Viral myocarditis is a rare but life-threatening complication in patients with ulcerative colitis.Management of myocarditis is primarily supportive,because there are currently no established targeted therapies.Recent ...Viral myocarditis is a rare but life-threatening complication in patients with ulcerative colitis.Management of myocarditis is primarily supportive,because there are currently no established targeted therapies.Recent studies have increasingly highlighted the association between the gut microbiota and myocarditis.Here,we report a case of acute severe ulcerative colitis complicated by cytomegalovirus and Epstein-Barr virus co-infections that led to viral myocarditis.The patient experienced rapid remission of both intestinal and cardiac symptoms following washed microbiota transplantation,suggesting this intervention may serve as a potential alternative treatment for these life-threatening conditions.展开更多
BACKGROUND Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infections in neonates.While typically associated with bronchiolitis and pneumonia,RSV can rarely cause extrapulmonary complicat...BACKGROUND Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infections in neonates.While typically associated with bronchiolitis and pneumonia,RSV can rarely cause extrapulmonary complications such as myocarditis,which may present with life-threatening symptoms if not promptly recognized.CASE SUMMARY We describe the case of a 26-day-old male neonate who presented with respiratory distress,poor feeding,and irritability.Initial evaluation revealed an RSV infection confirmed via nasopharyngeal swab.As the clinical course progressed,the infant developed cardiac arrhythmias,elevated cardiac enzymes,and echocardiographic findings consistent with myocarditis.Management included mechanical ventilation,corticosteroid therapy,L-carnitine,and vitamin D supplementation.The patient responded well to treatment and was successfully extubated and discharged in stable condition after nine days of hospitalization.CONCLUSION This case highlights the importance of early recognition and multidisciplinary management of RSV-associated myocarditis in neonates.展开更多
Clinical Data A 25-year-old female patient was admitted to our hospital on September 4,2019,with“fever for 3 days and chest tightness and shortness of breath for 2 days”.She had no previous history of coronary heart...Clinical Data A 25-year-old female patient was admitted to our hospital on September 4,2019,with“fever for 3 days and chest tightness and shortness of breath for 2 days”.She had no previous history of coronary heart disease or hypertension.Three days before admission,she developed chills,low-grade fever,dry cough,and clear nasal discharge after catching a cold.Two days before admission,she experienced chest tightness and shortness of breath after mild physical activity,which relieved after rest.Admission physical examination:Temperature 37.3℃,blood pressure 85/55 mmHg,clear consciousness,poor mental state,pale complexion,respiratory rate 27 breaths/min,heart rate 108 beats/min,regular rhythm,no murmurs.Abdomen(-),no edema of lower extremities.Admission ECG:Sinus rhythm;ST segment elevation of 0.1–0.3 mv in leadsⅡ,Ⅲ,aVF,V1-V6,and pathological Q waves in leadsⅡ,Ⅲ,aVF.Initial diagnosis after admission:Fulminant myocarditis?Acute ST-segment elevation myocardial infarction(to be excluded).Laboratory tests on admission:D-dimer:0.45 mg/L,B-type natriuretic peptide(BNP):7401.8 pg/mL,high-sensitivity troponin I(cTnI):11.41 ng/mL;creatine kinase isoenzyme(CK-MB):59.2 ng/mL,myoglobin:132.5 ng/mL;total white blood cell count:3.74×109/L;hemoglobin:125 g/L,C-reactive protein(CRP):19 mg/L,erythrocyte sedimentation rate(ESR):24 mm/1 h,procalcitonin:0.07 ng/mL.Blood gas analysis(without oxygen inhalation):pH value:7.403;partial pressure of carbon dioxide:31.60 mmHg;partial pressure of oxygen:45.50 mmHg;blood oxygen saturation:79.00%;blood lactic acid(lac):2.3 mmol/L.Transthoracic echocardiography showed:Left atrial diameter 31 mm,left ventricular diameter 35 mm,right atrial diameter 31 mm,right ventricular diameter 23 mm,interventricular septum 13 mm,left ventricular ejection fraction(LVEF)60%.Chest CT plain scan:No exudative lesions in both lungs.Coronary CTA:No coronary artery stenosis.Cardiac magnetic resonance imaging(MRI):Normal diameters of each cardiac chamber,normal left ventricular function,no definite myocardial fibrosis or edema.展开更多
Eosinophilic myocarditis(EM)is a rare inflammatory condition of the heart,often associated with eosinophilic infiltration.While its causes range from allergies to autoimmune and infectious diseases,parasitic infection...Eosinophilic myocarditis(EM)is a rare inflammatory condition of the heart,often associated with eosinophilic infiltration.While its causes range from allergies to autoimmune and infectious diseases,parasitic infections are an uncommon but critical etiology.This mini-review focuses on a case of EM in a 47-year-old male from Vietnam,linked to Schistosoma spp.,Strongyloides stercoralis,and Toxocara spp.infections.The patient presented with severe chest pain and recovered fully after treatment with corticosteroids and albendazole.Drawing insights from this case and existing literature,we discuss the pathophysiology,diagnostic approaches,and therapeutic strategies for parasite-induced EM.Early diagnosis and tailored treatment are essential to improve clinical outcomes,especially in endemic para-sitic areas.展开更多
BACKGROUND Clozapine,the gold standard for resistant schizophrenia,is underused due to risks like clozapine-induced myocarditis(CIM).Non-specific biomarkers and inconsistent imaging,and the significant overlap with cl...BACKGROUND Clozapine,the gold standard for resistant schizophrenia,is underused due to risks like clozapine-induced myocarditis(CIM).Non-specific biomarkers and inconsistent imaging,and the significant overlap with clozapine-induced pneumonia(CIP)lead to misdiagnosis and premature discontinuation.AIM To develop a diagnostic algorithm for CIM to enhance accuracy,differentiate from CIP,and guide safe clozapine rechallenge.METHODS A systematic review of 119 PubMed studies(published between 1990 and April 2025)was conducted in accordance with PRISMA guidelines.The review analyzed CIM diagnosis and rechallenge outcomes,with a focus on biomarkers,imaging,and collaboration with cardiology.RESULTS CIM diagnosis relies on troponin and C-reactive protein;electrocardiography and echocardiography are inconsistently applied,and cardiac magnetic resonance imaging(CMR)is underused.Rechallenge was successful in 64.7%to 68.9%of 136 cases,with 2.9%resulting in fatal outcomes.Up to 65%of presumed CIM cases lack confirmation.A proposed protocol integrates chest computed tomography to exclude pneumonia and CMR for CIM confirmation,with echocardiography as an alternative.CONCLUSION A protocol involving multidisciplinary collaboration among computed tomography,CMR,and cardiology improves CIM diagnosis.Slow titration prevents CIM;adjust the dose for CIP and discontinue for confirmed CIM.展开更多
This article pertains to the study by Liu et al.Myocarditis caused by immune checkpoint inhibitors in patients with esophageal cancer is a concerning issue.This was found to be linked by increased levels of creatine k...This article pertains to the study by Liu et al.Myocarditis caused by immune checkpoint inhibitors in patients with esophageal cancer is a concerning issue.This was found to be linked by increased levels of creatine kinase(CK)and CK isoenzymes,as well as older age and male gender.All these risk factors behind this phenomenon,which could be incorporated into a unified prediction model,have been briefly discussed.Several recommendations have been made to validate this prediction model for use in different clinical scenarios.展开更多
Background:Viral myocarditis(VMC)is an inflammatory myocardial disease induced by viral infections,and currently,there are no effective targeted treatments available.Cyclovirobuxine D(CVB-D),a major alkaloid extracted...Background:Viral myocarditis(VMC)is an inflammatory myocardial disease induced by viral infections,and currently,there are no effective targeted treatments available.Cyclovirobuxine D(CVB-D),a major alkaloid extracted from the traditional eastern medicinal plant Cephalotaxus,has been clinically used in the treatment of arrhythmias and coronary heart disease.However,its therapeutic effects and underlying mechanisms in VMC remain unclear.This study aims to investigate the cardioprotective effects of CVB-D in a murine model of viral myocarditis induced by Coxsackievirus B3(CVB3)and to elucidate the molecular mechanisms involved in its effects.Method:A murine model of VMC was established by infecting C57BL/6J mice with CVB3.The mice were randomly assigned to three groups:the sham-operated group,the model group,and the CVB-D treatment group.After 14 days of intervention,the general health status of the mice was evaluated.Histopathological changes in myocardial tissue and myocardial cell cross-sectional areas were examined using Hematoxylin and Eosin(H&E)staining.Cardiac function was assessed via echocardiography.Additionally,network pharmacology was employed to identify VMC-related targets and signaling pathways,which were further analyzed to hypothesize the potential therapeutic mechanisms of CVB-D in VMC.Result:CVB-D exerts significant protective effects against CVB3-induced VMC.The underlying mechanisms may be associated with mitochondrial energy metabolism,the electron transport chain,and oxidative phosphorylation processes.This study provides experimental evidence supporting the potential of CVB-D as a therapeutic agent for VMC.展开更多
BACKGROUND Esophageal cancer is a serious global health concern with poor prognosis in advanced stages.Immune checkpoint inhibitors(ICIs)have shown promise in enhancing survival,but they are associated with immune-rel...BACKGROUND Esophageal cancer is a serious global health concern with poor prognosis in advanced stages.Immune checkpoint inhibitors(ICIs)have shown promise in enhancing survival,but they are associated with immune-related adverse events,including potentially life-threatening myocarditis.Moreover,ICI-induced myocarditis can be asymptomatic,necessitating early diagnosis.Specific risk factors and biomarkers for esophageal cancer remain poorly characterized.AIM To investigate the determinants of ICI-associated asymptomatic myocarditis in patients with esophageal cancer and explore potential early biomarkers.METHODS A retrospective analysis was conducted on 202 cancer patients who received treatment at Shanxi Province Cancer Hospital from July 2019 to July 2024.RESULTS Older age,male gender,and elevated creatine kinase isoenzymes(CK-MB)and CK levels were found to be significant risk factors for asymptomatic myocarditis.The myocarditis occurrence group had higher CK-MB(3.05 ng/mL vs 5.02 ng/mL;P<0.001)and CK levels(187.29 U/L vs 212.25 U/L;P=0.005),and the predictive value of age,gender,CK,and CK-MB was low[are under the receiver operating characteristic curve(AUC)=0.579-0.608].However,their combination in a predictive model showed improved diagnostic capability,with an AUC of 0.808.CONCLUSION Age,gender,and cardiac biomarker levels considerably contribute to the risk of ICI-related myocarditis in patients with esophageal cancer.The integration of these factors into a predictive model enhances early diagnosis,facilitating personalized risk management.展开更多
BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemothe...BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemotherapy or radiation therapy related complications and cardiac metastasis.CASE SUMMARY We present a case of a 47-year-old female with metastatic cancer on immuno-therapy presented with anterior ST elevation myocardial infarction followed by emergent percutaneous coronary intervention in the left anterior descending artery.Echocardiography after 72 hours showed thickening of inferior wall and cardiac magnetic resonance depicted inflammation and necrosis attributable to either cardiac metastasis or immunotherapy induced myocarditis.Biopsy was not performed because of treatment with antiplatelet drugs and a definite diagnosis was achieved after probationary administration of high-dose intravenous methyl-prednisolone that led to recovery.CONCLUSION In patients with malignancy,chemotherapy-induced cardiovascular complications and cardiac metastasis are common concerns and may coexist with common acute cardiovascular diseases including acute coronary syndromes.In such cases clinical suspicion aided by multimodality imaging is crucial for the diagnosis.A multidisciplinary team approach is required for prompt initiation of the appro-priate treatment.展开更多
BACKGROUND Autoimmune myocarditis(AM)associated with autoimmune diseases can cause complete atrioventricular block(CAVB),but the related autoantigens and the underlying mechanisms are unclear.Anti-SSA/Ro antibodies ma...BACKGROUND Autoimmune myocarditis(AM)associated with autoimmune diseases can cause complete atrioventricular block(CAVB),but the related autoantigens and the underlying mechanisms are unclear.Anti-SSA/Ro antibodies may play an important role in this process,but cases of AM with positive anti-SSA/Ro antibodies are rare.In addition,arrhythmias,such as atrioventricular block,are very common in patients with autoimmune diseases,but severe atrioventricular block requiring permanent pacemaker implantation is extremely rare.CASE SUMMARY The patient in this case had AM with anti-SSA/Ro antibody positivity,which was associated with connective tissue disease,and the patient subsequently developed CAVB.After intensive immunosuppressive therapy,the antibody test results became negative,and pulmonary hypertension significantly improved.However,the outcome of permanent pacemaker implantation did not change.CONCLUSION In clinical practice,the awareness of adult AM associated with autoimmune diseases combined with CAVB should be strengthened in clinicians,and anti-SSA/Ro antibodies may play a role in this process.Therefore,improving the detection of antibodies and early intervention,such as active immunosuppression therapy,may be very important for improving disease prognosis.For patients who do not respond to immunosuppressive therapy,implantation of a permanent pacemaker may become an essential treatment option.展开更多
This paper summarizes the nursing experience of a 65-year-old elderly patient with fulminant myocarditis complicated by cardiogenic shock who received veno-arterial extracorporeal membrane oxygenation(V-A ECMO)combine...This paper summarizes the nursing experience of a 65-year-old elderly patient with fulminant myocarditis complicated by cardiogenic shock who received veno-arterial extracorporeal membrane oxygenation(V-A ECMO)combined with intra-aortic balloon pump(IABP)support therapy.The core nursing measures included:establishing a multidisciplinary collaboration team to implement daily goal management;standardized anticoagulation monitoring;refined hemodynamic management;stepped respiratory support;and early rehabilitation intervention.After 9 days of ECMO support combined with 5 days of IABP support,the patient’s cardiac and respiratory functions recovered.The patient was discharged on the 42nd day and was fully recovered during the follow-up on the 60th day.This case suggests that refined nursing care for ECMO combined with IABP is the key to the treatment of fulminant myocarditis.展开更多
Human herpesvirus 6(HHV-6)is a common childhood infection but rarely causes severe complications.In immunocompetent children,conditions such as febrile convulsions and roseola infantum are typical,with occasional seve...Human herpesvirus 6(HHV-6)is a common childhood infection but rarely causes severe complications.In immunocompetent children,conditions such as febrile convulsions and roseola infantum are typical,with occasional severe manifestations like meningoencephalitis and myocarditis.展开更多
Objective To study the state of oxidative stress in patients with acute coxsackie virusmyocarditis (ACM), and to investigate the pathological chain reactions of a series of freeradicals and oxidative and lipoperoxi...Objective To study the state of oxidative stress in patients with acute coxsackie virusmyocarditis (ACM), and to investigate the pathological chain reactions of a series of freeradicals and oxidative and lipoperoxidative damages in their bodies. Methods Eighty ACMpatients and 80 healthy adult volunteers (HAV) were enrolled in a case-control study, inwhich concentrations of nitric oxide (NO) in plasma, lipoperoxides (LPO) in plasma andLPO in erythrocytes (RBC), vitamin C (VC), vitamin E (VE) and b-carotene (b-CAR) inplasma as well as activities of superoxide dismutase (SOD), catalase (CAT) and glutathioneperoxidase (GSH-Px) in RBC were determined by using spectrophotometric assays. ResultsCompared with the average values (AV) of the above biochemical parameters (BP) in theHAV group, the AV of NO in plasma, and LPO in plasma and RBC in the ACM group weresignificantly increased (P=0.0001), while the AV of VC, VE, b-CAR, SOD, CAT and GSH-Px in the ACM group were significantly decreased (P=0.0001). The values of the above BPwere used to estimate the relative risk ratio (RR) between the ACM group and the HAVgroup; the RR and its 95 % confidence interval were 12.467 (5.745~27.051), 4.333(2.126~8.834), 6.517 (3.225~13.618), 3.310 (1.598~6.858), 31.000 (12.611~76.201),4.663 (2.228~9.759), 11.769 (5.440~25.462), 3.043 (1.486~6.229) and 6.594 (3.045~14.281)respectively, and their P levels ranged from 0.002 to 0.0001. The results were asfollows: D = 22.143 - 0.017SOD + 0.008NO + 0.244LPO in RBC, Eigenvalue = 13.659,Canonical correlation = 0.965, Wilks’λ= 0.068, c2 = 420.212, P = 0.0001. The correct rateof discrimination to the ACM group and to the HAV group was 87.5% and 95.0 %, respectively,and 91.3 % of originally grouped cases was correctly classified. Conclusion The findingsin this study suggested that the oxidative stress in bodies of ACM patients was severelyaggravated, and marked high oxidative constituents and low antioxidants and antioxidasesin the human body might increase the relative risk of inducing acute coxsackie virusmyocarditis, and measuring the values of NO in plasma, SOD and LPO in RBC mightincrease the correct rates of discriminatory analysis of the ACM.展开更多
BACKGROUND Myocarditis is an important cause of morbidity and mortality in children, leading to long-term sequelae including chronic congestive heart failure, dilated cardiomyopathy, heart transplantation, and death. ...BACKGROUND Myocarditis is an important cause of morbidity and mortality in children, leading to long-term sequelae including chronic congestive heart failure, dilated cardiomyopathy, heart transplantation, and death. The initial diagnosis of myocarditis is usually based on clinical presentation, but this widely ranges from the severe sudden onset of a cardiogenic shock to asymptomatic patients. Early recognition is essential in order to monitor and start supportive treatment prior to the development of severe adverse events. Of note, many cases of fulminant myocarditis are usually misdiagnosed as otherwise minor conditions during the weeks before the unexpected deterioration.AIM To provide diagnostic clues to make an early recognition of pediatric myocarditis.To investigate early predictors for poor outcomes.METHODS We conducted a retrospective cross-sectional single-center study from January 2008 to November 2017 at the Pediatric Department of our institution, including children < 18-years-old diagnosed with myocarditis. Poor outcome was defined as the occurrence of any of the following facts: death, heart transplant, persistent left ventricular systolic dysfunction or dilation at hospital discharge(early poor outcome), or after 1 year of follow-up(late poor outcome). We analyzed different clinical features and diagnostic test findings in order to provide diagnostic clues for myocarditis in children. Multivariable stepwise logistic regression analysis was performed using all variables that had been selected by univariate analysis to determine independent factors that predicted a poor early or late outcome in our study population.RESULTS A total of 42 patients [69% male; median age of 8(1.5-12) years] met study inclusion criteria. Chest pain(40%) was the most common specific cardiac symptom. Respiratory tract symptoms(cough, apnea, rhinorrhea)(38%),shortness of breath(35%), gastrointestinal tract symptoms(vomiting, abdominal pain, diarrhea)(33%), and fever(31%) were the most common non-cardiac initial complaints. Tachycardia(57%) and tachypnea(52%) were the most common signs on the initial physical exam followed by nonspecific signs of respiratory tract infection(44%) and respiratory distress(35%). Specific abnormal signs of heart failure such as heart murmur(26%), systolic hypotension(24%), gallop rhythm(20%), or hepatomegaly(20%) were less prevalent. Up to 43% of patients presented an early poor outcome, and 16% presented a late poor outcome. In multivariate analysis, an initial left ventricular ejection fraction(LVEF) < 30%remained the only significant predictor for early [odds ratio(OR)(95%CI) = 21(2-456), P = 0.027) and late [OR(95%CI) = 8(0.56-135), P = 0.047) poor outcome in children with myocarditis. LVEF correlated well with age(r = 0.51, P = 0.005),days from the initiation of symptoms(r =-0.31, P = 0.045), and N-terminal probrain natriuretic peptide levels(r = 0.66, P < 0.001), but not with troponin T(r =-0.05, P = 0.730) or C-reactive protein levels(r =-0.13, P = 0.391). N-terminal probrain natriuretic peptide presented a high diagnostic accuracy for LVEF < 30% on echocardiography with an area under curve of 0.931(95%CI: 0.858-0.995, P <0.001). The best cut-off point was 2000 pg/mL with a sensitivity of 90%,specificity of 81%, positive predictive value of 60%, and negative predictive value of 96%.CONCLUSION The diagnosis of myocarditis in children is challenging due to the heterogeneous and unspecific clinical presentation. The presence of LVEF < 30% on echocardiography on admission was the major predictor for poor outcomes.Younger ages, a prolonged course of the disease, and N-terminal pro-brain natriuretic peptide levels could help to identify these high-risk patients.展开更多
Myocarditis is a bacterial or viral inflammatory disease,often unnoticed or misdiagnosed.Athletes with myocarditis must stop practicing their activity since International medical Literature described some cases of sud...Myocarditis is a bacterial or viral inflammatory disease,often unnoticed or misdiagnosed.Athletes with myocarditis must stop practicing their activity since International medical Literature described some cases of sudden death.In the present report,we describe a case of an asymptomatic,apparently healthy,competitive athletes,who was diagnosed a myocarditis and as incidental finding a myocardial bridging.We focused the attention on the importance of anamnesis,electrocardiogram and athletes' entourage for the diagnosis of such insidious pathologies and we evaluated the follow up,focusing the attention on electrocardiogram changes as well as on restitution ad integrum and prognosis,especially for the athletes.展开更多
Globally, coxsackievirus B4 （CV-B4） has been continuously isolated and evidence suggests an association with the development of pancreatitis and type I diabetes. In addition, CV-B4 is also associated with myocarditi...Globally, coxsackievirus B4 （CV-B4） has been continuously isolated and evidence suggests an association with the development of pancreatitis and type I diabetes. In addition, CV-B4 is also associated with myocarditis and severe central nervous system （CNS） complications, which remain poorly studied and understood. In the present study, we established an institute for Cancer Research （ICR） mouse model of CV-B4 infection and examined whether CV-B4 infection resulted in a predisposition to myocarditis and CNS infection. We found high survival in both the treatment and control group, with no significant differences in clinical outcomes observed. However, pathological lesions were evident in both brain and heart tissue of the CV-B4-infected mice. in addition, high viral loads were found in the neural and cardiac tissues as early as 2 days post infection. Expressions of IFN-y and IL-6 in sera were significantly higher in CV-B4-infected mice compared to uninfected negative controls, suggesting the involvement of these cytokines in the development of histopathological lesions. Our murine model successfully reproduced the acute myocarditis and cerebral cortical neuron edema induced by CV-B4, and may be useful for the evaluation of vaccine candidates and potential antivirals against CV-B4 infection.展开更多
Fulminant myocarditis(FM)is an uncommon syndrome characterized by sudden and severe hemodynamic compromise secondary to acute myocardial inflammation,often presenting as profound cardiogenic shock,life-threatening ven...Fulminant myocarditis(FM)is an uncommon syndrome characterized by sudden and severe hemodynamic compromise secondary to acute myocardial inflammation,often presenting as profound cardiogenic shock,life-threatening ventricular arrhythmias and/or electrical storm.FM may be refractory to conventional therapies and require mechanical circulatory support(MCS).The immune system has been recognized as playing a pivotal role in the pathophysiology of myocarditis,leading to an increased focus on immunosuppressive treatment strategies.Recent data have highlighted not only the fact that FM has significantly worse outcomes than non-FM,but that prognosis and management strategies of FM are heavily dependent on histological subtype,placing greater emphasis on the role of endomyocardial biopsy in diagnosis.The impact of subtype on severity and prognosis will likewise influence how aggressively the myocarditis is managed,including whether MCS is warranted.Many patients with refractory cardiogenic shock secondary to FM end up requiring MCS,with venoarterial extracorporeal membrane oxygenation demonstrating favorable survival rates,particularly when initiated prior to the development of multiorgan failure.Among the challenges facing the field are the need to more precisely identify immunopathophysiological pathways in order to develop targeted therapies,and the need to better optimize the timing and management of MCS to minimize complications and maximize outcomes.展开更多
Myocarditis is a relatively rare,possibly life-threatening disease characterized by the inflammation of the myocardium.111 The disease pathogenesis is primarily initiated by acute injury and necrosis of cardiomyocytes...Myocarditis is a relatively rare,possibly life-threatening disease characterized by the inflammation of the myocardium.111 The disease pathogenesis is primarily initiated by acute injury and necrosis of cardiomyocytes,leading to an inflammatory response mediated by the immune system that can potentially cause further aggravation of myocardial damage and organ dysfunction.Prognosis in patients with myocarditis depends on the clinical presentation,which ranges from an asymptomatic disease course to the concomitant development of cardiac arrhythmias,heart failure,cardiogenic shock and even the occurrence of death in extreme cases[1].展开更多
Recent nationwide clinico-epidemiological surveys in Japan showed that the occurrence of cardiomyopathies was most frequently seen in the age of sixties, and that cardiomyopathies are important causes of heart failure...Recent nationwide clinico-epidemiological surveys in Japan showed that the occurrence of cardiomyopathies was most frequently seen in the age of sixties, and that cardiomyopathies are important causes of heart failure in the elderly. Viral infection was conventionally considered to cause myocarditis, which resulted in the development of dilated cardiomyopathy. Recent studies suggest that hepatitis C virus (HCV) is involved in the development of dilated cardiomyopathy, hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy in addition to myocarditis. Furthermore, left ventricular aneurysm represents the same morbid state not only after myocardial infarction but also after myocarditis. There were wide variations in the frequency of detection of HCV genomes in cardiomyopathy in different regions and in different populations. Major histocompatibility complex class Ⅱ genes may play a role in the susceptibility to HCV infection, and may influence the development of different phenotypes of cardiomyopathy. If in fact the myocardial damage is caused by HCV, it might be expected that interferon (IFN) administration would be useful for its treatment. Hepatitis patients receiving IFN treatment for hepatitis were screened by thallium myocardial scintigraphy, and an abnormality was discovered in half of the patients. Treatment with IFN resulted in a disappearance of the image abnormality. It has thus been suggested that mild myocarditis and myocardial damage may be cured with IFN. We have recently found that high concentrations of circulating cardiac troponin T are a specific marker of cardiac involvement in HCV infection. By measuring cardiac troponin T in patients with HCV infection, the prevalence of cardiac involvement in HCV infection will be clarified. We are proposing a collaborative work on a global network on myocarditis/cardiomyopathies due to HCV infection. (J Geriatr Cardiol 2004;1(2):83-89. )展开更多
AIM:To investigate molecular phenotypes of myocardial B19V-infection to determine the role of B19V in myocarditis and dilated cardiomyopathy(DCM).METHODS:Endomyocardial biopsies(EMBs) from 498 B19V-positive patients w...AIM:To investigate molecular phenotypes of myocardial B19V-infection to determine the role of B19V in myocarditis and dilated cardiomyopathy(DCM).METHODS:Endomyocardial biopsies(EMBs) from 498 B19V-positive patients with myocarditis and DCMwere analyzed using molecular methods and functional experiments.EMBs were obtained from the University Hospitals of Greifswald and Tuebingen and additionally from 36 German cardiology centers.Control tissues were obtained at autopsy from 34 victims of accidents,crime or suicide.Identification of mononuclear cell infiltrates in EMBs was performed using immunohistological staining.Anti-B19V-IgM and anti-B19V-IgG were analyzed by enzyme-linked immunosorbent assay(ELISA).B19V viral loads were determined using in-house quantitative real-time polymerase chain reaction(PCR).For B19V-genotyping a new B19V-genotype-specific restriction fragment length polymorphism(RFLP)-PCR was established.B19V-genotyping was verified by direct DNAsequencing and sequences were aligned using BLAST and BioEdit software.B19V P6-promoter and HHV6-U94-transactivator constructs were generated for cell culture experiments.Transfection experiments were conducted using human endothelial cells 1.Luciferase reporter assays were performed to determine B19Vreplication activity.Statistical analysis and graphical representation were calculated using SPSS and Prism5 software.RESULTS:The prevalence of B19V was significantly more likely to be associated with inflammatory cardiomyopathy(iCMP) compared to uninflamed DCM(59.6% vs 35.3%)(P < 0.0001).The detection of B19V-mRNA replication intermediates proved that replication of B19V was present.RFLP-PCR assays showed that B19V-genotype 1(57.4%) and B19V-genotype 2(36.7%) were the most prevalent viral genotypes.B19V-genotype 2 was observed more frequently in EMBs with iCMP(65.0%) compared to DCM(35%)(P = 0.049).Although there was no significant difference in gender-specific B19V-loads,women were more frequently infected with B19V-genotype 2(44.6%) than men(36.0%)(P = 0.0448).Coinfection with B19V and other cardiotropic viruses was found in 19.2% of tissuesamples and was associated with higher B19V viral load compared to B19V-monoinfected tissue(P = 0.0012).The most frequent coinfecting virus was human herpes virus 6(HHV6,16.5%).B19V-coinfection with HHV6 showed higher B19V-loads compared to B19V-monoinfected EMBs(P = 0.0033),suggesting that HHV6 had transactivated B19V.In vitro experiments confirmed a 2.4-fold increased B19V P6-promoter activity by the HHV6 U94-transactivator.CONCLUSION:The finding of significantly increased B19V loads in patients with histologically proven cardiac inflammation suggests a crucial role of B19V-genotypes and reactivation of B19V-infection by HHV6-coinfection in B19V-associated iCMP.Our findings suggest that B19V-infection of the human heart can be a causative event for the development of an endothelial cell-mediated inflammatory disease and that this is related to both viral load and genotype.展开更多
文摘Viral myocarditis is a rare but life-threatening complication in patients with ulcerative colitis.Management of myocarditis is primarily supportive,because there are currently no established targeted therapies.Recent studies have increasingly highlighted the association between the gut microbiota and myocarditis.Here,we report a case of acute severe ulcerative colitis complicated by cytomegalovirus and Epstein-Barr virus co-infections that led to viral myocarditis.The patient experienced rapid remission of both intestinal and cardiac symptoms following washed microbiota transplantation,suggesting this intervention may serve as a potential alternative treatment for these life-threatening conditions.
文摘BACKGROUND Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infections in neonates.While typically associated with bronchiolitis and pneumonia,RSV can rarely cause extrapulmonary complications such as myocarditis,which may present with life-threatening symptoms if not promptly recognized.CASE SUMMARY We describe the case of a 26-day-old male neonate who presented with respiratory distress,poor feeding,and irritability.Initial evaluation revealed an RSV infection confirmed via nasopharyngeal swab.As the clinical course progressed,the infant developed cardiac arrhythmias,elevated cardiac enzymes,and echocardiographic findings consistent with myocarditis.Management included mechanical ventilation,corticosteroid therapy,L-carnitine,and vitamin D supplementation.The patient responded well to treatment and was successfully extubated and discharged in stable condition after nine days of hospitalization.CONCLUSION This case highlights the importance of early recognition and multidisciplinary management of RSV-associated myocarditis in neonates.
基金Supported by the Program of Fuwai Yunnan Hospital,Chinese Academy of Medical Sciences(Project No.:2025YFKT-PY-08)Yunnan Provincial Department of Science and Technology Kunming Medical University Basic Research Joint Special Project(Project No.:202301AY070001-152)。
文摘Clinical Data A 25-year-old female patient was admitted to our hospital on September 4,2019,with“fever for 3 days and chest tightness and shortness of breath for 2 days”.She had no previous history of coronary heart disease or hypertension.Three days before admission,she developed chills,low-grade fever,dry cough,and clear nasal discharge after catching a cold.Two days before admission,she experienced chest tightness and shortness of breath after mild physical activity,which relieved after rest.Admission physical examination:Temperature 37.3℃,blood pressure 85/55 mmHg,clear consciousness,poor mental state,pale complexion,respiratory rate 27 breaths/min,heart rate 108 beats/min,regular rhythm,no murmurs.Abdomen(-),no edema of lower extremities.Admission ECG:Sinus rhythm;ST segment elevation of 0.1–0.3 mv in leadsⅡ,Ⅲ,aVF,V1-V6,and pathological Q waves in leadsⅡ,Ⅲ,aVF.Initial diagnosis after admission:Fulminant myocarditis?Acute ST-segment elevation myocardial infarction(to be excluded).Laboratory tests on admission:D-dimer:0.45 mg/L,B-type natriuretic peptide(BNP):7401.8 pg/mL,high-sensitivity troponin I(cTnI):11.41 ng/mL;creatine kinase isoenzyme(CK-MB):59.2 ng/mL,myoglobin:132.5 ng/mL;total white blood cell count:3.74×109/L;hemoglobin:125 g/L,C-reactive protein(CRP):19 mg/L,erythrocyte sedimentation rate(ESR):24 mm/1 h,procalcitonin:0.07 ng/mL.Blood gas analysis(without oxygen inhalation):pH value:7.403;partial pressure of carbon dioxide:31.60 mmHg;partial pressure of oxygen:45.50 mmHg;blood oxygen saturation:79.00%;blood lactic acid(lac):2.3 mmol/L.Transthoracic echocardiography showed:Left atrial diameter 31 mm,left ventricular diameter 35 mm,right atrial diameter 31 mm,right ventricular diameter 23 mm,interventricular septum 13 mm,left ventricular ejection fraction(LVEF)60%.Chest CT plain scan:No exudative lesions in both lungs.Coronary CTA:No coronary artery stenosis.Cardiac magnetic resonance imaging(MRI):Normal diameters of each cardiac chamber,normal left ventricular function,no definite myocardial fibrosis or edema.
文摘Eosinophilic myocarditis(EM)is a rare inflammatory condition of the heart,often associated with eosinophilic infiltration.While its causes range from allergies to autoimmune and infectious diseases,parasitic infections are an uncommon but critical etiology.This mini-review focuses on a case of EM in a 47-year-old male from Vietnam,linked to Schistosoma spp.,Strongyloides stercoralis,and Toxocara spp.infections.The patient presented with severe chest pain and recovered fully after treatment with corticosteroids and albendazole.Drawing insights from this case and existing literature,we discuss the pathophysiology,diagnostic approaches,and therapeutic strategies for parasite-induced EM.Early diagnosis and tailored treatment are essential to improve clinical outcomes,especially in endemic para-sitic areas.
文摘BACKGROUND Clozapine,the gold standard for resistant schizophrenia,is underused due to risks like clozapine-induced myocarditis(CIM).Non-specific biomarkers and inconsistent imaging,and the significant overlap with clozapine-induced pneumonia(CIP)lead to misdiagnosis and premature discontinuation.AIM To develop a diagnostic algorithm for CIM to enhance accuracy,differentiate from CIP,and guide safe clozapine rechallenge.METHODS A systematic review of 119 PubMed studies(published between 1990 and April 2025)was conducted in accordance with PRISMA guidelines.The review analyzed CIM diagnosis and rechallenge outcomes,with a focus on biomarkers,imaging,and collaboration with cardiology.RESULTS CIM diagnosis relies on troponin and C-reactive protein;electrocardiography and echocardiography are inconsistently applied,and cardiac magnetic resonance imaging(CMR)is underused.Rechallenge was successful in 64.7%to 68.9%of 136 cases,with 2.9%resulting in fatal outcomes.Up to 65%of presumed CIM cases lack confirmation.A proposed protocol integrates chest computed tomography to exclude pneumonia and CMR for CIM confirmation,with echocardiography as an alternative.CONCLUSION A protocol involving multidisciplinary collaboration among computed tomography,CMR,and cardiology improves CIM diagnosis.Slow titration prevents CIM;adjust the dose for CIP and discontinue for confirmed CIM.
文摘This article pertains to the study by Liu et al.Myocarditis caused by immune checkpoint inhibitors in patients with esophageal cancer is a concerning issue.This was found to be linked by increased levels of creatine kinase(CK)and CK isoenzymes,as well as older age and male gender.All these risk factors behind this phenomenon,which could be incorporated into a unified prediction model,have been briefly discussed.Several recommendations have been made to validate this prediction model for use in different clinical scenarios.
基金supported by Zhejiang Provincial College Students’Science and Technology Innovation Program and Xinmiao Talent Plan(No:2024R413C093)。
文摘Background:Viral myocarditis(VMC)is an inflammatory myocardial disease induced by viral infections,and currently,there are no effective targeted treatments available.Cyclovirobuxine D(CVB-D),a major alkaloid extracted from the traditional eastern medicinal plant Cephalotaxus,has been clinically used in the treatment of arrhythmias and coronary heart disease.However,its therapeutic effects and underlying mechanisms in VMC remain unclear.This study aims to investigate the cardioprotective effects of CVB-D in a murine model of viral myocarditis induced by Coxsackievirus B3(CVB3)and to elucidate the molecular mechanisms involved in its effects.Method:A murine model of VMC was established by infecting C57BL/6J mice with CVB3.The mice were randomly assigned to three groups:the sham-operated group,the model group,and the CVB-D treatment group.After 14 days of intervention,the general health status of the mice was evaluated.Histopathological changes in myocardial tissue and myocardial cell cross-sectional areas were examined using Hematoxylin and Eosin(H&E)staining.Cardiac function was assessed via echocardiography.Additionally,network pharmacology was employed to identify VMC-related targets and signaling pathways,which were further analyzed to hypothesize the potential therapeutic mechanisms of CVB-D in VMC.Result:CVB-D exerts significant protective effects against CVB3-induced VMC.The underlying mechanisms may be associated with mitochondrial energy metabolism,the electron transport chain,and oxidative phosphorylation processes.This study provides experimental evidence supporting the potential of CVB-D as a therapeutic agent for VMC.
文摘BACKGROUND Esophageal cancer is a serious global health concern with poor prognosis in advanced stages.Immune checkpoint inhibitors(ICIs)have shown promise in enhancing survival,but they are associated with immune-related adverse events,including potentially life-threatening myocarditis.Moreover,ICI-induced myocarditis can be asymptomatic,necessitating early diagnosis.Specific risk factors and biomarkers for esophageal cancer remain poorly characterized.AIM To investigate the determinants of ICI-associated asymptomatic myocarditis in patients with esophageal cancer and explore potential early biomarkers.METHODS A retrospective analysis was conducted on 202 cancer patients who received treatment at Shanxi Province Cancer Hospital from July 2019 to July 2024.RESULTS Older age,male gender,and elevated creatine kinase isoenzymes(CK-MB)and CK levels were found to be significant risk factors for asymptomatic myocarditis.The myocarditis occurrence group had higher CK-MB(3.05 ng/mL vs 5.02 ng/mL;P<0.001)and CK levels(187.29 U/L vs 212.25 U/L;P=0.005),and the predictive value of age,gender,CK,and CK-MB was low[are under the receiver operating characteristic curve(AUC)=0.579-0.608].However,their combination in a predictive model showed improved diagnostic capability,with an AUC of 0.808.CONCLUSION Age,gender,and cardiac biomarker levels considerably contribute to the risk of ICI-related myocarditis in patients with esophageal cancer.The integration of these factors into a predictive model enhances early diagnosis,facilitating personalized risk management.
文摘BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemotherapy or radiation therapy related complications and cardiac metastasis.CASE SUMMARY We present a case of a 47-year-old female with metastatic cancer on immuno-therapy presented with anterior ST elevation myocardial infarction followed by emergent percutaneous coronary intervention in the left anterior descending artery.Echocardiography after 72 hours showed thickening of inferior wall and cardiac magnetic resonance depicted inflammation and necrosis attributable to either cardiac metastasis or immunotherapy induced myocarditis.Biopsy was not performed because of treatment with antiplatelet drugs and a definite diagnosis was achieved after probationary administration of high-dose intravenous methyl-prednisolone that led to recovery.CONCLUSION In patients with malignancy,chemotherapy-induced cardiovascular complications and cardiac metastasis are common concerns and may coexist with common acute cardiovascular diseases including acute coronary syndromes.In such cases clinical suspicion aided by multimodality imaging is crucial for the diagnosis.A multidisciplinary team approach is required for prompt initiation of the appro-priate treatment.
文摘BACKGROUND Autoimmune myocarditis(AM)associated with autoimmune diseases can cause complete atrioventricular block(CAVB),but the related autoantigens and the underlying mechanisms are unclear.Anti-SSA/Ro antibodies may play an important role in this process,but cases of AM with positive anti-SSA/Ro antibodies are rare.In addition,arrhythmias,such as atrioventricular block,are very common in patients with autoimmune diseases,but severe atrioventricular block requiring permanent pacemaker implantation is extremely rare.CASE SUMMARY The patient in this case had AM with anti-SSA/Ro antibody positivity,which was associated with connective tissue disease,and the patient subsequently developed CAVB.After intensive immunosuppressive therapy,the antibody test results became negative,and pulmonary hypertension significantly improved.However,the outcome of permanent pacemaker implantation did not change.CONCLUSION In clinical practice,the awareness of adult AM associated with autoimmune diseases combined with CAVB should be strengthened in clinicians,and anti-SSA/Ro antibodies may play a role in this process.Therefore,improving the detection of antibodies and early intervention,such as active immunosuppression therapy,may be very important for improving disease prognosis.For patients who do not respond to immunosuppressive therapy,implantation of a permanent pacemaker may become an essential treatment option.
文摘This paper summarizes the nursing experience of a 65-year-old elderly patient with fulminant myocarditis complicated by cardiogenic shock who received veno-arterial extracorporeal membrane oxygenation(V-A ECMO)combined with intra-aortic balloon pump(IABP)support therapy.The core nursing measures included:establishing a multidisciplinary collaboration team to implement daily goal management;standardized anticoagulation monitoring;refined hemodynamic management;stepped respiratory support;and early rehabilitation intervention.After 9 days of ECMO support combined with 5 days of IABP support,the patient’s cardiac and respiratory functions recovered.The patient was discharged on the 42nd day and was fully recovered during the follow-up on the 60th day.This case suggests that refined nursing care for ECMO combined with IABP is the key to the treatment of fulminant myocarditis.
文摘Human herpesvirus 6(HHV-6)is a common childhood infection but rarely causes severe complications.In immunocompetent children,conditions such as febrile convulsions and roseola infantum are typical,with occasional severe manifestations like meningoencephalitis and myocarditis.
文摘Objective To study the state of oxidative stress in patients with acute coxsackie virusmyocarditis (ACM), and to investigate the pathological chain reactions of a series of freeradicals and oxidative and lipoperoxidative damages in their bodies. Methods Eighty ACMpatients and 80 healthy adult volunteers (HAV) were enrolled in a case-control study, inwhich concentrations of nitric oxide (NO) in plasma, lipoperoxides (LPO) in plasma andLPO in erythrocytes (RBC), vitamin C (VC), vitamin E (VE) and b-carotene (b-CAR) inplasma as well as activities of superoxide dismutase (SOD), catalase (CAT) and glutathioneperoxidase (GSH-Px) in RBC were determined by using spectrophotometric assays. ResultsCompared with the average values (AV) of the above biochemical parameters (BP) in theHAV group, the AV of NO in plasma, and LPO in plasma and RBC in the ACM group weresignificantly increased (P=0.0001), while the AV of VC, VE, b-CAR, SOD, CAT and GSH-Px in the ACM group were significantly decreased (P=0.0001). The values of the above BPwere used to estimate the relative risk ratio (RR) between the ACM group and the HAVgroup; the RR and its 95 % confidence interval were 12.467 (5.745~27.051), 4.333(2.126~8.834), 6.517 (3.225~13.618), 3.310 (1.598~6.858), 31.000 (12.611~76.201),4.663 (2.228~9.759), 11.769 (5.440~25.462), 3.043 (1.486~6.229) and 6.594 (3.045~14.281)respectively, and their P levels ranged from 0.002 to 0.0001. The results were asfollows: D = 22.143 - 0.017SOD + 0.008NO + 0.244LPO in RBC, Eigenvalue = 13.659,Canonical correlation = 0.965, Wilks’λ= 0.068, c2 = 420.212, P = 0.0001. The correct rateof discrimination to the ACM group and to the HAV group was 87.5% and 95.0 %, respectively,and 91.3 % of originally grouped cases was correctly classified. Conclusion The findingsin this study suggested that the oxidative stress in bodies of ACM patients was severelyaggravated, and marked high oxidative constituents and low antioxidants and antioxidasesin the human body might increase the relative risk of inducing acute coxsackie virusmyocarditis, and measuring the values of NO in plasma, SOD and LPO in RBC mightincrease the correct rates of discriminatory analysis of the ACM.
文摘BACKGROUND Myocarditis is an important cause of morbidity and mortality in children, leading to long-term sequelae including chronic congestive heart failure, dilated cardiomyopathy, heart transplantation, and death. The initial diagnosis of myocarditis is usually based on clinical presentation, but this widely ranges from the severe sudden onset of a cardiogenic shock to asymptomatic patients. Early recognition is essential in order to monitor and start supportive treatment prior to the development of severe adverse events. Of note, many cases of fulminant myocarditis are usually misdiagnosed as otherwise minor conditions during the weeks before the unexpected deterioration.AIM To provide diagnostic clues to make an early recognition of pediatric myocarditis.To investigate early predictors for poor outcomes.METHODS We conducted a retrospective cross-sectional single-center study from January 2008 to November 2017 at the Pediatric Department of our institution, including children < 18-years-old diagnosed with myocarditis. Poor outcome was defined as the occurrence of any of the following facts: death, heart transplant, persistent left ventricular systolic dysfunction or dilation at hospital discharge(early poor outcome), or after 1 year of follow-up(late poor outcome). We analyzed different clinical features and diagnostic test findings in order to provide diagnostic clues for myocarditis in children. Multivariable stepwise logistic regression analysis was performed using all variables that had been selected by univariate analysis to determine independent factors that predicted a poor early or late outcome in our study population.RESULTS A total of 42 patients [69% male; median age of 8(1.5-12) years] met study inclusion criteria. Chest pain(40%) was the most common specific cardiac symptom. Respiratory tract symptoms(cough, apnea, rhinorrhea)(38%),shortness of breath(35%), gastrointestinal tract symptoms(vomiting, abdominal pain, diarrhea)(33%), and fever(31%) were the most common non-cardiac initial complaints. Tachycardia(57%) and tachypnea(52%) were the most common signs on the initial physical exam followed by nonspecific signs of respiratory tract infection(44%) and respiratory distress(35%). Specific abnormal signs of heart failure such as heart murmur(26%), systolic hypotension(24%), gallop rhythm(20%), or hepatomegaly(20%) were less prevalent. Up to 43% of patients presented an early poor outcome, and 16% presented a late poor outcome. In multivariate analysis, an initial left ventricular ejection fraction(LVEF) < 30%remained the only significant predictor for early [odds ratio(OR)(95%CI) = 21(2-456), P = 0.027) and late [OR(95%CI) = 8(0.56-135), P = 0.047) poor outcome in children with myocarditis. LVEF correlated well with age(r = 0.51, P = 0.005),days from the initiation of symptoms(r =-0.31, P = 0.045), and N-terminal probrain natriuretic peptide levels(r = 0.66, P < 0.001), but not with troponin T(r =-0.05, P = 0.730) or C-reactive protein levels(r =-0.13, P = 0.391). N-terminal probrain natriuretic peptide presented a high diagnostic accuracy for LVEF < 30% on echocardiography with an area under curve of 0.931(95%CI: 0.858-0.995, P <0.001). The best cut-off point was 2000 pg/mL with a sensitivity of 90%,specificity of 81%, positive predictive value of 60%, and negative predictive value of 96%.CONCLUSION The diagnosis of myocarditis in children is challenging due to the heterogeneous and unspecific clinical presentation. The presence of LVEF < 30% on echocardiography on admission was the major predictor for poor outcomes.Younger ages, a prolonged course of the disease, and N-terminal pro-brain natriuretic peptide levels could help to identify these high-risk patients.
文摘Myocarditis is a bacterial or viral inflammatory disease,often unnoticed or misdiagnosed.Athletes with myocarditis must stop practicing their activity since International medical Literature described some cases of sudden death.In the present report,we describe a case of an asymptomatic,apparently healthy,competitive athletes,who was diagnosed a myocarditis and as incidental finding a myocardial bridging.We focused the attention on the importance of anamnesis,electrocardiogram and athletes' entourage for the diagnosis of such insidious pathologies and we evaluated the follow up,focusing the attention on electrocardiogram changes as well as on restitution ad integrum and prognosis,especially for the athletes.
基金supported by the Natural Science Foundation of Shandong Province(ZR2015JL026)the National Natural Science Foundation of China(81601773)supported by the Taishan Scholars program of Shandong Province(ts201511056)
文摘Globally, coxsackievirus B4 （CV-B4） has been continuously isolated and evidence suggests an association with the development of pancreatitis and type I diabetes. In addition, CV-B4 is also associated with myocarditis and severe central nervous system （CNS） complications, which remain poorly studied and understood. In the present study, we established an institute for Cancer Research （ICR） mouse model of CV-B4 infection and examined whether CV-B4 infection resulted in a predisposition to myocarditis and CNS infection. We found high survival in both the treatment and control group, with no significant differences in clinical outcomes observed. However, pathological lesions were evident in both brain and heart tissue of the CV-B4-infected mice. in addition, high viral loads were found in the neural and cardiac tissues as early as 2 days post infection. Expressions of IFN-y and IL-6 in sera were significantly higher in CV-B4-infected mice compared to uninfected negative controls, suggesting the involvement of these cytokines in the development of histopathological lesions. Our murine model successfully reproduced the acute myocarditis and cerebral cortical neuron edema induced by CV-B4, and may be useful for the evaluation of vaccine candidates and potential antivirals against CV-B4 infection.
文摘Fulminant myocarditis(FM)is an uncommon syndrome characterized by sudden and severe hemodynamic compromise secondary to acute myocardial inflammation,often presenting as profound cardiogenic shock,life-threatening ventricular arrhythmias and/or electrical storm.FM may be refractory to conventional therapies and require mechanical circulatory support(MCS).The immune system has been recognized as playing a pivotal role in the pathophysiology of myocarditis,leading to an increased focus on immunosuppressive treatment strategies.Recent data have highlighted not only the fact that FM has significantly worse outcomes than non-FM,but that prognosis and management strategies of FM are heavily dependent on histological subtype,placing greater emphasis on the role of endomyocardial biopsy in diagnosis.The impact of subtype on severity and prognosis will likewise influence how aggressively the myocarditis is managed,including whether MCS is warranted.Many patients with refractory cardiogenic shock secondary to FM end up requiring MCS,with venoarterial extracorporeal membrane oxygenation demonstrating favorable survival rates,particularly when initiated prior to the development of multiorgan failure.Among the challenges facing the field are the need to more precisely identify immunopathophysiological pathways in order to develop targeted therapies,and the need to better optimize the timing and management of MCS to minimize complications and maximize outcomes.
文摘Myocarditis is a relatively rare,possibly life-threatening disease characterized by the inflammation of the myocardium.111 The disease pathogenesis is primarily initiated by acute injury and necrosis of cardiomyocytes,leading to an inflammatory response mediated by the immune system that can potentially cause further aggravation of myocardial damage and organ dysfunction.Prognosis in patients with myocarditis depends on the clinical presentation,which ranges from an asymptomatic disease course to the concomitant development of cardiac arrhythmias,heart failure,cardiogenic shock and even the occurrence of death in extreme cases[1].
文摘Recent nationwide clinico-epidemiological surveys in Japan showed that the occurrence of cardiomyopathies was most frequently seen in the age of sixties, and that cardiomyopathies are important causes of heart failure in the elderly. Viral infection was conventionally considered to cause myocarditis, which resulted in the development of dilated cardiomyopathy. Recent studies suggest that hepatitis C virus (HCV) is involved in the development of dilated cardiomyopathy, hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy in addition to myocarditis. Furthermore, left ventricular aneurysm represents the same morbid state not only after myocardial infarction but also after myocarditis. There were wide variations in the frequency of detection of HCV genomes in cardiomyopathy in different regions and in different populations. Major histocompatibility complex class Ⅱ genes may play a role in the susceptibility to HCV infection, and may influence the development of different phenotypes of cardiomyopathy. If in fact the myocardial damage is caused by HCV, it might be expected that interferon (IFN) administration would be useful for its treatment. Hepatitis patients receiving IFN treatment for hepatitis were screened by thallium myocardial scintigraphy, and an abnormality was discovered in half of the patients. Treatment with IFN resulted in a disappearance of the image abnormality. It has thus been suggested that mild myocarditis and myocardial damage may be cured with IFN. We have recently found that high concentrations of circulating cardiac troponin T are a specific marker of cardiac involvement in HCV infection. By measuring cardiac troponin T in patients with HCV infection, the prevalence of cardiac involvement in HCV infection will be clarified. We are proposing a collaborative work on a global network on myocarditis/cardiomyopathies due to HCV infection. (J Geriatr Cardiol 2004;1(2):83-89. )
基金Supported by Grants of the Deutsche Forschungsgemeinschaft,Sonderforschungsbereich-Transregio 19(project B5)
文摘AIM:To investigate molecular phenotypes of myocardial B19V-infection to determine the role of B19V in myocarditis and dilated cardiomyopathy(DCM).METHODS:Endomyocardial biopsies(EMBs) from 498 B19V-positive patients with myocarditis and DCMwere analyzed using molecular methods and functional experiments.EMBs were obtained from the University Hospitals of Greifswald and Tuebingen and additionally from 36 German cardiology centers.Control tissues were obtained at autopsy from 34 victims of accidents,crime or suicide.Identification of mononuclear cell infiltrates in EMBs was performed using immunohistological staining.Anti-B19V-IgM and anti-B19V-IgG were analyzed by enzyme-linked immunosorbent assay(ELISA).B19V viral loads were determined using in-house quantitative real-time polymerase chain reaction(PCR).For B19V-genotyping a new B19V-genotype-specific restriction fragment length polymorphism(RFLP)-PCR was established.B19V-genotyping was verified by direct DNAsequencing and sequences were aligned using BLAST and BioEdit software.B19V P6-promoter and HHV6-U94-transactivator constructs were generated for cell culture experiments.Transfection experiments were conducted using human endothelial cells 1.Luciferase reporter assays were performed to determine B19Vreplication activity.Statistical analysis and graphical representation were calculated using SPSS and Prism5 software.RESULTS:The prevalence of B19V was significantly more likely to be associated with inflammatory cardiomyopathy(iCMP) compared to uninflamed DCM(59.6% vs 35.3%)(P < 0.0001).The detection of B19V-mRNA replication intermediates proved that replication of B19V was present.RFLP-PCR assays showed that B19V-genotype 1(57.4%) and B19V-genotype 2(36.7%) were the most prevalent viral genotypes.B19V-genotype 2 was observed more frequently in EMBs with iCMP(65.0%) compared to DCM(35%)(P = 0.049).Although there was no significant difference in gender-specific B19V-loads,women were more frequently infected with B19V-genotype 2(44.6%) than men(36.0%)(P = 0.0448).Coinfection with B19V and other cardiotropic viruses was found in 19.2% of tissuesamples and was associated with higher B19V viral load compared to B19V-monoinfected tissue(P = 0.0012).The most frequent coinfecting virus was human herpes virus 6(HHV6,16.5%).B19V-coinfection with HHV6 showed higher B19V-loads compared to B19V-monoinfected EMBs(P = 0.0033),suggesting that HHV6 had transactivated B19V.In vitro experiments confirmed a 2.4-fold increased B19V P6-promoter activity by the HHV6 U94-transactivator.CONCLUSION:The finding of significantly increased B19V loads in patients with histologically proven cardiac inflammation suggests a crucial role of B19V-genotypes and reactivation of B19V-infection by HHV6-coinfection in B19V-associated iCMP.Our findings suggest that B19V-infection of the human heart can be a causative event for the development of an endothelial cell-mediated inflammatory disease and that this is related to both viral load and genotype.
