Myocarditis: imaging up to date

Liguori, Carlo; Farina, Davide; Vaccher, Filippo; Ferrandino, Giovanni; Bellini, Davide; Carbone, Iacopo

doi:10.1007/s11547-020-01279-8

Cited by 47 publications

(39 citation statements)

References 38 publications

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“…CMR can also be useful for monitoring disease progression/activity. 14 Endomyocardial biopsy has traditionally been the reference standard diagnostic test for myocarditis (with specimens typically sent for histology, immunohistochemistry and polymerase chain reaction (PCR) for potential infectious agents). 15 It is useful for diagnostic confirmation and in determining the aetiopathogenic form of myocarditis (eg giant-cell myocarditis, lymphocytic or sarcoid).…”

Section: Key Investigationsmentioning

confidence: 99%

Acute myocarditis: aetiology, diagnosis and management

et al. 2021

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Acute myocarditis is a serious, likely underdiagnosed condition affecting people of all ages and for which the number of UK hospital admissions is rising. A primary diagnosis of myocarditis accounted for 0.04% (36.5 per 100,000) of all hospital admissions in England between 1998 and 2017, although this is likely to be an underestimate of the true burden of myocarditis. The aetiology is broad, including infective and inflammatory conditions as well as exposure to toxic agents. Clinical features are varied and overlap with other acute cardiac conditions making diagnosis a challenge. Cardiovascular magnetic resonance imaging currently serves as the gold standard non-invasive diagnostic modality. If an underlying aetiological process is identified, then therapy may be directed at the cause; however, for most, treatment is supportive and aimed at managing any complications such as heart failure or arrhythmias. There is emerging evidence for immunosuppressive therapy in certain cases. Prognosis is generally good with recovery in most; however, up to 30% with biopsy-proven myocarditis progress to develop a dilated cardiomyopathy and its potential associated complications. All-cause mortality in the UK for patients presenting to hospital with acute myocarditis is approximately 4%.

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Section: Key Investigationsmentioning

confidence: 99%

Acute myocarditis: aetiology, diagnosis and management

et al. 2021

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“…Symptoms are generally aspecific and include chest pain, syncope, palpitation, persistent dyspnea, possibly underlying arrhythmias, ventricular dysfunction, and new-onset heart failure [ 67 ]. These conditions have been identified as complications of COVID-19-related immune activation [ 28 ] in which chronic forms may manifest with persistent cardiac failure, which may progress to dilated cardiomyopathy [ 68 ]. In a recent paper [ 69 ], long COVID has been reported as the clinical expression of the presence of “anti-idiotype antibodies” of SARS-CoV-2 infection and/or vaccination.…”

Section: Imaging For the Detection Of Covid-19 Cardiovascular Injurymentioning

confidence: 99%

“…The clinical presentation is variable, and acute forms can mimic myocardial infarction since patients report chest pain and dyspnea, in some cases associated with troponin elevation. Fulminant forms may also occur and manifest with acute-onset heart failure [ 68 ]. ECG is usually abnormal with aspecific changes, such as sinus tachycardia, PR depression, or ST/T-wave anomalies; serum troponin and inflammatory markers (IL-6, CRP, procalcitonin) are usually elevated.…”

Section: Imaging For the Detection Of Covid-19 Cardiovascular Injurymentioning

confidence: 99%

“…Echocardiography is usually the first-line imaging, but findings are generally non-specific; echocardiography allows an exclusion diagnosis with other causes of acute chest pain; usual findings are diffuse wall motion abnormalities, reduced ejection fraction with left ventricular hypokinesis, and pericardial effusion [ 85 ]. Endomyocardial biopsy is the diagnostic gold standard but, especially during the early phases of the pandemic [ 68 ], was rarely employed for its invasive nature.…”

Section: Imaging For the Detection Of Covid-19 Cardiovascular Injurymentioning

confidence: 99%

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Advanced Imaging Supports the Mechanistic Role of Autoimmunity and Plaque Rupture in COVID-19 Heart Involvement

Laino

Ammirabile

Motta

et al. 2022

Clinic Rev Allerg Immunol

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The cardiovascular system is frequently affected by coronavirus disease-19 (COVID-19), particularly in hospitalized cases, and these manifestations are associated with a worse prognosis. Most commonly, heart involvement is represented by myocarditis, myocardial infarction, and pulmonary embolism, while arrhythmias, heart valve damage, and pericarditis are less frequent. While the clinical suspicion is necessary for a prompt disease recognition, imaging allows the early detection of cardiovascular complications in patients with COVID-19. The combination of cardiothoracic approaches has been proposed for advanced imaging techniques, i.e., CT scan and MRI, for a simultaneous evaluation of cardiovascular structures, pulmonary arteries, and lung parenchyma. Several mechanisms have been proposed to explain the cardiovascular injury, and among these, it is established that the host immune system is responsible for the aberrant response characterizing severe COVID-19 and inducing organ-specific injury. We illustrate novel evidence to support the hypothesis that molecular mimicry may be the immunological mechanism for myocarditis in COVID-19. The present article provides a comprehensive review of the available evidence of the immune mechanisms of the COVID-19 cardiovascular injury and the imaging tools to be used in the diagnostic workup. As some of these techniques cannot be implemented for general screening of all cases, we critically discuss the need to maximize the sustainability and the specificity of the proposed tests while illustrating the findings of some paradigmatic cases.

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“…Nevertheless, it is a cause of sudden cardiac death in young patients up to 10%, shown in autopsy-based series 8 . Myocarditis is often triggered by viral infections or caused by post-viral immune-mediated responses and up to 30% can progress into a dilatative cardiomyopathy 9 .…”

Section: Introductionmentioning

confidence: 99%

Acute cardiac side effects after COVID-19 mRNA vaccination, a case series

Freise

Kivel

Grebe³

et al. 2021

Preprint

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Background: Since development and approval of the world´s first mRNA vaccines, created under pressure of the global pandemic caused by SARS-CoV-2, potential side effects have naturally been a much-debated topic. Vaccination may be one, if not the only way out of the pandemic claiming more than 4 million deaths worldwide to date. Potential side effects from vaccination have long been controversial, and case reports of fatal side effects have been published. Therefore, data are needed to identify persons being at high risk for potential side effects. Until September 30, 2021, 1.243 cases of myocarditis after vaccination with BNT162b2 Comirnaty© in young adults were registered by the Paul-Ehrlich-Institute in Germany alone. The exact pathophysiology and the risk factors for myocarditis following vaccination remain unclear. We present a case series of eight patients with cardiac symptom shortly after SARS-CoV-2 mRNA vaccination (BNT162b6, Biontech, Comirnaty© or mRNA-1237 Moderna, Spikevax©).Patients and Methods: Eight patients between 13-56 years of age, vaccinated with mRNA vaccine either BNT162b2 or mRNA-1273 between January and August 2021 developed cardiac side effects shortly after either their first or second vaccination. Clinical data were retrieved from the clinical information system and analyzed. To support diagnosis of myocarditis or pericarditis, cardiac magnetic resonance imaging (MRI) was performed shortly after onset of symptoms and investigated further in severe cases. Symptoms were defined as dyspnea, chest pain, cardiac arrhythmia as determined by electrocardiography.Results: Eight patients (five males and three females) developed cardiac symptoms compatible with myocarditis according to CDC criteria shortly after SARS-CoV-2 mRNA vaccination. Three patients (two males, one female) required hospitalization due to severe chest pain and elevated troponin levels. All patients recovered fully within seven days after symptom onset Conclusion: Our data suggest that cardiac adverse events such as myocarditis or pericarditis shortly after SARS-CoV-2 mRNA vaccination are rare but possible and occur particularly in male patients.

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Myocarditis: imaging up to date

Cited by 47 publications

References 38 publications

Acute myocarditis: aetiology, diagnosis and management

Acute myocarditis: aetiology, diagnosis and management

Advanced Imaging Supports the Mechanistic Role of Autoimmunity and Plaque Rupture in COVID-19 Heart Involvement

Acute cardiac side effects after COVID-19 mRNA vaccination, a case series

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