ABSTRACT
BACKGROUND: Multiple reports have described myopericarditis following mRNA COVID-19 vaccination. However, data on the persistence of subclinical myocardial injury assessed by left ventricular (LV) longitudinal strain (LVLS) is limited. OBJECTIVES: Our aim was to assess LV function longitudinally in our cohort of COVID-19 vaccine-related myopericarditis using ejection fraction (EF), fractional shortening (FS), LVLS, and diastolic parameters. METHODS: Retrospective, single-center review of demographic, laboratory, and management data was performed on 20 patients meeting diagnostic criteria for myopericarditis after mRNA COVID-19 vaccination. Echocardiographic images were obtained on initial presentation (time 0), at a median of 12 days (7.5, 18.5; time 1), and at a median of 44 days (29.5, 83.5; time 2). FS was calculated by M-mode, EF by 5/6 area-length methods, LVLS by utilization of TOMTEC software, and diastolic function by tissue Doppler. All parameters were compared across pairs of these time points using Wilcoxon signed-rank test. RESULTS: Our cohort consisted predominantly of adolescent males (85%) with mild presentation of myopericarditis. The median EF was 61.6% (54.6, 68.0), 63.8% (60.7, 68.3), 61.4% (60.1, 64.6) at times 0, 1, and 2, respectively. Upon initial presentation, 47% of our cohort had LVLS < -18%. The median LVLS was -18.6% (-16.9, -21.0) at time 0, -21.2% at time 1 (-19.4, -23.5) (p = 0.004) and -20.8% (-18.7, -21.7) at time 2 (p = 0.004, as compared to time 0). CONCLUSIONS: Though many of our patients had abnormal strain during acute illness, LVLS improved longitudinally, indicating myocardial recovery. LVLS can be used as marker of subclinical myocardial injury and risk stratification in this population.
ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Post Acute Sequelae of SARS-CoV2 (PASC) became an new disease entity during the COVID-19 Pandemic, and in the midst of an evolving pandemic with social distancing and space contstraints, how could we create a platform to help evaluate and treat an emerging disease? DESCRIPTION OF PROGRAM/INTERVENTION: In October 2020, we created a Post-Covid Recovery Clinic that was a "hub and spoke" model. Primary Care Providers (n=4) served as the "hub" and conducted an initial appointment and the "spokes" were the speciality clinics. Each spoke created a referral algorithm with diagnostic testing requests. Eligible patients were those that did not have a PCP in our clinic. A PCP conducted an initial video visit, which accomodated for patient geographical constraints and space restrictions in our clinic. Initial appointments were 40 minutes in duration but were rapidly found to be inadequate. To address this challenge, we developed a detailed note template for documentation and pre-visit electronic health record questionnaires to facilitate elicitation of current symptoms, medications and medical history. To evaluate the clinic, a 21-question post-visit patient survey was emailed or administered by phone. The survey included questions about demographics and patient satisfaction (Likert scale, strongly disagree to strongly agree). All responses were anonymous and confidential. MEASURES OF SUCCESS: The metrics of success for the program were greater than 50% of patients 'agreeing' (defined as strongly agree and agree) with the following statements: 1) Without our clinic they would not have been able to seek care for their PASC symptoms 2) Telemedicine made it easier for them to be seen for their symptoms 3) They benefitted from seeking care from this clinic FINDINGS TO DATE: The survey was completed by 74 patients, who were predominantly women of non-Hispanic White ethnicity with a college education;age ranged from 16 to 79 and patients resided in 59 different Chicagoland zip codes. Overall, Likert results did not differ by gender, race, education, or employment status. The majority of respondents (74%) agreed that virtual visits made it easier to be seen for their PASC symptoms and that they benefitted from seeking care from the clinic. Slight under half of respondents (42%) agreed that without this clinic, they would not have received care for PASC with 37% disagreeing or strongly disagreeing with the statement. A majority respondents (86%) agreed that pre-visit questionnaires were not difficult to complete with a majority (73% and 84%) agreeing that telehealth is an acceptable way to receive healthcare services and that technology is not difficult for them to use. KEY LESSONS FOR DISSEMINATION: 1) A virtual clinic is an acceptable way of providing care for an emergent disease process and facilitates patients with geographical or time constraints to be seen by a specialized clinic. 2) Pre-visit questionnaires sent electronically were not burdensome to patients and helped streamline clinic visits, however there may be selection bias in our patient population.
ABSTRACT
Background: The SARS-Cov-2 virus and the associated Multi-System Inflammatory Syndrome in Children (MIS-C) can cause myocardial injury, cardiac dysfunction, and coronary dilation. This makes echocardiography a key component during clinical evaluation. To improve technician safety, we implemented a protocol utilizing a tablet-based echocardiography (TBE) system to evaluate patients who had active COVID-19 or whose testing was pending. We hypothesized that appropriate clinical evaluations could be completed with TBE while having a shorter exposure time for personnel. Methods: We retrospectively evaluated 35 patients at a tertiary, pediatric hospital between March 2020 and May 2021 who underwent TBE. We compared the TBE findings and duration to comprehensive echocardiograms done on average two weeks later with a traditional machine. A complete study included evaluation of ventricular function, coronary artery diameter, and pericardial fluid assessment. Pro-brain natriuretic peptide (pro-BNP) and troponin-T levels were reviewed. Subjects were divided into two groups based on an elevation in troponin-T as a surrogate for myocardial injury (Trop and Trop ).Results: Eight subjects had cardiac dysfunction with 6/12 being from the Trop group and 2/23 in the Trop group. The mean troponin-T elevation was 0.32 ng/mL. Pro-BNP levels were elevated in all but 1 of the 35 subjects but were ten times higher in the trop group (mean 18,055 vs 1,888 pg/mL;p = 0.001). Three subjects with MIS-C had coronary dilation noted by TBE (2 in Trop and 1 in Trop ) with one persistently dilated at follow up. TBE findings such as coronary dilation or cardiac dysfunction guided medical therapies and no clinically relevant findings were missed when compared to studies at follow up. TBE was on average 29 minutes shorter (41 ± 18 vs 12 ± 5 min;p < 0.001). One patent ductus arteriosus was found by TBE and this was confirmed on repeat imaging. Conclusions: TBE allows for experienced sonographers to limit exposure time to potentially contagious patients and easier decontamination while not compromising essential clinical information. This study shows TBE is a useful tool to effectively evaluate patients during highly contagious viral respiratory outbreaks.