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1.
Journal of Heart and Lung Transplantation ; 41(4):S459, 2022.
Article in English | EMBASE | ID: covidwho-1796806

ABSTRACT

Introduction: Extracorporeal photophoresis (ECP) has been used for select heart transplant (HT) recipients with acute cellular rejection, recurrent or refractory rejection, antibody-mediated rejection (AMR) and as prophylactic therapy. Effects of ECP on coronary allograft vasculopathy (CAV) are not as well-described. Case Report: A 48 year-old man with a history of familial cardiomyopathy required left ventricular assist device therapy and ultimately HT in 2001. He developed ISHLT CAV 1 (40% stenosis of LCx and RCA) with severe microvascular dysfunction detected on PET scan (MFR Total 1.14, LAD 1.11, LCx 0.98, RCA 1.40). He was started on treatment with everolimus, but progressive chronic kidney disease necessitated a change back to mycophenolate mofetil. Following this change, his chronic Class II DSA increased significantly and his renal function worsened requiring dialysis, during which time he also had COVID-19. He then presented in cardiogenic shock with ISHLT CAV 3 and pAMR 2 in July 2020 and was treated with an IABP, plasmapheresis, and thymoglobulin. He had recurrent pAMR 2 three months later, for which he was treated with plasmapheresis, bortezomib, rituximab, and ECP. Prior to initiation of ECP, his coronary angiogram demonstrated rapidly progressive ISHLT CAV 3 (80% proximal LAD, 80% ostial LCx, 70% OM1, and 80% mid RCA). Right heart catheterization demonstrated restrictive filling pressures and echocardiogram demonstrated normal graft systolic function. Four months following initiation of ECP therapy, repeat coronary angiography showed improvement of his CAV: the stenosis in the pLAD had regressed to 50%, the proximal LCX stenosis had regressed to 50%, and disease in the distal circumflex artery had also improved (Figure). In our patient, ECP along with multiple other therapies was associated with significant regression of CAV. Even many years post-HT, CAV may be amenable to some therapies.

2.
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation ; 41(4):S338-S338, 2022.
Article in English | EuropePMC | ID: covidwho-1781930

ABSTRACT

Purpose Heart transplant (HT) recipient are at increased risk of adverse outcomes following COVID-19 infection and may benefit from monoclonal antibody infusion to mitigate progression to clinically severe disease. The aim of this study is to describe the outcomes of HT patients who experienced mild to moderate coronavirus disease 2019 (COVID-19), with subsequent administration of casirivimab plus imdevimab administration. Methods A retrospective review of all HT recipients who were infected with COVID-19, and subsequently infused with monoclonal antibodies in a large academic medical center between January 1, 2021 to September 1, 2021. Results 14 HT patients were included in the analysis. The median age was 57.5 (interquartile range [IQR], 41.5-64) years, 10 (71%) were men, and median time from HT was 3.48 (IQR, 1.00-11.82) years. Comorbid conditions included hypertension in 6 patients (43%), diabetes in 4 (29%), and chronic kidney disease in 6 (43%). Eight patients (57%) were previously vaccinated, predominantly with the Pfizer-BioNTech vaccine. Three participants (21%) were admitted after clinical progression of COVID-19. Among patients managed at the study institution, mycophenolate mofetil was discontinued in two patients (14%) and calcineurin inhibitor was maintained at previous levels in all fourteen patients (100%). Of the admitted patients, 1 was treated with high dose corticosteroids alone and 2 were treated with corticosteroids plus remdesivir. No patient required intubation. All 3 patients were discharged home and no patients in this cohort died. Conclusion In this single-center case series, HT patients with mild-moderate COVID-19 who were treated with monoclonal antibody infusion had a hospitalization rate of 21% and 100% survival. Further studies are required to optimize management of COVID-19 infection in the HT population.

6.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1638539

ABSTRACT

Background: The trajectory of cardiac physiology throughout a COVID-19 infection remains poorly described. This study aimed to characterize physiologic changes associated with acute COVID-19 infection among patients with cardiac implantable electronic devices (CIEDs). Methods: The study population included 286 patients with a Boston Scientific CIED across a large health system. CIED sensor data from March 2020-February 2021 were linked to clinical data from electronic health records. Three cohorts were created: COVID-positive (n=20), COVID-negative (n=166), and an untested control (n=100) to account for testing bias as institutional protocols only allowed symptomatic patients to be tested in the early months of the study. The magnitude of sensor changes from baseline (30-60 days before a COVID-19 test) to event (15-day window around a test) was compared between cohorts using one-way ANOVA. A date during the study window was randomly selected to serve as the event for control cases. Results: Comparing COVID-positive vs. COVID-negative vs. control, there was a greater change from baseline to event in respiratory rate (15% vs. 2% vs. 0.6% [p<0.0001]), activity (-44% vs.-12% vs.-6% [p<0.0001]), temperature (1% vs. 0.1% vs.-0.3% [p<0.0001]), and HeartLogic Index, a composite index using multiple sensors (227% vs.-11% vs. 2% [p=0.004]). Average sensor changes show prominent differences surrounding a COVID-19 test for COVID-positive compared to COVIDnegative and control cases (Figure). Conclusions: Physiologic changes associated with COVID-19 infection are detectable using CIEDs. COVID-positive patients have significant increases in respiratory rate, temperature and HeartLogic index and significant decreases in activity compared to COVID-negative and untested patients. Future studies in a larger population will help characterize the utility of CIEDs in infection surveillance and physiologic worsening that should prompt medical attention.

7.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1632416

ABSTRACT

Cardiac microthrombi are postulated to underlie cardiac injury in critical COVID-19. To determine pathogenic mechanism(s) of cardiac injury in fatal COVID-19, we conducted a single-center prospective cohort study of 69 consecutive COVID-19 decedents. Microthrombi was the most commonly detected acute cardiac histopathologic feature (n=48, 70%). We tested associations of cardiac microthrombi with biomarkers of inflammation, cardiac injury, and fibrinolysis and with inhospital antiplatelet therapy, therapeutic anticoagulation, and corticosteroid treatment, while adjusting for multiple clinical factors, including COVID-19 therapies. Higher peak ESR and CRP during hospitalization were independently associated with higher odds of microthrombi (ESR, Pnonlinearity 0.015, Passociation=0.008;CRP per 20mg/L increase, OR 1.17, 95%CI 1.00-1.36). Using single nuclei RNA-sequence analysis, we discovered an enrichment of prothrombotic, anti-fibrinolytic, and extracellular matrix signaling amongst cardiac fibroblasts in microthrombi-positive COVID-19 hearts, compared with microthrombi-negative COVID-19 hearts and non-COVID-19 donor hearts. Our cumulative findings identify these specific transcriptomic changes in cardiac fibroblasts as salient features of COVID-19-associated cardiac microthrombi.

8.
European Heart Journal ; 42(SUPPL 1):3105, 2021.
Article in English | EMBASE | ID: covidwho-1554309

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic has necessitated the widespread adoption of telemedicine, and while many clinics have now re-established in-person patient visits, telemedicine is likely to continue to play an important role in health care delivery. In particular, the embrace of telemedicine presents an unprecedented opportunity through which to expand the reach of genetic counseling, i.e., telegenetics. Purpose: The aim of this study was to examine the impact of COVID-19 on genetic counseling practices within the cardiogenetics clinics at a large academic center in New York City. Methods: We retrospectively analyzed clinical characteristics of patients who were seen for cardiovascular genetic counseling visits pre-pandemic between April 1, 2019 through December 23, 2019 and during the pandemic between April 1, 2020 through December 23, 2020 at Columbia University Irving Medical Center. Genetic testing results were recorded for each encounter when available. Results: Overall, 104 patients had a cardiovascular genetic counseling visit in 2019 compared to 132 patients in 2020 (Table). Only 6% (n=6) of visits in 2019 were remote telemedicine encounters whereas 80% (n=106) of visits in 2020 were telemedicine encounters. There was a significant increase in the number of family members seen for genetic counseling in 2020;in 2019 only 15% (n=16) of the patients seen for genetic counseling were family members of probands whereas this percentage increased to 34% in 2020 (n=45;p=0.002). In addition, in 2020 the geographic reach of genetic counseling extended far beyond New York state, reaching a total of 11 states as well as one patient in Puerto Rico (Figure). Genetic testing results were similar between the two years with 29% of patients found to be genotype positive in 2019 and 29% of patients genotype positive in 2020 (p=0.91). Notably, of those patients who underwent telemedicine visits and were sent genetic testing kits (n=106), 14% (n=15) did not return a sample. Conclusions: In this study we found that despite the health care delivery barriers created by the COVID-19 pandemic, the use of telemedicine allowed us to not only continue seeing patients for cardiovascular genetic counseling visits but also to expand the reach of genetic counseling and testing beyond the geographical boundaries of our previous catchment area. Telegenetics offers patients and clinicians convenience and flexibility and has likely earned its permanent place in clinical practice. Future efforts are warranted to study the longer-term clinical impacts of telegenetics as well as to continue to improve telemedicine technology, with the ultimate aim of increasing patient access to personalized genomic medicine.

9.
MEDLINE; 2020.
Preprint in English | MEDLINE | ID: ppcovidwho-290700

ABSTRACT

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can result in a hyperinflammatory state, leading to acute respiratory distress syndrome (ARDS), myocardial injury, and thrombotic complications, among other sequelae. Statins, which are known to have anti-inflammatory and antithrombotic properties, have been studied in the setting of other viral infections and ARDS, but their benefit has not been assessed in COVID-19. Thus, we sought to determine whether antecedent statin use is associated with lower in-hospital mortality in patients hospitalized for COVID-19. This is a retrospective analysis of patients admitted with COVID-19 from February 1 st through May 12 th , 2020 with study period ending on June 11 th , 2020. Antecedent statin use was assessed using medication information available in the electronic medical record. We constructed a multivariable logistic regression model to predict the propensity of receiving statins, adjusting for baseline socio-demographic and clinical characteristics, and outpatient medications. The primary endpoint included in-hospital mortality within 30 days. A total of 2626 patients were admitted during the study period, of whom 951 (36.2%) were antecedent statin users. Among 1296 patients (648 statin users, 648 non-statin users) identified with 1:1 propensity-score matching, demographic, baseline, and outpatient medication information were well balanced. Statin use was significantly associated with lower odds of the primary endpoint in the propensity-matched cohort (OR 0.48, 95% CI 0.36 a" 0.64, p<0.001). We conclude that antecedent statin use in patients hospitalized with COVID-19 was associated with lower inpatient mortality. Randomized clinical trials evaluating the utility of statin therapy in patients with COVID-19 are needed.

11.
Journal of Heart and Lung Transplantation ; 40(4):S210-S211, 2021.
Article in English | Web of Science | ID: covidwho-1187632
12.
Journal of Heart and Lung Transplantation ; 40(4):S117-S118, 2021.
Article in English | Web of Science | ID: covidwho-1187393
13.
The Journal of Heart and Lung Transplantation ; 40(4, Supplement):S243, 2021.
Article in English | ScienceDirect | ID: covidwho-1141806

ABSTRACT

Purpose In the current era, televisits have become requisite to assess patients and monitor their conditions. Heart transplant (HT) recipients represent a complex population with multiple co-morbidities that require frequent evaluation. This study aimed to assess the effectiveness of televist encounters in a post-heart transplant cohort during the COVID-19 pandemic. Methods This was a prospective cohort study of all HT recipients evaluated via a televist between 3/1/20-5/30/20, at a large academic medical center. Patient demographics, baseline medications and details of televisit encounters were collected from electronic medical records. Patients were followed for 3-months from their first televisit for medication changes, in-person visits, hospital admissions, treated rejection or infection episodes and mortality. Results 301 patients were enrolled, mean age was 56.0±15.1 years and 213 were males (71%). Mean time between transplant and first televisit was 49 months. The number of televisits per patient is seen in Figure 1a. Following-televisits 152 patients (50.5%) had medication changes, mostly immunosuppression (43.5%) followed by diuretics (6.0%). 141 patients (46.8%) were seen in person for either a clinic visit or RHC following a televisit. There were 61 ED visits resulting in 42 admissions in 36 patients (12.0%) (Figure 1b). Of those, 17 occurred within 2 weeks of a televisit (40.5%). There were 8 cardiac related admissions (19.0%, 5 due to treated rejection), 14 (33.3%) due to infection, and 6 due to COVID-19. One patient died due to complications of COVID-19 during the study period. Conclusion In this post HT cohort, there was a high rate of admissions, with most readmissions due to non-cardiac or infectious causes. This study calls into question the role of televisits in this complex patient population and merits further study of how they can best supplement usual care to enhance outcomes in patients post-HT.

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