Introduction and objectives
Vaccines against SARS-CoV-2 have been a major scientific and medical achievement in the control of the COVID-19 pandemic. However, very infrequent cases of inflammatory ...heart disease have been described as adverse events, leading to uncertainty in the scientific community and in the general population.
Methods
The Vaccine–Carditis Registry has included all cases of myocarditis and pericarditis diagnosed within 30 days after COVID-19 vaccination since August 1, 2021 in 29 centers throughout the Spanish territory. The definitions of myocarditis (probable or confirmed) and pericarditis followed the consensus of the Centers for Disease Control and the Clinical Practice Guidelines of the European Society of Cardiology. A comprehensive analysis of clinical characteristics and 3-month evolution is presented.
Results
From August 1, 2021, to March 10, 2022, 139 cases of myocarditis or pericarditis were recorded (81.3% male, median age 28 years). Most cases were detected in the 1st week after administration of an mRNA vaccine, the majority after the second dose. The most common presentation was mixed inflammatory disease (myocarditis and pericarditis). 11% had left ventricular systolic dysfunction, 4% had right ventricular systolic dysfunction, and 21% had pericardial effusion. In cardiac magnetic resonance studies, left ventricular inferolateral involvement was the most frequent pattern (58%). More than 90% of cases had a benign clinical course. After a 3-month follow-up, the incidence of adverse events was 12.78% (1.44% mortality).
Conclusions
In our setting, inflammatory heart disease after vaccination against SARS-CoV-2 predominantly affects young men in the 1st week after the second dose of RNA-m vaccine and presents a favorable clinical course in most cases.
Graphical abstract
La oclusión total crónica del tronco común es unhallazgo angiográfico poco frecuente. Tras revisarlas coronariografías realizadas en nuestro centroentre 1986 y 1995, encontramos una prevalenciadel ...0,04%. Estos pacientes presentaron una clínicainespecífica no diferenciable de otros grados de enfermedadcoronaria, existiendo en todos ellos unaarteria coronaria derecha dominante con ampliacirculación colateral hacia la coronaria izquierda.La función ventricular estaba conservada en el 50%de los casos. Probablemente, en estos infrecuentescasos, la mejor alternativa terapéutica sea la cirugíade revascularización.
Total chronic occlusion of the left main coronaryartery is a rare angiographic finding in a catheterizationlaboratory. After reviewing the coronary angiographiesperformed in our laboratory betwen1986 to 1995, we found a prevalence of 0,04%. Thesepatients presented unspecific symptoms similarto other kinds of coronary artery disease. In all cases,the right coronary artery was dominant withextensive collateral circulation to the left coronaryartery. Ventricular function was normal in 50% ofthe cases. Probably, in these unusual cases, thebest therapeutic approach is surgical revascularization.
La metayodobenzilguanidina es un análogo de la noradrenalina que permite objetivar la inervación simpática del corazón. Durante el trasplante cardíaco el injerto queda completamente denervado. El ...presente estudio pretende valorar la evolución de la reinervación simpática después de un trasplante y relacionar ésta con el estado funcional del corazón.
Se estudiaron 31 pacientes, entre los 6 meses y los 12 años después del trasplante, mediante estudios con yodo-123-metayodobenzilguanidina, para valorar la reinervación, y mediante ventriculografía isotópica reposo/esfuerzo, para valorar el funcionalismo cardíaco. La captación miocárdica de metayodobenzilguanidina se semicuantificó mediante el índice corazón/mediastino, considerándose normal si era superior a 1,8, moderada entre 1,8 y 1,6, leve entre 1,6 y 1,3 y ausente si era inferior a 1,3.
El índice corazón/mediastino se correlacionó con el tiempo postrasplante (r = 0,607; p < 0,001). Los pacientes estudiados a partir de 2 años del trasplante presentaron un índice corazón/ mediastino más elevado (1,62 ± 0,2 frente a 1,34 ± 0,2; p < 0,05). La captación de metayodobenzilguanidina fue en región anterior en 3 pacientes, anterolateral en 25 y anterolateral y septal en 3. Funcionalmente fueron significativos la derivada de la velocidad respecto al tiempo diastólico de esfuerzo de los pacientes estudiados a partir de 2 años del trasplante (2,7 ± 0,8 vtd/s frente a 2,16 ± 0,5 vdt/s; p = 0,02), que también presentaron mayor incremento de la frecuencia cardíaca con el esfuerzo (p < 0,005 frente a p < 0,01).
En el corazón trasplantado la reinervación simpática aumenta a lo largo del tiempo, siendo más frecuente evidenciarla a partir de los 2 años, e iniciándose en las regiones anterior o anterolateral. Doce años después del trasplante no existe evidencia de reinervación simpática cardíaca completa.
Metaiodobenzylguanidine (MIBG) is an analogue of norepinephrine and its cardiac uptake shows sympathetic innervation. During the heart transplantation the allograft becomes completely denervated. The present study was conducted to assess the evolution of sympathetic re-innervation after transplantation, and to related re-innervation with functional status.
We studied 31 patients from 6 months to 12 years after transplantation by 123I-MIBG studies to evaluate re-innervation and by rest/exercise radionuclide ventriculography to evaluate cardiac function. Myocardial MIBG uptake was quantified by calculating a heart-to-mediastinum ratio (HMR). An HMR > 1.8 was considered normal, moderate between 1.8 and 1.6, mild between 1.6 and 1.3, and absent < 1.3.
HMR correlated with time after transplantation (r = 0.607; p < 0.001). HMR of patients studied after 2 years of transplantation was significantly higher (1.62 ± 0.2 vs 1.34 ± 0.2; p < 0.05). MIBG uptake was in the anterior region in 3 patients, in the antero-lateral region in 25, and in the antero-lateral and septal regions in 3. Froma functional point of view, peak filling rate at exercise was higher in patients studied 2 years after the transplantation (2.7 ± 0.8 edv/s vs 2.16 ± 0.5 edv/s; p = 0.02). These patients also showed a higher increase of heart rate with exercise (p < 0.005 vs p < 0.01).
Sympathetic re-innervation increases with time after heart transplantation, and is more frequently seen 2 years after transplantation. Sympathetic re-innervation first appears in the anterior or the antero-lateral regions. A complete re-innervation of the transplanted heart does not occur 12 years after transplantation.
Lymphoma after heart transplantation (HT) has been associated with induction therapy and herpesvirus infection. It is not known whether anti-viral agents administered immediately after HT can reduce ...the incidence of lymphoma.
This study was a retrospective review of 3,393 patients who underwent HT in Spain between 1984 and December 2003. Variables examined included development of lymphoma and, as possible risk factors, recipient gender and age, induction therapies (anti-thymocyte globulin, OKT3 and anti-interleukin-2 receptor antibodies) and anti-viral prophylaxis (acyclovir or ganciclovir). To study the effect of evolving treatment strategy, three HT eras were considered: 1984 to 1995; 1996 to 2000; and 2001 to 2003.
Induction therapy was employed in >60% of HTs, and anti-viral prophylaxis in >50%. There were 62 cases of lymphoma (3.1 per 1,000 person-years, 95% confidence interval: 2.4 to 4.0). Univariate analyses showed no influence of gender, age at transplant, HT era, pre-HT smoking or the immunosuppressive maintenance drugs used in the first 3 months post-HT. The induction agent anti-thymocyte globulin (ATG) was associated with increased risk of lymphoma, and prophylaxis with acyclovir with decreased risk of lymphoma. Multivariate analyses (controlling for age group, gender, pre-HT smoking and immunosuppression in the first 3 months with mycophenolate mofetil and/or tacrolimus) showed that induction increased the risk of lymphoma if anti-viral prophylaxis was not used (regardless of induction agent and anti-viral agent), but did not increase the risk if anti-viral prophylaxis was used.
Induction therapies with ATG or OKT3 do or do not increase the risk of lymphoma depending on whether anti-viral prophylaxis with acyclovir or ganciclovir is or is not employed, respectively.
Abstract Cardiac allograft vasculopathy (CAV) currently represents one of the most important causes of long-term morbidity and mortality in the heart transplant population. In well-designed studies ...with de novo patients, the use of proliferation signal inhibitors (PSIs; everolimus and sirolimus) has been shown to significantly prevent the intimal growth of graft coronary arteries in comparison to other immunosuppressive regimens, reducing the incidence of vasculopathy at 12 and 24 months. In addition, conversion to PSIs in maintenance patients with established CAV has also shown promising results in the reduction of the progression of the disease and its clinical consequences. For these reasons the interest shown by various transplantation units in the potential role of PSIs in this field is growing. The aim of the present article is to review the information obtained to date on the use of PSIs in heart transplant recipients, both in the prevention and the treatment of CAV. The principal published recommendations on the introduction and appropriate management of these drugs in clinical practice are also collected, as well as certain recommendations given by the authors based on their experience.
PDF
