Search Results (343)

Background/Objectives: Cardiac troponin I (TnI) is the reference biomarker for detecting myocardial injury. Saliva has recently emerged as a potential non-invasive diagnostic fluid; however, evidence regarding the clinical utility of salivary TnI remains limited. This study aimed to compare serum and salivary TnI concentrations in patients undergoing cardiac surgery and to evaluate their relationship during the perioperative period. Methods: A prospective longitudinal observational study included 54 adult patients undergoing elective cardiac surgery with cardiopulmonary bypass and cardioplegic arrest. Serum and unstimulated saliva samples were collected 18–20 h before surgery, 18–20 h after surgery, and 42–44 h after surgery. TnI concentrations were measured using a high-sensitivity chemiluminescent immunoassay. Salivary pH, salivary flow rate, renal function, and fluid balance were also recorded. Results: Significant perioperative changes in TnI concentrations were observed in both serum and saliva (p < 0.001). Median salivary TnI increased from 3.0 ng/L preoperatively to 9.2 ng/L at 18–20 h postoperatively and decreased to 6.4 ng/L at 42–44 h. Median serum TnI increased from 10.2 ng/L to 2593.1 ng/L and subsequently decreased to 1204.5 ng/L. Despite similar temporal trends, no significant correlation was found between serum and salivary TnI concentrations at any time point. Ischemic time was positively associated with postoperative serum TnI concentrations (ρ = 0.347, p = 0.01), whereas no such association was observed for salivary TnI. Salivary TnI concentrations were not significantly associated with salivary flow rate or pH. Conclusions: Salivary TnI concentrations increased significantly following cardiac surgery, indicating measurable perioperative changes within the salivary compartment. However, no significant association was observed between salivary and serum TnI concentrations under the conditions investigated in this study. Therefore, the present findings do not support the use of salivary TnI as a surrogate marker of circulating troponin concentrations. Further analytical validation of high-sensitivity troponin assays in saliva and additional clinical studies are required before definitive conclusions regarding the biological significance and potential clinical utility of salivary troponin measurements can be made. Full article

There have been considerable developments in the analytic precision of cardiac troponins in the last three decades. Whilst there has been near-universal uptake of this technology, there is considerable variability in how to assess acute chest pain patients using high-sensitivity cardiac troponins. This review describes the historical narrative for cardiac troponins and details the evidence base behind decision rules, such as single sample rule-out, single sample rule-in, and accelerated diagnostic protocols (ADPs). There is particular focus on the European Society of Cardiology (ESC) 0/1 and 0/3 h and the high-STEACS ADPs. The ESC 0/3 h ADP appears to have reduced rule-out safety compared to both the ESC 0/1 h and high-STEACS ADP. However, whilst high-STEACS performed well in its validation population, external validation in the US has been less impressive and warrants further investigation. The ESC 0/1 h pathway has demonstrated strong rule-out performance, helped by its observational zone. However, real world implementation studies comparing these ADPs are required to understand their impact on Emergency Department efficiency and the safety of clinician decision-making. Full article

Current acute coronary syndrome (ACS) care relies on sequential, single-modality diagnostics, in which the electrocardiogram, the troponin trajectory, and the coronary angiogram are interpreted independently rather than as a joint signal. This narrative review maps rather than pools the evidence. We selectively searched PubMed, EMBASE, Cochrane CENTRAL, and Web of Science (January 2015–February 2026); study selection was performed by a single reviewer, without duplicate screening, a PRISMA flow diagram, or a formal risk-of-bias assessment. The three key findings are as follows: A machine learning-enabled electrocardiogram (ECG) for diagnosing occlusion due to myocardial infarction achieved an AUC of 0.938 (95% CI = 0.924–0.951) on data not seen during training and correctly diagnosed 42% of patients that expert interpreters missed. A machine learning-enabled high-sensitivity troponin interpretation method, CoDE-ACS, reported an AUC of 0.953 and increased the number of patients ruled out at initial evaluation from 27% to 61%. Angiographically derived physiological methods produced conflicting results—quantitative flow ratios reduced major adverse cardiovascular events (MACE) in the FAVOR III China trial (HR 0.65), but in FAVOR III Europe the angiography-derived approach did not prove non-inferior to FFR; if anything, QFR guidance led to more events (6.7% vs. 4.2%, an event rate about 60% higher in the QFR arm; HR 1.63; 95% CI 1.11–2.41). There was no difference between FFR-angio and FFR in the ALL-RISE trial. These are diagnostic-accuracy and prognostic-association findings; no trial has yet shown that AI-guided ACS care reduces death, reinfarction, or ischemia-driven revascularization. Full article

Background/Objectives: Tumor-infiltrating lymphocyte (TIL) therapy is an important option for patients with metastatic melanoma progressing after standard systemic therapy, but real-world data on treatment delivery, toxicity monitoring, and immune recovery remain limited. We evaluated clinical outcomes, treatment tolerance, immune reconstitution, and cardiac biomarker dynamics across three Mayo Clinic sites. Methods: We retrospectively analyzed adults with metastatic melanoma who received lymphodepleting chemotherapy followed by TIL infusion and high-dose interleukin-2 (IL-2) between April 2024 and December 2025. Clinical outcomes, treatment delivery, and adverse events were assessed. Longitudinal immune monitoring included CD4 and CD8 T-cell counts, CD4:CD8 ratio, and immunoglobulin G (IgG) at baseline and follow-up. In a prespecified cardiac sub-cohort, high-sensitivity troponin (hs-Tn) was measured during IL-2 administration to evaluate associations with cardiac events and IL-2 interruption. Results: Thirty-six patients underwent TIL infusion. The objective response rate was 50.0%, including complete responses in 13.9%, and the disease control rate was 72.2%. Median progression-free survival was 3.61 months, and median overall survival was 12.94 months. M1d disease was associated with inferior overall survival on univariable analysis (HR 6.55, 95% CI 2.03–21.17; p = 0.002), with attenuation after multivariable adjustment. Receipt of ≥3 IL-2 doses was associated with longer overall survival on univariable analysis (HR 0.20, 95% CI 0.06–0.64; p = 0.007), but this association also attenuated after adjustment. Longitudinal immune monitoring demonstrated persistent CD4 lymphopenia through 6 months, sustained inversion of the CD4:CD8 ratio, and declining IgG at months 3 and 6. In the cardiac sub-cohort (24 patients; 87 IL-2 doses), post-dose hs-Tn ≥15 ng/L was associated with clinically significant cardiac events (OR 9.6, 95% CI 1.5–60.6; p = 0.016) and IL-2 interruption (OR 3.4, 95% CI 1.1–10.7; p = 0.036). For cardiac events, hs-Tn ≥15 ng/L had 100% sensitivity and 100% negative predictive value. Conclusions: In routine practice, TIL therapy was feasible and active in metastatic melanoma. M1d disease identified a subgroup with poor survival, peri-dose hs-Tn showed promise as a tool to support safer IL-2 delivery, and prolonged CD4 suppression with IgG decline suggests that recovery after TIL therapy extends beyond initial hematologic reconstitution. These findings support prospective validation of biomarker-guided IL-2 monitoring and extended post-treatment immune surveillance. Full article

Background/Objectives: Impaired kidney function is associated with persistently elevated cardiac troponin levels, complicating evaluation of suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The comparative performance of high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) across sampling intervals in this population remains uncertain. We aimed to identify a kidney function-adapted assay-sampling protocol combination for suspected NSTE-ACS that may support collaborative pathways between nephrologists and acute care clinicians. We therefore assessed kidney function-specific diagnostic and prognostic performance using 0/1 h and 0/3 h protocols. Methods: We conducted a prospective observational cohort study of adults presenting with suspected NSTE-ACS at a tertiary emergency department between March 2019 and December 2020. Patients were stratified according to kidney function at presentation using estimated glomerular filtration rate (eGFR). Impaired kidney function was operationally defined as eGFR < 60 mL/min/1.73 m². Serial hs-cTnT and hs-cTnI concentrations were measured at 0, 1, and 3 h and interpreted using assay-specific thresholds and delta criteria. Diagnostic performance for NSTE-ACS and prognostic performance for 30-day major adverse cardiovascular events (MACEs) were evaluated. Results: Among 140 patients, 58 (41%) had impaired kidney function. Baseline hs-cTnT and hs-cTnI concentrations were significantly higher in patients with impaired kidney function across all sampling time points. In this group, the 0/3 h protocol demonstrated superior diagnostic performance compared with the 0/1 h protocol for both assays. Using 0/3 h testing, hs-cTnI achieved the highest sensitivity (88.6%; 95% CI, 49.2–95.3), whereas hs-cTnT showed the highest negative predictive value (92.2%; 95% CI, 76.2–94.6). In patients with preserved kidney function, both assays demonstrated high specificity and positive predictive value with the 0/3 h protocol. Prognostic discrimination for 30-day MACEs also improved with a 0/3 h strategy, particularly in patients with impaired kidney function. Conclusions: In patients with impaired kidney function and suspected NSTE-ACS, extending troponin testing to 3 h improves diagnostic accuracy and short-term prognostic performance, supporting kidney function-adapted troponin strategies in emergency and nephrology care. Full article

The aim of this study was to retrospectively compare modified Del Nido and blood-based St. Thomas cardioplegia in adult patients undergoing isolated aortic valve replacement (AVR). This retrospective study included adult patients undergoing isolated AVR because of aortic valve stenosis between 2024 and 2025. Patients were stratified into blood-based St. Thomas and modified Del Nido groups. The main modification of the Del Nido solution was the adjustment of the crystalloid-to-blood ratio to 1:4. Preoperative and perioperative variables, as well as postoperative biomarkers, including high-sensitivity troponin I, creatine kinase (CK), CK-MB, and lactate, were analyzed. A total of 93 patients were included in the study (blood-based St. Thomas: n = 22; modified Del Nido: n = 71). No significant differences were observed in cardiopulmonary bypass time [98 min (IQR 84–110) vs. 90 min (IQR 74–110); p = 0.184] or aortic cross-clamp time [75 min (IQR 67–86) vs. 73 min (IQR 62–87); p = 0.345]. High-sensitivity troponin I levels at 24 h were numerically, but not statistically significantly, lower in the blood-based St. Thomas group [1961 ng/L (IQR 1367–4423) vs. 2819 ng/L (IQR 1698–5054); p = 0.240]. CK levels at 6 h were comparable between the groups [8.4 μkat/L (IQR 6.5–10.1) vs. 8.5 μkat/L (IQR 6.0–12.7); p = 0.632], as were CK-MB and lactate levels at all evaluated time points. In exploratory multivariable analyses adjusted for age, sex, preoperative LVEF, cardiopulmonary bypass time, and aortic cross-clamp time, cardioplegia type was not independently associated with postoperative biomarker levels. The less frequent dosing and membrane-stabilizing properties of modified Del Nido cardioplegia did not translate into statistically significant clinical or biochemical advantages in the setting of relatively short, isolated AVR procedures. Full article

Background/Objectives: Myocardial injury is linked to poor outcomes in respiratory infections. This study evaluated the prognostic value of high-sensitivity troponin I (hsTnI) in predicting 30-day outcomes in patients hospitalized with seasonal influenza. Methods: In this single-center retrospective study, 277 adults with laboratory-confirmed influenza were analyzed. Myocardial injury was defined by elevated hsTnI. The primary composite endpoint included 30-day mortality, intensive care unit (ICU) admission, and mechanical ventilation. Results: Patients with myocardial injury had significantly higher event rates for the composite endpoint than those without (p < 0.0001). Dynamic hsTnI elevations, reflecting acute myocardial injury, were also associated with worse outcomes (p = 0.026). Machine learning models incorporating hsTnI and laboratory data achieved excellent predictive performance (AUC = 0.99) and improved risk classification compared with conventional scores (p < 0.0001). Conclusions: Among hospitalized influenza patients, myocardial injury identified by hsTnI strongly predicted short-term adverse outcomes. Routine hsTnI assessment enhances risk stratification beyond standard clinical scores and may facilitate early identification and management of high-risk patients. Full article

The introduction of rapid, high-sensitivity cardiac troponin (hs-cTn)-based algorithms has markedly changed the work-up of patients admitted to the emergency department (ED) with suspected acute coronary syndrome (ACS). However, when applied to real-world ED populations, these algorithms perform worse than in clinical studies of derivation and validation. The main reasons for this discrepancy are that patients tested for hs-cTn in real-world settings tend to be older and less clinically preselected. Nevertheless, ACS must often be ruled out in patients with atypical presentations. Routine patients also more frequently have impaired renal function and pre-existing cardiac diseases, such as atrial fibrillation, heart failure, or coronary artery disease. These conditions do not necessarily cause the actual acute ED presentation. Using the standard decision limits of the 0 h, 0/1 h, or 0/2 h algorithms does not hinder the exclusion of ACS in the ED. However, using them in real-world conditions substantially decreases the positive predictive value for acute myocardial infarction (AMI) and classifies a higher percentage of patients into the “observe (gray) zone” than reported in clinical studies. Patients classified with a working diagnosis of “rule-in AMI” often require hospital admission for other reasons, though their discharge diagnosis may differ from AMI. A major challenge in real-world EDs is the high proportion of gray zone hs-cTn concentrations in approximately 50% of tested patients. Therefore, additional hs-cTn sampling at 3 h after admission is often necessary to rule out acute myocardial injury. This review summarizes and critically discusses the evidence for adjusting hs-cTn ED algorithm decision limits according to age, sex, and renal function. It also discusses the critical differential diagnosis of acute and chronic myocardial injury in the ED. Full article

Background: Hematological parameters derived from complete blood count (CBC) are inexpensive and widely available markers with potential utility in risk stratification of acute coronary syndrome (ACS). However, their incremental prognostic value when used alongside contemporary risk stratification tools such as the Troponin-only Manchester Acute Coronary Syndrome (T-MACS) score remains unclear. Methods: In this prospective, single-center cohort study, 521 patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina were enrolled. Admission CBC parameters (white blood cell count, neutrophils, monocytes, red cell distribution width, mean platelet volume) and derived inflammatory indices (neutrophil-to-lymphocyte ratio, white blood cell-to-mean platelet volume ratio, lymphocyte-to-monocyte ratio, mean platelet volume-to-platelet ratio, and red cell distribution width-to-platelet ratio) were recorded. T-MACS risk scores were calculated, and patients were followed for 30-day major adverse cardiac events (MACE), mortality, and coronary interventions. Associations were assessed using univariate and multivariate logistic regression analyses. Results: Patients experiencing 30-day MACE or mortality had significantly higher white blood cell counts, neutrophil counts, and WMR values (all p < 0.05). Several hematological indices showed significant associations with T-MACS risk categories. In multivariate analysis, intermediate- and high-risk T-MACS classifications independently predicted 30-day MACE (OR 4.49, 95% CI:1.46–13.77, p = 0.009; OR 9.34, 95% CI:3.00–29.03, p < 0.001, respectively), whereas white blood cell count, neutrophil count, and WMR did not demonstrate independent prognostic value beyond T-MACS classification. Conclusions: Admission white blood cell count, neutrophil count, and WMR are associated with short-term adverse outcomes and T-MACS risk severity in patients with NSTE-ACS. However, these markers do not provide additional prognostic value beyond T-MACS classification. These findings suggest that CBC-derived inflammatory markers primarily reflect disease severity rather than incremental prognostic information in the contemporary high-sensitivity troponin era. Full article

Background: Early assessment of myocardial injury severity at presentation remains challenging in acute myocardial infarction (AMI). Complete blood count (CBC)-derived inflammatory indices may provide accessible adjunctive biomarkers reflecting early systemic inflammatory activation associated with myocardial injury. This study evaluated the association and discriminative performance of CBC-derived inflammatory indices for presentation-time myocardial injury severity. Methods: This retrospective study included 252 patients with AMI. CBC-derived inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-lymphocyte × platelet ratio (NLPR), were calculated from blood samples obtained at presentation (0 h). Correlation analysis, multivariable linear regression, logistic regression, incremental model analysis, and receiver operating characteristic (ROC) analysis were performed to assess associations with high-sensitivity Troponin T (hs-Troponin T) levels and high myocardial injury, defined as the highest hs-Troponin T tertile. Results: Both log NLR and log NLPR showed significant positive correlations with log hs-Troponin T (ρ = 0.422 and 0.396, respectively; p < 0.001). In multivariable linear regression adjusted for clinical variables and AMI subtype, log NLR (B = 0.88, p < 0.001) and log NLPR (B =0.77, p < 0.001) remained independently associated with log hs-Troponin T. Incremental model analysis demonstrated significant increases in explanatory performance after addition of log NLR (ΔR² = 0.137) and log NLPR (ΔR² = 0.121, p < 0.001). In logistic regression, log NLR (adjusted OR 2.77, 95% CI 1.65–4.66) and log NLPR (adjusted OR 2.46, 95% CI 1.53–3.95) were independently associated with high myocardial injury. ROC analysis demonstrated modest improvement in discrimination after incorporation of inflammatory indices, with AUC increasing from 0.709 for the baseline clinical model to 0.778 with log NLR and 0.770 with log NLPR. Supplementary reclassification analyses demonstrated improved classification performance. Conclusions: CBC-derived inflammatory indices, particularly NLR and NLPR, were independently associated with presentation-time myocardial injury severity in patients with AMI, even after adjustment for AMI subtype. Although improvements in ROC-based discrimination were modest, supplementary reclassification analyses suggested incremental value beyond conventional clinical variables and AMI subtype. These findings support the potential utility of CBC-derived inflammatory indices for early assessment of myocardial injury during AMI presentation. Full article

High-sensitivity cardiac troponin (hs-cTn) assay offers improved diagnostic accuracy for the detection of myocardial infarction but has seen slow adoption in the United States, particularly in rural settings. Limited research has explored the impact of hs-cTn implementation on downstream testing, in rural hospitals where diagnostic delays are common. This study evaluates the effects of transitioning from standard assay to hs-cTn in a rural tertiary care medical center. We conducted a retrospective analysis of de-identified data from four weeks before and after the implementation of an hs-cTn assay. We assessed the presence of downstream cardiovascular testing and consults among emergency department and inpatient chest pain encounters. Lengths of stay were evaluated. In total, 1664 pre- and 1479 post-implementation admissions were evaluated. Demographic characteristics and comorbidities were similar during the study period. Chest pain was reported more frequently during the post-hs-cTn implementation period as the chief complaint (21.4% vs. 28.7%; p = 0.0036). There was a statistically significant decrease in the number of downstream stress tests performed in the second period (aOR 0.55, 95% CI: 0.31–0.98). The adjusted odds ratio (aOR) for cardiac catheterization trended toward a non-significant decrease (aOR 0.57, 95% CI: 0.40–1.11). Lengths of stay were similar between groups. In a retrospective analysis of patients who underwent cardiac troponin assays, we found that the implementation of hs-cTn was associated with a decrease in downstream stress testing without a significant increase in the number of cardiology consultations, coronary angiographies, or coronary computed tomography scans. Full article

Background and Objectives: The diagnostic accuracy of an artificial intelligence (AI)-derived initial 12-lead electrocardiogram (ECG) analysis was evaluated for early carbon monoxide-induced cardiomyopathy (CO-CMP) risk detection. Materials and Methods: Retrospective medical data of carbon monoxide poisoning (COP) cases between 1 January 2015 and 31 December 2024 were screened for the primary outcome: odds ratio (OR) for echocardiographically confirmed CO-CMP among those with high-risk probability score per the AI-derived model. Secondary outcomes included left ventricular ejection fraction (LVEF) and AI-derived probability score, critical care requirements, including intubation and intensive care unit (ICU) admission, and cardiac arrest events. Results: A total of 51 patients with acute COP were included in the final analysis, with 13 (25.5%) being diagnosed with CO-CMP. The LVEF in the CO-CMP group was lower than that in the non-CO-CMP group (40.00 ± 13.80% vs. 63.76 ± 6.24%, p < 0.001). The AI-derived probability score was higher in the CO-CMP group (11.3 [3.8–32.7] vs. 0.5 [0.2–2.2], p < 0.001). Among cardiac biomarkers, troponin I (2.37 [0.32–7.88] vs. 0.06 [0.06–0.95] ng/mL, p = 0.002) was higher in the CO-CMP group. Patients with CO-CMP required recurrent ventilator support (76.9% vs. 21.1%, p < 0.001) and ICU admission (92.3% vs. 42.1%, p = 0.003). In multivariable regression analysis, the AI-derived prediction model was independently associated with CO-CMP (OR 1.14; 95% confidence interval (CI) 1.02–1.27; p = 0.017; Firth-penalized OR 1.11; 95% CI 1.03–1.25; p < 0.001). Receiver operating characteristic analysis of the AI-derived model showed an area under the curve of 0.85 (95% CI 0.70–0.96) for the AI score alone and 0.92 (95% CI 0.83–0.99) for the Combined AI–cardiac marker model, with a sensitivity of 92.3% and specificity of 81.6%. Pairwise DeLong comparisons between the Combined AI model and comparator models did not reach statistical significance (Combined vs. AI-only, p = 0.092; Combined vs. cardiac markers, p = 0.052); however, the likelihood-ratio test for adding the AI probability score to the cardiac marker-only model demonstrated significant incremental information (χ² = 13.68, p < 0.001). Conclusions: AI-based ECG analysis showed exploratory diagnostic association with LV systolic dysfunction observed in suspected CO-CMP patients. Given the limited sample size, low events-per-variable ratio, and lack of external validation, these findings suggest that AI-ECG analysis may provide incremental information for early cardiac risk stratification in selected patients. Full article

Immune checkpoint inhibitors (ICIs) have transformed the therapeutic landscape of oncology but are increasingly associated with cardiovascular immune-related adverse events (irAEs), including myocarditis, heart failure, arrhythmias, and vascular complications. Among these, ICI-associated myocarditis represents the most severe manifestation, often characterized by high mortality and challenging early diagnosis. Detecting subclinical myocardial injury before irreversible cardiomyocyte necrosis occurs remains a major unmet need in contemporary cardio-oncology. This narrative expert review critically examines the biological rationale, preclinical evidence, and emerging clinical data supporting the potential role of heart-type fatty acid-binding protein (H-FABP) as an adjunctive biomarker of early immune-mediated myocardial injury during ICI therapy. H-FABP is a small cytosolic lipid chaperone abundantly expressed in cardiomyocytes and rapidly released into the circulation following subtle membrane destabilization and metabolic stress, frequently preceding detectable troponin elevation in other forms of myocardial injury. Experimental studies support a mechanistic association between H-FABP release, inflammasome activation, cytokine amplification, mitochondrial dysfunction, and immune–metabolic cardiomyocyte stress. Preliminary clinical observations further suggest that H-FABP elevations may occur during ICI treatment even in the absence of overt myocarditis or concomitant increases in high-sensitivity cardiac troponins (hs-cTns). Although H-FABP cannot replace hs-cTn, which remains the cornerstone biomarker for the diagnosis of clinically significant ICI-associated myocarditis, its rapid kinetics and sensitivity to early metabolic membrane injury support its potential role as an investigational adjunctive biomarker for early surveillance and risk stratification. This approach may be particularly relevant in patients receiving high-risk combination ICI regimens or in individuals with pre-existing cardiovascular disease. However, current evidence remains limited, and large prospective multicenter studies integrating H-FABP with hs-cTns, natriuretic peptides, cardiac magnetic resonance imaging, and clinical outcomes are required before routine clinical implementation can be considered. Full article

Background: Recreational half-marathon participation is increasing, particularly among middle-aged amateur runners, yet the interpretation of early post-race cardiac findings remains challenging in exercise-based cardiovascular health evaluation. This exploratory study assessed early post-race changes in left ventricular diastolic indices and circulating biomarkers in 20 healthy amateur runners (80% male; mean age 50.7 ± 12.3 years) after the 11th PELLA HALF MARATHON (21.1 km). Methods: Participants underwent transthoracic echocardiography and venous blood sampling within 30 days before the race and within 30 min after finishing. Diastolic assessment included the E/A ratio, tissue Doppler early diastolic myocardial velocity (e′), the E/e′ ratio, isovolumic relaxation time (IVRT), and left atrial area. Biomarkers included C-reactive protein (CRP), creatine phosphokinase (CPK), creatine kinase-MB (CK-MB), and high-sensitivity cardiac troponin I (hs-cTnI). Results: Post-race assessment showed a consistent pattern of lower early diastolic filling/relaxation indices, higher IVRT and left atrial area, and significant increases in all measured biomarkers. hs-cTnI exceeded the sex-specific 99th percentile upper reference limit in 7/20 participants (35%). Conclusions: Half-marathon completion was associated with early echocardiographic and biomarker changes in this cohort of amateur runners. These findings are consistent with acute physiological cardiac stress and may help clinicians contextualise early post-race abnormalities when advising on vigorous endurance exercise participation. However, subclinical myocardial injury cannot be excluded without serial biomarker assessment and advanced imaging, and the findings should be interpreted as exploratory because of the small convenience sample, absence of a control group, lack of hydration assessment, and single early post-race timepoint. Full article

Background: Myocarditis is an inflammatory disease of the myocardium with multiple causes and evolutions. The aim of our study was to design a prognostic multiparametric score in patients with myocarditis, to identify those at higher risk of cardiovascular outcomes. Methods: A prospective study was performed enrolling 98 patients with myocarditis: 72 M, 26 F; median age 27 [IQR 20–40]. Patients were divided into two groups: complicated (CM) and uncomplicated myocarditis (UM). Six months after hospital admission, cardiac magnetic resonance (CMR) and cardiological consultation were repeated. Cardiovascular outcomes (death, hospitalization for heart failure, heart transplant, ICD implantation, and heart failure development) were evaluated at 6 months and after 3 years. Results: We found 67 UM and 31 CM. Cardiovascular outcomes were significantly higher in patients with CM. We found a significant correlation between cardiovascular outcomes and reduced LVEF at hospital admission, reduced global longitudinal strain in absolute values, septal late gadolinium enhancement (LGE) at CMR, longer persistence time of increased troponin, LGE extension progression or persistence at 6 months of CMR. A myocarditis prognostic score was developed. A score ≥ 5 showed higher sensitivity (100%) and specificity (87%)—AUC 1, to identify cardiovascular outcomes in patients with myocarditis. A score between 3 and 4 showed high sensitivity but low specificity. A score ≤ 2 was associated with low probability of cardiovascular outcomes. Conclusion: Our study confirms the high probability of cardiovascular outcomes in patients with CM and it suggests a myocarditis prognostic score to identify patients at higher risk of cardiovascular outcomes. Full article