Hydroxychloroquine and risk of cardiac decompensation

Background Hydroxychloroquine (HCQ) is a 4-aminoquinoline derivative, used in the treatment of malaria and rheumatic diseases. HCQ has also been suggested as a treatment in patients suffering from severe acute respiratory syndrome–coronavirus 2 (SARS–CoV-2). One of the cardiac complications of SARS-CoV-2 is myocarditis and ventricular dysfunction. Case summary We present the case of a 52 year old lady presenting with 2 months history of breathlessness, found to have severely impaired left ventricular function. She had been taking HCQ for 28 months for seronegative inflammatory arthritis. No cause was identified on initial investigation. She was treated with optimal medical therapy, and HCQ was stopped. After 5 months a cardiac MRI scan revealed full remodelling of the ventricle. Discussion This case highlights one of the lesser recognized side effects of HCQ, and the potential for severe cardiac dysfunction. As this drug continues to be investigated and used in the management of SARS-CoV-2 it is important to recognize the potential for cardiac decompensation in patients who are already at increased risk of myocardial dysfunction.

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AB0178 COMORBIDITIES IN RHEUMATOID ARTHRITIS: DO THEY INTERFERE WITH MYOCARDIAL FUNCTION?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3650 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1114.3-1115

Author(s):

R. Dhahri ◽

W. Lahmar ◽

Y. Ben Abderrazek ◽

M. Slouma ◽

B. Louzir ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Diabetes Mellitus ◽

Longitudinal Strain ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Control Group ◽

Healthy Controls ◽

Increased Risk ◽

History Of

Background:Patients with rheumatoid arthritis are at increased risk for cardiovascular disease (CVD).The early myocardial dysfunction in RA patients may be detectable sooner using speckle-tracking echocariodgraphy to evaluate ventricular strain especially the global longitudinal strain (GLS), this has provided more comprehensive information on ventricular dysfunction in these patients.Objectives:In the present study, we evaluated comorbidities that interfered the most with the GLS in rheumatoid arthritis patients.Methods:The study population was comprised of a case group (36 patients with rheumatoid arthritis with no history of CVD and normal LVEF in the outpatient population of the Rheumatology department in the military hospital of Tunis) and a matched control group (individuals without a history of rheumatoid arthritis or cardiac abnormalities referred for clinical check-ups). In both groups, 2D and 3D echocardiographic examinations were performed by a single cardiologist to assess cardiac functional parameters.Results:Anemia (36%) was found to be the most common comorbidity followed by diabetes mellitus (25%), arterial hypertension (17%) and dyslipidemia (17%).Myocardial deformation study revealed that rheumatoid arthritis patients had a significantly worse global longitudinal strain than healthy controls (18.99±2.81% vs 20.42±1.33%; P=.015). Moreover, a third of the rheumatoid arthritis patients (and no healthy controls) exhibited subclinical left ventricular systolic dysfunction (GLS<18%).Anemia (r=−0.368, P=.027), Age (r=−0.365, P=.029), Diabetes mellitus (r=−0.540, P=.001) and E/A (r=0.351, P=.036) were significantly correlated with GLS in our univariate study. Receiver operating characteristic curve analysis revealed hemoglobin as the best predictor for subclinical LVSD (AUC=0.752, 95% CI: 0.577-0.927, P=.02) when compared to Age and E/A.Conclusion:This prospective comparative study highlighted the diabetes mellitus and anemia burden on myocardial dysfunction in RA patients.Disclosure of Interests:None declared

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Bradycardia associated with Multisystem Inflammatory Syndrome in Children with COVID-19: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab405 ◽

2021 ◽

Author(s):

Gian Paolo Ciccarelli ◽

Eugenia Bruzzese ◽

Gaetano Asile ◽

Edoardo Vassallo ◽

Luca Pierri ◽

...

Keyword(s):

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Myocardial Dysfunction ◽

Sinus Bradycardia ◽

Gastrointestinal Symptoms ◽

Case Series ◽

Left Ventricular ◽

Cardiac Monitoring ◽

History Of ◽

Inflammatory Syndrome

Abstract Background Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare life-threatening clinical condition that can develop in patients younger than 21 years of age with a history of infection/exposure to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The cardiovascular system is a main target of the inflammatory process that frequently causes myocardial dysfunction, myopericarditis, coronary artery dilation, hypotension, and shock. MIS-C-associated myocarditis is usually characterized by fever, tachycardia, nonspecific ECG abnormalities and left ventricular dysfunction, but serious tachyarrhythmias may also occur. We report 2 cases of patients with MIS-C-associated myocarditis who developed severe bradycardia. Case summary Two female adolescents with recent history of COVID-19 were initially hospitalized for long-lasting high-grade fever and severe gastrointestinal symptoms. Both patients were diagnosed with MIS-C-associated myocarditis for elevation of markers of myocardial injury (mean highly-sensitive cardiac Troponin 2663 pg/ml, mean NT-pro-BNP 5097 pg/ml) and left ventricular dysfunction, which was subsequently confirmed by cardiac magnetic resonance. Both patients developed a severe sinus bradycardia (lowest HR 36 and 42, respectively), that appeared refractory to the treatment with intravenous Methylprednisolone and Immunoglobulins, despite a clinical and biochemical improvement. The use of Anakinra (a recombinant IL-1 receptor antagonist), was associated with a rapid improvement of cardiac rhythm and excellent clinical outcome at 6 months follow-up. Discussion In patients with MIS-C-associated myocarditis, a continuous cardiac monitoring is mandatory to promptly identify potential conduction abnormalities. Adolescents may present bradycardia as a rhythm complication. We experienced a rapid recovery after treatment with Anakinra, to be considered as add-on therapy in cases refractory to standard anti-inflammatory treatment.

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An Unusual Association: Right Atrial Myxoma and Severe Left Ventricular Dysfunction. Case Report and Review of the Literature

The Heart Surgery Forum ◽

10.1532/hsf98.2014420 ◽

2015 ◽

Vol 17 (6) ◽

pp. 285

Author(s):

Lucian Florin Dorobantu ◽

Ovidiu Chioncel ◽

Alexandra Pasare ◽

Dorin Lucian Usurelu ◽

Ioan Serban Bubenek-Turconi ◽

...

Keyword(s):

Ejection Fraction ◽

Ventricular Dysfunction ◽

Left Ventricular Systolic Dysfunction ◽

Left Ventricular ◽

Right Atrial ◽

Left Ventricular Ejection ◽

Cardiac Tumors ◽

Severe Left Ventricular Dysfunction ◽

Ventricular Ejection Fraction ◽

Increased Risk

Myxomas comprise 50% of all benign cardiac tumors in adults, with the right atrium as their second most frequent site of origin. Surgical resection is the only effective therapeutic option for patients with these tumors. The association between right atrial myxomas and severe left ventricular systolic dysfunction is extremely rare and makes treatment even more challenging. This was the case for our patient, a 47-year-old male with a right atrial mass and a severely impaired left ventricular function, with a 20% ejection fraction. Global enlargement of the heart was also noted, with moderate right ventricular dysfunction. The tumor was successfully excised using the on-pump beating heart technique, with an immediate postoperative improvement of the left ventricular ejection fraction to 35%. The technique proved useful, with no increased risk to the patient.

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Late-Term Complications of COVID-19: Retropharyngeal Infection and Myocarditis in a 26-Year-Old Patient

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_002759 ◽

2021 ◽

Author(s):

Mohammad Yousef Mohammad Yousef ◽

Basel Abdelazeem ◽

Atefeh Kalantary ◽

Rebecca Pratiti

Keyword(s):

Ventricular Dysfunction ◽

Medical Literature ◽

Acute Myocarditis ◽

Late Complication ◽

Viral Myocarditis ◽

Left Ventricular ◽

Severe Left Ventricular Dysfunction ◽

Clinical Challenge ◽

History Of ◽

Tomography Scan

Deep neck space infection and viral myocarditis related to coronavirus disease 2019 (COVID-19) have both been described in the medical literature. However, there are only three reported cases of retropharyngeal infection as a presenting pathology in the setting of COVID-19. A 26-year-old woman presented to the emergency room with fever and neck swelling and pain 1 month after COVID-19 infection. A computed tomography scan of the neck demonstrated tonsillitis with retropharyngeal infection. She was also found to have heart failure with an ejection fraction (EF) of <20% due to acute myocarditis. Her infection resolved and the EF improved to 40% prior to discharge. Our case is the first to describe retropharyngeal infection as a late complication in an adult with a history of COVID-19 several weeks previously. It also presented a clinical challenge in terms of tailoring goal-directed medical therapy to manage severe left ventricular dysfunction caused by myocarditis.

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Abstract 2294: The Use of Myocardial Deformation Imaging Based on Ultrasonic Pixel Tracking to Identify Reversible Myocardial Dysfunction

Circulation ◽

10.1161/circ.116.suppl_16.ii_501-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Michael Becker ◽

Mithra Lenzen ◽

Katharina Stempel ◽

Andreas Franke ◽

Malte Kelm ◽

...

Keyword(s):

Left Ventricular Dysfunction ◽

Myocardial Viability ◽

Predictive Value ◽

Ventricular Dysfunction ◽

Myocardial Dysfunction ◽

Radial Strain ◽

Left Ventricular ◽

Myocardial Deformation ◽

Deformation Imaging ◽

Myocardial Deformation Imaging

Objective. Myocardial deformation imaging allows analysis of myocardial Objective. Myocardial deformation imaging allows analysis of myocardial viability in ischemic left ventricular dysfunction. This study evaluated the predictive value of myocardial deformation imaging for improvement in cardiac function after revascularization therapy in comparison to contrast-enhanced cardiac magnetic resonance imaging (ceMRI). Methods and Results. In 53 patients with ischemic left ventricular dysfunction, myocardial viability was assessed using pixel-tracking-derived myocardial deformation imaging and ceMRI to predict recovery of function at 9±2 months follow-up. For each left ventricular segment in a 16-segment model peak systolic radial strain was determined from parasternal 2D echocardiographic views using an automatic frame-by-frame tracking system of natural acoustic echocardiographic markers (EchoPAC, GE Ultrasound), and maximal thickness of myocardial tissue without late enhancement (LE) using ceMRI. Of 463 segments with abnormal baseline function, 227 showed regional recovery. Compared with segments showing functional improvement, those that failed to recover had lower radial strain (15.2±7.5 vs 22.6±6.3 %; p<0.001) and lower thickness without LE (5.2±2.9 vs 8.7±2.2 mm; p<0.001). Using a cut-off of 17.2 % for peak systolic radial strain, functional recovery could be predicted with high accuracy (specificity 85%, sensitivity 70%, area under the curve (AUC) 0.859, 95% CI: 0.825– 0.893). The predictive value of thickness without LE by ceMRI was similar at a cut-off of 8.2 mm (specificity 84%, sensitivity 70%, AUC 0.831, 95% CI: 0.793– 0.870). Conclusion. Myocardial deformation imaging based on frame-to-frame tracking of acoustic markers in 2D echocardiographic images is a powerful novel modality to identify reversible myocardial dysfunction.

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P321 Cardiotoxicity related to cancer therapy. is the study of mechanical dispersion an additional value?

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.174 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

F Privitera ◽

V Losi ◽

I P Monte

Keyword(s):

Ventricular Dysfunction ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Treated Group ◽

Left Ventricular ◽

Lv Function ◽

Breast Cancer Chemotherapy ◽

Mechanical Dispersion ◽

Group 2 ◽

Group 1

Abstract Myocardial dysfunction are the most concerning cardiovascular complications of cancer therapies with a poor prognosis, so it’s critical to detect subclinical cardiac abnormalities in order to start cardioprotective therapy early or increased surveillance frequency. Global longitudinal strain (GLS) by echocardiography is an excellent tool for assessing regional and global left ventricular (LV) function. Mechanical dispersion (MD) reflects heterogeneous myocardial contraction, evaluated in many cardiopathies. We evaluated subclinical myocardial dysfunction by GLS and MD using 2D Speckle-tracking Echo, in order to established if MD could be a predictor of ventricular dysfunction in the field of Cardiotoxicity (CTX). Were enrolled 42 women with breast cancer chemotherapy-treated and underwent to Echo evaluation during 3- and 6-months follow-up, compared to evaluation performed before starting chemotherapy (T0). Depending on chemotherapy type were identified 2 groups: Anthracyclines ± Taxol treated (group 1) and Anti-HER2 treated (group 2). CTX diagnosis was made according ESC criteria: LVEF < 50%, LVEF decrease >10% or GLS decrease >15% compared to previous check. At three months, 28% patients (p < 0,009) developed CTX and, in this group, MD was significantly increased compared to T0 (64,4ms ± 18,6 vs 43,48ms ± 7.88 p < 0,001). This finding was consistent regardless treatment group: 65,2 ms ± 5,30 (p < 0.0001) in group 1 and 63,14 ms ± 36,40 (p 0.02) in group 2. Also, GLS was significantly changed: in CTX patients decreased of 9% compared to T0 (p 0.02), but this finding was consistent in group 1 in which GLS decreased of 18% (p 0,01), while in group 2 decrease only of 5% and wasn’t statistically significant compared to T0 (p = 0,3). These patients were treated by beta-blockers or ACE-inhibitors. At six months there was a normalization of MD value (47.7 ± 15.97 ms in CTX group) that was not statistically significant compared to T0 (p = 0,2) and we have interpreted as consequence of positive effect induced by cardioprotective therapy. We believe that MD is a predictor of ventricular dysfunction earlier than GLS during Anti-HER2 treatment, so in this field MD could integrates information obtained from GLS about subclinical dysfunction.

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Ventricular tachycardia storm management in a COVID-19 patient: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa217 ◽

2020 ◽

Vol 4 (FI1) ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Gianfranco Mitacchione ◽

Marco Schiavone ◽

Alessio Gasperetti ◽

Giovanni B Forleo

Keyword(s):

Ventricular Tachycardia ◽

Ventricular Arrhythmias ◽

Cardiac Involvement ◽

Previous History ◽

Left Ventricular ◽

Electrical Storm ◽

Increased Risk ◽

History Of ◽

Myocardial Involvement ◽

Artery Disease

Abstract Background Coronavirus disease 2019 (COVID-19) has been associated with myocardial involvement. Among cardiovascular manifestations, cardiac arrhythmias seem to be fairly common, although no specifics are reported in the literature. An increased risk of malignant ventricular arrhythmias and electrical storm (ES) has to be considered. Case summary We describe a 68-year-old patient with a previous history of coronary artery disease and severe left ventricular systolic disfunction, who presented to our emergency department describing cough, dizziness, fever, and shortness of breath. She was diagnosed with COVID-19 pneumonia, confirmed after three nasopharyngeal swabs. Ventricular tachycardia (VT) storm with multiple implantable cardioverter defibrillator (ICD) shocks was the presenting manifestation of cardiac involvement during the COVID-19 clinical course. A substrate-based VT catheter ablation procedure was successfully accomplished using a remote navigation system. The patient recovered from COVID-19 and did not experience further ICD interventions. Discussion To date, COVID-19 pneumonia associated with a VT storm as the main manifestation of cardiac involvement has never been reported. This case highlights the role of COVID-19 in precipitating ventricular arrhythmias in patients with ischaemic cardiomyopathy who were previously stable.

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Early natural history of regional left ventricular dysfunction after experimental myocardial infarction

American Heart Journal ◽

10.1016/0002-8703(88)90801-0 ◽

1988 ◽

Vol 115 (3) ◽

pp. 538-546 ◽

Cited By ~ 3

Author(s):

Douglas L. Mann ◽

Rodney A. Foale ◽

Linda D. Gillam ◽

David Schoenfeld ◽

John Newell ◽

...

Keyword(s):

Myocardial Infarction ◽

Natural History ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Experimental Myocardial Infarction ◽

History Of

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Speckle Tracking Echocardiography and All-Cause and Cardiovascular Mortality Risk in Chronic Kidney Disease Patients

Kidney & Blood Pressure Research ◽

10.1159/000501225 ◽

2019 ◽

Vol 44 (4) ◽

pp. 690-703 ◽

Cited By ~ 2

Author(s):

Laura Jahn ◽

Rafael Kramann ◽

Nikolaus Marx ◽

Jürgen Floege ◽

Michael Becker ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Mortality Risk ◽

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Myocardial Dysfunction ◽

Left Ventricular ◽

Control Group ◽

Increased Risk ◽

All Cause Mortality

Background and Objectives: Patients with chronic kidney disease (CKD) exhibit a highly increased risk of cardiovascular (CV) morbidity and mortality. Subtle changes in left ventricular function can be detected by two-dimensional (2D) speckle tracking echocardiography (STE). This study investigated whether myocardial dysfunction detected by 2D STE may aid in CV and all-cause mortality risk assessment in patients with CKD stages 3 and 4. Method: A study group of 285 patients (CKD 3: 193 patients; CKD 4: 92 patients) and a healthy control group (34 participants) were included in the retrospective study. 2D STE values as well as early and late diastolic strain rates were measured in ventricular longitudinal, circumferential and radial directions. Patients’ CV and all-cause outcome was determined. Results: In the CKD group all measured longitudinal STE values and radial strain were significantly reduced compared to the control group. Cox proportional hazards regression revealed global longitudinal strain to predict CV and all-cause mortality (hazard ratio [HR] 1.15, 95% CI 1.06–1.25; p = 0.0008 and HR 1.09, 95% CI 1.04–1.14; p = 0.0003). After adjustment for sex, age, diabetes, estimated glomerular filtration rate, and preexisting CV disease, this association was maintained for CV mortality and all-cause mortality (HR 1.16, 95% CI 1.06–1.27; p = 0.0019 and HR 1.08, 95% CI 1.03–1.14; p = 0.0026, respectively). Conclusions: The present study shows that 2D STE detects reduced left ventricular myocardial function and allows the prediction of CV and all-cause mortality in patients at CKD stages 3 and 4.

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Transient left bundle branch block and left ventricular dysfunction in a patient with NLRP1-associated autoinflammation with arthritis and dyskeratosis syndrome

Cardiology in the Young ◽

10.1017/s1047951118002342 ◽

2019 ◽

Vol 29 (3) ◽

pp. 435-438

Author(s):

Mark R. Garrelfs ◽

Esther Hoppenreijs ◽

Ronald B. Tanke

Keyword(s):

Left Bundle Branch Block ◽

Cardiac Dysfunction ◽

Cardiac Involvement ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

High Dose ◽

Impaired Left Ventricular Function ◽

Autoinflammatory Disorder ◽

Bundle Branch Block ◽

High Dose Methylprednisolone

AbstractThe NLRP1-associated autoinflammation with arthritis and dyskeratosis syndrome is a rare novel autoinflammatory disorder. Cardiac involvement has not been previously reported. We present a 12-year-old girl with NLRP1-associated autoinflammation with arthritis and dyskeratosis syndrome who was diagnosed with severely impaired left ventricular function and complete left bundle branch block during an exacerbation of the disease. Cardiac dysfunction proved to be rapidly reversible after initiation of high-dose methylprednisolone.

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