Severe Transient Left Ventricular “Hypertrophy” Occurring during Acute Myocarditis

Hauser, Andrew M.; Gordon, Seymour; Cieszkowski, John; Timmis, Gerald C.

doi:10.1378/chest.83.2.275

Cited by 42 publications

(25 citation statements)

References 4 publications

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“…Furthermore, repetitive follow-up UCG examination may have revealed that the transient increase in IVSd was due to tissue edema, but not hypertrophy, as observed in acute myocarditis. [30][31][32][33] In spite of these limitations, the present study, which provides valuable information concerning early cardiac complications induced by cyclophosphamide, may contribute in the near future to an increase in the success rate for BSCT.…”

Section: Discussionmentioning

confidence: 95%

Left Ventricular Diastolic Dysfunction Induced by Cyclophosphamide in Blood Stem Cell Transplantation.

Mori

Yanagi

Maruyama³

et al. 2002

Jpn Heart J

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SUMMARYCardiac complications are major limiting factors regarding the success of high-dose chemotherapy supported by blood stem cell transplantation (BSCT). The cardiotoxicity of cyclophosphamide remains obscure relative to that of anthracyclines. The aim of this study was to estimate noninvasively the cardiotoxicity of cyclophosphamide administered during the pretransplant conditioning of BSCT for patients with various hematological diseases. A total of 27 consecutive patients were divided into two groups depending on the conditioning regimen, ie, group A (n=15) which received cyclophosphamide (median dose of 120 mg/kg; range 100 to 200 mg/kg) and group B (n=12) which did not. Ultrasound cardiograms (UCG) and signal-averaged electrocardiograms (SAECG) were recorded in the two groups both preceding and following the BSCT. There were no statistical intergroup or intragroup differences in left ventricular (LV) dimensions or contractile function. Significant (P<0.01) posttransplant increases in interventricular septal wall thickness and Ap/Ep ratio were noted in group A. Moreover, the filtered QRS duration as estimated by SAECG was prolonged (P<0.05) whereas the summated LV voltage (S V1 +R V5 ) was reduced in the posttransplant period only in group A. These results suggest that early cyclophosphamide cardiotoxicity was characterized by LV diastolic rather than systolic dysfunction. These findings may contribute to acute hemodynamic deterioration observed after cyclophosphamide-containing conditioning chemotherapy. (Jpn Heart J 2002; 43: 249-261)

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Section: Discussionmentioning

confidence: 95%

Left Ventricular Diastolic Dysfunction Induced by Cyclophosphamide in Blood Stem Cell Transplantation.

Mori

Yanagi

Maruyama³

et al. 2002

Jpn Heart J

View full text Add to dashboard Cite

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“…[24][25][26][27] In an earlier study, we reported cases of left ventricular wall thickening because of myocardial interstitial edema occurring in the acute phase of myocarditis, 28 resulting in narrowing of the left ventricular lumen and reducing the stroke volume. 29 Accordingly, left ventricular wall thickening was predicted to be significantly more pronounced in the present fulminant group.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Patients Developing a Fulminant Course With Acute Myocarditis

Kato¹,

Morimoto²,

Hiramitsu³

et al. 2004

Circ J

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Background A fulminant course can be difficult to predict at the onset of acute myocarditis, so the aim of the present study was to identify the predictive clinical symptoms/signs or laboratory findings. Methods and Results Thirty-nine patients with acute lymphocytic myocarditis, excluding 8 who manifested shock at admission, were studied. The fulminant group was defined as 12 patients who developed shock after admission, requiring intraaortic balloon pumping or percutaneous cardiopulmonary support, and the non-fulminant group comprised the 27 patients without shock. Various parameters at admission were compared between the 2 groups, together with multiple logistic regression analysis, excluding 6 patients with partially missing values. In the fulminant group, C-reactive protein (7.0±7.0 vs 2.3±2.2 mg/dl, p<0.01) and creatine kinase (1,147±876 vs 594±568 IU/L, p<0.05) concentrations were higher, intraventricular conduction disturbances were more frequent (9/12 vs 7/27 patients, p<0.01) and the left ventricular ejection fraction was lower (40.7±13.9 vs 50.1±10.6%, p<0.05) than in the non-fulminant group. In the multiple logistic regression analysis model with the presence/absence of a fulminant course considered as the independent variable, and C-reactive protein, creatine kinase, intraventricular conduction disturbances, and left ventricular ejection fraction as dependent variables, a high-risk group (expected proportion of fulminant course ≥0.5) and a low-risk group (<0.5) could be differentiated. A fulminant course occurred in 9/13 (69%) patients in the high-risk group, but in only 2/20 (10%) patients in the low risk group (p<0.001). Conclusions The risk of a fulminant course of acute myocarditis was high in patients with elevated C-reactive protein, and creatine kinase concentrations, decreased left ventricular ejection fraction, and intraventricular conduction disturbances at the time of admission. (Circ J 2004; 68: 734 -739)

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“…ransient thickening of the ventricular wall sometimes develops in patients with acute myocarditis, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] and we have shown that it is the result of interstitial edema. 1 However, the influence of the ventricular wall thickening per se on left ventricular function in acute myocarditis has not been elucidated, so we reviewed serial echocardiograms of patients with acute myocarditis and attempted to determine the relationship between ventricular wall thickening and left ventricular function.…”

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confidence: 99%

Narrowing of the Left Ventricular Cavity Associated With Transient Ventricular Wall Thickening Reduces Stroke Volume in Patients With Acute Myocarditis

Morimoto

Kato

Hiramitsu

et al. 2003

Circ J

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ransient thickening of the ventricular wall sometimes develops in patients with acute myocarditis, 1-17 and we have shown that it is the result of interstitial edema. 1 However, the influence of the ventricular wall thickening per se on left ventricular function in acute myocarditis has not been elucidated, so we reviewed serial echocardiograms of patients with acute myocarditis and attempted to determine the relationship between ventricular wall thickening and left ventricular function. Methods Study PatientsDuring the 12-year period from 1987 to 1998, 60 patients at Fujita Health University Hospital or Nagoya Dai-ni Red Cross Hospital were diagnosed as having acute myocarditis based on clinical symptoms and endomyocardial biopsy findings. Echocardiography and right ventricular endomyocardial biopsies were performed during both the acute (≤2 weeks after onset) and convalescent (≥1 month after onset) phases in 29 of the patients. Of these, 9 patients with second or third degree atrioventricular block were excluded, and the remaining 20 patients comprised the current study group (12 men, 8 women; mean age, 36.5±16.1 years) ( Table 1). In addition to the conventional pharmacological therapies, steroids, catecholamines, and diuretics were being taken by 5, 13, and 16 patients, respectively. Percutaneous cardiopulmonary support and intraaortic balloon pumping were used in 2 patients each. Endomyocardial BiopsiesRight ventricular endomyocardial biopsies were performed, and at least 3 tissue fragments were obtained in each patient. The samples were fixed immediately in 10% buffered formalin, and multiple sections were stained with hematoxylin-eosin, Azan-Mallory, and elastica van Gieson stains for light microscopic examination. The histologic sections were analyzed by 3 observers, and a diagnosis of myocarditis was reached by consensus. The final diagnosis of lymphocytic myocarditis [18][19][20] was based on the Dallas criteria. 18 Only patients with histologic evidence of "active" myocarditis were included.Eosinophilic myocarditis [21][22][23][24] was defined as the development of cardiac symptoms in the presence of peripheral blood eosinophilia and endomyocardial biopsy evidence of eosinophilic infiltration, degranulation, and myocyte necrosis. Using the Azan-Mallory-stained specimens, myocardial

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Severe Transient Left Ventricular “Hypertrophy” Occurring during Acute Myocarditis

Cited by 42 publications

References 4 publications

Left Ventricular Diastolic Dysfunction Induced by Cyclophosphamide in Blood Stem Cell Transplantation.

Left Ventricular Diastolic Dysfunction Induced by Cyclophosphamide in Blood Stem Cell Transplantation.

Risk Factors for Patients Developing a Fulminant Course With Acute Myocarditis

Narrowing of the Left Ventricular Cavity Associated With Transient Ventricular Wall Thickening Reduces Stroke Volume in Patients With Acute Myocarditis

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