Acute Perimyocarditis Research Articles

P92 PERIMYOCARDITIS AS FIRST MANIFESTATION OF DYSTHYROIDISM: AN UNUSUAL CASE

Abstract Thyroid and cardiovascular system are inextricably related and cardiovascular complications can occur in both subclinical and overt thyroid dysfunction. We report the case of a 42–year–old woman presenting with chest pain. She had a positive SARS–CoV–2 swab in June and she was hospitalised in suspicion of COVID–related pneumonia and pericarditis in July: treatment with ibuprofen and colchicine was started and patient was discharged. On July 26th, the patient came back to emergency department due to worsening chest pain and myalgias after therapy decalage. She had face edema and hoarse voice. 12–leads EKG was normal; echocardiography showed 8 mm pericardial effusion and normal ejection fraction. Blood testing revealed no inflammatory signs, a mild increase of Troponin (peak value 19.1 ng/L, n.v. 0–14) and a high value of CPK (peak value 2299 U/L, 464 U/L at time of discharge, n.v. 30–150). Moreover, she had a biohumoral profile of Hashimoto thyroiditis: severe hypothyroidism with increase in TSH levels (538 microU/ml peak value, 322 microU/ml at time of discharge, n.v. 0.27–4.2) and positivity to thyroid autoantibodies. The patient underwent a cardiac magnetic resonance imaging that was suggestive for acute perimyocarditis with biventricular diffuse myocardial edema, preserved biventricular function and mild–to–moderate pericardial effusion. Low dose L–T4 therapy was started together with liothyronine that was stopped after few days, once acceptable FT3 concentrations were obtained. At echocardiography control after 8 days, we registered a significant reduction of pericardial effusion (2 mm). Myocarditis is an inflammatory disease of the myocardium and it is predominantly mediated by viral infection. A rare cause of myocarditis is represented by dysthyroidism. In our case, the severe hypothyroidism seems to be the cause of myocardial and pericardial edema. The failure in diagnosis of this endocrinological disorder can determine a delay in specific therapy with possible serious cardiovascular manifestations. So, it would be reasonable to check the thyroid status of all patients presenting with myopericarditis, in the absence of another clearly identifiable aetiology. The role of to the prior SARS–CoV–2 infection in not certain in our case, but the quick recovery after specific endocrinological therapy suggests the low probability of perimyocarditis as SARS–CoV2 related manifestation.

COVID-19 a Possible Cause of Myocarditis and Pericarditis: About A Case

Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) is an unparalleled challenge for the healthcare community across the globe. Angiotensin-2 converting enzyme receptors play a central role in the pathogenesis of the virus. Disruption of this receptor results in cardiomyopathy, cardiac dysfunction, and heart failure. Pericarditis is described as another cause of morbidity in patients with COVID-19. The exact mechanisms of how SARS-CoV-2 can cause myocardial damage are not clearly understood. We report the case of a 72-year-old man presenting for 17 days with retrosternal chest pain suggestive of pericarditis associated with a dry cough and a decline in general condition. He has had exertional asthma and active smoking as a history. He is taken care of in the emergency room. His clinical examination found a patient hemodynamically and respiratory stable, afebrile with a normal somatic examination apart from crackling rales. The biological assessment shows an inflammatory syndrome with slightly increased troponins HS. The scan performed in the emergency room notes typical pulmonary involvement moderate to COVID-19 and low-abundance pericardial effusion confirmed by echocardiography. The COVID-19 nasopharyngeal smear was positive. We conclude in an acute peri-myocarditis with COVID-19. The clinical and biological outcome is rapidly favorable with colchicine.

Inflammation and Syndecan-4 Shedding from Cardiac Cells in Ischemic and Non-Ischemic Heart Disease

Circulating biomarkers reflecting cardiac inflammation are needed to improve the diagnostics and guide the treatment of heart failure patients. The cardiac production and shedding of the transmembrane proteoglycan syndecan-4 is upregulated by innate immunity signaling pathways. Here, we investigated the potential of syndecan-4 as a blood biomarker of cardiac inflammation. Serum syndecan-4 was measured in patients with (i) non-ischemic, non-valvular dilated cardiomyopathy (DCM), with (n = 71) or without (n = 318) chronic inflammation; (ii) acute myocarditis (n = 15), acute pericarditis (n = 3) or acute perimyocarditis (23) and (iii) acute myocardial infarction (MI) at day 0, 3 and 30 (n = 119). Syndecan-4 was investigated in cultured cardiac myocytes and fibroblasts (n = 6-12) treated with the pro-inflammatory cytokines interleukin (IL)-1β and its inhibitor IL-1 receptor antagonist (IL-1Ra), or tumor necrosis factor (TNF)α and its specific inhibitor infliximab, an antibody used in treatment of autoimmune diseases. The levels of serum syndecan-4 were comparable in all subgroups of patients with chronic or acute cardiomyopathy, independent of inflammation. Post-MI, syndecan-4 levels were increased at day 3 and 30 vs. day 0. IL-1Ra attenuated IL-1β-induced syndecan-4 production and shedding in vitro, while infliximab had no effect. In conclusion, syndecan-4 shedding from cardiac myocytes and fibroblasts was attenuated by immunomodulatory therapy. Although its circulating levels were increased post-MI, syndecan-4 did not reflect cardiac inflammatory status in patients with heart disease.

Abstract 10622: Association of Sustained Ventricular Arrhythmias and Increased Cardiac Metabolic Activity Mimicking Cardiac Sarcoidosis

Introduction: Cardiac sarcoidosis (CS) is increasingly diagnosed using 18F-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT). Patients with sustained ventricular tachycardia/fibrillation (VT/VF) and a positive FDG-PET/CT suggestive of CS often receive immunosuppressive therapy even in the absence of histologic documentation of non-caseating granulomas. Hypothesis: FDG-PET/CT performed early after sustained VT/VF can lead to increased myocardial FDG uptake mimicking CS. Methods: Consecutive patients with non-ischemic cardiomyopathy presenting with sustained VT/VF that underwent FDG-PET/CT immediately following the arrhythmic event were prospectively recruited. Patients with increased metabolic activity consistent with myocardial inflammation were followed. All patients received guideline-directed medical therapy, but without immunosuppressive therapy. Repeat FDG-PET/CT was performed ≥30 days after the last sustained VT/VF episode. Results: Six patients were enrolled with a mean age of 57.1 years (± 5.6), and a left ventricular ejection fraction of 47.5% (±14.8). Coronary artery disease and acute perimyocarditis were excluded. Initial presentation was electrical storm in 2 (33%), appropriate ICD or external shock in 3 (50%) and ATP in 1 (17%) case, respectively. Baseline FDG-PET/CT was performed a median 5.5 days (range 3-17) after sustained VT/VF termination. Distribution of metabolic activity was focal-multifocal in 4 (66%), focal-diffuse in 1 (17%) and focal in 1 (17%) case, respectively. Median SUVmax was 6.8 (range 4.9-18). No extracardiac metabolic foci were observed and histologic diagnosis of non-caseating granuloma could not be established in any patient. Repeat FDG-PET/CT (median after 139, range 38-448 days) showed complete FDG uptake regression in all patients. Final diagnosis of arrhythmogenic cardiomyopathy was made in all patients, and genetic testing was performed. Conclusion: Prolonged VT/VF episodes may result in increased myocardial FDG uptake, potentially leading to an overdiagnosis of CS. FDG-PET/CT to screen for CS should be performed at a VT/VF-free interval prior to immunosuppressive therapy.

Acute perimyocarditis following heterologous vaccination of CoronaVac and BNT162b2 SARS-CoV-2 vaccine in an elderly woman.

Acute perimyocarditis following heterologous vaccination of CoronaVac and BNT162b2 SARS-CoV-2 vaccine in an elderly woman.

Ulcerative colitis and acute perimyocarditis.

Ulcerative colitis and acute perimyocarditis.

646 Acute peri-myocarditis following COVID-19 Pfizer-Biontech vaccine second dose delivery in a male teenager: the good prognosis and unusual ECG

AimsMyocarditis due to COVID-19 mRNA vaccine is an uncommon side effect and the cases seem to have occurred predominantly in young adults under 30 years old. The estimated incidence is 12.6 cases per one million second dose m-RNA vaccine delivery.Methods and resultsA 17-years-old male was admitted at our department after 18 days COVID-19 Pfizer-BioNtech vaccine second dose delivery with persistent chest pain without respiratory symptoms and, ST-elevation and PR-depression in V3–V6 at the ECG on 3 August 2021. He had no history of heart disease. Physical examination didn’t show anything relevant except for mildly tachycardic heart sounds. In addition blood test showed increase in C-reactive protein, cardiac troponin and N-terminal-pro-B-type natriuretic peptide. An echocardiography showed widespread hypokinesia with reduced left ventricular ejection fraction and highly echogenic pericardium. During the first day cardiac magnetic resonance (CMR) was performed, which showed mild diffuse myocardial oedema on T2-weighted images and T2 mapping and two thin areas of delayed enhancement with non-ischaemic pattern in the lateral wall with involvement of the pericardial sheets confirming peri-myocarditis diagnosis. After 24 h, the ECG showed spread and deep T-waves with QTc prolongation. We performed multiple ECG during the days after to assess morphology changes and QTc. The patient has been asymptomatic for all the hospitalization and on day 7 was performed an echocardiography which describe a full recovery in terms of kinesia and left ventricular ejection fraction. He was discharged asymptomatic with ‘better’ but still negative T-waves and QTc normalization. Two months after discharge CMR was repeated and showed normal left ventricular function without myocardial oedema and pericardial involvement, but with persistent the areas of delayed enhancement with non-ischaemic pattern in the lateral wall.ConclusionsIn this case report we describe an uncommon COVID-19 m-RNA Vaccine side effect. The first issue is the timing of presentation. On 19 July 2021, AIFA stated that myocarditis is a very uncommon side effect and it usually presents within 14 days after 2nd dose delivery. Our patient was admitted at our department after that time period, probably because we reported the ending part of the myocarditis presented with symptoms of pericarditis; indeed we didn’t report the cardiac troponin plateau but only the descending cardiac troponin wave and we attend a very quick recovery. The second issue in the unique ECG with a very quick evolution (Tako-Tsubo morphology like) which could be characteristic of this kind of Myocarditis. Third, the good progress of the inflammation and quick recovery. Surely is a serious side effect but it’s still less frequent and with better prognosis than COVID-19 Myocarditis. European Medicines Agency (EMA) and Centers for Disease Control and Prevention (CDC) recently stated authorized COVID-19 vaccines advantages are still above risks in all age groups beyond 12 y/o. Why is myocarditis a side effect, Why are adolescent males affected the most and Why is the onset after second dose of m-RNA vaccine are questions still unanswered.

The role of multimodality imaging in diagnosing acute perimyocarditis secondary to Crohn\u2019s disease

BackgroundAcute perimyocarditis is a rare extra-intestinal manifestation in Crohn’s disease which required multimodality imaging to confirm the diagnosis. Here we present a case of acute perimyocarditis as the first presentation of Crohn’s disease. To date, this is the first case presentation reporting the use of 18F-FDG PET/CT Scan for diagnosing such condition.Case presentationA 25-year-old male presented to our hospital with severe persistent pleuritic sharp left-sided chest pain. This was his second hospital admission in the past 4 months for chest pain and diarrhea. At the first hospitalization, he was diagnosed with viral perimyocarditis and irritable bowel syndrome. Laboratory findings, electrocardiogram, and cardiac magnetic resonance imaging results confirm the diagnostic of perimyocarditis. Virology, bacteriology, parasitology, and autoimmune evaluations were unremarkable. Colonoscopy, colorectal biopsy, and 18FGD PET findings confirmed manifestation of perimyocarditis, Crohn’s disease, and negative for sarcoidosis.ConclusionsLooking at the overall clinical picture and investigation results of colonoscopy, colorectal biopsy findings, as well as multi-modality imaging with echocardiography, 18FDG PET—scan and CMRI, the patient was diagnosed to have perimyocarditis attending Chron’s disease flare up as a rare extra-intestinal manifestation.

Acute Perimyocarditis Following First Dose of mRNA Vaccine Against COVID-19.

Acute Perimyocarditis Following First Dose of mRNA Vaccine Against COVID-19.

ACHY BREAKY HEART

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Acute pericarditis accounts for about 5% of presentations of acute chest pain. Of those cases of pericarditis an etiology is found in about 22% of cases. Etiologies commonly include neoplasms, tuberculosis, infections, collagen diseases and thyroid disorders. CASE PRESENTATION: Our patient is a 16 year old healthy female that presented to the hospital with six days of fever, sore throat, cough, pleuritic chest pain and progressive dyspnea. She was sent to the emergency department (ED) by her pediatrician due hypotension. Upon arrival her blood pressure (BP) while supine was 70/40 and 50/30 with standing, with a heart rate (HR) of 121 bpm. In the ED she received 3 liters of normal saline. On admission BP was 107/63, HR 90, respiratory rate 33 and oxygen saturation was 80% on room air. The patient appeared drowsy. Her hands were cold and her lower extremities were warm; capillary refill was 4 seconds. Cardiovascular exam was normal with no pericardial friction rub. Lung exam was significant for diffuse inspiratory and expiratory crackles and decreased breath sounds at the left lung base. Initial laboratory work was significant for hemoglobin 10.5 g/dl, Sodium 128 mEq/L, creatinine 1.3 mg/dl, AST 129 U/L, ALT 72 U/L and Albumin 2.7 gm/dl. Troponin peaked at 0.682 ng/ml. BNP 141 pg/ml. Electrocardiogram showed nonspecific T wave abnormalities. Respiratory viral panel and rapid strep were negative. Chest radiograph showed patchy left lower lobe airspace disease that progressed bilaterally within 24 hours. Initial echo showed normal biventricular function with trivial pericardial effusion. She was diagnosed with acute perimyocarditis and treated with Ketorolac and IV Furosemide. Over her hospital course her respiratory distress worsened and she developed a moderate to large pericardial effusion 2 days after her initial echo. Work up included positive ANA (1:5120, speckled pattern), positive lupus anticoagulant, smith antibody and RNP antibody. Our patient was diagnosed with lupus (SLE) pericarditis and she was treated with high dose Methylprednisolone and Hydroxychloroquine which improved her pericardial effusion. DISCUSSION: This is a case of a female diagnosed with SLE perimyocarditis with pericardial effusion. This patient did not initially meet criteria for lupus, but by the end of her hospital course she met 4/11 criteria. Cardiac disease is rarely a presenting manifestation of SLE and only 1% of cases of SLE, in children and adults, present with pericarditis. While it is rare to present with cardiac symptoms, most patient with SLE develop cardiovascular manifestations at some point. Asymptomatic pericarditis is found in >50% of patients with SLE. Myocarditis, endocarditis and CAD are rare manifestations. CONCLUSIONS: This case highlights the importance of having a high index of suspicion for lupus in a patient that is not responding to initial treatment for viral myocarditis. Reference #1: Ansari, A., Larson, P. H., & Bates, H. D. (1985). Cardiovascular manifestations of systemic lupus erythematosus: Current perspective. Progress in Cardiovascular Diseases, 27(6), 421–434. doi: 10.1016/0033-0620(85)90003-9 Reference #2: Zayas, R., Anguita, M., Torres, F., Gime´nez, D., Bergillos, F., Ruiz, M., … Valle´s, F. (1995). Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. The American Journal of Cardiology, 75(5), 378–382. doi: 10.1016/s0002-9149(99)80558-x Reference #3: Durrance, R. J., Movahedian, M., Haile, W., Teller, K., & Pinsker, R. (2019). Systemic Lupus Erythematosus Presenting as Myopericarditis with Acute Heart Failure: A Case Report and Literature Review. Case Reports in Rheumatology, 2019, 1–7. doi: 10.1155/2019/6173276 DISCLOSURES: No relevant relationships by Alejandra Grana, source=Web Response

Une périmyocardite révélatrice d’une granulomatose éosinophilique avec polyangéite : une nouvelle observation

Churg-Strauss syndrome (CSS) or eosinophilic granulomatosis with polyangiitis is a systemic vasculitis characterized by necrotizing arteritis, eosinophilic infiltration and extravascular granuloma; that may involve several organs. Cardiac involvement is the first cause of death in this vasculitis. These include myocarditis, pericarditis, coronary heart disease, dysrhythmias, and rarely valvular involvement. We report the observation of CSS revealed by acute perimyocarditis.

P612Multimodal cardiac imaging in patients with suspected ST-elevation myocardial infarction and no obstructive coronary arteries

Abstract Background Patients with suspected ST-elevation myocardial infarction (STEMI) and normal coronary arteries comprise a heterogeneous group with various underlying causes of disease. Purpose To study pathophysiology and underlying diagnoses in patients with suspected STEMI and normal coronary arteries using multimodal cardiac imaging. Methods We consecutively included patients with suspected STEMI, normal coronary arteries on acute coronary angiography, and elevated troponin T levels at a tertiary heart center (2012–14). Patients were examined with echocardiography, cardiac magnetic resonance imaging, and 13NH3/82Rb and 18F-FDG positron emission tomography within one week from symptom onset. Results We included 42 patients (60% male, median age 58 (IQR 50–65) years. Median troponin T levels were 783 (IQR 566–1208) ng/l. Multimodal cardiac imaging findings are presented in Table 1. Multimodal cardiac imaging showed signs of cardiac involvement in all but one patient (98%). Underlying diagnoses were acute myocardial infarction (36%), Takotsubo cardiomyopathy (29%), perimyocarditis (10%), and cardiomyopathy (7%). The diagnosis was unclear in 19% of patients. Echocardiography Left ventricular ejection fraction <40%, n (%) 12 (29) Moderate to severe left ventricular hypertrophy, n (%) 3 (7) Moderate to severe valvular disease, n (%) 3 (7) Pericardial effusion, n (%) 5 (12) Apical thrombus, n (%) 1 (2) Magnetic resonance imaging Left ventricular end diastolic volume, ml (IQR) 157 (125–185) Left ventricular end systolic volume, ml (IQR) 75 (63–88) Left ventricular stroke volume, ml (IQR) 73 (57–93) Edema, n (%) 38 (91) Late gadolinium enhancement, n (%) 22 (52) 13NH3/82Rb and 18F-FDG positron emission computer tomography Myocardial perfusion defect, n (%) 29 (69) Myocardial perfusion-metabolism mismatch, n (%) 12/30 (40) Reduced myocardial viability, n (%) 6/30 (20) Conclusion The majority of patients with suspected STEMI and normal coronary arteries had signs of cardiac involvement by multimodal cardiac imaging and were diagnosed with cardiac disease. Acknowledgement/Funding The Danish Heart Foundation, the A.P. Møller Foundation, the Foundation of Reinholdt W. Jorck and Wife, Rigshospitalet's Research Foundation

Myocardial strain assessed by feature tracking cardiac magnetic resonance in patients with a variety of cardiovascular diseases \u2013 A comparison with echocardiography

Myocardial deformation assessed by speckle tracking echocardiography (STE) is increasingly used for diagnosis, monitoring and prognosis in patients with clinical and pre-clinical cardiovascular diseases. Feature tracking cardiac magnetic resonance (FT-CMR) also allows myocardial deformation analysis. To clarify whether the two modalities can be used interchangeably, we compared myocardial deformation analysis by FT-CMR with STE in patients with a variety of cardiovascular diseases and healthy subjects. We included 40 patients and 10 healthy subjects undergoing cardiac magnetic resonance and echocardiographic examination for left ventricular volumetric assessment. We studied patients with heart failure and reduced ejection fraction (n = 10), acute perimyocarditis (n = 10), aortic valve stenosis (n = 10), and previous heart transplantation (n = 10) by global longitudinal (GLS), radial (GRS) and circumferential strain (GCS). Myocardial deformation analysis by FT-CMR was feasible in all but one participant. While GLS, GRS and GCS measured by FT-CMR correlated overall with STE (r = 0.74 and p < 0.001, r = 0.58 and p < 0.001, and r = 0.76 and p < 0.001), the correlations were not consistent within subgroups. GLS was systematically lower, whereas GRS and GCS were higher by FT-CMR compared to STE (p = 0.04 and p < 0.0001). Inter- and intra-observer reproducibility were comparable for FT-CMR and STE overall and across subgroups. In conclusion, myocardial deformation can be evaluated using FT-CMR applied to routine cine-CMR images in patients with a variety of cardiovascular diseases. However, correlation between FT-CMR and STE was modest and agreement was not optimal due to systematic bias regarding GLS and GCS. Consequently, FT-CMR and STE should not be used interchangeably for myocardial strain evaluation.

Original research. Regional Wall Motion Abnormalities and Ventricular Function in Acute Peri-Myocarditis

Abstract Introduction: Myocardial involvement in pericardial diseases and the effect of pericardial inflammation and effusion on the function of the left ventricle (LV) is still a controversial issue. The present study aimed to evaluate LV regional wall abnormalities in patients with acute peri-myocarditis, using 3D echocardiographic assessment of LV contractility. Material and methods: The study included 56 subjects divided into two groups: Group 1 - 28 subjects with acute peri-myocarditis and Group 2 - 28 healthy controls. All subjects underwent a complete clinical examination, including laboratory tests. 3D echocardiography was performed to assess the left ventricular end-diastolic (EDV) and end-systolic volumes (ESV), and to calculate specific indexes for global and regional ventricular contractility, such as the index of contraction amplitude (ICA) and the regional index of contraction amplitude (RICA) for each segment corresponding to the region affected by peri- myocarditis. Results: 3D echocardiography showed no differences between the groups regarding the EDV (p = 0.2), the LV ejection fraction (Group 1: 55.82% ± 3.36% vs. Group 2: 57.21% ± 4.69%, p = 0.2). The ESV however, was significantly higher in Group 1 compared to Group 2 (55.78 ± 5.45 ml vs. 52.20 ± 6.43 ml, p = 0.04). ICA was similar between the groups (p = 0.2). However, the RICA was significantly lower in Group 1 compared to Group 2 (2.27 ± 0.63 vs. 5.16 ± 0.54, p &lt;0.0001). Conclusions: The extension of the inflammatory process from the pericardium to the adjacent myocardial layer may affect the contractility of the LV. A good association exists between peri-myocarditis and the regional contractility abnormalities of the LV.

Clozapine-Induced Perimyocarditis

Atypical antipsychotic drugs are widely used in the treatment of schizophrenia due to their higher efficacy and better side-effect profile compared with traditional antipsychotic drugs. However, serious cardiac toxicity of these drugs can occur, and if not recognized early, can be fatal. In this report, we present a case of acute perimyocarditis following the initiation of Clozapine, a frequently used atypical antipsychotic drug, for the treatment of refractory schizophrenia, which completely resolved after the discontinuation of this drug. Key words: Clozapine, Atypical antipsychotic drug, Perimyocarditis.

“Troponin Elevation in Coronary Ischemia and Necrosis”

Detection of a rise and/or fall of cardiac troponin (cTn) is the cornerstone in the diagnosis of myocardial infarction (MI). For the acute risk, it is hypothesized that cTn mirrors activated coagulation and platelet reactivity and indicates the presence of a ruptured plaque, which may help to identify patients at high risk who benefit particularly from aggressive pharmacological treatment and early invasive strategy. High-sensitivity assays using the 99th percentile as the threshold for positivity can achieve sensitivity at presentation of 90 % or more, and performance further improves with subsequent measurements within 3 to 6 h. By 3 h, negative predictive values of almost 100 % have been reported. However, use of assays with higher sensitivity lead ultimately to a loss of clinical specificity. Thus, other conditions than MI, such as stroke, pulmonary embolism, sepsis, acute perimyocarditis, Takotsubo, acute heart failure and tachycardia also can go with elevated troponin levels. The detection of brief rise and subsequent fall of troponin concentration in marathon runners, and even in healthy subjects, after a standardized exercise test has cast doubts on the hypothesis that troponin is released only upon irreversible damage. This kind of troponin leakage may originate from a cytosolic compartment of the cells and not from the necrosis of thin filaments.

症例 Mycoplasma Pneumoniae肺炎に合併した心膜心筋炎の2例

症例 Mycoplasma Pneumoniae肺炎に合併した心膜心筋炎の2例

Left ventricular function in acute inflammatory peri-myocardial diseases – new insights and long-term follow-up

BackgroundUntil recently acute inflammatory peri-myocardial syndromes have been associated with global rather regional left ventricular (LV) dysfunction. Recent advances in cardiac imaging with echocardiographic techniques and magnetic resonance imaging (MRI) permit comprehensive evaluation of global and regional LV function. Our study was aimed to assess regional LV function in 100 patients with acute perimyocarditis, and correlate these findings with the clinical presentation.MethodsWe report on 100 patients with acute perimyocarditis admitted during 2008–2011, in whom LV function was assessed by semi-quantitative wall motion score analysis on conventional echo. Long-term mortality and recurrent hospitalization were also assessed.ResultsWall motion score in 100 patients with acute perimyocarditis demonstrated a significant predominance of regional wall motion abnormalities in the infero-postero-lateral LV wall. These data correspond well with speckle tracking results of a subgroup of these patients published earlier. Recent MRI data show frequent late enhancement of contrast in the infero-lateral region of the LV in patients with perimyocarditis. These observations were useful in re-classification of our patients into one of the following groups: pure or predominant pericarditis, and pure or predominant myocarditis. Over a mean period of 37 months, there was no mortality. Though recurrent hospitalizations were rather frequent, no significant differences were observed among groups.ConclusionsRegional wall motion abnormalities in the infero-postero-lateral segments of the LV are frequent in patients with acute perimyocarditis. Detailed echocardiographic examination early in the course of the disease should become a major factor in the clinical differentiation among the various clinical presentations of acute inflammatory peri-myocardial syndromes. The long-term outcome of these patients appears to be benign, though recurrent hospitalizations are not infrequent.

IL-33 Independently Induces Eosinophilic Pericarditis and Cardiac Dilation

Background— IL-33 through its receptor ST2 protects the heart from myocardial infarct and hypertrophy in animal models but, paradoxically, increases autoimmune disease. In this study, we examined the effect of IL-33 or ST2 administration on autoimmune heart disease. Methods and Results— We used pressure-volume relationships and isoproterenol challenge to assess the effect of recombinant (r) IL-33 or rST2 (eg, soluble ST2) administration on the development of autoimmune coxsackievirus B3 myocarditis and dilated cardiomyopathy in male BALB/c mice. The rIL-33 treatment significantly increased acute perimyocarditis ( P =0.006) and eosinophilia ( P =1.3×10 −5 ), impaired cardiac function (maximum ventricular power, P =0.0002), and increased ventricular dilation (end-diastolic volume, P =0.01). The rST2 treatment prevented eosinophilia and improved heart function compared with rIL-33 treatment (ejection fraction, P =0.009). Neither treatment altered viral replication. The rIL-33 treatment increased IL-4, IL-33, IL-1β, and IL-6 levels in the heart during acute myocarditis. To determine whether IL-33 altered cardiac function on its own, we administered rIL-33 to undiseased mice and found that rIL-33 induced eosinophilic pericarditis and adversely affected heart function. We used cytokine knockout mice to determine that this effect was due to IL-33-mediated signaling but not to IL-1β or IL-6. Conclusions— We show for the first time to our knowledge that IL-33 induces eosinophilic pericarditis, whereas soluble ST2 prevents eosinophilia and improves systolic function, and that IL-33 independently adversely affects heart function through the IL-33 receptor.

Speckle Tracking Imaging in Acute Inflammatory Pericardial Diseases

Left ventricular (LV) function in acute perimyocarditis is variable. We evaluated LV function in patients with acute perimyocarditis with speckle tracking. Thirty-eight patients with acute perimyocarditis and 20 normal subjects underwent echocardiographic examination. Three-layers strain and twist angle were assessed with a speckle tracking. Follow-up echo was available in 21 patients. Strain was higher in normal subjects than in patients with perimyocarditis. Twist angle was reduced in perimyocarditis--10.9° ± 5.4 versus 17.6° ± 5.8, P < 0.001. Longitudinal strain and twist angle were higher in normal subjects than in patients with perimyocarditis and apparently normal LV function. Follow-up echo in 21 patients revealed improvement in longitudinal strain. Patients with acute perimyocarditis have lower twist angle, longitudinal and circumferential strain. Patients with perimyocarditis and normal function have lower longitudinal strain and twist angle. Short-term follow-up demonstrated improvement in clinical parameters and longitudinal strain despite of residual regional LV dysfunction.