ABSTRACT
Myocarditis has been recognized as a rare complication of coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccinations. The frequency of the event was reported 2-3 cases per million vaccinations. Clinical courses remain variable, ranging from asymptomatic to severe heart failure requires mechanical circulatory supports (MCS). Here we report a case of fulminant myocarditis requiring MCS following COVID-19 mRNA vaccination. A 22-year-old male presented to the hospital with chest pain and fever 2 days after receiving the third dose of the COVID-19 mRNA vaccination. Electrocardiography showed tachycardia with ST-segment elevation. Inflammatory and myocardial injury markers were elevated, and echocardiography demonstrated slight left ventricular (LV) dysfunction. He was hospitalized for suspecting acute myocarditis. On the second day of hospitalization, he developed recurrent ventricular fibrillation with cardiogenic shock leading to need for venoarterial extracorporeal membrane oxygenation and intra-aortic balloon pumping. Echocardiography revealed severe LV systolic dysfunction. Catheter examinations showed normal coronary with elevated right and left sided filling pressures and decreased cardiac output. Endomyocardial biopsy (EMB) revealed moderate endomyocardial thickening, mild inflammation, increased interstitial fibrosis and cell infiltration with more macrophages (CD68+) (Figure) (awaiting the results of tenascin-C, angiotensin converting enzyme 2 and severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] spike S protein). No viral genomes including SARS-CoV-2 were detected in the EMB specimens by polymerase chain reaction test. With advanced therapy, he was discharged on the 26th day without any cardiac dysfunction. Histological evaluation is important for diagnosing myocarditis following COVID-19 vaccination to confirm type of inflammation and the absence of viral genomes. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Background: Owing to the spread of coronavirus disease 2019 (COVID-19), people have refrained from going out unnecessarily and have been maintaining social distance. These new lifestyle approaches have affected people physically, psychologically, and socially. Patients with heart failure (HF) are more likely to have social frailty, physical frailty, cognitive impairment, and depressive symptoms, and an overlap of these conditions leads to adverse events. Therefore, multi-domain assessment and understanding of the condition of patients with HF are important for disease management. The spread of COVID-19 is a predicted risk factor for these events, but its impact in patients with HF has not been investigated. Purpose: We investigated whether the spread of COVID-19 is associated with the development of the multi-domain of frailty in patients with HF. Methods: Patients who were independent in their daily activities before admission were included in the study. The presence of social frailty (Makizako's five items), physical frailty (Fried phenotype model), cognitive impairment (Mini-Cog), and depressive symptoms (the Patient Health Questionnaire-2) in patients with HF were assessed at hospital discharge. Logistic regression analyses were used to examine the impact of the spread of COVID-19 on the development of the multi-domain of frailty in patients with HF. Results: We included 482 patients in this study. Median patient age was 74 years, and 64.5% were male. In multivariate logistic regression analyses, the spread of COVID-19 was significantly associated with the development of social frailty (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.02-1.30) and depressive symptoms (OR: 1.14, 95% CI: 1.02-1.27) but not with the development of physical frailty (OR: 1.24, 95% CI: 0.51-3.02) and cognitive impairment (OR: 1.72, 95% CI: 0.80-3.73). Conclusion: The spread of COVID-19 was associated with the development of social frailty and depressive symptoms in patients with HF. Evaluation of social frailty and depressive symptoms during hospitalization would support disease management and understand their social and psychological conditions specific to the spread of COVID-19. (Table Presented).
ABSTRACT
Introduction: The coexistence of heart failure (HF) and frailty leads to a worse prognosis. Frailty is generally diagnosed using the Fried criteria. To assess whether patients are frail according to the Fried scale, faceto-face physical examinations are required. However, with the COVID-19 pandemic, to avoid the spread of the virus in hospitals, it is important to screen hospitalized patients for frailty without contact. Therefore, noncontact measurement methods, such as questionnaires, should be used to screen for frailty in clinical practice. The FRAIL scale is a questionnaire used to screen for frailty. There are no studies regarding the consistency of the FRAIL scale with the Fried criteria, the impact on mortality, and physical dysfunction in elderly patients with HF. Purpose: We investigated whether the FRAIL scale questionnaire is consistent with the Fried criteria, predicts all-cause mortality, and reflects physical dysfunction in patients with HF. Methods: The present study was secondary analysis of FRAGILE-HF, a cohort study that enrolled participants from 2016 to 2018 and followed up for 1-year of discharge. A prospective multicenter cohort study in which 15 hospitals in Japan (8 university hospitals and 7 non-university teaching hospitals) participated. We prospectively enrolled 1332 consecutive hospitalized patients with HF ≥65 years old and analyzed 1028 patients after excluding 304 patients with missing data on the FRAIL scale. The FRAIL scale, the Fried model, and physical function were measured before discharge. The endpoint was all-cause mortality. Results: According to the FRAIL scale, 459 (44.6%) and 491 (47.8%) were classified as frail and pre-frail, respectively. The Kappa coefficient between the FRAIL scale and the Fried criteria were 0.39 (95% confidence interval [CI]: 0.34-0.44;P value: <0.001). The area under the receiver-operating characteristic curves for frailty diagnosed by the Fried criteria of the FRAIL scale was 0.74 (95% CI: 0.71-0.76;P value: <0.001). A total of 118 deaths occurred during 1 year of follow-up. After adjusting for the MAGGIC score and log-BNP, The FRAIL scale predicted all-cause mortality (hazard ratio: 1.17;95% CI: 1.01-1.36;P value = 0.035). The FRAIL scale was also associated with various physical dysfunction that correlated with poor prognosis. Conclusions: The FRAIL scale had moderate consistency with the Fried criteria, predicted all-cause mortality, and reflected clinically important physical dysfunction.