RESUMO
The prevalence and clinical consequences of coronavirus disease 2019 (COVID-19)-related non-ischemic cardiac injury are under investigation. The main purpose of this study was to determine the occurrence of non-ischemic cardiac injury using cardiac magnetic resonance (CMR) imaging in patients with persistent cardiac symptoms following recovery from COVID-19 pneumonia. We conducted a single-center, cross-sectional study. Between January 2021 and May 2021, we enrolled 121 patients with a recent COVID-19 infection and persistent cardiac symptoms. Study participants were divided into those who required hospitalization during the acute phase of SARS-CoV-2 infection (n = 58; 47.9%) and those non-hospitalized (n = 63; 52.1%). Non-ischemic cardiac injury (defined as the presence of late gadolinium enhancement (LGE) lesion and/or active myocarditis in CMR) was detected in over half of post-COVID-19 patients (n = 64; 52.9%). LGE lesions were present in 63 (52.1%) and active myocarditis in 10 (8.3%) post-COVID-19 study participants. The majority of LGE lesions were located in the left ventricle at inferior and inferolateral segments at the base. There were no significant differences in the occurrence of LGE lesions (35 (60.3%) vs. 28 (44.4%); p = 0.117) or active myocarditis (6 (10.3%) vs. 4 (6.3%); p = 0.517) between hospitalized and non-hospitalized post-COVID-19 patients. However, CMR imaging revealed lower right ventricular ejection fraction (RVEF; 49.5 (44; 54) vs. 53 (50; 58) %; p = 0.001) and more frequent presence of reduced RVEF (60.3% vs. 33.3%; p = 0.005) in the former subgroup. In conclusion, more than half of our patients presenting with cardiac symptoms after a recent recovery from COVID-19 pneumonia had CMR imaging abnormalities indicating non-ischemic cardiac injury. The most common finding was LGE, while active myocarditis was detected in the minority of patients. CMR imaging abnormalities were observed both in previously hospitalized and non-hospitalized post-COVID-19 patients. Further research is needed to determine the long-term cardiovascular consequences of COVID-19 infection and the optimal management of patients with suspected post-COVID-19 non-ischemic cardiac injury.
RESUMO
Selection of the optimal peri- and postprocedural antithrombotic regimen in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is a common clinical problem which may pose a challenge to medical practitioners. This systematic review summarizes the updated evidence on this topic. Non-vitamin K oral anticoagulants (NOACs) at standard doses are the preferred option in most of post PCI patients with AF, except those few with a clear indication for a vitamin K antagonist (VKA). Reduced NOAC doses should be considered in dabigatran- or rivaroxaban-treated patients with a high bleeding risk, which prevail over concerns about stent thrombosis or ischemic stroke. There is insufficient evidence to favor one NOAC over another in this setting. In the early post stenting period, triple therapy comprising a NOAC, clopidogrel and aspirin is recommended. Timing of post PCI aspirin cessation should be based on a careful analysis of the bleeding and ischemic risk. There is only low quality evidence regarding the optimal approach to elective or urgent/emergency PCI procedures in patients requiring oral anticoagulation. It is suggested that there is no need of interruption of VKA and PCI procedure should be performed via radial artery access with a lower dose of unfractionated heparin. On the other hand, NOACs are usually stopped before elective PCIs, while urgent/emergency procedures may be performed with the addition of low-dose parenteral anticoagulation.
