BACKGROUNDMyocarditis is an uncommon but serious manifestation of systemic lupus erythematosus (SLE). This study aimed to investigate clinical characteristics and outcomes of lupus myocarditis (LM) and to determine risk factors of LM in hospitalized Chinese patients with SLE.

METHODSWe conducted a retrospective case-control study. A total of 25 patients with LM from 2001 to 2012 were enrolled as the study group, and 100 patients with SLE but without LM were randomly pooled as the control group. Univariable analysis was performed using Chi-square tests for categorical variables, and the Student's t-test or Mann-Whitney U-test was performed for continuous variables according to the normality.

RESULTSLM presented as the initial manifestation of SLE in 7 patients (28%) and occurred mostly at earlier stages compared to the controls (20.88 ± 35.73 vs. 44.08 ± 61.56 months, P = 0.008). Twenty-one patients (84%) experienced episodes of symptomatic heart failure. Echocardiography showed that 23 patients (92%) had decreased left ventricular ejection fraction (<50%) and all patients had wall motion abnormalities. A high SLE Disease Activity Index was the independent risk factor in the development of LM (odds ratio = 1.322, P < 0.001). With aggressive immunosuppressive therapies, most patients achieved satisfactory outcome. The in-hospital mortality was not significantly higher in the LM group than in the controls (4% vs. 2%,P = 0.491).

CONCLUSIONSLM could result in cardiac dysfunction and even sudden death. High SLE disease activity might potentially predict the occurrence of LM at the early stage of SLE. Characteristic echocardiographic findings could confirm the diagnosis of LM. Early aggressive immunosuppressive therapy could improve the cardiac outcome of LM.

Adult ; Case-Control Studies ; China ; Echocardiography ; Female ; Humans ; Lupus Erythematosus, Systemic ; complications ; Male ; Multivariate Analysis ; Myocarditis ; diagnosis ; etiology ; Retrospective Studies ; Risk Factors

Fulminant myocarditis has been defined as the clinical manifestation of cardiac inflammation with rapid-onset heart failure and cardiogenic shock. We report on the case of a 23-yr-old woman with pathology-proven fulminant lymphocytic myocarditis presenting shock with elevated cardiac troponin I and ST segments in V1-2, following sustained ventricular tachycardia and a complete atrioventricular block. About 55 min of intensive cardio-pulmonary resuscitation, with extracorporeal membrane oxygenation support, bridged the patient to orthotopic heart transplantation. The explanted heart revealed diffuse lymphocytic infiltration and myocyte necrosis in all four cardiac chamber walls. Aggressive mechanical circulatory support may be an essential bridge for recovery or even transplantation in patients with fulminant myocarditis with shock.
Combined Modality Therapy/methods ; Extracorporeal Membrane Oxygenation/*methods ; Female ; *Heart Transplantation ; Humans ; Myocarditis/complications/*diagnosis/*therapy ; Shock/*diagnosis/etiology/*prevention & control ; Treatment Outcome ; Young Adult

OBJECTIVETo determine the optimum treatment for viral myocarditis (VMC).

METHODSA total of 126 VMC patients were randomly divided into the control group (42 cases) that was treated with conventional Western medicine, and the intervention group (84 cases) that was treated with a combination of Chinese medicine (CM) and Western medicine intervention termed optimum proposal of integration of disease and syndrome (OPIDS). Before and after 4 weeks of treatment, the integral of CM syndrome, self-rating depression and anxiety scales (SDS and SAS, respectively), echocardiograms (ECGs), heart rate variability and left ventricular systolic function were observed.

RESULTSCompared with the control group, the intervention group showed significant reductions on the SDS and SAS (P <0.05); improvement of premature ventricular beats, atrioventricular blocks, ST-segment abnormalities, and significant T wave changes (P <0.05); greater reductions in standard deviation of NN intervals (SDNN), standard deviation for per 5 min averages NN intervals (SDANN), and root-mean-square of successive difference of NN intervals (rMSSD) (P <0.05); and increases in cardiac output, stroke volume, and ejection fraction, the last of which was statistically significant (P <0.05). Overall, the treatment efficacy rate was significantly better P<0.05) in the intervention group (75.61%) compared with the control group (69.70%).

CONCLUSIONOPIDS is quite effective in treating VMC and improves symptoms such as anxiety and depression, left ventricular systolic dysfunction, premature ventricular contraction, and cardiac autonomic nervous system dysfunction. [

REGISTRATIONChinese clinical trial center (No. ChiCTR-TRC-00000298)].

Adolescent ; Adult ; Anxiety ; complications ; Depression ; complications ; Electrocardiography ; Female ; Heart Rate ; Humans ; Male ; Medicine, Chinese Traditional ; Myocarditis ; diagnostic imaging ; physiopathology ; therapy ; virology ; Syndrome ; Systole ; Ultrasonography ; Ventricular Function ; Young Adult

OBJECTIVETo study the role of tranilast in the pathogenesis of myocardiac fibrosis in viral myocarditis.

METHODSSeventy-two BALB/C mice were randomly divided into control, model and intervention groups (n=24 each). Mice in the model and intervention groups were infected with Coxsackievirus B3 to induce viral myocarditis. The intervention group was given with tranilast (200 mg/kg) by gavage until sacrifice for sampling, while the other two groups were administered with the same volume of normal saline. Cardiac tissues were obtained from 8 mice on 7, 14 and 28 days after modeling. The mast cell number was observed by toluidine blue staining and thionine staining. The cardiac tissues were stained with hematoxylin and eosin as well as masson trichrome to observe the pathological changes in cardiac tissues. The mRNA and protein expression of osteopontin and transforming growth factor-β1 was measured by RT-PCR and immunohistochemistry respectively.

RESULTSIn the model group, the mRNA and protein expression of osteopontin reached the highest level on the 7th day, decreasing from the 14th day, and became to the least on the 28th day; while the expression of TGF-β1 increased from the 7th day, reaching a peak on the 14th day, and decreased slightly on the 28th day. The mRNA and protein expression of TGF-β1 and OPN was lower in the intervention group than the model group (P<0.05), but higher than the control group (P<0.05). The expression of OPN mRNA was positively correlated to the number of mast cells.

CONCLUSIONSTranilast can reduce myocardial fibrosis by decreasing the number of mast cells, inhibiting the expression of TGF-β1 and OPN.

Animals ; Fibrosis ; Male ; Mast Cells ; drug effects ; Mice ; Mice, Inbred BALB C ; Myocarditis ; complications ; Myocardium ; pathology ; Osteopontin ; analysis ; genetics ; Transforming Growth Factor beta1 ; analysis ; genetics ; ortho-Aminobenzoates ; pharmacology ; therapeutic use

OBJECTIVETo study the difference in prognosis for children with acute viral myocarditis induced ventricular premature beats (VPB) originating from different positions, and to study the role of 99Mtc-MIBI myocardial perfusion ECT in the prognostic evaluation of VPB.

METHODSThe clinical data of 83 children with viral myocarditis induced VPB were retrospectively studied. They were divided into four groups according to the original site of VPB, as shown by the ECG: right ventricular (RV) outflow tract, RV anterior wall and apex, left ventricular (LV) outflow tract, LV anterior wall and apex. All patients were treated with anti-viral drugs and myocardial nutritional medicine. Short-term and long term outcomes in the four groups were compared. The relationship between the results of 99Mtc-MIBI myocardial perfusion ECT and prognosis in 40 patients was observed.

RESULTSThere were no significant differences in short-term and long-term effective rates among the four groups (P>0.05). There were no differences in the ECT positive rates between the patients with VPB originating from RV and those with VPB originating from LV (P>0.05). The treatment effective rates of ECT-positive patients were higher than the treatment effective rates of ECT-negative ones (P<0.05).

CONCLUSIONSThe short-term and long-term prognosis of children with VPB originating from different positions are not significantly different. In children with viral myocarditis induced VPB, positive ECT results suggest a better prognosis.

Acute Disease ; Humans ; Myocardial Perfusion Imaging ; methods ; Myocarditis ; complications ; Prognosis ; Retrospective Studies ; Technetium Tc 99m Sestamibi ; Ventricular Premature Complexes ; diagnostic imaging ; etiology ; Virus Diseases ; complications

Acute myopericarditis is usually caused by viral infections, and the most common cause of viral myopericarditis is coxsackieviruses. Diagnosis of myopericarditis is made based on clinical manifestations of myocardial (such as myocardial dysfunction and elevated serum cardiac enzyme levels) and pericardial (such as inflammatory pericardial effusion) involvement. Although endomyocardial biopsy is the gold standard for the confirmation of viral infection, serologic tests can be helpful. Conservative management is the mainstay of treatment in acute myopericarditis. We report here a case of a 24-year-old man with acute myopericarditis who presented with transient effusive-constrictive pericarditis. Echocardiography showed transient pericardial effusion with constrictive physiology and global regional wall motion abnormalities of the left ventricle. The patient also had an elevated serum troponin I level. A computed tomogram of the chest showed pericardial and pleural effusion, which resolved after 2 weeks of supportive treatment. Serologic testing revealed coxsackievirus A4 and B3 coinfection. The patient received conservative medical treatment, including nonsteroidal anti-inflammatory drugs, and he recovered completely with no complications.
Acute Disease ; *Coinfection ; Coxsackievirus Infections/complications/diagnosis/therapy/*virology ; Echocardiography, Doppler ; Electrocardiography ; Enterovirus A, Human/*isolation & purification ; Enterovirus B, Human/*isolation & purification ; Humans ; Male ; Myocarditis/diagnosis/therapy/*virology ; Pericardial Effusion/diagnosis/therapy/*virology ; Pericarditis, Constrictive/diagnosis/therapy/*virology ; Pleural Effusion/diagnosis/therapy/*virology ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

This study describes the expression of heat shock protein70 (HSP70) and alpha-basic-crystallin (alpha-BC) and their association with apoptosis and some related adaptor proteins in the pathogenesis of foot-and-mouth disease virus (FMDV)-induced myocarditis in lambs. HSP70 was generally overexpressed in the myocardial tissues and inflammatory cells of FMDV-induced myocarditis with differential accumulation and localization in same hearts when compared to non-foot-and-mouth disease control hearts. alpha-BC immunolabeling showed coarse aggregations in the Z line of the cardiomyocytes in FMDV-infected hearts in contrast to control hearts. Overall, the results of this study show that the anti-apoptotic proteins, HSP70 and alpha-BC, were overexpressed with increased apoptosis in FMDV-infected heart tissues. Both proteins failed to protect the cardiomyocytes from apoptosis as defense mechanisms to the FMDV during the infection, suggesting that the virus is able to increase apoptosis via both downregulation and/or upregulation of these anti-apoptotic proteins.
Animals ; Apoptosis Regulatory Proteins/metabolism ; Foot-and-Mouth Disease/*complications/*virology ; Foot-and-Mouth Disease Virus/*classification ; Gene Expression ; HSP70 Heat-Shock Proteins/*metabolism ; Myocarditis/complications/pathology/*veterinary/virology ; Myocardium/pathology ; Sheep ; Sheep Diseases/*virology ; Turkey ; alpha-Crystallin B Chain/*metabolism

Adolescent ; Electrocardiography ; Female ; Humans ; Myocarditis ; complications ; physiopathology ; Tachycardia, Ventricular ; etiology ; physiopathology

OBJECTIVE: In order to improve accuracy and reliability of forensic diagnosis of sudden cardiac death, pathogenesis and relationship between the viral myocarditis (VMC) and dilated cardiomyopathy (DCM) were investigated. METHODS: Improved immunohistochemical technique was used to detect the expression of the CAR in myocardium samples, including 22 deceased with VMC, 20 deceased with DCM and 16 control deceased. RESULTS: The brown staining on the cell membrane of myocardium showed positive result. There was a prominent CAR expression in VMC group and DCM group, which were statistically significant difference compared with control group (P < 0.05). CONCLUSION The CAR expression showed significantly higher in VMC and DCM groups. The viral infection can result in myocardial necrosis and impaired cardiac functions. These abnormalities can trigger a cascade of events that contributed to the progress of VMC to DCM.
Cardiomyopathy, Dilated/pathology* ; Case-Control Studies ; Coxsackie and Adenovirus Receptor-Like Membrane Protein ; Coxsackievirus Infections/complications* ; Death, Sudden, Cardiac ; Female ; Forensic Pathology ; Humans ; Immunohistochemistry ; Male ; Myocarditis/virology* ; Myocardium/pathology* ; Receptors, Virus/metabolism* ; Staining and Labeling

OBJECTIVETo explore the role of interleukin-17 (IL-17) in the evolution of viral myocarditis (VMC) into dilated cardiomyopathy (DCM).

METHODSA mouse model of VMC was established in 100 male Balb/c mice by intraperitoneal injection of coxsackievirus B3. The expression of IL-17 protein in the cardiac tissue of the mice was detected immunohistochemically, and IL-17 mRNA in the splenocytes was examined by reverse transcription-polymerase chain reaction (RT-PCR). IL-17 levels in the plasma, peripheral blood mononuclear cell (PBMC) culture supernatants, and phytohemagglutinin (PHA)-stimulated PBMC culture supernatants were measured in 30 DCM patients, 26 non-DCM patients and 20 normal adults using enzyme-linked immunosorbent assay (ELISA), and IL-17 mRNA expression in the PBMCs was detected using RT-PCR.

RESULTSThe levels of IL-17 mRNA in the splenocytes of the mice with VMC were significantly higher at 4 and 6 weeks than those at 8 weeks (P<0.01), but not detected at 2 weeks. No IL-17 expression was found in the ventricular tissue of the mice at 2 weeks, but peaked at 4 weeks followed by gradual decrease (P<0.01). IL-17 level in PHA-stimulated PBMC culture supernatants but not the plasma, and its mRNA level in PHA-stimulated PBMCs but not the PBMC culture supernatants, were significantly elevated in DCM patients as compared with those in non-DCM patients and normal control subjects.

CONCLUSIONSThe mouse model of VMC in the chronic phase and DCM patients express high levels of IL-17, which may contribute to the transition from VMC to DCM.

Adult ; Animals ; Cardiomyopathy, Dilated ; etiology ; metabolism ; pathology ; Coxsackievirus Infections ; complications ; metabolism ; Enterovirus B, Human ; Female ; Humans ; Interleukin-17 ; genetics ; metabolism ; Male ; Mice ; Mice, Inbred BALB C ; Middle Aged ; Myocarditis ; complications ; metabolism ; virology ; RNA, Messenger ; genetics ; metabolism