Iron Status and Short-Term Recovery after Non-Severe Acute Myocarditis: A Prospective Observational Study.

Pathomechanisms responsible for recovery from acute myocarditis (MCD) or progression to non-ischemic cardiomyopathy have not been comprehensively investigated. Iron, positioned at the crossroads of inflammation and the energy metabolism of cardiomyocytes, may contribute to the pathophysiology of inflammatory myocardial disease. The aim of this study was to evaluate whether systemic iron parameters are related to myocardial dysfunction in MCD patients. We prospectively enrolled 42 consecutive patients hospitalized for MCD. Their iron status and their clinical, laboratory, and echocardiographic indices were assessed during hospitalization and during ambulatory visits six weeks after discharge. A control group comprising healthy volunteers was recruited. The MCD patients had higher serum ferritin and hepcidin and lower serum iron concentration and transferrin saturation (TSAT) than the healthy controls (all p < 0.01). Six weeks after discharge, the iron status of the MCD patients was already comparable to that of the control group. During hospitalization, lower serum iron and TSAT correlated with higher NT-proBNP (both p < 0.05). In-hospital lower serum iron and TSAT correlated with both a lower left ventricular ejection fraction (LVEF) and worse left ventricular global longitudinal strain at follow-up visits (all p < 0.05). In conclusion, in patients with acute MCD, iron status is altered and normalizes within six weeks. Low serum iron and TSAT are related to greater in-hospital neurohormonal activation and subtle persistent left ventricular dysfunction.

Cardiovascular Complications of Viral Respiratory Infections and COVID-19.

Viral respiratory infections (VRI) are the most prevalent type of infectious diseases and constitute one of the most common causes of contact with medical care. Regarding the pathophysiology of the cardiovascular system, VRI can not only exacerbate already existing chronic cardiovascular disease (such as coronary artery disease or heart failure) but also trigger new adverse events or complications (e.g., venous thromboembolism), the latter particularly in subjects with multimorbidity or disease-related immobilization. In the current paper, we provide a narrative review of diverse cardiovascular complications of VRI as well as summarize available data on the pathology of the circulatory system in the course of coronavirus disease 2019 (COVID-19).

Burden of multimorbidity in a Polish cohort of ambulatory and hospitalized heart failure patients from 2 large European registry programs: prognostic implications.

Introduction: Individual comorbidities have been shown to adversely affect prognosis in heart failure (HF). However, our knowledge of multimorbidity in HF and understanding of its prognostic implications still remain incomplete. Objectives: We aimed to analyze the prevalence of multimorbidity in Polish HF patients and to investigate the quantitative and qualitative impact of comorbidity burden on 12-month outcomes in that population. Patients and methods: We retrospectively analyzed data of 1765 Polish patients with ambulatory or acute (requiring hospitalization) HF from 2 multicenter observational European Society of Cardiology registries: the ESC-HF Pilot Survey (2009­2010) and ESC-HF-LT Registry (2011­2013). Results: Arterial hypertension and coronary artery disease were the most prevalent comorbidities, similarly to the entire European cohort. The great majority of HF patients had more than 1 predefined comorbidity and the most frequent number of comorbidities was 3. Importantly, in almost half of the patients, 4 or more comorbidities were reported. The best accuracy for predicting the adjusted 12-month rate of all-cause death was ensured by the model including only anemia and kidney dysfunction. The model including 4 comorbidities­anemia, kidney dysfunction, diabetes, and coronary artery disease­provided best accuracy for predicting 12-month rate of composite all-cause death or HF hospitalization. Conclusions: Multimorbidity is highly prevalent in a real-world cohort of Polish HF patients and the quantitative burden of comorbidities is related to increased mortality. In such patients, the clinical profile characterized by pathophysiological continuum of diabetes, kidney dysfunction, and anemia is particularly associated with unfavorable outcomes.

Primary Human Cardiomyocytes and Cardiofibroblasts Treated with Sera from Myocarditis Patients Exhibit an Increased Iron Demand and Complex Changes in the Gene Expression.

Cardiac fibroblasts and cardiomyocytes are the main cells involved in the pathophysiology of myocarditis (MCD). These cells are especially sensitive to changes in iron homeostasis, which is extremely important for the optimal maintenance of crucial cellular processes. However, the exact role of iron status in the pathophysiology of MCD remains unknown. We cultured primary human cardiomyocytes (hCM) and cardiofibroblasts (hCF) with sera from acute MCD patients and healthy controls to mimic the effects of systemic inflammation on these cells. Next, we performed an initial small-scale (n = 3 per group) RNA sequencing experiment to investigate the global cellular response to the exposure on sera. In both cell lines, transcriptomic data analysis revealed many alterations in gene expression, which are related to disturbed canonical pathways and the progression of cardiac diseases. Moreover, hCM exhibited changes in the iron homeostasis pathway. To further investigate these alterations in sera-treated cells, we performed a larger-scale (n = 10 for controls, n = 18 for MCD) follow-up study and evaluated the expression of genes involved in iron metabolism. In both cell lines, we demonstrated an increased expression of transferrin receptor 1 (TFR1) and ferritin in MCD serum-treated cells as compared to controls, suggesting increased iron demand. Furthermore, we related TFR1 expression with the clinical profile of patients and showed that greater iron demand in sera-treated cells was associated with higher inflammation score (interleukin 6 (IL-6), C-reactive protein (CRP)) and advanced neurohormonal activation (NT-proBNP) in patients. Collectively, our data suggest that the malfunctioning of cardiomyocytes and cardiofibroblasts in the course of MCD might be related to alterations in the iron homeostasis.

Could an analysis of mean corpuscular volume help to improve risk stratification in non-anemic patients with acute myocardial infarction?

BACKGROUND: Nowadays, when the majority of patients with acute myocardial infarction (AMI) are treated with primary percutaneous coronary intervention and modern pharmacotherapy, risk stratification becomes a challenge. Simple and easily accessible parameters that would help in a better determination of prognosis are needed. The aim of the study was to estimate the prevalence of high mean corpuscular volume (MCV, defined as MCV > 92 fL) and to establish its prognostic value in non-anemic patients with AMI. METHODS: We retrospectively analyzed the data of 248 consecutive non-anemic patients hospitalized due to AMI (median age: 65 [59-76] years, men: 63%, ST segment elevation myocardial infarction: 31%, and median left ventricular ejection fraction [LVEF]: 50%). RESULTS: The prevalence of high MCV was 39 ± 6% (± 95% confidence interval) in the entire AMI population. High MCV was more prevalent in males, patients with low body mass index, non-diabetics and cigarette smokers (all p < 0.05). During the 180-day follow-up, there were 38 (15%) events, defined as another AMI or death. In a multivariable Cox proportional hazard model, female gender (p < 0.01), low LVEF (p < 0.001), previous AMI (p < 0.05), arterial hypertension (p < 0.05), and high MCV (p < 0.001) were prognosticators of pre-defined events. CONCLUSIONS: In non-anemic patients with AMI, high MCV is an independent prognostic factor of poor outcome defined as another AMI or death.

Stratifying risk for progression in IgA nephropathy: how to predict the future?

INTRODUCTION:  IgA nephropathy (IgAN) is characterized by a highly heterogeneous clinical course, which results in controversies regarding the assessment of individual prognosis and establishing the optimal treatment approach. OBJECTIVES:  The aim of the present study was to define risk factors for IgAN progression. We evaluated histopathological features derived from the Oxford classification of IgAN and additional, non­Oxford biopsy findings, as well as baseline and follow­up clinical data. PATIENTS AND METHODS:  We conducted a single­center retrospective study on 52 patients with biopsy­proven IgAN. The endpoint was an increase in serum creatinine levels of 50% from baseline. RESULTS:  Eight subjects (12%) reached the endpoint. Poor renal outcome was independently related to time­average proteinuria (TA­P) exceeding 2.0 g/d (P = 0.047), estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m2 (P = 0.01), history of tonsillectomy (P = 0.01), and crescent lesions in renal biopsy (P = 0.03). High global sclerosis index (GSI) (P = 0.009), TA­P (P = 0.03), and the presence of microscopic hematuria (P = 0.03) were independent predictors of a more rapid rate of renal function loss, assessed by the velocity of eGFR decline. Of the variables included in the Oxford classification, only interstitial fibrosis and tubular atrophy proved to have prognostic value, as revealed by a univariate, but not multivariate Cox regression analysis. CONCLUSIONS:  The extent of proteinuria during follow­up and impaired renal function at the time of diagnosis remain the most significant clinical prognostic factors in IgAN. We also report additional, non­Oxford histopathological features that can be used for risk stratification in IgAN, including the GSI and the presence of crescents.  

[Analysis of severe and threefold atypical and serious course of catatonic-paranoid psychosis]. / Analiza ciezkiego i potrójnie nietypowego przebiegu psychozy katatoniczno-paranoidalnej.

The paper describes the difficult course of catatonic-paranoid psychosis which began with symptoms similar to the myasthenia. The growing symptoms of catatonia (in this oral mechanisms with the compulsion of mastication, injuring with teeth of the mouth, tongue biting and damage, such as lockjaw) brought about choking which was followed by aspiration pneumonia. The patient had to have pharmacological coma induced, along with muscle relaxation and artificial ventilation in the conditions of the intensive care department. Despite treatment with high doses of neuroleptics, the repeated trials of bringing the patient out from the coma caused recurrence of the catatonic symptoms. A decision was made to go along with electroconvulsive therapy. During one of the ECT treatments there were complications in the form of circulation cessation which required defibrillation. The paper contains basic information about the serious complications of the electroconvulsive therapy. It moreover carries out the critical analysis of the whole treatment period.

Ten-year follow-up after in-hospital adult cardiac arrest.

BACKGROUND: The aim of the study was to determine the prevalence of in-hospital cardiac arrest and survival during 10 years of observation. STUDY GROUP: patients hospitalized in the Internal Medicine Unit (including Intensive Care) in the years 1995-1997 with cardiac arrest during hospitalization. The probable reasons for the cardiac arrest were defined (cardiac or non-cardiac) as well as the mechanism (VF/VT, other). The number of deaths during the first 24 hours from the episode, during the whole stay in the hospital and after one, five and ten-years was analyzed. RESULTS: During the period examined, 152 cardiac arrests took place. The resuscitation was successful in 83 cases. In that group, 66% patients had cardiac cause of cardiac arrest, 50.6% in the mechanism of VF. Ninety percent of the patients died during their stay in the hospital (38.5% during the first 24 hours after the episode), 10% of the patients left the hospital alive. Only 2 of them (2.4%) survived the next 5 years. Nobody survived 10 years. CONCLUSIONS: Cardiac arrest within the internal ward was characterized by high in-hospital mortality risk and unsuccessful late prognosis. Non-cardiac cause of cardiac arrest, relatively common in cases of in-hospital cardiac arrest, is connected with better survival after the first 24 hours; however, it does not improve the general survival to hospital discharge.

[Arctic Sun System for hypothermia treatment after near-drowning]. / Arctic Sun System w leczeniu hipotermii spowodowanej podtopieniem.

BACKGROUND: Hypothermia is frequently observed in near-downing victims, and rewarming is difficult to control. We describe the use of an automatic heating system (Arctic Sun Temperature Management System). The device consists of hydrogel coated pads that adhere to the patient's abdomen, back and thighs, and react to patient temperature by automatically adjusting the circulating pad water temperature to achieve a preset patient target temperature. Temperature is measured by a bladder temperature probe. The process of warming can be adjusted to allow the body temperature to increase at a rate from 0.5 to 1.0 degree C h(-1). CASE REPORT: A 62-yr-old woman was rescued from the Vistula river after a suicide attempt. The temperature of the river water was 150C and it was not possible to estimate the time she was submerged. On admission she was conscious and maintaining partially logical communication. She was hypothermic (temperature measured in the bladder was 32.7 degrees C), and dyspnoeic (SaO2 < 0.7). She was intubated and placed on a ventilator, her chest x-ray revealing bilateral patchy opacities. The Arctic Sun Temperature Management System was used for heating and the patient was warmed to 36.5 degrees C over 6 h. She was extubated after 48 h and transferred to a psychiatric ward two days later. No neurologic sequelae were observed. DISCUSSION: The Arctic Sun System has been developed for accurate control of body temperature in patients requiring moderate hypothermia during the post-resuscitation phase, in stroke and/or cranial trauma patients. It can be also used for management of accidental hypothermia.

Myocarditis related to Salmonella enteritidis infection.

Myocarditis associated with bacterial enteritis has only rarely been described in literature. The clinical manifestation of the disease is often oligosymptomatic, so the real incidence could be underestimated. A case of myocarditis in a 31-year-old male patient having Salmonella enteritidis infection is reported. The clinical course and problems concerning the diagnosis are discussed. The possibility of myocardial infection should be considered in any patient with cardiac complaints during gastrointestinal infection. (Cardiol J 2007; 14: 589-591).

[New antithrombotic drugs: fondaparinux, idraparinux, ximelagatran]. / Nowe leki przeciwzakrzepowe: fondaparinuks, idraparinuks, ximelagatran.

Antithrombotic drugs: heparins and oral vitamin K antimetabolites are connected with many side effects, which delimit their application in clinical practise. Continuous research has led to synthesis of new drugs which are safer and easier in use. Actually used antithrombotic drugs with their faults are discussed. Mechanism of action and data from trials relating to efficacy and safety of new drugs: fondaparinux, idraparinux and ximelagatran are presented.