Impact of the COVID-19 pandemic on cardiology fellow echocardiography education at a large academic center.

BACKGROUND: In response to COVID-19 pandemic state restrictions, our institution deferred elective procedures from 3/15/2020 to 6/13/2020, and removed cardiology fellows from the echocardiography rotation to staff clinical services. We assessed the impact of the COVID-19 pandemic on fellow education and echocardiography volumes. METHODS: Our institutional database was used to examine volumes of transthoracic (TTE), stress (SE), and transesophageal echocardiograms (TEE) from 7/1/2018 to 10/10/2020. Study volumes were compared in three intervals: pre-pandemic (7/1/2018- 3/14/2020), pandemic (3/15/2020-6/13/2020), and pandemic recovery (6/14/2020-10/10/2020). We examined weekly number of TTEs performed or interpreted by cardiology fellows during the study period, and compared these to the two previous academic years. RESULTS: Weekly TTE volume declined by 54% during the pandemic, and increased by 99% during pandemic recovery, (p < 0.05). SE and TEE revealed similar trends. A strong correlation between weekly TTE volume and inpatient admissions was observed during the study period (rs=0.67, p < 0.05). Weekly fellow TTE scans declined by 78% during the pandemic, with a 380% increase during pandemic recovery (p < 0.05). Weekly fellow TTE interpretations declined by 56% during the pandemic, with a 76% increase during pandemic recovery (p < 0.05). CONCLUSION: COVID restrictions between 3/15/2020- 6/14/2020 coincided with a marked decline in TTE, SE, and TEE volumes, with an increase similar to near pre-pandemic volumes during the pandemic recovery period. A similar decline with the onset of COVID restrictions, and increase to pre-restriction volumes thereafter was observed with fellow scans and interpretations, but total academic year fellow training volumes remained depressed. With the ongoing COVID-19 pandemic and rise of multiple variants, training programs may need to adjust fellows' clinical responsibilities so as to support achievement of echocardiography training certification.

Incidence of Myopericarditis and Myocardial Injury in Coronavirus Disease 2019 Vaccinated Subjects.

Several recent publications have described myopericarditis cases after the coronavirus disease 2019 (COVID-19) vaccination. However, it is uncertain if these cases occurred secondary to the vaccination or more common etiologies of myopericarditis. To help determine whether a correlation exists between COVID-19 vaccination and myopericarditis, the present study compared the gender-specific cumulative incidence of myopericarditis and myocardial injury in a cohort of COVID-19 vaccinated patients at a tertiary care center in 2021 with the cumulative incidence of these conditions in the same subjects exactly 2 years earlier. We found that the age-adjusted incidence rate of myopericarditis in men was higher in the vaccinated than the control population, rate ratio 9.7 (p = 0.04). However, the age-adjusted incidence rate of myopericarditis in women was no different between the vaccinated and control populations, rate ratio 1.28 (p = 0.71). We further found that the rate of myocardial injury was higher in both men and women in 2021 than in 2019 both before and after vaccination, suggesting that some of the apparent increase in the diagnosis of myopericarditis after vaccination may be attributable to factors unrelated to the COVID-19 vaccinations. In conclusion, our study reaffirms the apparent increase in the diagnosis of myopericarditis after COVID-19 vaccination in men but not in women, although this finding may be confounded by increased rates of myocardial injury in 2021. The benefits of COVID-19 vaccination to individual and public health clearly outweigh the small potential increased risk of myopericarditis after vaccination.

Stress responses and baroreflex function in coronary disease.

Exaggerated pressor responses to mental stress in patients with coronary artery disease (CAD) are associated with increased risk for subsequent cardiovascular events. The integrated baroreflex gain and its mechanical and neural component were estimated and then related to the blood pressure and heart rate responses to simulated real-life stressors: mental arithmetic and public speaking. Eighteen healthy individuals (aged 61 +/- 8 yr) and 29 individuals with documented CAD but no other comorbidities (aged 59 +/- 8 yr) were studied. Heart rate and blood pressures were continuously assessed before, during preparation for, and during performance of a math task and a speech task. The assessment of beat-to-beat carotid diameters during baroreflex engagement was used to estimate the integrated baroreflex gain and its mechanical and neural component. The CAD subjects demonstrated significantly greater increases in heart rate and blood pressures for the performance of the speech task. However, there were no group differences in integrated cardiovagal baroreflex gain or either mechanical or neural baroreflex component. These findings indicate that the augmented pressor responses in CAD do not result from a generalized arterial baroreflex deficit.