Atrial fibrillation (AF) and heart failure (HF) are two cardiovascular diseases with an increasing prevalence worldwide. These conditions share common pathophysiologiesand frequently co-exit. In fact, the occurrence of either condition can 'cause' the development of the other, creating a new patient group that demands different management strategies to that if they occur in isolation. Regardless of the temproral association of the two conditions, their presence is linked with adverse cardiovascular outcomes, increased rate of hospitalizations, and increased economic burden on healthcare systems. The use of low-cost, easily accessible and applicable biomarkers may hasten the correct diagnosis and the effective treatment of AF and HF. Both AF and HF effect multiple physiological pathways and thus a great number of biomarkers can be measured that potentially give the clinician important diagnostic and prognostic information. These will then guide patient centred therapeutic management. The current biomarkers that offer potential for guiding therapy, focus on the physiological pathways of miRNA, myocardial stretch and injury, oxidative stress, inflammation, fibrosis, coagulation and renal impairment. Each of these has different utility in current clinincal practice.
To the Editor.—We read with interest the important report published in Archives of Pathology & Laboratory Medicine1 describing 2 teenagers who were found dead 3 and 4 days after the second dose of the Pfizer-BioNTech COVID-19 vaccine. In both boys there were neither prior medical problems nor rashes nor lymphadenopathy. At autopsy, there were areas of contraction bands and occasional eosinophils with subepicardial/transmural fibrous scars in the first boy and confluent areas of hypereosinophilic myocytes but no subepicardial injury in the second boy. The authors correctly characterized these findings as atypical myocarditis and speculated on cytokine storm. They also correctly put a hypersensitivity reaction in the differential diagnosis and stated that the "infrequency/lack of eosinophils would be unusual."Indeed, there is still confusion on the classification of myocarditis caused by vaccines, drugs, or other substances. Myocarditis constitutes an inflammatory myocardial disease with absence of acute or chronic coronary artery damage. It can be classified by criteria such as causative (viral, bacterial, protozoal, trypanosomal, toxic, hypersensitivity), histologic (eosinophilic, giant cell, granulomatous, lymphocytic), and clinicopathologic (fulminant, acute, chronic active, chronic persistent, myopericarditis).2 Eosinophilic myocarditis is characterized by eosinophilic myocardial infiltration and is usually accompanied by eosinophilia and occasionally by myocyte fibrosis and/or necrosis. Subtypes of eosinophilic myocarditis include eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome), hypereosinophilic syndrome or its myeloproliferative variant, and idiopathic acute necrotizing eosinophilic myocarditis.Hypersensitivity myocarditis, or drug-induced myocarditis, is a discrete subtype of eosinophilic myocarditis that can present in 2 forms: the common form, which is neither necrotizing nor fibrotic, with absence of skin rash, malaise, fever, and eosinophilia in 75% of cases, and the second, rarer form, which may present with myocyte necrosis and fibrosis.3 Both forms of hypersensitivity myocarditis are caused by an allergic or hypersensitivity reaction to a variety of drugs and substances, including antibiotics and vaccines. Therefore, according to this classification, one of these boys might have suffered hypersensitivity myocarditis with subepicardial/transmural fibrosis and the other boy may have had hypersensitivity myocarditis with no subepicardial injury.So far, myocardial biopsies in patients with myocarditis after COVID-19 vaccination have been performed and reported in only a few patients worldwide because of the mild clinical course of the disease. In one extremely rare case, vaccine-related fatal fulminant necrotizing eosinophilic myocarditis occurred in a female patient following the initial dose of the Pfizer-BioNTech mRNA COVID-19 vaccine, and abundant eosinophils and focal myocyte necrosis were found at autopsy. The authors characterized this case as an extremely rare idiosyncratic hypersensitivity reaction.2 Moreover, in another fatal case of post Pfizer-BioNTech mRNA COVID-19 vaccine myocarditis, the autopsy demonstrated dense eosinophilic intracellular strips of myocytes in the Masson trichrome staining, consistent with contraction band necrosis.2Pfizer-BioNTech mRNA COVID-19 vaccines contain the excipient polyethylene glycol, which could potentially induce hypersensitivity reactions. This excipient is also present in creams, ointments, lotions, and cosmetics, which can sensitize their users. Indeed, 1% to 5.4% of the general population is sensitized to cosmetics or dental materials.4We agree, therefore, with the recent suggestion that the time has come for new vaccines containing different excipients.5
Background: We examined the effect of intubation time and the lung mechanics on clinical outcomes in coronavirus disease 2019 (COVID-19) patients. Methods: Based on the patient’s hospital admission, intubation time was defined as early (? 2 days) or late (> 2 days). Patients were further divided into three groups; early (? 3 days), late (4 - 6 days), and very late (> 6 days) intubated. Results: A total of 194 patients were included; 66.5% male, median age 65 years. Fifty-eight patients (29.9%) were intubated early and 136 (70.1%) late. Early intubated patients revealed lower mortality (44.8% vs. 72%, P < 0.001), were younger (60 vs. 67, P = 0.002), had lower sequential organ failure assessment (SOFA) scores (6 vs. 8, P = 0.002) and higher lung compliance on admission days 1, 6 and 12 (42 vs. 36, P = 0.006; 40 vs. 33, P < 0.001; and 37.5 vs. 32, P < 0.001, respectively). Older age (adjusted odds ratio (aOR) = 1.15, P < 0.001), intubation time (aOR = 1.15, P = 0.004), high SOFA scores (aOR = 1.81, P < 0.001), low partial pressure of oxygen (PaO 2 )/fractional inspired oxygen tension (FiO 2 ) ratio (aOR = 0.96, P = 0.001), and low lung compliance on admission days 1 and 12 (aOR = 1.12, P = 0.012 and aOR = 1.14, P < 0.001, respectively) were associated with higher mortality. Very late and late intubated patients had higher mortality rates than patients intubated early (78.4% vs. 63.4% vs. 44.6%, respectively, P < 0.001). Conclusions: Among COVID-19 intubated patients, age, late intubation, high SOFA scores, low PaO 2 /FiO 2 ratio, and low lung compliance are associated with higher intensive care unit (ICU) mortality. J Clin Med Res. 2024;16(1):15-23 doi: https://doi.org/10.14740/jocmr4984
Abstract Background: We investigated the impact of time to intubation and the ventilatory mechanics on clinical outcomes in patients with COVID-19. Methods: We conducted an observational cohort study. Time to intubation was defined based on the patient’s hospital admission as early (≤2 days) or late (>2 days). In a secondary analysis, patients were further divided into three groups: intubated early (≤3 days), late (4-6 days), and very late (>6 days). Results: We included 194 consecutively intubated patients; 66.5% were male, and the median age was 65 years old. From them, 58 (29.9%) were intubated early and 136 (70.1%) late. Compared to patients intubated late, patients intubated early had lower mortality (44.8% vs 72%, p < 0.001), were younger (60 vs 67, p = 0.002), had lower sequential organ failure assessment (SOFA) scores (6 vs 8, p=0.002) and higher lung compliance on admission days 1, 6 and 12 (42 vs 36, p = 0.006; 40 vs 33, p < 0.001; and 37.5 vs 32, p < 0.001, respectively). Older age (aOR = 1.15, p < 0.001), time to intubation (aOR = 1.15, p = 0.004), high SOFA scores (aOR = 1.81, p < 0.001), a lower PaO 2 /FiO 2 ratio (aOR = 0.96, p = 0.001), low lung compliance on admission Day 1 and 12 (aOR = 1.12, p = 0.012 and aOR = 1.14, p < 0.001, respectively), and a high white blood cell (WBC) number at admission (aOR = 1, p = 0.001) were associated with higher mortality. In the secondary analysis, very late and late intubated patients had higher mortality rates than patients intubated early (78.4% vs 63.4% vs 44.6%, respectively, p < 0.001). Conclusions: Among COVID-19 intubated patients, age, late intubation, high SOFA scores, high WBC, low PaO 2 /FiO 2 ratio, and low lung compliance are associated with higher ICU mortality.
Abstract Background/Purpose Coronary angiography and percutaneous coronary intervention (PCI) procedural details in swine are similar to those performed to humans, since their heart and coronary anatomy closely resembles. However, only a few detailed descriptions of the procedure are available, containing notable differences. We present a feasible and reproducible protocol for percutaneous coronary interventions in porcine experimental models, utilizing ultrasound-guided femoral approach. Methods/Materials Nine female pigs were studied to explore the feasibility of superficial femoral arterial (SFA) access for coronary angiography and provisional PCI, as well as the most suitable guiding coronary catheters and angiographic projections for the above interventions. Experiments were performed under general anesthesia, using ultrasound-guided puncture of the SFA to gain arterial access. The Amplatzer AR1® catheter, and the Right Coronary Bypass® catheter were used for the selective engagement of the right and the left coronary artery respectively. Results Successful arterial access and subsequent cardiac catheterization were performed in all pigs. Only one animal required a second puncture for femoral artery access. None of the 9 animals presented any significant tachycardia or hypotensive episode. One animal developed an access site-related complication following the first catheterization procedure. During follow-up, 100% success of SFA catheterization was achieved using the same ultrasound-guided technique. Conclusions The ultrasound-guided superficial femoral artery access for coronary angiography and provisional interventions in porcine models is a quick and safe alternative to the carotid artery approach. The RCB and AR1 catheters may be the best choice for the quick and easy selective coronary engagement of the right and left ostia respectively.
COVID-19 is one of the progressive viral pandemics that originated from East Asia. COVID-19 or SARS-CoV-2 has been shown to be associated with a chain of physio-pathological mechanisms that are basically immunological in nature. In addition, chemokines have been proposed as a subgroup of chemotactic cytokines with different activities ranging from leukocyte recruitment to injury sites, irritation, and inflammation to angiostasis and angiogenesis. Therefore, researchers have categorized the chemotactic elements into four classes, including CX3C, CXC, CC, and C, based on the location of the cysteine motifs in their structures. Considering the severe cases of COVID-19, the hyperproduction of particular chemokines occurring in lung tissue as well as pro-inflammatory cytokines significantly worsen the disease prognosis. According to the studies conducted in the field documenting the changing expression of CXC and CC chemokines in COVID-19 cases, the CC and CXC chemokines contribute to this pandemic, and their impact could reflect the development of reasonable strategies for COVID-19 management. The CC and the CXC families of chemokines are important in host immunity to viral infections and along with other biomarkers can serve as the surrogates of vaccine-induced innate and adaptive protective responses, facilitating the improvement of vaccine efficacy. Furthermore, the immunogenicity elicited by the chemokine response to adenovirus vector vaccines may constitute the basis of vaccine-induced immune thrombotic thrombocytopaenia.
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