ABSTRACT
Background: Left ventricular global longitudinal strain (LV-GLS) has been recently demonstrated to be predictive of poor outcomes in various cardiovascular settings. Therefore, this study sought to investigate the prognostic implications of LV-GLS in patients with coronavirus disease 2019 (COVID-19). Method(s): This prospective study enrolled 180 consecutive hospitalized patients with COVID-19 admitted to a tertiary care hospital. LV-GLS from the apical four-chamber view was obtained using two-dimensional speckle-tracking echocardiography (2D-STE). Patients with diabetes, hypertension, heart failure, atrial fibrillation, and/or ischemic heart disease were excluded from the study. A correlation between LV-GLS and interleukin-6 (IL-6) levels, C-reactive protein (CRP) levels, in-hospital mortality, intensive care unit (ICU), and hospital stay were sought. Result(s): The mean age of included patients was 58 +/- 16 years. The mean left ventricular ejection fraction (LVEF) was 70.2 +/-6.5, the mean GLS was -21.9+/-4.3. Mean IL-6 and CRP were 9.9 +/- 7.8 pg/ml and 25.8 +/- 25.8 mg/dl respectively. Mean ICU and hospital stay were 7.5 +/- 3.14 and 10.7 +/- 4.03 days respectively. The in-hospital mortality rate was 2.22% (4 patients). Pearson correlation showed a negative correlation between LV-GLS and IL-6, CRP, ICU, and hospital stay (correlation coefficient r= -0.273, -0.301, -0.275, and -0.259 respectively). Conclusion(s): In an observational cohort study, LV-GLS had a negative correlation with laboratory and clinical outcomes in hospitalized COVID-19 patients. So far, long-term cardiovascular complications of COVID-19 are still unknown. Several reports indicate that GLS can be used as a validated method for early prediction of poor outcomes in COVID-19 patients even after the resolution of the original infection. [Formula presented]Copyright © 2023
ABSTRACT
Case Report Restless legs syndrome (RLS) is a poorly understood underdiagnosed neurological, sensorimotor disorder. RLS arises from central nervous system dysfunction leading to both sensory and motor symptoms. Limited cases of COVID-19 vaccines related neurological sequelae, such as Guillain-Barré syndrome (GBS), have been reported. Case presentation A 77-year-old male patient with a past medical history of well-controlled hypertension, diabetes mellitus, hypothyroidism, coronary artery disease status post percutaneous coronary intervention, obstructive sleep apnea on CPAP at night, and restless leg syndrome diagnosed 20 years ago, presented complaining of a 3-month history of worsening of his restless leg symptoms although being compliant with his medications 2 weeks after his 2nd dose of Moderna vaccine. He stated that the frequency and severity of his symptoms had increased from 3-4 times a week lasting for minutes to a daily basis lasting for hours at night, had improved partially with exercise, and affected his sleep hygiene and daily morning activities. He requested several refills of his previously prescribed ropinirole. A comprehensive evaluation, including clinical examination, laboratory workup, brain computed tomography, and polysomnography was unremarkable. He was commenced on pramipexole 0.5 mg daily and instructed to follow up in the clinic in 3 months and call back with no improvement or worsening of his symptoms. Conclusion This case fulfilled the four essential features of RLS, urge to move, worsening with rest, improvement with exercise, and worsening in the evening. To date, no case of RLS associated with COVID-19 vaccines has been previously reported. Although COVID-19 vaccines are relatively safe, long-term complications should be monitored closely.
ABSTRACT
Introduction: The incidence of acute cardiac injury in COVID-19 patients is frequently subclinical and can be identified by cardiac magnetic resonance imaging. Left ventricular global longitudinal strain (LV-GLS) using two-dimensional speckle-tracking echocardiography (2D-STE) provides an accurate validated method for early detection of subclinical myocardial dysfunction. So far, long-term cardiovascular complications of COVID-19 are undetermined therefore several validated methods should be used for early diagnosis and intervention in those patients. Purpose: The aim of this work was to describe GLS as an indicator of myocardial injury in a case series of non-hospitalized COVID-19 patients complaining of persistent dyspnea after resolution of COVID-19 infection. Methods: A total number of 18 patients who were diagnosed with COVID- 19 and were not indicated for hospital admission due to mild symptoms presenting with residual persistent dyspnea following COVID-19 infection resolution. Through clinical examination and standard 2D transthoracic echocardiography with STE emphasizing on LV-GLS was performed using Philips Epic - Qlab 10 software. Results: The mean age of the included patients was 37.44±6.33 years, the mean time from COVID-19 diagnosis was 48.1±15.45 days, all patients (100%) had persistent dyspnea grade II. The mean left ventricular ejection fraction (LVEF) was 62.9±3.46% while the mean LV-GLS was -15.55±2.16%. Clinical and echocardiographic data is presented in Table 1. Conclusion: In a case series of non-hospitalized COVID-19 survivors who complained of persistent dyspnea, GLS was low in comparison to the normally reported values of LV-GLS although they had normal LVEF indicating the persistence of myocardial injury even in mild cases of COVID-19 long after infection resolution. Further close follow-up of even mild and moderate COVID-19 survivors is certainly required to detect long-term cardiovascular sequelae. 2D STE with LV-GLS can be used as a readily available validated technique to detect early or persistent myocardial dysfunction succeeding COVID-19 infection.