Pure SARS-CoV-2 related AVDS (Acute Vascular Distress Syndrome).

BACKGROUND: SARS-CoV-2 virus which targets the pulmonary vasculature is supposed to induce an intrapulmonary right to left shunt with an increased pulmonary blood flow. Such vascular injury is difficult to observe because it is hidden by the concomitant lung injury. We report here what may be, to the best of our knowledge, the first case of a pure Covid-19 related Acute Vascular Distress Syndrome (AVDS). CASE PRESENTATION: A 43-year-old physician, tested positive for Covid-19, was addressed to the emergency unit for severe dyspnoea and dizziness. Explorations were non informative with only a doubt regarding a sub-segmental pulmonary embolism (no ground-glass lesions or consolidations related to Covid-19 disease). Dyspnoea persisted despite anticoagulation therapy and normal pulmonary function tests. Contrast-enhanced transthoracic echocardiography was performed which revealed a moderate late right-to-left shunt. CONCLUSIONS: This case report highlights the crucial importance of the vascular component of the viral disease. The intrapulmonary shunt induced by Covid-19 which remains unrecognized because generally hidden by the concomitant lung injury, can persist for a long time. Contrast-enhanced transthoracic echocardiography is the most appropriate test to propose in case of persistent dyspnoea in Covid-19 patients.

Aortic root dilatation in PFO-related cryptogenic stroke: A propensity score-matched analysis.

BACKGROUND: Dilatation of the ascending aorta has an important role in the anatomical conformation of interatrial septum (IAS) especially when a patent foramen ovale (PFO) is present. The aim of the study was to investigate the relationship between ascending aortic dilation and PFO-related cryptogenic stroke in a cohort of cryptogenic strokes. METHODS: It is a retrospective, single-center echocardiographic study assessing aortic root dilatation in 315 consecutive patients with cryptogenic stroke between January 2011 and January 2019. Aortic root dilatation was defined by a diameter of the Valsalva sinuses of the proximal aorta >40 mm. Predictive factors of PFO were assessed by a multivariate analysis. Propensity score matching was applied to account for clinical differences. RESULTS: Of the 315 patients, 68 (22%) had an aortic root dilatation and 167 (53%) had a PFO. In the aortic root dilation group, PFO was more often diagnosed (n = 47/68 [69%], vs n = 120/247 [49%], P = .004). In the PFO group with aortic dilatation, IAS was more mobile (n = 37/47[79%] vs n = 69/120[57%], P < .012) and smaller (2.3 ± 0.5 vs 2.5 ± 0.5 mm, P < .009). On multivariate analysis, aortic root dilatation (OR: 2.6; 95% CI [1.2-5.6]; P = .001) and IAS hypermobility (OR: 5.2 95% CI [2.7-10]; P = .001) were associated with PFO. After propensity matching, aortic root dilatation remained strongly associated with PFO (n = 34/107 [32%] vs 15/107[14%], P = .002). CONCLUSION: Aortic root dilation and IAS hypermobility were strongly associated with PFO-related cryptogenic stroke.

Troponin levels help predict new-onset atrial fibrillation in ischaemic stroke patients: a retrospective study.

BACKGROUND: Elevated levels of cardiac troponin I (cTnI) have been reported in acute stroke and atrial fibrillation (AF). We tested a hypothesis in which the result of an initial cTnI assay helps predict new-onset AF (NAF) early in the course of ischaemic stroke in patients with sinus rhythm on admission. METHODS: This retrospective study included all patients admitted to our unit for acute ischaemic stroke between January 2006 and December 2007 (n = 402). NAF was defined as AF discovered during cardiac monitoring in patients with sinus rhythm on admission. Elevated cTnI was defined as a value > or =0.03 microg/l. RESULTS: 27 (6.7%) patients had NAF. In a univariate analysis, age (70.8 in patients with NAF vs. 64.6 years in patients without NAF, respectively; p = 0.024), smoking status (3.5 vs. 25.3%; p = 0.009), total anterior circulation infarcts (18.5 vs. 5.9%; p = 0.03) and elevated cTnI levels (63.0 vs. 29.9%; p = 0.001) were associated with NAF. Stepwise logistic regression identified elevated cTnI levels (OR 4.1; 95% CI 1.81-9.33; p = 0.001)and active smoking (OR 0.11; 95% CI 0.01-0.82; p = 0.03) as independent factors for NAF. CONCLUSION: Moderately elevated troponin levels in acute ischaemic stroke are independently associated with NAF.