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| 1 | A life support-based comprehensive treatment regimen dramatically lowers the in-hospital mortality of patients with fulminant myocarditis: a multiple center study显示文摘Fulminant myocarditis(FM) has unacceptable high mortality. This study aimed to evaluate the therapeutic efficacy of a life support-based comprehensive treatment regimen(LSBCTR), a completely novel treatment regimen, for FM. A total of 169 FM patients recruited from January 2008 to December 2018 were divided into two groups: patients receiving LSBCTR(81 cases),which includes(i) mechanical life support(positive pressure respiration, intra-aortic balloon pump with or without extracorporeal membrane oxygenation),(ii) immunomodulation therapy using sufficient doses of glucocorticoids and immunoglobulins, and(iii) application of neuraminidase inhibitors, and those receiving conventional treatment(88 cases). The endpoints were in-hospital death and heart-transplantation. Of all the population, 44 patients(26.0%) died in hospitals. Inhospital mortality was 3.7%(3/81) for LSBCTR group and 46.6%(41/88) for traditional treatment(P<0.001). Early application of LSBCTR, mechanical life support, neuraminidase inhibitors, and immunomodulation therapy significantly contributed to reduction in in-hospital mortality. This study describes a novel treatment regimen for FM patients that dramatically reduces inhospital mortality. Its generalization and clinical application will efficiently save lives although further optimization is needed.This study offers an insight that virus infection induced inflammatory waterfall results in cardiac injury and cardiogenic shock and is the therapeutic target. | Sheng Li Shengyong Xu Chenze Li Xiao Ran Guanglin Cui Mengying He Kun Miao Chunxia Zhao Jiangtao Yan Rutai Hui Ning Zhou Yan Wang Jiangang Jiang Jing Zhang Daowen Wang | 2019 | Science China(Life Sciences)2019，62，3： | 43 |
| 2 | Chinese expert consensus statement on the diagnosis and treatment of fulminant myocarditis显示文摘Fulminant myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock,with mortality rates as high as 50%–70%. Most importantly, there are no treatment options, guidelines or an expert consensus statement. Here, we provide the first expert consensus, the Chinese Society of Cardiology Expert Consensus Statement on the Diagnosis and Treatment of Fulminant Myocarditis, based on data from our recent clinical trial(NCT03268642). In this statement, we describe the clinical features and diagnostic criteria of fulminant myocarditis, and importantly, for the first time,we describe a new treatment regimen termed life support-based comprehensive treatment regimen. The core content of this treatment regimen includes(i) mechanical life support(applications of mechanical respirators and circulatory support systems,including intraaortic balloon pump and extracorporeal membrane oxygenation),(ii) immunological modulation by using sufficient doses of glucocorticoid, immunoglobulin and(iii) antiviral reagents using neuraminidase inhibitor. The proper application of this treatment regimen may and has helped to save the lives of many patients with fulminant myocarditis. | Daowen Wang Sheng Li Jiangang Jiang Jiangtao Yan Chunxia Zhao Yan Wang Yexin Ma Hesong Zeng Xiaomei Guo Hong Wang Jiarong Tang Houjuan Zuo Li Lin Guanglin Cui Section of Precision Medicine Group of Chinese Society of Cardiology,Editorial Board of Chinese Journal of Cardiology &Working Group of Adult Fulminant Myocarditis | 2019 | Science China(Life Sciences)2019，62，2： | 18 |
| 3 | 病毒性心肌炎的进展显示文摘病毒性心肌炎的病原虽在50年代已获证明。但得到广泛的承认还有一个过程,最初发现是新生儿。50年代欧洲学者认为这主要是婴幼儿的疾病。到1959年Null首次报道了成人的病毒性心肌炎、心包炎。60年代国外报道渐多。近十余年美国和日本进行了较多研究。国内70年代后期作为一个重点课题进行研究。80年代初期内科开始重视此病,下面就80年代以来国内外进展进行介绍。 | 李家宜 | 1990 | 医学临床研究1990，13，S1： | 15 |
| 4 | Impact of mechanical circulatory support and immunomodulation therapy on outcome of patients with fulminant myocarditis: Chinese registry of fulminant myocarditis显示文摘Dear Editor,Patients presenting with acute myocarditis and sudden hemodynamic instability (termed fulminant myocarditis [FM]) still have a high mortality and need for heart transplantation, up to 28% at 60 days.1,2,3 Recent scientific statements and expert opinion consensus suggests early use of temporary mechanical circulatory supports (t-MCS).3,4 Specifically, Chinese scientific statement proposed an extensive use of t-MCS combined with immunoregulatory therapy (IT),4 although formal trials are lacking. We present a multicenter, retrospective study to compare the outcome of patients who were treated with t-MCS and IT vs. patients who didn’t receive these treatments. We included patients with the diagnosis of FM based on the presence of viral prodromal signs/symptoms followed by acute onset of severe heart failure (HF) without other relevant differential diagnosis or pre-existing cardiac disorders. Patients who received both t-MCS and IT during hospitalization were classified as t-MCS+IT group. | Ning Zhou Yuhua Zhao Jiangang Jiang Lan Shen Junming Li Jing Wan Xueping Ma Jing Zhang Enrico Ammirati Dao Wen Wang | 2021 | Signal Transduction and Targeted Therapy2021，6，11： | 14 |
| 5 | Abnormal metabolism of nitric oxide, oxidative stress and lipoperoxidative stress in patients with acute viral myocarditis显示文摘Objective To investigate metabolic status of nitric oxide (NO) as well as oxidative and lipoperoxidative stress, pathological chain reactions of a series of free radicals, and oxidative and lipoperoxidative damages in patients with acute viral myocarditis (AVM)、 Methods Using a random paired control design, plasma levels of NO, lipoperoxides (LPO), vitamin C (VC), vitamin E (VE) and β-carotene (β-CAR), erythrocytic level of LPO as well as activities of erythrocytic superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) were investigated by spectrophotometric assays in 60 AVM patients and 60 healthy adult volunteers (HAV)、 Results Compared with the HAV group, plasma NO, and LPO in plasma and in erythrocyte of the AVM group significantly increased (P=0、0001), while VC, VE, β-CAR, SOD, CAT and GSH-Px of the AVM group significantly decreased (P=0、0001)、 Compared with the AVM group before treatment, plasma NO, and LPO in plasma and in erythrocyte of the AVM group post treatment significantly decreased (P<0、05), whereas plasma VC, VE and β-CAR as well as erythrocytic SOD, CAT and GSH-Px of the AVM group post treatment significantly increased (P<0、05)、Conclusion The findings in this study suggested that in the AVM patients the metabolism of NO was disturbed, and the pathological chain reactions of a series of free radicals were severely aggravated, thus produced the oxidative damage and lipoperoxidative damages、 Therefore, we recommend that antioxidants at suitable dosage, such as VC, VE, β-CAR and others, should be given to AVM patients daily to alleviate potential oxidative and lipoperoxidative damages in their | 陈鹏 周君富 | 2001 | Chinese Medical Journal2001，，11： | 11 |
| 6 | Clinical presentation and early predictors for poor outcomes in pediatric myocarditis:A retrospective study显示文摘BACKGROUND Myocarditis is an important cause of morbidity and mortality in children, leading to long-term sequelae including chronic congestive heart failure, dilated cardiomyopathy, heart transplantation, and death. The initial diagnosis of myocarditis is usually based on clinical presentation, but this widely ranges from the severe sudden onset of a cardiogenic shock to asymptomatic patients. Early recognition is essential in order to monitor and start supportive treatment prior to the development of severe adverse events. Of note, many cases of fulminant myocarditis are usually misdiagnosed as otherwise minor conditions during the weeks before the unexpected deterioration.AIM To provide diagnostic clues to make an early recognition of pediatric myocarditis.To investigate early predictors for poor outcomes.METHODS We conducted a retrospective cross-sectional single-center study from January 2008 to November 2017 at the Pediatric Department of our institution, including children < 18-years-old diagnosed with myocarditis. Poor outcome was defined as the occurrence of any of the following facts: death, heart transplant, persistent left ventricular systolic dysfunction or dilation at hospital discharge(early poor outcome), or after 1 year of follow-up(late poor outcome). We analyzed different clinical features and diagnostic test findings in order to provide diagnostic clues for myocarditis in children. Multivariable stepwise logistic regression analysis was performed using all variables that had been selected by univariate analysis to determine independent factors that predicted a poor early or late outcome in our study population.RESULTS A total of 42 patients [69% male; median age of 8(1.5-12) years] met study inclusion criteria. Chest pain(40%) was the most common specific cardiac symptom. Respiratory tract symptoms(cough, apnea, rhinorrhea)(38%),shortness of breath(35%), gastrointestinal tract symptoms(vomiting, abdominal pain, diarrhea)(33%), and fever(31%) were the most common non-cardiac initial complaints. Tachycardia(57%) and tachypnea(52%) were the most common signs on the initial physical exam followed by nonspecific signs of respiratory tract infection(44%) and respiratory distress(35%). Specific abnormal signs of heart failure such as heart murmur(26%), systolic hypotension(24%), gallop rhythm(20%), or hepatomegaly(20%) were less prevalent. Up to 43% of patients presented an early poor outcome, and 16% presented a late poor outcome. In multivariate analysis, an initial left ventricular ejection fraction(LVEF) < 30%remained the only significant predictor for early [odds ratio(OR)(95%CI) = 21(2-456), P = 0.027) and late [OR(95%CI) = 8(0.56-135), P = 0.047) poor outcome in children with myocarditis. LVEF correlated well with age(r = 0.51, P = 0.005),days from the initiation of symptoms(r =-0.31, P = 0.045), and N-terminal probrain natriuretic peptide levels(r = 0.66, P < 0.001), but not with troponin T(r =-0.05, P = 0.730) or C-reactive protein levels(r =-0.13, P = 0.391). N-terminal probrain natriuretic peptide presented a high diagnostic accuracy for LVEF < 30% on echocardiography with an area under curve of 0.931(95%CI: 0.858-0.995, P <0.001). The best cut-off point was 2000 pg/mL with a sensitivity of 90%,specificity of 81%, positive predictive value of 60%, and negative predictive value of 96%.CONCLUSION The diagnosis of myocarditis in children is challenging due to the heterogeneous and unspecific clinical presentation. The presence of LVEF < 30% on echocardiography on admission was the major predictor for poor outcomes.Younger ages, a prolonged course of the disease, and N-terminal pro-brain natriuretic peptide levels could help to identify these high-risk patients. | Moises Rodriguez-Gonzalez Maria Isabel Sanchez-Codez Manuel Lubian-Gutierrez Ana Castellano-Martinez | 2019 | World Journal of Clinical Cases2019，7，5： | 11 |
| 7 | Fulminant myocarditis:a comprehensive review from etiology to treatments and outcomes显示文摘Fulminant myocarditis(FM)is characterized by a rapid progressive decline in cardiac function and a high mortality rate.Since the first report of FM patients in the 1980s,several clinical trials and research studies have been published increasing our knowledge regarding FM.Currently,the diagnosis of FM depends on various techniques including electrocardiography,echocardiography,endomyocardial biopsy,and cardiac magnetic resonance.The development of mechanical circulation support(MCS)devices and progress in our understanding of the pathophysiological mechanisms underlying FM,treatment regimens have evolved from simple symptomatic treatment to a life support-based comprehensive treatment approach.The core mechanism underlying the development of FM is the occurrence of an inflammatory cytokine storm.This review provides a comprehensive account of the current understanding of FM pathophysiology and knowledge regarding its etiology,pathophysiology,treatments,and outcomes. | Weijian Hang Chen Chen John M.Seubert Dao Wen Wang | 2020 | Signal Transduction and Targeted Therapy2020，5，1： | 8 |
| 8 | China's treatment regimen for fulminant myocarditis is bringing wonderful achievement to the world显示文摘Fulminant myocarditis is characterized by acute and severe inflammation with injury of myocardium globally. It has a fulminant course and high in-hospital mortality rate of up to50%-70%. It onsets rapidly after viral infection and progresses to hypotension. | Jing Zhang Weijian Hang Rutai Hui Qiong Zhao Shashank S.Desai | 2019 | Science China(Life Sciences)2019，62，2： | 8 |
| 9 | An improved protocol for the treatment of fulminant myocarditis显示文摘Fulminant myocarditis is a rare form of severe myocarditis that is most commonly caused by viral infection.Fulminant myocarditis is often pathophysiologically indistinguishable from milder forms of acute myocarditis but is categorically defined based on clinical disease progression.Patients may initially present with mild symptoms,such as fever,shortness of breath or heart palpitations,but rapidly progress to severe respiratory distress,arrhythmias,and cardiogenic shock. | Matthew L.Edin Darryl C.Zeldin | 2019 | Science China(Life Sciences)2019，62，3： | 7 |
| 10 | Myocarditis presenting as typical acute myocardial infarction: A case report and review of the literature显示文摘BACKGROUND Myocarditis refers to a variety of myocardial inflammatory lesions. A variety of factors such as infection and physical and chemical factors can cause myocarditis.Depending on the severity of myocardial damage, myocarditis patients can manifest heart failure, cardiogenic shock, and even sudden death. Here we present a case of viral myocarditis that mimicked acute coronary syndrome.CASE SUMMARY A middle-aged male patient presented with chest pain and elevated troponin I after a flu-like infection. This patient had a history of hypertension and a habit of alcohol and tobacco use. Electrocardiography showed typical changes in acute myocardial infarction, with the T-wave increasing. Coronary angiogram revealed no stenosis. Cardiac magnetic resonance imaging revealed edema of the middle and apical septal and apical anterior walls on T2-weighted images and the T1 mapping. Late gadolinium enhancement of the middle and apical septal and apical anterior walls could be found. Rubella virus immunoglobulin G and immunoglobulin M antibodies were abnormally elevated. The patient was given antiviral and antibiotic treatments, and serum biomarkers and electrocardiograph returned to normal after 5 d of treatment. After one-year follow-up, the patient showed no symptoms, and cardiac magnetic resonance showed that myocardial thickness was significantly thinner than before, and fibrosis was less than before.CONCLUSIONThis case illustrates the utility of cardiac magnetic resonance for diagnosis of infarction-like myocarditis when the angiogram is normal. | Ya-Min Hou Peng-Xi Han Xia Wu Jing-Ru Lin Fei Zheng Lin Lin Rui Xu | 2020 | World Journal of Clinical Cases2020，8，2： | 6 |
| 11 | CMR多序列成像对病毒性心肌炎分期诊断的价值及研究进展显示文摘病毒性心肌炎(viral myocarditis,VMC)是病毒感染引起的心肌组织局限性或弥漫性炎性病变[1]。流行病学研究表明,VMC好发于青壮年及运动员,每年约9%VMC患者发展成为扩张型心肌病,且容易诱发猝死[2]。尽管心内膜心肌活检(EMB)是目前公认的心肌炎诊断"金标准",但由于其取样误差大、并发症多、缺乏统一诊断标准[3],加之操作难度大、风险高,故仅应用于合并心力衰竭的急性VMC患者[4]。VMC分为急性期和慢性期,临床上治疗急、慢性VMC的方法不尽相同。 | 袁尉峰 赵新湘 | 2016 | 临床放射学杂志2016，35，7： | 5 |
| 12 | Magnetic resonance imaging correlates of bee sting induced multiple organ dysfunction syndrome: A case report显示文摘Occasionally systemic complications with high risk of death,such as multiple organ dysfunction syndrome(MODS),can occur following multiple bee stings.This case study reports a patient who presented with MODS,i.e.,acute kidney injury,hepatic and cardiac dysfunc-tion,after multiple bee stings.The standard clinical findings were then correlated with magnetic resonance imaging(MRI)findings,which demonstrates that MRI may be utilized as a simpler tool to use than other mul-tiple diagnostics. | Sushant K Das Li-Chuan Zeng Bing Li Xiang-Ke Niu Jing-Liang Wang Anup Bhetuwal Han-Feng Yang | 2014 | World Journal of Radiology2014，6，9： | 5 |
| 13 | 重症心肌炎抢救成功1例显示文摘暴发性心肌炎(fulminant myocarditis,FM),又称急性重症病毒性心肌炎,临床表现重,可发生严重心力衰竭、心律失常、酷似急性心肌梗死表现,起病急骤,病情凶险,预后恶劣,多数来不及诊断或救治就已死亡。临床上以变化多端的心律失常、循环衰竭等为首发症状的FM比较少见,误诊为心肌梗死(心梗)的可能性大;准确及时诊断,合理救治是FM抢救成功的关键。现将我们救治的1例FM的经验和体会汇报如下: | 李雪蛟 江明宏 温静 | 2015 | 中国循证心血管医学杂志2015，7，6： | 5 |
| 14 | Magnetic resonance imaging and multi-detector computed tomography assessment of extracellular compartment in ischemic and non-ischemic myocardial pathologies显示文摘Myocardial pathologies are major causes of morbidity and mortality worldwide. Early detection of loss of cellular integrity and expansion in extracellular volume(ECV) in myocardium is critical to initiate effective treatment. The three compartments in healthy myocardium are: intravascular(approximately 10% of tissue volume), interstitium(approximately 15%) and intracellular(approximately 75%). Myocardial cells, fibroblasts and vascular endothelial/smooth muscle cells represent intracellular compartment and the main proteins in the interstitium are types Ⅰ/Ⅲ collagens. Microscopic studies have shown that expansion of ECV is an important feature of diffuse physiologic fibrosis(e.g., aging and obesity) and pathologic fibrosis [heart failure, aortic valve disease, hypertrophic cardiomyopathy, myocarditis, dilated cardiomyopathy, amyloidosis, congenital heart disease, aortic stenosis, restrictive cardiomyopathy(hypereosinophilic and idiopathic types), arrythmogenic right ventricular dysplasia and hypertension]. This review addresses recent advances in measuring of ECV in ischemic and non-ischemic myocardial pathologies. Magnetic resonance imaging(MRI) has the ability to characterize tissue proton relaxation times(T1, T2, and T2*). Proton relaxation times reflect the physical and chemical environments of water protons in myocardium. Delayed contrast enhanced-MRI(DE-MRI) and multi-detector computed tomography(DE-MDCT) demonstrated hyper-enhanced infarct, hypo-enhanced microvascular obstruction zone and moderately enhanced peri-infarct zone, but are limited for visualizing diffuse fibrosis and patchy microinfarct despite the increase in ECV. ECV can be measured on equilibrium contrast enhanced MRI/MDCT and MRI longitudinal relaxation time mapping. Equilibrium contrast enhanced MRI/MDCT and MRI T1 mapping is currently used, but at a lower scale, as an alternative to invasive sub-endomyocardial biopsies to eliminate the need for anesthesia, coronary catheterization and possibility of tissue sampling error. Similar to delayed contrast enhancement, equilibrium contrast enhanced MRI/MDCT and T1 mapping is completely noninvasive and may play a specialized role in diagnosis of subclinical and other myocardial pathologies. DE-MRI and when T1-mapping demonstrated sub-epicardium, sub-endocardial and patchy mid-myocardial enhancement in myocarditis, Behcet's disease and sarcoidosis, respectively. Furthermore, recent studies showed that the combined technique of cine, T2-weighted and DE-MRI technique has high diagnostic accuracy for detecting myocarditis. When the tomographic techniques are coupled with myocardial perfusion and left ventricular function they can provide valuable information on the progression of myocardial pathologies and effectiveness of new therapies. | Maythem Saeed Steven W Hetts Robert Jablonowski Mark W Wilson | 2014 | World Journal of Cardiology2014，6，11： | 4 |
| 15 | CTnI和CK-MB联合检测在小儿病毒性心肌炎诊断中的价值显示文摘目的探讨联合检测心肌肌钙蛋白I(CTnI)和肌酸激酶同工酶(CK-MB),在诊断小儿病毒性心肌炎中的价值。方法CTnI测定采用酶联免疫夹心法,CK-MB采用全自动生化分析仪测定;并对CTnI、CK-MB两项指标联合检测的敏感度与特异度与两单项指标检测的敏感度与特异度进行比较。结果CTnI、CK-MB联合检测阳性率为81.1%,均显著高于CTnI(68.5%)CK-MB(70.1%),p<0.05;两项指标联合检测的敏感度均明显高于各单项指标单独检测的敏感度(P均<0.001),而联合检测的特异度与各单项指标单独检测的特异度无显著性差异(P>0.05)。结论CTnI、CK-MB联合检测与各单项指标单独检测相比较,特异度无显著性差异,敏感度显著增高,在临床上可提高小儿病毒性心肌炎的阳性诊断率。 | 赵立红 陈丽萍 张晖 陈妍 | 2006 | 医学检验与临床2006，18，1： | 4 |
| 16 | Myocarditis in athlete and myocardial bridge:An innocent bystander?显示文摘Myocarditis is a bacterial or viral inflammatory disease,often unnoticed or misdiagnosed.Athletes with myocarditis must stop practicing their activity since International medical Literature described some cases of sudden death.In the present report,we describe a case of an asymptomatic,apparently healthy,competitive athletes,who was diagnosed a myocarditis and as incidental finding a myocardial bridging.We focused the attention on the importance of anamnesis,electrocardiogram and athletes' entourage for the diagnosis of such insidious pathologies and we evaluated the follow up,focusing the attention on electrocardiogram changes as well as on restitution ad integrum and prognosis,especially for the athletes. | Federico Quaranta Emanuele Guerra Fabio Sperandii Francesco De Santis Fabio Pigozzi Leonardo Calò Paolo Borrione | 2015 | World Journal of Cardiology2015，7，5： | 3 |
| 17 | Sudden cardiac death caused by myocarditis in persons aged 1-49 years:a nationwide study of 14 294 deaths in Denmark显示文摘Myocarditis is associated with an increased risk of sudden cardiac death (SCD) in the young.However,Information on nationwide burden of SCD caused by myocarditis (SCD-myocarditis) is sparse.For this study all deaths among persons in Denmark aged 1-35years in 2000-2009 and 36-49years in 2007-2009 (27.1 million person-years) were induded.Autopsy reports,death certificates,discharge summaries,and nationwide registries were used to identify all cases of SCD-myocarditis.In the 10-year study period,there were 14294 deaths,of which we identified 1 363 (10%) SCD.Among autopsied SCD (n=753,55%),cause of death was myocarditis in 42 (6%) cases corresponding to an SCD-myocarditis incidence of 0.16 (95%CI: 0.11-0.21) per 100000 person-years.Males had significantly higher incidence rates of SCD-myocarditis compared to females with an incidence rate ratio of 2.2 (95%CI:1.1-4.1).Myocarditis was not registered as cause of death In any of the non-autopsied SCD (n=610,45%).In conclusion,after nationwide unselected Inclusion of 14294 deaths,we found that 6% of all autopsied SCD was caused by myocarditis.No cases of SCD-myocarditis were reported in the non-autopsied SCD,which could reflect underdiagnosing of myocarditis in non-autopsied SCD.Furthermore,our data suggest a female protection towards SCDmyocarditis. | Thomas Hadberg Lynge Trine Skov Nielsen Bo Gregers Winkel Jacob Tfelt-Hansen Jytte Banner | 2019 | Forensic Sciences Research2019，4，3： | 3 |
| 18 | Risk of ventricular arrhythmia in patients with myocardial infarction and non-obstructive coronary arteries and normal ejection fraction显示文摘AIM To assess the arrhythmic determinants and prognosis of patients presenting with myocardial infarction and nonobstructive coronary arteries(MINOCA)with normal ejection fraction(EF).METHODS This is an observational analysis of 131 MINOCA patients with normal EF.Three cardiac magnetic resonance(CMR)diagnosis classes were recognized according to the late gadolinium enhancement(LGE)pattern:Myocardial infarction(MI)(n=34),myocarditis(n=47),and'no LGE'(n=50).Ventricular events occurring during hospitalization were recorded and the entire population was followed-up at 1 year.RESULTS Ventricular arrhythmia was observed in 18(13.8%)patients during hospitalization.The'no LGE'patients experienced fewer ventricular events than the MI and myocarditis patients[4.0%vs 26.5%and 14.9%,respectively(P=0.013)].There was no significant difference between the MI and myocarditis groups.On multivariate analysis,LGE transmural extent[OR=1.52(1.08-2.15),P=0.017]and ST-segment elevation[OR=4.65(1.61-13.40),P=0.004]were independent predictors of ventricular arrhythmic events,irrespective of the diagnosis class.Finally,no patient experienced sudden cardiac death or ventricular arrhythmia recurrence at 1-year.CONCLUSION MINOCA patients with normal EF presented no 1-year cardiovascular events,irrespective of the CMR diagnosis class.LGE transmural extent and ST segment elevation at admission are risk markers of ventricular arrhythmia during hospitalization. | Loic Bière Marjorie Niro Hervé Pouliquen Jean-Baptiste Gourraud Fabrice Prunier Alain Furber Vincent Probst | 2017 | World Journal of Cardiology2017，9，3： | 3 |
| 19 | Fulminant myocarditis in adults: a narrative review显示文摘Fulminant myocarditis(FM)is an uncommon syndrome characterized by sudden and severe hemodynamic compromise secondary to acute myocardial inflammation,often presenting as profound cardiogenic shock,life-threatening ventricular arrhythmias and/or electrical storm.FM may be refractory to conventional therapies and require mechanical circulatory support(MCS).The immune system has been recognized as playing a pivotal role in the pathophysiology of myocarditis,leading to an increased focus on immunosuppressive treatment strategies.Recent data have highlighted not only the fact that FM has significantly worse outcomes than non-FM,but that prognosis and management strategies of FM are heavily dependent on histological subtype,placing greater emphasis on the role of endomyocardial biopsy in diagnosis.The impact of subtype on severity and prognosis will likewise influence how aggressively the myocarditis is managed,including whether MCS is warranted.Many patients with refractory cardiogenic shock secondary to FM end up requiring MCS,with venoarterial extracorporeal membrane oxygenation demonstrating favorable survival rates,particularly when initiated prior to the development of multiorgan failure.Among the challenges facing the field are the need to more precisely identify immunopathophysiological pathways in order to develop targeted therapies,and the need to better optimize the timing and management of MCS to minimize complications and maximize outcomes. | Santiago Montero Darryl Abrams Enrico Ammirati Florent Huang Dirk WDonker Guillaume Hekimian Cosme García-García Antoni Bayes-Genis Alain Combes Matthieu Schmidt | 2022 | Journal of Geriatric Cardiology2022，19，2： | 3 |
| 20 | Molecular phenotypes of human parvovirus B19 in patients with myocarditis显示文摘AIM:To investigate molecular phenotypes of myocardial B19V-infection to determine the role of B19V in myocarditis and dilated cardiomyopathy(DCM).METHODS:Endomyocardial biopsies(EMBs) from 498 B19V-positive patients with myocarditis and DCMwere analyzed using molecular methods and functional experiments.EMBs were obtained from the University Hospitals of Greifswald and Tuebingen and additionally from 36 German cardiology centers.Control tissues were obtained at autopsy from 34 victims of accidents,crime or suicide.Identification of mononuclear cell infiltrates in EMBs was performed using immunohistological staining.Anti-B19V-IgM and anti-B19V-IgG were analyzed by enzyme-linked immunosorbent assay(ELISA).B19V viral loads were determined using in-house quantitative real-time polymerase chain reaction(PCR).For B19V-genotyping a new B19V-genotype-specific restriction fragment length polymorphism(RFLP)-PCR was established.B19V-genotyping was verified by direct DNAsequencing and sequences were aligned using BLAST and BioEdit software.B19V P6-promoter and HHV6-U94-transactivator constructs were generated for cell culture experiments.Transfection experiments were conducted using human endothelial cells 1.Luciferase reporter assays were performed to determine B19Vreplication activity.Statistical analysis and graphical representation were calculated using SPSS and Prism5 software.RESULTS:The prevalence of B19V was significantly more likely to be associated with inflammatory cardiomyopathy(iCMP) compared to uninflamed DCM(59.6% vs 35.3%)(P < 0.0001).The detection of B19V-mRNA replication intermediates proved that replication of B19V was present.RFLP-PCR assays showed that B19V-genotype 1(57.4%) and B19V-genotype 2(36.7%) were the most prevalent viral genotypes.B19V-genotype 2 was observed more frequently in EMBs with iCMP(65.0%) compared to DCM(35%)(P = 0.049).Although there was no significant difference in gender-specific B19V-loads,women were more frequently infected with B19V-genotype 2(44.6%) than men(36.0%)(P = 0.0448).Coinfection with B19V and other cardiotropic viruses was found in 19.2% of tissuesamples and was associated with higher B19V viral load compared to B19V-monoinfected tissue(P = 0.0012).The most frequent coinfecting virus was human herpes virus 6(HHV6,16.5%).B19V-coinfection with HHV6 showed higher B19V-loads compared to B19V-monoinfected EMBs(P = 0.0033),suggesting that HHV6 had transactivated B19V.In vitro experiments confirmed a 2.4-fold increased B19V P6-promoter activity by the HHV6 U94-transactivator.CONCLUSION:The finding of significantly increased B19V loads in patients with histologically proven cardiac inflammation suggests a crucial role of B19V-genotypes and reactivation of B19V-infection by HHV6-coinfection in B19V-associated iCMP.Our findings suggest that B19V-infection of the human heart can be a causative event for the development of an endothelial cell-mediated inflammatory disease and that this is related to both viral load and genotype. | C-Thomas Bock Anja Düchting Friederike Utta Eva Brunner Bui Tien Sy Karin Klingel Florian Lang Meinrad Gawaz Stephan B Felix Reinhard Kandolf | 2014 | World Journal of Cardiology2014，6，4： | 3 |
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