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1.
International Journal of Rheumatic Diseases ; 26(Supplement 1):1900/04/07 00:00:00.000, 2023.
Article in English | EMBASE | ID: covidwho-2227664

ABSTRACT

Objective: To compare the incidence of complications and the need for hospitalization for COVID-19 in groups of patients older than and younger than 60 years of age with rheumatic diseases (RD). Material(s) and Method(s): The study involved 89 patients with RD who underwent COVID-19, verified by RT-PCR for SARS-CoV- 2 RNA, for the period from 05/15/2020 to 12/01/2021. Participants in the study, after talking with the research physician, filled out questionnaires on past COVID-19 and post-COVID syndrome. The information was supplemented with data from discharge records after inpatient treatment for COVID-19. Statistica program (version 12) was used for statistical processing. Result(s): The data obtained were differentiated depending on the age of the participants: < 60 years (group 1), N = 69 and > = 60 years (group 2), N = 20. Both groups were dominated by women (82.6% and 85%). The average age in group 1 was 41.9 +/- 11.6 years, in group 2 -68.5 +/- 5.1 years. 19 patients (48.7%) in group 1 and 13 patients (65%) in group 2 were hospitalized. Of these, oxygen support was statistically more frequent (P < 0.05) in group 2 patients: 9 (69.2%) vs 5 (26.3%). Complications were registered in group 1 in 9 cases (13%): venous thrombosis in 1 patient, acute respiratory failure in 4 patients and the development of concomitant infections in 4 patients. In group 2, complications were noted significantly more often (P < 0.05) -in 8 cases (40%): venous thrombosis in 2, acute respiratory failure in 1, acute heart failure in 1, acute cerebrovascular accident in 1 and the development of concomitant infections in 3 patients. 7 patients (10.1%) in group 1 had COVID-19 again on average 11.5 +/- 2.2 months after the first case. Of these, 1 patient required hospitalization. There were no recurrences of COVID-19 in group 2. Conclusion(s): Elderly patients with RD with COVID-19 are more likely to need oxygen support. Also in this group, COVID-19 is more likely to cause serious complications, including cardiovascular and respiratory failure and thrombotic complications.

2.
European Heart Journal, Supplement ; 24(Supplement K):K173-K174, 2022.
Article in English | EMBASE | ID: covidwho-2188685

ABSTRACT

Purpose: The Multicentre observational REgistry of patients hospitalized for heart failure and reAL-life adherence to international guidelines for the management of patients with acute and chronic Heart Failure (REAL-HF) aims to provide a comprehensive overview of hospital management of HF patients in Italy. Method(s): The registry involves 11 cardiology centers from seven Italian regions, including all adult patients hospitalized for HF in the period 2020-2026. Data are derived from hospital discharge letters and electronic records. Patients are included in the registry based on Diagnosis Related Groups codes. Result(s): This preliminary analysis included 1600 patients hospitalized for HF in 2020 in two Italian tertiary university hospitals. Males were 851(53%) with a median age of 81(71-87) years. Less than one-third of the patients (n=461[29%]) was hospitalized in a cardiology unit, while almost half of the patients (n=783[49%]) was admitted to an internal medicine ward. Median hospital length of stay was 9(6-14) days. Readmission rates were 9% and 29% at 30 days and within the same year, respectively. In-hospital mortality was 9%, while 28% of the patients died within the same year. According to HF categories, 501(31%) patients were diagnosed as having HFrEF, 193(12%) mildly reduced ejection fraction (HFmrEF) and 689(43%) preserved ejection fraction (HFpEF). Median left ventricular EF was 49%(35-55%) and was significantly lower in patients with HFrEF (30%[25-35%]) compared to those with HFmrEF (45%[43-45%]) and HFpEF (55%[55-60%]) - p<0.001. Coronary artery disease proved to be the leading cause (n=460[29%]) of HF. Atrial fibrillation was highly prevalent (history -13%;during hospitalization -37%). Arterial hypertension was the most prevalent (71%) cardiovascular risk factor. Chronic kidney disease (51%) and chronic obstructive pulmonary disease (27%) were frequent comorbidities. Apparently, COVID-19 had a low impact, being present in only 3% of patients hospitalized for HF in 2020 at both centers. At discharge, 56% of patients were treated with angiotensin-converting enzyme inhibitors-ACEi (n=490[34%]), angiotensin receptor blockers-ARB (n=221[15%]) or angiotensin-neprilysin inhibitors-ARNi (n=100[7%]), 67%(n=964) with beta-blockers, while mineralocorticoid receptor antagonists- MRAs were prescribed for 56%(n=809) of patients. Loop diuretics were frequently prescribed (89%). When we considered patients with HFrEF, we found that only 69% were treated with ACEi/ARB/ARNi, 82% with a beta-blocker, and 67% with MRAs. Only 48% (n=240) were treated with all three of the abovementioned classes of drugs. Among patients with HFrEF, only 5% had an implantable cardioverter defibrillator, and only 4% were treated with cardiac resynchronization therapy. Patients hospitalized in wards other than cardiology were older (83vs70 years, p<0.0001), more frequently females (52%vs44%, p<0.001), and with HFpEF (51%vs24%, p<0.0001). In-hospital mortality and death within the same year resulted significantly lower in patients hospitalized in cardiology units (5%vs11% - p<0.001, and 17%vs32% - p<0.001). Overall, drugs indicated in HF were less frequently prescribed in patients hospitalized in non-specialist cardiac units. Conclusion(s): Preliminary data from the multicentre REAL-HF registry confirm that HF constitutes a clinical issue. Adherence to the guidelines is still inadequate and this may impact on patients' outcomes. Moreover, the significant differences in terms of patients' profiles might further increase the gap between highly specialized cardiology units and internal medicine departments.

3.
European Heart Journal, Supplement ; 24(Supplement K):K159-K160, 2022.
Article in English | EMBASE | ID: covidwho-2188683

ABSTRACT

Background: Heart failure (HF) patients are predisposed to recurrences and disease destabilizations, especially during the COVID-19 outbreak period. In this scenario, telemedicine could be a proper way to ensure continuous care. The purpose of the study was to compare two modalities of HF outpatients' follow up, the traditional in-person visits and telephone consultations, during the COVID-19 pandemic period in Italy. Method(s): We performed an observational study on consecutive HF outpatients. The follow up period was 12 months, starting from the beginning of the COVID-19 Italy lockdown. According to the follow up modality, and after the propensity matching score, patients were divided into two groups: those in G1 (n = 92) were managed with traditional in-person visits and those in G2 (n = 92) were managed with telephone consultation. Major adverse cardiovascular events (MACE) were the primary endpoints. Secondary endpoints were overall mortality, cardiovascular death, cardiovascular hospitalization, and hospitalization due to HF. Result(s): No significant differences between G1 and G2 have been observed regarding MACE (p = 0.65), cardiovascular death (p = 0.39), overall mortality (p = 0.85), hospitalization due to acute HF (p = 0.07), and cardiovascular hospitalization (p = 0.4). Survival analysis performed by the Kaplan-Meier method also did not show significant differences between G1 and G2. Conclusion(s): Telephone consultations represented a valid option to manage HF outpatients during COVID-19 pandemic. They were comparable to traditional in-person visits.

4.
New Zealand Medical Journal ; 133(1520):153-156, 2020.
Article in English | EMBASE | ID: covidwho-2170139
5.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194371

ABSTRACT

Introduction: Sex differences in COVID-19 outcomes are well-known and have been ascribed to numerous factors including age-dependent sex hormones. We hypothesize that the protective effect of female sex in hospitalized COVID-19 patients attenuates with age. Method(s): We retrospectively analyzed patients who were hospitalized for COVID-19 infection at three hospitals of the Rush University System for Health (RUSH) (Chicago, IL) between March to December 2020. The primary endpoints were in-hospital mortality and major adverse cardiovascular events (MACE), defined as a composite of acute myocardial infarction, cardiac arrest, acute heart failure, and stroke. Stratified logistic regression was performed to estimate the odds ratios of these endpoints in male compared to female patients by age group (<45, 45-55, 55-65, 65-75, and >=75 years). Result(s): Of 1705 patients (age 58.1+/-16.9 years, 54.3% male, 24.6% White) who were hospitalized for COVID-19 infection, 179 (10.5%) patients experienced in-hospital mortality and 290 (17.0%) patients experienced MACE, respectively. The incidence of these outcomes progressively increased with age in both sexes. In patients <45 years of age, there was a trend towards increased risk for inhospital mortality (aOR 4.47;95% CI: 0.54 - 42.38) and MACE (aOR 2.43;95% CI: 0.97 - 6.10) in men compared to women. However, this trend attenuated with increasing age strata and there was a slight decrease in risk for in-hospital mortality (aOR 0.79;95% CI: 0.39 - 1.58) and MACE (aOR 0.70;95% CI: 0.38 - 1.28) among middle-aged (55-65 years of age) men compared to women. Conclusion(s): In this multi-hospital registry of COVID-19 patients, there was a reverse J-shaped trend in odds of in-hospital mortality and MACE in men compared to women. Female sex appeared to be an independent protective factor for adverse hospital outcomes among patients <55 years of age but not among older patients, suggesting a protective role of premenopausal sex hormones.

6.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194358

ABSTRACT

Introduction: Recent data shows that when adults are discharged after hospitalization for acute heart failure (HF), a clinic follow up with either cardiology or general medicine within 7 days results in significantly lower chances of 30 day readmissions. We sought to analyze the trends of clinic follow up after acute HF hospitalization and the associated barriers and facilitators at our safety net hospital. Method(s): Data was extracted from the electronic medical records using ICD 9,10 codes for acute HF admissions between Jan 2019 and Dec 2021. Quarterly trends of rates of clinic follow up were analyzed over the past 3 years;t-test was used to assess for statistical significance. Multivariable logistic regression models were constructed to test the association between patient level factors and clinic follow up after adjusting for sociodemographic factors. A p value < 0.05 was used to establish significance. Result(s): Of 1,037 patients admitted for acute HF between 2019-2021, 29.5% were 65 years or older, 64.7% were males, 48.7% were Black and 16.6% were uninsured. Only 8% and 23.1% had a 7 and 14 day clinic follow up respectively. Of those with scheduled follow up 65% and 56% showed up to their appointments at 7 and 14 days respectively. Overtime we noted an increase in the proportion of encounters with a 7 day follow up although the effective follow up (after accounting for no-shows) remained unchanged. Patients that had an inpatient cardiology consult had higher odds of getting a 7 day follow up (OR=1.42, p value = 0.001) after adjusting for age, gender, insurance status and race (black > white, OR = 1.34, p<0.001). Conclusion(s): Our study showed that the effective 7 day follow up did not improve from 2019 to 2021 likely due to COVID19 pandemic. However, a significantly higher proportion of patients obtained 7 day appointments in the last quarter with room for improvement. Steps to increase follow up rates include intervening on the highlighted modifiable factors to achieve better results. (Figure Presented).

7.
Cardiol J ; 2023 Jan 18.
Article in English | MEDLINE | ID: covidwho-2202811

ABSTRACT

BACKGROUND: Since the beginning of the coronavirus disease-2019 (COVID-19) pandemic, numerous cardiology departments were reorganized to provide care for COVID-19 patients. We aimed to compare the impact of the COVID-19 pandemic on hospital admissions and in-hospital mortality in reorganized vs. unaltered cardiology departments. METHODS: The present subanalysis is a multicenter retrospective COV-HF-SIRIO 6 study that includes all patients (n = 101,433) hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, with a focus on patients with acute heart failure (AHF). RESULTS: Reduction of all-cause hospitalizations was 50.6% vs. 21.3% for reorganized vs. unaltered cardiology departments in 2020 vs. 2019, respectively (p < 0.0001). Considering AHF alone respective reductions by 46.5% and 15.2% were registered (p < 0.0001). A higher percentage of patients was brought in by ambulance to reorganized vs. unaltered cardiology departments (51.7% vs. 34.6%; p < 0.0001) alongside with a lower rate of self-referrals (45.7% vs. 58.4%; p < 0.0001). The rate of all-cause in-hospital mortality in AHF patients was higher in reorganized than unaltered cardiology departments (10.9% vs. 6.4%; p < 0.0001). After the exclusion of patients with concomitant COVID-19, the mortality rates did not differ significantly (6.9% vs. 6.4%; p = 0.55). CONCLUSIONS: In cardiology departments reorganized to provide care for COVID-19 patients vs. unaltered ones, observed: i) a greater reduction in hospital admissions in 2020 vs. 2019; ii) higher rates of patients brought by ambulance and lower rates of self-referrals; and iii) higher all-cause in-hospital mortality for AHF due to COVID-19 related deaths.

8.
Cardiovasc Res ; 2023 Jan 18.
Article in English | MEDLINE | ID: covidwho-2188640

ABSTRACT

BACKGROUND: Previous analyses on sex differences in case fatality rates at population-level data had limited adjustment for key patient clinical characteristics thought to be associated with COVID-19 outcomes. We aimed to estimate the risk of specific organ dysfunctions and mortality in women and men. METHODS AND RESULTS: This retrospective cross-sectional study included 17 hospitals within 5 European countries participating in the International Survey of Acute Coronavirus Syndromes (ISACS) COVID-19(NCT05188612). Participants were individuals hospitalized with positive SARS-CoV-2 from March 2020 to February 2022. Risk-adjusted ratios(RR) of in-hospital mortality, acute respiratory failure(ARF), acute heart failure(AHF), and acute kidney injury(AKI) were calculated for women versus men. Estimates were evaluated by inverse probability of weighting and logistic regression models. The overall care cohort included 4,499 patients with COVID-19 associated hospitalizations. Of these, 1,524(33.9%) were admitted to ICU, and 1,117(24.8%) died during hospitalization. Compared with men, women were less likely to be admitted to ICU (RR:0.80; 95%CI: 0.71-0.91). In general wards (GW) and ICU cohorts, the adjusted women-to-men RRs for in-hospital mortality were of 1.13(95%CI: 0.90-1.42) and 0.86(95%CI: 0.70-1.05; pinteraction=0.04). Development of AHF, AKI and ARF was associated with increased mortality risk (ORs: 2.27; 95%CI; 1.73-2.98,3.85; 95%CI:3.21-4.63 and 3.95; 95%CI:3.04-5.14, respectively). The adjusted RRs for AKI and ARF were comparable among women and men regardless of intensity of care. By contrast, female sex was associated with higher odds for AHF in GW, but not in ICU (RRs:1.25; 95%CI0.94-1.67 versus 0.83; 95%CI:0.59-1.16, pinteraction=0.04). CONCLUSIONS: Women in GW were at increased risk of AHF and in-hospital mortality for COVID-19 compared with men. For patients receiving ICU care, fatal complications including AHF and mortality appeared to be independent of sex. Equitable access to COVID-19 ICU care is needed to minimize the unfavourable outcome of women presenting with COVID-19 related complications.

9.
Journal of Cardiovascular Echography ; 32(5 Supplement):S67, 2022.
Article in English | EMBASE | ID: covidwho-2111922

ABSTRACT

A 42-year-old woman was referred to our Cardiac Intensive Care Unit for possible acute coronary syndrome (acute heart failure and elevated serum cardiac troponin levels). Urgent coronary angiogram was unremarkable. Transthoracic echocardiography revealed severe concentric biventricular hypertrophy, systolic dysfunction (LVEF 26%, FAC 20%), and restrictive physiology (E/E' 27). LV strain analysis showed an apical sparing pattern with severely reduced GLS (-6%) and raised the suspicion of cardiac amyloidosis (CA). The endomyocardial biopsy established the diagnosis of lightchains CA. The patient's prognosis was very poor at the diagnosis, with a median survival of 4 months based on Mayo Clinic's revised staging system. Combination chemotherapy with CyBorD scheme (Cyclofosfamide/Bortezomib/Dexamethasone) was promptly started, but prematurely stopped because of the development of rapidly progressive biventricular failure. Therefore, the patient received a total artificial heart (TAH) as a bridge-to-candidacy to orthotopic heart transplantation (OHT). The CyBorD therapy was then restarted, and complete haematological remission was achieved six months later. Therefore, the patient underwent effective monoclonal antibody therapy for nosocomial SARS-CoV-2 infection. Subsequently, the patient was placed on the urgent transplant list because of the bacterial device's driveline infection. Two months later, she underwent OHT. The patients died three days for multiple reasons: difficult TAH explant with prolonge extracorporeal circulation time, the necessity of central V-A ECMO, graft failure.

10.
Angiogenesis ; 2022 Nov 12.
Article in English | MEDLINE | ID: covidwho-2119476

ABSTRACT

A wide range of cardiac symptoms have been observed in COVID-19 patients, often significantly influencing the clinical outcome. While the pathophysiology of pulmonary COVID-19 manifestation has been substantially unraveled, the underlying pathomechanisms of cardiac involvement in COVID-19 are largely unknown. In this multicentre study, we performed a comprehensive analysis of heart samples from 24 autopsies with confirmed SARS-CoV-2 infection and compared them to samples of age-matched Influenza H1N1 A (n = 16), lymphocytic non-influenza myocarditis cases (n = 8), and non-inflamed heart tissue (n = 9). We employed conventional histopathology, multiplexed immunohistochemistry (MPX), microvascular corrosion casting, scanning electron microscopy, X-ray phase-contrast tomography using synchrotron radiation, and direct multiplexed measurements of gene expression, to assess morphological and molecular changes holistically. Based on histopathology, none of the COVID-19 samples fulfilled the established diagnostic criteria of viral myocarditis. However, quantification via MPX showed a significant increase in perivascular CD11b/TIE2 + -macrophages in COVID-19 over time, which was not observed in influenza or non-SARS-CoV-2 viral myocarditis patients. Ultrastructurally, a significant increase in intussusceptive angiogenesis as well as multifocal thrombi, inapparent in conventional morphological analysis, could be demonstrated. In line with this, on a molecular level, COVID-19 hearts displayed a distinct expression pattern of genes primarily coding for factors involved in angiogenesis and epithelial-mesenchymal transition (EMT), changes not seen in any of the other patient groups. We conclude that cardiac involvement in COVID-19 is an angiocentric macrophage-driven inflammatory process, distinct from classical anti-viral inflammatory responses, and substantially underappreciated by conventional histopathologic analysis. For the first time, we have observed intussusceptive angiogenesis in cardiac tissue, which we previously identified as the linchpin of vascular remodeling in COVID-19 pneumonia, as a pathognomic sign in affected hearts. Moreover, we identified CD11b + /TIE2 + macrophages as the drivers of intussusceptive angiogenesis and set forward a putative model for the molecular regulation of vascular alterations.

11.
Heart Views ; 23(3): 169-172, 2022.
Article in English | MEDLINE | ID: covidwho-2110434

ABSTRACT

During the current pandemic, acute coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) provokes overwhelming inflammatory response leading to a wide range of clinical presentations including, a rare multisystem inflammatory syndrome and cardiac injury. Not only during the acute phase of the disease but a delayed immunologic response to SARS-CoV-2 infection among people with hyperinflammatory illness several weeks postacute phase of the infection is recently recognized. We report a young adult male who presented with acute myocarditis and heart failure associated with laboratory evidence of hyperinflammatory syndrome 5 weeks after a full recovery from COVID-19 infection. We believe that health-care providers need to be aware and recognize this syndrome as a rare sequela of COVID-19 infection.

12.
Pharmaceutical Journal ; 308(7962), 2022.
Article in English | EMBASE | ID: covidwho-2065044
13.
Cardiology in the Young ; 32(Supplement 2):S176, 2022.
Article in English | EMBASE | ID: covidwho-2062097

ABSTRACT

Background and Aim: Mixed shock in multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 is con-sequence of acute heart failure, inflammation-induced vasodilation and potential volume loss. Method(s): Retrospective analysis included 25 patients (7 girls) with MIS-C-related combined shock, treated in period from April 2020 to December 2021. Result(s): Mean age of patients was 12.6 +/- 4.0 years. Admission was 6.1 +/- 1.6 days after symptoms onset. Systemic inflammatory response was manifested with neutrophilia (10.7 +/- 4.2 x109/), lymphopenia (1.1 +/- 0.7 x109/L), elevated CRP (220.9 +/- 86.1 mg/L), ferritin (684.5 +/- 549.5 mug/L) and D-dimer (1528 +/- 1254 ng/mL). One third of patients had acute kidney injury with glomerular filtration rate of 64 +/- 22 mL/min/1.73 m2 and urea level of 16.0 +/- 8.4 mmol/L. All patients had acute heart failure with ejection fraction 47.2% +/- 7.7% and fractional shortening 23.6% +/- 4.9%, 92% of patients had NTproBNP gt;1500 pg/mL and 58% had elevated troponin I (1.34 +/- 1.47 ng/mL). Z-scores for end-diastolic left ventricle, interventricular septum and pos-terior wall diameters were 0.7 +/- 1.1, 1.7 +/- 1.3 and 0.6 +/- 0.7 respectively. All patients had mild/moderate mitral regurgitation, and 60% had mild pericardial effusion. Inotropes, administered during first 3.7 +/- 1.6 days, were divided in three groups: 1) dop-amine (n = 14), 2) dobutamine + dopamine (n = 5), 3) milrinone +/- dopamine (n = 6). Additional treatment included diuretics and captopril. Total fluid balance (including insensible loss of 300 mL/m2/day) through days 1-7 was +860 mL/m2, +128 mL/m2,-108 mL/m2,-36 mL/m2,-306 mL/m2,-335 ml/m2,-298 ml/m2 (total-95 ml/m2). Methylprednisolone/intravenous immuno-globulin and low-molecular-weight heparin/acetylsalicylic acid were administered and fever persisted 1.2 days averagely. Oxygen supplementation was needed in 71% of patients. Transitory bradycardia was noticed and there was no difference in heart rate between treatment groups. Profound hypotension was revealed on admission and correction differed regarding treat-ment (p lt;0.05) (Figure 1). All patient survived with clinical improvement (one had mechanical ventilation, and one had stroke). Conclusion(s): Mixed shock is the most severe manifestation of MIS-C, and treatment of heart failure should be combined with cau-tious fluid resuscitation.

14.
Cardiology in the Young ; 32(Supplement 2):S268, 2022.
Article in English | EMBASE | ID: covidwho-2062093

ABSTRACT

Background and Aim: Kawasaki-like (multisystem inflammatory) syndrome associated with SARS-CoV-2 infection is characterized by acute severe systemic vasculitis, often with multi-organ dys-function and cardiac involvement. Although most patients recover, long-term outcomes are poorly studied [Gema de Lama Caro-Paton et al., 2021;Guimaraes D. et et al., 2021;Sharma C. et al., 2021]. Method(s): We analyzed the results of laboratory, clinical, radiologi-cal, ECG and EchoCG data in the dynamic observation of 15 patients (M 9, 1.5-16 yo, m = 7) in 3 months after the suffered MIS-C. Result(s): At the disease onset high refractory fever was observed in all cases, symptoms of Kawasaki disease in 12 (80%) of them, shock with multi-organ dysfunction-in 8 (53.3%), including symptoms of acute heart failure-in 5 (33%), concomitant in two cases with severe left ventricular dilatation with low LV EF. Myocardial damage was seen in 11 patients (73%), pericarditis in 12 (80%), coronary dilatation in two (13%);troponin level increased in 5 (33%), CK-MB-in 5 (33%), BNP-in 3 (25%). After 3 months, there were no signs of myocardial dysfunction and/or cardiomegaly in any patient, troponin and BNP levels normalized in all patients, a moderate increase of CK-MB was seen in 8 (53%), and coronary dilatation persisted in one patient. Arrhythmias were documented at onset in 9 (60%) patients, 3 (20%) after 3 months (p = 0.028). Conclusion(s): preliminary results of follow-up of children after MIS-C demonstrate favorable course in the majority of patients by clinical, laboratory, ECG and echocardiographic data. Further observations are needed to determine the long-term prognosis.

15.
Chest ; 162(4):A751, 2022.
Article in English | EMBASE | ID: covidwho-2060682

ABSTRACT

SESSION TITLE: Cardiovascular Complications in Patients with COVID-19 SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Previous case reports have shown a number of cardiac complications associated with, and attributed to COVID-19 infection including acute myocardial injury and infarction, dysrhythmias, acute heart failure, pericarditis, and venous thromboembolic events, among others. Up until this point, these cases have all been documented in unvaccinated individuals 1. CASE PRESENTATION: Here we report a unique case of a 40-year-old previously vaccinated woman who presented with generalized weakness, chest pain, dyspnea, and vomiting. She was found to be septic and positive for COVID-19. Transthoracic echocardiogram showed a small pericardial effusion on admission and the patient was diagnosed with acute myopericarditis secondary to COVID-19. Within the first 24 hours following admission, the patient's condition rapidly deteriorated and she developed worsening pericardial effusion, with subsequent cardiac tamponade, and cardiogenic shock. Following attempted pericardiocentesis and surgical drainage, cardiac function did not improve and she expired soon after. DISCUSSION: Despite most of the clinical attention being focused on the effects of SARS-CoV-2 on the respiratory system and the pneumonia it causes, there have been more reported complications involving other organ systems, particularly the heart and kidneys. Studies have shown three main categories of cardiac involvement and complications related to COVID-19: myocardial injury, acute heart failure, and arrhythmia. Focusing on myocardial injuries, there have been some reports attempting to elucidate the frequency of myo- and pericarditis as complications of COVID-19. Yet still to this date, little is known about pericarditis as a COVID-19 complication. Of the case reports published thus far regarding COVID-19 pericarditis, the majority of them do not exhibit cardiac tamponade. In one systematic review published in September, 2021, a total of 33 studies including 32 case reports and one case series were included and pericardial effusion and cardiac tamponade were reported in 76% and 35% of the cases, respectively 2. To our knowledge, our case is the first of its kind, illustrating cardiac tamponade in a fully vaccinated individual. Although, there have been no clear mechanisms explaining the pathogenesis of cardiac involvement in patients suffering from COVID-19, multiple possibilities have been hypothesized. Similar to other cardiotoxic viruses, an inflammatory response is likely triggered resulting in pericarditis and pericardial effusion 3. When left unabated, cardiac tamponade can occur. CONCLUSIONS: Our case documents a reminder of the critical nature of SARS-CoV-2, even in vaccinated patients. To our knowledge, this is the first reported case of cardiac tamponade in a previously vaccinated individual. This case highlights the importance of quick diagnosis and treatment in patients suffering from potential lethal complications of COVID-19. Reference #1: Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascular complications in COVID-19. Am J Emerg Med. 2020;38(7):1504-1507 Reference #2: Diaz-Arocutipa C, Saucedo-Chinchay J, Imazio M. Pericarditis in patients with COVID-19: a systematic review. J Cardiovasc Med (Hagerstown). 2021 Sep 1;22(9):693-700 Reference #3: Inciardi RM, Lupi L, Zaccone G, et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):819–24 DISCLOSURES: no disclosure on file for Thomas Bumbalo;no disclosure on file for Thaddeus Golden;No relevant relationships by Omar Kandah

16.
Chest ; 162(4):A254, 2022.
Article in English | EMBASE | ID: covidwho-2060546

ABSTRACT

SESSION TITLE: Infections In and Around the Heart Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Acute bacterial myocarditis due to Salmonella bacteremia is a rare cause of ST-segment elevation that can manifest as acute decompensated heart failure, life threatening arrhythmias, and sudden cardiac death. CASE PRESENTATION: A 62-year-old male with a past medical history of HTN, HLD, DM2, and TIA presented with nausea, vomiting, nonbloody diarrhea, and right upper quadrant pain for five days. He quickly decompensated in the ED, becoming increasingly hypotensive, tachycardic, and lethargic concerning for sepsis. Broad spectrum antibiotics and IV fluids were initiated. Chest X-ray revealed multifocal pneumonia. Labs revealed a metabolic acidosis consistent with acute hypoxic respiratory failure warranting emergent intubation. CTA chest showed multifocal pneumonia and Covid-19 antigen testing was negative. Troponin I was elevated at.211 ng/mL (n <.08) and ECG showed new onset atrial fibrillation, for which cardiology was consulted. On admission to the ICU, repeat labs showed acute renal failure and he was anuric warranting hemodialysis initiation. Despite medical optimization, his Troponin I trended up to 1.458 ng/mL, and repeat ECG showed 2:1 atrial flutter with new ST-elevations in leads II, III, and aVF, consistent with an acute inferior STEMI. Labs did not show hyperkalemia nor hypercalcemia. Transthoracic echocardiography revealed normal systolic and diastolic function, with a left ventricle ejection fraction of 65-70%. A heparin infusion was started and he was taken for a cardiac catheterization which showed no evidence of occlusive CAD. His blood cultures revealed Salmonella enteritidis for which he was switched to ciprofloxacin. Abdominal ultrasound appeared benign, but CT abdomen with contrast showed findings of cholecystitis, which was confirmed on HIDA scan. Gastroenterology and Surgery were consulted who recommended a cholecystostomy tube placement, with a delayed laparoscopic cholecystectomy (LC) when stable. Repeat ECG following the LC showed complete resolution of the previous STEMI. He was discharged to a rehabilitation facility where he made a full recovery. DISCUSSION: Acute bacterial myocarditis can mimic acute coronary syndromes and warrants a high index of suspicion in the setting of Salmonella bacteremia. Our patient presented with signs of acute cholecystitis and an ECG concerning for acute STEMI. Bacterial etiologies of myocarditis are less reported in the literature compared to viral infections, and are seen more often in patients with severe sepsis such as our patients. Common findings associated with Salmonella myocarditis include ST-segment elevation on ECG and elevated troponin levels. Serial ECG findings can distinguish myocarditis from acute myocardial infarction. Early diagnosis is essential to improve outcomes and reduce mortality. CONCLUSIONS: Acute bacterial myocarditis can mimic acute coronary syndromes. Reference #1: Villablanca P, Mohananey D, Meier G, Yap JE, Chouksey S, Abegunde AT. Salmonella Berta myocarditis: Case report and systematic review of non-typhoid Salmonella myocarditis. World J Cardiol. 2015;7(12):931-937. doi:10.4330/wjc.v7.i12.931 Reference #2: Sundbom P, Suutari AM, Abdulhadi K, Broda W, Csegedi M. Salmonella enteritidis causing myocarditis in a previously healthy 22-year-old male. Oxf Med Case Reports. 2018;2018(12):omy106. Published 2018 Nov 26. doi:10.1093/omcr/omy106 Reference #3: Majid A, Bin Waqar SH, Rehan A, Kumar S. From Gut to Heart: Havoc in a Young Patient with Typhoid-associated Cardiomyopathy. Cureus. 2019;11(7):e5049. Published 2019 Jul 1. doi:10.7759/cureus.5049 DISCLOSURES: No relevant relationships by Mohamed Faher Almahmoud No relevant relationships by JONATHAN BROWN No relevant relationships by Hytham Rashid No relevant relationships by Syed Raza

17.
ESC Heart Fail ; 2022 Aug 31.
Article in English | MEDLINE | ID: covidwho-2013463

ABSTRACT

Multisystem Inflammatory Syndrome in Adult (MIS-A) is a rare COVID-19 complication, presenting as fever with laboratory evidence of inflammation, severe illness requiring hospitalization and multisystem organ involvement. We report on a 25-year-old man presenting with fever, rash, abdominal pain, diarrhoea and vomiting following prior asymptomatic COVID-19 infection. He developed refractory shock and type 1 respiratory insufficiency requiring mechanical ventilation. Diagnostic testing revealed significant inflammation, anemia, thrombocytopenia, acute kidney injury, hepatosplenomegaly, colitis, lymphadenopathy and myocarditis necessitating inotropy. Ventilatory, vasopressor and inotropic support was weaned following pulse corticosteroids and intravenous immunoglobulins. Heart failure therapy was started. Short-term follow-up shows resolution of inflammation and cardiac dysfunction.

18.
Hepatology International ; 16:S125, 2022.
Article in English | EMBASE | ID: covidwho-1995880

ABSTRACT

Objectives: The objective of this study characterize abnormal liver function test after recovered coronavirus in patients with heart failure (HF) as they are commonly encountered yet poorly defined. Materials and Methods: This study is a Clinical Effectiveness of nesiritide in decompensated Heart Failure use data from SCEND-HF to characterize associations with baseline liver function tests (LFTs). each LFT was analysed as both a continuous and dichotomous variable >normal vs. abnormal;bilirubin>1.0 mg/dL;aspartate aminotransferase (AST) and alanine aminotransferase ALT>35 mmol/L. Results: Mean Logistic regression assessed the association of LFTs and 30-day all-cause mortality and HF rehospitalization, and Cox proportional hazards assessed the association with 180-day all-cause mortality among patients alive at a 30-day landmark. In SCEND-HF, 2128 (48%) had complete admission LFT data. of these, 39% had abnormal bilirubin, 22% had abnormal ALT, and 29% had abnormal AST. Patients with abnormal LFTs were younger, had lower body mass index, and lower left ventricular ejection fraction. In multivariable models, increased total bilirubin was associated with increased 30-day mortality or HF rehospitalization >hazard ratio (HR) 1.17 per 1 mg/dL increase 85% confidence interval (CI) 1.04, 1.32;P = 0.012], but not with an increase in 180-day mortality (HR 1.10, 95% CI 0.97, 1.25;P = 0.13) per 1 mg/dl increase. Compared with normal bilirubin levels, abnormal bilirubin was associated with increased 30-day mortality or HF rehospitalization (HR 1.24, 95% CI 1.00, 1.54;P = 0.048) and 180-day mortality (HR 1.32, 95% CI 1.08, 1.62;P = 0.007). We found no association with AST or ALT and outcomes. Conclusion: More than 40% of patients Hospitalized with acute HF had abnormal LFTS.After multivariable regulation, only High bilirubin was independently related with worse clinical outcomes and may represent an important prognostic variable.

19.
Hepatology International ; 16:S127-S128, 2022.
Article in English | EMBASE | ID: covidwho-1995879

ABSTRACT

Objectives: Recent studies indicate the need to redefine renal function (RF) in acute heart failure (AHF) linking a rise in creatinine with clinical status to identify patients who develop evaluated the usefulness of serial assessment of urinary levels of neutrophil gelatinaseassociated lipocalin kidney injury molecule-1 (KIM-1). Materials and Methods: In 96 patients with AHF, uNGAL, uKIM-1, and uCysC were measured using a highly sensitive immunoassay based on a single-molecule counting technology (Singulex, Alameda, CA, USA) at baseline, day 2, and day 3. Patients who developed WRF (a ≥ 0.3 mg/dL increase in serum creatinine or a >25% decrease in the estimated glomerular filtration rate from the baseline value). Results: were differentiated into those presence of deterioration/no improvement in clinical status during hospitalization vs. 'pseudo-WRF' (uneventful clinical course). occurred in 12 (10%), 'pseudo-WRF' in 14 (11%), whereas the remaining 104 (79%) patients did not develop WRF. Patients with 'true WRF' were more often females, had higher levels of NT-proBNP, creatinine, and urea on admission, higher urine albumin to creatinine ratio at day 2, higher uNGAL at baseline, day 2, and day 3, and higher KIM-1 at day 2 (vs. pseudo-WRF vs. without WRF, all P<0.05). Patients with pseudo-WRF did not differ from those without WRF. In the multivariable model, elevated uNGAL at all time points and KIM-1 at day 2 remained independent predictors. Conclusion: identify patients at high risk of death. Larger studies with more frequent biomarker assessments in the early stages of hospitalization are needed to portray the dynamics of these patients in a realistic way, to better demonstrate the usefulness of biomarkers.

20.
European Journal of Heart Failure ; 24:187, 2022.
Article in English | EMBASE | ID: covidwho-1995531

ABSTRACT

Background: about 25% of patients admitted for HF are readmitted to hospital within 30 days. Fluid congestion is the leading cause for short-term readmission. Lung ultrasound (LUS) has become widely used to assess pulmonary congestion of cardiac origin for hospitalized patients on admission and before discharge but also for patients with HF undergoing outpatient follow-up. Inferior vena cava ultrasonography (IVCUS) seems also to be a useful tool in the care of patients with chronic HF. General practitioners (GPs) can safely use POCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients. Furthermore, they have expressed a need for greater training to diagnose and manage HF. An effective advanced fluid management programme, consisting in an intervention providing tailored therapy guided by intravascular volume assessment, is associated with improving readmission and mortality in HF. However, experts report long waiting lists for HF clinics and emphasize that scheduled follow-up appointments with a cardiologist do not regularly occur within two weeks of discharge, as recommended in guidelines. Purpose: to assess if POCUS, including LUS and IVC collapse index (IVCCI), can help in-hospital management in the general ward and if GPs can early identify signs of fluid overload after discharge, providing early referral and optimal therapy according to 2021 ESC guidelines. Methods: observational pilot study to test routine POCUS performed on hospital admission, before discharge and after 2 weeks in the GP ambulatory setting, after an in-hospital training period. 30-day HR was retrospectively compared to the clinical standard. Results: among 250 consecutive SARS-CoV-2 negative patients admitted to the department of internal medicine, 56 (22.4%) have been hospitalized for acute decompensated HF (17.8% HFrEF, 26.8%, HFmrEF, 55.4% HFpEF). 17 patients (30% M/F 6/11: group 1) underwent POCUS, while 39 patients (70% M/F 25/14, group 2) the standard management. Mean age difference (group1: 80.6±9.6 vs group2: 82.8±8.2) as well as comorbidities were not significant among groups (t-test p<0.19), while mean length of stay (MLS) for group1 (6.5±2.9 days) vs group2 (12±6.2 days) was significant (t-test p<0.001). LUS on discharge excluded persistent congestion in 76.5% (B-lines ≥ 3: 23.5%, yet 75% of these patients had no findings on ascultation), while IVCCI was >50%, 30-50%, <30% respectively in 52.9%,17.6% and 29.4%). 3 patients were evaluated after 2 weeks by GP. The 30-day HR was 5.8% (group1) vs 12.8% (group2) (χ2 test p<0.0012). Conclusions: POCUS seems to have contributed to reduce MLS, encouraging attainment of an optimal volume status at discharge and prescription of an optimal therapy. LUS and IVCUS are simple tools which may be performed soon after discharge by GP, contributing to reduce 30-day HR improving post discharge quality of care.

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