Cardiovascular Risk Assessment after COVID-19 Infection before Resuming Sports Activities - Practical Flowchart and Meta-Analysis

Abstract Background: The risk of sports-related sudden cardiac arrest after COVID-19 infection can be a serious problem. There is an urgent need for evidence-based criteria to ensure patient safety before resuming exercise. Objective: To estimate the pooled prevalence of acute myocardial injury caused by COVID-19 and to provide an easy-to-use cardiovascular risk assessment toolkit prior to resuming sports activities after COVID-19 infection. Methods: We searched the Medline and Cochrane databases for articles on the prevalence of acute myocardial injury associated with COVID-19 infection. The pooled prevalence of acute myocardial injury was calculated for hospitalized patients treated in different settings (non-intensive care unit [ICU], ICU, overall hospitalization, and non-survivors). Statistical significance was accepted for p values <0.05. We propose a practical flowchart to assess the cardiovascular risk of individuals who recovered from COVID-19 before resuming sports activities. Results: A total of 20 studies (6,573 patients) were included. The overall pooled prevalence of acute myocardial injury in hospitalized patients was 21.7% (95% CI 17.3-26.5%). The non-ICU setting had the lowest prevalence (9.5%, 95% CI 1.5-23.4%), followed by the ICU setting (44.9%, 95% CI 27.7-62.8%), and the cohort of non-survivors (57.7% with 95% CI 38.5-75.7%). We provide an approach to assess cardiovascular risk based on the prevalence of acute myocardial injury in each setting. Conclusions: Acute myocardial injury is frequent and associated with more severe disease and hospital admissions. Cardiac involvement could be a potential trigger for exercise-induced clinical complications after COVID-19 infection. We created a toolkit to assist with clinical decision-making prior to resuming sports activities after COVID-19 infection.

Síndrome de ALCAPA em uma Mulher Jovem / ALCAPA Syndrome in a Young Woman

Mulher de 18 anos com histórico de síncope, angina e palpitações há um ano. Uma indicação crucial era artéria coronária direita dilatada na ecocardiografia transtorácica. Os achados da tomografia computadorizada resultaram no diagnóstico da origem anômala da artéria coronariana esquerda proveniente da síndrome da artéria pulmonar.(AU)

A importância da ecocardiografia para a avaliação de fonte embólica / The importance of echocardiography for the evaluation of cardiac sources of embolism

A pesquisa de fontes embólicas cardíacas por ecocardiografia é frequentemente requisitada no contexto de acidentes vasculares cerebrais embólicos. Seus achados têm também interesse para determinar o risco embólico de outras doenças cardíacas, mesmo ainda sem um evento embólico estabelecido. Neste trabalho apresenta-se uma revisão acerca do papel da ecocardiografia para as principais fontes embólicas cardíacas. Essas são divididas em fontes embólicas de alto risco (fibrilação atrial, infarto agudo do miocárdio e aneurisma do ventrículo esquerdo, miocardiopatias, estenose mitral, endocardite, prótese valvar mecânica, tumores e ateromas da aorta proximal) e de baixo risco (prolapso da válvula mitral, estenose aórtica calcificada, excrescências gigantes de Lambl e embolia paradoxal – forame oval patente e aneurisma do septo atrial). Dada a grande interação entre as diversas doenças cardiovasculares com potencial embólico, é difícil obter dados acerca do risco embólico isolado de cada achado de imagem. Não obstante, para as fontes embólicas cardíacas de alto risco estão mais bem determinados os achados que predizem um maior risco embólico.