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Background: It has been previously reported during the first COVID outbreak that patients presenting with ST-Segment Elevation Myocardial Infarction (STEMI) and concurrent COVID-19 infection have increased thrombus burden and poorer outcomes [1]. Subsequently, there have been multiple further waves of the pandemic with the emergence of at least two new COVID-19 variants and the emergence of vaccinations. To-date, there have been no reports comparing the outcomes of COVID-19-positive STEMI patients across all waves of the pandemic. Purpose(s): The purpose of this study was to compare the baseline demographic, procedural and angiographic characteristics alongside the clinical outcomes of patients presenting with STEMI and concurrent COVID-19 infection across the COVID-19 pandemic in the UK. Method(s): This was a single-centre, observational study of 1250 consecutive patients admitted with confirmed STEMI treated with primary percutaneous coronary intervention (PCI) at Barts Heart Centre between 01/03/2020 and 10/03/2022. COVID +ve patients were split into 3 groups based upon the time course of the pandemic (Wave 1: March 2020-June 2020, Wave 2: Sept 2020-March 2021, Wave 3: October 2021-March 2022). Comparison was made between waves and with a control group of COVID-ve patients treated during the same timeframe. Result(s): A total of 135 COVID +ive patients with STEMI (1st Wave: 39 patients, 2nd Wave: 60 patients, 3rd wave 35 pts) were included in the present analysis;and compared with 1115 COVID negative patients. Significant changes in the baseline characteristics, angiographic features and clinical outcomes of COVID +ive patients occurred over time. Early during the pandemic (Wave 1 2020), STEMI patients presenting with concurrent COVID-19 infection had high rates of cardiac arrest, evidence of increased thrombus burden (higher rates of multi-vessel thrombosis, stent thrombosis, higher modified thrombus grade higher use of GP IIb/IIIa inhibitors and thrombus aspiration, coagulability (more heparin for therapeutic ACT), bigger infarcts (lower myocardial blush grade and left ventricular function) and worse outcomes (mortality). However, by wave 3 (late 2021/2022), no differences existed in clinical characteristics, thrombus burden, infarct size or outcomes between COVID +ive patients and those without concurrent COVID-19 infection with significant differences compared to earlier COVID +ve patients. Poor outcomes later in the study period were predominantly in unvaccinated individuals. Conclusion(s): Significant changes have occurred in the clinical characteristics, angiographic features and outcomes of STEMI patients with COVID- 19 infection treated by primary PCI during the course of the pandemic. Importantly it appears that angiographic features and outcomes of recent waves are no different to a non-COVID-19 population.
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Background: The coronavirus (COVID-19) pandemic, which affected millions of people worldwide, is associated with a chronic fatigue sequela, also known as long-COVID. While various adverse effects of COVID-19 on the cardiovascular system were reported, the prolonged sequela of COVID-19 on heart rhythm remains unknown. Aim(s): To describe the prevalence of cardiac dysrhythmias among patients who presented with Long Covid following recovery from COVID-19 infection. Method(s): We conducted a prospective study among 87 patients who suffered from Long Covid syndrome following recovery from COVID-19 and were treated in the COVID-19 recovery clinic between December 2020 and June 2021. All patients were referred for transthoracic echocardiography (TTE) and 24-hour Holter examination. Result(s): The mean age was 52+13 years, and 52 (59.8%) patients were females. Seventy-nine (90.8%) of the patients had normal sinus rhythm without evidence of any arrhythmias. Atrial premature beats were recorded in 70 (80.5%) patients with a median of 6/day (interquartile range 3-20/day;maximum: 5180/day). Ventricular premature beats were recorded in 50 (57.5%) patients with a median of 4/day (interquartile range 2-19/day;maximum: 6847/day). Overall, seven patients (8%) had sustained atrial dysrhythmias: One had atrial fibrillation, one had atrial flutter, and five had atrial tachycardia. Sixty-six (75.9%) patients underwent TTE, which was mainly unremarkable as 65 patients had a normal left ventricular function, and three (4.5%) patients had evidence of pulmonary hypertension. Discussion(s): Cardiac arrhythmias are not uncommon among symptomatic COVID-19 recovered patients. Atrial arrhythmias were most common, with an up to 8% incidence rate. These findings may suggest that atrial dysrhythmias may be associated with long-term symptomatic sequela of COVID-19 infection.
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Cardiovascular complications are frequently reported in COVID-19 patients and are associated with increased mortality during hospitalization. However, no data exists on cardiac involvement in patients recovered from COVID-19 infection. Our study suggests a need for closer follow-up among COVID-19 recovered subjects including echocardiographic assessment of left ventricular function to elucidate long-term cardiovascular outcomes by early detection of left ventricular dysfunction.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Background Phospholamban (PLN), an inhibitor of sarcoplasmic reticulum (SR) Ca2+-ATPase, is a regulator of Ca2+ release during excitation-contraction coupling. We present a case of recurrent polymorphic ventricular tachycardia (PMVT)/ventricular fibrillation (VF) due to a PLN mutation. Case 38 year-old male presents after resuscitation following VF arrest. An ICD was implanted. Seven years later, he presented with VF storm requiring ventricular assist device support and he underwent catheter ablation of PVC triggers of VF arising from the moderator band. Because he had an ECG that was concerning for early repolarization syndrome, he was placed on quinidine and metoprolol. After an episode of VT in 2020 in the setting of COVID infection, whole genome sequencing was obtained and identified a pathogenic PLN mutation. PLN L39Ter has been associated with dilated and hypertrophic cardiomyopathy as well as sudden death. The patient has a history of normal left ventricular function and wall thickness by echocardiography. Decision-making Given the involvement of PLN on SR handling of Ca2+, flecainide may be a more effective therapy for the treatment of PMVT/VF in this patient. Conclusion PLN mutations have been associated with cardiomyopathies. This case illustrates a patient with the pathogenic PLN L39X variant with short-coupled PMVT with no imaging evidence of structural heart disease. Whether a more targeted therapy such as flecainide may be more effective in this patient remains to be determined. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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Background: Post COVID19 condition occurs in individuals with a history of probable or confirmed SARS Cov2 infection, usually 3 months from the onset of COVID19 with symptoms that last for up to at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction, but also arterial hypertension (AH) and generally have an impact on everyday function. Aim: COVID 19 pneumonia initiates new onset AH and aggravates the structural and functional myocardium remodeling in the long term after hospitalization. Methods: The study population /initially questioned 1500 patients for symptoms after acute COVID 19 pneumonia / included 220 patients without history of any disease, mean age of 45 ± 12 years, male 145 (43 ± 10 years) female 75 (52 ± 14 years). The global longitudinal strain (GLS) was extracted for left ventricle (LV) and right ventricle(RV) and AMBP analysis, mean arterial pressure (MAP)and heart rate HR were performed at baseline /30-40 days after acute infection/ 3rd and 12th months follow up. CMR was performed at 3rd (3mFU) and 12th months (12mFU) also to confirm our resulst. Results: From initial population /1500 pts/ self-reported symptoms at 12mFU are 1265 (84.6 %) and 235 /15.4 %) are symptom free at 12mFU. At 3mFU HR and MAP increased significantly / from 75 ± 6 beats /min to 88 ± 12 beats/ min, 109 ± 15 mmHg to 118 ± 19mmHg. Sys BP increased slightly at 3mFU /128 ± 14, p = 0.6/ and continue at 12mFU / 129 ± 12, p = 0.7/. Diastolic BP increased significantly at 12mFU /86 ± 12.3 to 91 ± 10.0, p > 0.01/ and AH presence at 3mFU in 143 (65%)up to 161(73%) at 12mFU. Symptoms of heart failure with preserved EF were found at 3mFU in 91 pts (41%) and in 99 pts (45%) at 12mFU. Echocardiography showed predominantly decrease of the load on the right heart at 3mFU and 12mFU (RV FAC % p < 0.019, TAPSE p < 0.05, RVOT VTI p < 0.01). LV function showd increased EDD, ESD, EDV, ESV, and decreased EF and GLS at 3mFU and slightly improvement at 12mFU. Despite normal EF, GLS / 18.5 %, p < 0.01) and segmental LS in all apical and mid anteroseptal, inferoseptal and basal anteroseptal and inferoseptal levels (16% to 18%, p < 0.01) and RV (22.3% to 24%) at 12mFU shown diminished and still preserved values. Conclusion: New onset AH is one of major symptoms after COVID 19 and remains at 12mFU. Despite of satisfactory improvement of conventional parameters for LV and RV function, GLS indicate worsening of the LV systolic function.
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Background and Aim: COVID-19 patients with cardiac involvement have a high mortality rate. The aim of this study was to investigate the echocardiographic features in COVID-19 patients between severe and non-severe groups. Method(s): For this single-center study, data from patients who were treated for COVID-19 between March 25, 2020 and April 15, 2020 were collected. Two-dimensional echocardiography (2DE) images were obtained for all patients. Patients were divided into two groups based on the severity of their COVID-19 infections. 2DE parameters indicating right ventricular (RV) and left ventricular (LV) functions were compared between the two groups. Result(s): A total of 90 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n=44) was 63.3+/-15.7 years, and 54% were male. The mean age of non-severe group (n=46) was 49.7+/-21.4 years, and 47% were male. In the severe group, RV and LV diameters were larger (RV, 36.6+/-5.9 mm vs 33.1+/-4.8 mm, p=0.003;LV 47.3+/-5.8 mm vs. 44.9+/-3.8 mm, p=0.023), the LE ejection fraction (LVEF) and the RV fractional area change (RV-FAC) were lower (LVEF, 54.0+/-9.8% vs 61.9+/-4.8%, p<0.001;RV-FAC, 41.4+/-4.1% vs 45.5+/-4.5%, p<0.001), and pericardial effusions were more frequent (23% vs 0%) compared to patients in the non-severe group. A multiple linear regression analysis determined that LVEF, right atrial diameter, high-sensitivity troponin I, d-dimer, and systolic pulmonary artery pressure, were independent predictors of RV dilatation. Conclusion(s): The results demonstrate that both right and left ventricular functions decreased due to COVID-19 infection in the severe group. 2DE is a valuable bedside tool and may yield valuable information about the clinical status of patients and their prognoses.
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INTRODUCTION: Point-of-care ultrasound (POCUS) is becoming increasingly important for rapid assessment and diagnosis in a variety of clinical situations. With the ongoing COVID-19 pandemic, the aim of this study is to determine whether a virtual POCUS session can improve learner competency in assessing left ventricular (LV) systolic function. METHOD(S): An hour long session, involving a short lecture and fourteen practice questions was created. The questions consisted of cardiac ultrasound clips from real patients, evaluated by three POCUS experts. For each clip, LV systolic function was classified as hyperdynamic, normal, reduced, or severely reduced. The session was given separately to a group of interns (n1=30) and a group of senior residents (n2=39) virtually via Zoom. Series of clips were shown as the lecture progressed and participants recorded their answers as either hyperdynamic, normal, reduced, or severely reduced using the polling feature within the Zoom platform. Effect size as the percent of correct responses was calculated. Data was analyzed using SPSS software with independent t-test and paired t-test analysis with a level of statistical significance as p <=0.05. Result(s): The intern group had a mean score of 69.9% [SD 21.8%] and the resident group had a mean score of 74.2% [SD 21.5%]. All participants achieved a mean score of 66.6% [SD 26.0%] during the first half of the lecture, which then improved to 77.6% [SD 14.2%] in the second half [p value 0.547]. Both groups showed similar overall trends, although these were not statistically significant. When combined, extremes of LV function (hyperdynamic and severely reduced) were better recognized than more subtle differences (reduced and normal) [81.4%+/-18.1 vs 55.2+/-15.9;p = 0.001] overall. Conclusion(s): Compared to the conventional in-person approach, this study highlights the potential for virtual didactic sessions in POCUS training with impressive results when recognizing extreme cardiac findings.
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Background and Aim: MIS-C is a hyperinflammatory syndrome caused by Sars-CoV-2 virus. Cardiovascular system impairment is observed up to 100 % of all MIS-C patients with a wide spectrum and severity of symptoms. It is important to identify the course of the disease and its outcome, which could significantly improve public health. Method(s): A single-centre study, prospective cohort study, con-ducted in the Children's Clinical University hospital in Latvia from January to December 2021. Patients between the ages of one to seventeen years who met the MIS-C criteria were included in the study. We evaluated blood pressure, left ventricular heart func-tion, size of coronary arteries and hospital course. Result(s): Thirty-one patients were included who met the MIS-C criteria. The median age was 8.0 years, 52% were boys. Of all patients 77% initially presented with hypotension of whom 42% required inotropic support. Treatment in PICU was required in 58% of all patients. Reduced left ventricular ejection fraction was observed in 35% of all patients. Mildly decreased ventricular ejection fraction (lt;55%) was observed in 19% of cases but mod-erate dysfunction (ejection fraction lt;45%) was observed in 16% of patients. Twelve percent of patients received milrinone to improve left heart function. Left heart function significantly improved in all patients during the hospitalisation. In 6 % of all patients coronary artery dilations was observed. All patients had dilations resolution at the time of discharge. Median length of hospitalisation was twelve days and median length of PICU stay was three days. Conclusion(s): All patients cardiovascular symptoms had resolved at the time of discharge. Whether patients will have chronic cardiac impairment is unknown therefore it is crucial to perform long-term follow-up.
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Background and Aim: Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) is a new dis-ease affecting children, almost alwaysinvolving cardiovascular system and with potential long-term effects still unknown. Method(s): Prospective study enclosed 80 children aged 1-17 years (mean 8.2 years) diagnosed with PIMS-TS between June 2020 and June 2021 who were controlled 6 weeks and 6 months after the disease. In patients with severe cardiac involvement during acute phase (deteriorated left ventricular ejection fraction (LVEF) lt;55% and significantly elevated concentration of NT-pro-BNP (gt;5000 pg/ml) or troponine (gt;500 ng/ml)) the addi-tional check-up after 3 months was scheduled. In all patients at control points three dimensional echocardiography (3D-ECHO) and average global longitudinal strain (GLS) were used to assess left ventricular function. Result(s): In all patients the means of LVEF and average GLS were within normal limits at the time of all check-up points. For the whole group LVEF after 6 weeks was 60.5% (SD: 3.1;51-69%) and GLS 21.2% (SD: 3.9;12.4-29.4%). After 6 months LVEF increased to 63% (SD: 2.4;58-69%) and GLS to 23.6% (SD: 3.2;17.3-33.3%)-both significantly (plt;0.001). In the subgroup of 54 patients with originally mild cardiac involvement LVEF after 6 weeks was 60.7% (SD: 2.6;57-69%) and GLS 21.8% (SD: 3.4;17.3-29.4%). In the subgroup of 26 patients with severe cardiac involvement LVEF after 6 weeks was 59.6% (SD: 3.1;55-67%) and was not significantly different than in subgroup with mild car-diac involvement (p = 0.175) while GLS was significantly lower (19.3%, SD: 3.8;12.4-24.8%;p = 0.009). After 3 months in this group LVEF and GLS did not increase (respectively, 59.9%, 56-67%;p = 0.794 and 20.2%, 13.7-26.9%;p = 0.149). After 6 months LVEF in this subgroup increased to 62.8% (60-68%) and GLS to 22.6% (17.7-27%)-like in patients with mild cardiac involvement (plt;0.001). Conclusion(s): 3D-ECHO and GLS are highly applicable tools for the assessment of cardiac function in children after PIMS-TS. Patients with originally severe cardiovascular involvement have lower average GLS after 6 weeks. 6 months after PIMS-TS patients present significant improvement of left ventricular function. Average GLS seems to be more sensitive test for functional assess-ment than LVEF.
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Cardiac involvement is an observable issue in multisystem inflammatory syndrome in children (MIS-C) associ20 ated with COVID-19. The most common echocardiographic findings in MIS-C are abnormal coronary arteries, decreased left ventricular function, mitral regurgitation, and pericardial effusion. Abnormalities in the coronary arteries were seen in less than 20% of MIS-C patients. These abnormalities include dilatation or aneurysms in the coronary arteries;however, giant or large aneurysms are rare. On the other hand, transient coronary artery dilatation (which can occur secondary to viral myocarditis) may also mean that the coronary artery Z-scores never exceed 2.5. Reviewing large case series revealed that approximately 30 - 40% of MIS-C patients had decreased left ventricular function. In most cases, left ventricular function is mildly depressed, and severe left ventricular dysfunction was observed in only one-fifth of cases. Hypoxia, myocardial ischemia secondary to coronary involvement, stress-induced cardiomyopathy, injury caused by systemic inflammation, and viral myocarditis are the possible etiologies for the myocardial injury in MIS-C. It is now clear that myocardial strain imaging indices such as a global longitudinal strain (GLS), end-diastolic strain rate (EDSR), and peak left atrial strain (LAS) can demonstrate systolic or diastolic dysfunction in myocarditis patients with preserved left ventricular ejection fraction. Furthermore, right-sided ventricular deformation imaging abnormalities have been reported in adult patients with MIS-C. Less information is currently available on mitral regurgitation and pericardial effusion in pediatric patients with MIS-C;however, in an extensive study on 286 pediatric patients with MIS-C, 28% had pericardial effusion, and 42.7% had mitral regurgitation;both were mild in most patients.
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Introduction: Point-of-Care Ultrasound (PoCUS) can rapidly diagnose presence and severity of COVID-19 disease and associated pathologies.1 PoCUS identifies life-threatening complications at the bedside, with the potential to reduce the need for out-of-department transfers for imaging, alongside associated radiation exposure and spread of infection.2 Use of PoCUS by doctors in the intensive care unit (ICU) is becoming increasingly widespread. However, uptake by ICU nurses is poor despite evidence to suggest comparable accuracy in acquiring and reporting PoCUS scans, and the potential benefit to patients as a result of an increased workforce of competent PoCUS clinicians.3-5 Objective: To report findings in critically ill COVID-19 patients identified through nurse-led cardiac and 6-point lung PoCUS. Method: This case series was part of the national service evaluation led by the Intensive Care Society, SAM, FUSIC, and FAMUS. Conduct was approved by the departmental lead for critical care ultrasound. An ICU nurse trained in Focused Intensive Care Echocardiography (FICE) and Focused Ultrasound in Intensive Care (FUSIC) performed cardiac and 6-point lung PoCUS scans on ICU patients with confirmed COVID-19 disease during the recovery phase. Severity of disease was scored between 0-3 (Table 1) in each lung region (upper anterior;mid-anterior;posterolateral) and a total score calculated (0-18). PoCUS scans were only performed on patients identified by the treating ICU consultant. Correlations between PoCUS findings and patient demographics, key clinical data, physiological parameters, and 30-day outcome were analysed using Pearson's coefficient. Descriptive statistics analysis (mean;standard deviation/ mode;interquartile range) were used to describe data. Results: A cardiac and 6-point lung PoCUS scan was performed on 15 patients. Fourteen (93%) scans were performed to answer lung-specific clinical questions including assessment of ventilation strategy (ventilation mode;PEEP level) in 5 (33%) patients, extravascular lung water assessment in 9 (60%), and lung assessment prior to tracheostomy decannulation in 1 (7%). Moderate to severe COVID-19 was apparent in all lung fields with severity scores from 6 to 14 (Figure 1). Left ventricular (LV) function was normal in 13 (87%) patients, 2 (13%) demonstrated signs of a dilated right ventricle (RV), and 1 (6%) had impaired LV and RV function (Figure 2). Ten scans identified pathologies that contributed to a change in clinical management immediately following the scan (Figure 3). Interventions included: (1) change in fluid management (increased fluid removal on renal filtration, new furosemide prescription) 4 (27%) patients) and a level 2 echo assessment due to identification of new cardiac pathologies (3 (20%) patients). Five patients had no change in care. We identified a moderate positive correlation between lung severity score and APACHE II (Pearson's coefficient: 0.69;p value <0.01). Weak correlation was found between lung severity score and white cell count, SOFA score, and PaO2/ FiO2. There was no difference in 30-day outcome in patients with a higher lung severity score or abnormal cardiac scan. Conclusion: Cardiac and lung PoCUS is a vital tool in the assessment of COVID-19 disease. The addition of ICU nurses to the growing workforce of PoCUS competent clinicians increases availability of real-time imaging.
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Purpose of the study: Respiratory syncytial virus (RSV) is a wellknown pathogen in pediatric patients. (1) However, it also causes substantial morbidity and mortality in adults, posing a major healthcare problem. (2). Methods:We reviewed a patient suffering from cardiac arrest (CA) and acute RSV infection who was admitted to the Department of Emergency Medicine, Medical University of Vienna, Austria. Results: A 74-year-old male patient complained about dyspnea and later went into CA. Bystander BLS was conducted for 7 minutes, and arriving EMS performed advanced life support (ALS). The initial rhythm check showed pulseless electrical activity. After further 6 minutes of ALS, sustained return of spontaneous circulation (ROSC) was achieved, and the patient was transported to the emergency department (ED). At the ED, the ECG showed no ischemia-like patterns, and point-of-care ultrasound revealed a highly reduced left ventricular function. Laboratory results showed signs of inflammation, and a routine PCR turned out positive for RSV. Awhole body computed tomography revealed no acute pathology, and before a background of chronic pulmonary disease, the CA event was deemed as hypoxic caused by exacerbation of the chronic pulmonary pathologies either parallel to- or directly through an acute RSV infection. Conclusion: An RSV infection should be considered during post- ROSC in adult patients with presumed hypoxic etiology of CA. From a public health perspective, an immune-naivety for RSV caused by the COVID-19 pandemic may potentially induce a rise in cases, morbidity, and mortality in the future.
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Introduction: After the outbreak of the Corona Virus Disease 2019 (COVID-19), there have been reports of impaired cardiac function in patients infected with this coronavirus. The tests are mostly based on myocardial injury markers and routine cardiac ultrasound examinations, which are mostly seen in critically ill patients. In this study, two-dimensional speckle tracking imaging (2DSTI) combined with Tei index and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) were used to more sensitively diagnose cardiac function impairment in COVID-19 patients. Materials and methods: For some COVID-19 patients in our hospital, there were 68 cases of mild disease (including mild and common types) and 11 cases of severe disease (4 cases of severe death), and 10 healthy volunteers were included as the control group. On the basis of conventional echocardiography in all subjects, the left ventricular end-diastolic volume (LV-EDV), left ventricular end-systolic volume (LV-ESV), and left ventricular ejection fraction (LV-EF) were obtained by Simpson method, the left ventricular Tei index by tissue Doppler, and the left ventricular global peak longitudinal strain (GLPS), left ventricular global peak radial strain (GRPS), and left ventricular global peak circumferential strain (GCPS) by 2DSTI offline analysis. The COVID-19 patients were subjected to quantitative detection of serum NT-proBNP for statistical analysis. Results: Left ventricular GLPS, left ventricular GRPS, and left ventricular GCPS in COVID-19 patients were significantly lower than those in the control group (P<0.05): The left ventricular GLPS was more significant (P<0.01), and the severe group (including the death group) < the mild group < the control group. The left ventricular Tei index: The severe group (including the death group) of COVID-19 was significantly higher than the mild group and the control group (P<0.05), and there was no statistical significance between the mild group and the control group. NT-proBNP: The severe group of COVID-19 was significantly higher than the mild group (P<0.05). Although the LV-EF in the COVID-19 patients was significantly lower than that in the control group (P<0.05), except for 2 sever cases less than 50%, the rest were all ≥50%;although there was a significant difference in LV-ESV among multiple groups (P<0.05), but there was no significant difference for the pairwise comparison, and there was no significant difference in LV-EDV. Conclusion: 2DSTI can more sensitively detect latent cardiac function impairment in COVID-19 patients, and the left ventricular GLPS is the most sensitive. Tei index is an effective indicator to reflect the degree of cardiac function impairment. NT-proBNP has significant significance in predicting the severity of cardiac dysfunction. The combined application of the three can significantly increase the predictive performance of cardiac function impairment, provide a diagnostic basis for cardiac function impairment with preserved ejection fraction, and predict the degree of impairment. Our study demonstrated that the cardiac function of COVID-19 patients is impaired to varying degrees.
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In hospitalized COVID-19 patients, myocardial injury and echocardiographic abnormalities have been described. The present study investigates cardiac function in COVID-19 patients 6 weeks post-discharge and evaluates its relation to New York Heart Association (NYHA) class. Furthermore cardiac function post-discharge between the first and second wave COVID-19 patients was compared. We evaluated 146 patients at the outpatient clinic of the Leiden University Medical Centre. NYHA class of II or higher was reported by 53% of patients. Transthoracic echocardiography was used to assess cardiac function. Overall, in 27% of patients reduced left ventricular (LV) ejection fraction was observed and in 29% of patients LV global longitudinal strain was impaired (> − 16%). However no differences were observed in these parameters reflecting LV function between the first and second wave patients. Right ventricular (RV) dysfunction as assessed by tricuspid annular systolic planar excursion (< 17 mm) was present in 14% of patients, this was also not different between the first and second wave patients (15% vs. 12%;p = 0.63);similar results were found for RV fraction area change and RV strain. Reduced LV and RV function were not associated with NYHA class. In COVID-19 patients at 6 weeks post-discharge, mild abnormalities in cardiac function were found. However these were not related to NYHA class and there was no difference in cardiac function between the first and second wave patients. Long term symptoms post-COVID might therefore not be explained by mildly abnormal cardiac function.
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Introduction: The impact of acute infection by SARS-COV2 on the cardiovascular system has been previously reported in the literature, with a higher propensity in patients with more serious pattern of disease and pro-inflammatory status. Nevertheless, the long-term burden and sequels of COVID-19 on the cardiovascular system is still unknown. Purpose: To evaluate the long-term impact of COVID-19 on left ventricular function in patients with severe clinical presentation requiring intensive care hospitalization. Methods: This was a single-center observational, prospective study which included patients requiring admission to the Intensive Care Unit (ICU) due to COVID-19 infection from January to November 2020. All discharged patients were contacted to perform a clinical, electrocardiographic and echocardiographic evaluation and those who accepted were included on the protocol. Baseline and clinical characteristics were collected from clinical reports. For the global longitudinal strain (GLS) analysis all patients with significant wall motion abnormalities and valvular cardiopathy were excluded. Statistical analysis was performed with Mann-Whitney and a safety cut-off was established with ROC curve analysis. Results: A total of 43 patients were included (mean age 64 ± 12, 67.4% males). During SARS-COV2 infection 49% presented with severe ARDS and 51% with moderate, 35% required invasive mechanical ventilation, 14% noninvasive mechanical ventilation and 52% with high nasal flow cannula. On the follow-up analysis, fatigue was the most reported in symptom (52% patients) and the majority did not present other signs or symptoms suggestive of heart failure, with the mean NT-proBNP of 49 ± 389 pg/dL. The standard ECG and echocardiogram did not show significant changes with a mean LVEF of 58 ± 7.8 and mean TAPSE of 21 ± 4. The strain analysis showed low value of GLS (mean GLS of -17.14 ± 2.36) for a reference cut-off of -18%, suggesting subclinical left ventricular dysfunction in this subset of patients with preserved ejection fraction. Maximum CPR values during ICU did not correlate either with the extent of disease evolvement in CT (p= NS) or ARDS severity (p= NS). Nevertheless, maximum CPR correlated significantly with GLS reduction (R = 0.44, p = 0.019). A CPR value higher than iger30mg/ dL had 100% specificity for GLS reduction and a cut-off of 14gm/dL reported a sensitivity of 65% and specificity pf 75% for reduction in GLS. Conclusion: In our study, we reported subclinical impairment in left ventricular function detected with global longitudinal strain after serious infection with SARS-COV2. The detected myocardial dysfunction was related with higher inflammatory as expressed by CPR values. Longterm monitoring of these patients should be undertaken in order to timely detect late complications.
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Background/Introduction: Ejection fraction (EF) is a parameter widely used in Echolab to evaluate left ventricular function. Recently, in parallel with the growing interest in artificial intelligence (AI), attemps have been made to create automated systems for EF assessment, in order to reduce time and improve the accuracy of the analysis. Purpose: to compare results of different methods of EF assessment: visual estimation (visual EF), manual and fully automated analysis. Methods: 28 consecutive pediatric patients were enrolled. This cohort of previously healthy patients was screened at our Center for cardiac evaluation within 6 months after an asymptomatic or paucisymptomatic COVID19 infection. All they were in sinus rhythm. Optimized apical 4- and 2- chamber views were collected for each patient using Canon Aplio i900. Off-line EF assessment was first evaluated visually by pediatric cardiologists with experience in echocardiography, then performed by both fully automated analysis (AI) using two different methods (Automatic Simpson -AI Simpson- and Wall Motion Tracking -AI WMT-) and pediatric cardiologists through manual tracing of endocardial border (Manual Simpson and Manual WMT respectively). Operators were blinded to the AI analysis. To measure intraobserver variability, evaluations of 16 patients' datasets were performed twice by both operators and AI. Results: Patients' demographic data were: age 9,8+/-4,7 years;males 22 (78%);height 134,3+/- 34,9 cm;weight 41,8+/-28,7 kg;BSA 1,2+/-0,4 mq, HR 85+/-15/min. The time taken for off-line analysis was 0.3-0.7 minutes, 1-1.5 minutes, 1-3 minutes and 3-4 minutes, respectively for AI WMT, AI Simpson, Manual WMT and Manual Simpson. As expected, visual EF showed high intraobserver variability and a poor reproducibility (ICC 43%). AI analysis revealed a good to excellent reproducibility (ICC from 80% to 99%, depending on the method used). WMT methods had the best reproducibility both for manual tracing of endocardial border and fully automated analysis (Table 1). The comparison between different methods (Table 2) showed a good agreement between AI Simpson and AI WMT (mean bias 2,9, from -3,2 to 9,0, ICC 86%). A moderate correlation was found between different methods of AI analysis while only poor correlation was found between manual Simpson and manual WMT (Table 2). Conclusion(s): Automatic Simpson and Wall Motion Tracking are two different fully automated methods which can be used for left ventricular function assessment. AI reproducibility is high for both methods, higher for WMT. WMT method is also less time consuming and improves reproducibility of manual tracing of endocardial borderd analysis.
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Background: Coronavirus disease 2019 (COVID-19) was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020. Apart from respiratory findings, cardiac involvement has been highlighted by some studies. COVID-19 is increasing rapidly among young adults. The present study was designed to evaluate left ventricular function using speckle-tracking echocardiography in young adult COVID-19 patients who underwent home recovery. Methods: The study assessed 40 patients aged between 18 and 39 years who recovered at home from COVID-19 and 20 healthy control subjects. All the participants underwent evaluations of left and right ventricular function via the conventional and global longitudinal strain (GLS) technique measured by speckle-tracking echocardiography. Results: Heart rate was significantly higher in the post–COVID-19 group (P=0.024). The patients were assessed for a mean period of 38.8 days (standard deviation=10.9 d) after negative COVID-19 testing. In the post–COVID-19 group, 19 patients (47%) reported ongoing dyspnea: 13 had dyspnea during ordinary daily activities and 6 had dyspnea during less-than-ordinary daily activities. Nine patients (23%) had chest pain, 8 (20%) had palpitations, 22 (55%) had fatigue, and 4 (10%) had joint pain. The left ventricular GLS value for the post–COVID-19 group was significantly impaired compared with the control group (P=0.006). Conclusions: Among our young adult patients, who had recovered from COVID-19 at home, left ventricular GLS was affected, which may indicate the subclinical impairment of left ventricular systolic function.
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Background: Louis-Dietz syndrome (LDS) Type 3 is a rare disorder caused by an autosomal-dominant mutation in SMAD-3, altering the TGF-β pathway. LDS Type 3 typically manifests as aortic aneurysms and early-onset osteoarthritis, however other dermatologic, cardiovascular, and skeletal abnormalities have been reported. Case: A 51-year-old woman was referred to the cardiology clinic for episodes of palpitations, syncope, chest pain, and shortness of breath during the COVID-19 pandemic. She had a history of congestive heart failure, cardiomyopathy, patent foramen ovale, atrial septal aneurysm, pre-COVID myocarditis, mitral valve prolapse, mitral regurgitation, and pericarditis. She also has a pertinent medical history of hypermobile Ehlers-Danlos syndrome (hEDS) and systemic lupus erythematosus (SLE). Her family and social history were remarkable for a daughter with SLE. Cardiopulmonary and general physical exams were remarkable for hypermobility. Evaluation with an ECG and Holter monitor showed normal sinus rhythm with unifocal premature ventricular contractions (PVCs) that correlated with her symptoms. Decision-making: The patient was initially managed un-successfully with beta and calcium channel blockers. Cardiac ablation was subsequently performed on a left ventricular septal focus with remote magnetic navigation using the Niobe system from Stereotaxis inc. (due to its low risk for cardiac perforation). At 6 months follow up, the patient exhibited an increase in left ventricular ejection fraction from 40-50% to 55-60%, fewer symptoms, and fewer PVCs. She was later diagnosed with a right internal carotid artery aneurysm that prompted genetic testing that was positive for LDS Type 3. Conclusion: This patient’s unique combination of illnesses required a multidisciplinary team for management. The Stereotaxis robotic system safely and successfully treated the patient’s PVCs and resulted in improvement of left ventricular function. Due to previous reports of arrhythmias associated with these connective tissue disorders, additional studies are necessary to understand the role of the SMAD-3 mutation, EDS, and SLE in contributing to arrhythmogenicity.
ABSTRACT
Background: Post-cardiac injury syndrome or Dressler syndrome, described as pericarditis with or without effusion, is often associated with myocardial infarction or a procedure in which the pericardium is disturbed. However, it may be provoked by a minor intervention, including radiofrequency ablation. Case: A 41 year-old male with paroxysmal atrial fibrillation (AF) and obstructive sleep apnea on CPAP presented with chest pain, palpitations, and dyspnea. He underwent cryoablation 1 month prior to presentation. He was febrile, tachycardic, and hypotensive. ECGs showed atrial flutter (Figure A) and AF with rapid ventricular response. Cardioversion was unsuccessful. Decision-making: Work-up included a negative COVID PCR. C-Reactive Protein was 311 mg/L (normal <10.0 mg/L). A CT chest showed bilateral pleural effusions and a pericardial effusion. Thoracentesis removed 850 mL of serous yellow fluid (exudative effusion). Transthoracic echo (TTE) revealed normal left ventricular function with a small pericardial effusion. Within 24 hours, the patient demonstrated tamponade physiology. Pericardiocentesis removed 400 cc of serosanguinous fluid.Cardiac MRI was concerning for myopericarditis (Figure B).Rate control for AF was difficult to achieve in the face of an inflammatory state. After several days of high-dose ibuprofen and colchicine, the patient started sotalol with conversion to normal sinus rhythm. Conclusion: Although rare, Dressler syndrome can be associated with minimally-invasive cardiac procedures, including cryoablation. [Formula presented]
ABSTRACT
Background: COVID-19 is a very heterogeneous infection that can vary in its course from asymptomatic to fatal. While the course of pediatric COVID-19 infections is mostly asymptomatic or very mild, patients with immunosuppressive therapy are at high risk of a severe infection. We conducted a multicenter survey with pediatric heart transplantation centers in Germany, Austria, and Switzerland (15 centers) to evaluate the risk of a severe COVID-19 infection after pediatric heart transplantation. Method: Retrospective analyses of all COVID-19 infections between February 2020 and June 2021 of patients after pediatric heart transplantation with medical care in one of the German, Austrian, or Swiss pediatric heart transplantation centers. Results: Twenty-one patients (nine male) with a mean age of 8.34 ± 5.33 years at time of transplantation and on average 8.33 ± 8.49 years after transplantation suffered from COVID-19 infection. Reasons for transplantation were dilated cardiomyopathy (n = 17), restrictive cardiomyopathy (n = 2), and congenital heart disease (n = 2). The immunosuppressive therapy consisted of tacrolimus (n = 17), cyclosporine A (n = 3), everolimus (n = 10), mycophenolate mofetil (n = 11), azathioprine (n = 1), and steroids (n = 3). Twelve patients had an asymptomatic COVID-19 infection, the other patients complained about cough (n = 3), rhinitis (n = 3), fever (n = 2), myalgia/fatigue (n = 5), diarrhea (n = 1), pain (n = 2), anosmia (n = 3), and loss of taste (n = 4). None of the patients showed dyspnea or reduced left ventricular function. Only one patient showed an increase in the degree of tricuspid regurgitation. Eight patients needed therapy in an outpatient setting and only two patients were hospitalized. One of these patients had a positive SARS-CoV-2 testing while on ICU early after heart transplantation. Interestingly, this patient had had a COVID-19 infection some weeks before heart transplantation. None of the patients needed oxygen supply or noninvasive ventilation or invasive mechanical ventilation. None of the patients needed a change of the immunosuppressive medication. No specific signs for graft dysfunction were found by noninvasive testing (echocardiography or electrocardiogram). Conclusion: After pediatric heart transplantation, a COVID-19 infection was very often asymptomatic or a mild infection and did not lead to a graft dysfunction despite the immunosuppressive therapy of the patients.