Subclinical Left Ventricular Systolic Dysfunction in Hospitalized Patients with COVID-19 by Strain: A 30-Day Echocardiographic Follow-Up.

Background and Objectives: Available studies confirm myocardial injury and its association with mortality in patients with COVID-19, but few data have been reported from echocardiographic studies. The aim of this study was to identify subclinical left ventricular dysfunction by global longitudinal strain (GLS) and its evolution in the short term in hospitalized patients with COVID-19. Materials and Methods: Thirty-one consecutive noncritical patients admitted for COVID-19 were included. Information on demographics, laboratory results, comorbidities, and medications was collected. Transthoracic echocardiograms were performed using a Philips Affinity 50, at the acute stage and at a 30-day follow-up. Automated left ventricular GLS was measured using a Philips Qlab 13.0. A GLS of <-15.9% was defined as abnormal. Results: The mean age was 65 ± 15.2 years, and 61.3% of patients were male. Nine patients (29%) had elevated levels of high-sensitivity troponin I. Left ventricular ejection fraction was preserved in all; however, 11 of them (35.5%) showed reduced GLS. These patients had higher troponin levels (median, 23.7 vs. 3.2 ng/L; p < 0.05) and NT-proBNP (median, 753 vs. 81 pg/mL; p < 0.05). The multivariate analysis revealed that myocardial injury, defined as increased troponin, was significantly associated with GLS values (coefficient B; p < 0.05). Follow-up at 30 days showed an improvement in GLS values in patients with subclinical left ventricular dysfunction (-16.4 ± 2.07% vs. -13.2 ± 2.40%; p < 0.01), without changes in the normal GLS group. Conclusions: Subclinical left ventricular dysfunction is common in noncritical hospitalized patients with COVID-19 (one in every three patients), even with preserved left ventricular ejection fraction. This impairment tends to be reversible on clinical recovery.

Valor pronóstico de la enfermedad arterial periférica en la cardiopatía isquémica / Prognostic implications of peripheral arterial disease for ischemic heart disease

La aterosclerosis es un proceso fisiopatológico progresivo que puede afectar simultáneamente a múltiples territorios vasculares y tiene origen en diversos factores como la diabetes mellitus, el tabaquismo, la hipertensión arterial o la dislipemia. Consecuentemente, la coexistencia de enfermedad arterial coronaria y enfermedad arterial periférica (EAP) es frecuente. Recientemente se han publicado datos que indican que la EAP en el paciente con enfermedad coronaria podría implicar un pronóstico peor que el meramente establecido por los factores de riesgo clásicos. Éstos señalan a la EAP como un marcador de riesgo independiente en los distintos subgrupos de pacientes con cardiopatía isquémica. Por lo tanto, la criba de EAP mediante el índice tobillo-brazo en esta población parece un paso obligado para detectar a pacientes en mayor riesgo e intensificar en ellos las medidas preventivas y terapéuticas de que disponemos (AU)

Atherosclerosis is a progressive pathophysiologic process that can simultaneously affect a number of different vascular beds and that can be caused by a range of factors such as diabetes mellitus, smoking, hypertension and dyslipidemia. Consequently, coronary artery disease and peripheral arterial disease (PAD) frequently coexist. Recently published data suggest that the presence of PAD in a patient with coronary artery disease implies a poorer prognosis than would be expected from classical risk factors alone. These findings indicate that PAD is an independent risk factor in different subgroups of patients with ischemic heart disease. Consequently, early diagnosis of PAD in these patients by measuring the ankle-brachial index would appear to be an essential step in identifying those at a high risk and in bringing about an increase in the use of currently available preventive and therapeutic measures in these patients (AU)

Situación de la enfermedad cardiovascular en España. Del riesgo a la enfermedad / Cardiovascular disease in Spain today. From risk factors to morbidity

La enfermedad cardiovascular es la primera causa de muerte en nuestro país pese a que la mayor parte de los factores de riesgo son conocidos y modificables. La pérdida de los hábitos cardiosaludables ha ralentizado la continua reducción de la mortalidad por cardiopatía isquémica durante los últimos años. Además, el aumento de los factores asociados al desarrollo de enfermedad cardiovascular durante las últimas décadas ya ha puesto en marcha los mecanismos patogénicos precisos que en unos años darán lugar a la aparición de eventos cardiovasculares en un porcentaje muy importante de la población española. El escaso control conseguido de determinados factores de riesgo hace que más de la mitad de la población española con algún factor conocido no cumpla los objetivos terapéuticos. La marcada prevalencia de estos predisponentes en el colectivo anciano, junto con el progresivo envejecimiento de la población, no hace más que acrecentar estos problemas y auguran un aumento de las enfermedades cardiovasculares cuyos límites todavía no conocemos (AU)

Cardiovascular disease is the leading cause of death in Spain. However, the majority of risk factors have been identified and are modifiable. In recent years, the loss of lifestyle habits that favor cardiovascular health has slowed the ongoing decline in mortality due to ischemic heart disease. Moreover, the increase in the incidence of factors associated with the development of cardiovascular disease that has occurred during the last few decades has already set in motion pathogenetic mechanisms that will, in the next few years, lead to the occurrence of cardiovascular events in a significant percentage of the Spanish population. Poor control of certain risk factors means that more than half the Spanish population with known risk factors does not achieve therapeutic objectives. The high prevalence of these predisposing factors in older people, coupled with the progressive aging of population, can only worsen the situation and presages a rise in the incidence of cardiovascular disease whose upper limit is still unknown (AU)