Comparison of clinical and echocardiographic parameters of patients with COVID-19 pneumonia three months and one year after discharge.

Aim    To study changes in clinical and echocardiographic parameters in patients after documented COVID-19 pneumonia at 3 months and one year following discharge from the hospital. Material and methods    The study included 116 patients who have had documented COVID-19 pneumonia. Patients underwent a comprehensive clinical evaluation at 3 months ± 2 weeks (visit 1) and at one year ± 3 weeks after discharge from the hospital (visit 2). Mean age of the patients was 49.0±14.4 years (from 19 to 84 years); 49.6 % were women. Parameters of global and segmentary longitudinal left ventricular (LV) myocardial strain were studied with the optimal quality of visualization during visit 1 in 99 patients and during visit 2 in 80 patients.Results    During the follow-up period, the incidence rate of cardiovascular diseases (CVD) increased primarily due to development of arterial hypertension (AH) (58.6 vs. 64.7 %, р=0.039) and chronic heart failure (CHF) (35.3% vs. 40.5 %, р=0.031). Echocardiography (EchoCG) showed decreases in values of end-diastolic dimension and volume, LV end-systolic and stroke volumes (25.1±2.6 vs. 24.5±2.2 mm /m2, p<0.001; 49.3±11.3 vs. 46.9±9.9 ml /m2, p=0.008; 16.0±5.6 vs. 14.4±4.1 ml /m2, p=0.001; 36.7±12.8 vs. 30.8±8.1 ml /m2, p<0.001, respectively). LV external short-axis area (37.1 [36.6-42.0] vs. 38.7 [35.2-43.1] cm2, р=0.001) and LV myocardial mass index calculated with the area-length formula (70.0 [60.8-84.0] vs. 75.4 [68.2-84.9] g /m², р=0.024) increased. LV early diastolic filling velocity (76.7±17.9 vs. 72.3±16.0 cm /sec, р=0.001) and lateral and septal early diastolic mitral annular velocities decreased (12,10±3,9 vs. 11.5±4.1 cm /sec, р=0.004 and 9.9±3.3 vs. 8.6±3.0 cm /sec, р<0.001, respectively). The following parameters of LV global longitudinal (-20.3±2.2 vs. -19.4±2.7 %, р=0.001) and segmental strain were impaired: apical segments (anterior, from -22.3±5.0 to -20.8±5.2 %, р=0.006; inferior, from -24.6±4.9 to -22.7±4.6, р=0.003; lateral, from -22.7±4.5 to -20.4±4.8 %, р<0.001; septal, from -25.3±4.2 to -23.1±4.4 %, р<0.001; apical, from -23.7±4.1 to -21.8±4.1 %, р<0.001), mid-cavity (anteroseptal, from -21.1±3.3 to -20.4±4.1 %, р=0.039; inferior, from -21.0±2.7 to -20.0±2.9 %, р=0.039; lateral, from -18.4±3.7 to -17.6±4.4 %, р=0.021). RV basal and mid-cavity sphericity indexes increased (0.44±0.07 vs. 0.49±0.07 and 0.37±0.07 vs. 0.41±0.07, respectively, р<0.001 for both). A tendency for increased calculated pulmonary arterial systolic pressure (22.5±7.1 and 23.3±6.3 mm Hg, р=0.076) was observed. Right ventricular outflow tract velocity integral decreased (18.1±4.0 vs. 16.4±3.7 cm, р<0.001).Conclusion    Patients after COVID-19 pneumonia one year after discharge from the hospital, compared to the follow-up data 3 months after the discharge, had an increased incidence of CVD, primarily due to the development of AH and CHF. EchoCG revealed changes in ventricular geometry associated with impairment of LV diastolic and systolic function evident as decreases in LV global longitudinal strain and LV myocardial apical and partially mid-cavity strain.

[Percutaneous Coronary Interventions in Patients With ST-Elevation Myocardial Infarction: 10-Years Follow-up].

Aim      To study long-term results and to identify predictors of death in patients with ST-segment elevation acute myocardial infarction (STEMI) who underwent endovascular revascularization.Materials and methods This study included 283 patients registered in the hospital registry of percutaneous coronary interventions (PCI) for STEMI from 2006 through 2009. Analysis of 10-year results included all-cause and cardiovascular death rate, incidence of recurrent myocardial infarction (MI), repeated revascularization, stroke, stent restenosis and thrombosis. Also, a composite endpoint МАССЕ (Major Adverse Cardiovascular and Cerebrovascular Events) was evaluated, which included death, recurrent MI, repeated PCI, stent restenosis and thrombosis, coronary bypass, and stroke.Results Information about the health condition was provided by 204 (72.1 %) patients. Mean follow-up period was 120.1±9.5 months. All-cause mortality was 25.5 % with cardiovascular death determined in 19.1 % of cases. Recurrent MI developed in 21.6 % of patients; in 1.5 % of cases, recurrent MI resulted from thrombosis of previously implanted stents. Repeated PCI was performed for 31.9 % of patients; in 13.7 % of cases, the PCI was performed for stent restenosis. Coronary bypass was performed for 5.4 % of patients. Incidence of stroke was 10.3 %. Major cardiovascular and cerebrovascular complications (МАССЕ) during the follow-up period were determined in 60.3 % patients. According to the Cox proportional hazards regression model, age ≥65 years (odds ratio (OR), 3.75 at 95 % confidence interval (CI) from 1.75 to 8.03; р=0.001) and incomplete coronary revascularization (OR, 3.09 at 95 % CI from 1.52 to 6.30; р=0.002) were independent predictors of death based on data of the 10-year observation.Conclusion      Therefore, at 10 years following endovascular revascularization, STEMI patients showed a moderate death rate with a high incidence of major cardiovascular and cerebrovascular complications. The leading causes for fatal outcomes were recurrent cardiovascular complications. The major predictors of death for the coming 10-year period included age ≥65 years and incomplete myocardial revascularization.