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Duerr GD, Hamiko M, Beer J, Nattermann J, Schafhaus M, Held SAE, Schewe JC, Wittmann M, Kurts C, Zimmer S, Velten M, Heine A. The interplay between COVID-19 and heart disease: Unravelling a complex connection. Life Sci 2025; 370:123524. [PMID: 40044033 DOI: 10.1016/j.lfs.2025.123524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 02/23/2025] [Accepted: 03/01/2025] [Indexed: 03/20/2025]
Abstract
The intersection of coronavirus (COVID-19) and heart disease has emerged as a critical nexus in the landscape of global health. Individuals with heart disease face elevated risks when infected with Severe Acute Respiratory-Syndrome Coronavirus-type-2 (SARS-CoV-2) leading to COVID-19. The virus can directly affect the heart, resulting in myocarditis, arrhythmias, and heart failure, even in individuals without prior medical cardiac history. Therefore, tools identifying patients with cardiac infestation and predicting disease severity are of utmost importance. This study's unbiased stratification of clinical and immunological parameters of 134 SARS-CoV-2 positive patients revealed clusters of course-severity within the established WHO ordinal severity-scale leading to its summary (SWOSS) into three categories, A-C. PE and SWOSS-C were significantly associated with reduced survival of COVID-19 patients. The previously introduced CD8/Treg/monocyte-ratio which hints at a dysfunctional antiviral immunity associated with poor prognosis could be verified in this larger study population. However, the number of circulating CD14 + HLA-DR+ monocytes represented the most significant predictor for myocardial damage indicated by PE. We used all available data for an unbiased examination of associations and predictions by machine learning algorithms: Predictive markers for PE can be obtained in clinic and may serve as prognostic features. Among numerous parameters, C-reactive protein (CRP) was the most important in determining the presence of PE and SWOSS-category. Prediction of survival was most relevantly influenced by SWOSS-category underlining the benefit of this condensed classification for clinical practice. All AI-revealed prognostic features serve as promising starting-point to gain further understanding of the interplay between COVID-19 and heart disease.
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Affiliation(s)
- G D Duerr
- Department of Cardiovascular Surgery, University Medical Center, Johannes-Gutenberg University, Mainz, Germany.
| | - M Hamiko
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - J Beer
- Department of Cardiovascular Surgery, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
| | - J Nattermann
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - M Schafhaus
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - S A E Held
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, Bonn, Germany
| | - J C Schewe
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Center Rostock, Rostock, Germany
| | - M Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - C Kurts
- Institute for Experimental Immunology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - S Zimmer
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, Bonn, Germany
| | - M Velten
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A Heine
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, Bonn, Germany
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Nitz JN, Ruprecht KK, Henjum LJ, Matta AY, Shiferaw BT, Weber ZL, Jones JM, May R, Baio CJ, Fiala KJ, Abd-Elsayed AA. Cardiovascular Sequelae of the COVID-19 Vaccines. Cureus 2025; 17:e82041. [PMID: 40351947 PMCID: PMC12065646 DOI: 10.7759/cureus.82041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2025] [Indexed: 05/14/2025] Open
Abstract
Vaccines against COVID-19 present a key tool in lowering the morbidity, mortality, and transmission of the disease, but they also present a strongly controversial topic. As a result, the adverse effects of the vaccine have been under scrutiny by the public eye. A comprehensive summary of the cardiovascular (CV) adverse effects of COVID-19 vaccines is vital for clinical recognition of rare adverse events, determining the public health implications, and creating a base for future research. In May 2023, a search was conducted in the PubMed and Cochrane databases to identify literature on CV complications resulting from the COVID-19 vaccine. All articles with relevant data and discussion regarding adverse effects of the COVID-19 vaccines were included in the review. In total, 4419 articles were screened, and 166 articles were included in the review. The vaccine-associated CV adverse events encompassed the following conditions: myocarditis, pericarditis, acute coronary syndrome, stress cardiomyopathy, hypertension, isolated tachycardia, myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA), cardiac arrest, vaccine-induced thrombotic thrombocytopenia (VITT), MI, cerebral venous thrombosis (CVT), deep vein thrombosis (DVT), pulmonary embolism (PE), and other venous thrombotic disorders. Among these, myocarditis and thrombosis, especially VITT, emerged as the most frequently cited complications in the reviewed literature. Ranges of incidences for the following were recorded among the reviewed articles: myocarditis: 2 to 17 per million, VITT: 3-10 per million, CVST: 2.6-10 per million, MI: 3-4 per million. COVID-19 vaccines entail the potential for adverse events, although at low incidence, some of which exhibit notable severity. These adverse events exhibit demographic specificity and vaccine-specific profiles. The adverse events reviewed are uniformly acute in nature. The existing body of evidence offers limited support for the assertion that COVID-19 vaccines may elevate the baseline risk of CV events in the long term. However, the available research on effects greater than six months is scarce.
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Affiliation(s)
- James N Nitz
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Kylie K Ruprecht
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Lukas J Henjum
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Andrew Y Matta
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Barnabas T Shiferaw
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Zoie L Weber
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Jalon M Jones
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Raven May
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Carmen J Baio
- Department of Anesthesiology, Loyola University Parkinson School of Health Sciences, Madison, USA
| | - Kenneth J Fiala
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Alaa A Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
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Veliz AL, Hughes L, Carrillo D, Pecaut MJ, Kearns-Jonker M. Immunization induces inflammation in the mouse heart during spaceflight. BMC Genomics 2025; 26:229. [PMID: 40065216 PMCID: PMC11892206 DOI: 10.1186/s12864-025-11426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 02/28/2025] [Indexed: 03/14/2025] Open
Abstract
Space travel is a growing area of interest and includes initiatives such as NASA's Moon-to-Mars Mission. Reports on the cardiovascular effects of space travel reveal changes in morphology, metabolism, and function of the cardiovascular system. In this study, the cardiovascular response to immunization in space was studied in mice which were housed and immunized while on the International Space Station (ISS). Mice were immunized with tetanus toxoid combined with the adjuvant CpG (TT + CpG) and the effects of vaccination in space were studied using transcriptomics. Analysis of the mouse heart transcriptome was performed on flight control and flight-immunized mice. The results show that immunization aboard the ISS stimulates heightened inflammation in the heart via induction of the nuclear factor kappa B (NF-κB) signaling pathway to promote the release of the pro-inflammatory cytokines IFNγ, IL-17 and IL-6. Additional transcriptomic changes included alterations in the cytoskeleton and in the expression of transcripts associated with protection from oxidative stress. In summary, inflammation in the heart can occur following immunization in space. This investigation explores the impact of immune challenges on the heart and lays the groundwork for future research into additional cardiac alterations which can occur during spaceflight.
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Affiliation(s)
- Alicia L Veliz
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Lorelei Hughes
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Delia Carrillo
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Michael J Pecaut
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Mary Kearns-Jonker
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA.
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Tabatabaei FS, Shafeghat M, Azimi A, Akrami A, Rezaei N. Endosomal Toll-Like Receptors intermediate negative impacts of viral diseases, autoimmune diseases, and inflammatory immune responses on the cardiovascular system. Expert Rev Clin Immunol 2025; 21:195-207. [PMID: 39137281 DOI: 10.1080/1744666x.2024.2392815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/17/2024] [Accepted: 08/12/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the leading cause of morbidity globally, with chronic inflammation as a key modifiable risk factor. Toll-like receptors (TLRs), pivotal components of the innate immune system, including TLR-3, -7, -8, and -9 within endosomes, trigger intracellular cascades, leading to inflammatory cytokine production by various cell types, contributing to systemic inflammation and atherosclerosis. Recent research highlights the role of endosomal TLRs in recognizing self-derived nucleic acids during sterile inflammation, implicated in autoimmune conditions like myocarditis. AREAS COVERED This review explores the impact of endosomal TLRs on viral infections, autoimmunity, and inflammatory responses, shedding light on their intricate involvement in cardiovascular health and disease by examining literature on TLR-mediated mechanisms and their roles in CVD pathophysiology. EXPERT OPINION Removal of endosomal TLRs mitigates myocardial damage and immune reactions, applicable in myocardial injury. Targeting TLRs with agonists enhances innate immunity against fatal viruses, lowering viral loads and mortality. Prophylactic TLR agonist administration upregulates TLRs, protecting against fatal viruses and improving survival. TLRs play a complex role in CVDs like atherosclerosis and myocarditis, with therapeutic potential in modulating TLR reactions for cardiovascular health.
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Affiliation(s)
- Fatemeh Sadat Tabatabaei
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Melika Shafeghat
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Research Center for Immunodeficiencies (RCID), Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirali Azimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashley Akrami
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, USA
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies (RCID), Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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5
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Bin Abdu AM, Assiri MS, Altasan AN, Alghamdi YI, Alshalawi AS, Alqahtani FN, Aljabr AA, Alnahdi OA, Alhamzani AI, Alghamdi SN, Alzahrani RJ, Alshahrani BM, Alzahrani MA, Alshalawi MS. Assessing outcomes of acute myocarditis in Saudi Arabia: A retrospective tertiary center experience. Saudi Med J 2025; 46:71-77. [PMID: 39779348 PMCID: PMC11717113 DOI: 10.15537/smj.2025.46.1.20240705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 12/11/2024] [Indexed: 01/11/2025] Open
Abstract
OBJECTIVES To assess the clinical course and long-term outcomes of complicated and uncomplicated AM in Saudi Arabia. Acute myocarditis (AM) can have different presentations and outcomes based on different factors, one of which is left ventricular ejection fraction (LVEF). METHODS Data from 382 patients with suspected AM, admitted between January 2016 and October 2023, were reviewed. Clinical course, in-hospital complications, and all-cause mortality were evaluated in both the acute and follow-up phases. Outcomes were compared between 2 groups: LVEF <50% (n=43); and normal LVEF (≥50% [n=41]) at presentation. RESULTS Data from 84 patients (mean [±SD] age, 33.5±10.2 years; 26.2% female) who fulfilled the inclusion criteria were analyzed. The most common symptom was chest pain (83.3%) and 11 (13.1%) patients had fulminant presentation. ST-T changes were found on electrocardiography in 45.2% of patients. The mean LVEF was 46±12.4% at presentation. Patients in the LVEF <50% group were significantly more likely to experience a first-time cardiac-related adverse event (CRAE) (hazard ratio 2.6 [95% confidence interval 1.1-6.2]; p=0.031) with a mean time of 38.8±3.8. The all-cause in-hospital and follow-up mortality rates in the LVEF <50% group were 4.7% (one-half cardiac-related) (p=0.494) and 4.7% (all cardiac-related) (p=0.494), respectively. CONCLUSION Of 84 patients diagnosed with AM, those with LVEF <50% were more likely to experience first-time CRAEs and exhibited low short- and long-term mortality rates.
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Affiliation(s)
- Abdullah M. Bin Abdu
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed S. Assiri
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah N. Altasan
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
| | - Yousef I. Alghamdi
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah S. Alshalawi
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
| | - Faisal N. Alqahtani
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
| | - Abdulmajeed A. Aljabr
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
| | - Osamah A. Alnahdi
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah I. Alhamzani
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
| | - Saud N. Alghamdi
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
| | - Raed J. Alzahrani
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
| | - Bandar M. Alshahrani
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed A. Alzahrani
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
| | - May S. Alshalawi
- From the College of Medicine (Bin Abdu, Assiri, Altasan, Alghamdi,
Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi, Alzahrani,
Alshahrani, Alzahrani, Alshalawi), King Saud Bin Abdulaziz University for
Health Sciences; from the Department of Medicine (Bin Abdu, Assiri, Altasan,
Alghamdi, Alshelawy, Alqahtani, Aljabr, Alnahdi, Alhamzani, Alghamdi,
Alzahrani, Alshahrani, Alzahrani, Alshalawi), King Abdullah International
Medical Research Center; and from the Emergency Department (Alshalawi), King
Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia.
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6
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Soleimani H, Nasrollahizadeh A, Nasrollahizadeh A, Razeghian I, Molaei MM, Hakim D, Nasir K, Al-Kindi S, Hosseini K. Cardiovascular disease burden in the North Africa and Middle East region: an analysis of the global burden of disease study 1990-2021. BMC Cardiovasc Disord 2024; 24:712. [PMID: 39702074 DOI: 10.1186/s12872-024-04390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 12/02/2024] [Indexed: 12/21/2024] Open
Abstract
AIMS Cardiovascular diseases (CVD) are a leading cause of mortality and morbidity in the North Africa and Middle East (NAME) region. Due to the paucity of research on this issue, we aimed to estimate the burden of CVD and its attributable risk factors in the NAME region. METHODS AND RESULTS Data from the Global Burden of Disease (GBD) were retrieved to estimate the incidence, prevalence, deaths, years of life lost, years lived with disability, disability-adjusted life years (DALYs) for CVD across 21 countries and both sexes. From 1990 to 2021, the incidence of CVD increased, but the age-standardized incidence rate slightly declined. The prevalence of CVD rose, with stable age-standardized prevalence rates. Additionally, the age-standardized DALY rate decreased from 11421.8 to 7353.8 per 100,000 people. Men consistently had higher rates of incidence, prevalence, deaths, and DALYs compared to women. Ischemic heart disease, stroke, and hypertensive heart disease were the leading causes of DALYs. Furthermore, high systolic blood pressure, dietary risks, and high LDL cholesterol were the top risk factors across NAME countries. countries with a history of war or ongoing conflict experience higher rates of death, disease burden (DALYs), and disease incidence compared to countries without such a history. CONCLUSION Despite the Progress in reducing the CVD burden in the NAME region, CVD remains a major public health problem, specifically due to significant sex disparities and various socio-economic factors. The study highlights the need for targeted interventions addressing these disparities and socio-economic determinants. CLINICAL TRIAL NUMBER not applicable.
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Affiliation(s)
- Hamidreza Soleimani
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, TUMS, Tehran, 1995614331, Iran
| | - Ali Nasrollahizadeh
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, TUMS, Tehran, 1995614331, Iran.
- Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Amir Nasrollahizadeh
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, TUMS, Tehran, 1995614331, Iran
| | - Iman Razeghian
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Diaa Hakim
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Khurram Nasir
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Sadeer Al-Kindi
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Kaveh Hosseini
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, TUMS, Tehran, 1995614331, Iran
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Kawczak P, Feszak I, Bączek T. Epinephrine, Pregabalin, and Crizotinib as Three Medicines with Polish Implications over Three Last Centuries and in View of Three Different Drug Discovery Approaches. Biomedicines 2024; 12:2021. [PMID: 39335535 PMCID: PMC11428485 DOI: 10.3390/biomedicines12092021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 08/20/2024] [Accepted: 09/03/2024] [Indexed: 09/30/2024] Open
Abstract
The discovery of epinephrine (adrenaline) and its subsequent implications in medicine owes significant contributions to Cybulski across different centuries, who, in 1894, was pivotal in identifying the adrenal medulla's role in blood pressure regulation and naming the active substance "nadnerczyna", known today as adrenaline. His work demonstrated the adrenal glands' critical function in the body's regulatory mechanisms beyond the nervous system. Cybulski's groundbreaking research laid foundational knowledge for future endocrinological studies and pharmaceutical advancements. In the late 20th century, Andruszkiewicz collaborated with Silverman at Northwestern University to develop pregabalin, the active ingredient in Lyrica. Their innovative synthesis of gamma-aminobutyric acid derivatives led to a significant advancement in treating epilepsy, neuropathic pain, and fibromyalgia. Andruszkiewicz's expertise in organic chemistry and enzymology was crucial in this collaborative effort, resulting in the successful development and commercialization of Lyrica. Additionally, Mroczkowski's leadership at Pfizer contributed to the development of crizotinib, a notable anaplastic lymphoma kinase and proto-oncogene 1 tyrosine-protein kinase inhibitor used to treat specific types of non-small cell lung cancer. Her work exemplifies the continuing influence of Polish researchers in pioneering drug discovery and advancing therapeutic treatments over the past three centuries. These contributions highlight Poland's significant role in global pharmaceutical innovations and medical research.
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Affiliation(s)
- Piotr Kawczak
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, 80-416 Gdańsk, Poland;
| | - Igor Feszak
- Institute of Health Sciences, Pomeranian University in Słupsk, 76-200 Słupsk, Poland;
| | - Tomasz Bączek
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, 80-416 Gdańsk, Poland;
- Department of Nursing and Medical Rescue, Institute of Health Sciences, Pomeranian University in Słupsk, 76-200 Słupsk, Poland
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Veeram A, Shaikh TB, Kaur R, Chowdary EA, Andugulapati SB, Sistla R. Yohimbine Treatment Alleviates Cardiac Inflammation/Injury and Improves Cardiac Hemodynamics by Modulating Pro-Inflammatory and Oxidative Stress Indicators. Inflammation 2024; 47:1423-1443. [PMID: 38466531 DOI: 10.1007/s10753-024-01985-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 03/13/2024]
Abstract
Acute myocarditis, also known as myocardial inflammation, is a self-limited condition caused by systemic infection with cardiotropic pathogens, primarily viruses, bacteria, or fungi. Despite significant research, inflammatory cardiomyopathy exacerbated by heart failure, arrhythmia, or left ventricular dysfunction and it has a dismal prognosis. In this study, we aimed to evaluate the therapeutic effect of yohimbine against lipopolysaccharide (LPS) induced myocarditis in rat model. The anti-inflammatory activity of yohimbine was assessed in in-vitro using RAW 264.7 and H9C2 cells. Myocarditis was induced in rats by injecting LPS (10 mg/kg), following the rats were treated with dexamethasone (2 mg/kg) or yohimbine (2.5, 5, and 10 mg/kg) for 12 h and their therapeutic activity was examined using various techniques. Yohimbine treatment significantly attenuated the LPS-mediated inflammatory markers expression in the in-vitro model. In-vivo studies proved that yohimbine treatment significantly reduced the LPS-induced increase of cardiac-specific markers, inflammatory cell counts, and pro-inflammatory markers expression compared to LPS-control samples. LPS administration considerably affected the ECG, RR, PR, QRS, QT, ST intervals, and hemodynamic parameters, and caused abnormal pathological parameters, in contrast, yohimbine treatment substantially improved the cardiac parameters, mitigated the apoptosis in myocardial cells and ameliorated the histopathological abnormalities that resulted in an improved survival rate. LPS-induced elevation of cardiac troponin-I, myeloperoxidase, CD-68, and neutrophil elastase levels were significantly attenuated upon yohimbine treatment. Further investigation showed that yohimbine exerts an anti-inflammatory effect partly by modulating the MAPK pathway. This study emphasizes yohimbine's therapeutic benefit against LPS-induced myocarditis and associated inflammatory markers response by regulating the MAPK pathway.
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Affiliation(s)
- Anjali Veeram
- Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, Telangana, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201 002, India
| | - Taslim B Shaikh
- Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, Telangana, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201 002, India
| | - Rajwinder Kaur
- Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, Telangana, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201 002, India
| | - E Abhisheik Chowdary
- Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, Telangana, India
| | - Sai Balaji Andugulapati
- Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, Telangana, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201 002, India.
| | - Ramakrishna Sistla
- Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, Telangana, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201 002, India.
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Gheban-Roşca IA, Gheban BA, Pop B, Mironescu DC, Siserman VC, Jianu EM, Drugan T, Bolboacă SD. A histopathological analysis of extrapulmonary lesions in fatal coronavirus disease (COVID-19). Pathol Res Pract 2024; 260:155373. [PMID: 38901140 DOI: 10.1016/j.prp.2024.155373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents diverse clinical manifestations and multi-organ involvement. This study aimed to evaluate the extra-pulmonary histopathological patterns underpinning COVID-19-induced lesions in cardiac, hepatic, renal, brainstem, and splenic tissues. MATERIALS AND METHODS The research involved conventional forensic autopsies conducted between April 2020 and April 2021 on individuals with confirmed SARS-CoV-2 infection in Cluj-Napoca, Romania. Tissues were processed and stained for histological examination. Differences in patients with and without diffuse alveolar damage (DAD) were evaluated. RESULTS In our study of 79 COVID-19 autopsies conducted on unvaccinated patients besides lung involvement, the patients had histological changes in at least two out of five (brain, heart, liver, kidney, and spleen) organs. Notable findings include hepatitis observed in 46.8 % of cases, 21.5 % with lobular hepatitis, and 41.8 % with liver steatosis. Additionally, 69.6 % exhibited acute tubular necrosis, and 55.7 % had varying degrees of splenic lymphocyte depletion. Almost 41 % of cases had pericardial effusion, 36.7 % myocarditis, 24.1 % myocardial infarction, and 12.7 % of cases had encephalitis. Acute tubular necrosis (78.6 %) was the most frequent histopathological finding observed in patients with DAD. Myocarditis was described in 45.9 % of the patients without DAD. DISCUSSION The autopsy findings in our cohort of COVID-19 victims align with international scientific literature. Distinguishing viral-induced myocarditis, encephalitis, hepatitis, or systemic inflammatory syndrome remains challenging. CONCLUSION Post-mortem analysis identified lesions associated with SARS-CoV-2 in multiple organs, highlighting the systemic nature of the virus and emphasizing the need for continued research into organ-specific damage and long-term sequelae of COVID-19.
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Affiliation(s)
- Ioana-Andreea Gheban-Roşca
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400347, Romania; Clinical Hospital for Infectious Diseases, Cluj-Napoca 400003, Romania
| | - Bogdan-Alexandru Gheban
- County Emergency Clinical Hospital, Cluj-Napoca 400347, Romania; Department of Histology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400347, Romania.
| | - Bogdan Pop
- The Oncology Institute " Prof. Dr. Ion Chiricuță", Cluj-Napoca 400015, Romania; Department of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400347, Romania
| | - Daniela-Cristina Mironescu
- Forensic Institute, Cluj-Napoca 400006, Romania; Department of Forensic Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400347, Romania
| | - Vasile Costel Siserman
- Forensic Institute, Cluj-Napoca 400006, Romania; Department of Forensic Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400347, Romania
| | - Elena Mihaela Jianu
- Department of Histology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400347, Romania
| | - Tudor Drugan
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400347, Romania
| | - Sorana D Bolboacă
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca 400347, Romania
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10
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Wattanachayakul P, Suenghataiphorn T, Srikulmontri T, Rujirachun P, Malin J, Danpanichkul P, Polpichai N, Saowapa S, Casipit BA, Amanullah A. Impact of COVID-19 infection on the in-hospital outcome of patients hospitalized for heart failure with comorbid atrial fibrillation: Insight from the National Inpatient Sample (NIS) database 2020. J Arrhythm 2024; 40:895-902. [PMID: 39139900 PMCID: PMC11317655 DOI: 10.1002/joa3.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/14/2024] [Accepted: 05/06/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction Atrial fibrillation (AF) and heart failure (HF) commonly coexist, resulting in adverse health and economic consequences such as declining ventricular function, heightened mortality, and reduced quality of life. However, limited information exists on the impact of COVID-19 on AF patients that hospitalized for HF. Methods We analyzed the 2020 U.S. National Inpatient Sample to investigate the effects of COVID-19 on AF patients that primarily hospitalized for HF. Participants aged 18 and above were identified using relevant ICD-10 CM codes. Adjusted odds ratios for outcomes were calculated through multivariable logistic regression. The primary outcome was inpatient mortality, with secondary outcomes including system-based complications. Results We identified 322,090 patients with primary discharge diagnosis of HF with comorbid AF. Among them, 0.73% (2355/322,090) also had a concurrent diagnosis of COVID-19. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 3.17; 95% CI 2.25, 4.47, p < 0.001), prolonged length of stay (β LOS 2.82; 95% CI 1.71, 3.93, p < 0.001), acute myocarditis (aOR 6.64; 95% CI 1.45, 30.45, p 0.015), acute kidney injury (AKI) (aOR 1.48; 95% CI 1.21, 1.82, p < 0.001), acute respiratory failure (aOR 1.24; 95% CI 1.01, 1.52, p 0.045), and mechanical ventilation (aOR 2.00; 95% CI 1.28, 3.13, p 0.002). Conclusion Our study revealed that COVID-19 is linked to higher in-hospital mortality and increased adverse outcomes in AF patients hospitalized for HF.
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Affiliation(s)
- Phuuwadith Wattanachayakul
- Department of Medicine, Jefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | | | | | | | - John Malin
- Department of Medicine, Jefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | | | | | | | - Bruce A. Casipit
- Department of Medicine, Jefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Aman Amanullah
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
- Division of Cardiovascular DiseaseJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
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11
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Powell AA, Dowell AC, Moss P, Ladhani SN. Current state of COVID-19 in children: 4 years on. J Infect 2024; 88:106134. [PMID: 38432584 DOI: 10.1016/j.jinf.2024.106134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
Children have been disproportionately affected by the COVID-19 pandemic. Despite evidence of a very low risk of severe disease, children were subjected to extensive lockdown, restriction and mitigation measures, including school closures, to control the rapid spread of SARS-CoV-2 in most parts of the world. In this review we summarise the UK experience of COVID-19 in children four years into the largest and longest pandemic of this century. We address the risks of SARS-CoV-2 infection, immunity, transmission, severity and outcomes in children. We also assess the implementation, uptake, effectiveness and impact of COVID-19 vaccination, as well as the emergence, evolution and near disappearance of PIMS-TS (paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2) and current understanding of long COVID in children. This review consolidates current knowledge on childhood COVID-19 and emphasises the importance of continued research and the need for research-driven public health actions and policy decisions, especially in the context of new variants and future vaccines.
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Affiliation(s)
- Annabel A Powell
- Public Health Programmes, UK Health Security Agency, London, UK.
| | - Alexander C Dowell
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Paul Moss
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Shamez N Ladhani
- Public Health Programmes, UK Health Security Agency, London, UK; Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
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12
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Wang J, Lu W, Zhang J, Du Y, Fang M, Zhang A, Sungcad G, Chon S, Xing J. Loss of TRIM29 mitigates viral myocarditis by attenuating PERK-driven ER stress response in male mice. Nat Commun 2024; 15:3481. [PMID: 38664417 PMCID: PMC11045800 DOI: 10.1038/s41467-024-44745-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 12/29/2023] [Indexed: 04/28/2024] Open
Abstract
Viral myocarditis, an inflammatory disease of the myocardium, is a significant cause of sudden death in children and young adults. The current coronavirus disease 19 pandemic emphasizes the need to understand the pathogenesis mechanisms and potential treatment strategies for viral myocarditis. Here, we found that TRIM29 was highly induced by cardiotropic viruses and promoted protein kinase RNA-like endoplasmic reticulum kinase (PERK)-mediated endoplasmic reticulum (ER) stress, apoptosis, and reactive oxygen species (ROS) responses that promote viral replication in cardiomyocytes in vitro. TRIM29 deficiency protected mice from viral myocarditis by promoting cardiac antiviral functions and reducing PERK-mediated inflammation and immunosuppressive monocytic myeloid-derived suppressor cells (mMDSC) in vivo. Mechanistically, TRIM29 interacted with PERK to promote SUMOylation of PERK to maintain its stability, thereby promoting PERK-mediated signaling pathways. Finally, we demonstrated that the PERK inhibitor GSK2656157 mitigated viral myocarditis by disrupting the TRIM29-PERK connection, thereby bolstering cardiac function, enhancing cardiac antiviral responses, and curbing inflammation and immunosuppressive mMDSC in vivo. Our findings offer insight into how cardiotropic viruses exploit TRIM29-regulated PERK signaling pathways to instigate viral myocarditis, suggesting that targeting the TRIM29-PERK axis could mitigate disease severity.
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Affiliation(s)
- Junying Wang
- Department of Surgery and Immunobiology and Transplant Science Center, Houston Methodist Research Institute, Houston Methodist, Houston, TX, 77030, USA
| | - Wenting Lu
- Department of Surgery and Immunobiology and Transplant Science Center, Houston Methodist Research Institute, Houston Methodist, Houston, TX, 77030, USA
| | - Jerry Zhang
- Department of Surgery and Immunobiology and Transplant Science Center, Houston Methodist Research Institute, Houston Methodist, Houston, TX, 77030, USA
| | - Yong Du
- Department of Surgery and Immunobiology and Transplant Science Center, Houston Methodist Research Institute, Houston Methodist, Houston, TX, 77030, USA
| | - Mingli Fang
- Department of Surgery and Immunobiology and Transplant Science Center, Houston Methodist Research Institute, Houston Methodist, Houston, TX, 77030, USA
| | - Ao Zhang
- Department of Surgery and Immunobiology and Transplant Science Center, Houston Methodist Research Institute, Houston Methodist, Houston, TX, 77030, USA
| | - Gabriel Sungcad
- Department of Surgery and Immunobiology and Transplant Science Center, Houston Methodist Research Institute, Houston Methodist, Houston, TX, 77030, USA
| | - Samantha Chon
- Department of Surgery and Immunobiology and Transplant Science Center, Houston Methodist Research Institute, Houston Methodist, Houston, TX, 77030, USA
| | - Junji Xing
- Department of Surgery and Immunobiology and Transplant Science Center, Houston Methodist Research Institute, Houston Methodist, Houston, TX, 77030, USA.
- Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston Methodist, Houston, TX, 77030, USA.
- Department of Surgery, Weill Cornell Medicine, Cornell University, New York, NY, 10065, USA.
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13
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Ramphul K, Singh Dhaliwal J, Sombans S, Passi JK, Aggarwal S, Kumar N, Sakthivel H, Ahmed R, Verma R. Trends in admissions for COVID-19 in the United States between April 2020 and December 2021 and cardiovascular events. Arch Med Sci Atheroscler Dis 2024; 9:e60-e65. [PMID: 38846059 PMCID: PMC11155464 DOI: 10.5114/amsad/185410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) can lead to cardiovascular complications. We aimed to understand the trends in admission for COVID-19 and the incidence of various cardiovascular events. Material and methods The 2020 and 2021 National Inpatient Sample (NIS) was studied for cases of COVID-19 between April 2020 and December 2021 in the United States. Linear-by-linear association helped us understand the trends of various events. Results The number of cases of COVID-19 was highest in January 2021 (261,469 patients). The incidence of acute pulmonary embolism rose from 2.08% in April 2020 to 4.82% in November 2021, while deep vein thrombosis cases rose from 1.74% in April 2020 to 2.63% in December 2021. The incidence of cardiac arrest varied, with a maximum of 3.00% in August 2021. Similarly, acute ischemic stroke cases experienced their highest incidence in January 2021 (0.91%). The incidence of myocarditis was highest in April and May 2020 (0.42% each). Peak takotsubo cases were seen between October and December 2021. The highest overall all-cause mortality among COVID-19 cases was seen in April 2020 (16.74%). Conclusions Throughout the 21 months of our analysis, various trends in COVID-19 cases and incidence of cardiac events were noticed. This could relate to the different variants of COVID-19, their direct and indirect impact on coagulation pathways and the myocardial tissues, and the protective roles of the vaccines.
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Affiliation(s)
| | | | | | - Jatin Kumar Passi
- Department of Internal Medicine, Guru Gobind Singh Medical College, Faridkot, India
| | - Shruti Aggarwal
- Department of Internal Medicine, Guru Gobind Singh Medical College, Faridkot, India
| | - Nomesh Kumar
- Department of Internal Medicine, Detroit Medical Center Sinai Grace-Wayne State University, Michigan, US
| | | | - Raheel Ahmed
- Royal Brompton Hospital, part of Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Renuka Verma
- Department of Internal Medicine, University of Nevada, Las Vegas(UNLV), Las Vegas, US
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14
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Ahmad I, Omura S, Sato F, Park AM, Khadka S, Gavins FNE, Tanaka H, Kimura MY, Tsunoda I. Exploring the Role of Platelets in Virus-Induced Inflammatory Demyelinating Disease and Myocarditis. Int J Mol Sci 2024; 25:3460. [PMID: 38542433 PMCID: PMC10970283 DOI: 10.3390/ijms25063460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 12/26/2024] Open
Abstract
Theiler's murine encephalomyelitis virus (TMEV) infection has been used as a mouse model for two virus-induced organ-specific immune-mediated diseases. TMEV-induced demyelinating disease (TMEV-IDD) in the central nervous system (CNS) is a chronic inflammatory disease with viral persistence and an animal model of multiple sclerosis (MS) in humans. TMEV infection can also cause acute myocarditis with viral replication and immune cell infiltration in the heart, leading to cardiac fibrosis. Since platelets have been reported to modulate immune responses, we aimed to determine the role of platelets in TMEV infection. In transcriptome analyses of platelets, distinct sets of immune-related genes, including major histocompatibility complex (MHC) class I, were up- or downregulated in TMEV-infected mice at different time points. We depleted platelets from TMEV-infected mice by injecting them with platelet-specific antibodies. The platelet-depleted mice had significantly fewer viral antigen-positive cells in the CNS. Platelet depletion reduced the severities of TMEV-IDD and myocarditis, although the pathology scores did not reach statistical significance. Immunologically, the platelet-depleted mice had an increase in interferon (IFN)-γ production with a higher anti-TMEV IgG2a/IgG1 ratio. Thus, platelets may play roles in TMEV infection, such as gene expression, viral clearance, and anti-viral antibody isotype responses.
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Affiliation(s)
- Ijaz Ahmad
- Department of Microbiology, Faculty of Medicine, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan; (I.A.); (S.O.); (F.S.); (A.-M.P.); (S.K.)
| | - Seiichi Omura
- Department of Microbiology, Faculty of Medicine, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan; (I.A.); (S.O.); (F.S.); (A.-M.P.); (S.K.)
| | - Fumitaka Sato
- Department of Microbiology, Faculty of Medicine, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan; (I.A.); (S.O.); (F.S.); (A.-M.P.); (S.K.)
| | - Ah-Mee Park
- Department of Microbiology, Faculty of Medicine, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan; (I.A.); (S.O.); (F.S.); (A.-M.P.); (S.K.)
- Department of Arts and Sciences, Faculty of Medicine, Kindai University, Osaka 589-8511, Japan
| | - Sundar Khadka
- Department of Microbiology, Faculty of Medicine, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan; (I.A.); (S.O.); (F.S.); (A.-M.P.); (S.K.)
- Department of Immunology, Duke University, Durham, NC 27708, USA
| | - Felicity N. E. Gavins
- Department of Biosciences, Centre for Inflammation Research and Translational Medicine, College of Health and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK;
| | - Hiroki Tanaka
- Division of Tumor Pathology, Department of Pathology, Asahikawa Medical University, Asahikawa 078-8510, Japan;
| | - Motoko Y. Kimura
- Department of Experimental Immunology, Graduate School of Medicine, Chiba University, Chiba 263-8522, Japan;
| | - Ikuo Tsunoda
- Department of Microbiology, Faculty of Medicine, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan; (I.A.); (S.O.); (F.S.); (A.-M.P.); (S.K.)
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15
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Ono R, Iwahana T, Aoki K, Kato H, Okada S, Kobayashi Y. Fulminant Myocarditis with SARS-CoV-2 Infection: A Narrative Review from the Case Studies. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:9000598. [PMID: 38469104 PMCID: PMC10927348 DOI: 10.1155/2024/9000598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/13/2024]
Abstract
One of the severe complications of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is myocarditis. However, the characteristics of fulminant myocarditis with SARS-CoV-2 infection are still unclear. We systematically reviewed the previously reported cases of fulminant myocarditis associated with SARS-CoV-2 infection from January 2020 to December 2022, identifying 108 cases. Of those, 67 were male and 41 female. The average age was 34.8 years; 30 patients (27.8%) were ≤20 years old, whereas 10 (9.3%) were ≥60. Major comorbidities included hypertension, obesity, diabetes mellitus, asthma, heart disease, gynecologic disease, hyperlipidemia, and connective tissue disorders. Regarding left ventricular ejection fraction (LVEF) at admission, 93% of the patients with fulminant myocarditis were classified as having heart failure with reduced ejection fraction (LVEF ≤ 40%). Most of the cases were administered catecholamines (97.8%), and mechanical circulatory support (MCS) was required in 67 cases (62.0%). The type of MCS was extracorporeal membrane oxygenation (n = 56, 83.6%), percutaneous ventricular assist device (Impella®) (n = 19, 28.4%), intra-aortic balloon pumping (n = 12, 12.9%), or right ventricular assist device (n = 2, 3.0%); combination of these devices occurred in 20 cases (29.9%). The average duration of MCS was 7.7 ± 3.8 days. Of the 76 surviving patients whose cardiac function was available for follow-up, 65 (85.5%) recovered normally. The overall mortality rate was 22.4%, and the recovery rate was 77.6% (alive: 83 patients, dead: 24 patients; outcome not described: 1 patient).
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Affiliation(s)
- Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Togo Iwahana
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Kaoruko Aoki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Hirotoshi Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Sho Okada
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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Wang L, Liu T, Yue H, Zhang J, Sheng Q, Wu L, Wang X, Zhang M, Wang J, Wang J, Yu W. Clinical characteristics and high risk factors of patients with Omicron variant strain infection in Hebei, China. Front Cell Infect Microbiol 2023; 13:1294904. [PMID: 38145047 PMCID: PMC10744887 DOI: 10.3389/fcimb.2023.1294904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The Omicron variant has a weaker pathogenicity compared to the Delta variant but is highly transmissible and elderly critically ill patients account for the majority. This study has significant implications for guiding clinical personalized treatment and effectively utilizing healthcare resources. Methods The study focuses on 157 patients infected with the novel coronavirus Omicron variant, from December, 2022, to February, 2023. The objective is to analyze the baseline data, test results, imaging findings and identify risk factors associated with severe illness. Results Among the 157 included patients, there were 55 cases in the non-severe group (all were moderate cases) and 102 cases in the severe group (including severe and critical cases). Infection with the Omicron variant exhibits significant differences between non-severe and severe cases (baseline data, blood routine, coagulation, inflammatory markers, cardiac, liver, kidney functions, Chest CT, VTE score, etc.). A multifactorial logistic regression analysis showed that neutrophil percentage >75%, eosinophil percentage <0.4%, D-dimer >0.55 mg/L, PCT >0.25 ng/mL, LDH >250 U/L, albumin <40 g/L, A/G ratio <1.2, cholinesterase<5100 U/L, uric acid >357 mole/L and blood calcium<2.11 mmol/L were the most likely independent risk factors for severe novel coronavirus infection. Conclusion Advanced age, low oxygenation index, elevated neutrophil percentage, decreased eosinophil percentage, elevated PCT, elevated LDH, decreased albumin, decreased A/G ratio, elevated uric acid, decreased blood calcium, and elevated D-dimer are independent prognostic risk factors for non-severe patients progressing to severe illness. These factors should be closely monitored and actively treated to prevent or minimize the occurrence of severe illness.
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Affiliation(s)
- Lihong Wang
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ting Liu
- Department of Endoscopy Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongjuan Yue
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiaojiao Zhang
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qihong Sheng
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ling Wu
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoyu Wang
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mei Zhang
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jing Wang
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jia Wang
- Department of Infectious Diseases, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Weifang Yu
- Department of Endoscopy Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
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17
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Munjal JS, Flores SM, Yousuf H, Gupta V, Munjal RS, Anamika FNU, Mendpara V, Shah P, Jain R. Covid- 19 Vaccine-induced Myocarditis. J Community Hosp Intern Med Perspect 2023; 13:44-49. [PMID: 37868673 PMCID: PMC10589044 DOI: 10.55729/2000-9666.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 10/24/2023] Open
Abstract
Myocarditis and pericarditis are rare adverse reactions, more commonly seen in young males after receiving the second dose of an mRNA vaccine. However, the benefits of vaccination heavily outweigh the risk of these side effects. In addition, vaccination boosters are effective against the newest, more infective variants. Therefore we expect more vaccines to be administered in the following years. The objective of this study is to review the current understanding of the mechanism, diagnosis, and treatment of myocarditis and pericarditis. Proposed mechanisms include molecular mimicry against the S protein and hypersensitivity reactions with mRNA vaccines and platelet aggregation and thrombus formation in cardiac blood vessels with adenoviral vaccines. Diagnosis of myocarditis is based on clinical findings, cardiac enzymes, ECG, MRI, and echocardiographic findings. Management includes NSAIDs and cardiovascular support in selected cases with ventricular dysfunction. Most patients have a mild presentation with preservation of cardiac function and recover entirely within seven days; the average hospital stay is three days. Long-term complications are infrequent.
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Affiliation(s)
- Jaskaran S. Munjal
- Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh,
India
| | | | - Hamza Yousuf
- Dow University of Health Sciences, Karachi,
Pakistan
| | - Vasu Gupta
- Dayanand Medical College and Hospital, Ludhiana,
India
| | | | - FNU Anamika
- University College of Medical Sciences, New Delhi,
India
| | | | - Priyanshi Shah
- Narendra Modi Medical College, Ahmedabad, Gujarat,
India
| | - Rohit Jain
- Department of Internal Medicine Penn State Milton S Hershey Medical Center, Hershey, PA,
United States
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18
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Sai Santhosha Mrudula A, Agarwal P, Vempati R, Alla D, Balusu K, Tarannum S, Patel K, Devaragudi S, Patel D, sultana Q, Paudel K. Clinical outcome of established diagnostic and treatment modalities of COVID-19-associated myocarditis: a systematic review. Ann Med Surg (Lond) 2023; 85:3583-3594. [PMID: 37427189 PMCID: PMC10328593 DOI: 10.1097/ms9.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/10/2023] [Indexed: 07/11/2023] Open
Abstract
UNLABELLED Despite the significant research and development of COVID-19 diagnostic and therapeutic approaches, the virus still poses a concern, particularly to groups that are already vulnerable. Several individuals experienced cardiac problems like myocardial infarction, arrhythmia, heart failure, cardiomyopathy, myocarditis, and pericarditis after they had recovered from the infection. Early diagnosis and timely management of sequelae are part of the therapy. However, there are gaps in the knowledge of the diagnostic and definitive treatment options for COVID-19 myocarditis. This review focuses on myocarditis associated with COVID-19. OBJECTIVE This systemic review provides the most recent overview of myocarditis caused by COVID-19, including clinical manifestations, diagnostic techniques, available treatments, and outcomes. METHODS The PubMed, Google Scholar, and ScienceDirect servers were used to conduct a systematic search in compliance with the PRISMA guidelines. Boolean search terms included "(COVID-19)" OR "(COVID19)" OR "(COVID-19 VIRUS INFECTION)" AND "(MYOCARDITIS)". The results were tabulated and analyzed. RESULTS A total of 32 studies, including 26 case reports and 6 case series, were included in the final analysis, and 38 cases of COVID-19-associated myocarditis were analyzed. Middle-aged men constituted the most affected population (60.52%). Dyspnoea (63.15%), chest pain or discomfort (44.73%), and fever (42.10%) were the prevalent presentations. ST-segment abnormalities were reported in 48.38% of cases on electrocardiography testing. Leucocytic infiltration (60%) was the frequent finding obtained on endomyocardial biopsy. Cardiac magnetic resonance imaging yielded myocardial oedema (63.63%), and late gadolinium enhancement (54.54%) as the most common findings. Reduced ejection fraction (75%) was the frequent result obtained on echocardiography. Corticosteroids (76.31%) and immunomodulators (42.10%) were the well-established in-hospital medications. Veno-arterial extracorporeal membrane oxygenation (35%) was the most common intervention used to support the treatment. The frequent in-hospital complications were cardiogenic shock (30.76%), followed by pneumonia (23.07%). The mortality rate was 7.9%. CONCLUSION Early detection and timely management of myocarditis are essential to reduce the risk of developing further complications. It is crucial to emphasize the need to evaluate COVID-19 as a possible cause of myocarditis in populations that are young and healthy to avoid fatal consequences.
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Affiliation(s)
| | | | | | - Deekshitha Alla
- Department of Medicine, Andhra Medical College, Andhra Pradesh
| | | | | | - Krish Patel
- Department of Medicine, Government Medical College, Surat
| | - Sanjana Devaragudi
- Department of Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, India
| | - Devkumar Patel
- Department of Medicine, Deccan College of Medical Sciences, Telangana
| | - Qamar sultana
- Department of Medicine, Deccan College of Medical Sciences, Telangana
| | - Kusum Paudel
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
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19
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Paruchuri SSH, Farwa UE, Jabeen S, Pamecha S, Shan Z, Parekh R, Lakkimsetti M, Alamin E, Sharma V, Haider S, Khan J, Razzaq W. Myocarditis and Myocardial Injury in Long COVID Syndrome: A Comprehensive Review of the Literature. Cureus 2023; 15:e42444. [PMID: 37637608 PMCID: PMC10449234 DOI: 10.7759/cureus.42444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
The repercussions of coronavirus disease 2019 (COVID-19) have been devastating on a global scale. Long COVID, which affects patients for weeks or even months after their initial infection, is not limited to individuals with severe symptoms and can affect people of all ages. The condition can impact various physiological systems, leading to chronic health conditions and long-term disabilities that present significant challenges for healthcare systems worldwide. This review explores the link between long COVID and cardiovascular complications such as myocardial injury and myocarditis. It also highlights the prevalence of these complications and identifies risk factors for their development in long COVID patients. Myocardial injury occurs due to direct cellular damage and T-cell-mediated cytotoxicity resulting in elevated cardiac biomarkers. Diagnostic techniques like electrocardiogram, troponin level testing, and magnetic resonance imaging can help identify myocarditis, but endomyocardial biopsy is considered the gold-standard diagnostic technique. Guideline-directed medical therapy is recommended for COVID-19 myocarditis patients for better prognosis while being monitored under comprehensive care management approaches. Therefore, it's critical to develop effective screening techniques specifically for vulnerable populations while conducting further research that addresses the effects of long COVID on society's physical health.
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Affiliation(s)
- Sai Sri Hari Paruchuri
- Internal Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, IND
| | - Umm E Farwa
- Emergency Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Shaista Jabeen
- Medicine, Pakistan Air Force (PAF) Hospital, Islamabad, PAK
| | - Shreyansh Pamecha
- Internal Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Zoofi Shan
- Cardiology, Hero DMC (Dayanand Medical College) Heart Institute, Ludhiana, IND
| | - Ritika Parekh
- Community Health, K. J. (Karamshibhai Jethabhai) Somaiya Medical College and Research Centre, Mumbai, Mumbai, IND
| | | | - Eman Alamin
- Community Health, University of Medical Sciences and Technology, Khartoum, SDN
| | - Vagisha Sharma
- College of Medicine, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Salar Haider
- Physiology, Shifa College of Medicine, Islamabad, PAK
| | - Javeria Khan
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Waleed Razzaq
- Internal Medicine, Services Hospital Lahore, Lahore, PAK
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20
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Ulucay AS, Singh G, Kanuri SH. Do COVID-19 viral infection and its mRNA vaccine carry an equivalent risk of myocarditis? Review of the current evidence, insights, and future directions. Indian Heart J 2023; 75:217-223. [PMID: 37399904 PMCID: PMC10421995 DOI: 10.1016/j.ihj.2023.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/31/2023] [Accepted: 06/30/2023] [Indexed: 07/05/2023] Open
Abstract
According to recent epidemiological analysis, the percentage of world population infected with COVID-19 by end of December 2020 is approximately 12.56%1. COVID induced acute care and ICU hospitalization rates are around 9.22 (95% CI: 18.73-19.51), and 4.14 (95% CI: 4.10-4.18) per 1000 population1. Although therapeutic strategies such as antivirals, intravenous immunoglobulins and corticosteroids have shown modest efficacy in reducing the disease progression, they are not disease specific and only temper the immune mediated attack on the systemic tissues. Therefore, clinicians started to rely on mRNA COVID-19 vaccines, which are clinically efficacious in reducing the incidence, disease severity and systemic complications of COVID-19 infections. Nevertheless, usage of COVID-19 mRNA vaccines is also associated with cardiovascular complications such as myocarditis and pericarditis. On the other hand, COVID-19 infections itself are associated with cardiovascular complications such as myocarditis. The underlying signaling pathways for occurrence of COVID-19 and mRNA COVID-19 vaccine induced myocarditis are quite different although there is some overlap in autoimmunity and cross reactivity mechanisms. With media reports highlighting the cardiovascular complications of COVID-19 vaccines such as myocarditis, general population have become more hesitant and uncertain regarding the safety and efficacy of these mRNA vaccines. We plan to review the current literature and provide insights into their pathophysiological mechanisms for myocarditis and offer recommendations for further research studies in this regard. This will hopefully dispel some doubts and encourage more people to be vaccinated for preventing the risk of COVID-19 induced myocarditis and other associated cardiovascular complications.
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Affiliation(s)
- Ayse Sena Ulucay
- Department of Physiology, Case Western Reserve University, Cleveland, OH, USA
| | - Gaaminepreet Singh
- Department of Physiology, Case Western Reserve University, Cleveland, OH, USA
| | - Sri Harsha Kanuri
- Stark Neurosciences Institute, IU School of Medicine, Indianapolis, IN, USA.
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21
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Sai Santhosha Mrudula A, Agarwal P, Vempati R, Alla D, Balusu K, Tarannum S, Patel K, Devaragudi S, Patel D, sultana Q, Paudel K. Clinical outcome of established diagnostic and treatment modalities of COVID-19-associated myocarditis: a systematic review. Ann Med Surg (Lond) 2023; 85:3583-3594. [DOI: 10.1097/ms9.0000000000000964 | pmid: 37427189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2025] Open
Abstract
Background:Despite the significant research and development of COVID-19 diagnostic and therapeutic approaches, the virus still poses a concern, particularly to groups that are already vulnerable. Several individuals experienced cardiac problems like myocardial infarction, arrhythmia, heart failure, cardiomyopathy, myocarditis, and pericarditis after they had recovered from the infection. Early diagnosis and timely management of sequelae are part of the therapy. However, there are gaps in the knowledge of the diagnostic and definitive treatment options for COVID-19 myocarditis. This review focuses on myocarditis associated with COVID-19.Objective:This systemic review provides the most recent overview of myocarditis caused by COVID-19, including clinical manifestations, diagnostic techniques, available treatments, and outcomes.Methods:The PubMed, Google Scholar, and ScienceDirect servers were used to conduct a systematic search in compliance with the PRISMA guidelines. Boolean search terms included “(COVID-19)” OR “(COVID19)” OR “(COVID-19 VIRUS INFECTION)” AND “(MYOCARDITIS)”. The results were tabulated and analyzed.Results:A total of 32 studies, including 26 case reports and 6 case series, were included in the final analysis, and 38 cases of COVID-19-associated myocarditis were analyzed. Middle-aged men constituted the most affected population (60.52%). Dyspnoea (63.15%), chest pain or discomfort (44.73%), and fever (42.10%) were the prevalent presentations. ST-segment abnormalities were reported in 48.38% of cases on electrocardiography testing. Leucocytic infiltration (60%) was the frequent finding obtained on endomyocardial biopsy. Cardiac magnetic resonance imaging yielded myocardial oedema (63.63%), and late gadolinium enhancement (54.54%) as the most common findings. Reduced ejection fraction (75%) was the frequent result obtained on echocardiography. Corticosteroids (76.31%) and immunomodulators (42.10%) were the well-established in-hospital medications. Veno-arterial extracorporeal membrane oxygenation (35%) was the most common intervention used to support the treatment. The frequent in-hospital complications were cardiogenic shock (30.76%), followed by pneumonia (23.07%). The mortality rate was 7.9%.Conclusion:Early detection and timely management of myocarditis are essential to reduce the risk of developing further complications. It is crucial to emphasize the need to evaluate COVID-19 as a possible cause of myocarditis in populations that are young and healthy to avoid fatal consequences.
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Affiliation(s)
| | | | | | - Deekshitha Alla
- Department of Medicine, Andhra Medical College, Andhra Pradesh
| | | | | | - Krish Patel
- Department of Medicine, Government Medical College, Surat
| | - Sanjana Devaragudi
- Department of Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, India
| | - Devkumar Patel
- Department of Medicine, Deccan College of Medical Sciences, Telangana
| | - Qamar sultana
- Department of Medicine, Deccan College of Medical Sciences, Telangana
| | - Kusum Paudel
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
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22
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Kim H, Ahn HS, Hwang N, Huh Y, Bu S, Seo KJ, Kwon SH, Lee HK, Kim JW, Yoon BK, Fang S. Epigenomic landscape exhibits interferon signaling suppression in the patient of myocarditis after BNT162b2 vaccination. Sci Rep 2023; 13:8926. [PMID: 37264110 PMCID: PMC10234245 DOI: 10.1038/s41598-023-36070-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/29/2023] [Indexed: 06/03/2023] Open
Abstract
After the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, a novel mRNA vaccine (BNT162b2) was developed at an unprecedented speed. Although most countries have achieved widespread immunity from vaccines and infections, yet people, even who have recovered from SARS-CoV-2 infection, are recommended to receive vaccination due to their effectiveness in lowering the risk of recurrent infection. However, the BNT162b2 vaccine has been reported to increase the risk of myocarditis. To our knowledge, for the first time in this study, we tracked changes in the chromatin dynamics of peripheral blood mononuclear cells (PBMCs) in the patient who underwent myocarditis after BNT162b2 vaccination. A longitudinal study of chromatin accessibility using concurrent analysis of single-cell assays for transposase-accessible chromatin with sequencing and single-cell RNA sequencing showed downregulation of interferon signaling and upregulated RUNX2/3 activity in PBMCs. Considering BNT162b2 vaccination increases the level of interferon-α/γ in serum, our data highlight the immune responses different from the conventional responses to the vaccination, which is possibly the key to understanding the side effects of BNT162b2 vaccination.
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Affiliation(s)
- Hyeonhui Kim
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, Korea
- Severance Biomedical Science Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Hyo-Suk Ahn
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, 06591, Korea
- Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Nahee Hwang
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, Korea
- Department of Biochemistry and Molecular Biology, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Yune Huh
- Department of Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Seonghyeon Bu
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, 06591, Korea
- Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Kyung Jin Seo
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, South Korea
| | - Se Hwan Kwon
- Department of Radiology, Kyung Hee University Medical Center, Seoul, South Korea
| | - Hae-Kyung Lee
- Severance Biomedical Science Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Jae-Woo Kim
- Department of Biochemistry and Molecular Biology, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Bo Kyung Yoon
- Department of Biochemistry and Molecular Biology, Yonsei University College of Medicine, Seoul, 03722, Korea.
| | - Sungsoon Fang
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, Korea.
- Severance Biomedical Science Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, Korea.
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23
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Mondal H, Kumar M. Heart Rate Variability in Normotensive and Hypertensive Adults After a Year of Receiving Oxford/AstraZeneca COVID-19 Vaccine: A Cross-Sectional Observational Study. Cureus 2023; 15:e40010. [PMID: 37425583 PMCID: PMC10328452 DOI: 10.7759/cureus.40010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 07/11/2023] Open
Abstract
Background and aim Heart rate variability (HRV) helps in assessing the autonomic nervous system's function, which has been implicated in cardiovascular disease risk. HRV has been found to be deranged in hypertension. In addition, studies have shown that COVID-19 infection and vaccination can affect HRV. However, the long-term effect of HRV on hypertension has not been explored after COVID-19 vaccination. The objective of this study was to observe the HRV in hypertensive adults after one year of receiving the Oxford/AstraZeneca COVID-19 vaccine and to compare it with normotensive adults. Methods The study included 105 normotensives (blood pressure below 120/80 mmHg) and 75 hypertensive participants who had received the Oxford/AstraZeneca COVID-19 vaccine one year prior. HRV was measured using the PowerLab system (ADInstruments) with the participants in a sitting posture. The HRV parameters assessed included the time domain, frequency domain, and nonlinear measures. Data were presented in descriptive and inferential statistical terms, and the parameters of two groups of individuals were compared by either an unpaired t-test or the Mann-Whitney U test. Results A total of 105 normotensive participants with a mean age of 42.51 ± 9.28 years and 75 hypertensive participants with a mean age of 44.24 ± 10.19 years comprised the sample (p=0.24). Normotensive individuals had a higher standard deviation of RR intervals, a higher coefficient of variation of RR intervals, a higher standard deviation of heart rate, and a higher percentage of successive differences in RR intervals in the time domain. They also had higher values of very low-frequency power, low-frequency (LF) power, and high-frequency (HF) power in the frequency domain. The LF/HF ratio was not significantly different between the two groups. In nonlinear analysis, SD2, a measure of long-term heart rate variability, was higher in normotensive individuals. Conclusion The Oxford/AstraZeneca COVID-19 vaccine did not have a significant effect on HRV parameters in normotensive and hypertensive adults one year after vaccination. However, changes in HRV parameters were observed between supine and standing positions, suggesting the importance of postural changes in HRV assessment.
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Affiliation(s)
- Himel Mondal
- Physiology, All India Institute of Medical Sciences, Deoghar, IND
| | - Manish Kumar
- Physiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
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24
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COVID-19-Induced Myocarditis: Pathophysiological Roles of ACE2 and Toll-like Receptors. Int J Mol Sci 2023; 24:ijms24065374. [PMID: 36982447 PMCID: PMC10049267 DOI: 10.3390/ijms24065374] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
The clinical manifestations of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection responsible for coronavirus disease 2019 (COVID-19) commonly include dyspnoea and fatigue, and they primarily involve the lungs. However, extra-pulmonary organ dysfunctions, particularly affecting the cardiovascular system, have also been observed following COVID-19 infection. In this context, several cardiac complications have been reported, including hypertension, thromboembolism, arrythmia and heart failure, with myocardial injury and myocarditis being the most frequent. These secondary myocardial inflammatory responses appear to be associated with a poorer disease course and increased mortality in patients with severe COVID-19. In addition, numerous episodes of myocarditis have been reported as a complication of COVID-19 mRNA vaccinations, especially in young adult males. Changes in the cell surface expression of angiotensin-converting enzyme 2 (ACE2) and direct injury to cardiomyocytes resulting from exaggerated immune responses to COVID-19 are just some of the mechanisms that may explain the pathogenesis of COVID-19-induced myocarditis. Here, we review the pathophysiological mechanisms underlying myocarditis associated with COVID-19 infection, with a particular focus on the involvement of ACE2 and Toll-like receptors (TLRs).
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25
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Vosko I, Zirlik A, Bugger H. Impact of COVID-19 on Cardiovascular Disease. Viruses 2023; 15:508. [PMID: 36851722 PMCID: PMC9962056 DOI: 10.3390/v15020508] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a viral infection with the novel severe acute respiratory distress syndrome corona virus 2 (SARS-CoV-2). Until now, more than 670 million people have suffered from COVID-19 worldwide, and roughly 7 million death cases were attributed to COVID-19. Recent evidence suggests an interplay between COVID-19 and cardiovascular disease (CVD). COVID-19 may serve as a yet underappreciated CVD risk modifier, including risk factors such as diabetes mellitus or arterial hypertension. In addition, recent data suggest that previous COVID-19 may increase the risk for many entities of CVD to an extent similarly observed for traditional cardiovascular (CV) risk factors. Furthermore, increased CVD incidence and worse clinical outcomes in individuals with preexisting CVD have been observed for myocarditis, acute coronary syndrome, heart failure (HF), thromboembolic complications, and arrhythmias. Direct and indirect mechanisms have been proposed by which COVID-19 may impact CVD and CV risk, including viral entry into CV tissue or by the induction of a massive systemic inflammatory response. In the current review, we provide an overview of the literature reporting an interaction between COVID-19 and CVD, review potential mechanisms underlying this interaction, and discuss preventive and treatment strategies and their interference with CVD that were evaluated since the onset of the COVID-19 pandemic.
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Affiliation(s)
| | | | - Heiko Bugger
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria
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26
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Comparison of COVID-19 Vaccine-Associated Myocarditis and Viral Myocarditis Pathology. Vaccines (Basel) 2023; 11:vaccines11020362. [PMID: 36851240 PMCID: PMC9967770 DOI: 10.3390/vaccines11020362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
The COVID-19 pandemic has led to significant loss of life and severe disability, justifying the expedited testing and approval of messenger RNA (mRNA) vaccines. While found to be safe and effective, there have been increasing reports of myocarditis after COVID-19 mRNA vaccine administration. The acute events have been severe enough to require admission to the intensive care unit in some, but most patients fully recover with only rare deaths reported. The pathways involved in the development of vaccine-associated myocarditis are highly dependent on the specific vaccine. COVID-19 vaccine-associated myocarditis is believed to be primarily caused by uncontrolled cytokine-mediated inflammation with possible genetic components in the interleukin-6 signaling pathway. There is also a potential autoimmune component via molecular mimicry. Many of these pathways are similar to those seen in viral myocarditis, indicating a common pathophysiology. There is concern for residual cardiac fibrosis and increased risk for the development of cardiomyopathies later in life. This is of particular interest for patients with congenital heart defects who are already at increased risk for fibrotic cardiomyopathies. Though the risk for vaccine-associated myocarditis is important to consider, the risk of viral myocarditis and other injury is far greater with COVID-19 infection. Considering these relative risks, it is still recommended that the general public receive vaccination against COVID-19, and it is particularly important for congenital heart defect patients to receive vaccination for COVID-19.
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Aleksova A, Fluca AL, Gagno G, Pierri A, Padoan L, Derin A, Moretti R, Noveska EA, Azzalini E, D'Errico S, Beltrami AP, Zumla A, Ippolito G, Sinagra G, Janjusevic M. Long-term effect of SARS-CoV-2 infection on cardiovascular outcomes and all-cause mortality. Life Sci 2022; 310:121018. [PMID: 36183780 PMCID: PMC9561478 DOI: 10.1016/j.lfs.2022.121018] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 12/03/2022]
Abstract
Since the very beginning of the coronavirus disease 2019 (COVID-19) pandemic in early 2020, it was evident that patients with cardiovascular disease (CVD) were at an increased risk of developing severe illness, and complications spanning cerebrovascular disorders, dysrhythmias, acute coronary syndrome, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure, thromboembolic disease, stroke, and death. Underlying these was excessive systemic inflammation and coagulopathy due to SARS-COV-2 infection, the effects of which also continued long-term as evidenced by post-COVID-19 cardiovascular complications. The acute and chronic cardiovascular effects of COVID-19 occurred even among those who were not hospitalized and had no previous CVD or those with mild symptoms. This comprehensive review summarizes the current understanding of molecular mechanisms triggered by the SARS-CoV-2 virus on various cells that express the angiotensin-converting enzyme 2, leading to endothelial dysfunction, inflammation, myocarditis, impaired coagulation, myocardial infarction, arrhythmia and a multisystem inflammatory syndrome in children or Kawasaki-like disease.
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Affiliation(s)
- Aneta Aleksova
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Alessandra Lucia Fluca
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giulia Gagno
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alessandro Pierri
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Laura Padoan
- Department of Cardiology and Cardiovascular Physiopathology, Università degli Studi di Perugia, Perugia, Italy
| | - Agnese Derin
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy
| | - Rita Moretti
- Department of Internal Medicine and Neurology, Neurological Clinic, University of Trieste, Trieste, Italy
| | - Elena Aleksova Noveska
- Department of Pediatric and Preventive Dentistry, Faculty of Dental Medicine, Ss. Cyril and Methodius University, Skopje, Macedonia
| | - Eros Azzalini
- Department of Medical Sciences (DSM), University of Trieste, Trieste, Italy
| | - Stefano D'Errico
- Department of Medicine, Surgery and Health, University of Trieste, Trieste, Italy
| | | | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, UK; National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK
| | | | - Gianfranco Sinagra
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Milijana Janjusevic
- Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Pulmonary Involvement in SARS-CoV-2 Infection Estimates Myocardial Injury Risk. Medicina (B Aires) 2022; 58:medicina58101436. [PMID: 36295594 PMCID: PMC9610985 DOI: 10.3390/medicina58101436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection represents a pathology with primary pulmonary involvement and multisystemic impact, including cardiovascular injuries. The present study aimed to assess the value of clinical, biochemical, and imaging factors in COVID-19 patients in determining the severity of myocardial involvement, and to create a model that can be used toevaluate myocardial injury risk based on clinical, biochemical and imaging factors. Materials and Methods: We performed an observational cohort study on 150 consecutive patients, evaluating their age, sex, hospitalization period, peripheral oxygen saturation (SpO2) in ambient air, systolic and diastolic blood pressure, heart rate, respiratory rate, biochemical markers of cardiac dysfunction (TnI, and NT-proBNP), inflammatory markers (C reactive protein (CRP), fibrinogen, serum ferritin, interleukin-6 (IL-6), tumor necrosis factor alpha (TNFα)), D-dimers, lactate dehydrogenase (LDH), myoglobin and radio-imaging parameters. All patients underwent computerized tomography chest scan in the first two days following admission. Results: We observed elevated heart and respiratory rates, higher systolic blood pressure, and a lower diastolic blood pressure in the patients with cardiac injury; significant differences between groups were registered in TnI, NT-proBNP, LDH, CRP, and D-dimers. For the radiological parameters, we found proportional correlations with the myocardial injury for the severity of lung disease, number of pulmonary segments with alveolar consolidation, number of pulmonary lobes with pneumonia, crazy paving pattern, type of lung involvement, the extent of fibroatelectatic lesions and the mediastinal adenopathies. Conclusions: Myocardial injury occurred in 12% of patients in the study group. Ground glass opacities, interstitial interlobular septal thickening (crazy paving pattern), fibroatelectasic lesions and alveolar consolidations on CT scan were correlated with myocardial injury. Routine lung sectional imaging along with non-specific biomarkers (LDH, D-dimers, and CRP) can be further valuable in the characterization of the disease burden, thus impacting patient care.
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Xanthopoulos A, Bourazana A, Giamouzis G, Skoularigki E, Dimos A, Zagouras A, Papamichalis M, Leventis I, Magouliotis DE, Triposkiadis F, Skoularigis J. COVID-19 and the heart. World J Clin Cases 2022; 10:9970-9984. [PMID: 36246800 PMCID: PMC9561576 DOI: 10.12998/wjcc.v10.i28.9970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/27/2022] [Accepted: 08/24/2022] [Indexed: 02/05/2023] Open
Abstract
An outbreak of coronavirus disease 2019 (COVID-19) occurred in December 2019 due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is a strain of SARS-CoV. Patients infected with the virus present a wide spectrum of manifestations ranging from mild flu-like symptoms, cough, fever and fatigue to severe lung injury, appearing as bilateral interstitial pneumonia or acute respiratory failure. Although SARS-CoV-2 infection predominantly offends the respiratory system, it has been associated with several cardiovascular complications as well. For example, patients with COVID-19 may either develop type 2 myocardial infarction due to myocardial oxygen demand and supply imbalance or acute coronary syndrome resulting from excessive inflammatory response to the primary infection. The incidence of COVID-19 related myocarditis is estimated to be accountable for an average of 7% of all COVID-19 related fatal cases, whereas heart failure (HF) may develop due to infiltration of the heart by inflammatory cells, destructive action of pro-inflammatory cytokines, micro-thrombosis and new onset or aggravated endothelial and respiratory failure. Lastly, SARS-CoV-2 can engender arrhythmias through direct myocardial damage causing acute myocarditis or through HF decompensation or secondary, through respiratory failure or severe respiratory distress syndrome. In this comprehensive review we summarize the COVID-19 related cardiovascular complications (acute coronary syndromes, myocarditis, HF, arrhythmias) and discuss the main underlying pathophysiological mechanisms.
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Affiliation(s)
- Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Angeliki Bourazana
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Grigorios Giamouzis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | | | - Apostolos Dimos
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Alexandros Zagouras
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | | | - Ioannis Leventis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Dimitrios E Magouliotis
- Department of Cardiothoracic Surgery, University of Thessaly, Larissa Biopolis, Larissa 41110, Greece
| | | | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
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Zaoui N, Bachir N, Terki A, Boukabous A. Myocardite à COVID-19 : « à propos d'une série monocentrique de 33 cas ». Ann Cardiol Angeiol (Paris) 2022; 71:219-222. [PMID: 36089415 PMCID: PMC9395290 DOI: 10.1016/j.ancard.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/13/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022]
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Neupane NP, Rajlawot K, Adhikari C, Kandel D, Mustafa I. Cardiac MRI in post COVID acute myocarditis: A case report. IDCases 2022; 29:e01579. [PMID: 35873653 PMCID: PMC9295317 DOI: 10.1016/j.idcr.2022.e01579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/19/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Myocarditis is an acute or chronic inflammatory reaction of the heart muscle frequently associated with viral infections and post-viral immune-mediated responses. Recently the SARS-CoV-2 virus has been identified as a cause of myocarditis in COVID-19 patients. The role of cardiac MRI in such patients hence has become a subject of concern. Thus, we present a case of post-COVID-19 myocarditis where cardiac MRI was helpful in establishing the diagnosis.
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