ABSTRACT
Aims Cardiac manifestations are common in COVID-19, often elevated serum troponin levels or myocardial dysfunction on trans-thoracic echocardiography (TTE) is observed. Both parameters are associated with increased in-hospital mortality. Possibly, subclinical coronary atherosclerosis plays a role, of which severity can be assessed by calculating the coronary artery calcium (CAC) score. This study aims to determine the relation between coronary atherosclerosis and cardiac manifestations in COVID-19 survivors. Methods This study was conducted at the Leiden University Medical Center. All patients admitted for COVID-19 were included and scheduled for a 6-week follow-up visit with trans-thoracic echocardiography (TTE). CAC was assessed according to an ordinal score on non-gated, non-contrast enhanced computed tomography of the chest. Patients with and without CAC were compared on cardiac injury as reflected by elevated serum troponin levels and impaired cardiac function assessed through TTE. Results In total, 146 patients were included. Mean age was 62 years and 62 % of the patients were male. During admission, patients with CAC showed significantly higher levels of troponin (19 ng/L vs 10 ng/L;p < 0.01). Overall, mild echocardiographic abnormalities were seen;12 % showed reduced left ventricular function (left ventricular ejection fraction of <50 %) and 14 % reduced right ventricular function (tricuspid annular planar systolic excursion ≤17 mm). Following multivariable adjustments, there was no significant relation between CAC and myocardial function at 6 weeks. Conclusion The present study shows that coronary atherosclerosis is associated with cardiac injury in COVID-19 survivors. However, no significant relation with impaired cardiac function was demonstrated.
ABSTRACT
In the recent parliamentary elections (2021), the Scottish National Party (SNP) won by far the largest number of seats (64), with the Scottish Labour Party, once the dominant political force in Scotland, reduced to 22. In Ireland, the pro-independence republican Sinn Fein, the second biggest party in the country, is calling for a vote on Ulster’s split from the United Kingdom and reunification with Southern Ireland. Independence is in the air and there is now a real prospect of the break-up of imperial Britain. At the same time, the Left in Scotland is still divided over the issue of independence. The clash of opinion in Scotland is certainly understandable given the deep-seated scepticism about the radical credentials of the SNP who have previously promoted neoliberal policies, not least with regard to Scotland’s rich North Sea oil and gas reserves. The ongoing crisis in relation to Brexit and the COVID pandemic has also deepened this process of political, social and economic fragmentation. I want therefore to situate this debate about national self-determination in the context of some classic Marxist interventions on the question. The discussion will also be linked to the figure of Hugh MacDiarmid (1892–1978), Scotland’s most controversial modernist poet, whose combination of communist and nationalist engagement will hopefully help throw a clearer literary and political light on the troubled relationship between Scotland and England. While European Marxism has been generally sensitive to the rights of small nations, it still seems necessary to clarify some of the important ideological distinctions between bourgeois and working-class national liberation. Taken together, these different threads provide a sustained argument about the need to support Scottish independence, much in the same way as the cause of Irish independence has been part of the left political agenda in Britain and elsewhere since the time of Marx.