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1.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2371008.v1

ABSTRACT

Background Multiple reports have described myopericarditis following mRNA COVID-19 vaccination. However, data on the persistence of subclinical myocardial injury assessed by left ventricular (LV) longitudinal strain (LVLS) is limited.Objectives Our aim was to assess LV function longitudinally in our cohort of COVID-19 vaccine-related myopericarditis using ejection fraction (EF), fractional shortening (FS), LVLS, and diastolic parameters.Methods Retrospective, single-center review of demographic, laboratory, and management data was performed on 20 patients meeting diagnostic criteria for myopericarditis after mRNA COVID-19 vaccination. Echocardiographic images were obtained on initial presentation (time 0), at a median of 12 days (7.5, 18.5; time 1), and at a median of 44 days (29.5, 83.5; time 2). FS was calculated by M-mode, EF by 5/6 area-length methods, LVLS by utilization of TOMTEC software, and diastolic function by tissue Doppler. All parameters were compared across pairs of these time points using Wilcoxon signed-rank test.Results Our cohort consisted predominantly of adolescent males (85%) with mild presentation of myopericarditis. The median EF was 61.6% (54.6, 68.0), 63.8% (60.7, 68.3), 61.4% (60.1, 64.6) at times 0, 1, and 2, respectively. Upon initial presentation, 47% of our cohort had LVLS < -18%. The median LVLS was − 18.6% (-16.9, -21.0) at time 0, -21.2% at time 1 (-19.4, -23.5) (p = 0.004) and − 20.8% (-18.7, -21.7) at time 2 (p = 0.004, as compared to time 0).Conclusions Though many of our patients had abnormal strain during acute illness, LVLS improved longitudinally, indicating myocardial recovery. LVLS can be used as marker of subclinical myocardial injury and risk stratification in this population.


Subject(s)
Cardiomyopathies , COVID-19 , Ventricular Dysfunction, Left
2.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2340932.v1

ABSTRACT

Background Cardiac problems are frequent (20 to 25%) with COVID-19 and are associated with cardiac complications and in-hospital mortality. Existing research on the echocardiographic examination of COVID-19 focuses mostly on hospitalized patients with severe symptoms and in the acute phase of the disease, leaving out of the spotlight non-hospitalized individuals with mild symptoms. In this study, we wanted to determine the long-term influence of both severe and non-severe COVID-19 on echocardiographic changes. Methods This prospective cohort study was conducted during Iran's third COVID-19 wave in November 2020 among healthcare workers with a history of COVID-19 but otherwise healthy. Initially, a total of 100 patients underwent the primary echocardiographic examination 6 to 8 weeks following COVID-19 onset, and 6 months after the COVID-19 diagnosis, 64 subjects underwent the secondary echocardiographic evaluations. Based on clinical or radiological evidence, individuals were categorized into two groups of non-severe and severe COVID-19. Results Of 64 participants, 42 (65.6%) were women. The patients ' mean age was 40.4±8.1 years. In the non-severe COVID-19 group, among left ventricular (LV) echocardiographic indices, stroke volume index and ejection fraction increased significantly (24.7±4.1 cc/m2 vs. 29.7±7.0 cc/m2, p-value<0.001 and 61.9% [59.8-64.5] vs. 63.8% [58.2-68.9], p-value=0.029, respectively). Among right ventricular indices, free-wall global longitudinal strain decreased significantly in the secondary echocardiogram: (-32.3±4.6% vs. -28.8±5.8%, p-value=0.002). In the severe COVID-19 group, from LV echocardiographic indices, global longitudinal strain increased significantly over the follow-up period (-20% [-21.4- -19] vs. -23.9% [-25.3--21.9], p-value=0.004) and from RV indices, the fractional area change showed a significant decrease (47.2% [42.3-52.2] vs. 36.4% [31.1-45], p-value=0.002). Conclusion Although some patterns of significant change were seen among echocardiographic indices, COVID-19, regardless of severity, did not lead to cardiac impairment in an otherwise healthy population. The current results may not present the outcomes of older adults or with a history of cardiac problems against COVID-19.


Subject(s)
Cardiac Complexes, Premature , Heart Diseases , COVID-19 , Ventricular Dysfunction, Left , Stroke
3.
Sci Rep ; 12(1): 18038, 2022 Oct 27.
Article in English | MEDLINE | ID: covidwho-2087313

ABSTRACT

The pathogenesis of long-Covid symptoms remains incompletely understood. Therefore, we aimed to determine cardiopulmonary limitations 6 months after surviving COVID-19 using pulmonary function tests, echocardiographic studies to the point of analysis of global-longitudinal-strain (GLS), which describes the cycling myocardium deformation and provides better data on left ventricular (LV) dysfunction than LV ejection fraction (LVEF), and validated questionnaires. Overall, 60 consecutive hospitalized patients were included (61 ± 2 years, 40% treated in the ICU). At follow-up (194 ± 3 days after discharge), fatigue was the most prevalent symptom (28%). Patients with fatigue were more symptomatic overall and characterized by worse quality of life (QoL) scores compared to patients without fatigue (all p < 0.05), mainly due to limited mobility and high symptom burden. While PFT variables and LVEF were normal in the vast majority of patients (LVEF = 52% (45-52%)), GLS was significantly reduced (- 15% (- 18 to - 14%)). However, GLS values were not different between patients with and without fatigue. In conclusion, fatigue was the most prevalent long-Covid symptom in our cohort, which was associated with worse QoL mainly due to limited mobility and the high burden of concomitant symptoms. Patients showed a subtle myocardial dysfunction 6 months after surviving COVID-19, but this did not relate to the presence of fatigue.


Subject(s)
COVID-19 , Ventricular Dysfunction, Left , Humans , Quality of Life , Ventricular Function, Left , Stroke Volume , Fatigue/complications
4.
Echocardiography ; 39(11): 1391-1400, 2022 11.
Article in English | MEDLINE | ID: covidwho-2052401

ABSTRACT

PURPOSE: Left ventricular diastolic dysfunction (LVDD) is associated with poor outcomes in the intensive care unit (ICU). Nonetheless, precise reporting of LVDD in COVID-19 patients is currently lacking and assessment could be challenging. METHODS: We performed an echocardiography study in COVID-19 patients admitted to ICU with the aim to describe the feasibility of full or simplified LVDD assessment and its incidence. We also evaluated the association of LVDD or of single echocardiographic parameters with hospital mortality. RESULTS: Between 06.10.2020 and 18.02.2021, full diastolic assessment was feasible in 74% (n = 26/35) of patients receiving a full echocardiogram study. LVDD incidence was 46% (n = 12/26), while the simplified assessment produced different results (incidence 81%, n = 21/26). Nine patients with normal function on full assessment had LVDD with simplified criteria (grade I = 2; grade II = 3; grade III = 4). Nine patients were hospital-survivors (39%); the incidence of LVDD (full assessment) was not different between survivors (n = 2/9, 22%) and non-survivors (n = 10/17, 59%; p = .11). The E/e' ratio lateral was lower in survivors (7.4 [3.6] vs. non-survivors 10.5 [6.3], p = .03). We also found that s' wave was higher in survivors (average, p = .01). CONCLUSION: In a small single-center study, assessment of LVDD according to the latest guidelines was feasible in three quarters of COVID-19 patients. Non-survivors showed a trend toward greater LVDD incidence; moreover, they had significantly worse s' values (all) and higher E/e' ratio (lateral).


Subject(s)
COVID-19 , Ventricular Dysfunction, Left , Humans , Incidence , Feasibility Studies , Ventricular Function, Left , Diastole , Intensive Care Units , Heart Murmurs/complications
5.
Echocardiography ; 39(9): 1190-1197, 2022 09.
Article in English | MEDLINE | ID: covidwho-1968088

ABSTRACT

BACKGROUND: Myocardial strain assessed with speckle tracking echocardiography is a sensitive marker of cardiac dysfunction. Both left-ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) were affected by severe SARS-CoV-2 infection. However, data about cardiac involvement in patients with asymptomatic/mild Coronavirus disease-19 (COVID-19) is still lacking. AIM: To evaluate myocardial function using LV-GLS and RV-LS in patients with previous asymptomatic/mild COVID-19. METHODS: Forty young adults without previously known comorbidities/cardiovascular risk factors and with a confirmed diagnosis of asymptomatic or paucisymptomatic SARS-CoV-2 infection were retrospectively included. A 2D-transthoracic echocardiogram with speckle tracking analysis was performed at least 3 months after the diagnosis. Forty healthy subjects, matched for age, sex, and body surface area in a 1:1 ratio were used as the control group. RESULTS: Left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and RV-LS were comparable between the two groups. LV-GLS was significantly lower in the cases compared to the control group (-22.7 ± 1.6% vs. -25.7 ± 2.3%; p < .001). Moreover, the prevalence of regional peak systolic strain below -16% in at least two segments was three times higher in patients with previous COVID-19 compared to controls (30% vs. 10%, p = .02). In multivariable logistic regression, previous COVID-19 infection was independently associated with reduced LV-GLS values (p < .001). CONCLUSION: SARS-CoV-2 infection may affect left ventricular deformation in 30% of young adult patients despite an asymptomatic or only mildly symptomatic acute illness. Speckle-tracking echocardiography could help early identification of patients with subclinical cardiac involvement, with potential repercussions on risk stratification and management.


Subject(s)
COVID-19 , Ventricular Dysfunction, Left , COVID-19/complications , Echocardiography , Humans , Retrospective Studies , SARS-CoV-2 , Stroke Volume , Ventricular Dysfunction, Left/complications , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Function, Left , Young Adult
6.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.08.07.22278506

ABSTRACT

Background: Cardiac involvement in coronavirus disease 2019 (COVID-19) is associated with poor outcomes. Transthoracic echocardiography (TTE) can be used to assess cardiac structure and function non-invasively, and has been shown to influence management in COVID-19. Objectives: We aim to investigate the prognostic value of TTE findings in hospitalized adults with confirmed COVID-19. Methods: All consecutive hospitalized adult patients with confirmed COVID-19 who underwent TTE assessment between 3rd April 2020-6th April 2021 were included. Comprehensive clinical data including TTE findings were collected from electronic medical records. Patients with mild-moderate and severe-critical COVID-19 were compared. Within the severe-critical group, patients who survived hospitalization and died were compared. Further analyses were conducted after matching for age >60 years, obesity, and diabetes. Results: A total of 488 COVID-19 patients were included in this study; 202 with mild-moderate and 286 severe-critical disease. All mild-moderate patients and 152 severe-critical patients survived hospitalization. In the matched cohorts, TTE findings associated with severe-critical COVID-19 included left ventricular (LV) hypertrophy (OR: 1.91; CI: 1.21-3.02), LV diastolic dysfunction (OR: 1.55; CI: 1.00-2.38), right ventricular (RV) dysfunction (OR: 3.86; CI: 1.06-14.08), wall motion abnormalities (WMAs) (OR: 2.76; CI: 1.28-5.96), and any TTE abnormalities (OR: 2.99; CI: 1.73-5.17). TTE findings associated with mortality included RV dysfunction (OR: 3.53; CI: 1.12-11.19) and WMAs (OR: 2.63; CI: 1.26-5.49). Conclusion: TTE is a non-invasive modality that can potentially be used for risk-stratification of hospitalized COVID-19 patients. These findings must be confirmed in larger prospective studies.


Subject(s)
Motion Sickness , Cardiovascular Abnormalities , COVID-19 , Hypertrophy , Ventricular Dysfunction, Left , Obesity , Ventricular Dysfunction, Right , Diabetes Mellitus
8.
Arq Bras Cardiol ; 119(2): 267-279, 2022 08.
Article in English, Portuguese | MEDLINE | ID: covidwho-1935019

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (Covid-19) can lead to severe respiratory distress and acute cardiac injury, but it is unclear how often it can cause cardiac dysfunction. OBJECTIVE: In this systematic review, we aimed to summarize the main echocardiographic findings in patients with Covid-19. METHODS: We systematically searched in PUBMED, EMBASE, LILACS and Cochrane databases, in addition MedRxiv and Scielo preprints from inception to July 21st, 2021. Studies reporting echocardiographic data in patients with Covid-19 were included. Demographic characteristics, previous cardiovascular disease (CVD), and echocardiographic findings were extracted. We performed a meta-analysis of proportions to estimate the main echocardiographic findings. The level of significance was p < 0.05. RESULTS: From 11,233 studies, 38 fulfilled inclusion criteria and were included in the meta-analysis. The estimated proportions of left ventricular (LV) systolic dysfunction were 25% (95%CI: 19, 31; I293%), abnormal global longitudinal strain 34% (95% CI 23, 45; I290%), righ ventricular (RV) systolic dysfunction 17% (95%CI 13, 21; I290%), pericardial effusion 17% (95%CI: 9, 26; I297%), and pulmonary hypertension 23% (95%CI: 15, 33, I2 96%). LV systolic dysfunction was directly associated with study-specific prevalence of previous abnormal echocardiogram (p<0.001). The proportion of patients in mechanical ventilation, indicating severity of disease, did not explain the heterogeneity in the proportions of LV dysfunction (p=0.37). CONCLUSION: Among hospitalized patients with Covid-19, LV dysfunction has been reported in one quarter, with smaller proportions of right ventricular dysfunction, pericardial effusion and pulmonary hypertension. However, there was a higher proportion of LV dysfunction among studies reporting the presence of prior heart disease, which suggests that cardiac dysfunction was mostly pre-existing.


FUNDAMENTOS: A doença do coronavírus 2019 (Covid-19) pode levar à insuficiência respiratória grave e lesão cardíaca aguda, mas não está claro com que frequência ela pode causar disfunção cardíaca. OBJETIVOS: Nesta revisão sistemática, nosso objetivo foi resumir os principais achados ecocardiográficos em pacientes com Covid-19. MÉTODOS: Conduzimos uma busca sistemática nos bancos de dados PUBMED, EMBASE, LILACS e Cochrane, além de artigos não pulicados ( preprints ) no MedRxiv e Scielo desde o início até 21 de julho de 2021. Foram incluídos estudos que apresentaram dados ecocardiográficos de pacientes com Covid-19. Características demográficas, doença cardiovascular (DCV) prévia, e achados ecocardiográficos foram extraídos dos estudos. Realizamos uma metanálise de proporções para estimar os principais achados ecocardiográficos. O nível de significância foi p<0,05. RESULTADOS: Do total de 11 233 estudos, 38 preencheram os critérios de inclusão e foram incluídos na metanálise. A proporção estimada de disfunção sistólica do ventrículo esquerdo (VE) foi 25% (IC95%: 19, 31; I2 93%), strain longitudinal global anormal 34% (IC95% 23, 45; I2 90%), disfunção sistólica do ventrículo direito (VD) 17% (IC95% 13, 21; I2 90%), derrame pericárdico 17% (IC95%: 9, 26; I2 97%), e hipertensão pulmonar 23% (IC95%: 15, 33, I2 96%). Disfunção sistólica do VE foi diretamente associada com prevalência de ecocardiograma anormal prévio nos estudos (p<0,001). A proporção de pacientes em ventilação mecânica, indicando gravidade da doença, não explicou a heterogeneidade nas proporções de disfunção do VE (p=0,37). CONCLUSÃO: Entre os pacientes internados com Covid-19, a disfunção ventricular esquerda foi descrita em um quarto dos pacientes, com menores proporções de disfunção do ventrículo direito, derrame pericárdico e hipertensão pulmonar. No entanto, houve uma proporção mais alta de disfunção do VE nos estudos que relataram presença de doença cardíaca prévia, sugerindo que a disfunção cardíaca era predominantemente pré-existente.


Subject(s)
COVID-19 , Hypertension, Pulmonary , Pericardial Effusion , Ventricular Dysfunction, Left , Ventricular Dysfunction, Right , COVID-19/diagnostic imaging , Echocardiography , Humans , Hypertension, Pulmonary/complications , Pericardial Effusion/complications
9.
authorea preprints; 2022.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.165825007.78531479.v1

ABSTRACT

Background: Cardiac injury has been described in children with both acute COVID-19 and the multisystem inflammatory syndrome in children (MIS-C). Strain has been shown to be a sensitive measure of systolic function and can be used for detecting subclinical left ventricular (LV) dysfunction. We sought to describe strain findings in both groups on initial presentation and outpatient follow up. Methods: A retrospective study analyzing echocardiograms of all patients presenting with acute COVID-19 infection and MIS-C at our institution between March 2020 and December 2020 was performed. TOMTEC software was used for strain analysis in both study groups (COVID-19 and MIS-C) and age matched healthy controls. Regional strain was obtained and comparison amongst groups was performed using the Mann-Whitney U test. Strain was compared against LV ejection fraction (EF) as measured by 5/6 area length method. Results: 45 patients (34 MIS-C and 11 COVID-19) met inclusion criteria. There was a statistically significant decrease in LV longitudinal strain (p <0.001), LV circumferential strain (p <0.001) and left atrial strain (p = 0.014) in the MIS-C group when compared to the control group. There was a statistically significant decrease in LV longitudinal strain (p = 0.028) in the acute COVID-19 group. All patients with abnormal LVEF had abnormal strain. However 14 patients (41%) in the MIS-C group and 3 (27%) in the acute COVID-19 group had preserved LVEF but abnormal strain. Abnormal strain persisted in one-third of patients in the MIS-C and acute COVID-19 groups on outpatient follow up. Conclusion: Patients with MIS-C and acute COVID-19 can develop myocardial dysfunction as seen by abnormal strain. Strain may provide an additional tool in detecting subtle myocardial dysfunction. It can be routinely employed at diagnosis and at follow up evaluation of these patients.


Subject(s)
Heterotaxy Syndrome , Heart Diseases , COVID-19 , Cardiomyopathies , Cryopyrin-Associated Periodic Syndromes , Ventricular Dysfunction, Left
10.
Heart Fail Rev ; 27(4): 1173-1191, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1906285

ABSTRACT

Dilated cardiomyopathy (DCM) is an umbrella term entailing a wide variety of genetic and non-genetic etiologies, leading to left ventricular systolic dysfunction and dilatation, not explained by abnormal loading conditions or coronary artery disease. The clinical presentation can vary from asymptomatic to heart failure symptoms or sudden cardiac death (SCD) even in previously asymptomatic individuals. In the last 2 decades, there has been striking progress in the understanding of the complex genetic basis of DCM, with the discovery of additional genes and genotype-phenotype correlation studies. Rigorous clinical work-up of DCM patients, meticulous family screening, and the implementation of advanced imaging techniques pave the way for a more efficient and earlier diagnosis as well as more precise indications for implantable cardioverter defibrillator implantation and prevention of SCD. In the era of precision medicine, genotype-directed therapies have started to emerge. In this review, we focus on updates of the genetic background of DCM, characteristic phenotypes caused by recently described pathogenic variants, specific indications for prevention of SCD in those individuals and genotype-directed treatments under development. Finally, the latest developments in distinguishing athletic heart syndrome from subclinical DCM are described.


Subject(s)
Cardiomyopathy, Dilated , Ventricular Dysfunction, Left , Cardiomyopathy, Dilated/diagnosis , Cardiomyopathy, Dilated/genetics , Cardiomyopathy, Dilated/therapy , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Humans , Phenotype , Precision Medicine/methods , Ventricular Dysfunction, Left/complications
11.
authorea preprints; 2022.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.165774063.30486833.v1

ABSTRACT

Purpose: Left ventricular diastolic dysfunction (LVDD) is associated with poor outcomes in intensive care unit (ICU). Nonetheless, precise reporting of LVDD in COVID-19 patients is currently lacking and assessment could be challenging. Methods: : We performed an echocardiography study in COVID-19 patients admitted to ICU with the aim to describe the feasibility of full or simplified LVDD assessment and its incidence. We also evaluated the association of LVDD or of single echocardiographic parameters with hospital mortality. Results: : Between 06.10.2020 and 18.02.2021, full diastolic assessment was feasible in 74% (n=26/35) of patients receiving full echocardiogram study. LVDD incidence was 46% (n=12/26), whilst the assessment produced different results (incidence 81%, n=21/26). Nine patients were hospital-survivors (39%); incidence of LVDD (full assessment) was not different between survivors (n=2/9, 22%) and non-survivors (n=10/17, 59%; p=0.11). Also, the E/e’ ratio lateral was lower in survivors (7.4 [3.6] vs non-survivors 10.5 [6.3], p=0.03). We also found that s’ wave was higher in survivors (average, p=0.01). Conclusion: In a small single-center study, assessment of LVDD according to latest guidelines was feasible in three quarter of COVID-19 patients. Non-survivors showed a trend towards greater LVDD incidence; moreover, they had significantly worse s’ values (all) and higher E/e’ ratio (lateral).


Subject(s)
COVID-19 , Ventricular Dysfunction, Left
12.
Intensive Care Med ; 48(6): 667-678, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1899121

ABSTRACT

PURPOSE: Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU). METHODS: Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap). RESULTS: Six hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR > 4), pulmonary embolism (OR > 5) and increased PaCO2. Exploratory analyses showed that patients with ACP and older age were more likely to die in hospital (including ICU). CONCLUSION: Almost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.


Subject(s)
COVID-19 , Heart Failure , Hypertension, Pulmonary , Pulmonary Embolism , Ventricular Dysfunction, Left , Ventricular Dysfunction, Right , Aged , Echocardiography , Female , Humans , Intensive Care Units , Male , Retrospective Studies , Ventricular Dysfunction, Right/diagnostic imaging
13.
ESC Heart Fail ; 9(4): 2189-2198, 2022 08.
Article in English | MEDLINE | ID: covidwho-1881405

ABSTRACT

AIMS: To describe the natural history of SARS-CoV-2 infection in patients with hypertrophic cardiomyopathy (HCM) compared with a control group and to identify predictors of adverse events. METHODS AND RESULTS: Three hundred and five patients [age 56.6 ± 16.9 years old, 191 (62.6%) male patients] with HCM and SARS-Cov-2 infection were enrolled. The control group consisted of 91 131 infected individuals. Endpoints were (i) SARS-CoV-2 related mortality and (ii) severe clinical course [death or intensive care unit (ICU) admission]. New onset of atrial fibrillation, ventricular arrhythmias, shock, stroke, and cardiac arrest were also recorded. Sixty-nine (22.9%) HCM patients were hospitalized for non-ICU level care, and 21 (7.0%) required ICU care. Seventeen (5.6%) died: eight (2.6%) of respiratory failure, four (1.3%) of heart failure, two (0.7%) suddenly, and three (1.0%) due to other SARS-CoV-2-related complications. Covariates associated with mortality in the multivariable were age {odds ratio (OR) per 10 year increase 2.25 [95% confidence interval (CI): 1.12-4.51], P = 0.0229}, baseline New York Heart Association class [OR per one-unit increase 4.01 (95%CI: 1.75-9.20), P = 0.0011], presence of left ventricular outflow tract obstruction [OR 5.59 (95%CI: 1.16-26.92), P = 0.0317], and left ventricular systolic impairment [OR 7.72 (95%CI: 1.20-49.79), P = 0.0316]. Controlling for age and sex and comparing HCM patients with a community-based SARS-CoV-2 cohort, the presence of HCM was associated with a borderline significant increased risk of mortality OR 1.70 (95%CI: 0.98-2.91, P = 0.0600). CONCLUSIONS: Over one-fourth of HCM patients infected with SARS-Cov-2 required hospitalization, including 6% in an ICU setting. Age and cardiac features related to HCM, including baseline functional class, left ventricular outflow tract obstruction, and systolic impairment, conveyed increased risk of mortality.


Subject(s)
Atrial Fibrillation , COVID-19 , Cardiomyopathy, Hypertrophic , Ventricular Dysfunction, Left , Humans , Male , Adult , Middle Aged , Aged , Female , COVID-19/complications , COVID-19/epidemiology , SARS-CoV-2 , Cardiomyopathy, Hypertrophic/complications , Cardiomyopathy, Hypertrophic/epidemiology , Registries , Ventricular Dysfunction, Left/complications , Atrial Fibrillation/complications
14.
Eur Heart J Cardiovasc Imaging ; 23(8): 1066-1074, 2022 07 21.
Article in English | MEDLINE | ID: covidwho-1873887

ABSTRACT

AIMS: Multisystem inflammatory syndrome in children (MIS-C) with cardiovascular manifestations are frequent. However, there is lacking evidence regarding cardiological follow-up of this cohort of patients. The aim of our study was to describe the early and mid-term cardiac abnormalities assessed by standard and speckle-tracking echocardiography (STE), and cardiac MRI (CMR). METHODS AND RESULTS: We enrolled 32 patients (21 male, 11 female), mean age 8.25 ± 4years, with diagnosis of MIS-C. During admission, all children underwent TTE, STE with analysis of left ventricle global longitudinal strain (GLS) and CMR. Patients underwent cardiological evaluation at 2 (T1) and 6 months (T2) after discharge. Cardiac MRI was repeated at 6 months after discharge. Mean left ventricular ejection fraction (LVEF) at baseline was 58.8 ± 10% with 10 patients (31%) below 55%. Speckle-tracking echocardiography showed reduced mean LV GLS (-17.4 ± 4%). On CMR, late gadolinium enhancement (LGE) with non-ischaemic pattern was evident in 8 of 23 patients (35%). Follow-up data showed rapid improvement of LVEF at T1 (62.5 ± 7.5 vs. 58.8 ± 10.6%, P-value 0.044) with only three patients (10%) below ≤ 55% at T1. Left ventricular (LV) GLS remained impaired at T1 (-17.2 ± 2.7 vs.-17.4 ± 4, P-value 0.71) and significantly improved at T2 (-19 ± 2.6% vs. -17.4 ± 4%, P-value 0.009). LV GLS was impaired (>-18%) in 53% of patients at baseline and T1, whereas only 13% showed persistent LV GLS reduction at T2. Follow-up CMR showed LGE persistence in 33.4% of cases. CONCLUSION: Early cardiac involvement significantly improves during follow-up of MIS-C patients. However, subclinical myocardial dysfunction seems to be still detectable after 6 months of follow-up in a not negligible proportion of them.


Subject(s)
Heart Defects, Congenital , Ventricular Dysfunction, Left , COVID-19/complications , Child , Child, Preschool , Contrast Media , Echocardiography/methods , Female , Follow-Up Studies , Gadolinium , Humans , Magnetic Resonance Imaging , Magnetic Resonance Imaging, Cine/methods , Male , Stroke Volume , Systemic Inflammatory Response Syndrome , Ventricular Function, Left
15.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.06.13.22276244

ABSTRACT

Background. Long COVID-19 symptoms appeared in many COVID-19 survivors. However, the prevalence and symptoms associated with long COVID and its comorbidities have not been established. Methods. Between May and September 2020 we included 312 patients with post-COVID-19 from 21 primary care centers if they had any persistent symptoms for at least three months from the first onset of the disease. On the 6 months follow up, their lung function was assessed by CT and spirometry, whereas cardiac function was assessed by electrocardiogram (ECG), Holter ECG, Echocardiography, and 24-hour blood pressure monitoring. A six-minute test (6MWT) was conducted on 308 participants during the follow-up visit. All participants were given a questionnaire with items on demographic information, current complaints, comorbidities, and medications, and Chalder Fatigue Scale (CFS) questionnaire. Statistical analysis was done using R vs. 4.1.2. Two-group comparison of continuous variables was performed using a T-test for normally distributed data, and the Mann-Whitney Wilcoxon test, ANOVA, and Kruskal-Wallis tests were applied for multiple comparisons following with Tukey and Dunn tests as post-hoc methods. Hochberg p-value adjustment was used to reduce the false discovery rate during multiple comparisons. Categorical variables were analyzed with Fishers Exact test. Results. Of 312 persons investigated, there was no significant gender difference between post-COVID-19 clinical manifestations except for memory dysfunction and anxiety, more prevalent among female participants. Chalder Fatigue Score was predominant in female participants (243, 78%). 39 (12.5%) participants reported having type 2 diabetes mellitus, and 158 (50.64%) had hypertension. Among the tested parameters, those positively correlated with comorbid conditions include age, BMI, D-dimers, NT-proBNP, C-reactive protein, neutrophils, fasting glucose, and HbA1c; hypertension also shows three associations that were not found in patients when examining the role of diabetes: increased hemoglobin, fibrinogen, and ferritin. 24-hour blood pressure monitoring revealed significantly higher systolic and diastolic blood pressure, left ventricular hypertrophy, and elevated NT-proBNP in participants with hypertension and subjects with type 2 diabetes. Left ventricular diastolic dysfunction is more frequently present in patients with hypertension. Chest CT was conducted on 227 (72.8%) participants 5.8+/-0.9 months after the onset of COVID-19. The most common registered CT abnormality was chronic bronchitis (198, 87.2%), followed by fibrotic changes in (83, 36.6%) and mediastinal lymphadenopathy (23, 10.1%). Immunological test results showed that SARS-CoV19 IgG antibodies were present in 241 subjects (77.2%), and SARS-CoV19 IgM antibodies were present in 9 subjects (2.88%). Conclusions. Our study provides valuable clues for long-term post-sequelae in a cohort of the Long COVID-19 subjects. We demonstrated a strong association of signs of cardiac dysfunction, lung fibrotic changes, increased hemoglobin, fibrinogen, and ferritin with hypertension but not with other comorbidities. Our results are of importance for understanding the Long Covid-19 syndrome.


Subject(s)
Heart Diseases , COVID-19 , Lymphatic Diseases , Memory Disorders , Hypertension , Cardiomyopathy, Hypertrophic, Familial , Bronchitis , Anxiety Disorders , Ventricular Dysfunction, Left , Diabetes Mellitus
16.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-1564946.v1

ABSTRACT

Introduction: Multisystem inflammatory syndrome in adults (MIS-A) after SARS-CoV-2 infection or vaccination is a known complication. However, longitudinally extensive transverse myelitis (LETM) as a manifestation of MIS-A after SARS-CoV-2 infection or vaccination has not been reported before. Case presentation: 38-year old female, known case of hypothyroidism with history of mild SARS-Cov-2 infection in May 2021 and recent second dose of SARS-CoV-2 vaccination (on 1 st November 2021, COVISHIELD TM Oxford/Astra Zeneca) presented with acute onset progressive flaccid quadriparesis with bowel and bladder involvement since 26 th December 2021. Over next 3 days she developed fever, maculopapular rash , shock, myocarditis, breathlessness, Jaundice, acute kidney injury. Investigations revealed polymorphonuclear leukocytosis, thrombocytopenia, deranged Liver and renal function , severe left ventricular dysfunction. C reactive protein, D-dimer, procalcitonin, Interleukin-6 levels were raised. MRI whole spine revealed LETM from C6 to conus medullaris. Reverse transcriptase polymerase chain reaction for SARS-CoV-2 infection was negative. SARS-CoV-2 antibody titre was raised. Diagnosed as a case of MIS-A with LETM. Managed with ventilatory and ionotropic support, Intravenous Iimmunoglobulin, antibiotics, hemodialysis and intravenous methyl prednisolone and oral steroid. Improved gradually and discharged. Presently patient has grade 5/5 power in both upper limbs and 2/5 power in both lower limbs with improving bowel and bladder control. Conclusions: : This is the first reported case of LETM associated with MIS-A after SARS-CoV-2 infection or vaccination. With wider availability of SARS-CoV-2 vaccination, various side effects are emerging. However as these side effects are rare, SARS-CoV-2 vaccination represents the hope for mankind to overcome this global pandemic.


Subject(s)
Exanthema , COVID-19 , Urinary Bladder Diseases , Thrombocytopenia , Fever , Cryopyrin-Associated Periodic Syndromes , Acute Kidney Injury , Ventricular Dysfunction, Left , Myocarditis , Spinal Cord Compression , Myelitis , Leukocytosis , Hypothyroidism
17.
J Card Fail ; 28(8): 1287-1297, 2022 08.
Article in English | MEDLINE | ID: covidwho-1850752

ABSTRACT

BACKGROUND: COVID-19 may negatively impact the prognosis of patients with chronic HFrEF and vice versa. METHODS: This study included 2 parallel analyses of patients in the United States who were in the TriNetX health database and who underwent polymerase chain reaction testing for SARS-CoV-2 as an inpatient or outpatient between January and September of 2020. Analysis A included patients with positive tests for COVID-19 and compared patients with histories of worsening heart failure with reduced ejection fraction (HFrEF) (hospitalization due to heart failure (HF) or IV diuretic use during the prior 12 months), HFrEF without worsening, and no prior HF. Analysis B included patients with histories of HFrEF and compared patients with positive vs negative COVID-19 tests. Outcomes included mortality and worsening HF. In both analyses, prespecified subgroup analyses were stratified by inpatient vs outpatient settings of the COVID-19 tests. RESULTS: In Analysis A, of 99,052 patients with positive COVID-19 tests, 514 (0.5%) and 524 (0.5%) patients had histories of worsening HFrEF and HFrEF without worsening, respectively. After adjustment, compared to patients without HF, worsening HFrEF (risk ratio [RR] 1.42, 95% CI 1.10-1.83; P< 0.001) and HFrEF without worsening (RR 1.33, 95% CI 0.96-1.84; P= 0.06) were associated with higher 30-day mortality rates. Excess risk of mortality tended to be pronounced in patients initially diagnosed with COVID-19 as outpatients (P for interaction, 0.12 and 0.006, respectively). In Analysis B, of 14,838 patients with HFrEF tested for COVID-19, 1038 (7.0%) had positive tests. After adjustment, testing positive was associated with excess 30-day mortality risk (RR 1.67, 95% CI 1.38-2.02; P< 0.001) and worsening HF (RR 1.33, 95% CI 1.17-1.51; P< 0.001). Mortality risk was nominally more pronounced among patients presenting as outpatients (P for interaction 0.07). CONCLUSION: In this large cohort of patients tested for COVID-19, among patients testing positive, a history of HFrEF with or without worsening was associated with excess mortality rates, particularly among patients diagnosed with COVID-19 as outpatients. Among patients with established HFrEF, compared with testing negative, testing positive for COVID-19 was independently associated with higher risk of death and worsening HF.


Subject(s)
COVID-19 , Heart Failure , Ventricular Dysfunction, Left , Heart Failure/complications , Heart Failure/diagnosis , Heart Failure/epidemiology , Hospitalization , Humans , Prognosis , SARS-CoV-2 , Stroke Volume , United States
18.
authorea preprints; 2022.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.165372304.42579951.v1

ABSTRACT

A 43-year-old healthy man complained of constant general fatigue for 11 days. Twenty-two days earlier, the patient received his third dose of the coronavirus disease 2019 vaccine. An electrocardiogram revealed inverted T waves with a wide spectrum of precordial lead, and echocardiography revealed diffuse left ventricular dysfunction, indicating acute myocarditis.


Subject(s)
Myocarditis , COVID-19 , Ventricular Dysfunction, Left
19.
Pediatr Cardiol ; 43(8): 1879-1887, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1844351

ABSTRACT

Multisystem inflammatory syndrome in children (MIS-C) secondary to COVID-19 infection in previously healthy children often results in subtle but persistent echocardiographic abnormalities despite complete clinical recovery. This study was done to investigate medium-term cardiovascular outcomes of patients with MIS-C using cardiovascular magnetic resonance imaging (CMR). This is a single-center retrospective study of patients aged less than 21 years, diagnosed with MIS-C who received an outpatient CMR, around 6 months after discharge. CMR was done in patients with significant troponin leak or depressed LVEF. CMR performed on a GE Signa HDxt 1.5 Tesla magnet with a myocarditis protocol. Diagnosis of myocarditis was determined by the original Lake Louise Criteria. There were 21 patients with a median age of 11 years, (IQR 8-13 years), who underwent CMR at median follow-up duration of 6 months (IQR 5-7 months). At the peak of illness during admission, there were 95.2% patients with abnormal Troponin I and BNP. By echocardiogram, 76.2% had left ventricular systolic dysfunction and 9.5% had coronary ectasia, which all resolved by 6 months. By CMR, there were five patients (23.8%) with abnormal left atrial volume, one patient (4.8%) with an abnormal indexed left ventricular end-diastolic volume, and three patients (15%) with abnormal LVEF. There was no evidence of myocardial edema in T2-weighted image sequence. There were three patients with persistent late gadolinium enhancement (14.3%). Follow-up CMR is a useful tool in diagnosing subtle myocardial abnormalities and guide necessity for future follow-up.


Subject(s)
COVID-19 , Myocarditis , Ventricular Dysfunction, Left , Child , Humans , Adolescent , Myocarditis/diagnostic imaging , Follow-Up Studies , Gadolinium , Contrast Media , Retrospective Studies , Troponin I , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/etiology , Magnetic Resonance Imaging, Cine , Ventricular Function, Left , Stroke Volume
20.
BMJ Open ; 12(4): e059281, 2022 04 27.
Article in English | MEDLINE | ID: covidwho-1816766

ABSTRACT

INTRODUCTION: Recent reports linked acute COVID-19 infection in critical patients to cardiac structure and function abnormalities. The left ventricular (LV) diastolic dysfunction could result in obvious adverse prognostic impacts. The aim of this meta-analysis is to summarise the incidence, risk factors and the prognostic effect of imaging LV diastolic dysfunction in adult patients with COVID-19. METHODS: Databases to be used for the pertinent literature are PubMed, EMBase, ISI Knowledge via Web of Science, and preprint databases (MedRxiv and BioRxiv) (until May 2023) to identify all cohort studies in adult patients with COVID-19. The primary outcome will be the incidence of LV diastolic dysfunction assessed by echocardiography or cardiac MRI. Secondary outcomes will include the risk factors for LV diastolic dysfunction and the association with all-cause mortality during hospitalisation. Additional outcomes will be septal or lateral é, average E/é, E/A, peak tricuspid regurgitation velocity, left atrial volume index and LV wall thickness. Univariable or multivariable meta-regression and subgroup analyses will be conducted for related risk factors and the association of LV diastolic dysfunction with all-cause mortality. Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of LV diastolic dysfunction incidence and related risk factors, association with all-cause mortality and other LV diastolic dysfunction parameters. ETHICS AND DISSEMINATION: There was no need for ethics approval for the systematic review protocol according to the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER: CRD42021256666; URL: https://www.crd.york.ac.uk/prospero/.


Subject(s)
COVID-19 , Ventricular Dysfunction, Left , Adult , COVID-19/complications , COVID-19/epidemiology , Humans , Incidence , Meta-Analysis as Topic , Prognosis , Risk Factors , Systematic Reviews as Topic , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/epidemiology , Ventricular Dysfunction, Left/etiology
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