Impact of COVID-19 on the imaging diagnosis of cardiac disease in Europe.

OBJECTIVES: We aimed to explore the impact of the COVID-19 pandemic on cardiac diagnostic testing and practice and to assess its impact in different regions in Europe. METHODS: The online survey organised by the International Atomic Energy Agency Division of Human Health collected information on changes in cardiac imaging procedural volumes between March 2019 and March/April 2020. Data were collected from 909 centres in 108 countries. RESULTS: Centres in Northern and Southern Europe were more likely to cancel all outpatient activities compared with Western and Eastern Europe. There was a greater reduction in total procedure volumes in Europe compared with the rest of the world in March 2020 (45% vs 41%, p=0.003), with a more marked reduction in Southern Europe (58%), but by April 2020 this was similar in Europe and the rest of the world (69% vs 63%, p=0.261). Regional variations were apparent between imaging modalities, but the largest reductions were in Southern Europe for nearly all modalities. In March 2020, location in Southern Europe was the only independent predictor of the reduction in procedure volume. However, in April 2020, lower gross domestic product and higher COVID-19 deaths were the only independent predictors. CONCLUSION: The first wave of the COVID-19 pandemic had a significant impact on care of patients with cardiac disease, with substantial regional variations in Europe. This has potential long-term implications for patients and plans are required to enable the diagnosis of non-COVID-19 conditions during the ongoing pandemic.

Impact of COVID-19 on Cardiovascular Testing in the United States Versus the Rest of the World.

OBJECTIVES: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-U.S. institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. BACKGROUND: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. METHODS: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. RESULTS: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. CONCLUSIONS: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection.

International Impact of COVID-19 on the Diagnosis of Heart Disease.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. OBJECTIVES: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. METHODS: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. RESULTS: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower-middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. CONCLUSIONS: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19-related changes in care delivery is warranted.

Crystal structure of poly[µ2-aqua-aqua-(µ2-4-nitro-2,5,6-trioxo-1,2,5,6-tetra-hydro-pyridin-3-olato)hemi-µ4-oxalato-barium(II)].

In the title coordination polymer, [Ba(C5HN2O6)(C2O4)0.5(H2O)2] n , the tenfold coordination of the Ba centre consists of four O atoms from the two 4-nitro-2,5,6-trioxo-1,2,5,6-tetra-hydro-pyridin-3-olate (L) anions, three O atoms of two oxalate anions and three water mol-ecules. The Ba-O bond lengths fall in the range 2.698 (3)-2.978 (3) Å. The L ligand chelates two Ba atoms related by a screw axis, leading to formation of fused five- and six-membered chelate rings. Due to the bridging function of the ligands and water mol-ecules, the complex monomers are connected into polymeric two-dimensional layers parallel to the bc plane. Inter-molecular O-H⋯O hydrogen bonds link these layers into a three-dimensional supra-molecular framework.

Lariat ethers with fluoroaryl side-arms: a study of CFmetal cation interaction in the complexes of N-(o-fluoroaryl)azacrown ethers.

New lariat ethers, N-(o-fluorophenyl)aza-15-crown-5 (F-A15C5) and N,N'-bis(o-fluorophenyl)diaza-18-crown-6 (F(2)-A(2)18C6), were prepared by the N-arylation of the corresponding azacrown ethers. The interaction of the ligands with metal cations was studied in solution by (1)H and (19)F NMR (in acetone-d(6)) and UV spectroscopy (MeOH) confirming the formation of complexes of F(2)-A(2)18C6 with K(+), Na(+), Ag(+), Ba(2+), Pb(2+) and of F-A15C5 with Na(+) and giving evidence of CFmetal cation interaction. Cation binding constants (beta, evaluated by UV titration method), demonstrate that F-A15C5 and F(2)-A(2)18C6 form more stable complexes than their fluorine-free analogs. The effect depends on the nature of the metal cation and is at a maximum for hard, singly charged cations (up to 3 logbeta units for K(+) complex of F(2)-A(2)18C6). The X-ray structures of complexes [Pb(F(2)-A(2)18C6)(H(2)O)](ClO(4))(2) () and [Ba(F(2)-A(2)18C6)(ClO(4))(2)] () reveal short Pb-F (2.805 A) and Ba-F (2.965 A) contacts. Complex is centrosymmetric (C(i)), while complex has C(2) symmetry with one-side coordination of o-fluorophenyl groups to Pb(2+). This "one-side" coordination mode of Pb(2+) is indicative of a partial localization of the Pb(2+) lone pair.