Coronary Artery Calcium Score: Current Efficacy of Cardiac CT in Patients at Hail Region, Saudi Arabia

Calcium levels in the Coronary Artery are an indicative marker of the presence and extent of atherosclerosis. This serves as an additional prognostic indicator in addition to traditional risk factors. Moreover, the coronary calcium test is associated with a descriptor known as the calcium score or calcium score (Cs), which is primarily useful for stratifying the risk of asymptomatic patients, while for patients with acute or chronic chest pain, coronary axial computed tomography is generally required. A retrospective analysis of data was conducted in the radiology department of King Salman Specialist Hospital in Hail City, the kingdom of Saudi Arabia, between January and May 2022. A total of 40 patients were randomly selected, 25 males and 15 females. The study included all patients with or suspected of having a calcium deposit who underwent a CT scan using the Siemens SOMATOM definition MDC scan. Patients underwent a scan with the preparations and laboratory tests required for their coronary artery calcium scores. In this study, males were more likely to be affected by calcium deposits (64%), whereas females were 36%. Approximately 50 percent of the study populations were found to be normal (no identifiable calcium deposits) and 37.5% to have moderate calcium deposits. There is a significant association between CACS and moderate CVD risks based on age and gender in this study. Better control of cardiovascular system (CVS) risks is recommended in all primary care centers in the Kingdom of Saudi Arabia (KSA).Copyright © 2022 International Journal of Pharmaceutical Research and Allied Sciences. All rights reserved.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) complicating myocarditis

Myocarditis can lead to myocardial infarction in the absence of coronary artery obstruction. We report a case of probable myocarditis, complicated by myocardial infarction with non-obstructive coronary arteries. A 19-year-old man presented with chest pain typical of myocarditis. He was a smoker but was otherwise well. Electrocardiogram revealed diffuse ST-elevation and echocardiography revealed a thin, akinetic apex. Troponin-T levels on admission were raised leading to an initial diagnosis of myocarditis being made. However, late gadolinium enhancement study on cardiac magnetic resonance imaging demonstrated transmural enhancement typical of ischaemia. Coronary angiogram was normal, leading to a likely diagnosis of myocardial infarction with non-obstructive coronary arteries. It is important to highlight that coronary assessment remains important when working up for myocarditis, as myocardial infarction with non-obstructive coronary arteries can often complicate myocarditis in cases of normal angiography. Another important lesson was on how cardiac magnetic resonance imaging provided vital evidence to support underlying ischaemia despite normal coronary angiogram, leading to a diagnosis of myocardial infarction with non-obstructive coronary arteries. Myocardial infarction with non-obstructive coronary arteries remains a broad 'umbrella' term and cardiac magnetic resonance imaging, as well as more invasive coronary imaging techniques during angiography, can further assist in its diagnosis. Our case provides a reminder that myocardial infarction with non-obstructive coronary arteries, although increasingly recognised, remains under-diagnosed and can often overlap with peri-myocarditis, highlighting the need to employ multi-modality imaging in guiding management.Copyright © The Author(s) 2021.

ESC Asia 2022 with APSC and AFC

The proceedings contain 138 papers. The topics discussed include: cardiovascular profile and electrocardiographic findings of hospitalized adult patients during the surge of delta and omicron variants of COVID-19 in a COVID-19 tertiary referral center;abnormal left atrial strain is associated with eventual diagnosis of atrial fibrillation in patients with embolic stroke of undetermined source;sex differences in the evaluation and outcomes of multi-ethnic Asian patients undergoing stress echocardiography;intraventricular pressure gradient: a novel color M-mode echocardiographic-derived imaging modality to assess and predict the alterations following acute myocardial infarction;nationwide trends of gatekeeper to invasive coronary angiography in suspected coronary artery disease;change in minimum indexed left atrial volume predicts incident heart failure: the multi-ethnic study of atherosclerosis;and the diagnostic utility of cardiac imaging (echocardiogram and cardiac MRI) in COVID 19 patients and cardiac complications: retrospective cohort study in Saudi Arabia.

The diagnostic utility of cardiac imaging (echocardiogram and cardiac MRI) in COVID 19 patients and cardiac complications: retrospective cohort study in Saudi Arabia

Background/Introduction: Coronavirus disease (COVID-19) continues to cause considerable morbidity and mortality worldwide. The complication in patients with severe COVID-19 disease include arrhythmias, perimyocarditis (PM), and heart failure (HF). Purpose(s): The important role of echocardiogram (ECHO) and cardiac MRI (CMRI) in the diagnosis of myocarditis in COVID-19 patients in Saudi Arabia has not been assessed. The objective is to assess the diagnostic value of ECHO and CMRI and define phenotypes patterns in the COVID-19 subgroup. Method(s): In this retrospective study, adults with suspected COVID-19 presented with dyspnea and cardiovascular comorbidities were studied between January 2021 and December 2021. We collected 329 patients, (LVEF by ECHO was 44+/-11%). Fifty-two percent (173/329), had HF (HFrEF or HFpEF), thirty-six percent presented with acute coronary syndrome ACS (120/329), and four percent had adult congenital heart disease (ACHD). CMRI was performed in 160 patients (LVEF is 40 +/-11%), and fifty-two were COVID-19 positive. CMRI Phenotypes patterns were described as normal, ischemic, or nonischemic (peri-myocarditis). LVEF was divided by CMRI as (EF>=50 or EF <50%). The average time interval from diagnosis to CMRI was 4-8weeks. Result(s): Sixty percent of patients (221/329) were confirmed COVID-19 infection, the mean age is 54+/-13 years. Ten patients were diagnosed with pulmonary embolism (2/10 were ACHD). peri-myocarditis patterns were found in sixty percent of COVID-19 patients (31/52), five percent (3/52) had an ischemic pattern, and thirty- five percent (18/52) had normal LGE. However, in COVID-19 negative patients, Eighty percent (85/108) had an ischemic pattern, and twenty percent (23/108) had normal LGE. Conclusion(s): In this observational study, CMRI confirms its high diagnostic tool in evaluating myocarditis activity. In COVID-19 patients, two third of the population were found to have peri-myocarditis, with half of them reporting LVEF was >=50 %.

How Does COVID-19 Affect the Heart?

PURPOSE OF REVIEW: Cardiac consequences occur in both acute COVID-19 and post-acute sequelae of COVID-19 (PASC). Here, we highlight the current understanding about COVID-19 cardiac effects, based upon clinical, imaging, autopsy, and molecular studies. RECENT FINDINGS: COVID-19 cardiac effects are heterogeneous. Multiple, concurrent cardiac histopathologic findings have been detected on autopsies of COVID-19 non-survivors. Microthrombi and cardiomyocyte necrosis are commonly detected. Macrophages often infiltrate the heart at high density but without fulfilling histologic criteria for myocarditis. The high prevalences of microthrombi and inflammatory infiltrates in fatal COVID-19 raise the concern that recovered COVID-19 patients may have similar but subclinical cardiac pathology. Molecular studies suggest that SARS-CoV-2 infection of cardiac pericytes, dysregulated immunothrombosis, and pro-inflammatory and anti-fibrinolytic responses underlie COVID-19 cardiac pathology. The extent and nature by which mild COVID-19 affects the heart is unknown. Imaging and epidemiologic studies of recovered COVID-19 patients suggest that even mild illness confers increased risks of cardiac inflammation, cardiovascular disorders, and cardiovascular death. The mechanistic details of COVID-19 cardiac pathophysiology remain under active investigation. The ongoing evolution of SARS-CoV-2 variants and vast numbers of recovered COVID-19 patients portend a burgeoning global cardiovascular disease burden. Our ability to prevent and treat cardiovascular disease in the future will likely depend on comprehensive understanding of COVID-19 cardiac pathophysiologic phenotypes.

Selection of the best of 2022 in congenital heart disease

This paper shows a selection of the most relevant articles in congenital heart diseases in the last year. About intervencional procedures, we comment the latest guidelines in 2021, as well as some interesting papers on the implementation of materials and techniques in the field of percutaneous treatment of congenital heart diseases. In cardiac imaging, we focus on articles related to the revolutionary advance of 4D-NMR and 3D echo in the study of these congenital diseases. Respect pediatrics, there are interesting studies about multisystem inflammatory syndrome linked to SARS-CoV-2 (MIS-C) and also in the field of hypertrophic cardiomyopathy. Related to surgery, we comment the hybrid technique for treating hypoplastic left ventricle. Finally, regarding arrhythmias in congenital heart disease, we focus our attention on atrial fibrillation, due to the peculiarities that exist in this type of patients.

Cardiac Biomarkers in 2022 - A Vital Tool for Emergency Care

The role of cardiac biomarkers in diagnosing acute myocardial infarction is undoubted. In the 2020 guidelines of the European Society of Cardiology, the measurement of cardiac peptides to gain prognostic information has a class IIa indication in all patients with ACS. In emergency care, ruling out a non-ST elevation myocardial infarction requires documentation of normal levels of cardiac biomarkers, which remain stable or have very small variations within several hours. This review aims to summarize the current knowledge and recent progresses in the field of cardiac biomarker discovery, from their routine use in emergency rooms to their prognostic roles in modern risk assessment tools. Integrated approaches combining cardiac troponin with other biomarkers of ventricular dysfunction or inflammation, or with modern cardiac imaging in emergency care are also presented, as well as the role of modern algorithms for serial troponin measurement in the modern management of emergency departments.

Cardiac MRI with late gadolinium enhancement shows cardiac involvement 3-6 months after severe acute COVID-19 similar to or worse than PIMS.

Background: Coronavirus disease 2019 (COVID-19) in children is rarely severe. However, severe courses occur, especially in the presence of risk factors. A minority of children develop pediatric inflammatory multisystem syndrome (PIMS) with substantial morbidity. While the importance of cardiac involvement after PIMS is well established, its role after severe acute COVID-19 remains unclear. We aim to compare cardiac sequelae of children after severe acute COVID-19 using cardiac MRI and compare them with patients after PIMS. Methods: For this prospective cohort study, we recruited patients with acute COVID or PIMS in a single center. Clinical follow-up, lab work, ECG, and echocardiography were done within 2 days after disease onset and 3-6 months after discharge. At the last visit 3-6 months later, cardiac MRI (CMR) with late gadolinium enhancement (LGE) was performed to evaluate cardiac sequelae and compare both groups. Results: Data were obtained from n = 14 patients with PIMS and n = 7 patients with severe acute COVID-19. At the start of the respective disease, left ventricular (LV) ejection fraction was reduced in seven patients with PIMS but none in the acute COVID-19 group. Transient mitral valve insufficiency was present in 38% of patients, of whom PIMS accounted for 7/8 cases. Eight patients (38%) with PIMS presented coronary artery abnormalities, with normalization in 7/8 patients. A significant decrease in LV mass index 3-6 months after disease onset was observed in both groups. MRI follow-up revealed non-ischemic myocardial pattern of LGE in 12/21 patients- in all (6/6) after severe acute COVID-19 and in less than half (6/14) after PIMS. Normal body weight-adjusted stroke volumes and end-diastolic volumes were found in 20/21 patients. Conclusions: We show that children suffering from severe acute COVID-19 have a similar, or worse, cardiac risk profile as patients with PIMS. Both patient groups should therefore receive close pediatric cardiac follow-up examinations. Cardiac MRI is the technique of choice, as most patients presented with delayed LGE as a sign of persistent cardiac injury despite normalization of laboratory and echocardiographic findings.

Myocardial injury after major non-cardiac surgery evaluated with advanced cardiac imaging: a pilot study.

BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) is a frequent complication caused by cardiac and non-cardiac pathophysiological mechanisms, but often it is subclinical. MINS is associated with increased morbidity and mortality, justifying the need to its diagnose and the investigation of their causes for its potential prevention. METHODS: Prospective, observational, pilot study, aiming to detect MINS, its relationship with silent coronary artery disease and its effect on future adverse outcomes in patients undergoing major non-cardiac surgery and without postoperative signs or symptoms of myocardial ischemia. MINS was defined by a high-sensitive cardiac troponin T (hs-cTnT) concentration > 14 ng/L at 48-72 h after surgery and exceeding by 50% the preoperative value; controls were the operated patients without MINS. Within 1-month after discharge, cardiac computed tomography angiography (CCTA) and magnetic resonance imaging (MRI) studies were performed in MINS and control subjects. Significant coronary artery disease (CAD) was defined by a CAD-RADS category ≥ 3. The primary outcomes were prevalence of CAD among MINS and controls and incidence of major cardiovascular events (MACE) at 1-year after surgery. Secondary outcomes were the incidence of individual MACE components and mortality. RESULTS: We included 52 MINS and 12 controls. The small number of included patients could be attributed to the study design complexity and the dates of later follow-ups (amid COVID-19 waves). Significant CAD by CCTA was equally found in 20 MINS and controls (30% vs 33%, respectively). Ischemic patterns (n = 5) and ischemic segments (n = 2) depicted by cardiac MRI were only observed in patients with MINS. One-year MACE were also only observed in MINS patients (15.4%). CONCLUSION: This study with advanced imaging methods found a similar CAD frequency in MINS and control patients, but that cardiac ischemic findings by MRI and worse prognosis were only observed in MINS patients. Our results, obtained in a pilot study, suggest the need of further, extended studies that screened systematically MINS and evaluated its relationship with cardiac ischemia and poor outcomes. Trial registration Clinicaltrials.gov identifier: NCT03438448 (19/02/2018).

Selection of the best of 2022 in cardiac imaging

This review article aims to summarize the role of cardiac imaging regarding the most relevant technical and knowledge advances published within the last year. Although diagnosis and detection of cardiac involvement due to coronavirus disease maintain a prominent place, other interesting hot topics have been raised. Among the most relevant, it is noteworthy to highlight the prognostic utility of different parameters obtained by advanced imaging techniques in the field of valvular heart disease, cardiovascular prevention or cardio-oncology, the prominent role of imaging in the first diagnostic step of the new Chest Pain guidelines or the exponential growth of percutaneous structural interventionism, where further knowledge is demanded in terms of patient selection, procedure timing or predictors of success. Finally, artificial intelligence is a promising tool already in our hands, we hope that diagnostic precision and interpretation time will improve thanks to these technological advances. Copyright © 2022 Sociedad Espanola de Cardiologia

Combination Immune Therapies for Acute Management of Mis-C and Longterm Outcomes

INTRODUCTION: Since the recognition of Multisystem Inflammatory Syndrome in Children (MIS-C), different immune therapies have been utilized as monotherapy (MT) or combination therapy (CT). Currently there is a lack of sufficient literature examining the long-term cardiac and functional outcomes in children following MT versus CT for MIS-C. METHOD(S): We conducted a retrospective chart review of children < 21 years old admitted to our tertiary care children's hospital for MIS-C from January 2020 to January 2022. We collected clinical data, especially cardiac imaging data [left ventricular ejection fraction (LVEF), coronary artery dilation (CAD)], and functional status scores (FSS) during hospital stay and long-term (up to 6 months) follow up. We then compared the long-term outcomes of children who received three different treatment regimens during hospitalization: Steroid only (S), Steroid and IVIg (S + IVIg), and Steroid, IVIg, and Anakinra (S + IVIg + Ana), using a student t-test and Fisher's exact test. RESULT(S): Of the 40 children admitted with MIS-C during the study period, one who did not receive any immune therapy was excluded and of the remaining 39, the number of patients in each treatment group (S, S+IVIg, S+IVIg+Ana) was 13 (33%), 14 (36%) and 12 (31%) respectively. During hospitalization, among the S, S+IVIg, and S+IVIg+Ana groups, the mean (SD) LVEF were 63.9 (4.9)%, 60.0 (7.2)%, 55.9 (9.1)% respectively and CAD was documented in 1/11 (9.1%), 3/14 (21.4%) and 2/11 (18.2%) patients, respectively and at up to 6-month follow-up, the mean (SD) LVEF were 63.9 (2.8)%, 63.5 (4.0)%, and 66.3 (3.1)%, respectively, and CAD was documented in 0/11 (0%), 0/10 (0%), 2/10 (20%) patients, respectively. There was no significant difference in the proportion of patients with persistent low (<= 55%) LVEF or CAD across the groups at long-term follow-up (p>0.05). There was no significant difference in DELTAFSS across the 3 groups at discharge [mean (SD): S 0 (0), S+IVIg 0.3 (1.1), and S+IVIg+Ana 0.3 (0.9)] as well as at follow-up [mean (SD): S 0 (0), S+IVIg 0 (0), and S+IVIg+Ana 0.3 (0.7)]. CONCLUSION(S): In our cohort of MIS-C patients, cardiac and functional outcomes were favorable at follow-up irrespective of combination of immune therapies offered during hospitalization.

Selection of the best of 2022 in congenital heart disease

This paper shows a selection of the most relevant articles in congenital heart diseases in the last year. About intervencional procedures, we comment the latest guidelines in 2021, as well as some interesting papers on the implementation of materials and techniques in the field of percutaneous treatment of congenital heart diseases. In cardiac imaging, we focus on articles related to the revolutionary advance of 4D-NMR and 3D echo in the study of these congenital diseases. Respect pediatrics, there are interesting studies about multisystem inflammatory syndrome linked to SARS-CoV-2 (MIS-C) and also in the field of hypertrophic cardiomyopathy. Related to surgery, we comment the hybrid technique for treating hypoplastic left ventricle. Finally, regarding arrhythmias in congenital heart disease, we focus our attention on atrial fibrillation, due to the peculiarities that exist in this type of patients. Copyright © 2022 Sociedad Espanola de Cardiologia

Post COVID-19 Infection Multisystem Inflammatory Syndrome in Adults Presenting with Pain, Ascending Weakness, and Paresthesias: A Case Report

Case Diagnosis: Post COVID-19 infection multisystem inflammatory syndrome in adults presenting in a 28-year-old African American female with pain, ascending weakness, paresthesias, and chest pain. Case Description or Program Description: Patient with documented COVID-19 infection 5 weeks prior to arrival and presented with pain, paresthesias, and weakness in the bilateral lower extremities. Symptoms began shortly after patient recovered from COVID-19 infection, however, patient developed ascending weakness extending into the hands with left sided chest pain, prompting patient to present for evaluation. Setting(s): Major academic and referral center with level 1 adult trauma. Assessment/Results: Lumbar puncture and cerebrospinal fluid studies were not suggestive of Guillain- Barre syndrome. Imaging of the entire neuraxis was unremarkable. Echocardiogram revealed new onset heart failure with reduced ejection fraction of 35% consistent with non-ischemic cardiomyopathy and cardiac imaging was not suggestive of amyloidosis. EMG was consistent with primarily axonal greater than motor peripheral polyneuropathy. Further inflammatory workup revealed elevated erythrocyte sedimentation rate and C reactive protein. Paraneoplastic workup was unremarkable. Patient was started on intravenous immunoglobulin (IVIG) for suspected Multisystem Inflammatory Syndrome in Adults (MIS-A), however, patient developed infusion reaction shortly after infusion began and IVIG was discontinued pending hemodynamic stability. Discussion (relevance): Post COVID-19 multisystem inflammatory syndrome is seen more commonly in children than in adults per literature review. Clinicians must be mindful of potential MIS-A in adult patients with symptoms mimicking Guillain-Barre syndrome with negative workup and imaging, especially with concomitant cardiovascular compromise and elevated inflammatory markers. This case demonstrates one of the various presentations documented of MIS-A and is important for accurate diagnosis of this syndrome in the future. Conclusion(s): Post COVID-19 patients presenting with symptoms similar to Guillain-Barre syndrome with negative workup should be evaluated for MIS-A as this syndrome can affect multiple organ systems simultaneously, such as the nervous system and cardiovascular system as seen in this patient.

Selection of the best of 2022 in cardiac imaging

This review article aims to summarize the role of cardiac imaging regarding the most relevant technical and knowledge advances published within the last year. Although diagnosis and detection of cardiac involvement due to coronavirus disease maintain a prominent place, other interesting hot topics have been raised. Among the most relevant, it is noteworthy to highlight the prognostic utility of different parameters obtained by advanced imaging techniques in the field of valvular heart disease, cardiovascular prevention or cardio-oncology, the prominent role of imaging in the first diagnostic step of the new Chest Pain guidelines or the exponential growth of percutaneous structural interventionism, where further knowledge is demanded in terms of patient selection, procedure timing or predictors of success. Finally, artificial intelligence is a promising tool already in our hands, we hope that diagnostic precision and interpretation time will improve thanks to these technological advances. Copyright © 2022 Sociedad Espanola de Cardiologia

Selección de lo mejor del año 2022 en imagen cardiaca

Resumen Este artículo de revisión pretende resumir el papel de la imagen cardiaca en cuanto a los avances técnicos y de conocimiento más relevantes publicados en el último año. Aunque la imagen cardiaca sigue ocupando un lugar destacado en el diagnóstico y en la detección de complicaciones de la afectación cardiaca por la infección por coronavirus, otros temas candentes están claramente de actualidad. Entre lo más relevante cabe destacar la confirmación de la utilidad pronóstica de parámetros obtenidos mediante técnicas de imagen avanzada en el campo de las valvulopatías, prevención cardiovascular o cardio-oncología, el papel destacado de la imagen en el primer escalón diagnóstico de las nuevas guías de dolor torácico o el crecimiento exponencial del intervencionismo estructural percutáneo, donde se hace necesario un mayor conocimiento en la selección de pacientes, el timing del procedimiento o los predictores de éxito. Por último, la inteligencia artificial es un aliado que ha llegado para quedarse, y esperemos que la precisión y la rentabilidad diagnósticas, así como los tiempos dedicados a la interpretación, mejoren gracias a este avance tecnológico. This review article aims to summarize the role of cardiac imaging regarding the most relevant technical and knowledge advances published within the last year. Although diagnosis and detection of cardiac involvement due to coronavirus disease maintain a prominent place, other interesting hot topics have been raised. Among the most relevant, it is noteworthy to highlight the prognostic utility of different parameters obtained by advanced imaging techniques in the field of valvular heart disease, cardiovascular prevention or cardio-oncology, the prominent role of imaging in the first diagnostic step of the new Chest Pain guidelines or the exponential growth of percutaneous structural interventionism, where further knowledge is demanded in terms of patient selection, procedure timing or predictors of success. Finally, artificial intelligence is a promising tool already in our hands, we hope that diagnostic precision and interpretation time will improve thanks to these technological advances.

HEPATO-PULMONARY SYNDROME: LOOK CLOSELY OR YOU MIGHT MISS IT

CASE: A Hispanic-speaking 63-year-old lady presented with left shoulder pain and dyspnea since two weeks. Past history was significant for cirrhosis due to autoimmune hepatitis and portal hypertension diagnosed 1.5 years prior. Upon further questioning, she revealed that she had exertional dyspnea for 2 years, which got progressively worse after her COVID-19 infection, 14 months prior. On initial exam, her hemoglobin levels were unchanged with previous. Troponin and BNP levels were unremarkable. CT Pulmonary Embolus scan and shoulder X-ray were negative. However, her SpO2 which was 90% on lying flat, fell to 84% on walking and she was admitted for further workup. On exam, she had a loud S2, spider angioma, and clubbing. ABG showed an alveolar-arterial oxygen gradient of 54.7 mm and PO2 of 61.7 mm. A contrastenhanced transthoracic echo with saline showed significant shunting with dilated pulmonary veins. Upon close inspection, she had a small right to left intracardiac shunt through an incidental PFO and a rather large intrapulmonary shunt. This was confirmed on trans-esophageal echo. Right heart catheterization showed a high cardiac index (5.3 L/min) suggestive of a high-output state, as typically seen with cirrhosis. It also revealed increased right-sided oxygen saturations, confirming the presence of a significant left to right shunt. Finally, pulmonary CT angiography was negative for AVMs. These findings were congruent with hepato-pulmonary syndrome (HPS) and based on her presenting symptoms she was referred to hepatology for consideration of liver transplantation. IMPACT/DISCUSSION: HPS is characterized by abnormal oxygenation due to intrapulmonary vascular dilations (IPVD) in the setting of advanced liver disease. Diagnosis needs an elevated A-a gradient (≥ 15mm or ≥ 20 mm if >64 years). IPVDs may not be seen on CT scans and are optimally detected on CE-TTE. The delayed appearance of injected microbubbles in the left heart, 3 or more cardiac cycles after visualization in the right heart signifies abnormally dilated pulmonary capillaries which don't trap the bubbles. TTE can help differentiate intracardiac and intrapulmonary shunts, by revealing the source of the microbubbles entering into the left atrium (across the atrial septum vs pulmonary veins). Shunting classically causes platypnea-orthodexia (worsening dyspnea on standing or sitting, alleviated by lying down). Alterations in lung parenchyma due to COVID-19 could have increased the flow through intrapulmonary AVMs and contributed to the worsening of symptoms. Management of HPS is supportive. Liver transplantation improves survival. CONCLUSION: Evaluation and management of HPS involves multiple modalities of testing and specialists in gastroenterology, cardiac imaging, interventional cardiology, interventional radiology, and transplant surgery. The diagnosis of HPS should escalate referral to a liver transplant center. Engaging medical interpreters can help elicit more detailed history and improve clinical outcomes.

COVID-19-Associated Myocarditis: An Evolving Concern in Cardiology and Beyond.

The direct and indirect adverse effects of SARS-CoV-2 infection on the cardiovascular system, including myocarditis, are of paramount importance. These not only affect the disease course but also determine clinical outcomes and recovery. In this review, the authors aimed at providing an update on the incidence of Coronavirus disease-2019 (COVID-19)-associated myocarditis. Our knowledge and experience relevant to this area continues to evolve rapidly since the beginning of the pandemic. It is crucial for the scientific and medical community to stay abreast of current information. Contrasting early reports, recent data suggest that the overall incidence of SARS-CoV-2-associated myocarditis is relatively low, yet infected individuals are at a substantially increased risk. Therefore, understanding the pathophysiology and diagnostic evaluation, including the use of serum biomarkers and imaging modalities, remain important. This review aims to summarize the most recent data in these areas as they relate to COVID-19-associated myocarditis. Given its increasing relevance, a brief update is included on the proposed mechanisms of myocarditis in COVID-19 vaccine recipients.

Cardiac Imaging on COVID-19 Pandemic Era: the Stand, The Lost, and Found.

Purpose of Review: The present review will outline the main effects of COVID-19 pandemic on cardiovascular pathologies, focusing on the role of modern non-invasive cardiac imaging techniques in this setting. Recent Findings: Multimodality cardiac imaging seems particularly suited for the in-depth characterization of patients with COVID-19, allowing the assessment of the variegated impact of the disease on the different aspects of myocardial perfusion, structure, and function. Summary: The infection of SARS-CoV-2, leading to the coronavirus disease-19 (COVID-19), has represented a consistent challenge for the organization of the healthcare systems, associating to a significant increase of the fatality rate of different acute and chronic disease. Moreover, the reallocation of healthcare providers led to a significant reduction of the availability of tests and therapies, with the deferral of non-urgent tests and non-lifesaving procedures.