara Sebayang

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Side Effects ◽

Oral Anticoagulants ◽

Left Ventricular ◽

Systemic Embolism ◽

New Anticoagulants ◽

Clinical Benefits

ABSTRACT Atrial Fibrillation (AF) is an arrhythmia characterized by disorganization of atrial depolarization resulting in the impaired mechanical function of the atrium. Management of AF aims to prevent complications of ischemic stroke and systemic embolism, carried out by the administration of anticoagulant, warfarin, but warfarin has many side effects. New Oral Anticoagulants (NOAC) can be used as alternatives in preventing complications of AF.New anticoagulants such as dabigatran, rivaroxaban, and apixaban have better effects than other anticoagulants such as warfarin and have major side effects of bleeding and minimal relevant bleeding. Based on a national survey in Denmark to see a balance between stroke and intracranial bleeding, CHA2DS2-VASc 1 scores were only apixaban and both dabigatran doses (110 mg bid and 150 mg bid) which provided better clinical benefits than warfarin, but if the CHA2DS2- score VASc ≥2 of all NOACs is superior to warfarin. Atrial fibrillation can cause ischemic stroke and systemic embolism. New Oral Anticoagulant (NOACs) can be used as a solution to prevent complications from AF with minimal side effects. It is expected that the presence of new anticoagulants can reduce the rate of ischemic stroke and ischemic embolism due to AF with minimal side effects of bleeding and other side effects. Keywords: Anticoagulant, Atrial Fibrillation, NOAC, Warfarin ABSTRAK Atrial Fibrilasi (AF) adalah suatu aritmia yang ditandai dengan disorganisasi dari depolarisasi atrium sehingga berakibat pada gangguan fungsi mekanik atrium. Penatalaksanaan AF bertujuan mencegah komplikasiyakni stroke iskemik dan emboli sistemik, dilakukan dengan cara pemberian anti-koagulan yakni warfarin. Pemberian warfarin memiliki banyak efek samping. Novel Oral Anti Coagulants (NOAC) dapat dijadikan alternatif dalam mencegah komplikasi AF. Anti-koagulan baru seperti dabigatran, rivaroxaban dan apixaban memiliki efektifitas yang lebih baik daripada anti-koagulan lainnya seperti warfarin dan memiliki efek samping perdarahan mayor dan perdarahan relevan yang minimal. Berdasarkan survei nasional di Denmark untuk melihat keseimbangan antara stroke dan perdarahan intra-kranial didapatkan bila skor Congestive heart failure, Hypertension, Age ≥75 years (skor 2), Diabetes mellitus, Stroke history (skor 2), peripheral Vascular disease, Age between 65 to 74 years, Sex Category (female) dan “C” adalah adanya disfungsi ventrikel kiri sedang hingga berat (Left Ventricular Ejection Fraction/LVEF ≤ 40%) CHA2DS2-VASc 1 hanya apixaban dan kedua dosis dabigatran (110 mg b.i.ddan 150 mg b.i.d) yang memberikan manfaat klinis yang lebih baik daripada warfarin, tetapi apabila skor CHA2DS2-VASc ≥2 seluruh NOAC lebih superior dibanding warfarin.AF dapat menyebabkan stroke iskemik dan emboli sistemik.NOAC dapat dijadikan solusi untuk mencegah komplikasi dari AF dengan efek samping yang minimal. Diharapkan dengan hadirnya anti-koagulan baru dapat menurunkan angka stroke iskemik dan emboli iskemik akibat AF dengan efek samping perdarahan dan efek samping lainnya yang minimal. Kata Kunci: Antikoagulan, Atrial Fibrilasi, NOAC, Warfarin

A Rare Case of Massive Pericardial Effusion as the First Presentation of Hashimoto’s Hypothyroidism With Complete Resolution With Levothyroxine Treatment - A Case Report

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1871 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A916-A916

Author(s):

Randa Abdelmasih ◽

Ramy Abdelmaseih ◽

Dewansh Goel ◽

S Mustajab Hasan ◽

Khalid Abusaada

Keyword(s):

Pericardial Effusion ◽

Lower Extremity ◽

Troponin I ◽

Hormone Replacement ◽

Clinical Manifestations ◽

Left Ventricular ◽

Thyroid Peroxidase ◽

Lower Extremity Edema ◽

Ventricular Ejection Fraction

Abstract Introduction: Hypothyroidism is a common endocrine disorder with multi-system involvement, with prevalence rate of 4.6% among the U.S. population. Clinical manifestations of hypothyroidism can vary widely from subclinical condition to multi-organ failure. One of the rare but serious complications of hypothyroidism is pericardial effusion (PE). To our knowledge, there are few case reports of PE secondary to hypothyroidism. We report a case of massive PE without tamponade secondary to hypothyroidism. Case Presentation: 52 year old obese male presented to the hospital with worsening dyspnea, dry cough, chest discomfort and lower extremity edema for 2 months. He was in mild respiratory distress, and afebrile. He had myxedematous facies, with dry skin. Thyroid gland was palpable. He was noted to have distant heart sounds and bradycardia with lower extremity edema and delayed deep tendon reflexes. Chest X-ray showed marked cardiomegaly suggestive of pericardial effusion. Laboratory testing was noted for elevated thyroid stimulating Hormone 55.9 mU/L, Low T4F <0.07 mU/L, low T3F 1.0 mU/L, and elevated Thyroid peroxidase antibodies of 520 IU/ml. Troponin-I, BNP, and D-Dimer were normal. Echocardiography showed left ventricular ejection fraction of 50%, and a large, free-flowing pericardial effusion >2 cm with focal strands. Patient was given intravenous Levothyroxine 100 mcg once, then was started on oral Levothyroxine 75 mcg daily. No pericardiocentesis was done. Patient was discharged and followed up after 6 month of treatment with resolution of his symptoms, facies, and pericardial effusion. Discussion: Hypothyroidism is predominant worldwide with reported prevalence rates of 5–10% in women and 1–3% in men. Common symptoms include: fatigue, cold intolerance, and constipation. Cardiovascular involvement is less common. Small PE has been reported in 10-30% of cases. Severe PE -with or without tamponade- is a very rare complication and is only linked to severe degrees of myxedema. A recent study evaluating 70 newly diagnosed adult hypothyroid patients showed mild PE prevalence of 17%, with moderate PE seen in only 1 patient (0.01%). Severe PE or tamponade was not observed in this cohort. The development of PE secondary to hypothyroidism is not well understood. Increased systemic capillary permeability and decreased lymphatic drainage of albumin which leads to increased pericardial colloid pressure are proposed mechanisms for hypothyroid PE. Most of hypothyroidism clinical symptoms can be reversed with thyroid hormone replacement within 1-15 months. Pericardiocentesis is reserved for symptomatic patients despite treatment, patients with tamponade or with persistent PE for more than 3 months. Our case sheds light on a rare, yet, serious complication of hypothyroidism, most likely explained by low socio-economic status. Hence the importance of patient education and proper follow up.

Level of aurathrenomedullin in chronic heart failure of ischemic genesis: associations with clinical manifestations

Bulletin of Siberian Medicine ◽

10.20538/1682-0363-2019-3-81-89 ◽

2019 ◽

Vol 18 (3) ◽

pp. 81-89

Author(s):

E. I. Myasoedova

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Clinical Manifestations ◽

Left Ventricular ◽

Ventricular Ejection ◽

Control Group ◽

Ventricular Ejection Fraction

Objective. To identify and evaluate the relationship between the level of proadrenomedullin and clinical and anamnestic data of patients with chronic heart failure of ischemic genesis.Materials and methods. 240 men with chronic forms of coronary heart disease (mean age 55.9 [43; 63] years) and past Q-forming myocardial infarction were examined. Of these, 110 patients had chronic heart failure and preserved left ventricular ejection fraction (group 1) and 130 patients had chronic heart failure and dilatation with a low left ventricular ejection fraction (group 2). In all patients the MR-proADM level in the blood serum was determined.Results. In the control group, the level of MR-proADM was 0.49 [0.18; 0.58] nmol /l. In the meantime, it was statistically significantly higher in the studied groups of patients than in the control group (p < 0.001 and p < 0.001, respectively). And in the group of patients with chronic heart failure and dilatation with a low left ventricular ejection fraction, it was statistically significantly higher than in the group of patients with chronic heart failure and preserved left ventricular ejection fraction (1.72 [1.56; 1.98] nmol/l and 0.89 [0.51; 1.35] nmol/l, respectively, p < 0.038). The study demonstrated the presence of statistically significant associations between the level of MR-proADM and the severity of chronic heart failure and exertional angina pectoris as well as between the presence of a constant form of atrial fibrillation and the levels of systolic and diastolic blood pressure.Conclusion. MR-proADM is a new promising marker, which will be possible to use as a diagnostic standard for assessing the effectiveness of treatment of cardiac patients.

Immunosuppression and outcomes of myocarditis patients presenting with ventricular arrhythmias

European Heart Journal ◽

10.1093/ehjci/ehaa946.2055 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G Peretto ◽

S Sala ◽

G De Luca ◽

R Marcolongo ◽

C Campochiaro ◽

...

Keyword(s):

Ventricular Arrhythmias ◽

Protective Factor ◽

Clinical Laboratory ◽

Left Ventricular ◽

Study Cohort ◽

Diagnostic Features ◽

Indirect Immunofluorescence Technique

Immune Mediated ◽

Abstract Background Effects of immunosuppressive therapy (IST) on ventricular arrhythmias (VA) have not been reported in immune-mediated biopsy-proven myocarditis patients. Furthermore, myocarditis arrhythmic risk is still unpredictable. The aim of our study was to evaluate effectiveness of IST on VA in myocarditis patients, and stratify their arrhythmic risk, using clinical and diagnostic features, including serum organ-specific anti-heart (AHA) and antiintercalated-disk autoantibodies (AIDA). Methods From a cohort of 498 consecutive patients, we enrolled 255 cases with biopsy-proven virus-negative myocarditis and evidence of VA (VF, VT, NSVT, and Lown's grade ≥2 PVC) at index hospitalization. Serum AHA and AIDA were detected by a standardised indirect immunofluorescence technique. Whenever accepted and non-contraindicated, IST was started. Controls (IST-) were chosen after 1:1 matching to IST+ cases by age, gender, ethnicity, left ventricular ejection fraction, VA type, and treatment. Prospective follow-up (FU), occurred at defined timepoints. Results 58 matched patient couples (42±13 y, 67% males, 50% IST+) were analyzed in the main study cohort. Overall, 28 (24%) had VT, and 62 (53%) were discharged with ICD. IST duration was 12±1 months. No patients died and no serious complications from IST occurred. By 24-month FU, major VA occurred in 6 IST+ vs. 10 IST- patients (p=0.420), with no cases of VT following IST termination. As compared to IST- ones, IST+ patients showed a significant reduction in NSVT and PVC burden, as well as an improvement in clinical, laboratory and imaging findings (all p<0.05). Major VA onset and positive AIDA status were independently associated with major VA at FU (HR 14.2, 95% CI 2.9–68.7, and 8.0, 95% CI 2.6–25.2, respectively, both p<0.001). Furthermore, in the whole study population (N=255), IST played as an independent protective factor from major VA (HR 0.3, 95% CI 0.2–0.7, p=0.005) at 38±21 months FU. Conclusions In immune-mediated virus-negative myocarditis patients presenting with VA, IST is feasible and effective on NSVT and PVC burden, as well as on structural, laboratory and imaging endpoints. Short-term effects are limited on major VA, which were independently associated with major arrhythmic onset and positive AIDA, in keeping with the proposed etiopathogenetic involvement of autoimmunity in virus-negative myocarditis. Funding Acknowledgement Type of funding source: None

Cardiac Safety of NEPA, a Fixed-Dose Antiemetic Combination, Administered Prior to Anthracycline-Based Chemotherapy

Blood ◽

10.1182/blood.v124.21.4821.4821 ◽

2014 ◽

Vol 124 (21) ◽

pp. 4821-4821 ◽

Cited By ~ 2

Author(s):

Meinolf Karthaus ◽

Matti Aapro ◽

Giada Rizzi ◽

Marco Palmas

Keyword(s):

Solid Tumors ◽

Chemotherapeutic Agents ◽

Left Ventricular ◽

Fixed Dose ◽

Cardiac Safety ◽

Antiemetic Drug ◽

Double Blind ◽

Ecg Abnormalities

Abstract Background: Cardiotoxicity is a well-known risk associated with anthracyclines, a widely prescribed class of chemotherapeutic agents. While the cumulative dose represents the greatest risk factor, concomitant use of other chemotherapy, such as cyclophosphamide can also contribute to this risk. As supportive care agents may be necessary to manage side effects associated with anthracycline treatment, it is critical that these agents do not contribute to the potential for cardiac adverse effects. NEPA is a unique fixed-dose antiemetic combination of netupitant (NETU), a new highly-selective NK1 receptor antagonist (RA) and palonosetron (PALO), an established pharmacologically distinct 5-HT3RA with a clean cardiac safety profile (Morganroth, ESMO 2007). Superiority of NEPA over oral PALO in preventing chemotherapy-induced nausea and vomiting associated with anthracycline-cyclophosphamide (AC) chemotherapy was recently demonstrated in a large multicycle study in solid tumors (Aapro, ASCO 2014). Because AC is also part of treatment utilized for hematologic malignancies, such as the CHOP combination, an evaluation of the cardiac safety of NEPA in this study is relevant to the hematology setting. Methods: This multinational, randomized, double-blind, parallel group study compared a single oral dose of NEPA (NETU 300 mg + PALO 0.50 mg) versus a single oral 0.50 mg dose of PALO in chemotherapy-naïve patients receiving AC chemotherapy for solid tumors during cycle 1 and during a multicycle extension. All patients also received oral dexamethasone on Day 1 (12 mg in the NEPA arm and 20 mg in the PALO arm). Cardiac safety was evaluated by cardiac adverse events, ECG changes, cardiac troponin levels (a biomarker used for early detection of cardiotoxicity) and left ventricular ejection fraction (LVEF, by ECHO). Results: 1450 and 1286 patients were included in the safety population for cycle 1 (n = 725 each group) and the multicycle extension (n = 635 NEPA, 651 PALO), respectively; 76% of all patients completed at least 4 cycles. Treatment groups were comparable with the majority of patients being female (98%) and white (80%), with a mean age of 54 years. The percentage of patients with at least one treatment-emergent adverse event (AE) classified as a cardiac disorder was similar for both groups in cycle 1 (2.6% NEPA vs. 2.1% PALO) and during the multicycle extension (5.0% vs. 4.6%). Overall, four AEs (n = 1 NEPA, n = 3 PALO) were classified as serious while none were considered related to study treatment. The percent of patients with treatment-emergent ECG abnormalities was comparable between groups. In cycle 1, the most frequently reported abnormalities were flat T waves (12.6% and 12.1% for NEPA and PALO, respectively). ST depression was the same in both groups (6.5%). The mean changes in QTcF were small and similar between groups and returned to baseline at 120 hours. The percentage of patients with increases from baseline of > 60 ms in QTcF were 0.7% and 1.1% for NEPA and PALO, respectively. This pattern for ECG abnormalities and QTcF changes was similar in the multicycle extension with no differences seen between groups. Similar proportions of patients had high troponin levels (ie, >0.12 ng/mL) in cycle 1 (0.1% NEPA vs. 0.3% PALO) and in the multicycle extension (3.4% NEPA vs. 2.9% PALO). Of these, 0.4% NEPA and 0.7% PALO had troponin values greater than 0.50 ng/mL. In the majority of cases, the high values developed in cycles 5 and 6. Mean LVEF changes from screening to end of study were negligible and comparable between groups. Conclusions: In this large study of 1450 patients, there was no indication of increased cardiac safety concerns with the NEPA combination relative to PALO after single or repeated cycles of anthracycline-based chemotherapy. Consequently, clinicians can utilize this highly effective convenient, fixed-dose antiemetic drug combination with the knowledge that NEPA is not expected to contribute to the potential for cardiotoxicity seen with anthracyclines or other chemotherapies. Disclosures Karthaus: Helsinn Healthcare: Honoraria. Off Label Use: NEPA is a combination antiemetic currently under FDA review. Aapro:Helsinn Healthcare: Consultancy, Honoraria. Rizzi:Helsinn Healthcare: Employment. Palmas:Helsinn Healthcare: Employment.

The Value of Biomarkers in the Diagnosis and Prognosis of Heart Failure in Older Age

The Russian Archives of Internal Medicine ◽

10.20514/2226-6704-2021-11-2-98-110 ◽

2021 ◽

Vol 11 (2) ◽

pp. 98-110

Author(s):

V. N. Larina ◽

V. I. Lunev

Keyword(s):

Heart Failure ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Clinical Manifestations ◽

Volume Overload ◽

Left Ventricular ◽

Myocardial Stress ◽

Outpatient Practice

The search for reliable algorithms for diagnosing heart failure with preserved left ventricular ejection fraction (LVEF) in elderly patients is an urgent problem due to the low specificity of clinical manifestations and the peculiarities of involutive processes occurring in the human body. As an alternative diagnostic approach, it is possible to determine in the blood laboratory biochemical markers — a promising method of diagnosis, prognosis and control of the effectiveness of treatment. The article examines the significance of myocardial stress markers (brain natriuretic peptide, N-terminal brain natriuretic peptide, median fragment of atrial natriuretic peptide); «mechanical» myocardial stress (soluble stimulating growth factor expressed by gene 2 — sST2), copeptin, galectin-3 in patients with heart failure and preserved LVEF, including older persons, as well as the possibility of their use in outpatient practice to predict the course of heart failure. The contribution of the multimarker model for a comprehensive assessment of prognosis is discussed, taking into account both the «hemodynamic» side of myocardial stress (pressure or volume overload, markers — natriuretic peptides), and «mechanical» (fibrosis / hypertrophy / heart remodeling, marker — sST2) myocardial changes.

Clinical characteristics and therapeutic strategy of frequent accelerated idioventricular rhythm

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02221-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lan Wang ◽

Hailei Liu ◽

Chao Zhu ◽

Kai Gu ◽

Gang Yang ◽

...

Keyword(s):

Catheter Ablation ◽

Electrophysiological Study ◽

Clinical Manifestations ◽

Left Ventricular ◽

Ventricular Rate ◽

Lv Function ◽

Idioventricular Rhythm

Abstract Background Accelerated idioventricular rhythm (AIVR) is often transient, considered benign and requires no treatment. This observational study aims to investigate the clinical manifestations, treatment, and prognosis of frequent AIVR. Methods Twenty-seven patients (20 male; mean age 32.2 ± 17.0 years) diagnosed with frequent AIVR were enrolled in our study. Inclusion criteria were as follows: (1) at least three recordings of AIVR on 24-h Holter monitoring with an interval of over one month between each recording; and (2) resting ectopic ventricular rate between 50 to 110 bpm on ECG. Electrophysiological study (EPS) and catheter ablation were performed in patients with distinct indications. Results All 27 patients experienced palpitation or chest discomfort, and two had syncope or presyncope on exertion. Impaired left ventricular ejection fraction (LVEF) was identified in 5 patients, and LVEF was negatively correlated with AIVR burden (P < 0.001). AIVR burden of over 73.8%/day could predict impaired LVEF with a sensitivity of 100% and specificity of 94.1%. Seventeen patients received EPS and ablation, five of whom had decreased LVEF. During a median follow-up of 60 (32, 84) months, LVEF of patients with impaired LV function returned to normal levels 6 months post-discharge, except one with dilated cardiomyopathy (DCM). Two patients died during follow-up. The DCM patient died due to late stage of heart failure, and another patient who refused ablation died of AIVR over-acceleration under fever. Conclusions Frequent AIVR has unique clinical manifestations. AIVR patients with burden of over 70%, impaired LVEF, and/or symptoms of syncope or presyncope due to over-response to sympathetic tone should be considered for catheter ablation.