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1.
Echocardiography ; 39(11): 1401-1411, 2022 11.
Article in English | MEDLINE | ID: covidwho-2078440

ABSTRACT

OBJECTIVE: Cardiac involvement in recovered COVID-19 patients assessed by cardiac magnetic resonance imaging (MRI). METHODS: Subjects recently recovered from COVID-19 and with an abnormal left ventricular global longitudinal strain were enrolled. Cardiac MRI in all the enrolled subjects was done at baseline (within 30-90 days following recovery from COVID-19) with a follow-up scan at 6 months in individuals with an abnormal baseline scan. Additionally, 20 age-and sex-matched individuals were enrolled as healthy controls (HCs). RESULTS: All the 30 enrolled subjects were symptomatic during active COVID-19 disease and were categorized as mild: 11 (36.7%), moderate: 6 (20%), and severe: 13 (43.3%). Of the 30 patients, 16 (53.3%) had abnormal CMR findings. Myocardial edema was reported in 12 (40%) patients while 10 (33.3%) had late gadolinium enhancement (LGE). No difference was observed in terms of conventional left ventricular (LV) parameters; however, COVID-19-recovered patients had significantly lower right ventricular (RV) ejection fraction, RV stroke volume, and RV cardiac index compared to HCs. Follow-up scan was abnormal in 4/16 (25%) with LGE persisting in three patients (who had severe COVID-19 [3/4;75%]). Subjects with severe COVID-19 had a greater frequency of LGE (53.8%) and myocardial edema (61.5%) as compared to mild and moderate cases. Myocardial T1 (1284 ± 43.8 ms vs. 1147.6 ± 68.4 ms; p < .0001) and T2 values (50.8 ± 16.7 ms vs. 42.6 ± 3.6 ms; p = .04) were significantly higher in post COVID-19 subjects compared to HCs. Similarly, T1 and T2 values of severe COVID-19 patients were significantly higher compared to mild and moderate cases. CONCLUSIONS: An abnormal CMR was seen in half of the recovered patients with persistent abnormality in one-fourth at 6 months. Our study suggests a need for closer follow-up among recovered subjects in order to evaluate for long-term cardiovascular sequelae. COVID-19 causes structural changes in the myocardium in a small segment of patients with partial spontaneous resolution.


Subject(s)
COVID-19 , Magnetic Resonance Imaging, Cine , Humans , Follow-Up Studies , Magnetic Resonance Imaging, Cine/methods , COVID-19/complications , Contrast Media , Gadolinium , Stroke Volume , Myocardium/pathology , Magnetic Resonance Imaging , Ventricular Function, Left , Predictive Value of Tests
2.
Can J Cardiol ; 38(11): 1676-1683, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2035864

ABSTRACT

BACKGROUND: Acute myocarditis is a rare complication of mRNA-based COVID-19 vaccination. Little is known about the natural history of this complication. METHODS: Baseline and convalescent (≥ 90 days) cardiac magnetic resonance (CMR) imaging assessments were performed in 20 consecutive patients meeting Updated Lake Louise Criteria for acute myocarditis within 10 days of mRNA-based vaccination. CMR-based changes in left ventricular volumes, mass, ejection fraction (LVEF), markers of tissue inflammation (native T1 and T2 mapping), and fibrosis (late gadolinium enhancement [LGE] and extracellular volume [ECV]) were assessed between baseline and convalescence. Cardiac symptoms and clinical outcomes were captured. RESULTS: Median age was 23.1 years (range 18-39 years), and 17 (85%) were male. Convalescent evaluations were performed at a median (IQR) 3.7 (3.3-6.2) months. The LVEF showed a mean 3% absolute improvement, accompanied by a 7% reduction in LV end-diastolic volume and 5% reduction in LV mass (all P < 0.015). Global LGE burden was reduced by 66% (P < 0.001). Absolute reductions in global T2, native T1, and ECV of 2.1 ms, 58 ms, and 2.9%, repectively, were documented (all P ≤ 0.001). Of 5 patients demonstrating LVEF ≤ 50% at baseline, all recovered to above this threshold in convalescence. A total of 18 (90%) patients showed persistence of abnormal LGE although mean fibrosis burden was < 5% of LV mass in 85% of cases. No patient experienced major clinical outcomes. CONCLUSIONS: COVID-19 mRNA vaccine-associated myocarditis showed rapid improvements in CMR-based markers of edema, contractile function, and global LGE burden beyond 3 months of recovery in this young patient cohort. However, regional fibrosis following edema resolution was commonly observed, justifying need for ongoing surveillance.


Subject(s)
COVID-19 , Heart Injuries , Myocarditis , Humans , Male , Adolescent , Young Adult , Adult , Female , Myocarditis/diagnosis , Myocarditis/etiology , Myocarditis/pathology , COVID-19 Vaccines/adverse effects , Contrast Media , Gadolinium , COVID-19/epidemiology , COVID-19/prevention & control , Convalescence , Ventricular Function, Left , Stroke Volume , Predictive Value of Tests , Fibrosis , RNA, Messenger , Magnetic Resonance Imaging, Cine , Myocardium/pathology
3.
Nat Med ; 28(10): 2117-2123, 2022 10.
Article in English | MEDLINE | ID: covidwho-2016773

ABSTRACT

Cardiac symptoms are increasingly recognized as late complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in previously well individuals with mild initial illness, but the underlying pathophysiology leading to long-term cardiac symptoms remains unclear. In this study, we conducted serial cardiac assessments in a selected population of individuals with Coronavirus Disease 2019 (COVID-19) with no previous cardiac disease or notable comorbidities by measuring blood biomarkers of heart injury or dysfunction and by performing magnetic resonance imaging. Baseline measurements from 346 individuals with COVID-19 (52% females) were obtained at a median of 109 days (interquartile range (IQR), 77-177 days) after infection, when 73% of participants reported cardiac symptoms, such as exertional dyspnea (62%), palpitations (28%), atypical chest pain (27%) and syncope (3%). Symptomatic individuals had higher heart rates and higher imaging values or contrast agent accumulation, denoting inflammatory cardiac involvement, compared to asymptomatic individuals. Structural heart disease or high levels of biomarkers of cardiac injury or dysfunction were rare in symptomatic individuals. At follow-up (329 days (IQR, 274-383 days) after infection), 57% of participants had persistent cardiac symptoms. Diffuse myocardial edema was more pronounced in participants who remained symptomatic at follow-up as compared to those who improved. Female gender and diffuse myocardial involvement on baseline imaging independently predicted the presence of cardiac symptoms at follow-up. Ongoing inflammatory cardiac involvement may, at least in part, explain the lingering cardiac symptoms in previously well individuals with mild initial COVID-19 illness.


Subject(s)
COVID-19 , Heart Diseases , COVID-19/complications , Contrast Media , Female , Heart/diagnostic imaging , Heart Diseases/diagnostic imaging , Humans , Male , Myocardium/pathology , SARS-CoV-2
4.
Dokl Biol Sci ; 505(1): 95-99, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2008770

ABSTRACT

The article focuses on the pathogenetic mechanisms of posttraumatic stress disorder (PTSD), which is associated with psychological stress because of the coronavirus pandemic. The molecular mechanisms responsible for disease susceptibility in some individuals and stress resistance in others are amongst crucial research interests of experimental and clinical medicine. Priority data were obtained to indicate that distortions of synthesis and metabolism and, most significantly, a switch between two energy transport forms, glucose and lipids, underlie myocardial dysfunction in young and old stress-sensitive Wistar rats in a PTSD model. Histochemistry and polarization microscopy showed energy deficit in cardiomyocytes and signs of ischemic and hypoxic areas emerging in the myocardium as a result of an accumulation of NADH and NADPH, which initiate excessive production of reactive oxygen species.


Subject(s)
Cardiovascular Diseases , Stress Disorders, Post-Traumatic , Animals , Cardiovascular Diseases/complications , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/pathology , Myocardium/pathology , Rats , Rats, Wistar , Risk Factors
5.
Arch Pathol Lab Med ; 146(8): 925-929, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1975265

ABSTRACT

CONTEXT.­: Myocarditis in adolescents has been diagnosed clinically following the administration of the second dose of an mRNA vaccine for coronavirus disease 2019 (COVID-19). OBJECTIVE.­: To examine the autopsy microscopic cardiac findings in adolescent deaths that occurred shortly following administration of the second Pfizer-BioNTech COVID-19 dose to determine if the myocarditis described in these instances has the typical histopathology of myocarditis. DESIGN.­: Clinical and autopsy investigation of 2 teenage boys who died shortly following administration of the second Pfizer-BioNTech COVID-19 dose. RESULTS.­: The microscopic examination revealed features resembling a catecholamine-induced injury, not typical myocarditis pathology. CONCLUSIONS.­: The myocardial injury seen in these postvaccine hearts is different from typical myocarditis and has an appearance most closely resembling a catecholamine-mediated stress (toxic) cardiomyopathy. Understanding that these instances are different from typical myocarditis and that cytokine storm has a known feedback loop with catecholamines may help guide screening and therapy.


Subject(s)
COVID-19 Vaccines , COVID-19 , Myocarditis , Myocardium , Adolescent , Autopsy , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Catecholamines/adverse effects , Humans , Male , Myocarditis/chemically induced , Myocardium/pathology , Vaccination/adverse effects , mRNA Vaccines
7.
Clin Cardiol ; 45(9): 952-959, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1935672

ABSTRACT

PURPOSE: To study the clinical signs and mechanisms (viral and autoimmune) of myoendocarditis in the long-term period after COronaVIrus Disease 2019 (COVID-19). METHODS: Fourteen patients (nine male, 50.1 ± 10.2 y.o.) with biopsy proven post-COVID myocarditis were observed. The diagnosis of COVID-19 was confirmed by IgG seroconversion. The average time of admission after COVID-19 was 5.5 [2; 10] months. An endomyocardial biopsy (EMB) of the right ventricle was obtained. The biopsy analysis included polymerase chain reaction diagnosis of viral infection, morphological, immunohistochemical (IHC) examination with antibodies to CD3, CD45, CD68, CD20, SARS-Cov-2 spike, and nucleocapsid antigens. Coronary atherosclerosis was ruled out in all patients over 40 years. RESULTS: The new cardiac symptoms (congestive heart failure 3-4 New York Heart Association class with severe right ventricular involvement, various rhythm, and conduction disturbances) appeared 1-5 months following COVID-19. Magnetic resonance imaging showed disseminated or focal subepicardial and intramyocardial late gadolinium enhancement, hyperemia, edema, and increased myocardial native T1 relaxation time. Antiheart antibodies levels were increased 3-4 times in 92.9% of patients. The mean left ventricular (LV) ejection fraction (EF) was 28% (24.5; 37.8). Active lymphocytic myocarditis was diagnosed in 12 patients, eosinophilic myocarditis in two patients. SARS-Cov-2 RNA was detected in 12 cases (85.7%), in association with parvovirus B19 DNA-in one. Three patients had also endocarditis (infective and nonbacterial, with parietal thrombosis). As a result of steroid and chronic heart failure therapy, the EF increased to 47% (37.5; 52.5). CONCLUSIONS: COVID-19 can lead to long-term severe post-COVID myoendocarditis, that is characterized by prolonged persistence of coronavirus in cardiomyocytes, endothelium, and macrophages (up to 18 months) in combination with high immune activity. Corticosteroids and anticoagulants should be considered as a treatment option of post-COVID myoendocarditis.


Subject(s)
COVID-19 , Heart Failure , Myocarditis , Biopsy/methods , COVID-19/complications , Contrast Media , Gadolinium , Humans , Male , Myocarditis/diagnosis , Myocarditis/etiology , Myocardium/pathology , RNA, Viral , SARS-CoV-2
8.
Am J Case Rep ; 23: e935974, 2022 Jul 08.
Article in English | MEDLINE | ID: covidwho-1924685

ABSTRACT

BACKGROUND Myocarditis is an inflammatory process that can present as acute or chronic with either focal or diffuse involvement of the myocardium. Its incidence is approximately 1.5 million cases per year worldwide. In the United States, viral infection is the most common cause of myocarditis. Most of the reported cases are singular and self-limiting in nature. We present the case of severe recurrent myocarditis in a young adult who was transferred to the Intensive Care Unit. CASE REPORT An 18-year-old man presented with chest pressure and troponin I 33 ng/mL. He had presented to another hospital with similar symptoms 3 months prior and was diagnosed with myocarditis that had resolved with colchicine. As part of his workup during this admission, coronary angiogram was normal and biopsy obtained without evidence of an inflammatory process; however, cardiac magnetic resonance imaging (MRI) was consistent with myocarditis and Coxsackie B titers indicated prior infection, leading to a diagnosis of clinically suspected recurrent viral myocarditis. He was treated with intravenous immunoglobulin (IV Ig) and a steroid taper, with rapid improvement in symptoms over the ensuing weeks without evidence of further recurrence or sequelae. CONCLUSIONS We present a case of recurrent Coxsackie B myocarditis based on presentation and imaging. Myocarditis is an important diagnosis to consider when a young, healthy individual presents with chest pain mimicking acute coronary syndrome, especially during the COVID pandemic. If there is evidence of myocarditis on MRI or endomyocardial biopsy, immunosuppressive therapy should be considered in patients with recurrent and severe presentations.


Subject(s)
COVID-19 , Coxsackievirus Infections , Myocarditis , Adolescent , Coxsackievirus Infections/complications , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Myocarditis/diagnosis , Myocarditis/drug therapy , Myocarditis/etiology , Myocardium/pathology , Steroids
9.
J Cardiovasc Magn Reson ; 24(1): 33, 2022 06 06.
Article in English | MEDLINE | ID: covidwho-1881271

ABSTRACT

Cardiovascular magnetic resonance (CMR) is considered the gold standard imaging modality for myocardial tissue characterization. Elevated transverse relaxation time (T2) is specific for increased myocardial water content, increased free water, and is used as an index of myocardial edema. The strengths of quantitative T2 mapping lie in the accurate characterization of myocardial edema, and the early detection of reversible myocardial disease without the use of contrast agents or ionizing radiation. Quantitative T2 mapping overcomes the limitations of T2-weighted imaging for reliable assessment of diffuse myocardial edema and can be used to diagnose, stage, and monitor myocardial injury. Strong evidence supports the clinical use of T2 mapping in acute myocardial infarction, myocarditis, heart transplant rejection, and dilated cardiomyopathy. Accumulating data support the utility of T2 mapping for the assessment of other cardiomyopathies, rheumatologic conditions with cardiac involvement, and monitoring for cancer therapy-related cardiac injury. Importantly, elevated T2 relaxation time may be the first sign of myocardial injury in many diseases and oftentimes precedes symptoms, changes in ejection fraction, and irreversible myocardial remodeling. This comprehensive review discusses the technical considerations and clinical roles of myocardial T2 mapping with an emphasis on expanding the impact of this unique, noninvasive tissue parameter.


Subject(s)
Cardiomyopathies , Myocarditis , Cardiomyopathies/pathology , Contrast Media , Edema , Humans , Magnetic Resonance Imaging/methods , Magnetic Resonance Imaging, Cine/methods , Myocarditis/pathology , Myocardium/pathology , Predictive Value of Tests , Water
10.
Cardiovasc Pathol ; 60: 107447, 2022.
Article in English | MEDLINE | ID: covidwho-1894842

ABSTRACT

SARS-Cov-2 infection is not limited to the respiratory tract and can involve other organs including the heart, blood vessels, kidneys, liver, gastrointestinal tract, placenta, and skin. Covid-19 patients with cardiac involvement usually have higher morbidity and mortality compared to those without cardiac involvement. The frequency and the specificity of the myocardial pathological changes in patients who die after documented infection with SARS-Cov-2 is uncertain. Macrophages can be found in the normal heart (interstitium, around the endothelial cells and in the epicardial adipose tissue), and they are considered part of the major immune cell population in the heart. In this case-control autopsy study, we compare the gross and microscopic cardiac findings, and the available clinical characteristics between a group of 10 Covid-19 decedents and a control group of 20 patients who died with non-SARS-Cov-2 severe bronchopneumonia and/or diffuse alveolar damage. The objectives of this semi-quantitative study are to study single myocyte necrosis and its relation to the strain on the heart caused by lung injury as a causative mechanism, and to study the density of myocardial and epicardial macrophages in Covid-19 hearts in comparison to the control group, and in Covid-19 hearts with single myocyte necrosis in comparison to Covid-19 hearts without single myocyte necrosis. Lymphocytic myocarditis was not identified in any of the hearts from the Covid-19 or the control group. Single myocyte necrosis is more frequent in the Covid-19 group compared to the control group, suggesting that it is unrelated to the strain on the heart caused by underlying lung injury. The density of the macrophages in the epicardium and myocardium in the hearts of the Covid-19 group is higher compared to those in the control group. The density of epicardial macrophages is higher in the Covid-19 hearts with single myocyte necrosis than in those without. These observations contribute to our increasing appreciation of the role of macrophages in the pathophysiologic response to infection by SARS-CoV-2.


Subject(s)
Acute Lung Injury , COVID-19 , Acute Lung Injury/pathology , COVID-19/complications , Endothelial Cells , Humans , Macrophages , Muscle Cells , Myocardium/pathology , Necrosis/pathology , SARS-CoV-2
11.
Eur Heart J Cardiovasc Imaging ; 23(4): 450-464, 2022 03 22.
Article in English | MEDLINE | ID: covidwho-1886392

ABSTRACT

Inflammatory cardiomyopathy (I-CMP) is defined as myocarditis in association with cardiac dysfunction and/or ventricular remodelling. It is characterized by inflammatory cell infiltration into the myocardium and has heterogeneous infectious and non-infectious aetiologies. A complex interplay of genetic, autoimmune, and environmental factors contributes to the substantial risk of deteriorating cardiac function, acute heart failure, and arrhythmia as well as chronic dilated cardiomyopathy and its sequelae. Multi-parametric cardiovascular magnetic resonance (CMR) imaging is sensitive to many tissue changes that occur during myocardial inflammation, regardless of its aetiology. In this review, we summarize the various aetiologies of I-CMP and illustrate how CMR contributes to non-invasive diagnosis.


Subject(s)
Cardiomyopathies , Cardiomyopathy, Dilated , Myocarditis , Cardiomyopathies/pathology , Cytidine Monophosphate , Heart , Humans , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Myocarditis/diagnostic imaging , Myocardium/pathology
12.
Minerva Cardiol Angiol ; 70(2): 273-284, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1884909

ABSTRACT

Myocarditis is an inflammatory heart muscle disease characterized by heterogeneous clinical presentation and outcome. Clinical heterogeneity of myocarditis, ranging from acute onset chest pain with electrocardiographic changes resembling an acute coronary syndrome, to arrhythmic storm and chronic decompensated heart failure, makes diagnosis challenging. However, a correct diagnosis is fundamental to proper patients' management and should always be seeked. Although a definite diagnosis is only provided by endomyocardial biopsy, the European Society of Cardiology task force on myocardial and pericardial diseases provided specific criteria for the diagnosis of clinically suspected myocarditis, which has been facilitated by the advent of noninvasive imaging tests (i.e. cardiovascular magnetic resonance based myocardial tissue characterization). Due to the heterogeneous presentation and disease course of myocarditis, a tailored treatment would be the best strategy, but a standardized management is still not available. However, over the years, new, promising therapies, such as antiviral and immune-suppressive treatment, have come side by side to the standard pharmacological heart treatment, i.e. antiheart failure medications. In this paper we will review the basic principles of myocarditis management in clinical practice, including diagnostic work-up, conventional and disease-specific therapy and patients' follow-up.


Subject(s)
Heart Failure , Myocarditis , Biopsy/methods , Chest Pain/pathology , Disease Progression , Heart Failure/diagnosis , Heart Failure/therapy , Humans , Magnetic Resonance Imaging , Myocarditis/diagnosis , Myocarditis/pathology , Myocarditis/therapy , Myocardium/pathology
13.
Am J Case Rep ; 23: e935492, 2022 May 13.
Article in English | MEDLINE | ID: covidwho-1847722

ABSTRACT

BACKGROUND Varying degrees of cardiovascular involvement have been noted with COVID-19, with myocarditis being one of the feared complications. We present the case of a healthy, young individual with persistent myocardial involvement on cardiac magnetic resonance (CMR) imaging at 10 months' follow-up. CASE REPORT A 23-year-old man with no prior medical conditions presented to our outpatient cardiology clinic with a chief concern of left-sided exertional chest discomfort of 1-week duration, lasting 30-60 min before resolving. The patient was previously active and ran 2 miles per day, 6 days a week without any issues. Three months prior to presentation, the patient had a mild case of COVID-19 managed conservatively on an outpatient basis. On evaluation, the vital signs, physical examination, and laboratory work-up were unremarkable. Electrocardiography (EKG) displayed normal sinus rhythm with incomplete right bundle branch block. Transthoracic echocardiography (TTE) was normal. CMR was performed and indicated myopericarditis in several sub-epicardial and pericardial segments, with a quantitative scar burden of 18.6% on late gadolinium enhancement (LGE) images using the mean+5 SD method. A repeat CMR 7 months later demonstrated persistent sub-epicardial fibrosis with improvement in the LGE burden to 5.1% and resolution of pericarditis. CONCLUSIONS Myopericarditis with persistent myocardial scarring can be detected using CMR in healthy individuals with mild COVID-19 symptoms. The exact prevalence and potential clinical implications of this entity is unclear and warrants further longitudinal research.


Subject(s)
COVID-19 , Myocarditis , Adult , Cicatrix , Contrast Media , Follow-Up Studies , Gadolinium , Humans , Magnetic Resonance Imaging/methods , Magnetic Resonance Imaging, Cine , Male , Myocarditis/diagnostic imaging , Myocardium/pathology , Young Adult
15.
Eur J Pediatr ; 181(7): 2879-2883, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1813679

ABSTRACT

Myocarditis is a rare complication of the COVID-19 mRNA vaccine. We previously reported a case series of 15 adolescents with vaccine-associated myocarditis, 87% of whom had abnormalities on initial cardiac magnetic resonance (CMR), including late gadolinium enhancement (LGE) in 80%. We performed follow-up CMRs to determine the trajectory of myocardial recovery and better understand the natural history of vaccine-associated myocarditis. Case series of patients age < 19 years admitted to Boston Children's Hospital with acute vaccine-associated myocarditis following the BNT162b2 vaccine who had abnormal CMR at the time of initial presentation, and underwent follow-up testing. CMR assessment included left ventricular (LV) ejection fraction, T2-weighted myocardial imaging, LV global native T1, LV global T2, extracellular volume (ECV), and late gadolinium enhancement (LGE). Ten patients (9 male, median age 15 years) with vaccine-associated myocarditis underwent follow-up CMR at a median of 92 days (range 76-119) after hospital discharge. LGE was persistent in 80% of patients, though improved from prior in all cases. Two patients (20%) had abnormal LV global T1 at presentation, which normalized on follow-up. ECV decreased between acute presentation and follow-up in 6/10 patients; it remained elevated at follow-up in 1 patient and borderline in 3 patients. CONCLUSION: CMR performed ~3 months after admission for COVID-19 vaccine-associated myocarditis showed improvement of LGE in all patients, but persistent in the majority. Follow-up CMR 6-12 months after acute episode should be considered to better understand the long-term cardiac risks. WHAT IS KNOWN: • Myocarditis is a rare side effect of COVID-19 mRNA vaccine. •Late gadolinium enhancement is present on most cardiac magnetic resonance at the time of acute presentation. WHAT IS NEW: •Late gadolinium enhancement improved on all repeat cardiac magnetic resonance at 3-month follow-up. •Most patients still had a small amount of late gadolinium enhancement, the clinical significance of which is yet to be determined.


Subject(s)
COVID-19 , Myocarditis , Adolescent , Adult , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Child , Contrast Media/adverse effects , Follow-Up Studies , Gadolinium/adverse effects , Humans , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Male , Myocarditis/diagnostic imaging , Myocarditis/etiology , Myocardium/pathology , Predictive Value of Tests , Vaccines, Synthetic , Ventricular Function, Left , Young Adult , mRNA Vaccines
18.
BMJ Case Rep ; 15(3)2022 Mar 14.
Article in English | MEDLINE | ID: covidwho-1741597

ABSTRACT

A young man in his late 20s was presented with acute chest pain, concave ST elevation in lateral and inferior leads on ECG and elevated cardiac troponin. A thorough clinical history was notable for clenbuterol abuse. Transthoracic echocardiography revealed a small area of hypokinesia in the inferior wall and cardiac magnetic resonance supported the diagnosis of acute myocarditis revealing signs of myocardial oedema and subepicardial delayed enhancement. The patient was managed conservatively and had an uneventful clinical course. Awareness of the possibility of clenbuterol myocardial toxicity in young men admitted due to chest pain is essential to prompt diagnosis and management of this condition.


Subject(s)
Clenbuterol , Myocarditis , Clenbuterol/adverse effects , Humans , Magnetic Resonance Imaging , Male , Myocarditis/diagnosis , Myocarditis/diagnostic imaging , Myocardium/pathology , Weight Loss
19.
J Pediatr ; 245: 95-101, 2022 06.
Article in English | MEDLINE | ID: covidwho-1720473

ABSTRACT

OBJECTIVE: To describe the cardiac magnetic resonance (MR) findings of children recovered from multisystem inflammatory syndrome in children (MIS-C) longer than 3 months after acute illness. STUDY DESIGN: We performed a retrospective cohort study of children hospitalized with MIS-C at a single institution receiving cardiac MR imaging between July 2020 and May 2021. Patient demographics, echocardiogram data from diagnosis through follow-up, and cardiac MR data obtained at approximately 3 months after hospitalization were recorded. RESULTS: In total, 51 children with a median age of 11.3 years were included; 80% of patients had left ventricular ejection fraction <55%, 65% of patients developed valvular regurgitation, and 20% of patients developed coronary artery dilation during acute illness. Cardiac MR was performed at a median time of 105 days after diagnosis; 8% of patients had left ventricular ejection fraction <55%; 1 patient had residual valvular regurgitation; and 2 patients had residual coronary artery dilation. Two of 51 patients were found to have late gadolinium enhancement, T1 mapping abnormalities, and abnormal or borderline extracellular volume calculations suggesting myocardial fibrosis. No patient had T2 mapping abnormalities corresponding with edema, and no patient met the modified Lake Louise criteria for acute myocarditis; 10 of 51 patients had isolated elevated T1 values. CONCLUSIONS: At 3-5 months following diagnosis, cardiac MR reveals no evidence of acute myocarditis as described by the modified Lake Louise criteria in patients with MIS-C. Two patients were observed to have myocardial fibrosis without regional wall motion abnormalities, and 10 had isolated imaging changes (elevated T1 values) in the absence of macroscopic fibrosis.


Subject(s)
Cardiomyopathies , Myocarditis , Acute Disease , COVID-19/complications , Child , Contrast Media , Fibrosis , Gadolinium , Humans , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy , Myocarditis/diagnostic imaging , Myocarditis/etiology , Myocardium/pathology , Predictive Value of Tests , Retrospective Studies , Stroke Volume , Systemic Inflammatory Response Syndrome , Ventricular Function, Left
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