Cardiac involvement in Adult Multisystemic Inflammatory Syndrome related to COVID-19. Two case reports.

In this article we describe two cases that presented with persistent fever and a hyperinflammatory state in association with severe acute respiratory syndrome-coronavirus-2 infection with various negative reverse transcription-polymerase chain reaction results. These cases subsequently developed myocarditis with cardiogenic shock that required vasoactive drugs and had a good response to corticosteroid treatment. All cases met criteria for a definitive case of multisystemic inflammatory syndrome in adults, a recently described entity associated with coronavirus disease 2019, which has a good response to immunomodulators and a good prognosis in most cases. .

Real-time three-dimensional echocardiography in aortic stenosis: a novel, simple, and reliable method to improve accuracy in area calculation.

AIMS: The aim of the study was to validate a novel formula for aortic area, based on the principle of continuity equation (CE), that substitutes Doppler-derived stroke volume (SV) by SV directly measured with real-time three-dimensional (RT3D) echo and semi-automated border detection. RT3D has proved outstanding accuracy for left ventricular volume calculation. So far, however, neither this potential has been applied to haemodynamic assessment, nor RT3D has succeeded in the evaluation of aortic valve disease. METHODS AND RESULTS: Aortic area was measured in 41 patients with aortic stenosis using Gorlin's equation, Hakki's formula, Doppler CE, two-dimensional Simpson's volumetric method, and by the novel RT3D method. RT3D has the best linear association and absolute agreement with Gorlin of all non-invasive methods r = 0.902, intraclass correlation coefficient (ICC) = 0.846, better than CE (r = 0.646, ICC = 0.626) and two-dimensional volumetric method (r = 0.627, ICC = 0.378). Linear and Passing-Bablok regression show that RT3D fits better to Gorlin (r(2) = 0.814) than CE (r(2) = 0.417) and two-dimensional method (r(2) = 0.393). Its accuracy is comparable to Hakki's formula, routinely employed in catheter laboratories. Inter- and intraobserver agreements (ICC) were, respectively, 0.732 and 0.985, better than CE (0.662, 0.857). RT3D also grades most efficiently the severity of aortic stenosis as mild, moderate, or severe (weighted kappa = 0.932). RT3D underestimates aortic area (95% CI 0.084-0.193). ROC curves, however, show that the optimal cutoff point to consider aortic stenosis severity remains close to 1 cm(2) (1.06 cm(2)). CONCLUSIONS: RT3D is more accurate than CE and than two-dimensional volumetric methods to calculate area and to grade the severity of aortic stenosis. Area obtained by three-dimensional echo is slightly underestimated, but its range is clinically negligible.

Enfermedad cardiovascular y función renal. Mecanismos patogénicos / Cardiovascular disease and renal function. Pathogenetic mechanisms

Los pacientes con insuficiencia renal crónica tienen más probabilidad de morir por causa cardiovascular que de progresar a insuficiencia renal terminal. La excreción urinaria de albúmina es un marcador de riesgo tanto de enfermedad renal como de enfermedad cardiovascular en diabéticos y no diabéticos. En la insuficiencia renal crónica, la hipertensión, la dislipemia y la diabetes mellitus son los principales factores de riesgo de disfunción endotelial, inflamación, estrés oxidativo y arteriosclerosis acelerada. La inhibición del sistema renina-angiotensina enlentece la progresión de la enfermedad renal en la diabetes mellitus tipos 1 y 2 y en los no diabéticos con nefropatía. El grado de reducción de albuminuria se relaciona con el riesgo cardiovascular en la diabetes mellitus tipo 2 y la nefropatía. La excreción urinaria de albúmina debe ser utilizada como objetivo terapéutico similar a la presión arterial para reducir las complicaciones renales y cardiovasculares en pacientes con nefropatía (AU)

Patients with chronic kidney failure are more likely to die of cardiovascular disease than to develop end-stage kidney failure. Urinary albumin excretion is a risk marker for both renal and cardiovascular disease in diabetics and nondiabetics. In patients with chronic kidney failure, hypertension, dyslipidemia and diabetes are the main risk factors for the development of endothelial dysfunction, inflammation, oxidative stress and accelerated atherosclerosis. Inhibition of the renin-angiotensin system slows the progression of renal disease in patients with type-1 or type-2 diabetes as well as in nondiabetic patients with nephropathy. In those with type-2 diabetes or nephropathy, there is an association between the degree of albuminuria reduction and cardiovascular risk. The level of urinary albumin excretion should be used as a therapeutic target, like blood pressure, for reducing renal and cardiovascular complications in patients with nephropathy (AU)