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1.
Acad Radiol ; 28(1): 8-17, 2021 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1023392

RESUMEN

RATIONALE AND OBJECTIVES: Cardiac indices can predict disease severity and survival in a multitude of respiratory and cardiovascular diseases. Herein, we hypothesized that CT-measured cardiac indices are correlated with severity of lung involvement and can predict survival in patients with COVID-19. MATERIALS AND METHODS: Eighty-seven patients with confirmed COVID-19 who underwent chest CT were enrolled. Cardiac indices including pulmonary artery-to-aorta ratio (PA/A), cardiothoracic ratio (CTR), epicardial adipose tissue (EAT) thickness and EAT density, inferior vena cava diameter, and transverse-to-anteroposterior trachea ratio were measured by non-enhanced CT. Logistic regression and Cox-regression analyses evaluated the association of cardiac indices with patients' outcome (death vs discharge). Linear regression analysis was used to assess the relationship between the extent of lung involvement (based on CT score) and cardiac indices. RESULTS: Mean (±SD) age of patients was 54.55 (±15.3) years old; 65.5% were male. Increased CTR (>0.49) was seen in 52.9% of patients and was significantly associated with increased odds and hazard of death (odds ratio [OR] = 12.5, p = 0.005; hazard ratio = 11.4, p = 0.006). PA/A >1 was present in 20.7% of patients and displayed a nonsignificant increase in odds of death (OR = 1.9, p = 0.36). Furthermore, extensive lung involvement was positively associated with elevated CTR and increased PA/A (p = 0.001). CONCLUSION: CT-measured cardiac indices might have predictive value regarding survival and extent of lung involvement in hospitalized patients with COVID-19 and could possibly be used for the risk stratification of these patients and for guiding therapy decision-making. In particular, increased CTR is prevalent in patients with COVID-19 and is a powerful predictor of mortality.


Asunto(s)
Corazón , Pulmón , Tomografía Computarizada por Rayos X , Adulto , Anciano , Femenino , Corazón/diagnóstico por imagen , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Persona de Mediana Edad , Miocardio/patología , Pandemias , Pronóstico , Estudios Retrospectivos
2.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artículo en Inglés | MEDLINE | ID: covidwho-963649

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st,  the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.


Asunto(s)
Cardiomegalia/diagnóstico por imagen , Infecciones por Coronavirus/diagnóstico por imagen , Corazón/diagnóstico por imagen , Isquemia Miocárdica/diagnóstico por imagen , Miocarditis/diagnóstico por imagen , Derrame Pericárdico/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Betacoronavirus , Cardiomegalia/fisiopatología , Angiografía Coronaria , Infecciones por Coronavirus/fisiopatología , Ecocardiografía , Edema/diagnóstico por imagen , Edema/fisiopatología , Corazón/fisiopatología , Humanos , Imagen por Resonancia Magnética , Isquemia Miocárdica/fisiopatología , Miocarditis/fisiopatología , Pandemias , Derrame Pericárdico/fisiopatología , Neumonía Viral/fisiopatología , Radiografía Torácica , Recuperación de la Función , Tomografía Computarizada por Rayos X , Disfunción Ventricular/diagnóstico por imagen , Disfunción Ventricular/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología
3.
Radiology ; 297(3): E283-E288, 2020 12.
Artículo en Inglés | MEDLINE | ID: covidwho-930393

RESUMEN

This case series examines cardiac MRI findings in four children and adolescents admitted to intensive care in April 2020 for multisystem inflammatory syndrome and Kawasaki disease-like features related to coronavirus disease 2019 (COVID-19). Acute myocarditis occurred less than 1 week after onset of fever and gastrointestinal symptoms. Physical examination showed rash and cheilitis or conjunctivitis. All patients recovered after intravenous immunoglobulin therapy. Severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction was negative in nasopharyngeal, stool, and respiratory samples and was positive on serology. Cardiac MRI showed diffuse myocardial edema on T2 short tau inversion-recovery sequences and native T1 mapping, with no evidence of late gadolinium enhancement suggestive of replacement fibrosis or focal necrosis. These findings favor postinfectious myocarditis in children and adolescents with COVID-19.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Imagen por Resonancia Magnética/métodos , Neumonía Viral/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico por imagen , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Betacoronavirus , Niño , Femenino , Corazón/diagnóstico por imagen , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Miocarditis/diagnóstico por imagen , Miocarditis/etiología , Miocarditis/terapia , Pandemias , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Resultado del Tratamiento
4.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artículo en Inglés | MEDLINE | ID: covidwho-918289

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st,  the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.


Asunto(s)
Cardiomegalia/diagnóstico por imagen , Infecciones por Coronavirus/diagnóstico por imagen , Corazón/diagnóstico por imagen , Isquemia Miocárdica/diagnóstico por imagen , Miocarditis/diagnóstico por imagen , Derrame Pericárdico/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Betacoronavirus , Cardiomegalia/fisiopatología , Angiografía Coronaria , Infecciones por Coronavirus/fisiopatología , Ecocardiografía , Edema/diagnóstico por imagen , Edema/fisiopatología , Corazón/fisiopatología , Humanos , Imagen por Resonancia Magnética , Isquemia Miocárdica/fisiopatología , Miocarditis/fisiopatología , Pandemias , Derrame Pericárdico/fisiopatología , Neumonía Viral/fisiopatología , Radiografía Torácica , Recuperación de la Función , Tomografía Computarizada por Rayos X , Disfunción Ventricular/diagnóstico por imagen , Disfunción Ventricular/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología
5.
J Am Coll Cardiol ; 76(18): 2043-2055, 2020 11 03.
Artículo en Inglés | MEDLINE | ID: covidwho-887081

RESUMEN

BACKGROUND: Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data. OBJECTIVES: This study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19. METHODS: We conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization. RESULTS: A total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities. CONCLUSIONS: Among patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Corazón/diagnóstico por imagen , Miocardio/patología , Neumonía Viral/diagnóstico por imagen , Disfunción Ventricular/virología , Anciano , Betacoronavirus , Biomarcadores/sangre , Angiografía Coronaria , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/mortalidad , Ecocardiografía , Electrocardiografía , Femenino , Corazón/fisiopatología , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Estudios Retrospectivos
6.
J Am Coll Cardiol ; 76(17): 1965-1977, 2020 10 27.
Artículo en Inglés | MEDLINE | ID: covidwho-872172

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a growing pandemic that confers augmented risk for right ventricular (RV) dysfunction and dilation; the prognostic utility of adverse RV remodeling in COVID-19 patients is uncertain. OBJECTIVES: The purpose of this study was to test whether adverse RV remodeling (dysfunction/dilation) predicts COVID-19 prognosis independent of clinical and biomarker risk stratification. METHODS: Consecutive COVID-19 inpatients undergoing clinical transthoracic echocardiography at 3 New York City hospitals were studied; images were analyzed by a central core laboratory blinded to clinical and biomarker data. RESULTS: In total, 510 patients (age 64 ± 14 years, 66% men) were studied; RV dilation and dysfunction were present in 35% and 15%, respectively. RV dysfunction increased stepwise in relation to RV chamber size (p = 0.007). During inpatient follow-up (median 20 days), 77% of patients had a study-related endpoint (death 32%, discharge 45%). RV dysfunction (hazard ratio [HR]: 2.57; 95% confidence interval [CI]: 1.49 to 4.43; p = 0.001) and dilation (HR: 1.43; 95% CI: 1.05 to 1.96; p = 0.02) each independently conferred mortality risk. Patients without adverse RV remodeling were more likely to survive to hospital discharge (HR: 1.39; 95% CI: 1.01 to 1.90; p = 0.041). RV indices provided additional risk stratification beyond biomarker strata; risk for death was greatest among patients with adverse RV remodeling and positive biomarkers and was lesser among patients with isolated biomarker elevations (p ≤ 0.001). In multivariate analysis, adverse RV remodeling conferred a >2-fold increase in mortality risk, which remained significant (p < 0.01) when controlling for age and biomarker elevations; the predictive value of adverse RV remodeling was similar irrespective of whether analyses were performed using troponin, D-dimer, or ferritin. CONCLUSIONS: Adverse RV remodeling predicts mortality in COVID-19 independent of standard clinical and biomarker-based assessment.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Ecocardiografía , Corazón/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Remodelación Ventricular , Anciano , Anciano de 80 o más Años , Betacoronavirus , Biomarcadores/sangre , Estudios de Cohortes , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Femenino , Corazón/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Pandemias , Neumonía Viral/sangre , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Medición de Riesgo
7.
Turk Kardiyol Dern Ars ; 48(7): 703-706, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-842020

RESUMEN

The clinical presentation of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2, can range from only mild, flu-like symptoms to severe progressive pneumonia. Cardiac involvement may be observed during the course of the infection and may include myocarditis, acute myocardial infarction, heart failure, and cardiac rhythm disturbances, but cases describing cardiac tamponade in patients previously diagnosed with COVID-19 are very rare. A 58-year-old female had been hospitalized in another hospital 2 weeks prior to the currently described presentation due to atypical pneumonia. A nasopharyngeal swab specimen was positive for COVID-19. The hospitalization was uncomplicated and she was discharged after a week. She presented at our emergency department with symptoms of shortness of breath and swelling in both legs. A bedside transthoracic echocardiography showed globally depressed left ventricular contraction with an ejection fraction of 30% and there was significant pericardial effusion, which surrounded the entire heart and restricted diastolic filling. The patient was admitted to the coronary intensive care unit with the diagnosis of pericardial tamponade. Bedside pericardiocentesis was performed and serohemorrhagic fluid was drained. Pericardial effusion and pericardial tamponade should be considered in the differential diagnosis of patients with COVID-19 exhibiting dyspnea or worsening of dyspnea. A 58-year-old female has been hospitalized in another hospital two weeks ago due to atypical pneumonia. Her nasopharyngeal swab specimen was positive for COVID-19. She had an uncomplicated course during the hospitalization and was discharged a week ago. She presented to our emergency department (ED) with symptoms of shortness of breath and swelling in both legs. We performed bedside transthoracic echocardiography (TTE) which showed globally depressed left ventricular contraction with ejection fraction (EF) of 30% and there was significant pericardial effusion which surrounded the entire heart and restricted diastolic filling. The patient was admitted to the coronary intensive care unit (CICU) with the diagnosis of pericardial tamponade. Bedside pericardiosentesis was performed and serohemorrhagic fluid was drained. Patients with COVID-19 infection who develops or have worsening dyspnea, pericardial effusion and pericardial tamponade should be considered in differential diagnosis.


Asunto(s)
Taponamiento Cardíaco/virología , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Betacoronavirus , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/patología , Femenino , Corazón/diagnóstico por imagen , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Persona de Mediana Edad , Miocardio/patología , Pandemias
10.
JACC Cardiovasc Imaging ; 13(8): 1792-1808, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-612980

RESUMEN

The severe acute respiratory syndrome-coronavirus-2 outbreak has rapidly reached pandemic proportions and has become a major threat to global health. Although the predominant clinical feature of coronavirus disease-2019 (COVID-19) is an acute respiratory syndrome of varying severity, ranging from mild symptomatic interstitial pneumonia to acute respiratory distress syndrome, the cardiovascular system can be involved in several ways. As many as 40% of patients hospitalized with COVID-19 have histories of cardiovascular disease, and current estimates report a proportion of myocardial injury in patients with COVID-19 of up to 12%. Multiple pathways have been suggested to explain this finding and the related clinical scenarios, encompassing local and systemic inflammatory responses and oxygen supply-demand imbalance. From a clinical point of view, cardiac involvement during COVID-19 may present a wide spectrum of severity, ranging from subclinical myocardial injury to well-defined clinical entities (myocarditis, myocardial infarction, pulmonary embolism, and heart failure), whose incidence and prognostic implications are currently largely unknown because of a significant lack of imaging data. Integrated heart and lung multimodality imaging plays a central role in different clinical settings and is essential in the diagnosis, risk stratification, and management of patients with COVID-19. The aims of this review are to summarize imaging-oriented pathophysiological mechanisms of lung and cardiac involvement in COVID-19 and to provide a guide for integrated imaging assessment in these patients.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Cardiopatías/diagnóstico , Corazón/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Imagen Multimodal/métodos , Neumonía Viral/diagnóstico , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Salud Global , Cardiopatías/epidemiología , Cardiopatías/etiología , Humanos , Incidencia , Imagen por Resonancia Cinemagnética/métodos , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Tomografía Computarizada por Rayos X/métodos
11.
J Cardiovasc Comput Tomogr ; 14(4): 291-293, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-591731

RESUMEN

The impact of the coronavirus disease (COVID-19) pandemic in the United States and around the world has required significant changes to medical practice. Amidst the rapidly evolving public health emergency, hospital centers have been required to postpone elective procedures, preserve personal protective equipment (PPE), practice social distancing and limit staff exposures. Patients with congenital heart disease (CHD) often need urgent evaluation, most commonly for preprocedural evaluation. We have stratified the most common indications for cardiac computed tomography (CCT) imaging in patients with CHD to help guide care for these patients during the COVID-19 pandemic including considerations for reopening.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Cardiopatías Congénitas/diagnóstico por imagen , Pandemias/prevención & control , Neumonía Viral/prevención & control , Tomografía Computarizada por Rayos X/métodos , Corazón/diagnóstico por imagen , Humanos , Riesgo
12.
Radiology ; 297(3): E283-E288, 2020 12.
Artículo en Inglés | MEDLINE | ID: covidwho-591393

RESUMEN

This case series examines cardiac MRI findings in four children and adolescents admitted to intensive care in April 2020 for multisystem inflammatory syndrome and Kawasaki disease-like features related to coronavirus disease 2019 (COVID-19). Acute myocarditis occurred less than 1 week after onset of fever and gastrointestinal symptoms. Physical examination showed rash and cheilitis or conjunctivitis. All patients recovered after intravenous immunoglobulin therapy. Severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction was negative in nasopharyngeal, stool, and respiratory samples and was positive on serology. Cardiac MRI showed diffuse myocardial edema on T2 short tau inversion-recovery sequences and native T1 mapping, with no evidence of late gadolinium enhancement suggestive of replacement fibrosis or focal necrosis. These findings favor postinfectious myocarditis in children and adolescents with COVID-19.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Imagen por Resonancia Magnética/métodos , Neumonía Viral/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico por imagen , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Betacoronavirus , Niño , Femenino , Corazón/diagnóstico por imagen , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Miocarditis/diagnóstico por imagen , Miocarditis/etiología , Miocarditis/terapia , Pandemias , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Resultado del Tratamiento
13.
Heart Rhythm ; 17(9): 1445-1451, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-436694

RESUMEN

BACKGROUND: Early during the current coronavirus disease 19 (COVID-19) pandemic, hydroxychloroquine (HCQ) received a significant amount of attention as a potential antiviral treatment, such that it became one of the most commonly prescribed medications for COVID-19 patients. However, not only has the effectiveness of HCQ remained questionable, but mainly based on preclinical and a few small clinical studies, HCQ is known to be potentially arrhythmogenic, especially as a result of QT prolongation. OBJECTIVE: The purpose of this study was to investigate the arrhythmic effects of HCQ, as the heightened risk is especially relevant to COVID-19 patients, who are at higher risk for cardiac complications and arrhythmias at baseline. METHODS: An optical mapping technique utilizing voltage-sensitive fluorescent dyes was used to determine the arrhythmic effects of HCQ in ex vivo guinea pig and rabbit hearts perfused with the upper therapeutic serum dose of HCQ (1000 ng/mL). RESULTS: HCQ markedly increased action potential dispersion, resulted in development of repolarization alternans, and initiated polymorphic ventricular tachycardia. CONCLUSION: The study results further highlight the proarrhythmic effects of HCQ.


Asunto(s)
Antimaláricos/farmacología , Frecuencia Cardíaca/efectos de los fármacos , Corazón/efectos de los fármacos , Corazón/fisiopatología , Hidroxicloroquina/farmacología , Animales , Estimulación Cardíaca Artificial , Infecciones por Coronavirus/tratamiento farmacológico , Cobayas , Corazón/diagnóstico por imagen , Conejos , Técnicas de Cultivo de Tejidos , Imagen de Colorante Sensible al Voltaje
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