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The aim of the research. To study the features of cardiovascular system disorders in post-covid syndrome (PCS) in children and adolescents after a mild form of coronavirus infection (COVID-19). Material and methods. From 260 children and adolescents after a mild form of COVID-19, a total of 30 patients aged 7-17 years with cardiac manifestations of PCS were selected. Therewith, 32 patients with an uncomplicated form of the disease were selected to form a comparison group. In 3 and 6 months after disease onset, a comprehensive examination of patients was performed with a questionnaire on the subjective scale for MFI-20 assessment asthenia (Multidimensional Fatigue Inventory-20), electrocardiography (ECG), echocardiography;daily monitoring of ECG and blood pressure. The biochemical blood test included assay of creatine phosphokinase-MB (CPK-MB), troponin I and lactate dehydrogenase (LDH). Results. The incidence of PCS with cardiac manifestations amounted to 11.5 %. After 3 months from the disease onset, complaints of pain and discomfort in the chest, palpitations, fatigue, and poor exercise tolerance persisted. Asthenic syndrome was diagnosed in 70 % of patients. The "general asthenia" indicator totalled14 [12;16] points (p<0.001) and was associated with the age of patients (r=+0.5;p<0.05). Arrhythmic syndrome and conduction disorders were detected in 67% of children. Labile arterial hypertension and hypotension occurred in 23 % of the adolescents. The increase in CPK-MB remained in 17% of the children, LDH - in 10%. In the sixth month after the onset of the disease, there were no significant differences in the results of the examination in the observation groups. However, a decrease in the level of resistance within 6 months was recorded in 43.3% of the schoolchildren with PCS (p<0.001). Conclusion. The data obtained indicate the need for early verification of cardiopathies in children with COVID-19, determination of a set of therapeutic and rehabilitation measures as well as ECG monitoring.Copyright © 2022, Krasnoyarsk State Medical University. All rights reserved.
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Post-COVID syndrome develops after COVID-19 (COronaVIrus Disease 2019) and leads to cumulative effects in the form of shortness of breath and impaired lung function. Notably, patients with airway inflammation and COVID-19 were found to have increased concentrations of hyaluronic acid (HA). Since bovhyaluronidase azoximer (Longidase) catalyzes the hydrolysis of HA, this drug has the potential to reduce HA levels and improve lung function in patients with post-COVID syndrome. The aim of the DISSOLVE trial, which was conducted early in the pandemic, was to investigate the efficacy and safety of bovhyaluronidase azoximer in patients with symptoms associated with post-COVID syndrome. Methods. An open, prospective, controlled, comparative, multicenter clinical trial (NCT04645368) included adult patients (n = 160) who had post-COVID syndrome. Patients in the treatment group (n = 81) received bovhyaluronidase azoximer, and individuals in the control group (n = 79) were followed up without intervention. The study included physical examination, evaluation of forced vital capacity (FVC), assessment of dyspnea with the Modified Medical Research Council Dyspnea Scale (mMRC), 6-minute walking test, and pulse oximetry. These indicators were measured on 3 visits, at days 1 (baseline), 75, and 180. In addition, the number of patients who experienced adverse events and serious adverse events were recorded. Results. Baseline patient characteristics in the treatment group and the control group were similar. In the treatment group, there was a statistically significant reduction in residual pulmonary abnormalities after visit 2 (day 75) and visit 3 (day 180). In addition, FVC, pulse oximetry values, and functional exercise tolerance increased statistically significantly at days 75 and 180 compared to baseline. The mMRC scores for dyspnea decreased statistically significantly in the treatment group over 75 days. The safety profile of the drug was reported to be favorable throughout the study. Conclusion. Treatment with bovhyaluronidase azoximer in patients with post-COVID syndrome showed improvement in FVC, pulse oximetry, functional exercise tolerance, and mMRC dyspnea.Copyright © Chuchalin A.G. et al., 2023.
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Introduction/Aim: SARS-CoV-2 (COVID-19) has affected over 60 million people world-wide. In most cases symptoms are mild, however some people have ongoing symptoms lasting longer known as 'long COVID'. Exertional breathlessness is a common complaint in these patients. Dysfunctional breathing (DB) and vocal cord dysfunction (VCD) are two underappreciated causes of breathlessness. We hypothesized that in individuals who had experienced COVID-19, dysfunctional breathing could give rise to VCD. Method(s): Nine convenience-sampled participants with confirmed COVID-19 infection were included following resolution of the acute illness. Vocal cords movements were visualised via continuous laryngoscopy. Hyperventilation was employed as a surrogate for DB, using a standard protocol of 40 breathes per minute (bpm). Participants breathed through a flow sensor with concomitant laryngoscopy, and we monitored hyperventilation, gas exchange measurements and laryngeal movements. After 12-weeks patients returned for repeat hyperventilation testing. Result(s): The nine participants consisted of five females and four males, age range 24-66 years. Three of the nine participants developed classic inspiratory VCD during hyperventilation. Patients with VCD were female, younger (<45), reported significantly reduced exercise tolerance post infection and had been physically very active prior to COVID infection. In two participants VCD associated with hyperventilation had resolved on laryngoscopy at 12-weeks. In these two participants who had VCD, breathlessness and reduced exercise tolerance resolved at 12-weeks following laryngeal retraining. In one person evidence of VCD and reduced exercise tolerance persisted post 12-weeks review. Conclusion(s): This study provides the first evidence that COVID-19 may facilitate VCD via DB, causing unexplained breathlessness. Our findings suggest that this disease process may be implicated in 'long COVID' and provide a rationale for therapies such as breathing and laryngeal retraining.
ABSTRACT
Post-COVID syndrome develops after COVID-19 (COronaVIrus Disease 2019) and leads to cumulative effects in the form of shortness of breath and impaired lung function. Notably, patients with airway inflammation and COVID-19 were found to have increased concentrations of hyaluronic acid (HA). Since bovhyaluronidase azoximer (Longidase) catalyzes the hydrolysis of HA, this drug has the potential to reduce HA levels and improve lung function in patients with post-COVID syndrome. The aim of the DISSOLVE trial, which was conducted early in the pandemic, was to investigate the efficacy and safety of bovhyaluronidase azoximer in patients with symptoms associated with post-COVID syndrome. Methods. An open, prospective, controlled, comparative, multicenter clinical trial (NCT04645368) included adult patients (n = 160) who had post-COVID syndrome. Patients in the treatment group (n = 81) received bovhyaluronidase azoximer, and individuals in the control group (n = 79) were followed up without intervention. The study included physical examination, evaluation of forced vital capacity (FVC), assessment of dyspnea with the Modified Medical Research Council Dyspnea Scale (mMRC), 6-minute walking test, and pulse oximetry. These indicators were measured on 3 visits, at days 1 (baseline), 75, and 180. In addition, the number of patients who experienced adverse events and serious adverse events were recorded. Results. Baseline patient characteristics in the treatment group and the control group were similar. In the treatment group, there was a statistically significant reduction in residual pulmonary abnormalities after visit 2 (day 75) and visit 3 (day 180). In addition, FVC, pulse oximetry values, and functional exercise tolerance increased statistically significantly at days 75 and 180 compared to baseline. The mMRC scores for dyspnea decreased statistically significantly in the treatment group over 75 days. The safety profile of the drug was reported to be favorable throughout the study. Conclusion. Treatment with bovhyaluronidase azoximer in patients with post-COVID syndrome showed improvement in FVC, pulse oximetry, functional exercise tolerance, and mMRC dyspnea.Copyright © Chuchalin A.G. et al., 2023.
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Introduction: The purpose of this study was to evaluate the functional status and ongoing respiratory symptoms of patients who have been discharged home, who were admitted to the intensive care unit (ICU) with severe COVID-19 disease. Long term complications post critical illness, such as post intensive care syndrome (PICS), are well-recognised [1], however, little data exists specific to COVID-19 ICU survivors. Method(s): Local ethics committee approval was secured. Participants were recruited using the electronic intensive care chart database. All patients, from March 2020 to November 2021, who survived Covid-19 were included. Researchers conducted phone interviews with participants and completed three questionnaires;Katz Index of Independent Living Questionnaire, Karnofsky Performance Status Scale and the American Thoracic Society (ATS) Respiratory Disease Questionnaire. Data was input and analysed using excel and stored on a password encrypted computer. Result(s): Database search revealed 61 patients available, 33 of 61 patients were included. 20 (61%) were male, 13 (39%) were female. Mean age was 58, with a range of 25-81. Mean length of ICU stay was 15 days, with a range of 1-74 days. 15 (45%) patients were intubated. Most common Katz score (range 1-6) was the highest score of 6 in 23 (70%) patients. Most common Karnofsky score (range 10-100) was 60 in 11 (33%) patients, with 31 (94%) scoring < 100. The most frequent ATS shortness of breath (SOB) grade (range 0-4) was 3 in 10 (9%) patients, with 23 (70%) patients scoring > 0. 14 (42%) patients had an ongoing cough, 11 (33%) patients had a wheeze and 0 (0%) patients were on home oxygen therapy. Conclusion(s): This study highlights in the majority of patients who survived severe Covid-19 disease to discharge home, there were serious ongoing limitations to their functional status and exercise tolerance, however, they remained independent of basic activities of daily living.
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Background. Prior research has shown that viruses may trigger JDM, although the degree to which COVID-19 may serve as a trigger for JDM remains unknown. We present two case reports of JDM occurring after COVID-19 infection. We also provide case numbers of new JDM diagnoses pre-and post-COVID-19 as well as an analysis of JDM population characteristics pre-and post-COVID-19. A 5year-old female developed upper respiratory infection (URI) symptoms and was diagnosed with COVID-19 in December of 2020. She developed Gottron's sign, heliotrope rash, and weakness resulting in admission in February of 2021. She had elevated CK, AST, ALT, LDH, and aldolase. Her CMAS (childhood myositis assessment scale) was 24. An MRI showed diffuse myositis. Myositis specific antibody (MSA) testing revealed a positive MJ antibody. She was diagnosed with JDM and started on steroids, methotrexate, hydroxychloroquine, and IVIG with improvement. The second patient was a 4year-old female who was diagnosed with COVID-19 in October 2020. In January 2021, she developed heliotrope rash and Gottron's papules. She developed decreased exercise tolerance in May 2021 found to have elevated Aldolase and LDH. Her CMAS was 34. An MRI showed diffuse myositis. MSA testing was significant for a positive P155/140 antibody. She was started on hydroxychloroquine, steroids, IVIG and methotrexate with improvement. Due to the aforementioned cases a retrospective analysis was performed assessing the characteristics of JDM pre-and post-COVID-19 at Lurie Children's Hospital. Methods. The Cure JM biorepository houses clinical data, laboratory data, and patient samples obtained at the onset of JDM. The following information was obtained from newly diagnosed JDM patients: MSA, DAS (disease activity score), flow cytometry results, vWF antigen, neopterin, CMAS, capillary end row loop(ERL), LDH, Aldolase, ESR, CRP, IgG, complements, ANA, and age at diagnosis. We identified 10 patients with a diagnosis of JDM from January 1st 2020 -July 1st 2021 who were designated as the post-COVID-19 group. This population was compared to a total of 51 patients diagnosed with JDM between Jan 1st 2010 and December 31st 2019 who were designated as the pre-COVID-19 group. Data analysis was performed using Welch T-testing. Research enrollment was impacted due to the COVID-19 pandemic. To better assess JDM rates, chart review and EMR reports were obtained to determine the total number of JDM diagnoses. Results. T-testing showed no significant change in DAS, ERL count, T or B cell flow cytometry, vWF antigen, CK, CMAS, CRP, Aldolase, LDH, IgG, complements or ANA titer between the pre-and post-COVID-19 JDM groups. The analysis showed a significant change in NK cell population with a decrease in the absolute NK cell number (pre 163, post 90.75. P value 0.03), and NK cell percentage (pre 6.6%, post 3.625%, P value 0.008). Both of the patients presented in this case report showed a low NK cell number (1% and 3% respectively). The total number of new JDM cases rose from an average of 6.3 cases per year to an average 9 cases per year from January 1st 2020 to December 31st 2021. Conclusion. This study provides two case reports of COVID-19 likely triggering JDM. This study also shows a modest increase in the number of new JDM cases since the onset of the pandemic. Interestingly, the NK cell population in the post-COVID-19 JDM patients were significantly decreased. NK cells have multiple roles in not only immune regulation, but also the immune response to viruses. This study suggests that NK cells play a role in the development of in virally mediated JDM, specifically in cases triggered by COVID-19. Future studies will be important to further delineate the function of NK cells in these patients. Markers of JDM disease severity, including DAS, Neopterin, CK, and CMAS, did not significantly change in our institution's JDM population after the onset of the COVID-19 pandemic.
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Background: COVID-associated and vaccine-triggered myocarditis in young people have received much attention over the course of the pandemic due to early results of vaccination associated myocarditis. This may have led to an increase in myocarditis suspicions. In this study we wanted to examine the actual amount of COVID-associated myocarditis in ourtertiary center. Method(s): We included all cardiac MRIs performed in our institution for the indication of suspected myocarditis between 2020and 2022. We excluded patients with primary cardiomyopathy. We divided the patients into three groups: Group 1 had noCOVID infection or COVID-vaccine associated with their suspected myocarditis, group 2 had received a COVID vaccination prior to developing symptoms, group 3 had had an acute COVID infection and group 4 had a clinical diagnosis of Pediatric inflammatory multisystem syndrome (PIMS). Result(s): Overall, 28 patients had MRIs for suspected myocarditis performed at our center in the investigated time frame. They were 10 to 18 years of age (mean: 15.1 years). Symptoms included chest pain, fatigue, palpitations and reduction in exercise tolerance. Nineteen patients were in group one, 4 patients had symptoms associated with COVID vaccination, three had acute infection and two had a clinical diagnosis of PIMS. Late gadolinium enhancement (LGE) was found in 7 patients. None of these were in groups 2 or 3. Both patients with PIMS(n = 2) had myocarditis on biopsy but only one on MRI. Myocardial biopsy was performed in 8 patients. They showed myocarditis in 6 patients. Apart from the PIMS cases, none of them were associated with Corona infection or COVID vaccine. Three patients had parvovirus B19 on biopsy and one also had EBV. One of the PIMS patients also had HHV6. Theother four biopsies did not yield any viral DNA on PCR. Conclusion(s): Myocarditis associated with acute COVID infection or vaccination was not found in our cohort. Exercise intolerance or chest pain was not reliable indicators of cardiac causes. Even in the pandemic, coronavirus and COVID-19vaccines are unlikely causes of myocarditis. Most cases were associated with classic cardiotropic viruses. However, in cases of PIMS, cardiac involvement is likely and should be investigated accordingly.
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Background: Among many complications of coronavirus disease 2019 (COVID-19) there is a wide range of cardiovascular (CV) problems ranging from mild to severe ones. Even asymptomatic patients and those with mild course of COVID-19 may develop severe CV complications. Factors leading to such state have not been extensively studied so far. Purpose(s): We aimed to assess which factors were linked to the severe complications of COVID-19. Method(s): We included 200 consecutive patients admitted to the Department of Cardiology and Adult Congenital Heart Diseases of the Polish Mother's Memorial Research Institute (PMMHRI) due to post-Covid cardiovascular complications. SARS-CoV2 infection was confirmed with real-life PCR testing. Laboratory tests, 24-hour ECG monitoring and echocardiography were performed in all patients from the investigated group. For the purposes of our study severe complications were defined as: Myocarditis, a decrease of ejection fraction >10% from the pre-disease value, thromboembolic complications, angina pectoris requiring myocardial revascularization and the new onset of atrial fibrillation of supraventricular tachycardia. Some patients presented more than one of the above. Statistical analysis was performed using the software Statistica v.13 (TIBCO Software Inc., Palo Alto, CA, USA). Data were presented as mean +/-SD or median (25th- 75th percentile) for continuous variables and as proportions for categorical variables. Comparisons between groups were performed using Student's t-test for independent variables and the Mann-Whitney U test or chi2 test with Yates's correction, as appropriate. For all calculations p-values <0.05 were considered statistically significant. Result(s): Finally, we included 200 consecutive patients (aged 54+/-16 years, 76 males - 38%), hospitalized for COVID-19 complications after a median 3 (2-6) months following the acute phase of infection. On admission patients presented with dyspnea (23%), impairment of exercise tolerance (47%), chest pain (32%), increase in blood pressure (29%), palpitations (25%), weight loss (13%), brain fog (6%), general malaise (11%), headache (5%), limb pain (13%), swelling (14%). Severe complications of COVID-19 were diagnosed in 31 patients (16%).Taking into consideration symptoms, the presence of severe COVID-19 complications was significantly associated with dyspnoea and deterioration of exercise tolerance. In comparison to patients with mild complications, severe ones were linked to age (the older patients, the higher risk), previous history of heart failure and diabetes mellitus. We did not observe statistically significant differences in severity of complications depending on smoking status (Tables 1 and 2). Conclusion(s): Previous history of heart failure and diabetes mellitus as well as symptoms (dyspnoea and deterioration of exercise tolerance) along with older age are related to more severe complications following COVID- 19.
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Background: Exercise intolerance de novo is one of the most common reported symptoms in patients (pts) recovering from COVID-19. Purpose(s): The present study determines etiological and pathophysiological factors influencing the mechanism of exercise intolerance in the COVID-19 survivors. Therefore, the factors affecting percent predicted oxygen uptake at peak exercise VO2 (%VO2pred) in pts after COVID-19 with normal left ventricular ejection fraction were assessed. Methods and Results: The 120 consecutive patients from the Department of Cardiology recovering from COVID-19 at three to six months after confirmed diagnosis were included. The clinical examinations, laboratory test results, echocardiography using Vivid E95 - GE Healthcare, non-invasive body mass analysis using Body Composition Analyzer (Tanita Pro), and spiroergometry using The MetaSoft Studio application were analysed. The subjects were divided into the two following groups: Study i.e. pts with worse oxygen uptake (%VO2pred <80%;N=47) and control including these cases with %VO2pred >=80% (N=73) - Table 1. Pts with %VO2pred <80% presented significantly lower global peak systolic strain (GLPS) [p=0.03], tricuspid annular plane systolic excursion (TAPSE) [p=0.002] and late diastolic filling velocity (A) [p=0.004] compared to controls - Figure 1. The male gender (p=0.007) and the percent of total body water content (TBW %) (p=0.02) were significantly higher in study in comparison to the control group. The results of multiple logistic regression model independently associated with %VO2pred were as follows: A (OR 0.4, 95% CI: 0.17-0.95;p=0.03) and gender (OR 2.52, 95% CI: 1.07-5.91;p=0.03). Conclusion(s): Males have over twice risk of persistent limited exercise tolerance after COVID-19 infection than females. The lower late diastolic filling velocity, tricuspid annular plane systolic excursion, worse global peak systolic strain, and hydration status are connected with limited exercise tolerance after COVID-19 in patients with normal left ventricular ejection fraction.
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Long COVID-19 is defined as persistency of symptoms, such as exertional dyspnea, twelve weeks after recovery from SARS-CoV-2 infection;its pathophysiology still needs to be fully understood. We investigated exercise tolerance and ventilatory efficiency using cardiopulmonary exercise testing (CPET) in patients with long COVID-19. Methods. One hundred patients admitted to our hospital from March to August 2020 for a moderate to critical COVID-19 were enrolled in our long COVID-19 program. Medical history, physical examination and chest HRCT were obtained at hospitalization (T0), at 3 (T3) and 15 months (T15). All HRCTs were revised using a semiquantitative CT severity score (Pan, F. et al. Radiology 2020;295(3):715-721). Pulmonary function tests (PFTs) were obtained at T and T . CPET was performed at T15 in twenty patients (10 male/10 female;mean age 62 years) with residual respiratory symptoms (e.g., exertional dyspnea) and/or an impairment in PFTs, DLCO and/or KCO . Results. At CPET, peak oxygen uptake (VO2 -peak) and ventilatory efficiency (VE /VCO2 slope) were 95.9+/-18.4 SD %pred and 31.4+/-3.9 SD, respectively. Of notice, significant correlations between VE/V'CO2 slope and CT score (T0 ) (r=0.403;p=0.039), CT score (T3) (r=0.453;p=0.022) and DLCO (T3 ) (r=-0.465;p=0.019) were observed. Conclusions. At fifteen-months from COVID-19 pneumonia, a significant number of subjects (20%) still complains of exertional dyspnea. At CPET this may be explained by reduced ventilatory efficiency (i.e., increase in VE/VCO2), possibly related to the degree of lung parenchymal involvement in the COVID-19 acute phase, likely reflecting a damage in the interstitial/pulmonary capillary structure.
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Introduction: Coronavirus disease 2019 causes severe complications in subjects with risk factors: advanced age, diabetes, hypertension, obesity, among others. Patients with COVID-19 with severe disease have prolonged hospital stays, which causes dynapenia, muscle depletion, and sarcopenia, this induce a worse disease evolution and poor prognosis. Objective(s): Evaluate lung function in recovered COVID-19 with sarcopenia patients. Method(s): Cross-sectional study. 102 patients recovered from COVID-19 who required hospitalization wereincluded. Lung function was assessed using PIMAX, PEMAX, DLCO2 spirometry. Body composition was evaluated by electrical bioimpedance. Sarcopenia was diagnosed by appendicular muscle mass index (men: <7 kg / m, women <5.5 kg) and hand strength (men <27 kg, women <16 kg). Result(s): The population's average age was 44 years +/- 11.66, 58.88% were men, the subjects with sarcopenia had a higher prevalence of diabetes (26.32% vs 7.81%, p=0.039) hypertension (28.95% vs 12.5%, p = 0.039) compared with those without sarcopenia. Subjects with sarcopenia had worse respiratory parameters of FEV1(2.73lt vs 3.19lt, p=0.003), FEV1 post (2.70lt vs 3.24 lt, p=0.0005), FVC (3.19lt vs 3.9lt, p<0.001), FVCpost (3.22lt vs 3.90lt, p<0.001), FEV1/FVC (81.83 vs 84.17, p=0.040), DLCO (25.21 vs 31.83, p<0.001), and exercise tolerance (464.16 m vs 535.84 m, p<0.001) compared to the subjects withoout sarcopenia. Conclusion(s): COVID-19 recovered patients with a higher amount and sarcopenia developed a worse pulmonary and probably poor prognosis.
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Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has showed to cause long-term pulmonary sequelae. Objects: The aim of this study was to evaluate the consequences on pulmonary function of the SARS-CoV-2 infection related to the severity of the disease and exercise tolerance. Method(s): a retrospective cohort study was performed at the "Policlinico Tor Vergata" Academic hospital (Rome, Italy) where 75 patients evaluated in the post-COVID outpatient clinics at the Respiratory units were included in the study. Complete pulmonary function tests, 6-minute walk tests and persistence of symptoms were evaluated. Result(s): among the 75 subjects, 23 were mild, 16 moderate, 26 severe and 10 very severe based on the WHO classification. Very severe patients had a lower FVC (100+/-10%pr) compared to the others groups (116+/-16%pr, 116+/-13%pr, 122+/-20%pr from mild to severe;p<0,05) and a lower TLC (94+/-13%pr) compared to the others (102+/-10%pr, 108+/-15%pr, 108+/-12%pr from mild to severe;p<0,05). DL'co and DL'co/VA were similar among groups. At the 6MWT, distance, basal and nadir SpO2 were similar among groups, but all groups presented a significant decrease of SpO2 from basal to the nadir (Basal SpO2: 97,0+/-1,0% vs Nadir SpO2: 93,6+/-2,7%, p.<0,01). A positive correlation was found between desaturation and delta SpO2 (basal-nadir) (R: 0.29, p<0,05) and the Distance Desaturation Product (R: 0.39, p<0,01). Conclusion(s): These results showed that, although the PFTs are within the normal range, there is a restrictive spirometric pattern in very severe subjects. Moreover, the only persistent pathological sequalae of SARS-CoV-2 infection were a mild desaturation at 6MWT, despite the severity.
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Introduction: Pulmonary function can be affected in Long COVID Syndrome as long-term health consequences caused by SARS CoV2 infection. Objects: The aim of the study was to evaluate the consequences of SARS-CoV-2 infection on pulmonary function, exercise tolerance and muscle strength in healthy middle age outpatients. Method(s): a retrospective cohort study was carried out at the long-COVID outpatient clinics after 3 month from the last negative PCR test. Pulmonary function tests, diffusion of carbon monoxide (Dlco), 6 Minute Walk Test (6MWT), Handgrip Test (HT), and One Minute Sit to Stand Test (1'STS) were perfomed and only in symptomatic patients chest HRCT was carried out. Subjects included were divided according to age, BMI positive HRCT for pneumonia and comorbidities. Result(s): 89 males and 4 female (age: 49,49 +/- 9,1yrs) were included. Subjects older than 50 yrs or with a positive HRCT had a significantly (p<0,05) lower FVC, DLco, and 6MWT distance compared to younger subjects or subjects with negative or no HRCT. Subjects with a greater BMI (>30) had similar lung function compared to the group with a BMI<=30, but a significantly lower distance at the 6MWT (509m vs 570m, p.<0,05), a lower nadir saturation and a lower number of repetition at the 1'STS. In the all group, the DLco, %pr positively correlates with number of repetition at the 1'STS, the distance at the 6MWT and the strength at the HG. Conclusion(s): These results showed that BMI has an impact on exercise tolerance impairment, age and CT pulmonary involvement due to SARS-CoV-2 infection lead to a spirometric restrictive pattern, while DLco correlates with an impaired exercise tolerance, regardless of the exercise modalities.
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Introduction: Face to Face (FTF) PR is a gold standard treatment for chronic respiratory diseases. However low uptake is reported (Sing, S. et al. NACAP 2020). Evaluating virtual alternatives is important when considering methods to improve uptake. Aim(s): To determine the feasibility, and efficacy of virtual PR (VPR). Method(s): Covid-19 led to VPR replacing FTF in 3 London boroughs from March 2020-May 2021. VPR included videoconferencing supported group aerobic and resistance training. The 1 minute sit to stand (1MSTS), CRQ, CAT, HAD and Lung Information Needs Questionnaire (LINQ) were completed pre and post VPR. Result(s): 695 patients were referred with 181 (26%) enrolled into VPR (mean age 67.5+/-11.8;%predicted FEV1 62+/-23.1). 138 completed (76% of enrolled). Reasons for non-enrolment were digital access (n=125), clinical reasons (n=138), declined/non-contactable (n=251). There were significant improvements in 1MSTS (3.3+/-5.3;p<0.001);CRQ-dyspnoea (0.56+/-1.1;p<0.001);emotional functioning (0.32+/-0.9;p<0.001);mastery (0.53+/-1.1;P<0.001);fatigue (0.39+/-1.0;p<0.0001), total (0.43+/-0.8;p<0.001);CAT (-2.2+/-5.4;P<0.001);LINQ (-2.8+/-2.6 P<0.001) and HAD-D (-1.2+/-2.8;P<0.001). 1MSTS, CAT, LINQ, CRQ dyspnoea and mastery exceeded the minimal clinically important differences (MCID). 86% of patients met the MCID for health status and 54% for exercise tolerance (ET). Conclusion(s): VPR was feasible and efficacious in some patients. Our data shows higher completion rates in those enrolled than national F2F data with more patients meeting the health status MCID but less for exercise tolerance. Further work is needed to improve digital access for VPR.
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Introduction: After Covid-19 pneumonia, regular respiratory function assessment is necessary for the subsequent management of patients, including resting respiratory function tests and assessment of submaximal exercise tolerance by six-minute walk (6MW) test. Method(s): Six-minute walk test was undergone for 326 patients about 3 months after Covid-19 pneumonia. Physiological cost of walking (PCW) defined as the difference between maximum heart rate reached at the 6MWT and resting heart rate divided by walking speed was calculated. Result(s): Median age and BMI were respectively 61 [18-95] years-old and 30,4 [18,5-65,2] kg/m2 with a sex-ratio at 1.26. Smoking was reported in 52.8% of cases (12,45 PY). Median 6MW distance was 528 meters [48-832], corresponding of 80% [7-113] of theoric. Median PCW was 0,379 beats/meter [-1.38-5.38]. Low 6MW distance and low saturation during the test were found respectively in 33.1% and 15.2% of cases and were both correlated with DLCO (r=-0.258;p<10-3 and r=-0.423;p<10-3). Chronotropic insufficiency and chronotropic intolerance were found in 13.8% and 7% of cases. PCW was correlated with BMI (r=0.463;p<10-3), FEV1 (r=-0.175;p=0.001), FVC (r=-0.167;p=0.002) and DLCO (r=-0.161;p=0.004). Conclusion(s): Six-minute walk test is an inexpensive, easy and reliable tool that tells us about the global response to submaximal exercise, especially after Covid-19 pneumonia. It is an interesting alternative for patients follow-up, especially when rehabilitation is considered.
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Several months after COVID-19 infection, a high proportion of patients complains of persistent symptoms (long COVID). Regardless of acute disease severity, dyspnea and fatigue are part of major symptoms. Spontaneous recovery is unlikely without any intervention. Thus, our aim was to assess the feasibility and efficacy of a pulmonary rehabilitation (PR) program to relieve these symptoms. 39 patients with a documented COVID-19 infection and suffering from persistent symptoms were included. They took part in PR program between Feb.-Dec. 2021. The program comprised, at the very least, 18 endurance and 10 resistance training sessions and 6 educational sessions (dyspnea management, psychological support and counselling). Exercise tolerance (ET), dyspnea (D-12), fatigue (MFI-20) and quality of life (QoL) were assessed by questionnaires before (T1) and after (T2) PR. Main delay between first symptoms and PR enrolment was 297+/-131 days. Main symptoms were dyspnea (n=34), fatigue (n=29), concentration disorders (n=16) and musculoskeletal pain (n=15). After PR, D-12 and MFI-20 decreased significantly (T1:15.5+/-8;T2: 8.3+/-5.6;p<.05 and T1: 65.6+/-14.3;T2:53.2+/-12.8;p<.05, respectively). In addition, QoL, through physical (PCS) and mental (MCS) dimensions, and ET significantly improved (PCS (T1): 34.8+/-9.7;PCS (T2): 42.7+/-8.3;p<.01;MCS (T1): 40.3+/-9.3;MCS (T2): 48.8+/-8.5;p<.01 and T1: 516.6+/-131.6 m;T2: 602.6+/-118.8 m;p<.05, respectively). PR appears to be a safe, feasible and efficient therapy to relieve dyspnea and fatigue in patients with residual symptoms of COVID-19 several months after initial infection. In addition, PR allows a significant improvement in ET and QoL for these patients.
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Introduction: Atrial fibrillation (AF) is one of the most common forms of arrhythmia in the clinic. There are about 10 million AF patients in China, of which 1/3 are paroxysmal AF, and the remaining 2/3 are persistent or permanent AF. Long-term AF impairs cardiac function and leads to heart failure and thromboembolism. Moreover, AF increases the risk of mortality and ischemic stroke. Drug therapy and radiofrequency catheter ablation (RFCA) are still the mainstream treatment for AF patients. However, drug therapy has its drawbacks because of the high recurrence rate and side effects. Therefore, the current antiarrhythmic drugs could not meet all the clinical needs of patients with AF. RFCA is superior to antiarrhythmic drugs in maintaining sinus rhythm, improving symptoms and exercise tolerance, and improving quality of life. The role of RFCA in the treatment of persistent AF has gradually been recognized and affirmed. Although RFCA has been progressively used in the treatment of AF, there is still a high recurrence rate of AF after RFCA, especially in patients with persistent AF. Hence, it is meant to solve the high recurrence rate of AF after RFCA. Shensong Yangxin (SSYX) capsule has been proven to treat arrhythmia both in animal studies and clinical research. SSYX capsule could regulate multi-ion channels, improve cardiomyocyte metabolism and regulate autonomic nervous function. In addition, randomized, double-blind, multicenter clinical research indicated that the SSYX capsule exhibited good clinical efficacy in treating ventricular premature beats and paroxysmal AF. However, the effect of SSYX on recurrence after RFCA for patients with persistent AF remains unclear. High-level randomized controlled trials (RCTs) could offer clinicians high-quality evidence regarding the usage of SSYX capsule, especially in persistent AF patients who received RFCA. Hence, the RCTs aim to evaluate the effect of SSYX capsules on the prognosis in patients with persistent AF after RFCA through multicenter, double-blind RCTs. Method(s): This trial will be conducted with a total of 920 participants diagnosed with persistent AF who received RFCA. The participants will be randomized (1:1) into groups receiving either SSYX or Placebo for 1 year. The primary endpoint includes the recurrence of AF within 1 year after RFCA. The secondary outcome measures include changes of AF load at 3 months, 6 months, 9 months, and 1 year after treatment, the time of first atrial flutter/AF, the incidence of cardioversion 1 year after treatment, changes of transthoracic echocardiographic parameters 1 year after treatment, the incidence of stroke and thromboembolism at 6 months and 1 year after treatment, the score of SF-36 within 1 year after treatment. Application: The trial is ongoing. The trial started in September 2019 and recruiting patients. Data collection will be completed after all participants have completed the treatment course and follow-up assessments (expected in 2022, pending COVID-19). Next Steps/Future: The SS-ADJUST study is a randomized control study of TCM in persistent AF after RFCA. It will determine the place of SSYX capsule as a new treatment approach and provide additional and innovative information regarding TCM and the specific use of SSYX in persistent AF after RFCA.
ABSTRACT
Prosthetic heart valve thrombosis is one of the most dangerous prosthetic valve complications. Proper monitoring and management of these patients help to prevent this complication. Fluoroscopy is advantageous in cases of thrombosis to assess the function of the prosthetic valve by measuring opening and closing angles. We describe two cases of aortic mechanical valve thrombosis with different mechanisms of thrombus formation. The first case was a 48-year-old woman admitted to the hospital because of shortness of breath during minimal exertion and significantly reduced exercise tolerance. Due to rheumatic heart disease the patient underwent aortic and mitral mechanical prosthesis and has been using warfarin in therapeutic norms. During echocardioscopy aortic prosthesis obstruction and severe tricuspid valve regurgitation were observed. The patient was scheduled for aortic root and TV prosthesis surgery. The second patient also had aortic mechanical valve due to severe aortic stenosis caused by rheumatism and presented with organizing pneumonia and progressing respiratory failure as complications of the COVID-19 infection and was admitted with dyspnea, cough, and weakness. Aortic prosthetic valve thrombosis was diagnosed despite optimal treatment and therapeutic INR.Copyright © 2023, CKS.
ABSTRACT
Introduction: The impact caused by the Coronavirus disease (COVID-19) has considerably altered the provision of outpatient rehabilitation services, especially pulmonary rehabilitation (PR). Objective(s): To describe the situation of PR services in Latin America 18 months after the beginning of the COVID-19 pandemic. Method(s): Cross-sectional study in which a survey was sent to professionals from PR centers in Latin America. An online questionnaire was applied from May to September 2021. The following data were included: demographic data of the programs, evaluation strategies, program structure, RP intervention in post-COVID-19 patients, and perception of therapeutic strategies for the care of post-COVID patients. COVID-19. The questionnaire was distributed in Spanish and Portuguese languages. This study was approved by the ethics committee. Result(s): Responses were received from 196 centers from 14 countries;Most of the surveys were answered by physiotherapists/kinesiologists in 65.7%. In the evaluation of exercise tolerance, the 6-minute walk test is the most used. Less than 50% of the institutions evaluate the quality of life, symptoms, and lung function. In the prescription of exercise intensity, there is reduced use of CPET and it is prescribed mainly with subjective scales of symptoms (Borg Scale) (78.1%), and response to exercise with vital signs (71.4%). The programs have, practically, for the most part, physical therapists (90.8%), as well as pulmonologists (60%), psychologists (35%), among other professionals. Conclusion(s): The application of these programs in Latin America is heterogeneous, both in the evaluations and the interventions carried out.