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Coronavirus disease-2019 (COVID-19) and legionnaires disease (LD) caused by Gram-negative water-born bacteria Legionella pneumophila show certain similarities, including a predisposition to pulmonary involvement and extrapulmonary manifestations in some of the patients infected. One disease can mimic the other, both can rarely coexist. CASE SERIES REPORT: The authors describe 7 such cases (5 females), aged 51-90 years (mean 69.7 years) detected while screening 133 subjects with moderate to severe pneumonia and confirmed COVID- 19, which constituted 5.3% of the patients in whom urinary antigen test (UAT) for L. pneumophila was performed. The patients had multiple concomitant disorders: hypertension (6), heart failure (4), diabetes (4), obesity (4), coronary heart disease (3), chronic kidney disease (3), chronic obstructive pulmonary disease (3), anemia (3). Positive UAT was obtained at admission in 4 patients, and on 3rd, 11th and 14th days of hospitalization in the remaining 3 patients. One patient also had positive UAT for Streptococcus pneumoniae. We analyzed: radiological imaging, laboratory data (CRP, interleukin-6, procalcitonin, troponin I, BNP), ECG, echocardiography, treatment and outcome. Three patients required a modification of initial antibiotic therapy, two developed Clostridioides difficile infection. The duration of hospitalization ranged from 13 to 59 days (mean 24.3 days);two patients died. CONCLUSIONS: The authors suggest that the coexistence of COVID- 19 and LD may result in prolonged hospitalization, in increased mortality risk and in subsequent cardiovascular complications, including takotsubo syndrome (TTS) which was found in 2 cases, both presented as focal TTS (fTTS).
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INTRODUCTION Coronavirus disease-2019 (COVID-19) is an emerging disease with a wide spread, multiorgan involvement beyond pulmonary manifestations and unknown cardiovascular (CV) consequences. Therefore our aim was to assess the myocardial injury in patients recovered from COVID-19 in cardiovascular magnetic resonance (CMR). MATERIAL AND METHODS This was a multicenter, prospective study involving 5 Polish CMR labs with a high and long-standing experience in CV diseases. All the consecutive patients recovered from COVID-19 (confirmed in reverse transcription polymerase chain reaction [RT-PCR] test) and scheduled for CMR due to cardiac symptoms and a clinical suspicion of myocarditis were enrolled into the study. Patients with a history of previous cardiac injury were excluded from the study. All the patients underwent a contrast-enhanced CMR with conventional myocarditis protocol, including a late gadolinium enhancement (LGE). RESULTS The study group included 250 patients (age 45 ± 12 years old;53% females) with hypertension (24%), diabetes (6%), obesity (67%) and chronic pulmonary disease (6%) sent for cardiac imaging. The main single indications were: a suspicion of myocarditis (42%) or unexplained fatigue (22%) or arrhythmia (12%). Sixty patients had at least moderate COVID-19 requiring hospitalization and the CMR was performed up to 6 months after the disease with the majority of cases performed within 3 months (76%). The left ventricle (LV) function was normal in 91,5% (mean ejection fraction [EF] 62 ± 14%) with a moderate or severe dysfunction in 17 and 4 pts. The right ventricle (RV) function was normal in 85% (mean EF 56.2 ± 8%) with a borderline dysfunction (EF 45-50%) in 17 patients and dysfunction in 20 patients. The enlargement of ventricles (indexed to body surface area) was found in 19 (LV) and 7 (RV) cases. The pericardial effusion was found in 29 pts (11%) and active pericarditis in 21 cases (8%). Finally, active myocarditis and/or edema was noticed in 28 (11%) individuals and myocarditis-like LGE as a post-myocarditis injury in LV myocardium was found in 129 patients (51%). However, 79% of patients showed LGE limited to four or less segments and great majority of the injured segments (92%) revealed only a mild range of LGE (<25% of segment). There was a trend and a weak association between the time of recovery and number of injured segments (r = 0.1;P = 0.05) and no association between the number of injured segments and age (P = ns). CONCLUSIONS Half of the patients recovered from COVID-19 were found to have a myocarditis-like LGE injury in LV, mostly with limited myocardial extent and preserved systolic function. Every fifth of them revealed signs of active inflammation within perior myocardium. The long-term clinical consequences of our findings are unknown.
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Introduction: Cardiovascular involvement during SARS-CoV-2 infection has been described previously in hospitalized patients mainly. The percentage of patients vulnerable after coronavirus infection disease 2019 (COVID-19) is still being under discussion. What remains unknown is the impact of coronary virus on heart on mildly symptomatic patients. Aim of the study The aim of the study was to evaluate cardiac injury 4 months after COVID-19 in mildly symptomatic patients. Material and methods 80 patients successfully cured from COVID-19 were evaluated between 3-4 months after the disease. The study group consisted of 30 males (37.5%) and 50 females (62.5%) with the mean (SD) age 45 (11) years. All patients had laboratory tests, electrocardiogram (ECG) and cardiac magnetic resonance (CMR) done. Cardiac magnetic resonance was performed on 1,5T scanner (Aera, Siemens, Germany). During the CMR study cine imagines, T2-mapping, T1-mapping before and after gadolinium, extracellular volume (ECV) assumption and late gadolinium enhancement were done. Additionally global longitudinal strain was examined. Dedicated software (QMass, Medis, Holland) was used. Results: During SARS-CoV-2 infection 31 patients (39%) had comorbidities, 16 patients (20%) were hospitalized for 3-5 days. 64 (80%) recovered at home, from whom 10 (12.5%) were asymptomatic. At the time of CMR, high-sensitivity troponin I (hs TnI) was in the normal range in all subjects, while 8 (10%) subjects showed slightly elevated NT pro-BNP and 11 (14%) subjects showed elevated D-dimers. Based on myocardial injury detected during CMR the patients were divided into 2 groups. CMR examination showed myocardial injury in 34 (42.5%) patients. The patients with myocardial injury had significant higher native T1 (1011ms in injured group vs 967ms in group without injury;p = 0.006) and ECV (29.5% vs 27% respectively;p = 0.003). NT pro-BNP levels were elevated in 9 patients with myocardial injury on CMR. None of the patients without myocardial injury had NT pro-BNP elevated (p = 0.007). Conclusions: This study indicates that even in mildly symptomatic patients there are occurrences of myocardial injury. The cardiac magnetic resonance is a useful tool for diagnosing myocardial injury after COVID-19.
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Cardiovascular complications of the COVID-19 comprise cardiac arrhythmias, including sinus bradycardia (SB). CASE REPORTS: The authors present clinical data of 19 hospitalized patients (12 males), aged 20-73 years, with marked (less than 45/min during daily hours) self-limiting SB. None of them had SB at admission or earlier, none had used cardiovascular medications potentially decreasing the heart rate. Pulmonary involvement was severe in 4, moderate in 13 and mild in 2 patients;14 needed oxygen therapy (4 using high flow oxygen equipment), none required treatment in the intensive care unit. All patients were given low molecular weight heparin in a prophylactic dose, 13 intravenous ceftriaxone, 12 dexamethasone, 8 convalescent plasma. Before SB appearance, 12 patients were treated with remdesivir (3 patients did not receive a full planned dose) and 2 with tocilizumab. SB appeared suddenly on day 5-14 from the onset of the disease, with a minimal heart rate of 32-44/min and in 3 cases it was mildly symptomatic;2 of those received ad-hoc atropine, one orciprenaline. Interleukin-6 (Il-6) and C-reactive protein (CRP) concentrations at SB onset were significantly lower than at admission (9.3 vs 70.0 pg/ml and 16.8 vs 98.5 mg/l, respectively). Cardiac troponin I was slightly elevated in 2 patients. ECG morphology abnormalities (transient negative T waves or ST depression) were found in 4 males. All subjects had normal left ventricular ejection fraction;in 5 echocardiography revealed small pericardial effusion;in 10 patients, longitudinal strain was also studied: reginal abnormalities were found in all of them, particularly in basal segments. SB lasted 3-11 days and was reversible in all patients;none required temporary stimulation. The COVID-19 course was favorable in all patients;they were stable at discharge. During 4-12 months of posthospital observation, including clinical features, control ECG and 24-hour Holter monitoring, none of the patients was qualified for pacemaker implantation.