Determining Extracellular Water Effects in Mild and Severe COVID-19 Pneumonia Clinical Course by using the Bioimpedance Method

Aim: Coronavirus disease-2019 (COVID-19) pneumonia is characterized by a clinical picture showing similar features in severe patients. Some studies evaluate the pathophysiology, prognosis, and treatment of COVID-19 pneumonia. Different laboratory tests have been used to assess the severity and prognosis of rigorously ill COVID-19 patients in addition to clinical and radiological findings. There is no precise indicator for predicting prognosis. We aimed to analyze disease severity by using extracellular water (ECW) measurements. Methods: Extracellular water values and cardiac parameters as cardiac output (CO), and stroke volume (SV) measurements of patients were performed using a non-invasive, easy-to-use, validated device non-invasive cardiac system (NICaS) within the first 2 h after admission. Hemodynamic parameters and ECW values were measured by connecting the NICaS device to make 12 measurements for 2 h at 5 min intervals during admission to service and intensive care patients. Results: Comparing the ward and intensive care groups, there was not any statistically significant difference found between demographic data and ECW, SV, and CO measurements. Conclusion: Although we could not find a statistically significant difference between our measurements, we believe that the NICaS device can play a significant role in the fluid treatment of COVID-19 patients. © 2023 by the Istanbul Haseki Training and Research Hospital.

Echocardiographic phenotype in severe aortic valve stenosis with and without cardiac amyloidosis: The AMY-TAVI trial

Background: Longitudinal Strain (LS) pattern in cardiac amyloidosis (CA) typically spares the apex of the heart, which is a sensitive and specific finding that can be used to distinguish CA from other causes of left ventricular (LV) hypertrophy. RELAPS >1 suggests with high specificity CA, and shows a bright red in the apical segments of the polar map. Purpose(s): To identify differential echocardiographic characteristics of aortic stenosis (AS) with concomitant TTR-CA (AS-CA) compared to AS alone. Method(s): Patients with severe symptomatic AS undergoing TAVI were prospectively and consecutively included between Jan-19 and Dec-20. Pre-procedure, a complete echocardiogram was performed that included deformation parameters using Speckle-Tracking. Strain derived Indices accepted for CA screening were calculated: RELAPS: Relative apical LS (average apical LS/average basal+mid LS);SAB: (apical-septal/basal-septal LS);EFSR: (LVEF/GLS). After TAVI, a 99Tc-DPD scintigraphy and a proteinogram were performed to screen for CA. Result(s): 324 patients were included. The mean age was 81 yo, 52% women. 39 (12%) patients presented cardiac uptake on scintigraphy: 14 (4.3%) grade 1;13 (4%) grade 2, and 11 (3.4%) grade 3. Strain analysis could be performed in 243 patients due to acoustic window and covid19 pandemic restrictions. Echocardiographic characteristics between AS alone and those with grade 1 (AS-DTD1) and grade 2/3 (AS-CA) are shown in Table 1. Compared with AS alone, patients with AS-CA had significantly lower transvalvular gradients, although similar AVA, and low flow-low gradient (LF-LG) AS was more prevalent. AS-CA exhibited slightly worse cardiac remodeling (LV mass ind: 202 g/m2 vs 176 g/m2, p=0.032), and worse diastolic dysfunction, but without significant differences in thickness, diameters or volumes, with similar relative wall thickness (RWT: 0.53 vs. 0.51 mm, p=0.52). LVEF was similar, however myocardial contraction fraction (MCF= stroke volume/myocardial volume) and MAPSE were worse in AS-CA. GLS, RELAPS, SAB and EFSR were not different, but RELAPS >1 pattern was more prevalent in AS-CA (74% vs 44%, p=0,006) (Figure 1). Mass/strain ratio (RMS) was similar. There were no differences in size and fractional emptying of left atrium, or atrial septum thickness. Right ventricle (RV) size was similar, as well as conventional function parameters (TAPSE and S'). However, RV LS was worse in AS-CA. Pericardial effusion was more prevalent in AS-CA (25% vs 7.4%, p=0.013). In the multivariate analysis, predictors of AS-CA were: Age (OR: 1,2, p=0,02), BG (OR: 0,2, p=0,01), E/A (OR: 4,7, p=0,02), LV Mass index (OR: 1,02, p=0,04) and RELAPS >1 (OR: 0,12, p=0,01). Conclusion(s): Dual pathology of AS-AC is common in older patients referred for TAVI. Although it is more prevalent in patients with AS-CA, RELAPS>1 pattern can be present in almost 50% of patients with severe AS alone, which reduces its value as screening tool for CA in this clinical setting respect to others. (Table Presented).

Echocardiographic phenotype and prognostic value of relative apical sparing of longitudinal strain pattern in severe aortic stenosis with and without cardiac amyloidosis. The AMYTAVI study

Introduction: It is estimated that 15% of patients with AS have concomitant cardiac amyloidosis (CA). Left ventricular (LV) longitudinal strain (LS) pattern with relative apical sparing (RELAPS>1), shown as bright red in the apical segments on the polar map, has been strongly associated with CA. Its presence and its significance in AS is yet to be determined. Purpose(s): To determine the prevalence of the RELAPS>1 pattern in patients with severe AS with and without concomitant CA, and to analyze the echocardiographic phenotype associated with this strain pattern and its prognostic value. Method(s): Patients with severe symptomatic AS undergoing TAVI were prospectively and consecutively included between Jan-19 and Dec-20. Pre-procedure, a complete echocardiogram was performed that included deformation parameters using Speckle-Tracking. Strain derived Indices accepted for CA screening were calculated: RELAPS: Relative apical LS (average apical LS/average basal+mid LS);SAB: (apical-septal/basal-septal LS);EFSR: (LVEF/GLS). After TAVI, a 99Tc-PYP scintigraphy and a proteinogram were performed to screen for CA. Result(s): 324 patients were included. The mean age was 81 yo, 52% women. Strain analysis could be performed in 243 patients due to acoustic window and covid19 pandemic restrictions. Among those, 111 (46%) presented relative apical sparing (RELAPS>1). There were no differences in clinical characteristics between patients with RELAPS <1 and >1: Similar age, sex, cardiovascular risk factors and funcional class, renal function or NT-proBNP. Among patients with RELAPS>1 there was more frecuently CA with uptake grade 2 and 3 on scintigraphy (15% vs. 4.5%, P=0.006) (Figure 1). RELAPS>1 group showed greater LV hypertrophic remodeling: Thicker myocardial wall with smaller ventricular cavity, especially concentric hypertrophy;LVEF and GLS was similar, however, MAPSE and myocardial contraction fraction (MCF) were worse in RELAPS >1 group, and EFSR was significantly higher (4.2 vs 3.9, p=0.002). RELAPS >1 group had smaller aortic valve area (AVA: 0.6 vs 0.7 cm2, p=0.045), but similar transvalvular gradients due to lower stroke volume. It had larger atria and less left atrial (LA) fractional emptying, as well as higher prevalence of atrial fibrillation (AF: 41% vs 27%, p=0.03). Right ventricle (RV) size were similar, however, RV function was worse in RELAPS >1 group (TAPSE: 19 vs 21 mm, p=0.003;free Wall LS: -24 vs -27%, p=0.008). There was no difference in all-cause mortality at 1 year of follow-up between groups (6.4% vs. 6.3%, p=1). Figure 2 represents the morphological characteristics according to the LS phenotype. Conclusion(s): In severe AS, RELAPS >1 is present in almost half of the patients. It is associated with worse cardiac remodeling, as well as higher prevalence of AF. However, it wasn't associated with higher mortality at 1 year. 1 in 7 patients with AS and RELAPS >1 have concomitant ATTR CA grade 2/3.

Prognostic Value Of Echocardiographic Evaluation Of Left Ventricular Function In Recovered Covid-19 Patients

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.

Right Ventricular Hemodynamics in COVID Patients With Shock

Introduction: Patients with serious COVID infections frequently develop shock. Their right-sided hemodynamic profiles have not been well characterized. Method(s): In a prospectively collected database including 1997 patients hospitalized for COVID pneumonia from March 2020 to March 2021, 368 had shock requiring vasopressors. 327 had echocardiography to assess ventricular function and stroke volume based on clinical indications. LVEF (LV ejection fraction) and RVFAC (RV fractional area change) were measured using Simpson's rule, stroke volume (SV) by aortic Doppler, and RVSP (RV systolic pressure) from tricuspid regurgitation velocity;187 had evaluable data on all parameters. Patients were divided into groups with low or preserved RVFAC (RVFAC or RVFAC , cutoff <e35%), and low or normal cardiac index, (CI, CI or CI cutoff <e2.2 L/min/m2 ). Result(s): Mean age: 65+/-12, LVEF 59.5+/-12.8, RVFAC 35.3+/-10.6, CI 2.41+/-0.89. Overall hospital mortality in this cohort with shock was 80%. Mean RVSP was 38.8+/-12.2, PEEP 11.0+/-3.7. 43% of patients had low RVFAC (<35%), and RVFAC correlated with other measures of RV function such as tricuspid annular peak systolic excursion (TAPSE) and lateral tricuspid annulus peak systolic velocity (S'). Higher RVSP correlated with lower CI (r=0.134, p= 0.016) but not with PEEP (r=0.03, p=0.70). Mortality did not differ significantly among groups, (p=0.19 by ANOVA) but was highest in the group with low RVFAC and low CI. (Figure) Conclusion(s): RV dysfunction is common in patients with severe COVID-19 and shock. Although RV dysfunction is probably associated with a worse prognosis, outcome in COVID may be tied to pulmonary recovery. Whether treatment targeted at RV dysfunction will improve outcome remains uncertain.

Treatment Fluid Volume May Predict Stroke Volume Improvement

INTRODUCTION: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) and Stroke Volume (SV) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. In the FRESH study, we have previously shown the impact of the volume of administered treatment fluid on fluid balance and patient outcome. The goal of this study was to explore the relationship between volume of fluid and stroke volume improvement in septic patients. METHOD(S): The Starling Registry study is an observational registry study evaluating trends in CO and SV over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in SV (first SV measurement compared to last SV measurement) were compared to those who did not exhibit improvement. RESULT(S): A total of 201 patients received hemodynamic monitoring during their stay at three different ICUs. 46% were female, and the average age was 63 years. 72% of the patients had sepsis, and 20% of patients were positive for COVID. When patients who improved their stroke volume over the course of treatment were compared to those who did not improve, results indicate that SV improved patients had received a total volume fluid of 1241 ml, while patients did not improve received 893 ml fluid, for a difference of 348 ml (p=0.018). CONCLUSION(S): Registry patients with minimal change in stroke volume appear to receive less fluid volume. FRESH and other studies have shown improved outcomes in restricting fluid in non-preload dependent (non-fluid responsive) state. Further research in the phenotype of nonresponsive patients may be helpful in identifying new methods to improve outcomes in this group.

Stroke Volume Change May Predict Outcome in Patients with Lv/Rv Dysfunction

INTRODUCTION: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) and Stroke volume (SV) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. In the FRESH study, we have previously shown that patients who improve CO and SV exhibit improved outcome such as decreased mortality and decreased need for ventilation. The goal of this study was to explore the relationship between the change in stroke volume and cardiac output in patients with LV and RV Dysfunction. METHOD(S): The Starling Registry study is an observational registry study evaluating trends in CO and SV over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in CO (first CO measurement compared to last CO measurement) were compared to those who did not exhibit improvement. RESULT(S): 71 patients with LV/RV dysfunction received hemodynamic monitoring during their stay across 4 units at 3 hospitals. 48% were female, and the average age was 68 years. 67% of the patients had sepsis, and 17% of patients were positive for COVID. Notably, in this population of LV/ RV dysfunction, patients with COVID (p=0.016), pneumonia (p=0.034) and those that required oxygen treatment (p=0.034) were less likely to improve Cardiac Output following fluid challenge. CONCLUSION(S): Patients with LV/RV dysfunction represent a vulnerable population. We have previously shown the benefits of trending cardiac output and stroke volume in this patient population (ATS, 2018). Trends observed in this population may help indicate which patients may be at risk for more negative outcome.

Fluid Challenge in children patients with COVID-19 Disease

COVID-19 Disease is a global problem that starts with fever, anorexia, malaise and cough. In severe cases needs ICU admission. Fluid therapy in critically children with COVID-19 Disease is a concern. Conservative fuid administration with crystalloid solution is recommended. Bullous fuids are considered only if patient is fuid responsiveness based on clinical, paraclinical and laboratory parameters such as passive leg raising and stroke volume variations. The aim of this review is to study fuid therapy in critically ill pediatric patients with COVID-19 Disease admitted to ICU.

Impact of lockdown on cardiopulmonary function in children with heart disease

Background and Aim: The COVID-19 lockdown in Germany has led to the closure of sports facilities and to the closure of schools with their curricular physical activities (PA). However, physical activity is essential for improving or at least maintaining cardiopulmonary function assessed by VO2peak. VO2peak represents the best pre-dictor for mortality and morbidity in patients with congenital heart disease (CHD). It is therefore essential to evaluate the effect of lock-downs on this important parameter in children with heart disease. Method(s): We evaluated data from cardiopulmonary exercise data from before lockdown with twin-paired data from during lockdown. The statistically approved twin-pairing was achieved by matching patients with similar heart disease, age, sex, and test method. The subjects con-sisted of a variety of patients who had received cardiopulmonary exer-cise testing in our department in the past 3 years. Result(s): We were able to twin-pair 52 tests leading to 27 twins. A mean RER of more than 1.1 was achieved in both groups with comparable exercise times. There was a significant decrease of cardiopulmonary function (VO2peak: 35.7 +/- 9.8 vs.30.4 +/- 10.6) in our patient cohort along with a significant decrease in peak O2pulse (13.3 +/- 4.1 vs. 11.4 +/- 4.5), a surrogate parameter for stroke volume and most pronounced in peak minute ventilation (VE: 83.05 +/- 29.08 vs.71,49 +/- 24.96). Conclusion(s): We observed a significant decline of V O-2peak during lockdown. This involved a loss of cardiac function assessed by O2pulse as well as a loss of pulmonary function assessed by V E. We believe that the decline of these important predictive param-eters could be explained by the limited access to sports facilities as well as the restriction of regular daily movement as a consequence of closing schools and thus curricular PA. Measures need to be established to ensure access to physical activity for children suffer-ing from heart disease during lockdowns.

Early signs of myocardial remodeling in children with multisystem inflammatory syndrome associated with COVID-19 and cardiac involvement

Background and Aim: Multisystem Inflammatory Syndrome in Children (MIS-C) associate with Coronavirus disease-19 is a life-threatening clinical condition in which cardiovascular system is frequently affected. Shock, cardiac arrhythmias, myocarditis, reduced left ventricular ejection fraction (LVEF), pericardial effu-sion, and coronary artery dilatation are amongst the most common cardiac complications. In this study, we aim to assess myocardial status in patient with cardiac involvement in MIS-C. Method(s): Over a 14-month period, we retrospectively collected clinical, biological, echocardiographic data in children who were admitted to our hospital with a diagnosis of MIS-C and cardiac involvement. WHO criteria for clinical case definition of MIS-C were adopted. Elevation in brain-natriuretic-peptide and troponin-I, electrocardiographic abnormalities, echocardio-graphic evidence of pericarditis, myocarditis, reduced LVEF, valvular disease, and coronary artery dilatation were including cri-teria. LV indexed end-diastolic (EDVi), end-systolic (ESVi), stroke volumes were measured with Cardiac Magnetic Resonance (CMR). T2 mapping, Cine-RM and late gadolinium enhance-ment studies were performed. Result(s): 14 children were identified and included in the study, 71% of which were male. Median age at disease onset was 7 years old (IQR 5 to 9 years). All patients underwent cardiological evaluation in the first 48 hours of hospital staying. LVEF was lt;45% in 28.6% and lt;35% in 14.3% of patients. Myocarditis was detected in 78.6%, pericarditis in 28.6%, valvular damage in 35.7%, coronary abnormalities in 42.9%. All patients underwent CMR after on average 4 months (median: 3.87, IQR 2 to 4) from disease onset, after full clinical and biological recovery. ESVi and stroke volumes resulted within normal range in 100%. CMR abnormalities were observed in 21%. Particularly, left ventricular EDVi resulted elevated in 7%, delayed washout in T2 was described in 7%, and increased T2 mapping in 7%. Conclusion(s): Despite complete clinical and biological resolution, increased EDVi, delayed washout in T2 and increased T2 mapping at follow-up CMR in patient with cardiac involvement due to MIS-C may be signs of myocardial remodeling.

FLUID RESPONSIVENESS AND PATIENT OUTCOMES

SESSION TITLE: Sepsis: Beyond 30cc/kg and Antibiotics SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Cardiac function is known to be negatively impacted by sepsis. Stroke volume (SV) change in response to Passive Leg Raise (PLR) is an effective method to predict fluid responsiveness (FR) or cardiac response to preload expansion. We have previously shown that short-term sepsis resuscitation phenotypes based responses to passive leg raise (PLR) can identify discrete patient sub-groups. The goal of this study was to identify resuscitation phenotypes and explore the relationship between the cardiac physiology and patient outcome. METHODS: The Starling Registry study is an observational registry study evaluating trends in cardiac output (CO) and SV over time as related to patient outcome (NCT04648293). Patients were classified as FR if SV increased ≥ 10% when measured with non-invasive bioreactance (Starling Monitor, Baxter Healthcare). Patients were characterized Non FR if SV increased <10%. Patients were grouped into 6 different sextets based on the percentage of FR PLRs within each group. RESULTS: 222 critical care patients received hemodynamic monitoring during their ICU stay across two different hospitals. 46 % were female, and the average age was 64 years. 65% of the patients had sepsis, and 20% of patients were positive for COVID. There were an equal percentage of septic patient in whose who were not FR (68%) and patients who were 100% FR (65%, p=0.334). Patients who were not FR received significantly less resuscitation fluid (609 ml) compared to patients who were 100% FR (1094 ml, p<0.0001). Patients who were 100% FR exhibited a decreased incidence of mortality (20.2%) compared to patient with 0% incidence FR (35.5%, p= 0.028). CONCLUSIONS: Short-term sepsis resuscitation phenotypes based responses to PLR identify discrete patient sub-groups. We have previously shown patients who improve CO in response to the resuscitation exhibited improved outcome. The ability to respond to the addition of IV fluid by increasing CO and SV may improve perfusion and lead to decreased adverse events. As there were an equal number of septic patients in both groups, a 0% incidence of FR may reflect a reduced EF or cardiac dysfunction instead of peripheral leakage. The results provided by a real time dynamic assessment may predict patient outcome and demonstrate physiology based on fluid responsiveness. CLINICAL IMPLICATIONS: Monitoring cardiac function closely is a high priority to prevent clinically relevant changes in patient outcome. DISCLOSURES: Employee relationship with Cheetah Medical Please note: >$100000 by Douglas Hansell, value=Salary Stock Holder relationship with Baxter Please note: 13 years Added 03/29/2022 by Kai Harenski, value=Stocks No relevant relationships by Muhammad Ali Javed Speaker/Speaker's Bureau relationship with Cheetah Medical Inc Please note: $1001 - $5000 by Heath Latham, value=Consulting fee Removed 03/28/2022 by Heath Latham Speaker/Speaker's Bureau relationship with Baxter Please note: 1/2021 - 3-2022 Added 03/28/2022 by Heath Latham, value=Consulting fee Employee relationship with Baxter Healthcare Please note: 15 months by Jennifer Sahatjian, value=Salary

Fluid Management 100% Non-invasive for COVID Patient in ICU by Sterling Stroke Volume Guided Resuscitation ABS0007)

Aim and objective: Non-invasive fluid management in COVID shock patient in ICU. Materials and methods: Our hospital use sterling stroke volume-guided fluid management for COVID shock patients. In the University of Kansas health system evaluated 200 cases for stroke volume (sv) guided fluid resuscitation this study showed ICU length of stay reduced by 2.89 days, risk of mechanical ventilation reduced by 51%, initiation of acute dialysis therapy reduced by 13.2%, this system saves an estimated $14498 per treated patient this system use Bioreactance technology to measure sv in shock patient in two sensor place above the heart and two below the heart and continue measurement of sv done in 48 seconds. Validation studies over 500 patient published clinical studies result are same all major technologies (Swan Ganz, pulse contour, Doppler, fick) and over 100 peer-reviewed publications are there. This technique is 100% non-invasive accurate flexible-this sterling system use PLR or bolus test for sv management we are using in emergency for our Rapid Response Team in MICU OT for perioperative fluid management and all surgical ICU. Results: 1 ICU length of stay reduced by 2.89 days 2 risk of mechanical ventilation reduced by 51% 3 initiations of acute dialysis therapy reduced by 13.5% 4 save an estimated $14498 per treated patient. Conclusion: Sterling monitoring platforms use unique, patented Bioreactance technology to take measures continuously and precisely, and they require only four easy to place sensor pads. The sensors can be- anywhere on the chest two above the heart and two below the heart to create a box around the heart we advise sterling stroke volume guided fluid management in emergency medical ICU surgical ICU and perioperative and RRT for accurate fast and 100% non-invasive technique for COVID patient.

Abstracts Criticare - IJCCM2022

The proceedings contain 246 papers. The topics discussed include: nasotracheal vs orotracheal intubation and post-extubation airway obstruction in critically ill children: an open-label randomized controlled trial;prognostication of the outcomes in patients on mechanical ventilation due to severe ARDS in COVID-19 using neutrophil to lymphocyte ratio (NLR) at admission;prognostic role of different severity indexes in COVID-19 pneumonia: a retrospective study;monoclonal antibody for COVID treatment;fluid management 100% non-invasive for COVID patient in ICU by sterling stroke volume guided resuscitation;post-COVID double valve and bypass surgery one of 1st in world;terlipressin-induced skin necrosis;safety, feasibility, and outcome of percutaneous dilatational tracheostomy in critically ill COVID-19 Patients;Cisatracurium for Orgen failure patient in ICU;and is there association between trends of inflammatory marker to clinical course of critically ill COVID-19 patient require prolong hospitalization?.

Snowball effect of COVID-19: Stroke Care Underutilization

Objective: This study aims to investigate the utilization of acute ischemic stroke (AIS) services during the Corona Virus Disease 2019 (COVID-19) pandemic. Background: Based on early observations among healthcare utilization on stroke and other healthcare services, we hypothesized that there would be a persistent significant decline in AIS patients presenting to hospitals as the pandemic has progressed for over a year. Design/Methods: TriNetX, a large research network, is used to collect real-time electronic medical data. Data on utilization of acute ischemic stroke service was collected for the years 2018, 2019, and 2020 for variables including overall stroke volume and the number of patients that received intravenous tissue plasminogen activator (tPA) and mechanical thrombectomy (MT). Results: We found a 13.2-15.4% decrease in total number of AIS patients in 2020 (n 77231) compared with the years 2018 and 2019 (n 88948 and 91270 respectively, p <0.001). In the year 2020 Stroke volume was significantly lower in Q4 comparing to Q1 (Q1 vs Q4, p <0.01). The proportion of patients receiving tPA in 2020 was significantly lower compared to prior years (5.4% in 2020, 6.4% in 2018, 6.0% in 2019, p <0.01), however, the proportion of patients receiving MT was significantly higher in 2020 than in 2018(0.024 vs 0.022, p <0.01). Conclusions: Despite significant alteration in practices to optimize healthcare delivery and mitigate the collateral impact of the pandemic on care for other conditions, a persistent decline in AIS volumes remains. Delayed presentation, fear-of-contagion, reallocation, and poor availability of health care resources are potential contributors. Prospective evaluation and further investigation for these trends is needed.

Longitudinal Tracking of Cardiac Alterations Among Young Adults with SARS-CoV2

Background The novel SARS-CoV-2 virus inflicts far-reaching health decrements, both directly and through secondary inflammatory stimulation. To date, there is little information regarding the effects of COVID-19 on the heart after infection, especially among young healthy adults. Purpose We sought to determine whether contracting SARS-CoV-2 affects cardiac function in young, otherwise healthy adults and whether these alterations recede after testing positive for SARS-CoV-2. Methods Transthoracic echocardiography was performed on 7 subjects with SARS-CoV-2 (3F/4M, 21±1y, 24±2 kg m ) who tested positive 3-4 weeks prior to baseline testing followed by 1- month and 2-month follow-up testing. A parasternal long-axis view was utilized to measure septal and left ventricular posterior wall thickness, left ventricular volume, and left ventricular outflow tract dimensions. A four-chamber view was utilized to measure mitral and tricuspid valve, left ventricular, and pulmonary vein function. Data are mean±SD. Results Stroke volume (Baseline: 44±11ml, 1-month: 42±13ml, 2-month: 54±12ml) and stroke index (Baseline: 24±6ml/m

Cardiac output change predicts patient outcome

Introduction: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. The goal of this study was to explore the relationship between the change in stroke volume and outcome in critically ill patients. Methods: The Starling Registry study is an observational registry study evaluating trends in CO and SV (Stroke Volume) over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in CO (first CO measurement compared to last CO measurement) were compared to those who did not exhibit improvement. Results: A total of 229 critical care patients received hemodynamic monitoring during their ICU stay across three different hospitals. 48% were female, and the average age was 64 years. 64% of the patients had sepsis, and 17% of patients were positive for COVID. Notably, patients who exhibited an overall improvement in CO exhibited a decrease need for mechanical ventilation (4.8% vs 15%, p = 0.041) and a trend toward a decrease in mortality (16.4%) compared to those who did not improve (28.0%, p = 0.080) (Fig. 1). Conclusions: We have previously shown that patients who show an improvement in CO in response to the resuscitation exhibited improved outcome. Trending cardiac output over a 1-3 day monitoring period revealed additional usefulness in predicting patients with improved outcome. These results highlight the importance of trending hemodynamics in therapy. (Figure Presented).

Acute cor pulmonale and mortality in mechanically ventilated patients with COVID-19 acute respiratory distress syndrome

Introduction: Although COVID-19 affects primarily the respiratory system, several studies have shown evidence of cardiovascular alterations and right ventricular dysfunction. Our aim was to evaluated cardiac function and its association with lung function, hemodynamic compromise and mortality. Methods: Prospective, cross-sectional multicenter study in four university-affiliated hospitals in Chile. All consecutive patients with COVID-19 ARDS on mechanical ventilation admitted between April and July 2020 were included. Transthoracic echocardiography was performed within the first 24 h of intubation. Results: Consecutive 140 patients on mechanical ventilation with COVID-19 ARDS were included in the study, the mean age was 57 ± 11 years, PaO2/FiO2 ratio was 155 [IQR 107-177], cardiac output was 5.1 L/min [IQR 4.5-6.2] and 86% of the patients required norepinephrine. ICU mortality was 29% (40 patients). Fifty-four patients (39%) exhibited right ventricle dilation and 20 of them (37%) exhibited acute cor pulmonale (ACP). Eight of twenty (40%) patients with ACP exhibited pulmonary embolism. Patients with ACP had higher norepinephrine requirement, lower stroke volume, tachycardia, prolonged capillary refill time and higher lactate levels. In addition, acute cor pulmonale patients presented lower compliance, higher driving pressure and the presence of respiratory acidosis. Left ventricular systolic function was normal or hyperkinetic in most cases and only thirteen patients (9%) exhibited left ventricular systolic dysfunction (ejection fraction < 45%). In the multivariate analysis acute core pulmonale, PaO2/FiO2 ratio and pH were independent predictors of mortality (Table 1). Conclusions: Right ventricular dilation is highly prevalent in mechanically ventilated patients with COVID-19 ARDS. The presence of acute cor pulmonale is associated with poorer lung function, but only in 40% of patients it was associated to pulmonary embolism. Acute cor pulmonale is an independent risk factor for mortality in the ICU. (Table Presented).

A Telecare System for Use in Traditional Persian Medicine

Background: In Persian Medicine (PM), measuring the wrist temperature/humidity and pulse is one of the main methods for determining a person's health status and temperament. An important problem is the dependence of the diagnosis on the physician's interpretation of the above-mentioned criteria. Perhaps this is one reason why this method has yet to be combined with modern medical methods. Also, sometimes there is a need to use PM to diagnose patients remotely, especially during a pandemic. This brings up the question of how to implement PM into a telecare system. This study addresses these concerns and outlines a system for measuring pulse signals and temperament detection based on PM. Methods: A system was designed and clinically implemented based on PM that uses data from recorded thermal distribution, a temperament questionnaire, and a customized device that logs the pulse waves on the wrist. This system was used for patient care via telecare. Results: The temperaments of 34 participants were assessed by a PM specialist using the standardized Mojahedi Mizaj Questionnaire (MMQ). Thermal images of the wrist in the supine position (named Malmas in PM), the back of the hand, and the entire face were also recorded under the supervision of the physician. Also, the wrist pulse waves were evaluated by a customized pulse measurement device. Finally, the collected data could be sent to a physician via a telecare system for further interpretation and prescription of medications. Conclusion: This preliminary study focused on the implementation of a combinational hardware-software system for patient assessment based on PM. It appears that the design and construction of a customized device that can measure the pulse waves, and some other criteria, according to PM, is possible and can decrease the dependency of the diagnostic to PM specialists. Thus, it can be incorporated into a telemedicine system. © 2021 Nafisi and Ghods.

Indicators of high morbidity and poor functional outcome in acute ischemic stroke patients with concurrent covid-19

Objectives: Evidence suggests an association of increased cerebrovascular accidents frequency in patients diagnosed with the novel coronavirus disease, COVID-19. Coagulopathy resulting from the 2019 novel coronavirus (SARS-CoV-2) infection is suspected. This study aims at evaluating thrombotic markers in relation to stroke severity and functional outcomes in a patient cohort of acute ischemic stroke (AIS) with concurrent COVID-19. Methods: We performed a retrospective observational cohort study of 28 patients who tested positive for SARS-CoV-2 via polymerase chain reaction and concomitant AIS confirmed by brain imaging. We analyzed data regarding initial stroke presentation, markers of coagulopathy, and 90- day functional outcomes. Results: The patient cohort displayed high rate of comorbidities with 78.6% having at least 1 vascular risk factor. NIHSS had a median of 16 at initial presentation and median stroke volume of 52 mL. Median NIHSS at discharge or prior to death was 19, and median 90-day mRS was 4. Highest fibrinogen level recorded showed a median of 759.54 mg/dL (IQR 653.75-940.75), D-dimer and lactate dehydrogenase (LDH) showed a median highest recorded value 24,106 ng/mL (IQR 6105.00-80165.00) and 442 ng/mL (IQR 277.00-545.50), respectively. LDH (p=0.0008), D-dimer (p=0.001), and maximum fibrinogen levels (p=0.049) near the time of stroke significantly predicted final NIHSS and functional outcome 90-days after discharge. Conclusions: Adult patients with acute ischemic stroke and concurrent COVID-19 disease exhibited abnormally high markers of coagulopathy, and LDH, D-Dimer, and fibrinogen levels were predictors of morbidity and neurological disability at 90-days in this patient population. Further research is necessary to establish a definitive pattern and assess the ability to use these markers as prognostic elements of 90-day functional outcome.

Impact of COVID-19 on number of acute stroke patients in Japan: A nationwide survey in primary stroke centers

Background and Purpose: We sought to investigate the impact of COVID-19 pandemic on number of acute stroke patients admitted to Japanese primary stroke centers (PSCs). Methods: The Japan Stroke Society and the MHLW registry of mechanical thrombectomy for acute ischemic stroke conducted a national annual survey of hospitalization volumes for acute ischemic stroke, intracranial cerebral hemorrhage, and subarachnoid hemorrhage in PSCs. Number of acute stroke patients was defined as sum of three stroke subtypes admitted within 7 days after the onset. Monthly acute stroke volumes were compared between 2019 and 2020, among COVID-19 waves, and regional infectious rates. Results: The stroke volume data was completed in 530 PSCs. The annual acute stroke volume was declined 2.5% from 179,893 in 2019 to 174,385 in 2020. Number of acute stoke patients was declined during COVID-19 expanding periods (1 wave, Mar-May;2 wave Jul-Aug;3 wave NovDec), whereas it was increased in the other months. The mean decline rate of stroke volumes from 2019 to 2020 was greater in 125 PSCs located in prefectures with high estimated SARS-CoV 2 infected rate (more than 2,300 per million people) than in 405 PSCs of the other regions (-4.6±15.4% vs -0.1±20.0%, P=0.008), especially during COVID-19 expanding periods (-8.2±17.9% vs -3.1±21.3%, P=0.009). Conclusions: Acute stroke volumes were declined in 2020 from 2019 in Japanese PSCs, especially during COVID-19 expanding periods and in highly infected regions. The overwhelmed health care system and infection control practices may have associated with decline of number of acute stroke patients during COVID-19 pandemic.