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Assessment of Prognosis in Myocarditis and Inflammatory Heart Disease
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Assessment of Prognosis in Myocarditis and Inflammatory Heart Disease

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Acquired Cardiovascular Disease".

Deadline for manuscript submissions: closed (15 February 2023) | Viewed by 25706

Special Issue Editors

Dr. Michael Lichtenauer

E-Mail Website
Guest Editor
Department of Internal Medicine II, University Clinic Salzburg, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
Interests: biomarkers; myocardial ischemia; heart failure; HFpEF; microRNA; vascular/endothelial stress; atherosclerosis; valvular heart disease; risk assessment; mortality prediction
Special Issues, Collections and Topics in MDPI journals
Dr. Moritz Mirna

E-Mail Website
Guest Editor
Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
Interests: inflammatory heart diseases; myocarditis; endocarditis; interventional cardiology; coronary heart disease

Special Issue Information

Dear Colleagues,

Inflammatory heart diseases remain challenging conditions in everyday clinical practice. As such, acute myocarditis is not only a relatively frequent cardiovascular disease (global incidence of approximately 22 per 100,000 people [1]) which predominately affects patients of young age, but it can also lead to a persistent decline in left ventricular function, i.e., inflammatory cardiomyopathy, which can be associated with formidable symptoms and adverse outcomes for affected patients. For example, approximately 354,000 patients died from the sequelae of myocarditis in 2015, representing a mortality rate of 4.8 per 100,000 patients [2]. Hence, because of its associated impact on individual morbidity, as well as the possible detrimental adverse outcomes for our patients, myocarditis constitutes a serious disease, which requires timely diagnosis and appropriate treatment.

In recent years, several studies have investigated novel cardiovascular biomarkers and microRNAs in patients with acute myocarditis, and animal studies have yielded promising findings for future innovative therapeutic approaches. However, while novel approaches are being investigated on a daily basis, their translation to bedside is currently still far away, probably because of the still comparatively low recognition of this serious and debilitating cardiovascular disease. In this Special Issue of the Journal of Cardiovascular Development and Disease, we want to collect the latest innovative research in the field of inflammatory heart diseases in order to stimulate new investigations regarding the pathophysiological and clinical implications of myocarditis, as well as possible approaches for enhanced risk stratification in these patients. Moreover, also studies from the field of basic research, such as in vitro or animal models of inflammatory heart disease, are welcome to foster research on molecular pathways and cellular communication (e.g., proteomics, microRNA). We invite you to consider contributing a review article or research article on an aspect related to the topic of this Special Issue, hereby displaying your area of expertise in inflammatory heart diseases. Together, we can improve the clinical care of our patients.

Dr. Michael Lichtenauer
Dr. Moritz Mirna
Guest Editors

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Keywords

  • myocarditis
  • endocarditis 
  • inflammatory cardiomyopathy 
  • biomarkers 
  • heart failure

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Published Papers (7 papers)

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16 pages, 1000 KiB  
Article
Low Plasma Levels of Irisin Predict Acutely Decompensated Heart Failure in Type 2 Diabetes Mellitus Patients with Chronic Heart Failure
by Alexander A. Berezin, Anica Babic Obradovic, Ivan M. Fushtey, Tetiana A Berezina, Michael Lichtenauer and Alexander E Berezin
J. Cardiovasc. Dev. Dis. 2023, 10(4), 136; https://doi.org/10.3390/jcdd10040136 - 23 Mar 2023
Cited by 6 | Viewed by 2497
Abstract
The aim of this study was to determine the discriminative value of irisin for acutely decompensated heart failure (ADHF) in type 2 diabetes mellitus (T2DM) patients with chronic HF. We included 480 T2DM patients with any phenotype of HF and followed them for [...] Read more.
The aim of this study was to determine the discriminative value of irisin for acutely decompensated heart failure (ADHF) in type 2 diabetes mellitus (T2DM) patients with chronic HF. We included 480 T2DM patients with any phenotype of HF and followed them for 52 weeks. Hemodynamic performances and the serum levels of biomarkers were detected at the study entry. The primary clinical end-point was ADHF that led to urgent hospitalization. We found that the serum levels of N-terminal natriuretic pro-peptide (NT-proBNP) were higher (1719 [980–2457] pmol/mL vs. 1057 [570–2607] pmol/mL, respectively) and the levels of irisin were lower (4.96 [3.14–6.85] ng/mL vs. 7.95 [5.73–9.16] ng/mL) in ADHF patients than in those without ADHF. The ROC curve analysis showed that the estimated cut-off point for serum irisin levels (ADHF versus non-ADHF) was 7.85 ng/mL (area under curve [AUC] = 0.869 (95% CI = 0.800–0.937), sensitivity = 82.7%, specificity = 73.5%; p = 0.0001). The multivariate logistic regression yielded that the serum levels of irisin < 7.85 ng/mL (OR = 1.20; p = 0.001) and NT-proBNP > 1215 pmol/mL (OR = 1.18; p = 0.001) retained the predictors for ADHF. Kaplan–Meier plots showed a significant difference of clinical end-point accumulations in patients with HF depending on irisin levels (<7.85 ng/mL versus ≥7.85 ng/mL). In conclusion, we established that decreased levels of irisin were associated with ADHF presentation in chronic HF patients with T2DM independently from NT-proBNP. Full article
(This article belongs to the Special Issue Assessment of Prognosis in Myocarditis and Inflammatory Heart Disease)
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14 pages, 5219 KiB  
Article
Long COVID-19 Myocarditis and Various Heart Failure Presentations: A Case Series
by Justyna Rohun, Karolina Dorniak, Anna Faran, Anna Kochańska, Dariusz Zacharek and Ludmiła Daniłowicz-Szymanowicz
J. Cardiovasc. Dev. Dis. 2022, 9(12), 427; https://doi.org/10.3390/jcdd9120427 - 30 Nov 2022
Cited by 7 | Viewed by 3385
Abstract
(1) Background: Emerging data indicate that the ongoing COVID-19 pandemic may result in long-term cardiovascular complications, among which long COVID-19 myocarditis seems to be one of the most dangerous. Clinical presentation of cardiac inflammation ranges from almost asymptomatic to life-threatening conditions, including heart [...] Read more.
(1) Background: Emerging data indicate that the ongoing COVID-19 pandemic may result in long-term cardiovascular complications, among which long COVID-19 myocarditis seems to be one of the most dangerous. Clinical presentation of cardiac inflammation ranges from almost asymptomatic to life-threatening conditions, including heart failure (HF) in different stages. (2) Methods: This is a retrospective case-series study that includes three adults with different clinical presentations of heart failure on grounds of myocarditis after initial COVID-19 infection. (3) Results: All patients had new-onset symptomatic HF of various severity: from a moderately reduced left ventricular ejection fraction in one patient to significantly reduced fractions in the remaining two. Moreover, complex ventricular arrhythmias were present in one case. All patients had confirmed past myocarditis in cardiac magnetic resonance. With optimal medical treatment, cardiac function improved, and the symptoms subsided in all cases. (4) Conclusions: In COVID-19 patients, long COVID myocarditis may be one of the severe complications of this acute disease. The heterogeneity in clinical symptoms and a paucity of specific diagnostic procedures expose the patient to the significant risk of misdiagnosing and further HF development. Full article
(This article belongs to the Special Issue Assessment of Prognosis in Myocarditis and Inflammatory Heart Disease)
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8 pages, 2829 KiB  
Article
Tei Index Is a Useful Adjunctive Tool in the Diagnostic Workup of Patients with Acute Myocarditis
by Moritz Mirna, Lukas Schmutzler, Fabian Vogl, Albert Topf, Uta C. Hoppe and Michael Lichtenauer
J. Cardiovasc. Dev. Dis. 2022, 9(8), 283; https://doi.org/10.3390/jcdd9080283 - 22 Aug 2022
Cited by 4 | Viewed by 1840
Abstract
Background: Tei index (TI) is a combined myocardial performance index, which was found to be more sensitive for overall cardiac dysfunction than systolic or diastolic parameters alone. Currently, there is only limited evidence for this measure in the context of myocarditis. Thus, TI [...] Read more.
Background: Tei index (TI) is a combined myocardial performance index, which was found to be more sensitive for overall cardiac dysfunction than systolic or diastolic parameters alone. Currently, there is only limited evidence for this measure in the context of myocarditis. Thus, TI could add additional benefits to conventional diagnostic workup. Methods: TI of patients with myocarditis (n = 40), acute coronary syndrome (n = 29) and controls (n = 50) was retrospectively analyzed concerning its discriminatory ability for myocarditis. Results: TI was most pathological in patients with myocarditis (median 0.41 vs. 0.35 vs. 0.31, p < 0.0001). Its discriminatory ability was better than that of EF or E/e’ (AUCs: TI: 0.71, p < 0.0001; EF: 0.57, p = 0.112; E/e’: 0.64, p = 0.983), which was also verified in logistic regression analysis (B(SE) = 0.81(0.23), p = 0.0004). The association of TI with myocarditis remained significant even after correction for confounders in propensity score weighted analysis. Conclusions: The TI showed a better discriminatory ability for myocarditis than conventional echocardiographic parameters. Since TI is easily conducted, it might be a helpful adjunctive tool to supplement conventional diagnostic modalities in patients with suspected myocarditis. Full article
(This article belongs to the Special Issue Assessment of Prognosis in Myocarditis and Inflammatory Heart Disease)
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11 pages, 1015 KiB  
Article
Treatment with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Does Not Affect Outcome in Patients with Acute Myocarditis or Myopericarditis
by Moritz Mirna, Lukas Schmutzler, Albert Topf, Elke Boxhammer, Brigitte Sipos, Uta C. Hoppe and Michael Lichtenauer
J. Cardiovasc. Dev. Dis. 2022, 9(2), 32; https://doi.org/10.3390/jcdd9020032 - 19 Jan 2022
Cited by 11 | Viewed by 4010
Abstract
Background: Previous animal studies reported an association of non-steroidal anti-inflammatory drugs (NSAIDs) with adverse outcomes in acute myocarditis, which is why these drugs are currently not recommended in affected patients. In this retrospective case-control study, we sought to investigate the effects of NSAID [...] Read more.
Background: Previous animal studies reported an association of non-steroidal anti-inflammatory drugs (NSAIDs) with adverse outcomes in acute myocarditis, which is why these drugs are currently not recommended in affected patients. In this retrospective case-control study, we sought to investigate the effects of NSAID treatment in patients with acute myocarditis and myopericarditis to complement the available evidence. Method: A total of 114 patients with acute myocarditis were retrospectively enrolled. Demographical, clinical and laboratory data were extracted from hospital records. Patients who received NSAIDs (n = 39, 34.2%) were compared to controls. Follow-up on all-cause mortality was acquired for two years. Propensity score matching was additionally conducted to account for covariate imbalances between groups. Results: Treatment with NSAIDs was neither associated with a worse outcome (p = 0.115) nor with significant differences in left ventricular systolic function (p = 0.228) or in-hospital complications (p = 0.507). Conclusion: Treatment with NSAIDs was not associated with adverse outcomes in our study cohort. Together with the findings of previous studies, our results indicate that these drugs could be safely administered in patients with myocarditis and myopericarditis. Full article
(This article belongs to the Special Issue Assessment of Prognosis in Myocarditis and Inflammatory Heart Disease)
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9 pages, 8788 KiB  
Case Report
Perimyocarditis as First Manifestation of Systemic Lupus Erythematosus Successfully Treated with Heart Failure and Immunosuppressive Therapy
by Marina Ikić Matijašević, Petra Grubić Rotkvić, Zrinka Planinić, Lucija Ikić, Ines Zadro Kordić and Edvard Galić
J. Cardiovasc. Dev. Dis. 2023, 10(4), 134; https://doi.org/10.3390/jcdd10040134 - 23 Mar 2023
Viewed by 1875
Abstract
Systemic lupus erythematosus (SLE) myocarditis is presumed to be rare, but associated with adverse outcomes. If SLE diagnosis has not previously been established, its clinical presentation is often unspecific and difficult to recognize. Furthermore, there is a lack of data in the scientific [...] Read more.
Systemic lupus erythematosus (SLE) myocarditis is presumed to be rare, but associated with adverse outcomes. If SLE diagnosis has not previously been established, its clinical presentation is often unspecific and difficult to recognize. Furthermore, there is a lack of data in the scientific literature regarding myocarditis and its treatment in systemic immune-mediated diseases, leading to its late recognition and undertreatment. We present the case of a young woman whose first lupus manifestations included acute perimyocarditis, among other symptoms and signs that provided clues to the diagnosis of SLE. Transthoracic and speckle tracking echocardiography were helpful in detecting early abnormalities in the myocardial wall thickness and contractility while waiting for cardiac magnetic resonance. Since the patient presented with acute decompensated heart failure (HF), HF treatment was promptly started in parallel with immunosuppressive therapy, with a good response. In the treatment of myocarditis with heart failure, we were guided by the clinical signs, echocardiographic findings, biomarkers of myocardial stress, necrosis, and systemic inflammation, as well as markers of SLE disease activity. Full article
(This article belongs to the Special Issue Assessment of Prognosis in Myocarditis and Inflammatory Heart Disease)
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11 pages, 1035 KiB  
Systematic Review
From Streptococcal Pharyngitis/Tonsillitis to Myocarditis: A Systematic Review
by Lukas Schmutzler, Moritz Mirna, Uta C. Hoppe and Michael Lichtenauer
J. Cardiovasc. Dev. Dis. 2022, 9(6), 170; https://doi.org/10.3390/jcdd9060170 - 25 May 2022
Cited by 6 | Viewed by 8068
Abstract
(1) Background: Myocarditis following group A streptococcal pharyngitis and tonsillitis is a relatively rare medical condition. The aim of this systematic review was to identify specific ECG changes, laboratory parameters and signs, and symptoms associated with this disease. (2) Methods: A systematic literature [...] Read more.
(1) Background: Myocarditis following group A streptococcal pharyngitis and tonsillitis is a relatively rare medical condition. The aim of this systematic review was to identify specific ECG changes, laboratory parameters and signs, and symptoms associated with this disease. (2) Methods: A systematic literature review was performed in concordance with the current PRISMA guidelines, including the databases PubMed/MEDLINE, Web of Science, CDSR, CENTRAL, CCAs, EBM Reviews, and LILACS. Articles were included if they covered myocarditis after streptococcal pharyngitis/tonsillitis in humans. Exclusion criteria were rheumatic, autoimmune, or toxic myocarditis. (3) Results: Patients that developed myocarditis after group A streptococcal throat infection frequently presented with chest pain, elevated cardiac markers, and ST-segment elevations, making it a condition that shows more similarities to acute coronary syndrome than viral myocarditis. (4) Conclusions: Myocarditis after streptococcal pharyngitis and/or tonsillitis is a rather infrequently described disease; however, it is necessary to consider this condition when investigating streptococcal sore throat because it can be associated with severe adverse events for the individual patient. Full article
(This article belongs to the Special Issue Assessment of Prognosis in Myocarditis and Inflammatory Heart Disease)
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9 pages, 2481 KiB  
Case Report
Autoimmune Myocarditis and Arrhythmogenic Mitral Valve Prolapse: An Unexpected Overlap Syndrome
by Andrea Villatore, Simone Sala, Stefano Stella, Davide Vignale, Elena Busnardo, Antonio Esposito, Cristina Basso, Paolo Della Bella, Patrizio Mazzone and Giovanni Peretto
J. Cardiovasc. Dev. Dis. 2021, 8(11), 151; https://doi.org/10.3390/jcdd8110151 - 6 Nov 2021
Cited by 4 | Viewed by 3139
Abstract
Background: both myocarditis and mitral valve prolapse (MVP) are known uncommon causes of ventricular arrhythmias in young patients. Aim: to report the first clinical case of endomyocardial biopsy (EMB)-proven autoimmune myocarditis and associated arrhythmogenic MVP in a patient with recurrent ventricular fibrillation (VF) [...] Read more.
Background: both myocarditis and mitral valve prolapse (MVP) are known uncommon causes of ventricular arrhythmias in young patients. Aim: to report the first clinical case of endomyocardial biopsy (EMB)-proven autoimmune myocarditis and associated arrhythmogenic MVP in a patient with recurrent ventricular fibrillation (VF) episodes. Methods: myocarditis was diagnosed both by cardiac magnetic resonance (CMR) and EMB. Arrhythmogenic MVP was documented by transthoracic echocardiogram, CMR, and electroanatomical mapping of the trigger premature ventricular contractions (PVCs). Results: a 22-year-old woman underwent immunosuppressive therapy after EMB-proven diagnosis of autoimmune myocarditis with VF onset and early implantable cardioverter defibrillator (ICD) placement. Three years later, she experienced two VF recurrences and persistent PVCs, despite no signs of myocarditis recurrence. An echocardiogram revealed bileaflet MVP with high arrhythmic risk features. Finally, electroanatomical mapping and ablation of the trigger PVC were successfully performed. Conclusion: in patients with recurrent VF episodes despite evidence-based medical treatment for myocarditis, MVP should be considered as an alternative arrhythmogenic substrate, and warrants early ICD implant and PVC-targeted therapy. Full article
(This article belongs to the Special Issue Assessment of Prognosis in Myocarditis and Inflammatory Heart Disease)
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