Genetic Basis of Myocarditis: Myth or Reality?

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Cytokine gene polymorphisms are associated with markers of disease severity and prognosis in patients with idiopathic dilated cardiomyopathy

Aims: To identify potential genetic associations of five cytokine gene polymorphisms with disease severity and prognosis in patients with idiopathic dilated cardiomyopathy (DCM). Methods and results: Eighty patients with DCM were genotyped for transforming growth factor beta1 (TGF-β1)+869 T/C (codon10 Leu→Pro), TGF-β1+915 G/C (codon25 Arg→Pro), interleukin (IL)-6 -174G/C, tumor necrosis factor-alpha (TNF-α) -308A/G, interferon-gamma (IFN-γ)+874T/A, IL-10 -1082A/G, IL-10 -819T/C and IL-10 -592A/C gene polymorphisms. In homozygous TT patients for TGF-β1 +869 T/C polymorphism mean VO 2 max was significantly higher than in CC homozygous patients (25.67±6.73ml/kg/min vs. 20.29±6.35ml/kg/min, p=0.046), which remained significant only for patients younger than 39years old after adjusting for age and sex (p=0.009). C carriers of TGF-β1 +915 G/C polymorphism are 4.2 times more likely to be in a worse NYHA stage (III-IV) than non C carriers [OR: 4.25, 95% CI (1.53-11.80), p=0.006]. Patients GG homozygous for IL-6 -174G/C polymorphism presented greater left ventricle end-systolic (p=0.018) and end-diastolic (p=0.04) diameters in comparison to the CC homozygous. The AA homozygote for IFN-γ+874T/A polymorphism (p=0.02) and the combination of the TGF-β1+869 T/C and TGF-β1+915 G/C genotypes were associated with adverse outcome (p=0.014). Conclusion: Specific cytokine gene polymorphisms seem to be associated with worse prognosis as well as with measures of disease severity in DCM. © 2011 Elsevier Ltd

Clustering analysis based on automated electrocardiographic measurements to identify prognostically distinct phenotypes in patients hospitalized for heart failure : a retrospective cohort study

Background Heart failure (HF) is a heterogeneous disease with complex structural and electrophysiological derangements of the heart. Attempts to classify HF from the electrophysiological perspective are lacking. Purpose To use electrocardiographic (ECG) data for phenotypic classification of patients with HF. Methods In this retrospective cohort study, all adult patients hospitalized for HF during 2010-2016 at a tertiary center were included. Automated measurements of the first ECG obtained during the index admission were recorded. K-means clustering using premorbid conditions and selected ECG measurements were used to classify the cohort into four mutually exclusive clusters. The primary (all-cause and cardiovascular mortality) and secondary (ventricular arrhythmia (VA)) outcomes were compared between clusters using Cox regression analysis. Results In total, 2849 patients (1363 males, age 75.1 ± 13.4 years) were included. Over a mean follow-up period of 5.37 ± 4.10 years, all-cause and cardiovascular mortality occurred in 2071 (72.7%) and 600 (21.1%) patients respectively, while VA occurred in 110 patients (3.9%). Cluster 1 was characterised by a low heart rate and low ventricular activation time (VAT). Cluster 2 was characterised by old age, low absolute QRS area, and high QTc and QT dispersion. Cluster 3 was characterised by young age, and left ventricular hypertrophy (LVH), and few had history of VA. Cluster 4 was characterised by wide QRS, hypertension, ischaemic heart disease, high VAT, and high absolute T wave area. Cluster 4 had the highest and cluster 1 the lowest risks of all-cause (hazard ratio (HR) 2.96 [1.09, 1.50], p = 0.003; Figure A) and cardiovascular mortality (HR 2.90 [1.15, 2.11], p = 0.004; Figure B). Meanwhile, cluster 2 had the highest risk of VA (HR 2.23 [1.09, 3.85], p = 0.025; Figure C) while clusters 1 and 3 similarly had the lowest risks. Conclusion HF presents with clinically and electrophysiologically distinct phenotypes. Clustering analysis is useful in identifying HF phenotypes which are prognostically significant

HEllenic Registry on Myocarditis SyndromES on behalf of Hellenic Heart Failure Association: The HERMES-HF Registry

Aims: Despite the existence of many studies, there are still limited data about the characteristics of myocarditis in Greece. This led to the creation of the Greek Myocarditis Registry aiming to document the different symptoms and treatment of myocarditis, assess possible prognostic factors, and find similarities and differences to what is already published in literature. This paper is a preliminary descriptive analysis of this Registry. Methods and results: We analysed data for the hospitalization period of all patients included in the Registry from December 2015 until November 2017. Statistics are reported as frequency (%) or median and inter-quartile range (IQR) as appropriate. In total, 146 patients were included; 83.3% of the patients reported an infection during the last 3 months. The most common symptom, regardless of the underlying infection, was chest pain (82.2%) followed by dyspnoea (18.5%), while the most common finding in clinical examination was tachycardia (26.7%). Presentation was more frequent in the winter months. ECG findings were not specific, with the repolarization abnormalities being the most frequent (60.3%). Atrial fibrillation was observed in two patients, both of whom presented with a reduced ventricular systolic function. Left ventricular ejection fraction changed significantly during the hospitalization [55% (IQR: 50–60%) on admission vs. 60% (IQR: 55–60%) on discharge, P = 0.0026]. Cardiac magnetic resonance was performed in 88 patients (61%), revealing mainly subepicardial and midcardial involvement of the lateral wall. Late gadolinium enhancement was present in all patients, while oedema was found in 39 of them. Only 11 patients underwent endomyocardial biopsy. Discharge medication consisted mainly of beta-blockers (71.9%) and angiotensin-converting enzyme inhibitors (41.8%), while 39.7% of the patients were prescribed both. Conclusions: This preliminary analysis describes the typical presentation of myocarditis patients in Greece. It is a first step in developing a better prognostic model for the course of the disease, which will be completed after the incorporation of the patients' follow-up data. © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiolog

The European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery: third report

OBJECTIVES In the third report of the European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery, outcomes of patients receiving mechanical circulatory support are reviewed in relation to implant era. METHODS Procedures in adult patients (January 2011-June 2020) were included. Patients from centres with 3 months). Risk factors for death were explored using univariable Cox regression with a stepwise time-varying hazard ratio (3 months). RESULTS In total, 4834 procedures in 4486 individual patients (72 hospitals) were included, with a median follow-up of 1.1 (interquartile range: 0.3-2.6) years. The annual number of implants (range: 346-600) did not significantly change (P = 0.41). Both Interagency Registry for Mechanically Assisted Circulatory Support class (classes 4-7: 23, 25 and 33%; P < 0.001) and in-hospital deaths (18.5, 17.2 and 11.2; P < 0.001) decreased significantly between eras. Overall, mortality, transplants and the probability of weaning were 55, 25 and 2% at 5 years after the implant, respectively. Major infections were mainly noted early after the implant occurred (AER(3 months): 0.45). Bilirubin and creatinine levels were significant risk factors in the early phase but not in the late phase after the implant. CONCLUSIONS In its 10 years of existence, EUROMACS has become a point of reference enabling benchmarking and outcome monitoring. Patient characteristics and outcomes changed between implant eras. In addition, both occurrence of outcomes and risk factor weights are time dependent.As a registry of the European Association for Cardio-Thoracic Surgery, the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) offers a robust repository of clinical data on long-term mechanical circulatory support (MCS) from a large international community