An index of open-access myocardial damage content relevant to primary care
Recent Advances in the Diagnostic Value of New Biochemical Markers of Sepsis-induced Myocardial Injury
CHEN Fachao1，XU Yinchuan1，ZHANG Zhaocai2*
1.Department of Cardiovascular，the Second Affiliated Hospital of Zhejiang University School of Medicine，Hangzhou 310009，China
2.Intensive Care Unit，the Second Affiliated Hospital of Zhejiang University School of Medicine，Hangzhou 310009，China
*Corresponding author：ZHANG Zhaocai，Chief physician；E-mail：2313003@zju.edu.cn
Abstract: Sepsis-induced myocardial damage（SIMD）can lead to poor prognosis and high mortality，so early identification and active treatment are essential. As traditional biomarkers such as cardiac troponin and brain natriuretic peptide are not specific for SIMD，we reviewed the advances in biomarkers for this disease，with detailed summary of the history，release mechanism and diagnostic value of several novel biomarkers〔miRNAs，heart-type fatty acid binding protein（H-FABP），pregnancy-associated plasma protein A（PAPP-A），histone，high mobility group protein-1（HMGB-1），soluble triggering receptor expressed on myeloid cell-1（sTREM-1），and neutrophil gelatinase-associated lipocalin（NGAL）〕in SIMD，and found that miRNAs may be a good predictor as well as an improvement parameter for SIMD，and H-FABP，PAPPA，histone，HMGB-1，sTREM-1 and NGAL may be predictors for SIMD，but the combination of multiple biomarkers may have higher predictive value. In view of the fact that patient enrolment using the sepsis 1.0 or 2.0 diagnostic criteria in majority of SIMD-related clinical studies，and there are few studies using the current sepsis 3.0 criteria，in the era of sepsis 3.0，the value of above-mentioned biomarkers for SIMD diagnosis may be challenged，and the power of multi-biomarkers to predict SIMD also needs to be re-evaluated using new clinical evaluation methods.
Fulminant Type 1 Diabetes Mellitus Complicated with Acute Myocarditis：a Case Report and Analysis
YU Fang，WANG Aihua，JIN Jianlan，XU Chenglin，GONG Min*
Department of Endocrinology，Shanghai Pudong Hospital，Fudan University Pudong Medical Center，Shanghai 201399，China
*Corresponding author：GONG Min，Associate chief physician；E-mail：gongmin9808@126.com
Abstract: We reported the diagnosis and treatment of a patient with fulminant type 1 diabetes mellitus （FT1DM） with acute myocarditis，and discussed the possible pathogenesis. The FT1DM is a subtype featured by rapid-onset，critical condition，quick progression from hyperglycemia to diabetic ketoacidosis and nearly complete destruction of pancreatic beta cells even just after the onset while the patient is autoantibody negative. The patient that we encountered had a history of upper respiratory tract infection before the onset of FT1DM，and suffered from acute myocarditis one week after the onset of FT1DM，suggesting that FT1DM may be caused by the destruction of islet beta cells due to virus infection，which may be a clue for exploring the pathogenesis of type 1 diabetes. Clinicians should improve their understanding of FT1DM in order to identify it in the early stage and provide an active treatment.
Recent Developments in the Pathogenesis of COVID-19-associated Myocarditis
LUO Fei1，LI Shuren2*，HAO Xiao2，BAI Yuhao1，YUAN Kexin2，XIE Yuetao2
1.Graduate School，North China University of Science and Technology，Tangshan 063210，China
2.No.1 Cardiovascular Department，Hebei General Hospital，Shijiazhuang 050051，China
*Corresponding author：LI Shuren，Master supervisor；E-mail：lsr64@126.com
Abstract: Severe acute respiratory syndrome coronavirus-2（SARS-CoV-2）was initially thought to mainly affect the respiratory system.A growing body of research has found that SARS-CoV-2 infection can affect multiple human organ systems，and heart is a major target organ secondary to lung.COVID-19-associated cardiac injury is often seen clinically，about 1%-7% of which is myocarditis.COVID-19-associated myocarditis often has a poor outcome.However，the possible pathogenesis mechanisms of COVID-19-associated cardiac injury，and its progression to COVID-19-associated myocarditis，as well as related pathophysiological changes are still unknown.Available data analysis has revealed that the recognized mechanism of cardiac injury in COVID-19 is ACE2-mediated cardiac injury，and cytokine storm-mediated or immune-mediated cardiac injury is only suggestive currently.Due to limited use of cardiac MRI and endocardial biopsy as well as insufficient autopsy findings and other basic research data in patients with COVID-19-associated myocarditis，the diagnosis and treatment of COVID-19-associated myocarditis are challenges that still exist for clinicians.We reviewed the possible pathophysiological mechanisms of COVID-19-associated myocarditis，which will contribute to improving medical workers' understanding of this disease so that its related mortality may be reduced.
Immune-related Myocarditis Caused by PD-L1 Inhibitor Atezolizumab in Thymoma Treatment：Report of One Case
LONG Lang1，LUO Feng1*，WANG Li1，YAN Guoqing2
1.Lung Cancer Center，West China Hospital，Sichuan University，Chengdu 610041，China
2.Minda Hospital of Hubei Minzu University，Enshi 445000，China
*Corresponding author：LUO Feng，Chief physician，Doctoral supervisor；E-mail：hxyyluofeng@sina.com
Abstract: In recent years，a breakthrough has been made in cancer treatment by immune checkpoint inhibitors （ICIs）.However，with the extensive application of ICIs，reports of immune-related adverse event（irAE） associated with ICIs are increasing，among which immune-related myocarditis is rare but highly fatal.We reported a case of immune-related myocarditis after Atezolizumab treatment of thymoma，and conducted a literature review of the clinical features，possible pathogenesis，treatment and prognosis of this disease.