Myocardial oedema in acute myocarditis detected by echocardiographic 2D myocardial deformation analysis

Løgstrup, Brian Bridal; Nielsen, J; Kim, Won Yong; Poulsen, Steen Hvitfeldt

doi:10.1093/ehjci/jev302

Cited by 95 publications

(82 citation statements)

References 26 publications

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“…One important effect of TNFα is its ability to modulate vascular leakiness as evidenced by studies demonstrating that elevated TNFα concentrations increase vascular permeability (Hansen et al, 1994). Increased vascular permeability can then lead to extracellular edema formation in tissue (Logstrup et al, 2015). In the heart, extracellular edema has been demonstrated to slow CV and increase arrhythmogenesis possibly due to reduced ephaptic coupling between myocytes (George and Poelzing, 2015; George et al, 2015; Veeraraghavan et al, 2015; George et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Mechanically, myocardial inflammation can cause cardiac dysfunction and reduced ejection fraction (Lurz et al, 2012; Banka et al, 2015). Myocardial inflammation can also alter electrical impulse propagation by modulating gap junctional coupling (GJC) (Zhu et al, 2000; Xu H. F. et al, 2012), ionic currents (Tang et al, 2007; De Jesus et al, 2015), and tissue hydration state (Logstrup et al, 2015). …”

Section: Introductionmentioning

confidence: 99%

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TNFα Modulates Cardiac Conduction by Altering Electrical Coupling between Myocytes

et al. 2017

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Background: Tumor Necrosis Factor α (TNFα) upregulation during acute inflammatory response has been associated with numerous cardiac effects including modulating Connexin43 and vascular permeability. This may in turn alter cardiac gap junctional (GJ) coupling and extracellular volume (ephaptic coupling) respectively. We hypothesized that acute exposure to pathophysiological TNFα levels can modulate conduction velocity (CV) in the heart by altering electrical coupling: GJ and ephaptic.Methods and Results: Hearts were optically mapped to determine CV from control, TNFα and TNFα + high calcium (2.5 vs. 1.25 mM) treated guinea pig hearts over 90 mins. Transmission electron microscopy was performed to measure changes in intercellular separation in the gap junction-adjacent extracellular nanodomain—perinexus (WP). Cx43 expression and phosphorylation were determined by Western blotting and Cx43 distribution by confocal immunofluorescence. At 90 mins, longitudinal and transverse CV (CVL and CVT, respectively) increased with control Tyrode perfusion but TNFα slowed CVT alone relative to control and anisotropy of conduction increased, but not significantly. TNFα increased WP relative to control at 90 mins, without significantly changing GJ coupling. Increasing extracellular calcium after 30 mins of just TNFα exposure increased CVT within 15 mins. TNFα + high calcium also restored CVT at 90 mins and reduced WP to control values. Interestingly, TNFα + high calcium also improved GJ coupling at 90 mins, which along with reduced WP may have contributed to increasing CV.Conclusions: Elevating extracellular calcium during acute TNFα exposure reduces perinexal expansion, increases ephaptic, and GJ coupling, improves CV and may be a novel method for preventing inflammation induced CV slowing.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

TNFα Modulates Cardiac Conduction by Altering Electrical Coupling between Myocytes

et al. 2017

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“…There is no any parameter predicting which patients are likely to recover and until the guideline published in 2013 by European Society of Cardiology that we are also using for both diagnosis and follow‐up of patients with acute viral myocarditis, the matter was a challenge somewhat . The diagnosis of acute myocarditis is based on symptoms, electrocardiography, elevated myocardial biomarkers, and ECHO . Pathological confirmation of myocardial inflammation continues to be required for a definitive diagnosis of myocarditis .…”

Section: Discussionmentioning

confidence: 99%

The assessment of treatment outcomes in patients with acute viral myocarditis by speckle tracking and tissue Doppler methods

et al. 2019

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Objectives The aim was to evaluate the role of tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE), to identify myocardial dysfunction, and to evaluate myocardial segmental deformation in acute viral myocarditis. Methods Twenty‐one patients and twelve healthy children were studied prospectively. The TDI and STE were performed before and after treatment. The myocardial velocities (Sm, Em, and Am) and time intervals (isovolumic contraction, isovolumic relaxation, and ejection times [ET]) at interventricular septum (IVS), left, and right ventricular basal segments were examined by TDI. The left ventricular global longitudinal strain (LVGLS) and strain rate (LVGLSR), left ventricular global circumferential strain (LVGCS) and strain rate (LVGCSR), and right ventricular global longitudinal strain (RVGLS) and strain rate (RVGLSR) were examined by STE. Results Sm and Em at IVS and at LV, ET at IVS, ET at RV, ET at LV were significantly lower in patients before treatment than controls. LVGLS, LVGLSR, LVGCS, LVGCSR, RVGLS, RVGLSR were significantly decreased in patients before treatment than controls. There was significant improvement for LVGLS, LVGLSR, LVGCS, LVGCSR, and RVGLS in patients after treatment. Sm, Em, and Am at LV were significantly lower in patients before treatment than in patients after treatment. In spite of improvements, Sm, Em, and ET at IVS, LVGLS, LVGLSR, LVGCS, LVGCSR were significantly lower in patients after treatment than controls. Conclusions The TDI and STE were useful methods for detection of early myocardial dysfunction and evaluation of treatment outcomes in acute viral myocarditis.

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“…In a study by Khoo et al, impairment of the LV circumferential early diastolic strain rate additionally hinted at impaired LV diastolic function in the setting of MC [14]. Using the 17 segment model of the American Heart Association, another study showed reduced strain corresponding to intramyocardial edema in the basal inferior and inferolateral segments and in the midventricular anterior, anterolateral, and inferolateral segments in comparison to the other segments of the respective slice [15]. …”

Section: Speckle Trackingmentioning

confidence: 97%

Modern Imaging of Myocarditis: Possibilities and Challenges

Baeßler

Schmidt

Lücke

et al. 2016

Fortschr Röntgenstr

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▼Myocarditis is known as the chameleon of cardiac diseases. The symptoms and the course of disease vary greatly so that it is often challenging to establish a diagnosis. Early and accurate diagnosis is of utmost importance, since myocarditis is one of the leading causes of sudden cardiac death in young adults and represents an important precursor to dilated cardiomyopathy. Due to the constraints of the routinely used diagnostic approach, including clinical history and examination, laboratory testing, and electrocardiogram, different imaging modalities have emerged over the last decades as contributors to the noninvasive diagnosis of myocarditis. With this interdisciplinary review we would like to present the current state-of-the-art imaging of myocarditis across all available imaging modalities (i. e., echocardiography, cardiac magnetic resonance, cardiac computed tomography, and nuclear medicine). Furthermore, we present novel imaging techniques that might become useful in the near future for easier and more accurate diagnosis of this highly relevant disease.

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Myocardial oedema in acute myocarditis detected by echocardiographic 2D myocardial deformation analysis

Cited by 95 publications

References 26 publications

TNFα Modulates Cardiac Conduction by Altering Electrical Coupling between Myocytes

TNFα Modulates Cardiac Conduction by Altering Electrical Coupling between Myocytes

The assessment of treatment outcomes in patients with acute viral myocarditis by speckle tracking and tissue Doppler methods

Modern Imaging of Myocarditis: Possibilities and Challenges

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