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1.
Am J Cardiol ; 165: 109-115, 2022 02 15.
Article in English | MEDLINE | ID: covidwho-1568471

ABSTRACT

Evidence of the involvement of the cardiovascular system in patients with COVID-19 is increasing. The evaluation of the subclinical cardiac involvement is crucial for risk stratification at admission, and left ventricular global longitudinal strain (LVGLS) may be useful for this purpose. A total of 87 consecutive patients admitted to the COVID Center were enrolled from December 2020 to April 2021. A complete echocardiography examination was performed within 72 hours from admission. The main outcome was the need for mechanical ventilation by way of orotracheal intubation (OTI) and mortality, and the secondary outcome was the worsening of the respiratory function during hospitalization, interpreted as a decrease of the ratio between the partial pressure of oxygen and the fraction of inspired oxygen (P/F) <100. Of 87 patients, 14 had severe disease leading to OTI or death, whereas 24 had a P/F <100. LVGLS was significantly impaired in patients with severe disease. After adjustment for risk factors, by considering LVGLS as continuous variable, the latter remained significantly associated with severe acute respiratory distress syndrome (P/F <100) (hazard ratio [HR] 1.48, 95% confidence interval [CI] 1.18 to 1.88, p = 0.001) and OTI/death (HR 1.63, 95% CI 1.13 to 2.38, p = 0.012). When using an LVGLS cutoff of -16.1%, LVGLS ≥ -16.1% was independently associated with a higher risk of severe acute respiratory distress syndrome (HR 4.0, 95% CI 1.4 to 11.1, p= 0.008) and OTI/death (HR 7.3, 95% CI 1.6 to 34.1, p = 0.024). LVGLS can detect high-risk patients at the admission, which can help to guide in starting early treatment of the admitted patients.


Subject(s)
COVID-19/complications , COVID-19/mortality , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/virology , Ventricular Dysfunction, Left/diagnostic imaging , Aged , Aged, 80 and over , COVID-19/therapy , Echocardiography , Female , Hospitalization , Humans , Italy , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Respiration, Artificial , Respiratory Distress Syndrome/therapy , Survival Rate , Ventricular Dysfunction, Left/virology
2.
J Pediatr ; 241: 237-241.e1, 2022 02.
Article in English | MEDLINE | ID: covidwho-1474761

ABSTRACT

At midterm follow-up visits performed at a median of 7 months (IQR 6.0-8.4 months), 16 patients with multisystem inflammatory syndrome in children had resolution of left ventricular dysfunction and most had resolution of coronary aneurysms. On cardiovascular magnetic resonance imaging, no patients had late gadolinium enhancement.


Subject(s)
COVID-19/complications , Coronary Aneurysm/diagnostic imaging , Magnetic Resonance Imaging , Systemic Inflammatory Response Syndrome/diagnostic imaging , Systemic Inflammatory Response Syndrome/physiopathology , Ventricular Dysfunction, Left/diagnostic imaging , Adolescent , COVID-19/diagnostic imaging , COVID-19/physiopathology , Child , Child, Preschool , Coronary Aneurysm/virology , Disease Progression , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Prognosis , Retrospective Studies , Ventricular Dysfunction, Left/virology , Young Adult
3.
Viruses ; 13(10)2021 10 07.
Article in English | MEDLINE | ID: covidwho-1463839

ABSTRACT

SARS-CoV-2 infection in children can trigger cardiovascular manifestations potentially requiring an intensive treatment and defining a new entity named Multisystem Inflammatory Syndrome in Children (MIS-C), whose features partially overlap with Kawasaki Disease (KD). A cross-sectional study including all diagnoses of MIS-C and KD from April 2020 to May 2021 in our metropolitan area was conducted evaluating clinical, laboratory (including immunological response, cytokines, and markers of myocardial damage), and cardiac (coronary and non-coronary) features at onset of the diseases. Evolution of ventricular dysfunction, valve regurgitations, and coronary lesions was documented. The severity of the disease was also considered based on the need for inotropic support and ICU admission. Twenty-four MIS-C were diagnosed (14 boys, median age 82 months): 13/24 cases (54.17%) presented left ventricular dysfunction, 12/24 (50%) required inotropic support, and 10/24 (41.67%) developed coronary anomalies (CALs). All patients received steroids and IVIG at a median time of 5 days (IQR1:4, IQR3:6.5) from onset of fever and heart function normalized 6 days (IQR1: 5, IQR3: 7) after therapy, while CALs persisted in one. One patient (12.5%) required infliximab because of refractory disease and still presented CALs 18 days after therapy. During the same study period, 15 KD were diagnosed: none had ventricular dysfunction, while 7/15 (46.67%) developed CALs. Three out of 15 patients (20%) still presented CALs 46 days from onset. Compared to KD, MIS-C pts have significantly higher IL8 and similar lymphocytes subpopulations. Despite a more severe presentation and initial cardiac findings compared to KD, the myocardial injury in MIS-C has a rapid response to immunomodulatory treatment (median time 6 days), in terms of ventricular function, valve regurgitations, and troponin. Incidence of CALs is similar at onset, but it tends to regress in most of the cases of MIS-C differently than in KD where CALs persist in up to 40% in the subacute stage after treatment.


Subject(s)
COVID-19/complications , COVID-19/pathology , Mucocutaneous Lymph Node Syndrome/pathology , Myocardium/pathology , Systemic Inflammatory Response Syndrome/pathology , Ventricular Dysfunction, Left/pathology , Adolescent , COVID-19/diagnosis , COVID-19/epidemiology , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Interleukin-10/blood , Interleukin-8/blood , Italy/epidemiology , Male , Mucocutaneous Lymph Node Syndrome/diagnosis , Prospective Studies , SARS-CoV-2/metabolism , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/epidemiology , Ventricular Dysfunction, Left/virology
4.
Clin Res Cardiol ; 109(12): 1549-1566, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1384407

ABSTRACT

BACKGROUND: Myocardial involvement induced by SARS-CoV-2 infection might be important for long-term prognosis. The aim of this observational study was to characterize the myocardial effects during SARS-CoV-2 infections by echocardiography. RESULTS AND METHODS: An extended echocardiographic image acquisition protocol was performed in 18 patients with SARS-CoV-2 infection assessing LV longitudinal, radial, and circumferential deformation including rotation, twist, and untwisting. Furthermore, LV deformation was analyzed in an age-matched control group of healthy individuals (n = 20). The most prevalent finding was a reduced longitudinal strain observed predominantly in more than one basal LV segment (n = 10/14 patients, 71%). This pattern reminded of a "reverse tako-tsubo" morphology that is not typical for other viral myocarditis. Additional findings included a biphasic pattern with maximum post-systolic or negative regional radial strain predominantly basal (n = 5/14 patients, 36%); the absence or dispersion of basal LV rotation (n = 6/14 patients, 43%); a reduced or positive regional circumferential strain in more than one segment (n = 7/14 patients, 50%); a net rotation showing late post-systolic twist or biphasic pattern (n = 8/14 patients, 57%); a net rotation showing polyphasic pattern and/or higher maximum net values during diastole (n = 8/14 patients, 57%). CONCLUSION: Myocardial involvement due to SARS-CoV-2-infection was highly prevalent in the present cohort-even in patients with mild symptoms. It appears to be characterized by specific speckle tracking deformation abnormalities in the basal LV segments. These data set the stage to prospectively test whether these parameters are helpful for risk stratification and for the long-term follow-up of these patients.


Subject(s)
COVID-19/complications , Echocardiography , Heart/diagnostic imaging , Myocarditis/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/virology , Case-Control Studies , Female , Heart/physiopathology , Heart/virology , Host-Pathogen Interactions , Humans , Male , Middle Aged , Myocarditis/physiopathology , Myocarditis/virology , Predictive Value of Tests , SARS-CoV-2/pathogenicity , Severity of Illness Index , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/virology , Ventricular Function, Left
5.
Heart Lung Circ ; 30(8): 1117-1129, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1101247

ABSTRACT

COVID-19 has rapidly spread around the world and threatened global health. Although this disease mainly affects the respiratory system, there is increasing evidence that SARS-CoV-2 also has effects on the cardiovascular system. Echocardiography is a valuable tool in the assessment of cardiovascular disease. It is cost-effective, widely available and provides information that can influence management. Given the risk of personnel infection and equipment contamination during echocardiography, leading world societies have recommended performing echocardiography only when a clinical benefit is likely, favouring focussed evaluations and using smaller portable equipment. In the past months, multiple reports have described a wide pattern of echocardiographic abnormalities in patients with COVID-19. This review summarises these findings and discusses the possible mechanisms involved.


Subject(s)
COVID-19/complications , Echocardiography , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Right/diagnostic imaging , Biomarkers/blood , Humans , Prognosis , SARS-CoV-2 , Ventricular Dysfunction, Left/blood , Ventricular Dysfunction, Left/virology , Ventricular Dysfunction, Right/blood , Ventricular Dysfunction, Right/virology
6.
J Korean Med Sci ; 35(40): e366, 2020 Oct 19.
Article in English | MEDLINE | ID: covidwho-881335

ABSTRACT

BACKGROUND: This study aimed to investigate the cardiac manifestations of coronavirus disease 2019 (COVID-19). METHODS: From February to March 2020, we prospectively and retrospectively enrolled consecutive patients diagnosed with COVID-19. Patient's data such as the demographic characteristics, symptoms, vital signs, laboratory and radiologic findings, electrocardiographic, and echocardiographic data, including the global longitudinal strain (GLS) of both ventricles, were obtained. RESULTS: Forty patients (median age, 58 years; 50% men) were enrolled in the initial analysis. Patients were classified into severe and nonsevere groups based on the current guidelines. The 13 patients in the severe group were significantly older, had a greater prevalence of bilateral pneumonia and leukocytosis, and higher aspartate transaminase levels than patients in the nonsevere group. Patients in the severe group had a slightly lower left ventricular ejection fraction (LVEF) than those in the nonsevere group (median [interquartile range], 61.0% [58.5%, 62.3%] vs. 66.7% [60.6%, 69.8%], P = 0.015). In a subgroup of 34 patients in whom GLS could be analyzed, patients in the severe group had a significantly impaired left ventricular GLS (LVGLS) than those in the nonsevere group (-18.1% [-18.8%, -17.1%] vs. -21.7% [-22.9%, -19.9%], P = 0.001). There were no significant differences in total wall (RVGLStotal, -19.3% [-23.9%, -18.4%] vs. -24.3% [-26.0%, -22.6%], P = 0.060) and free wall (RVGLSfw, -22.7% [-27.2%, -18.6%] vs. -28.8% [-30.4%, -24.1%], P = 0.066) right ventricle GLS (RVGLS). CONCLUSION: Patients with severe COVID-19 had lower LVEF and LVGLS. RVGLS was not different between patients with severe and nonsevere COVID-19.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Heart Diseases/diagnosis , Heart Diseases/virology , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Adult , Aged , Betacoronavirus , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Echocardiography , Electrocardiography , Female , Heart/physiopathology , Heart Ventricles , Hospitalization , Humans , Male , Middle Aged , Observer Variation , Pandemics , Prospective Studies , Reproducibility of Results , Retrospective Studies , SARS-CoV-2 , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/virology , Ventricular Function, Left
7.
Future Cardiol ; 17(4): 655-661, 2021 07.
Article in English | MEDLINE | ID: covidwho-841164

ABSTRACT

COVID-19 infection can affect the cardiovascular system. We sought to determine if left ventricular global longitudinal strain (LVGLS) is affected by COVID-19 and if this has prognostic implications. Materials & methods: Retrospective study, with LVGLS was measured in 58 COVID-19 patients. Patients discharged were compared with those who died. Results: The mean LV ejection fraction (LVEF) and LVGLS for the cohort was 52.1 and -12.9 ± 4.0%, respectively. Among 30 patients with preserved LVEF (>50%), LVGLS was -15.7 ± 2.8%, which is lower than the reference mean LVGLS for a normal, healthy population. There was no significant difference in LVGLS or LVEF when comparing patients who survived to discharge or died. Conclusion: LVGLS was reduced in COVID-19 patients, although not significantly lower in those who died compared with survivors.


Subject(s)
COVID-19/complications , Echocardiography/methods , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/virology , Female , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors , SARS-CoV-2 , Stroke Volume
8.
Mayo Clin Proc ; 95(11): 2464-2466, 2020 11.
Article in English | MEDLINE | ID: covidwho-779413

ABSTRACT

Coronavirus disease 2019 (COVID-19) can result in deterioration of cardiac function, which is associated with high mortality. A simple point-of-care diagnostic test to screen for ventricular dysfunction would be clinically useful to guide management. We sought to review the clinical experience with an artificial intelligence electrocardiogram (AI ECG) to screen for ventricular dysfunction in patients with documented COVID-19. We examined all patients in the Mayo Clinic system who underwent clinically indicated electrocardiography and echocardiography within 2 weeks following a positive COVID-19 test and had permitted use of their data for research were included. Of the 27 patients who met the inclusion criteria, one had a history of normal ventricular function who developed COVID-19 myocarditis with rapid clinical decline. The initial AI ECG in this patient indicated normal ventricular function. Repeat AI ECG showed a probability of ejection fraction (EF) less than or equal to 40% of 90.2%, corroborated with an echocardiographic EF of 35%. One other patient had a pre-existing EF less than or equal to 40%, accurately detected by the algorithm before and after COVID-19 diagnosis, and another was found to have a low EF by AI ECG and echocardiography with the COVID-19 diagnosis. The area under the curve for detection of EF less than or equal to 40% was 0.95. This case series suggests that the AI ECG, previously shown to detect ventricular dysfunction in a large general population, may be useful as a screening tool for the detection of cardiac dysfunction in patients with COVID-19.


Subject(s)
Artificial Intelligence , Coronavirus Infections/complications , Electrocardiography/methods , Pneumonia, Viral/complications , Ventricular Dysfunction, Left/diagnosis , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Echocardiography , Feasibility Studies , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Ventricular Dysfunction, Left/virology
9.
ESC Heart Fail ; 7(5): 2838-2852, 2020 10.
Article in English | MEDLINE | ID: covidwho-643370

ABSTRACT

AIMS: Left ventricular (LV) dysfunction in viral myocarditis is attributed to myocardial inflammation and fibrosis, inducing acute and long-time cardiac damage. Interventions are not established. On the basis of the link between inflammation, fibrosis, aldosterone, and extracellular matrix regulation, we aimed to investigate the effect of an early intervention with the mineralocorticoid receptor antagonist (MRA) eplerenone on cardiac remodelling in a murine model of persistent coxsackievirus B3 (CVB3)-induced myocarditis. METHODS AND RESULTS: SWR/J mice were infected with 5 × 104 plaque-forming units of CVB3 (Nancy strain) and daily treated either with eplerenone (200 mg/kg body weight) or with placebo starting from Day 1. At Day 8 or 28 post infection, mice were haemodynamically characterized and subsequently sacrificed for immunohistological and molecular biology analyses. Eplerenone did not influence CVB3 load. Already at Day 8, 1.8-fold (P < 0.05), 1.4-fold (P < 0.05), 3.2-fold (P < 0.01), and 2.1-fold (P < 0.001) reduction in LV intercellular adhesion molecule 1 expression, presence of monocytes/macrophages, oxidative stress, and apoptosis, respectively, was observed in eplerenone-treated vs. untreated CVB3-infected mice. In vitro, eplerenone led to 1.4-fold (P < 0.01) and 1.2-fold (P < 0.01) less CVB3-induced cardiomyocyte oxidative stress and apoptosis. Furthermore, collagen production was 1.1-fold (P < 0.05) decreased in cardiac fibroblasts cultured with medium of eplerenone-treated vs. untreated CVB3-infected HL-1 cardiomyocytes. These ameliorations were in vivo translated into prevention of cardiac fibrosis, as shown by 1.4-fold (P < 0.01) and 2.1-fold (P < 0.001) lower collagen content in the LV of eplerenone-treated vs. untreated CVB3-infected mice at Days 8 and 28, respectively. This resulted in an early and long-lasting improvement of LV dimension and function, as indicated by reduced LV end-systolic volume and end-diastolic volume, and an increase in LV contractility (dP/dtmax ) and LV relaxation (dP/dtmin ), respectively (P < 0.05). CONCLUSIONS: Early intervention with the MRA eplerenone modulates the acute host and defence reaction and prevents cardiac disease progression in experimental CVB3-induced myocarditis without aggravation of viral load. The findings advocate for an initiation of therapy of viral myocarditis as early as possible, even before the onset of inflammation-induced myocardial dysfunction. This may also have implications for coronavirus disease-19 therapy.


Subject(s)
Endomyocardial Fibrosis/prevention & control , Enterovirus B, Human/pathogenicity , Eplerenone/pharmacology , Myocarditis/drug therapy , Myocarditis/virology , Ventricular Dysfunction, Left/virology , Analysis of Variance , Animals , Biopsy, Needle , Disease Models, Animal , Disease Progression , Endomyocardial Fibrosis/pathology , Immunohistochemistry , Male , Matrix Metalloproteinases/drug effects , Matrix Metalloproteinases/metabolism , Mice , Mice, Transgenic , Myocarditis/prevention & control , Random Allocation , Reference Values , Treatment Outcome , Ventricular Dysfunction, Left/pathology , Ventricular Dysfunction, Left/physiopathology
10.
JAMA Cardiol ; 5(7): 819-824, 2020 07 01.
Article in English | MEDLINE | ID: covidwho-17622

ABSTRACT

Importance: Virus infection has been widely described as one of the most common causes of myocarditis. However, less is known about the cardiac involvement as a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Objective: To describe the presentation of acute myocardial inflammation in a patient with coronavirus disease 2019 (COVID-19) who recovered from the influenzalike syndrome and developed fatigue and signs and symptoms of heart failure a week after upper respiratory tract symptoms. Design, Setting, and Participant: This case report describes an otherwise healthy 53-year-old woman who tested positive for COVID-19 and was admitted to the cardiac care unit in March 2020 for acute myopericarditis with systolic dysfunction, confirmed on cardiac magnetic resonance imaging, the week after onset of fever and dry cough due to COVID-19. The patient did not show any respiratory involvement during the clinical course. Exposure: Cardiac involvement with COVID-19. Main Outcomes and Measures: Detection of cardiac involvement with an increase in levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T, echocardiography changes, and diffuse biventricular myocardial edema and late gadolinium enhancement on cardiac magnetic resonance imaging. Results: An otherwise healthy 53-year-old white woman presented to the emergency department with severe fatigue. She described fever and dry cough the week before. She was afebrile but hypotensive; electrocardiography showed diffuse ST elevation, and elevated high-sensitivity troponin T and NT-proBNP levels were detected. Findings on chest radiography were normal. There was no evidence of obstructive coronary disease on coronary angiography. Based on the COVID-19 outbreak, a nasopharyngeal swab was performed, with a positive result for SARS-CoV-2 on real-time reverse transcriptase-polymerase chain reaction assay. Cardiac magnetic resonance imaging showed increased wall thickness with diffuse biventricular hypokinesis, especially in the apical segments, and severe left ventricular dysfunction (left ventricular ejection fraction of 35%). Short tau inversion recovery and T2-mapping sequences showed marked biventricular myocardial interstitial edema, and there was also diffuse late gadolinium enhancement involving the entire biventricular wall. There was a circumferential pericardial effusion that was most notable around the right cardiac chambers. These findings were all consistent with acute myopericarditis. She was treated with dobutamine, antiviral drugs (lopinavir/ritonavir), steroids, chloroquine, and medical treatment for heart failure, with progressive clinical and instrumental stabilization. Conclusions and Relevance: This case highlights cardiac involvement as a complication associated with COVID-19, even without symptoms and signs of interstitial pneumonia.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Myocarditis/virology , Pericarditis/virology , Pneumonia, Viral/complications , Ventricular Dysfunction, Left/virology , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Humans , Middle Aged , Myocarditis/diagnostic imaging , Myocarditis/therapy , Pandemics , Pericarditis/diagnostic imaging , Pericarditis/therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , SARS-CoV-2 , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/therapy
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