scholarly journals Efficiency of immunosuppressive therapy in virus-negative and virus-positive patients with morphologically verified lymphocytic myocarditis

2017 ◽  
Vol 89 (8) ◽  
pp. 57-67 ◽  
Author(s):  
O V Blagova ◽  
A V Nedostup ◽  
E A Kogan ◽  
V A Sulimov
Keyword(s):  
Immunosuppressive Therapy ◽  
Viral Genome ◽  
Parvovirus B19 ◽  
Smooth Muscles ◽  
Anticardiolipin Antibody ◽  
Left Ventricular ◽  
Lymphocytic Myocarditis ◽  
Antibody Titers ◽  
Epstein Barr ◽  
Group 2

Aim. To evaluate the efficiency of immunosuppressive therapy (IST) in virus-negative (V–) and virus-positive (V+) patients with lymphocytic myocarditis (LM). Subjects and methods. 60 patients (45 males) (mean age 46.7±11.8 years) with dilated cardiomyopathy (mean left ventricular (LV) end diastolic size (EDS) 6.7±0.7 cm; ejection fraction (EF) 26.2±9.1%) were examined. The diagnosis of active/borderline LM was verified by right ventricular endomyocardial biopsy in 38 patients, by intraoperative LV biopsy in 10, in the study of explanted hearts from 3 patients and at autopsy in 9. The investigators determined the genomes of parvovirus B19, herpes viruses types 1, 2 and 6, Epstein—Barr (EBV), zoster, and cytomegalovirus in the blood and myocardium and, if antibodies were present in the blood, hepatitis B and C viruses, as well as antibodies against antigens in the endothelium, cardiomyocytes and their nuclei, smooth muscles, fibers of the conducting system. IST was used in terms of histological, immune, and viral activities. IST was performed in 22 V+ patients (Group 1) and in 24 V– patients (Group 2); this was not done in 10 V+ patients (Group 3) and V– patients (Group 4). IST comprised methylprednisolone at a mean dose of 24 mg/day (n=40), hydroxychloroquine 200 mg/day (n=20), azathioprine at a mean dose of 150 mg/day (n=21); antiviral therapy included acyclovir, ganciclovir, intravenous immunoglobulin (n=24). The follow-up period was 19 (7.3—40.3) months. Results. The viral genome was detected in the myocardium of 32 patients who made up a V+ group. The degree of histological activity did not differ in relation to the presence of viral genome in the myocardium. The degree of immune activity (anticardiolipin antibody titers) in the V+ patients was as high as that in V– ones. At baseline, the V+ patients had a significantly higher LV EDS and a lower EF than the V– patients. Overall, IST only could lead to a significant increase in EF (from 26.5±0.9 to 36.0±10.8%; p

scholarly journals Comparative efficacy and safety of mycophenolate mofetil and azathioprine in combination with corticosteroids in the treatment of lymphocytic myocarditis

2021 ◽  
Vol 26 (11) ◽  
pp. 4650
Author(s):  
R. S. Rud ◽  
O. V. Blagova ◽  
E. A. Kogan ◽  
V. M. Novosadov ◽  
A. Yu. Zaitsev ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Parvovirus B19 ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Symptom Duration ◽  
Efficacy And Safety ◽  
Standard Drug ◽  
Lymphocytic Myocarditis ◽  
Antibody Titers

Aim. To study the efficacy and safety of mycophenolate mofetil (MM) in combination with corticosteroids in the treatment of lymphocytic myocarditis in comparison with a standard combination of corticosteroids and azathioprine.Material and methods. The study included 46 patients aged 18 years and older with severe and moderate lymphocytic myocarditis (men, 34; women 12; mean age, 53,5±13,0 years). The diagnosis was verified using endomyocardial biopsy. Symptom duration averaged 9,5 [4; 20.25] months. All patients had class 3 [2,75; 3] heart failure (HF). The main group included 29 patients who received MM 2 g/day, including six patients — instead of azathioprine, which was canceled due to cytopenia (n=3) or insufficient effect (n=3). The comparison group included 17 patients who received azathioprine 150 [100; 150] mg/day. Patients of both groups also received methylprednisolone at a starting dose of 24 [24; 32] and 24 [24; 24] mg/day and standard HF therapy. In 7/2 patients, the parvovirus B19 genome was detected in the myocardium. In all cases, an increase in anticardiac antibody titers was evidence of immune activity. The average follow-up period was 24 [12; 54] months (at least 6 months).Results. The groups were completely comparable in age, initial characteristics and standard drug therapy. In both groups, a comparable significant increase in the ejection fraction (EF) was noted as follows: from 31,2±7,6 to 44,7±8,3% and from 29±9,1 to 46±11,9% (p<0,001). An excellent response to treatment (an increase in EF by 10% or more) was noted in 68,2% and 66,7% of patients, a good response (by 9-5%) — in 27,3% and 14,3%, a poor response (an increase in less than 5% or a decrease in EF) — in 4,5% and 19,0%, respectively. In both groups, we noted the same significant (p<0,01) decrease in pulmonary artery systolic pressure (36,3±12 to 28,1±6,1 mm Hg in the MM group and from 44,1±8,5 to 30,7±12,1 mm Hg in the azathioprine group), left ventricular (LV) end-diastolic dimension (from 6,4±0,6 to 6±0,7 cm and from 6,2±0,5 to 5,8±0,6 cm), LV end-diastolic volume (from 188,7±55,2 to 178,8±57,1 ml and from 167,8±47,5 to 163,3±61,8 ml), LV end-systolic volume (from 130,3±44,1 to 98,4±32 ml and from 118,1±39 to 94,1±46 ml), left atrial volume (from 98,3±30,3 to 86,7±32,6 ml and from 105±27,4 to 91,2±47,3 ml, p<0,05), as well as mitral regurgitation grade. The incidence of deaths was 2 (6,9%) and 2 (8,7%), transplantation — 1 (3,4%) and 1 (4,3%) patients, death+transplantation end point — 3 (10,3%) and 2 (11,8%) without significant differences between the groups. The presence of the parvovirus B19 genome did not affect the results of treatment. The incidence of infectious complications was comparable in both groups (in one case, MM was completely canceled), no new cytopenia cases were noted during the follow-up period.Conclusion. In patients with moderate and severe virus-negative (except for parvovirus B19) lymphocytic myocarditis, the combination of moderate-dose corticosteroids with mycophenolate mofetil 2 g/day is at least no less effective than the standard regimen of immunosuppressive therapy. There was a tendency towards a more pronounced decrease in anticardiac antibody titers in combination with better tolerance (no cases of cytopenia) in MM group. MM in combination with corticosteroids can be recommended as an alternative treatment regimen for lymphocytic myocarditis.

scholarly journals Effectiveness of myocarditis therapy depending on the diagnosis approach (with or without myocardial biopsy)

2021 ◽  
Vol 20 (3) ◽  
pp. 2637
Author(s):  
O. V. Blagova ◽  
A. V. Nedostup ◽  
V. P. Sedov ◽  
A. Yu. Zaitsev ◽  
V. M. Novosadov ◽  
...  
Keyword(s):  
Viral Genome ◽  
Parvovirus B19 ◽  
Combined Therapy ◽  
Left Ventricular ◽  
Class Iii ◽  
Myocardial Biopsy ◽  
Non Invasive ◽  
Group 2 ◽  
Diagnosis Approach ◽  
Group 1

Aim. To evaluate the effectiveness of myocarditis therapy depending on the diagnosis approach (with or without myocardial biopsy).Material and methods. The study included 83 patients ≥18 years old with severe and moderate myocarditis (25 women and 58 men; mean age, 45,7±11,7 years), established by myocardial biopsy (group 1, n=36) or by a non-invasive diagnostic algorithm (group 2, n=47), for which immunosuppressive therapy (IST) was carried out. Inclusion criteria were left ventricular (LV) end-diastolic dimension >5,5 cm and ejection fraction (EF) <50%. An endomyocardial (n=31) or intraoperative (n=5) biopsy with a study of the viral genome and level of anticardiac antibodies were performed. Coronary angiography (29%), cardiac multislice computed tomography (75%), cardiac magnetic resonance imaging (41%), and 99mTc-MIBI scintigraphy (35%) were also carried out. The mean follow-up period was 3 years (36 [12; 65] months). The study was approved by the Intercollegiate Ethics Committee.Results. The groups were completely comparable in age, baseline parameters (class III [2,25; 3] and III [2; 3] heart failure (HF); end-diastolic LV dimension, 6,7±0,7 and 6,4±0,7 cm; EF, 29,9±8,7 and 31,4±9,3%), the extent of cardiac therapy (excluding the administration rate of в-blockers — 94,4 and 78,7%, p<0,05) and 1ST (methylprednisolone in 91,7 and 89,4% of patients at a mean dose of 24 [16; 32] and 20 [15; 32] mg/day, azathioprine in 50,0 and 46,8% of patients at a mean dose of 150 mg/day or mycophenolate mofetil 2,0 g/day in 30,6% in group 1, hydroxychloroquine 0,2 g/day in 27,8 and 23,4%). Biopsy in group 1 revealed active/borderline (61/39%) myocarditis, in 8 patients — viral genome in the myocardium, including parvovirus B19 in 7 of them. Both groups showed a comparable significant increase in EF after 6 months up to 37,6±8,1 and 42,6±11,5% (p<0,001) and after 27 [12; 54] months up to 43,4±9,6 and 45,5±12,3% (p<0,001), as well as a significant decrease in HF class to 2 [1; 2] in both groups. An increase in EF by ≥10% was recorded in 70 and 72% of patients, respectively. The mortality rate was 13,9 and 12,8%. Taking into account the only transplantation in group 2, the death+transplantation endpoints reached 13,9 and 14,9% of patients (without significant differences between the groups).Conclusion. In patients with severe and moderate myocarditis diagnosed with and without myocardial biopsy, the effectiveness of combined therapy, including IST, was comparable. If it is impossible to perform a biopsy, complex non-invasive strategy makes it possible to diagnose myocarditis with different probability rate and conduct an effective IST, the refusal of which mostly is not justified.

Histopathologic, Immunohistochemical Features and Profile of Viral Antigens in Patients with Myocarditis

2015 ◽  
Vol 1085 ◽  
pp. 447-452 ◽  
Author(s):  
Yuliya Rogovskaya ◽  
Roman Botalov ◽  
Vyacheslav Ryabov
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Interstitial Fibrosis ◽  
Morphological Changes ◽  
Parvovirus B19 ◽  
Consensus Definition ◽  
Barr Virus ◽  
Epstein Barr ◽  
Group 2 ◽  
The Right

We studied medical records and endomyocardial biopsies of patients with morphological confirmed lymphocytic myocarditis. The patients were divided into two groups: 1 - patients with arrhythmias; group 2 - patients with predominance syndrome heart failure. Morphological verification of myocarditis was based on World Heart Federation Consensus definition of Inflammatory Cardiomyopathy, 1997. Immunohistological study was performed to identify antigens of cardiotrophic viruses. We revealed some features in topic and character of morphological changes in depending on clinical scenario of myocarditis. In patients with chronic heart failure due to myocarditis revealed a high incidence of expression of LMP-antigen Epstein-Barr virus, the lack of expression of adenovirus antigens. Arrhythmic presentation of myocarditis was characterized by a high frequency of expression of enteroviral VP-1 antigen and the type 1 antigen herpes virus. We were not detected expression of the VP-2 antigen parvovirus B19. As a result the most severe inflammatory changes and interstitial fibrosis of intraventricular septum, widespread damage of myocytes the severe myocardial remodeling was found in patients with presentation of myocarditis by chronic heart failure. Interstitial fibrosis of the outflow tracts of the right ventricle, the low activity of inflammation and mild fibrotic changes were feature of arrhythmic scenario of myocarditis.

scholarly journals POS1404 ECHOCARDIOGRAPHIC FINDINGS IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS AND ITS RELATION TO ANTIBODIES TITERS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 984.2-985
Author(s):  
A. B. Rodriguez-Romero ◽  
J. R. Azpiri-López ◽  
I. J. Colunga-Pedraza ◽  
D. Á. Galarza-Delgado ◽  
S. Lugo-Perez ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Anticardiolipin Antibody ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systemic Lupus ◽  
Ventricular Ejection Fraction ◽  
Positive Correlation ◽  
Antibody Titers ◽  
Echocardiographic Findings

Background:Systemic lupus erythematosus (SLE) is a chronic and autoimmune disease characterized by systemic involvement. Patients with SLE have accelerated atherosclerosis, resulting in an up to nine-fold increased risk of cardiovascular disease, compared to the general population (1), being the leading cause of death for these patients. Speckle tracking echocardiography (STE) is an accurate technique to estimate myocardial function and deformation.Objectives:This study aims to determine the association between echocardiographic findings and the presence of antibodies in SLE patients.Methods:This was a cross-sectional and observational study. A total of forty-three patients ≥18 years with a diagnosis of SLE according to EULAR/ACR 2019 criteria were included for this study. Those with a history of cardiovascular disease (myocardial infarction, cerebrovascular accident, or peripheral arterial disease) and pregnancy were excluded. Transthoracic echocardiogram was performed and reviewed by 2 board-certified cardiologists, in all study subjects. Blood samples obtained from all patients were analyzed for the following: anti-nuclear antibodies (ANA), anti, SSA/Ro, SSB/La antibodies, anti-cardiolipin antibodies (IgA, IgM, IgG), and complement levels. Distribution was evaluated with the Kolmogorov-Smirnov test. Correlations between numerical variables were done using Spearman’s rho, considering two-tailed p-values <0.05 as statistically significant.Results:The 39 female patients (90.7%) and 4 male patients (9.3%) had a mean age of 35.5 ± 12.0 years and a median disease duration of 72 months (14-132). At the time of inclusion, 90.7% of the patients were being treated with glucocorticoids and antimalarials. Concerning traditional cardiovascular risk factors; 20.9% of the patients had hypertension, 7.0% had dyslipidemia, 2.3% had diabetes mellitus and 18.6% were active smokers. Correlations between echocardiographic findings and antibodies are shown in Table 1. We found a moderate positive correlation between global circumferential strain and IgA anticardiolipin antibody (r=0.507, p=0.002), a low positive correlation in left ventricular ejection fraction with anti-Ro (r=0.397, p=0.012) and anti-La (r=0.397, p=0.012) and a low positive correlation between TAPSE and C3 levels (r=0.396, p=0.013).Conclusion:There is an association between anticardiolipin antibody titers, anti-Ro, and anti-La with echocardiographic alterations. All SLE patients especially those who had positive antibodies should be screened for the presence of structural cardiac abnormalities. STE can be helpful as a noninvasive diagnostic tool, that could result in earlier treatment and prognosis.References:[1]Hesselvig JH, Ahlehoff O, Dreyer L, et al. Cutaneous lupus erythematosus and systemic lupus erythematosus are associated with clinically significant cardiovascular risk: a Danish nationwide cohort study. Lupus 2017;26(1):48-53. doi: 10.1177/0961203316651739Table 1.Spearman rho correlations between antibody titers and echocardiographic findings.VariablesGLS,mean ± SD-19.11 ± 3.33LVEF,mean ± SD57.43 ± 7.17TAPSE,mean ± SD22.23 ± 3.24ANA, median (p25-p75)640 (160-2550)NSNSNSIgA Anti-Cardiolipin, median (p25-p75)2 (2-3)0.507**NSNSIgM Anti-Cardiolipin, median (p25-p75)2 (2-4)NSNSNSIgG Anti-Cardiolipin, median (p25-p75)4 (3-6)NSNSNSAnti-Ro, median (p25-p75)17 (2-80)NS0.326*NSAnti-La, median (p25-p75)3 (2-5.5)NS0.397*NSC3, mean ± SD91.41 ± 37.38NSNS0.396***Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level. NS, not significant; GLS, global circumferential strain; LVEF, left ventricular ejection fraction; TAPSE, tricuspid annular plane systolic excursion.Disclosure of Interests:None declared

scholarly journals Comparative efficacy and safety of mycophenolate mofetil and azathioprine in combination with corticosteroids in the treatment of lymphocytic myocarditis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
O Blagova ◽  
R S Rud' ◽  
V M Novosadov ◽  
A Y U Zaitsev ◽  
E A Kogan
Keyword(s):  
Heart Failure ◽  
Mycophenolate Mofetil ◽  
Parvovirus B19 ◽  
Nyha Class ◽  
Average Dose ◽  
Efficacy And Safety ◽  
Lymphocytic Myocarditis ◽  
Group 2 ◽  
Group 1

Abstract Purpose To compare of the efficacy and safety of mycophenolate mofetil (MM) and azathioprine in combination with corticosteroids in the treatment of lymphocytic myocarditis. Methods The study included 45 patients with lymphocytic myocarditis, 34 male, the average age 48.1±11.2 years. The diagnosis of myocarditis is verified by endomyocardial biopsy. In ten patients of both groups, the parvovirus B19 DNA was detected in the myocardium. All patients had heart failure 3 [3; 3] NYHA class. High immune activity was indicated by the presence of anti-heart antibodies in all patients. Group 1 included twenty-six patients who received MM 2 g per day. Twenty of them were naive; six patients received MM instead of azathioprine, which was canceled due to cytopenia and/or insufficient effect. Group 2 included nineteen patients who received azathioprine at an average dose of 100 [75; 150] mg per day. Patients of both groups also received methylprednisolone in an average starting dose 24 [24; 32] mg per day and standard therapy for heart failure. Initial group distribution was random. Patients in both groups did not differ significantly in baseline parameters. The mean follow-up period was 23 [8; 57] months (12 and 34 months in the groups). The study is approved by the university ethics committee. Results The level of anti-heart antibodies significantly decreased in both groups. In both groups there was a significant improvement in the structural and functional parameters of the heart: NYHA class decreased from 3 [2.75; 3] to 2 [1; 2] (group 1, p&lt;0.001) and from 3 [3; 3] to 2 [1; 2] (group 2, p&lt;0.001), LV EF increased initially from 30.6±7.8 to 40.1±7.5% (group 1, p&lt;0.001) and from 27.9±8.1 to 37.1±7.6% (group 2, p&lt;0.01), by the end of follow-up to 45.9±9.0% (group 1, p&lt;0.001) and to 42.4±13.7% (group 2, p&lt;0.01). LV EDD significantly decreased from 6.4±0.6 to 6.1±0.8 cm (p&lt;0.01), left atria size from 4.9±0.7 to 4.3±0.6 cm (p&lt;0.05) and pulmonary arteria systolic pressure from 37.8±12.3 to 29.3±7.6 (p&lt;0.05) only in the group 1. No direct side effects of MM were noted. Cytopenia due to treatment of azathioprine developed in 3 patients and required its replacement. There were no significant differences between groups 1 and 2 in overall mortality (7.7 vs 15.8%) and the transplant + death rate (7.7 vs 21.1%). The better survival in the MM group may be due to a shorter follow-up period. Conclusion In patients with lymphocytic myocarditis, a combination of moderate doses of corticosteroids with MM is at least no less effective and safe than steroids with azathioprine. With a shorter follow-up period, the tendency to lower mortality and a more pronounced improvement in structural parameters with better tolerance was noted in the MM group. MM should be considered as an alternative option in the treatment of isolated lymphocytic myocarditis. FUNDunding Acknowledgement Type of funding sources: None.

The Relationship between Plasma Microparticles, Protein S and Anticardiolipin Antibodies in Patients with Human Immunodeficiency Virus Infection

1996 ◽  
Vol 76 (01) ◽  
pp. 038-045 ◽  
Author(s):  
Jean-Christophe Gris ◽  
Pierre Toulon ◽  
Sophie Brun ◽  
Claude Maugard ◽  
Christian Sarlat ◽  
...  
Keyword(s):  
Poor Prognosis ◽  
Anticardiolipin Antibody ◽  
Protein S ◽  
Anticardiolipin Antibodies ◽  
Protein S Deficiency ◽  
Free Protein ◽  
Precipitation Technique ◽  
S Deficiency ◽  
Immunodeficiency Virus ◽  
Antibody Titers

SummaryThe high prevalence of free protein S deficiency in human immunodeficiency virus (HlV)-infected patients is poorly understood. We studied 38 HIV seropositive patients. Free protein S antigen values assayed using the polyethylene-glycol precipitation technique (PEG-fS) were statistically lower in patients than in controls. These values using a specific monoclonal antibody-based ELISA (MoAb-fS) and the values of protein S activity (S-act) were not statistically different between patients and controls. C4b-binding protein values were not different from control values. In patients, PEG-fS values were lower than MoAb-fS values. Ten patients had a PEG-fS deficiency, 4 patients had a MoAb-fS deficiency and 8 had a S-act deficiency. Protein S activity and MoAb-fS were lower in clinical groups with poor prognosis and in patients with AIDS but PEG-fS was not. A trend for reduced S-act/MoAb-fS ratios was observed in patients. PEG-fS was negatively correlated with anticardiolipin antibody titers whereas MoAb-fS was not. The plasma of PEG-fS deficient HIV-patients contained high amounts of flow cytometry detectable microparticles which were depleted from plasma by PEG precipitation. The microparticles were partly CD42b and CD4 positive but CD8 negative. These microparticles were labelled by an anti free protein S monoclonal antibody. The observed differences between MoAb-fS and PEG-fS values were correlated with the amount of detectable plasma microparticles, just like the differences between MoAb-fS and S-act. Plasma microparticles correlated with anticardiolipin antibody titers.In summary, free protein S antigen in HIV infected patients is underestimated when the PEG precipitation technique is used due to the presence of elevated levels of microparticles that bind protein S. The activity of free protein S is also impaired by high levels of microparticles. The prevalence of free protein S deficiency in HIV positive patients is lower than previously published (4/38, -10%) and is correlated with poor prognosis. By implication, use of a PEG precipitation technique might give artefactually low free protein S antigen values in other patient groups if high numbers of microparticles are present. In HIV patients, high titers of anticardiolipin antibodies are associated with high concentrations of cell-derived plasma microparticles.

scholarly journals Minimising radiation exposure in catheter ablation of ventricular arrhythmias

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matevž Jan ◽  
David Žižek ◽  
Tine Prolič Kalinšek ◽  
Dimitrij Kuhelj ◽  
Primož Trunk ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Ventricular Arrhythmias ◽  
Major Complication ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Complex Nature ◽  
Group 2 ◽  
Procedural Outcomes ◽  
Group 1

Abstract Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

scholarly journals The outcome of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and impaired kidney function: a 3-year observational study

2021 ◽  
Author(s):  
Malgorzata Zalewska-Adamiec ◽  
Jolanta Malyszko ◽  
Ewelina Grodzka ◽  
Lukasz Kuzma ◽  
Slawomir Dobrzycki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Incidence Rate ◽  
Kidney Function ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
Group 2 ◽  
Group 1

Abstract Background Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes about 10% of the cases of acute coronary syndromes (ACS). It is a working diagnosis and requires further diagnostics to determine the cause of ACS. Methods In this study, 178 patients were initially diagnosed with MINOCA over a period of 3 years at the Department of Invasive Cardiology of the University Clinical Hospital in Białystok. The value of estimated glomerular filtration rate (eGFR) was calculated for all patients. The patients were divided into 2 groups depending on the value of eGFR: group 1—53 patients with impaired kidney function (eGFR < 60 mL/min/1.73 m2; 29.8%) and group 2—125 patients with normal kidney function (eGFR ≥ 60 mL/min/1.73 m2; 70.2%). Results In group 1, the mean age of patients was significantly higher than that of group 2 patients (77.40 vs 59.27; p < 0.0001). Group had more women than group 2 (73.58% vs 49.60%; p = 0.003). Group 1 patients had higher incidence rate of arterial hypertension (92.45% vs 60.80%; p < 0.0001) and diabetes (32.08% vs 9.60%; p = 0.0002) and smoked cigarettes (22.64% vs 40.80%; p = 0.020). Group 1 patients had higher incidence rate of pulmonary edema, cardiogenic shock, sudden cardiac arrest (13.21% vs 4.00%; p = 0.025), and pneumonia (22.64% vs 6.40%; p = 0.001). After the 37-month observation, the mortality rate of the patients with MINOCA was 16.85%. Among group two patients, more of them became deceased during hospitalization (7.55% vs 0.80%; p = 0.012), followed by after 1 year (26.42% vs 7.20%; p = 0.0004) and after 3 years (33.96% vs 9.6%; p < 0.0001). Multivariate analysis revealed that the factors increasing the risk of death in MINOCA are as follows: older age, low eGFR, higher creatinine concentration, low left ventricular ejection fraction, and ST elevation in ECG. Conclusion Impaired kidney function is diagnosed in every third patient with MINOCA. Early and late prognosis of patents with MINOCA and renal dysfunction is poor, and their 3-year mortality is comparable to patients with myocardial infarction with significant stenosis of the coronary arteries and impaired kidney function.

scholarly journals Hypertrophy of unaffected cardiomyocytes correlates with severity of cardiomyopathy in female patients with Fabry disease

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Cristina Chimenti ◽  
Romina Verardo ◽  
Andrea Frustaci
Keyword(s):  
Fabry Disease ◽  
Wall Thickness ◽  
Left Ventricular ◽  
Female Patients ◽  
Maximal Wall Thickness ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Aim To investigate the contribution of unaffected cardiomyocytes in Fabry disease cardiomyopathy. Findings Left ventricular (LV) endomyocardial biopsies from twenty-four females (mean age 53 ± 11 ys) with Fabry disease cardiomyopathy were studied. Diagnosis of FD was based on the presence of pathogenic GLA mutation, Patients were divided in four groups according with LV maximal wall thickness (MWT): group 1 MWT ≤ 10.5 mm, group 2 MWT 10.5–15 mm, group 3 MWT 16–20 mm, group 4 MWT > 20 mm. At histology mosaic of affected and unaffected cardiomyocytes was documented. Unaffected myocytes’ size ranged from normal to severe hypertrophy. Hypertrophy of unaffected cardiomyocytes correlated with severity of MWT (p < 0.0001, Sperman r 0,95). Hypertrophy of unaffected myocytes appear to concur to progression and severity of FDCM. It is likely a paracrine role from neighboring affected myocytes.

scholarly journals Vitamin D Status in Children with Idiopathic Dilated Cardiomyopathy

2021 ◽  
Vol 11 (01) ◽  
pp. e120-e124
Author(s):  
Duaa M. Raafat ◽  
Osama M. EL-Asheer ◽  
Amal A. Mahmoud ◽  
Manal M. Darwish ◽  
Naglaa S. Osman
Keyword(s):  
Vitamin D ◽  
Serum Level ◽  
Dilated Cardiomyopathy ◽  
Smooth Muscles ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Vitamin D Receptors ◽  
Left Ventricular Dimensions ◽  
And Function ◽  
Ventricular Dimensions

AbstractDilated cardiomyopathy (DCM) is the third leading cause of heart failure in pediatrics. The exact etiology of DCM is unknown in more than half of the cases. Vitamin D receptors are represented in cardiac muscles, endothelium, and smooth muscles of blood vessels suggesting that vitamin D could have a vital cardioprotective function. This study aimed to assess serum level of vitamin D in children with idiopathic DCM and to correlate the serum level of vitamin D with the left ventricular dimensions and function. This study is a descriptive cross-sectional single-center study, includes 44 children of both sexes, diagnosed as idiopathic DCM. Serum level of vitamin D was assessed and correlated with the left ventricular dimensions and function. Mean age of studied children was 6.08 ± 4.4 years. Vitamin D deficiency was found in 90.9% of children with idiopathic DCM with a mean level 13.48 ng/mL. There was a negative correlation between vitamin D level and fraction shortening and left ventricular end-diastolic diameter in children with DCM. Vitamin D level is not only significantly low in children with idiopathic DCM but it is also significantly correlated with the degree of left ventricular dysfunction.

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