Cardiac dysfunction and mortality in critically ill patients with COVID-19: A Swedish multicentre observational study.

BACKGROUND: The prevalence and importance of cardiac dysfunction in critically ill patients with COVID-19 in Sweden is not yet established. The aim of the study was to assess the prevalence of cardiac dysfunction and elevated pulmonary artery pressure (PAP), and its influence on mortality in patients with COVID-19 in intensive care in Sweden. METHODS: This was a multicentre observational study performed in five intensive care units (ICUs) in Sweden. Patients admitted to participating ICU with COVID-19 were examined with echocardiography within 72 h from admission and again after 4 to 7 days. Cardiac dysfunction was defined as left ventricular (LV) dysfunction (ejection fraction <50% and/or regional hypokinesia) or right ventricular (RV) dysfunction (defined as TAPSE <17 mm or visually assessed moderate/severe RV dysfunction). RESULTS: We included 132 patients, of whom 127 (96%) were intubated. Cardiac dysfunction was found in 42 (32%) patients. Most patients had cardiac dysfunction at the first assessment (n = 35) while a few developed cardiac dysfunction later (n = 7) and some changed type of dysfunction (n = 3). LV dysfunction was found in 21 and RV dysfunction in 19 patients, while 5 patients had combined dysfunction. Elevated PAP was found in 34 patients (26%) and was more common in patients with RV dysfunction. RV dysfunction and elevated PAP were independently associated with an increased risk of death (OR 3.98, p = .013 and OR 3.88, p = .007, respectively). CONCLUSIONS: Cardiac dysfunction occurs commonly in critically ill patients with COVID-19 in Sweden. RV dysfunction and elevated PAP are associated with an increased risk of death.

Cardiac involvement in critically ill and mechanically ventilated patients with COVID-19 - a prospective, observational echocardiographic study.

INTRODUCTION: In this prospective, observational study, we have evaluated right (RV) and left (LV) ventricular function with echocardiography and correlated it to the levels of biomarkers, hs-TNT, NT-pro-BNP, D-dimer and fibrinogen. In a subgroup, we have evaluated the effect of inhaled milrinone on RV afterload and function. METHODS: Thirty-one ICU patients with COVID-19 in need of mechanical ventilation and norepinephrine infusion were prospectively included. Hemodynamic and respiratory variables were measured at the time of the echocardiographic examination and biomarkers were obtained on arrival at the ICU and then followed up routinely. Eight patients received inhaled aerosolized milrinone at a dose of 2.5 mg/hour. RESULTS: The most common echocardiographic pattern was RV dilation with or without systolic dysfunction, which was found in 62% of patients. Pulmonary acceleration time was abnormal in 55% and indices of RV systolic function, such as fractional area of change, RV strain, were abnormal in 30% and 31% of patients respectively. A cardiac index of < 2.5 l/min*m2 was seen in 58% of the patients. Left ventricular ejection fraction and global left ventricular strain were impaired in 10% and 16% respectively. The correlation between echocardiographic variables and cardiac biomarkers was poor. RV afterload correlated well to the levels of D-dimer. Milrinone inhalation did not improve RV function or afterload. CONCLUSION: RV dysfunction was the most common finding. The poor correlation to cardiac biomarkers argues against extensive myocardial involvement. The lack of improvement in RV function after milrinone inhalation suggests that the most likely cause of RV dysfunction is increased RV afterload caused by pulmonary thrombosis/embolism.

Current surveys on the prevalence and distribution of Dirofilaria spp. in dogs in Germany.

The Central Upper-Rhine (Baden-Württemberg, Germany) is one of the warmest regions in Germany and also harbours abundant numbers of mosquitoes. Case reports on presumably autochthonous occurrence of Dirofilaria spp. were reported previously and were a reason for a further investigation into the occurrence of vector-borne pathogens. For this purpose, 44 hunting dogs from the Central Upper-Rhine region were tested between 4(th) and 29(th) June 2007. The blood samples were tested using the Knott's test and IDEXX SNAP 4Dx test. The Knott's test revealed unsheathed microfilaria identified as Dirofilaria repens by PCR in 3 dogs with no history of travelling (6.8%; 95% CI: 2.4-18.2%). The seroprevalence for Anaplasma phagocytophilum was 43.2% (95% CI: 29.7-57.8%), but only 4.5% (95% CI: 1.3-15.1%) for antibodies to Borrelia C6 peptide. Dirofilaria immitis antigen was not detected in any of the samples. A further 288 blood samples from non-hunting companion dogs of the Central Upper-Rhine region were tested negative for heartworm antigen between February and August 2007.

Occurrence of Dirofilaria immitis and tick-borne infections caused by Anaplasma phagocytophilum, Borrelia burgdorferi sensu lato and Ehrlichia canis in domestic dogs in France: results of a countrywide serologic survey.

The occurrence of Dirofilaria immitis antigen and antibodies against tick-borne pathogens in French dogs has been analysed based on 1,050 blood samples. Serum samples of 919 dogs (group A) were sent for a variety of diagnostic investigations, further 131 dogs (group B) were tested for a tentative diagnosis of heartworm disease. All samples were tested for D. immitis antigen. Samples in group A were also tested for specific antibodies against three tick-borne pathogens (Anaplasma phagocytophilum, Borrelia burgdorferi sensu lato and Ehrlichia canis). Results were plotted in geographical maps. Occurrence of D. immitis antigen in group A (0.22%; 95 % CI: 0.03-0.78%) was significantly lower (p < 0.0001) than in group B (6.87%; 95% CI: 3.19-12.64%). Heartworm infections in both groups were regionally restricted to the areas of Bouches-du-Rhône in the South of France and Corsica. In group A, the calculated seroprevalence was 2.72% (95% CI: 1.77-3.99%) for A. phagocytophilum, 1.09% (95% CI: 0.52-1.99%) for B. burgdorferi and 0.33% (95% CI: 0.07-0.95%) for E. canis with a distribution of the positive cases throughout the country. This study represents the first data of A. phagocytophilum seroprevalence in the French dog population.