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 ven...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.展开更多
The novel coronavirus disease(COVID-19)has hit the healthcare system worldwide.The risk of severe infection and mortality increases with advancing age,especially in subjects with comorbidities such as cardiovascular d...The novel coronavirus disease(COVID-19)has hit the healthcare system worldwide.The risk of severe infection and mortality increases with advancing age,especially in subjects with comorbidities such as cardiovascular disease,hypertension,diabetes,obesity and cancer.Moreover,cardiovascular complications such as myocardial injury,heart failure and thromboembolism are frequently observed in COVID-19 cases,and several biomarkers(troponin,NTpro BNP and D-Dimer)have been identified as prognostic indicators of disease severity and worst outcome.Currently,there is no specific therapy against SARS-Co V-2,although many medications are under investigation.The aim of this review will be to explore the intertwined relationship between COVID-19 disease and the cardiovascular system,focusing on elderly population.The available supportive treatments along with the related concerns in elderly patients,due to their comorbidities and polypharmacotherapy,will be explored.展开更多
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 ...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.展开更多
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.
文摘The novel coronavirus disease(COVID-19)has hit the healthcare system worldwide.The risk of severe infection and mortality increases with advancing age,especially in subjects with comorbidities such as cardiovascular disease,hypertension,diabetes,obesity and cancer.Moreover,cardiovascular complications such as myocardial injury,heart failure and thromboembolism are frequently observed in COVID-19 cases,and several biomarkers(troponin,NTpro BNP and D-Dimer)have been identified as prognostic indicators of disease severity and worst outcome.Currently,there is no specific therapy against SARS-Co V-2,although many medications are under investigation.The aim of this review will be to explore the intertwined relationship between COVID-19 disease and the cardiovascular system,focusing on elderly population.The available supportive treatments along with the related concerns in elderly patients,due to their comorbidities and polypharmacotherapy,will be explored.
基金This work grants from the National Natural Science Foundation of China(No.81790624 and 81630010,82070316)National Key R&D Program of China(NO.2017YFC0909400).
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.
