COVID-19 Pneumonia in Patients with Chronic Myocarditis (Recurrent Infectious Immune): Specifics of the Diseases Course, the Role of Basic Therapy (Part 1)

Patients with chronic myocarditis have a high risk of an unfavorable course of the novel coronavirus disease (COVID-19) due to the ability of the SARS-Cov-2 virus to independently cause acute myocarditis, to have a direct and cytokine-mediated cytopathic effect on the myocardium, as well as immunosuppressive therapy. At the same time, the features of the interaction of chronic myocarditis and COVID-19 have not been studied. The article describes a 31-year-old patient with a 10-year history of chronic recurrent infectious-immune myocarditis, who was on long-term immunosuppressive therapy (methylprednisolone and azathioprine in the past, then hydroxychloroquine). In May 2020, a serologically confirmed COVID-19 diagnosis was made. There were risk factors for the unfavorable course of coronavirus infection: heart failure and a history of persistent atrial fibrillation, male sex. Basic therapy with hydroxychloroquine (with an increase in its dose to 800-400 mg/day), ceftriaxone, and levofloxacin was carried out. The severity of pneumonia was moderate, despite febrile fever and severe intoxication. No relapses of arrhythmias, respiratory or heart failure were observed. Minimal laboratory (some increase in anticardial antibody titers) and echocardiographic signs of exacerbation of myocarditis without an increase in troponin T levels were revealed, which quickly regressed. It can be assumed that the maintenance immunosuppressive therapy of myocarditis with hydroxychloroquine had a positive effect on the course of coronavirus pneumonia and made it possible to avoid recurrence of myocarditis. Further study of the features of the course of the pre-existing myocarditis and pneumonia in COVID-19 is necessary.

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COVID-19 Pneumonia in Patients with Chronic Myocarditis (HBV-Associated with InfarctLike Debute): Specifics of the Diseases Course, the Role of the Basic Therapy (Part II)

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2020-10-03 ◽

2020 ◽

Vol 16 (5) ◽

pp. 730-736

Author(s):

O. V. Blagova ◽

N. V. Varionchik ◽

M. M. Beraia ◽

V. A. Zaidenov ◽

E. A. Kogan ◽

...

Keyword(s):

Immunosuppressive Therapy ◽

Troponin T ◽

Oral Anticoagulants ◽

Adverse Outcomes ◽

Interleukin 17 ◽

Chronic Myocarditis ◽

Life Threatening ◽

History Of ◽

Therapy Withdrawal

Chronic infectious-immune myocarditis of severe course can potentially be considered as a factor that aggravates the course of new coronavirus disease (COVID-19) and increases the risk of adverse outcomes. The interaction of chronic myocarditis and COVID-19 during long-term immunosuppressive therapy has not been studied. We present a description of a 35-year-old female patient with chronic infectious-immune myocarditis (morphologically confirmed, with a history of infarction-like onset and thromboembolic complications), who had continuous immunosuppressive therapy with methylprednisolone and mycophenolate mofetil. The patient also received new oral anticoagulants and tenofovir (for chronic HBV infection). COVID-19 (SARS-Cov-2 RNA+) was diagnosed in May 2020. Risk factors for the adverse course of coronavirus infection included severe obesity, heart failure, and life-threatening ventricular arrhythmias. Correction of immunosuppressive therapy (withdrawal of the cytostatic agent, administration of hydroxychloroquine) and therapy with levofloxacin, an interleukin-17 inhibitor (netakimab) were performed. The severity of pneumonia and respiratory failure was moderate despite high fever and high levels of inflammatory markers in the blood (including interleukin-6). Signs of exacerbation of myocarditis, increased levels of troponin T and anticardial antibodies (compared with the initial ones) were not found. It can be assumed that supportive immunosuppressive therapy for myocarditis has a positive effect on the course of coronavirus pneumonia and avoids exacerbation of myocarditis. Careful continuation of immunosuppressive therapy with temporary withdrawal of aggressive cytostatics can be recommended in chronic myocarditis. Further study of the features of the course of previous myocarditis and COVID-19 pneumonia is necessary.

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Abstract 337: Prognostic Impact of Cardiac Arrest Among Patients With ST-Elevation Myocardial Infarction

Circulation ◽

10.1161/circ.138.suppl_2.337 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Anirudh Kumar ◽

Chetan P Huded ◽

Michael J Johnson ◽

Venu Menon ◽

Stephen G Ellis ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Cardiac Arrest ◽

Troponin T ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Prognostic Impact ◽

History Of ◽

St Elevation ◽

The Impact

Background: ST-elevation myocardial infarction (STEMI) is a potentially fatal condition that may be complicated by cardiac arrest (CA). However, the impact of CA complicating STEMI on prognosis in the contemporary era of rapid primary PCI is uncertain. Methods: We reviewed consecutive cases of STEMI treated with percutaneous coronary intervention (PCI) at our center between January 1, 2011 and December 31, 2016. Baseline clinical characteristics and in-hospital long-term outcomes were compared between patients with and without CA. Results: Among 1,272 patients with STEMI, 148 (11.6%) had CA (30.4% out-of-hospital, 69.6% after ED arrival). Compared to patients without CA, patients with STEMI+CA were more likely to have a history of heart failure, valve surgery, peripheral and cerebrovascular disease, and chronic kidney disease with a trend towards increased prevalence of left main or left anterior descending culprit vessel. Patients with STEMI+CA had greater creatinine (1.28±0.92 vs. 1.07±0.67, p=0.013, infarct size (CK-MB 171.6±131.6 vs. 139.2±117.0 ng/mL, p=0.010; troponin T 6.2±6.2 vs. 5.0±4.8 ng/mL, p=0.024), door-to-balloon-time (118.1±63.6 vs. 106.8±64.0, p=0.045), and incidence of cardiogenic shock (48.0% vs. 5.9%, p<0.0001) and intra-aortic balloon pump need (36.5% vs. 8.3%, p<0.0001). Patients with STEMI+ CA had higher rates of major bleeding (25.0% vs. 9.4%, p<0.0001) and post-PCI heart failure (13.5% vs. 8.1%, p=0.042). Patients with STEMI+CA had significantly greater mortality in-hospital (14.9% vs. 3.6%, p<0.0001) and at 1-year (22.9% vs. 9.3%, p<0.0001) (Figure). Conclusions: CA is a complication in >1 in 10 patients with STEMI and is associated with significantly higher morbidity and mortality compared with STEMI without CA. Strategies to improve the care and outcomes of STEMI patients with CA are needed.

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Severe Sinus Bradycardia: An Unusual Cardiac Manifestation of COVID-19

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211013185 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110131

Author(s):

Mohammed Ali ◽

Abdalaziz Awadelkarim ◽

Patrick Bishop ◽

Rashid Alhusain ◽

Omeralfaroug Adam ◽

...

Keyword(s):

Heart Failure ◽

Sinus Bradycardia ◽

Systolic Heart Failure ◽

Cardiovascular Complications ◽

Pacemaker Placement ◽

History Of ◽

Symptomatic Bradycardia ◽

Cardiac Manifestation ◽

Novel Coronavirus

There has been an accumulating evidence of association between COVID-19 (coronavirus disease 2019) infection and cardiovascular complications. We describe a case of a 58-year-old lady with a history of systolic heart failure and COVID-19 infection, who developed persistent symptomatic bradycardia, requiring pacemaker placement as unusual conductive tissue involvement of this novel coronavirus.

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Rationale for the use of immunosuppressive therapy in patients with acute myocarditis

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2018-22(1)-35 ◽

2018 ◽

Vol 22 (1) ◽

pp. 185-189

Author(s):

S.V. Cherniuk

Keyword(s):

Heart Failure ◽

Immunosuppressive Therapy ◽

Systolic Function ◽

Acute Myocarditis ◽

Immunosuppressive Treatment ◽

Ventricular Myocardium ◽

Left Ventricular ◽

Functional Class ◽

Immunoglobulin M ◽

Left Ventricular Myocardium

To date, the expediency of immunosuppressive treatment with corticosteroids in patients with myocarditis is one of the most controversial issues of modern cardiology. The purpose of the study was to establish predictors of corticosteroid therapy efficiency in patients with acute myocarditis. 47 patients with acute myocarditis were examined, who received immunosuppressive therapy for 6 months. All patients underwent for immune state assessment, echocardiography and cardiac magnetic resonance imaging. Statistical processing of the results was performed using Excel XP and Statistica for Windows v. 6.0 programming studying Student's criterion, parametric correlation analysis and distribution of the studied indicators by binary scale. It has been established that the appointment of immunosuppressive therapy in patients with high activity of immunopathological reactions of humoral type in the debut of myocarditis after 6 months of treatment leads to a decrease in the activity of autoimmune damage of the myocardium, recovery of left ventricular systolic function and improvement of heart failure functional class. The predictors of heart failure functional class improvement after 6-months of corticosteroid treatment were determined as: concentrations of immunoglobulin M>2,5 g/l, CD19+ lymphocytes >0,23 × 109/l, tumor necrosis factor α>200 pg/ml, interleukin-1β >150 pg/ml, content of circulating immune complexes >75 un. opt. sq., titre of antibodies to myocardium >20.0 conv. un. before the start of immunosuppressive therapy, as well as the absence of fibrotic changes in the left ventricular myocardium on cardiac MRI. Thus, early prognostic markers of the effectiveness of glucocorticoid therapy in patients with acute myocarditis were established. Further research should focus on the search for criteria of immunosuppressive therapy effectiveness and the introduction of clear recommendations for clinical practice that will contain indications and contraindications for its management in patients with myocarditis.

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P3557Heart failure patients show increase of white matter lesions in MRI-imaging: LIFE-Adult-Study

European Heart Journal ◽

10.1093/eurheartj/ehz745.0420 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Stegmann ◽

M L Chu ◽

A Villringer ◽

U Laufs ◽

M Loeffler ◽

...

Keyword(s):

Heart Failure ◽

White Matter ◽

Troponin T ◽

Univariate Analysis ◽

White Matter Lesions ◽

Future Research ◽

Cerebral Mri ◽

History Of ◽

Study Participants ◽

Structural Brain

Abstract Background Heart Failure (HF) is a risk factor for stroke and dementia and is associated with cognitive impairment. However, whether or not HF is directly linked to structural brain changes is unknown. White matter lesions (WML) are common structural alterations in the white matter of the brain and their prevalence increases with age. They are associated with cerebral ischemia and cognitive dysfunction. However, there are only a few reports on HF and WML. Purpose We hypothesized that the presence and duration of heart failure are associated with WML. Methods LIFE Adult is a population-based study whose participants are a representative sample of the city of Leipzig, Germany (approximately 580,000 inhabitants). All study participants (18–80 years of age) underwent an extensive core assessment program (5–6 h) including structured medical interviews, medical and psychological questionnaires, physical examination and bio specimen collection. A subgroup of 2490 participants additionally underwent cerebral MRI (cMRI). The Fazekas Score was used for the classification of the WML (none or mild WML versus moderate or severe WML). Raters were blinded to other medical information of study participants. History of HF and other diseases were ascertained as part of the self-reported medical history questionnaire. Results Mean age was 64 years and 46% were female. On univariate analysis age, troponin T, NT-proBNP, body mass index, history of acute myocardial infarction, stroke, HF and diabetes were positively associated with WML. On multivariate analysis, only age, hypertension, stroke and HF were associated with WML. Interestingly, the Odd's ratio (OR) for HF was 2.5 (95% confidence interval (CI) 1.1; 5.6) and numerically higher than the OR for stroke (OR 2.0 (95% CI 1.0; 3.8)). Additionally, the OR increased with longer duration of HF (OR 1.3 for HF-duration <3 years, OR 1.7 for HF 4–6 years duration and OR 2.9 for HF-diagnosis >6 years). Conclusion HF is independently associated with structural brain damage, i. e. WML. Future research is needed to elaborate whether WML could be a therapeutic target for treatment targeting cognitive decline in HF.

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Abstract 13581: Combined Assessment of N-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity Troponin T Levels Improves the Prediction of Future Admission for Heart Failure in Outpatients with Hypertension and Preserved Left Ventricular Ejection Fraction

Circulation ◽

10.1161/circ.130.suppl_2.13581 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Shigeru Matsui ◽

Junnichi Ishii ◽

Hiroshi Takahashi ◽

Ryuunosuke Okuyama ◽

Hideki Kawai ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular Ejection Fraction ◽

Troponin T ◽

High Sensitivity ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Galectin 3 ◽

History Of ◽

High Sensitivity Troponin T

Background: Hypertension is one of the most prevalent cardiovascular diseases and one of the most important causes of heart failure (HF) with preserved left ventricular ejection fraction (LVEF). We prospectively investigated the incremental predictive value of a combination of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), and galectin-3 for HF admission in outpatients with hypertension. Methods: Baseline serum NT-proBNP, hsTnT, and galectin-3 levels were measured in 443 outpatients (mean age, 69.4 years) with hypertension and LVEF ≥ 50%. Using tissue Doppler echocardiography, E/e’ ratio was calculated. Among these patients, 34% had a history of cardiovascular disease, and 46% had a history of diabetes. Results: Galectin-3 levels significantly (p < 0.0001) correlated with E/e’ ratio (r = 0.21) and estimated glomerular filtration rate (eGFR; r = –0.78). During a mean follow-up period of 899 days, there were 40 (9%) HF admissions. Using multivariate Cox regression analysis including 10 clinical, biochemical, and echocardiographic variables, increased NT-proBNP (relative risk, 2.88 per 10-fold increment, p = 0.007) and hsTnT (4.30 per 10-fold increment, p = 0.004) levels, but not ga1ectin-3 levels, were shown to be independent predictors of HF admission. When patients were stratified into four groups according to NT-proBNP levels ≥ a median value of 193.7 pg/mL and/or hsTnT levels ≥ a median value of 14 pg/mL, HF admission rates were 1.1%, 2.1%, 4.3%, and 20%, respectively (p < 0.0001). Furthermore, when NT-proBNP and hsTnT levels were combined, the predictive values for HF admission were increased, as shown by the C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI; Table 1). Conclusions: The combined assessment of NT-proBNP and hsTnT levels can improve the prediction of HF admission in outpatients with hypertension.

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The state of the circulatory, respiratory and hemostasis organs of the servisemen, suffered from coronavirus pneumonia, in a remote recovery period

Russian Military Medical Academy Reports ◽

10.17816/rmmar77051 ◽

2021 ◽

Vol 40 (3) ◽

pp. 27-32

Author(s):

Dmitriy Yu. Serdyukov ◽

Nikolay S. Rodichev ◽

Anastasiya A. Tretyakovа

Keyword(s):

Heart Failure ◽

Troponin T ◽

Recovery Period ◽

Circulatory System ◽

Dynamic Monitoring ◽

Cytokine Storm ◽

Long Term Effects ◽

Military Medical Academy ◽

Novel Coronavirus ◽

D Dimer

The problem of the long-term effects of COVID-19, especially its severe forms, is already acutely relevant for world healthcare. Severe course of the novel coronavirus infection (cytokine storm) may be accompanied with the damage of respiratory system, circulatory system, and hemostasis. In the Department of Hospital Therapy Military Medical Academy have been examined 64 servicemen: 1st group of 44 people aged 46.1 7 years with developed cytokine storm; 2nd group 20 men 47 4.4 years without this complication. Patients were screened and treated under the standard scheme; 3 months after discharge from the hospital, respiratory, heart failure and D-dimer levels were assessed. There was a significant increase pulmonary damage with decrease in saturation to 92.3 % (p = 0.003) in the 1st group; laboratory signs of myocardial lesions: increase of troponin T to 15.4 ng/l (p = 0.001), a significant increase in the total creatine phosphokinase, aspartate amine transferase and alanine aminotransferase compared to patients of the 2nd group. The average rates of standard hemogram, with the exception of platelet levels (173 103/l, p = 0.03) in the 1st group were no different from similar parameters of patients from the 2nd group. It was drawn to attention the reliable increase in C-reactive protein, D-dimer and ferritin in men of the 1st group. During the reexamination after 3 months more often diagnosed the phenomenon of respiratory and heart failure and hypercoagulation in patients from the 1st group, which dictates the need for further dynamic monitoring of this category (1 figure, 2 tables, bibliography: 14 refs).

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Prognostic Implications of Chronic Heart Failure and Utility of NT-proBNP Levels in Heart Failure Patients with SARS-CoV-2 Infection

Journal of Clinical Medicine ◽

10.3390/jcm10020323 ◽

2021 ◽

Vol 10 (2) ◽

pp. 323

Author(s):

Laia C. Belarte-Tornero ◽

Sandra Valdivielso-Moré ◽

Miren Vicente Elcano ◽

Eduard Solé-González ◽

Sonia Ruíz-Bustillo ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Prognostic Value ◽

Troponin T ◽

Previous History ◽

High Sensitivity ◽

All Cause Mortality ◽

History Of ◽

Prognostic Implications ◽

High Sensitivity Troponin T

Background: The prevalence and prognostic value of chronic heart failure (CHF) in the setting of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has seldom been studied. The aim of this study was to analyze the prevalence and prognosis of CHF in this setting. Methods: This single-center study included 829 consecutive patients with SARS-CoV-2 infection from February to April 2020. Patients with a previous history of CHF were matched 1:2 for age and sex. We analyze the prognostic value of pre-existing CHF. Prognostic implications of N terminal pro brain natriuretic peptide (NT-proBNP) levels on admission in the CHF cohort were explored. Results: A total of 129 patients (43 CHF and 86 non-CHF) where finally included. All-cause mortality was higher in CHF patients compared to non-CHF patients (51.2% vs. 29.1%, p = 0.014). CHF was independently associated with 30-day mortality (hazard ratio (HR) 2.3, confidence interval (CI) 95%: 1.26–2.4). Patients with CHF and high-sensitivity troponin T < 14 ng/L showed excellent prognosis. An NT-proBNP level > 2598 pg/mL on admission was associated with higher 30-day mortality in patients with CHF. Conclusions: All-cause mortality in CHF patients hospitalized due to SARS-CoV-2 infection was 51.2%. CHF was independently associated with all-cause mortality (HR 2.3, CI 95% 1.26–4.2). NT-proBNP levels could be used for stratification risk purposes to guide medical decisions if larger studies confirm this finding.

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