Abnormal echocardiographic findings after COVID-19 infection: A multicenter registry

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has transformed health systems worldwide. There is conflicting data regarding the degree of cardiovascular involvement following infection, generating uncertainty in patients and an additional healthcare burden with increased diagnostic testing. A registry was designed to evaluate the prevalence of echocardiographic abnormalities in Latin American adults recovered from COVID-19. Method(s): We prospectively evaluated 595 participants (mean age 45.5+/-14.9 years;50.8% female) from 10 institutions in Argentina and Brazil. Echocardiographic studies were conducted with General Electric equipment;2DE imaging and global longitudinal strain (GLS) of both ventricles were performed. Comparisons between groups were made with Chisquare, Fisher and Student's t-test. Logistic regression was performed to determine variables associated with abnormal echocardiogram findings. Result(s): A total of 61.7% of the participants denied any relevant cardiovascular medical history. Table 1 summarizes the comorbidities of the included patients. The majority of patients (82.5%) had the disease at home or in an out-of-hospital center. Of the patients who required hospitalization, 15.3% were in a general ward, 1.9% in intensive care and 0.3% required mechanical ventilation during the disease. The median time between infection and performance of the echocardiographic study was two months (IQR 1- 3 months). Among patients who reported symptoms following COVID-19 recovery (41.8%), the most frequently reported was dyspnea (47.4%), followed by mild symptoms such as asthenia, arterial hypertension or palpitations (32.9%), 12.9% referred chest pain, 6% of patients reported dyspnea and chest pain, and 0.8% reported various other symptoms. The mean left ventricular ejection fraction (LVEF) was 61.0+/-5.5% and the mean left atrial volume was 33.1+/-13.2 ml/m2. In patients without prior comorbidities, 8.2% had some echocardiographic abnormality (Figure 1). We found no significant differences in LVEF between symptomatic and asymptomatic patients (61.4% versus 60.6% respectively, p=0.104). Symptomatic patients showed slightly reduced GLS (-20.3% versus -20.9%, p=0.012) with a trend in the same direction in the RV free wall GLS (-25.6% versus -26.3%, p=0.103). Male patients were more likely to have any new echocardiographic abnormalities (OR 2.82, p=0.002). Time elapsed since infection resolution (p=0.245), the presence of symptoms (p=0.927), or history of hospitalization during infection (p=0.671) did not have any correlation with echocardiographic abnormalities. The difference between sexes remains unchanged after adjusting for left atrial volume, wall thicknesses, diastolic function and abnormal wall motion. Conclusion(s): Our results suggest that cardiovascular abnormalities after COVID-19 infection are rare and usually mild, especially in cases of mild disease. These abnormalities may be more frequent among males.

Identification of SARS-CoV-2 Main Protease (Mpro) Cleavage Sites Using Two-Dimensional Electrophoresis and In Silico Cleavage Site Prediction.

The main protease (Mpro) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) plays a crucial role in its life cycle. The Mpro-mediated limited proteolysis of the viral polyproteins is necessary for the replication of the virus, and cleavage of the host proteins of the infected cells may also contribute to viral pathogenesis, such as evading the immune responses or triggering cell toxicity. Therefore, the identification of host substrates of the viral protease is of special interest. To identify cleavage sites in cellular substrates of SARS-CoV-2 Mpro, we determined changes in the HEK293T cellular proteome upon expression of the Mpro using two-dimensional gel electrophoresis. The candidate cellular substrates of Mpro were identified by mass spectrometry, and then potential cleavage sites were predicted in silico using NetCorona 1.0 and 3CLP web servers. The existence of the predicted cleavage sites was investigated by in vitro cleavage reactions using recombinant protein substrates containing the candidate target sequences, followed by the determination of cleavage positions using mass spectrometry. Unknown and previously described SARS-CoV-2 Mpro cleavage sites and cellular substrates were also identified. Identification of target sequences is important to understand the specificity of the enzyme, as well as aiding the improvement and development of computational methods for cleavage site prediction.

Insight about Echocardiographic manifestations in COVID-19

Background: COVID-19 infection is associated with many direct or indirect cardiovascular complications, including myocarditis, myocardial damage, arrhythmia, heart failure (HF), venous thromboembolism, myocardial ischemia and necrosis is associated with impaired ventricular function that causes an increased mortality risk in patients.Two-dimensional echocardiography (2DE) is an important, noninvasive test which helps to identify cardiac function and hemodynamic status. Two-dimensional echocardiography has gained importance in COVID-19 patients with multi-organ involvement, especially in cases involving hemodynamic instability. Due to risk of infection, routine 2DE is not recommended for each patient, and there are currently no comprehensive 2DE studies in COVID-19 patientsMyocardial injury has been shown to be associated with worse prognoses in patients with COVID-19 In these patients, myocardial involvement, segmental contraction defects or global hypokinesia may be observed in the left heart due to hypoxic damage, respiratory distress, and inflammation, and a recent report.