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Among the longstanding problems made vivid by the COVID-19 pandemic are challenges in gathering data to inform the use of vaccines in pregnancy. Although it was known early on that pregnant persons and their offspring faced greater risks of morbidity and mortality from COVID-19 infection, they were excluded from all trials that led to authorization of vaccines. And while reassuring evidence has since been gathered, delays, as well as mixed public health messaging, have led to low uptake of vaccines among pregnant populations, as well as disproportionate burdens for pregnant persons. Dr. Lyerly will consider key ethical issues foregrounded by the COVID-19 response in pregnancy, including the distortions of risk, misaligned incentives, and regulatory challenges. Drawing on results of the NIH-funded PHASES Project, she will describe key conceptual shifts and ethical frameworks that have recently been advanced to better serve the interests of pregnant persons and their offspring facing illness in pandemic and other contexts, as well as specific recommendations for responsible and timely research with this population.
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Nowadays, the world confronts a highly infectious pandemic called coronavirus (COVID-19) and over 4 million people worldwide have now died from this illness. So, early detection of COVID-19 outbreak and distinguishing it from other diseases with the same physical symptoms can give enough time for treatment with true positive results and prevent coma or death. For early recognition of COVID-19, several methods for each modality are proposed. Although there are some modalities for COVID-19 detection, electrocardiography (ECG) is one of the fastest, the most accessible, the cheapest and the safest one. This paper proposed a new method for classifying COVID-19 patients from other cardiovascular disease by ECG signals. In the proposed method, Resnet50v2 which is a kind of convolutional neural network, is used for classification. In this paper because of image format of data, first data with image format are applied to the network and then for comparison, ECG images are changed to signal format and classification is done. These two strategies are used for COVID-19 classification from other cardiac abnormalities with different filter sizes and the results of strategies are compared with each other and other methods in this field. As it can be concluded from the results, signal-based data give better accuracy than image classification at best performance and it is better to change the image format to signals for classification. The second result can be found by comparing with other methods in this field, the proposed method of this paper gives better performance with high accuracy in COVID-19 classification. Copyright © 2023 National Taiwan University. National Taiwan University.
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Background: Previous studies have reported ongoing cardiac inflammation as assessed by cardiac magnetic resonance imaging (CMR) in a significant proportion of patients several months after recovery from SARSCoV- 2 infection, many of whom had no or minimal symptoms at the time of infection. Purpose(s): The aim of SETANTA was to investigate the prevalence of cardiac abnormalities by CMR in unselected patients in Ireland after acute SARS-CoV-2 infection and the correlation with immunological response and biomarkers of coagulation. Method(s): This was a prospective, observational, community-based study (clinicaltrials.gov identifier NCT04823182). Consecutive patients recovered from recent SARS-CoV-2 infection at 3 primary care sites were invited to participate. Key inclusion/exclusion criteria and outcomes of interest are shown in Figure 1. Result(s): 100 participants were enrolled (Feb-Sept 2021) at a median of 188 (IQR, 125, 246) days after positive SARS-CoV-2 swab. At index infection, 18% and 35% reported severe and moderate symptoms, respectively;14% were hospitalized;3% were admitted to intensive care for ventilatory support. At enrolment, 83% had ongoing symptoms. 85% had detectable SARS-CoV-2 antigens. CMR and laboratory findings are shown in Figure 1. Conclusion(s): Among an unselected cohort of patients recovered from acute SARS-CoV2 infection, we report a low prevalence of cardiac abnormalities by CMR, despite a high prevalence of moderate/severe symptoms at presentation and a high prevalence of persistent symptoms. Correlation with biomarkers of immunity and coagulation will be available at ESC 2022.
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Background: The COVID-19 disease is known for its severe respiratory complications, however it was found to have some cardiovascular complication in post COVID-19 patients. The heart rate variability (HRV) is a non invasive, objective and reliable method for assessment of autonomic dysfunction in those recovered patients. Purpose(s): We aimed to evaluate the cardiac autonomic function by using valid HRV indices in subjects who recovered from mild to moderate acute COVID-19 but still symptomatic. Method(s): The study Group composed of 50 subjects with confirmed history of mild to moderate post COVID 19. All subjects underwent routine 2D echocardiography assessment in addition to 2D speckle tracking and 24 hours Holter monitoring for HRV analysis. Result(s): The mean age of the study population was 42+/-18 years, symptoms were reported as follows 27 (54%) had Dyspnea, 17 (34%) had palpitations, 7 (14%) had dizziness. Time domain parameters SDNN, SDANN and rMSSD were diminished with mean SDNN value being markedly impaired in 12 (24%) patient, while frequency domain parameters as assessed by LF/HF ratio with mean of 1.837 with 8% of patients being impaired. SDNN was significantly reduced in elderly patients (p=0.001), smokers (p=0.019) and hypertensive (p=0.016) and those complaining mainly of palpitation (p=0.006). SDNN was significantly reduced in patient with impaired LV diastolic function (p=0.009), in patients with reduced MAPSE (p=0.047), reduced TAPSE (p=0.00) and impaired Global longitudinal strain (0.000). Conclusion(s): Patients with post COVID-19 syndrome have abnormalities in the HRV which indicates some degree of dysfunction in the autonomic nervous system and consequently impaired parasympathetic function in this population, however this have been also correlating with subtle impairment of the left ventricular systolic function.We believe that this preliminary research can serve a starting point for future research in this direction.
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Background: Adults with congenital heart disease (ACHD) are considered at increased risk for complications due to COVID-19, especially in those with cyanosis or heart failure. However, data regarding the rate of infection as well as regarding a myocardial involvement of a COVID-19 infection in ACHD patients are currently lacking. Purpose(s): To study the rate of COVID-19 infections in ACHD patients from a tertiary centre as well as the rate of myocardial involvement of a COVID- 19 infection. Method(s): All consecutive ACHD patients (over the age of 18 years) who attended the outpatient clinic of a tertiary centre from January 2021 to June 2021 were eligible to participate. Demographic data, as well as medical/ surgical data including a history of a COVID-19 infection were collected. All patients had an antibody test for COVID-19. Patients with a positive antibody test were offered cardiovascular magnetic resonance imaging (CMR). Result(s): Altogether, 420 patients (44.8% female, mean age 36.4+/-11.6 years) were included in the study. Congenital heart defect (CHD) complexity according to the Bethesda classification was simple in 96 (22.9%), moderate in 186 (44.3%), complex in 117 (27.9%), and miscellaneous in 21 (5.0%) patients. A positive antibody test for COVID-19 was present in 28 (6.7%) patients (CHD complexity: Simple n=5, moderate n=14, severe n=7, miscellaneous n=2). Out of these 28 patients, 14 had no symptoms at all. Those with symptoms had mainly mild symptoms and were all managed in the outpatient setting. While 11 patients (39.3%) were not at all aware of their infection, 17 already knew that they had COVID-19. There was no significant difference between ACHD patients with a positive test vs those with a negative test regarding age, gender, New York Heart Association class, or complexity of CHD. Out of the 28 patients with a positive antibody test, 14 agreed to a CMR. A myocardial involvement, i.e. signs of active or healed myocarditis, was not present in any of these. Conclusion(s): In this single-centre study, 6.7% of ACHD patients attending the outpatient clinic had positive antibodies for COVID-19. Out of these, 50% were asymptomatic and 39.3% were not aware of their infection. A myocardial involvement was not found in any of the patients that underwent a CMR. These results indicate a large number of undetected cases of COVID-19 in the ACHD population and offer reassurance that in the vast majority of cases the infection has a mild course.
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Background: Physical activity is important for healthy physical and mental development in children and adolescents with congenital heart defects (CHD). The COVID-19 pandemic, which is still ongoing, had an impact on many sports activities. These often could not take place or were limited due to closures, staff shortages and group size restrictions. Method(s): The aim of the study was to learn more about the nutrition and physical activity of young and adolescent CHD patients. CHD patients registered in the German National Register for Congenital Heart Defects were invited by email/postto join the study. In total, 981 patients took part and 894 patients have completed the online questionnaire (average age:12.5 +/- 3 years;47.2% female). CHD severity: 213 simple CHD (23.8%), 338 moderate CHD (37.8%), and 343 complex CHD (38.4%). The study participants were asked to answer questions regarding nutrition, physical activity and (school)sports. Result(s): Subjective fitness level at the time of the survey was rated 6.2 on a scale of 1 (very unfit) to 10 (very fit).Significant differences in subjective fitness levels were present between all three CHD severity groups (p < 0.01): simple CHD 6.8 +/- 2.2;moderate CHD 6.3 +/- 2.2;complex CHD 5.8 +/- 2.2. For 40.7% of the respondents, the physical-sporting fitness has deteriorated during the 1st lockdown in Germany from March 2020 to May 2020 according to their own assessment (no significant differences between CHD severity groups). Also, during the 2nd lockdown in Germany starting in December 2020 until the end of April 2021, physical activity fitness status worsened in 41.5% of cases without significant influence of CHD severity. Overall, 43.8% of respondents reported doing less exercise than before the pandemic, 13.1%reported doing the same amount of exercise, and 43.1% self-reported doing more exercise than before the pandemic (no significant differences between CHD severity groups). Conclusion(s): Overall, the assessment of the own fitness level of young and adolescent CHD patients CHD seems to be dependent on the CHD severity, which is also expected and thus plausible from a medical point of view. The pandemic has a major impact on the sports behavior and decreased the possibility and willingness to participate in (regular) sports. However, the pandemic affects all patients to a similar extent. In the pandemic, it has unfortunately been only partially successful so far to support and encourage young patients to do sports regularly to prevent secondary diseases.
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Background: Clinical usefulness of Handheld Ultrasound Device [HUD] was previously confirmed in numerous clinical scenarios. During the previous two years Covid-19 patients become a focal point of healthcare worldwide. The assessment of long term consequences of this infection is bound to overload already burdened healthcare system. Purpose(s): To assess clinical usefulness of HUD as an adjunct to physical cardiac examination of patients with history of COVID-19. Method(s): Study population consisted of randomly selected patients with no symptoms of cardiovascular pathology, who had been hospitalized due to COVID-19 one year prior to examination. Physical examination and clinical assessment was augmented with short examination with the use of HUD, which included: Visual evaluation of the global and regional LV function, measurement of RV size, screening for the significant valve defects and the presence of pericardial effusion. Subsequently full echocardiographic examination with the use of high-end workstation was performed, which results were treated as reference. Result(s): 54 patients (35 men, mean age 63+/-13 years) were enrolled into the study. In clinical examination no significant cardiovascular abnormalities were discovered. In 30 [56%] of patients cardiac abnormalities in HUD examination were detected. In 18 patients [33%] LV function assessment was not performed, due to insufficient quality of registered view. In the remaining group significant impairment of LV ejection fraction (<50%) was detected in HUD examination in 3 [6%] patients (2 confirmed in full examination, positive predictive value [PPV] 57%, negative predictive value [NPV] 97%, AUC 0,82+/-0,17, P 0,057). WMA were diagnosed in 6 [11%] patients (4 confirmed in full examination, PPV 84% NPV 78%, AUC 0,69+/-0,17, P 0,02). RV enlargement was identified in 21 [39%] patients (PPV 57%, NPV 97%, AUC 0,85+/-0,05, P<0,0001), mild pericardial effusion in 3 [6%] patient (1 confirmed in full echocardiographic examination;2 false positive, no false negative), at least moderate mitral/tricuspid/aortic valve insufficiency in 7 [13%] patients (3 confirmed, 4 false positive cases, no false negative). A total mean time of the heart and lungs HUD examination was 2,1+/-0,6 minute. Conclusion(s): Cardiac abnormalities exposed in brief assessment with the use HUD are a relatively common finding in asymptomatic patients previously hospitalized due to COVID infection in a 1-year follow-up, despite normal physical examination. Normal HUD examination excludes the presence of significant cardiac abnormalities with high probability. However one should keep in mind a relatively high percentage of false positive results, which may lead to an exceeding number of patients referred for a full echocardiographic examination.
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Limited evidence exists regarding adverse effects on cardiovascular and pulmonary function in adults affected by covid 19 infection. We describe the cardiopulmonary functions in a cohort of national level athletes with recent covid infection. 42 healthy athletes were evaluated after at least a 10-day period of quarantine after mild covid infection.44% females [n=19] and 56% males [n=23]. The age range was 15 - 38 years. The commonest persistent symptoms were difficulty in breathing (4.8%), cough (7%) and chest tightness (4.8%). PCFS (post covid functional score) was 0 in 93%. The CXR and 6-minute walk test were normal in all. The spirometry was normal in 83% (n=35). The mean FEV1 were 2.68l and 3.75l;mean FVC were 3.09l and 4.6l in females and males respectively. The mid expiratory flow rate (FEF 25-75) was less than the predicted lower limit of normal in 52.4%(mean=2.8L). Cardiac abnormalities were detected in 7%;moderate interventricular septal dyssynchrony, global hypokinesia with mild LV dysfunction and mild pulmonary hypertension. 13 players with persistent difficulty in breathing and chest tightness who had otherwise normal spirometry and echo were referred for CPET. Only 6 players had CPET due to limited resources: evidence of deconditioning (n=3) and cardiac limitation with poor O2 pulse (n=3). 78% (n=33) had normal cardiopulmonary assessment and were referred for graduated return to practice. Abnormalities were identified in 21% (n=9). Mid expiratory flow was reduced in 53% indicating possible effect on peripheral airways post covid. Evaluation of athletes and guidelines on return to practice after covid infection are an important and timely need.
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Introduction: Early reports from China estimated that overall cardiac arrhythmia prevalence in patients hospitalized for COVID-19 was 17%. A higher arrhythmia incidence (44%) was observed in patients admitted to intensive care unit. The industrial workforce was affected by COVID-19 to a great extent. A noteworthy proportion also suffered from cardiac abnormalities. Objective(s): To determine the incidence of arrhythmia in patients with COVID-19 among the industrial workforce using remote patient monitoring technology. Material(s) and Method(s): This was a retrospective, observational, descriptive study of the industrial workforce from Telangana State, India. Approval of the institutional ethics committee was obtained. The need for informed consent was waived off. Patients who tested positive for COVID-19 by RTPCR and aged above 18 years were eligible. The five-day recording of lead-2 ECG on Vigo Monitoring Solution (Connect Care India Pvt. Ltd) was collected and analysed. Brady-arrhythmia during day time, second degree AV block Type-2 (Mobitz II) during the day time, complete heart block, wide QRST, non-sustained ventricular tachycardia and sinus pause were considered "clinically significant". The other sub-types were defined as "clinically non-significant". The ECGs with regular sinus rhythm were interpreted as "normal". The prevalence of clinically significant, clinically non-significant and normal heart rhythm are described here. Result(s): Out of 240 COVID-19 patients who were on-board for remote monitoring, 216 (148 male and 68 female, mean age 51+/-15 years) met the eligibility criteria and only their ECG were analysed. Among them, 18 were known diabetics, 40 were hypertensive and 31 had both comorbidities. 112 were asymptomatic and 104 were symptomatic. The burden of arrhythmia was found clinically significant in 12 (5.6%) patients, clinically non-significant in 87 (40.4%) and normal among 117 (54%) out of 216 patients. Conclusion and Recommendation: The remote patient monitoring may be utilized as a tool for early screening of significant arrhythmia which are to be addressed immediately for better clinical outcome. These devices on being integrated into COVID-19 management strategies may contribute to patient satisfaction, emergency alerts, timely management, reducing mortality rate and enhancing the safety of healthcare providers.
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Background Many patients with COVID-19, particularly from the pandemic's early phase, have been reported to have evidence of cardiac injury such as cardiac symptoms, troponinemia, or imaging or ECG abnormalities during their acute course. Cardiac magnetic resonance (CMR) has been particularly useful to assess myocardial abnormalities given its comprehensive characterization of structure, function, and tissue. Overall, findings have varied, and long term impact of COVID-19 on myocardial structure and function needs further elucidation. Methods We performed TTE and 3T CMR with gadoterate meglumine (Clariscan, GE Healthcare) in survivors of the initial stage of the pandemic without preexisting cardiac disease and matched controls at long-term follow up?>6 months after infection, using an array of techniques to comprehensively evaluate the myocardium. Chi square tests for categorical and t tests for continuous variables were used. P <0.05 was considered significant. Results Our study population consisted of 40 COVID survivors and 12 controls of similar age, sex and race-ethnicity distribution with median age 46, 50% female, 48% Hispanic, 28% Black, mean BMI 27. None had presented with thromboembolism, myocarditis, or ischemia;35% had been hospitalized with 28% intubated. Imaging was performed median 308 days after initial infection. We found no difference in echo characteristics including measures of LV and RV structure and systolic function, valvular abnormalities, or LV diastolic function with median LVEF 60% v 58%, LVEDD 4.0 v 4.4, E/e' ~6, and no RWMA in either group. Using CMR, we confirmed no differences in LV and RV structure and function including median LVEF 57% v 58%, RVEF 53% v 53%, LVEDVi 74 v 72, and RVEDVi 77 v 74. We found no significant differences in T1 (1305 v 1280), T2 (46 v 47), ECV (29 v 30), or LGE mapping. With analysis stratified by patient hospitalization status as an indicator of COVID severity, no differences were uncovered. Conclusion Multimodal imaging of a diverse cohort of COVID-19 survivors who had not presented with acute cardiac pathology reveals no distinct features indicating long-lasting structural or functional damage or inflammation of the myocardium.Copyright © 2023 American College of Cardiology Foundation
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Background and Aims Hepatitis C virus (HCV) infection is a major global health problem in adults & children. The recent efficacy of Direct Acting Anti-viral therapy (DAA) has cure rates of 99% in adults and adolescents. These drugs were licensed for children 3-12 yrs during the recent coronavirus pandemic. To ensure equitable access, safe & convenient supply during lockdown, we established a virtual national treatment pathway for children with HCV in England & evaluated its feasibility, efficacy & treatment outcomes. Method A paediatric Multidisciplinary Team Operational Delivery Network (pMDT ODN), supported by NHS England (NHSE), was established with relevant paediatric specialists to provide a single point of contact for referrals & information. Referral & treatment protocols were agreed for HCV therapy approved by MHRA & EMA. On referral the pMDT ODN agreed the most appropriate DAA therapy based on clinical presentation & patient preferences, including ability to swallow tablets. Treatment was prescribed in association with the local paediatrician & pharmacist, without the need for children & families to travel to national centres. All children were eligible for NHS funded therapy;referral centres were approved by the pMDT ODN to dispense medication;funding was reimbursed via a national NHSE agreement. Demographic & clinical data, treatment outcomes & SVR 12 were collected. Feedback on feasibility & satisfaction on the pathway was sought from referrers. Results In the first 6 months, 34 children were referred;30- England;4 - Wales;median (range) age 10 (3.9 - 14.5) yrs;15M;19F: Most were genotype type 1 (17) & 3 (12);2 (1);4(4). Co-morbidities included: obesity (2);cardiac anomaly (1);Cystic Fibrosis (1);Juvenile Arthritis (1). No child had cirrhosis. DAA therapy prescribed: Harvoni (21);Epclusa (11);Maviret (2) .27/34 could swallow tablets;3/7 received training to swallow tablets;4/7 are awaiting release of granules.11/27 have completed treatment and cleared virus;of these 7/11 to date achieved SVR 12. 30 children requiring DAA granule formulation are awaiting referral and treatment. Referrers found the virtual process easy to access, valuing opportunity to discuss their patient's therapy with the MDT & many found it educational. There were difficulties in providing the medication through the local pharmacy. However there are manufacturing delays in providing granule formulations because suppliers focused on treatments for COVID, leading to delays in referring and treating children unable to swallow tablets. Conclusion The National HCV pMDT ODN delivers high quality treatment & equity of access for children & young people, 3- 18 yrs with HCV in England, ensuring they receive care close to home with 100% cure rates.
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Introduction: Autosomal recessive interferon alpha/beta receptor 1 (IFNAR1) deficiency increases susceptibility to live-attenuated vaccines and wild-type viruses. Currently 16 cases, half with Polynesian ancestry have been reported since the discovery in 2019. Most cases present with severe MMR or yellow fever vaccine-related disease. Some cases report severe SARS-CoV-2, herpes simplex, and enterovirus. Varicella vaccine-related disease has been hypothesized but not previously reported. Case Description: A pediatric Samoan girl with congenital cardiac anomaly, otherwise healthy until receiving Varicella and MMR vaccines at 12 months. Two weeks later with presumed incomplete Kawasaki Disease with 10-day fever, red lips, and maculopapular rash, given IVIG and infliximab;also, positive SARS-CoV-2 PCR and IgG that admission. Developed diffuse vesicular rash 3 weeks after vaccination requiring re-admission for disseminated varicella. At 14 months, admitted again for acute respiratory failure with viral pericarditis, positive for rhinovirus/enterovirus on respiratory viral panel and varicella serum PCR. Samoan parents are first-degree cousins and her stillborn sister had significant homozygosity on genetic evaluation. Normal lymphocyte subsets, normal mitogen proliferation, absent antigen proliferation in vitro, and normal NK function. Intact humoral immunity. Primary immunodeficiency disease panel identified homozygous pathogenic variant in IFNAR1. Future live viral vaccines contraindicated. Managed with acyclovir with return to baseline. Discussion(s): This case demonstrates a novel finding of homozygous IFNAR1 deficiency predisposing to disseminated varicella after vaccination. TNF inhibition may have also contributed. IFNAR1 deficiency should be considered in patients with severe varicella or other severe viral illnesses, especially after live-attenuated viral vaccines in those of Polynesian ancestry. Copyright © 2022
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INTRODUCTION: Multisystem Inflammatory Syndrome in Children (MIS-C) after SARS-CoV-2 infection is often complicated by ventricular dysfunction. Our prior work suggests that strain echocardiography (SE) detects abnormalities in cardiac function in ICU patients unrecognized by conventional echocardiography (CE). This study compares the relative strengths of CE and SE in predicting needs for ICU level therapies in MIS-C patients. METHOD(S): A retrospective, single center analysis was performed on patients admitted to a quaternary-care children's hospital with the diagnosis of MIS-C from March 2020 to January 2022. Only patients with CE and SE measured prior to initiation of vasoactives were included. Abnormal LVEF was defined as < 55% and abnormal strain as <= -17.2%. Clinical metrics included use of positive pressure ventilation (PPV), vasoactives, or any ICU level care. RESULT(S): Of 90 patients diagnosed with MIS-C, median LVEF was normal in both normal (64.0%) and abnormal strain (57.2%) groups. We found 97.6% of patients with normal strain had normal LVEF but only 57.1% of those with normal LVEF had normal strain. Median LVEF was normal in both those who did and did not require ICU level care (63% vs 57.1%), and those who did and did not require vasoactives (62.4% vs 56.5%). Strain was abnormal in patients who required ICU level care, PPV, and vasoactives (-13.8%, -12.9%, -13.8% respectively), compared to those who did not (all -19.3%, p all < 0.001). Sensitivity analysis showed strain was superior to LVEF in identifying need for ICU level care (75.8% vs 39%), PPV (88% vs 48%), and vasoactives (90% vs 55%). Negative predictive value of strain was superior to LVEF for similar outcomes (ICU level care (80.9% vs 72%), PPV (92.7% vs 81.9%) and vasoactives (95.1% vs 87.2%)). CONCLUSION(S): We demonstrate that SE detects abnormalities in cardiac function in MIS-C patients unrecognized by CE. In both ICU and non-ICU patients, we found compared to LVEF, detection of abnormal strain better identifies patients who will need ICU level therapies. Similarly, a measurement of normal strain is superior to a normal LVEF in predicting those who will not need these interventions.
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Background. Multisystem Inflammatory Syndrome (MIS-C), a new entity in children which developed 2-4 weeks after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is a severe condition. It can affect the multisystem, while the most severe manifestation is cardiac involvement. Left ventricular dysfunction, cardiogenic shock, coronary artery dilatation/aneurysm, valvulitis, pericardial effusion, arrhythmia, and conduction abnormalities were reported in approximately 80% of children with cardiovascular system involvement. It is still unclear the duration of the cardiac symptoms, and even they are permanent or persistent. Few studies evaluated persistent cardiac abnormalities by cardiac magnetic resonance imaging (MRI). Therefore, we aimed to assess persisting cardiac abnormalities with MIS-C by cardiac MRI and compare them with echocardiograms. Methods. A retrospective study was conducted at a tertiary-level University Hospital between June 2020-July 2021. Thirty-four children diagnosed with MIS-C according to the criteria defined by the Centers for Disease Control and Prevention were retrospectively evaluated. Results. The study included 17 males and 17 females with a mean age of 9.31 +/-4.72 years. Initial echocardiographic evaluation showed cardiac abnormality in 18 (52.9%) patients;4 (11.8%) pericardial effusion, 4 (11.8%) left ventricular ejection fraction (LVEF) < 55%, 5 (14.7%) LV fractional shortening < 30%, 5 (14.7%) coronary artery dilatation. Echocardiography showed normal LV systolic function in all patients at follow-up;coronary dilatation persisted in 2 of 5 (40 %) patients at the 6th-month visit. Cardiac MRI was performed in 31 (91.2%) patients. We didn't detect abnormal T1 levels, whereas 9 (29%) had isolated elevated T2 values. 19 (61.3%) of 31 patients had at least one of the followingfindings: pericardial effusion, right ventricular dysfunction, LVEF abnormality. Conclusion. Cardiac involvement persisted at a higher rate which was shown by cardiac MRI in the late period, particularly pericardial effusion. Cardiac MRI may be suggested for all MIS-C patients at a later phase. Prospective studies with larger sample sizes are needed to determine long-term cardiac effects.
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Background/Significance: Electroconvulsive therapy (ECT) is a safe procedure with infrequent cardiovascular complications. Takotsubo cardiomyopathy (TC) associated with ECT has been rarely reported. Cases: JP is a 67-year-old woman with Schizoaffective Disorder, admitted for psychosis and depressive symptoms. ECT was planned given lack of response to multiple antipsychotics, including clozapine, prior to admission. After the first ECT, patient had elevated troponin, EKG with precordial biphasic T-waves and T-wave inversions, prolonged QTc, negative coronary CT angiogram, and apical wall motion abnormality in TTE with preserved LVEF. Cardiac abnormalities were hypothesized to be due to clozapine-related myocarditis, TC, or sarcoidosis, and clozapine was replaced with haloperidol. ECT was resumed and notable for episodes of bradycardia requiring glycopyrrolate, and hypertension requiring labetalol, yet after 12 sessions, most of her psychosis and depressive symptoms remitted. MT is a 50-year-old woman with MDD with psychotic features, admitted after suicide attempt by hanging. While in NICU, patient was found to have TC with anterior T-wave inversion on EKG and apical hypokinesis in TTE. New EKG 12 days later for ECT clearance showed anteroseptal ST changes suggestive of ischemia, but coronary CTA was normal, and repeat TTE showed no segmental wall motion abnormalities. ECT was started without further cardiac issue but was discontinued after 5 sessions due to marked improvement in depressive symptoms while having intermittent episodes of post-ECT fever and COVID infection with multifocal pneumonia. NE is a 68-year-old woman with MDD with psychotic features, catatonia, and suspected TC after ECT in 2007, admitted for severe catatonia. During ECT session 3, patient had 4 seconds of asystole on telemetry, immediately following succinylcholine with rapid return of palpable pulse, stable heart rate and blood pressure. Post-procedure EKG and recent TTE were normal, and ECT was continued with rocuronium and sugammadex instead of succinylcholine given its associated risk of asystole. Patient did not have any further episodes of asystole or arrythmia but required multiple medications for high blood pressure during ECT sessions. Discussion(s): Regardless of whether TC was diagnosed during the course or prior to initiation of ECT, the decision to perform ECT was based on patient's symptoms and overall cardiac function. 20 cases of TC associated with ECT have been reported with successful resumption of ECT in 8 cases and varying use of beta-blocker to prevent secondary TC. The reported time between TC and ECT ranges from weeks to months, with our cases being approximately 2 weeks (Medved 2018). Conclusion/Implications: ECT can be safely performed on patients with recent, including intercurrent, or remote TC with pharmacological management to mitigate cardiovascular risks. Reference: Medved S, et al: Takotsubo cardiomyopathy after the first electroconvulsive therapy regardless of adjuvant beta-blocker use: a case report and literature review. Croat Med J. 2018;59:307-12. Copyright © 2022
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Background: The prevalence of coronavirus and its health-related psychological consequences such as fear and anxiety has been one of the most important health concerns in the 21st century. Objective(s): This study aimed to investigate the predictive role of fear of COVID-19 and lockdown fatigue in coronavirus anxiety among patients with Congenital Heart Disease (CHD). Method(s): This descriptive-correlational study was conducted through path analysis. The statistical population included the patients with CHD referred to Shahid Rajaei Hospital and Tehran Heart Center, 105 of whom were selected using convenience sampling. The data were collected using the Coronavirus Anxiety Scale (CAS), Fear of COVID-19 Scale (FCV-19S), and Lockdown Fatigue Scale (LFS). The reliability and validity of these scales were approved in the previous studies. After all, the data were entered into the SPSS 21 software and were analyzed using Pearson's correlation test and step-wise regression analysis. Result(s): The study was conducted on 105 participants (6% males and 94% females) aged 20 to above 41 years. Considering marital status, 5% of the participants were single, 94% were married, and 1% were divorced. In addition, the participants' education levels ranged from diploma and lower degrees to postgraduate and higher degrees. According to the findings, coronavirus anxiety was positively correlated to the fear of COVID-19 (r = 0.509, P = 0.000) and lockdown fatigue (r = 0.466, P = 0.000) in patients with CHD. The results of step-wise regression analysis showed that based on the calculated coefficient of determination, 31% of the variability of coronavirus anxiety could be explained by the fear of COVID-19 and lockdown fatigue. Conclusion(s): The study findings indicated that the fear of COVID-19 and lockdown fatigue could predict coronavirus anxiety. Therefore, interventions are recommended to be designed based on the introduction of programs concerning coronavirus anxiety, which may help reduce the anxiety and fear experienced by these patients. They can also be used as prevention programs to help prevent the onset of coronavirus anxiety in patients with CHD. Copyright © 2022, Iranian Cardiovascular Research Journal. All rights reserved.
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Background and Aim: The WHO recommends physical activity (PA-60 min/day) for children and adolescents, also having chronic diseases (CCD). Studies have shown that children and adolescents with congenital heart defects (CHD) exercise regularly and PA can be influenced by health programs (e.g. kidsTUMove). Children and adolescents with/without CCD, are willing to achieve the guidelines recommended by the WHO. Likewise, studies show that life quality (HrQl) in CHD has equally good values than healthy controls. However, the covid 19 pandemic has an impact on children's, adolescents and young adults lives. The aim is to summarize the impact and its measures on healthy children as well as in CHD/CDD and point out possible solutions improving the health of the affected subjects. Method(s): A systematic review regarding HrQl, mental health and PA in children with/without CHD/CDD was conducted. In addition, data was collected at different times of the pandemic using questionnaires (kindl, Kidsscreen, WHO 5) regarding HrQl in children with/without CHD (age: 3-6, 8-16). A second survey was conducted in spring 2021 (age: 3-14) before and after a virtual sports camp (VIC). To have a glimps into adulthood HrQl data in student was evaluated in Dec 2020/Jan 2021. Result(s): The review shows a decrease in PA of children in relation to the COVID-19 pandemic. Mental health (stress, anxiety and depression) was also affected as well as increasing concerns and fears. Result first survey: summer-fall 2020: Age 3-6: HrQLsum20 79% +/- 8.89 vs. HrQLfall20 78.98% +/- 11.21;p gt;0.05;age 8-16 kidsscreen: HrQLsum20 51,63% +/- 7,64 vs. HrQLfall20 51,12% +/- 7,50. HrQl in healthy children remained constant, but HRQoLsum/fall20 in children with CHD was sig-nificant lower (plt;0.005). HrQLspring21 after VIC increased (HrQLpre21 74.50% +/- 11.34 vs HrQLpost21 80.13 % +/- 9.57;plt;0.05). Student WHO5 survey showed that 51.8% felt more burdened by second lockdown 2021. There was a significant worsening of study life balance since the onset of the pan-demic (plt;0.001). Conclusion(s): It is important to provide suitable offers to increase PA, HRQoL, and mental health to minimize adverse health outcomes and prevent future health problems in adulthood in CHD/CDD.
ABSTRACT
Background and Aim: Growing evidence has documented a severe systemic hyperinflammation syndrome affecting children previ-ously exposed to SARS-CoV-2, known as Multisystem Inflammatory Syndrome in Children (MIS-C). Cardiovascular manifestations in MIS-C are frequent (34%-82%). The aim of our study was to describe the early and late cardiac abnormalities in patients with MIS-C, assessed by standard echocardiography, speckle tracking echocardiography (STE), and cardiac MRI (CMR). Method(s): 32 consecutive patients (21M, 11F), mean age 8.25 +/- 4years (range 1.3-17.7), with confirmed MIS-C diagnosis were enrolled in this study. Clinical, laboratory and microbiological data were collected. At disease onset, all children underwent standard transthoracic echocardiography, STE with analysis of left ventricle global longitudinal strain (GLS) and 23 (75%) of them performed CMR. Patients underwent complete cardiological evaluation, including echocardiography and STE at two months (T1) and six months (T2) after diagnosis. CMR was repeated at six months after diagnosis. Result(s): Cardiovascular symptoms were present in 45.8% of cases. Thirteen children (40.6%) shared Kawasaki Disease-like symp-toms, and 5 (15.6%) needed ICU admission. Early survival was 100%. All patients showed an hyperinflammatory state. Tn-I was elevated in 20 (62.5%) and BNP in 28 (87.5%) patients. Mean LVEF at baseline was 58.8 +/- 10% with 10 patients (31%) below 55%. STE showed reduced mean LV GLS (-17.4 +/- 4%). On CMR, LGE with nonischemic pattern was evident in 8/23 patients (35%). Follow-up data showed rapid improvement of LVEF at T1 (62.5 +/- 7.5 vs. 58.8 +/- 10.6%, p value 0.044) with only three patients (10%) below <= 55% at T1 and one (4%) at T2. LV GLS remained impaired at T1 (-17.2 +/- 2.7 vs.-17.4 +/- 4, p value 0.71), and significantly improved at T2 (-19 +/- 2.6% vs.-17.4 +/- 4%, p value 0.009). LV GLS was impaired (gt;-18%) in 53% of patients at baseline and T1, while only 13% showed persistent LV GLS reduc-tion at T2. Follow-up CMR showed LGE persistence in 33.4% of cases. Conclusion(s): Even though, early cardiac involvement significantly improves during follow-up, subclinical myocardial damage seems to be still detectable 6 months follow up in one third of MIS-C patients.
ABSTRACT
Background and Aim: COVID-19 pandemic caused by SARS-Cov-2 coronavirus affects all groups of patients. Although pediatric pop-ulation seems to be less affected with milder or asymptomatic course of SARS-CoV-2 infection, there are few groups of patients with potential high risk of severe or fatal course of coronavirus dis-ease. These include children with congenital heart defects. The aim of this study was to evaluate the course of SARS-Cov-2 infection in patients with univentricular heart after Fontan operation. Method(s): From September 2020 to May 2021 (before vccination started in pediatric population in Poland) we screen all 38 Fontan patients admitted to Cardiology Department, Polish Mother's Memorial Hospital Research Institute for SARS-Cov2 antibodies. Result(s): We found positive SARS-Cov-2 antibodies in 21 unvac-cinated Fontan patients (55% of all hospitalized Fontan patients), 15 boys (71%) and 6 girls in the age 3-22 years (mean 11 years). 14 patients (67%) had hypoplastic left heart syndrome. Course of SARS-CoV-2 infection: asymptomatic course in 11(52%) patients, fever in 7 (33%) patients, cough 4 (19%) patients, diar-rhoea in 2 patients, loss of smell and taste-1 patient. One, 18 years old patient suffered from Covid fog symptoms (impairment of sus-tained attention and memory problems), he hasn't notice any SARS-Cov-2 symptoms but the level of antiobodies was high. Only 3 patients were hospitalized in acute SARS Cov2 infection: 2 due beacause of need for intravenous rehydratation during severe diarrhoea, 1 because of JET (junctional ectopic tachycardia) during fever. There was no case of PIMS (pediatric inflammatory multi-system syndrome) in study group. Medications used in study group: aspirin in 19 (90 %), warfarin in 2, spironolactone in 18 (86%), sildenafil in 9 (43%), angiotensyn-converting enzyme inhibitors in 17 (81%), beta-blockers in 4 (19%) of patients. Conclusion(s): 1. In our study severe congenital heart defect such as univentricular heart was not a risk factor of severe course of SARS-Cov-2 infection. 2. Absence of PIMS in analized group of patients may be connected with changed immunologic response in Fontan patients and chronic use of ASA (acetylsalicylic acid). 3. The impact of SARS CoV 2 infection on patients with congenital heart defects needs further studies.