Absence of Long-Term Structural and Functional Cardiac Abnormalities on Multimodality Imaging in a Multi-Ethnic Population of Covid-19 Survivors from the Early Stage of the Pandemic

Background Many patients with COVID-19, particularly from the pandemic's early phase, have been reported to have evidence of cardiac injury such as cardiac symptoms, troponinemia, or imaging or ECG abnormalities during their acute course. Cardiac magnetic resonance (CMR) has been particularly useful to assess myocardial abnormalities given its comprehensive characterization of structure, function, and tissue. Overall, findings have varied, and long term impact of COVID-19 on myocardial structure and function needs further elucidation. Methods We performed TTE and 3T CMR with gadoterate meglumine (Clariscan, GE Healthcare) in survivors of the initial stage of the pandemic without preexisting cardiac disease and matched controls at long-term follow up?>6 months after infection, using an array of techniques to comprehensively evaluate the myocardium. Chi square tests for categorical and t tests for continuous variables were used. P <0.05 was considered significant. Results Our study population consisted of 40 COVID survivors and 12 controls of similar age, sex and race-ethnicity distribution with median age 46, 50% female, 48% Hispanic, 28% Black, mean BMI 27. None had presented with thromboembolism, myocarditis, or ischemia;35% had been hospitalized with 28% intubated. Imaging was performed median 308 days after initial infection. We found no difference in echo characteristics including measures of LV and RV structure and systolic function, valvular abnormalities, or LV diastolic function with median LVEF 60% v 58%, LVEDD 4.0 v 4.4, E/e' ~6, and no RWMA in either group. Using CMR, we confirmed no differences in LV and RV structure and function including median LVEF 57% v 58%, RVEF 53% v 53%, LVEDVi 74 v 72, and RVEDVi 77 v 74. We found no significant differences in T1 (1305 v 1280), T2 (46 v 47), ECV (29 v 30), or LGE mapping. With analysis stratified by patient hospitalization status as an indicator of COVID severity, no differences were uncovered. Conclusion Multimodal imaging of a diverse cohort of COVID-19 survivors who had not presented with acute cardiac pathology reveals no distinct features indicating long-lasting structural or functional damage or inflammation of the myocardium.Copyright © 2023 American College of Cardiology Foundation

Analysis of the restoration of cardiology diagnostics scope in the Russian Federation during the COVID-19 pandemic: results of the Russian segment of the INCAPS COVID 2 study under the auspices of the International Atomic Energy Agency

Aim. To assess the changes in cardiology diagnostics scope in the Russian Federation during the coronavirus disease 2019 (COVID-19) pandemic. Material and methods. In an online survey organized by the Division of Human Health of the International Atomic Energy Agency (IAEA), including questions about changes in the workflow of diagnostic laboratories and the scope of cardiac diagnostics from March 2019 (pre-pandemic) to April 2020 (first wave of the pandemic) and April 2021 (recovery stage), 15 Russian medical centers from 5 cities took part. Results. The decrease in the diagnostics scope by April 2020 by 59,3% compared to March 2019, by April 2021, stopped and was replaced by growth (+7,1%, the recovery rate, 112,1%). The greatest increase was in routine examinations, such as echocardiography (+11,6%), stress echocardiography (+18,7%), stress single photon emission computed tomography (+9,7%), and to a lesser extent resting computed tomography angiography (+7,0%) and magnetic resonance imaging (+6,6%). The performance of stress electrocardiography, stress magnetic resonance imaging and positron emission tomography for the diagnosis of endocarditis in April 2021 compared to March 2019 decreased by 10,3%, 63,2% and 62,5%, respectively. Conclusion. Due to the resumption of patient admissions for cardiac examinations during the ongoing COVID-19 pandemic, with the anti-epidemic measures taken and certain changes in the workflow, there has been a recovery in the diagnostics scope in most of the included centers. Copyright © 2022, Silicea-Poligraf. All rights reserved.

Sustainable indigenous cattle production in Brebes Regency, Indonesia: opportunities and threats during pandemic

This study assesses the sustainability of indigenous cattle production (Jabres Cattle) during the COVID 19 pandemic in Brebes Regency, Indonesia. The sustainability of Jabres cattle production is considered from the aspects of production, socio-economic, and environmental aspects. The study was conducted on 64 Jabres farmers in 5 sub-districts (Ketanggungan, Bantarkawung, Banjarharjo, Larangan, and Salem). Respondents were taken using a simple random sampling method and data was taken using online questionnaires. The collected data were analyzed using descriptive statistics. The indigenous cattle farmers in Brebes Regency have a long experience as beef cattle farmers (10.7 years on average) with an average ownership scale of 7 heads. During the pandemic, there was an increase of 54.7 percent of farmers who felt it was difficult to get cattle breeds compared to before the pandemic. The number of farmers who found it difficult to get forage also showed an increase of 36 percent compared to before the pandemic. Likewise, an increase in the number of farmers (75 percent) felt that it was increasingly difficult to sell beef cattle, which resulted in not making it easy for profits. However, the COVID 19 pandemic can encourage all farmers to pay more attention to the cleanliness of cowshed and the cage environment. Most of the indigenous cattle farmers (89 percent) remain committed to continuing their business despite difficulties in obtaining calves, feed, and selling cattle. Farmers still have confidence that the difficult situation will pass, and demand slaughter cattle will recover.

Improvement in Coronary Allograft Vasculopathy Following Treatment with a Regimen Including Extracorporeal Photophoresis in a Heart Transplant Recipient

Introduction: Extracorporeal photophoresis (ECP) has been used for select heart transplant (HT) recipients with acute cellular rejection, recurrent or refractory rejection, antibody-mediated rejection (AMR) and as prophylactic therapy. Effects of ECP on coronary allograft vasculopathy (CAV) are not as well-described. Case Report: A 48 year-old man with a history of familial cardiomyopathy required left ventricular assist device therapy and ultimately HT in 2001. He developed ISHLT CAV 1 (40% stenosis of LCx and RCA) with severe microvascular dysfunction detected on PET scan (MFR Total 1.14, LAD 1.11, LCx 0.98, RCA 1.40). He was started on treatment with everolimus, but progressive chronic kidney disease necessitated a change back to mycophenolate mofetil. Following this change, his chronic Class II DSA increased significantly and his renal function worsened requiring dialysis, during which time he also had COVID-19. He then presented in cardiogenic shock with ISHLT CAV 3 and pAMR 2 in July 2020 and was treated with an IABP, plasmapheresis, and thymoglobulin. He had recurrent pAMR 2 three months later, for which he was treated with plasmapheresis, bortezomib, rituximab, and ECP. Prior to initiation of ECP, his coronary angiogram demonstrated rapidly progressive ISHLT CAV 3 (80% proximal LAD, 80% ostial LCx, 70% OM1, and 80% mid RCA). Right heart catheterization demonstrated restrictive filling pressures and echocardiogram demonstrated normal graft systolic function. Four months following initiation of ECP therapy, repeat coronary angiography showed improvement of his CAV: the stenosis in the pLAD had regressed to 50%, the proximal LCX stenosis had regressed to 50%, and disease in the distal circumflex artery had also improved (Figure). In our patient, ECP along with multiple other therapies was associated with significant regression of CAV. Even many years post-HT, CAV may be amenable to some therapies.

Assessment of Serology after Sars-Cov-2 Vaccine in Allogeneic HCT Recipients

Introduction: Randomized trials demonstrated ~95% efficacy of SARS-CoV-2 spike messenger RNA (mRNA) vaccines. Patients (pts) after allogeneic hematopoietic cell transplant (HCT) have a variable period of immune deficiency and the impact of diagnosis, treatment regimens, GvHD, and immunosuppression on vaccine (vacc) immunogenicity is unknown. Methods: We performed a retrospective analysis of 149 consecutive pts (Table) who received a SARS-CoV-2 vacc between 12/17/2020, and 5/21/21, and were tested for anti-SARS-CoV-2 S1/S2 antibodies. Serology testing was performed with the Liaison® SARS-CoV-2 S1/S2 IgG assay (DiaSorin) with ≥15 AU/mL defined as a positive result. Pts with prior COVID-19 infection were excluded. Pts received mRNA-1273/Moderna (n= 46), BNT162b2/Pfizer-BioNTech (n= 100) or Jannsen vacc (n= 3). Reactogenicity was not investigated. Demographic and treatment variables were tested for prediction of vaccine response using Chi-square test or Fisher's exact test for categorical variables and two-sample t test for continuous variables. Univariate and multivariable logistic regression analyses with backward selection using Akaike information criterion (AIC) were used to examine interdependence of those variables and odds ratios (OR) with 95% confidence intervals (CI). Results: Pts underwent HCT from a related HLA matched sibling (n=36), related haploidentical (n= 23), or matched/mismatched unrelated donor (n= 89). 93% received fludarabine in the HCT conditioning regimen (data not shown). All pts received a calcineurin inhibitor (CNI) and 76 pts received ATG for GvHD prophylaxis. All pts achieved at least mixed donor lymphoid engraftment (data not shown). Median time from HCT to 1st vaccination was 26 months (range, 3-258 months). Median age at time of vaccination was 61 years (range, 24-78) and 75 (50%) were female. Serology was tested at a median of 37 days (range, 6-119 days) after the second vacc dose. Serology was tested <14 days in 3 pts;all were seropositive. No pt developed COVID-19 during the period of observation. 101 pts (67%) tested positive for anti-SARS-CoV-2 S1/S2 antibodies (vacc responders). Of the responders, the median time from HCT to 1st vacc was 45.5 months (range, 3-258, SD 39.78). Among the 23 pts between 3-9 months after HCT, 26% (n=6) had a positive antibody response, but all were receiving ongoing immunosuppression at time of vaccination. 29% (n=29) vacc responders were receiving prednisone (pred) in the management of cGvHD at the time of vaccination. 48 pts did not mount an antibody response (vacc non-responders). Of the non-responders, 30 pts were receiving cGvHD treatment at the time of vacc, 31 pts were taking pred, and 20 pts were taking CNIs. In univariate analysis, we found a history of prolonged use of pred (>8 weeks) and/or CNIs, on current treatment for cGvHD at time of vacc, and receipt of rituximab in the preceding 12 months predicted for lack of response (Table). Active use of pred and treatment with pred >8 weeks in the preceding 12 months prior to vacc predicted vacc non-response [OR 0.221;95% CI (0.106 - 0.456);p<0.001] and [OR 0.408;95% CI (0.197 - 0.844);p=0.016] in univariate analysis, respectively, however, active use of pred was predictive [OR 0.07;95% CI (0.016-0.304;p<0.001] while pred treatment >8 weeks was not [OR 2.00;95% CI (0.55-7.298;p=0.293] in multivariable analysis. Other significant predictors for non-response in the multivariable analysis include pt use of ruxolitinib [OR, 0.233, 95% CI, (0.067-0.808);p=0.022], and rituximab within 1 year [OR, 0.026, 95% CI, (0.007-0.099);p<0.001]. Discussion: In this study, we found that 67% allogeneic HCT pts developed anti-SARS-CoV-2 S1/S2 antibodies after SARS-CoV-2 vaccination. Predictors of non-response after adjustment for potential confounders, were factors that are expected to suppress immune response including active use of immunosuppressive medications. Consistent with prior studies, anti-CD20 therapy likely impairs humoral response to vaccination. Ruxolitinib also appears to impair response. owever, a proportion of pts being actively treated for cGvHD responded to vaccination and these pts should still be encouraged to receive vaccination in consideration of the COVID-19 mortality risk. Many questions remain including the protective benefit of immune response, the duration of response, and the potential value of booster vaccinations in non-responders. [Formula presented] Disclosures: Rowley: ReAlta Life Sciences: Consultancy.

Impact of the first wave of coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of heart disease in the Russian Federation: Results from the russian segment of the IAEA INCAPS COVID study

Aim. To assess the impact of the first wave of coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of heart disease in the Russian Federation. Material and methods. Fifteen Russian medical centers from 5 cities took part in an online survey organized by the Division of Human Health of the International Atomic Energy Agency (IAEA), containing questions regarding alterations in cardiovascular procedure volumes resulting from COVID-19 in March-April 2020. Results. A number of outpatients undergoing cardiac diagnostic procedures was noted in 80% of clinics. Cardiovascular procedure volumes in the period from March 2019 to March 2020 in general decreased by 9,5%, and from March 2019 to April 2020, by 56,5%. Stress electrocardiography decreased by 38,4%, stress echocardiography by 72,5%, stress single-photon emission computed tomography by 66,9%, computed tomography angiography by 49,7%, magnetic resonance imaging by 42,7%, invasive coronary angiography by 40,7%. The decrease in diagnostic procedure volumes in selected regions (Tomsk Oblast, Kemerovo Oblast, Tatarstan) was not so pronounced compared to Moscow and St. Petersburg (-20,7%,-75,2%,-93,8% in April 2020, respectively, p<0,001). Conclusion. The first wave of the COVID-19 pandemic caused a sharp decrease in the number of diagnostic cardiac procedures in Russia. This has potential long-term implications for patients with cardiovascular disease. Understanding these implications can help guide diagnostic strategies during the ongoing COVID-19 pandemic and minimize the future losses.

Mining Concepts for a COVID Interface Terminology for Annotation of EHRs

The COVID-19 pandemic has overwhelmed the healthcare services of many countries with increased number of patients and also with a deluge of medical data. Furthermore, the emergence and global spread of new infectious diseases are highly likely to continue in the future. Incomplete data about presentations, signs, and symptoms of COVID-19 has had adverse effects on healthcare delivery. The EHRs of US hospitals have ingested huge volumes of relevant, up-to-date data about patients, but the lack of a proper system to annotate this data has greatly reduced its usefulness. We propose to design a COVID interface terminology for the annotation of EHR notes of COVID-19 patients. The initial version of this interface terminology was created by integrating COVID concepts from existing ontologies. Further enrichment of the interface terminology is performed by mining high granularity concepts from EHRs, because such concepts are usually not present in the existing reference terminologies. We use the techniques of concatenation and anchoring iteratively to extract high granularity phrases from the clinical text. In addition to increasing the conceptual base of the COVID interface terminology, this will also help in generating training data for large scale concept mining using machine learning techniques. Having the annotated clinical notes of COVID-19 patients available will help in speeding up research in this field. © 2020 IEEE.