ABSTRACT
Background Nearly half of the patients with hypereosinophilic syndrome (HES) have cardiovascular involvement, a major cause of mortality. COVID-19 infection can lead to cardiac involvement, negatively impacting the clinical course and prognosis. We reported two cases of HES with cardiac involvement resulting in valve replacement, which were complicated by COVID-19.Case presentation: Our first case was a 27-year-old woman admitted due to dyspnea and signs of heart failure. An echocardiogram revealed severe mitral stenosis and mitral regurgitation. Corticosteroid therapy resulted in the improvement of her symptoms. However, she deteriorated during her hospital course following a positive COVID-19 test. A repeated echocardiogram showed right ventricular failure with severe mitral regurgitation and torrential tricuspid regurgitation. Therefore, she underwent mitral and tricuspid valve replacement. Our second case was a 43-year-old man with HES resulted in severe tricuspid stenosis. Corticosteroid treatment improved tricuspid stenosis, but he underwent valve replacement due to severe valvular regurgitation. He was admitted following tricuspid prosthetic valve thrombosis. Initial workups revealed lung involvement in favor of COVID-19 infection, and his PCR test was positive.Conclusion COVID-19 pandemic can change the clinical course of HES. It may result in a heart failure exacerbation due to myocardial injury and an increased risk of thrombosis in prosthetic valves or native vessels due to hypercoagulability.
Subject(s)
COVID-19ABSTRACT
Background: Diastolic dysfunction has been reported in patients with COVID-19. Due to the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the diagnosis of heart failure, this study investigated the relationship between serum NT-proBNP levels and diastolic heart failure in COVID-19 patients. Methods: : This descriptive-analytical study was performed at Ayatollah Rouhani Hospital in Babol. Fifty-four patients with confirmed COVID-19 diagnosis who were admitted to the ICU were included in the study. The primary outcome was the relationship and predictive role of NT-proBNP and diastolic heart failure in patients with severe SARS-COV-2 infection. Patients with pro BNP >125 pg/mL underwent echocardiography and the relationship between echocardiographic indices and NT-proBNP was assessed as a secondary outcome. Results: : Our study showed that plasma NT-proBNP levels in patients with increased diastolic dysfunction were associated with disease severity. It was also found that the cut-off point of NT-proBNP = 799 pg/mL could be a predictor of diastolic dysfunction grades two and three. In this study, patients with a serum NT-proBNP level equal or above 799 had 37 times higher chance of having diastolic dysfunction than those with a serum NT-proBNP level below 799. Patients with NT-proBNP above 556 had RV_EA> 2 in echocardiography, indicating increased right-sided filling pressures. Conclusion: Despite the confounding factors in the interpretation of the pro BNP level in COVID-19, its level can be used to estimate the presence of high-grade diastolic heart failure on the left and right sides of the heart and the presence of high filling pressures. Lower levels of NT-proBNP are associated with right-sided diastolic failure.