Detection and Management of Myocarditis and Fulminant Myocarditis

Myocarditis is commonly caused due to systemic viral infection with cardiotropic nature. In the acute phase, this disorder could cause lethal hemodynamic or arrhythmic disorders. Newest studies showed that the use of guideline-directed medical care in the care of myocarditis will lead to better outcomes. This condition varies in presentation ranging from mild to life-threatening such as cardiogenic shock. With the current advances in early detection and circulatory support using extracorporeal membrane oxygenation (ECMO), myocarditis could be managed very well. Cases of myocarditis related to COVID 19 has been reported, however as per this time there has no confirmed pathological evidence regarding direct causation between COVID19 and myocarditis, however, in these severely ill patients, elevations in cardiac biomarkers (cTn, BNP and NTproBNP) occurs, and the administration of immunosuppressant could increase the chance of remission. Keyword: Myocarditis, fulminant, COVID 19.Miokarditis umumnya terjadi akibat infeksi sistemik dari virus yang bersifat kardiotropik. Pada kondisi miokarditis akut ini dapat menyebabkan gangguan hemodinamik atau aritmia letal. Studi terbaru menunjukkan tatalaksana miokarditis terkait penyebab ditambah dengan “guideline directed medical care” akan memberi keluaran yang baik. Presentasi klinis miokarditis beragam dari  yang tidak terlalu berat sampai dengan syok kardiogenik. Dengan perkembangan terapi saat ini, bantuan sirkulasi extracorporeal membrane oxygenation (ECMO) dan deteksi dini miokarditis fulminan, maka miokarditis dapat tertangani dengan baik. Dugaan miokarditis fulminan pada COVID-19 telah dilaporkan pada beberapa laporan kasus namun belum ada bukti patologi yang telah terkonfirmasi dari spesimen miokard adanya keterlibatan virus pada miokarditis COVID-19. Pada kasus dengan gambaran critical ill didapatkan tanda dan bukti peningkatan biomarker kerusakan miokard (cTn) dan peningkatan biomarker akibat stress dinding ventrikel kiri (BNP atau NTproBNP). Pada beberapa kasus, pemberian imunosupresan dan monitoring yang baik dapat meningkatkan peluang remisi. Kata kunci : Miokarditis, fulminan, COVID 1

Prevalensi, Karakteristik, dan Faktor Risiko Penderita Peripartum Cardiomyopathy di RS.Hasan Sadikin Bandung

Background. Peripartum cardiomyopathy (PPCM) is one of the important health problem and can be fatal. The aim of this study is to determine the prevalence and characteristics of patients with PPCM in the Hasan Sadikin Hospital (RSHS).Methods. Data were retrieved retrospectively from medical records at the Cardiology and Vascular Medicine, RSHS, Bandung, from 1stJanuary2011 to 31thDecember, 2013. The analysis was performed using SPSS 21 and Chi Square significance test.Results.Eighty (26.23%,) subjects with PPCM out of 305 women with pregnancy or postpartum and cardiovascular complications are paticipated. The PPCMproportion are significantly decrease by time from 51.25%, 27.5%, 21,25% in 2011, 2012, and 2013 respectively. The average age was 30.3±7.9years. Deliveries were cesarean delivery in 43.8%, pervaginal in 37.5%, forceps in 15%, and vacuum-extractor in 3.8%. Preeclampsia was found in 43.8% of patients and most of them with NYHA functional class IV (86.3The average ejection fraction of 34.8±7.5%.Conclusion. The prevalence of PPCM in RSHS is 26.23%, with the majority (86.3%) was NYHA functional class IV.Significant risk factorsof PPCM were age over 30 years, multiparous, low socioeconomic, and preeclampsia.Latar Belakang. Peripartum Cardiomyopathy (PPCM) merupakan salahsatu maslah kesehatn penting yang dapat berakibat fatal. Tujuan penelitian ini adalah mengetahui prevalensi dan karakteristik penderita PPCM di RS. Hasan Sadikin (RSHS).Metode. Data diambil secara retrospektif dari catatan medik di bagian Kardiologi dan Kedokteran Vaskular RSHS Bandung periode 1 Januari 2011 hingga 31 Desember 2013. Analisis dilakukan dengan SPSS 21 dan uji kemaknaan chi square.Hasil. Didapatkan 80 penderita PPCM (26.23%) dari total 305 penderita dengan komplikasi kardiovaskular selama kehamilan dan pascapersalinan. Sebaran menurun signifikan (p 0.002) yaitu 51.25%, 27.5%, dan 21.25% pada tahun 2011, 2012 dan 2013 secara berurutan. Usia rata-rata penderita 30.3±7.9 tahun. Proses persalinan dengan operasi sesar (43.8%), spontan pervaginam (37.5%), forceps (15%), dan vacum (3.8%). Preeklampsi didapatkan pada 43.8% penderita dan mayoritas penderita termasuk NYHA kelas fungsional IV (86.3%) dengan gambaran kardiomegali (96.25%).Rerata fraksi ejeksi 34.8±7.5%.Kesimpulan. Prevalensi PPCM di RSHS 26.23%, dengan sebagian besar penderita (86.3%) termasuk dalam NYHA kelas fungsional IV. Beberapa faktor risiko yang signifikan adalah usia diatas 30 tahun, multipara, sosioekonomi rendah, dan hipertensi dalam kehamilan (preeklampsia)

Role of N-terminal pro-B type natriuretic peptide as a predictor of poor outcomes in patients with HFrEF receiving primary prevention implantable cardioverter-defibrillator therapy: a systematic review and dose–response meta-analysis

Introduction Several studies have demonstrated that combining left ventricular ejection fraction and New York Heart Association functional class is insufficient for predicting risk of appropriate implantable cardioverter-defibrillator (ICD) shock in primary prevention candidates. Hence, our aim was to assess the relationship between N-terminal pro-B type natriuretic peptide (NT-pro BNP) along with appropriate ICD shock and all-cause mortality in order to improve the stratification process of patients with heart failure with reduced ejection fraction (HFrEF) being considered for primary preventive ICD therapy.Methods A systematic literature search from several databases was conducted up until 9 June 2022. Studies were eligible if they investigated the relationship of NT-pro BNP with all-cause mortality and appropriate ICD shock.Results This meta-analysis comprised nine studies with a total of 5117 participants. Our study revealed that high levels of NT-pro BNP were associated with all-cause mortality (HR=2.12 (95% CI=1.53 to 2.93); p<0.001, I2=78.1%, p<0.001 for heterogeneity) and appropriate ICD shock (HR=1.71 (95% CI=1.18 to 2.49); p<0.001, I2=43.4%, p=0.102 for heterogeneity). The adjusted HR for all-cause mortality and appropriate ICD shock increased by approximately 3% and 5%, respectively per 100 pg/mL increment pursuant to concentration–response model (Pnon-linearity <0.001). The curves became steeper after NT-pro BNP reached its inflection point (3000 pg/mL).Conclusion A positive concentration-dependent association between elevated NT-pro BNP levels along with the risk of all-cause mortality and appropriate ICD shock was found in patients with HFrEF with ICD.PROSPERO registration number CRD42022339285

A novel score to predict left ventricular recovery in peripartum cardiomyopathy derived from the ESC EORP Peripartum Cardiomyopathy Registry

Background and Aims There are no established clinical tools to predict left ventricular (LV) recovery in women with peripartum cardiomyopathy (PPCM). Using data from women enrolled in the ESC EORP PPCM Registry, the aim was to derive a prognostic model to predict LV recovery at 6 months and develop the ‘ESC EORP PPCM Recovery Score’—a tool for clinicians to estimate the probability of LV recovery. Methods From 2012 to 2018, 752 women from 51 countries were enrolled. Eligibility included (i) a peripartum state, (ii) signs or symptoms of heart failure, (iii) LV ejection fraction (LVEF) ≤ 45%, and (iv) exclusion of alternative causes of heart failure. The model was derived using data from participants in the Registry and internally validated using bootstrap methods. The outcome was LV recovery (LVEF ≥50%) at six months. An integer score was created. Results Overall, 465 women had a 6-month echocardiogram. LV recovery occurred in 216 (46.5%). The final model included baseline LVEF, baseline LV end diastolic diameter, human development index (a summary measure of a country’s social and economic development), duration of symptoms, QRS duration and pre-eclampsia. The model was well-calibrated and had good discriminatory ability (C-statistic 0.79, 95% confidence interval [CI] 0.74–0.83). The model was internally validated (optimism-corrected C-statistic 0.78, 95% CI 0.73–0.82). Conclusions A model which accurately predicts LV recovery at 6 months in women with PPCM was derived. The corresponding ESC EORP PPCM Recovery Score can be easily applied in clinical practice to predict the probability of LV recovery for an individual in order to guide tailored counselling and treatment

Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registry

Aims: Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy. Methods: The European Society of Cardiology PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: 1) women without hypertension (‘PPCM-noHTN’); 2) women with hypertension but without pre-eclampsia (‘PPCM-HTN’); 3) women with pre-eclampsia (‘PPCM-PE’). Maternal (6-month) and neonatal outcomes were compared. Results: Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (NYHA IV in 44.4% and 29.9%, p<0.001), more frequent signs of heart failure (pulmonary rales in 70.7% and 55.4%, p=0.002), higher baseline LVEF (32.7% and 30.7%, p=0.005) and smaller left ventricular end diastolic diameter (57.4mm [±6.7] and 59.8mm [±8.1], p<0.001). There were no differences in the frequencies of death from any cause, re-hospitalization for any cause, stroke, or thromboembolic events. Compared to women with PPCM-noHTN, women with PPCM-PE had a greater likelihood of left ventricular recovery (LVEF≥50%) (adjusted OR 2.08 95% CI 1.21-3.57) and an adverse neonatal outcome (composite of termination, miscarriage, low birth weight or neonatal death) (adjusted OR 2.84 95% CI 1.66-4.87). Conclusion: Differences exist in phenotype, recovery of cardiac function and neonatal outcomes according to hypertensive status in women with PPCM