RESUMEN
PURPOSE: The coronavirus disease 2019 (COVID-19) outbreak has become a global public health concern; however, relatively few detailed reports of related cardiac injury are available. The aims of this study were to compare the clinical and echocardiographic characteristics of inpatients in the intensive-care unit (ICU) and non-ICU patients. METHODS: We recruited 416 patients diagnosed with COVID-19 and divided them into two groups: ICU (n = 35) and non-ICU (n = 381). Medical histories, laboratory findings, and echocardiography data were compared. RESULTS: The levels of myocardial injury markers in ICU vs non-ICU patients were as follows: troponin I (0.029 ng/mL [0.007-0.063] vs 0.006 ng/mL [0.006-0.006]) and myoglobin (65.45 µg/L [39.77-130.57] vs 37.00 µg/L [26.40-53.54]). Echocardiographic findings included ventricular wall thickening (12 [39%] vs 1 [4%]), pulmonary hypertension (9 [29%] vs 0 [0%]), and reduced left-ventricular ejection fraction (5 [16%] vs 0 [0%]). Overall, 10% of the ICU patients presented with right heart enlargement, thickened right-ventricular wall, decreased right heart function, and pericardial effusion. Cardiac complications were more common in ICU patients, including acute cardiac injury (21 [60%] vs 13 [3%]) (including 2 cases of fulminant myocarditis), atrial or ventricular tachyarrhythmia (3 [9%] vs 3 [1%]), and acute heart failure (5 [14%] vs 0 [0%]). CONCLUSION: Myocardial injury marker elevation, ventricular wall thickening, pulmonary artery hypertension, and cardiac complications including acute myocardial injury, arrhythmia, and acute heart failure are more common in ICU patients with COVID-19. Cardiac injury in COVID-19 patients may be related more to the systemic response after infection rather than direct damage by coronavirus.
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COVID-19/complicaciones , COVID-19/epidemiología , Cardiopatías/epidemiología , Cardiopatías/etiología , SARS-CoV-2 , Anciano , COVID-19/diagnóstico , COVID-19/virología , China/epidemiología , Comorbilidad , Cuidados Críticos , Ecocardiografía , Femenino , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Pruebas de Función Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Miocarditis/diagnóstico , Miocarditis/epidemiología , Miocarditis/etiología , Pronóstico , Radiografía Torácica , Evaluación de SíntomasRESUMEN
BACKGROUND: Coronavirus disease 2019 (COVID-19) has been demonstrated to be the cause of pneumonia. Nevertheless, it has not been reported as the cause of acute myocarditis or fulminant myocarditis. CASE PRESENTATION: A 63-year-old male was admitted with pneumonia and cardiac symptoms. He was genetically confirmed as having COVID-19 according to sputum testing on the day of admission. He also had elevated troponin I (Trop I) level (up to 11.37 g/L) and diffuse myocardial dyskinesia along with a decreased left ventricular ejection fraction (LVEF) on echocardiography. The highest level of interleukin-6 was 272.40 pg/ml. Bedside chest radiographs showed typical ground-glass changes indicative of viral pneumonia. Laboratory test results for viruses that cause myocarditis were all negative. The patient conformed to the diagnostic criteria of the Chinese expert consensus statement for fulminant myocarditis. After receiving antiviral therapy and mechanical life support, Trop I was reduced to 0.10 g/L, and interleukin-6 was reduced to 7.63 pg/mL. Moreover, the LVEF of the patient gradually recovered to 68%. The patient died of aggravation of secondary infection on the 33rd day of hospitalization. CONCLUSION: COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. This is the first report of COVID-19 complicated with fulminant myocarditis. The mechanism of cardiac pathology caused by COVID-19 needs further study.
Asunto(s)
Infecciones por Bacteroides/complicaciones , Betacoronavirus/patogenicidad , Candidiasis/complicaciones , Infecciones por Coronavirus/complicaciones , Miocarditis/complicaciones , Neumonía Viral/complicaciones , Enfermedad Aguda , Antivirales/uso terapéutico , Infecciones por Bacteroides/diagnóstico por imagen , Infecciones por Bacteroides/tratamiento farmacológico , Infecciones por Bacteroides/virología , Betacoronavirus/efectos de los fármacos , Biomarcadores/sangre , COVID-19 , Candidiasis/diagnóstico por imagen , Candidiasis/tratamiento farmacológico , Candidiasis/virología , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/virología , Combinación de Medicamentos , Ecocardiografía , Resultado Fatal , Humanos , Interleucina-6/sangre , Lopinavir/uso terapéutico , Masculino , Persona de Mediana Edad , Miocarditis/diagnóstico por imagen , Miocarditis/tratamiento farmacológico , Miocarditis/virología , Pandemias , Combinación Piperacilina y Tazobactam/uso terapéutico , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/virología , Ritonavir/uso terapéutico , SARS-CoV-2 , Volumen Sistólico/efectos de los fármacos , Tomografía Computarizada por Rayos X , Troponina I/sangreRESUMEN
BACKGROUND: Takotsubo cardiomyopathy (TCM) is a brief ventricular dysfunction that usually occurs after emotional or physical stress. Here, we report a patient who underwent cardiac surgery and then developed TCM during the postoperative period. CASE PRESENTATION: A 51-year-old woman was admitted to our hospital complaining of chest tightness, palpitations and dyspnoea after activity. An echocardiogram performed by our hospital showed rheumatic heart disease (severe mitral stenosis and regurgitation) with normal cardiac function and wall motion. After mitral valve replacement, this patient developed heart failure with low blood pressure and tachycardia. Urgent bedside echocardiography demonstrated akinesis in the middle and apical segments of the left ventricle and a depressed ejection fraction (EF) of 36%. Myocardial contrast echocardiography (MCE) showed similar enhancement intensity in the basal, middle and apical segments. Quantitative analysis showed approximately equivalent maximum intensity in these regions. The diagnosis was considered TCM instead of myocardial infarction. Then, an intra-aortic balloon pump was inserted to maintain effective circulation and reduce the postcardiac load. Given ventilation therapy, postoperative anticoagulation therapy and anti-infection treatment, the patient recovered quickly. In the follow-up examination, the patient remained asymptomatic and showed normalization of ventricular wall motion in the apical segment. CONCLUSION: This report presents a case of TCM in which MCE was used to demonstrate intact microvascular perfusion despite apical akinesis. This report might support the use of MCE as a substitute for invasive coronary angiography.
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Medios de Contraste/administración & dosificación , Ecocardiografía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/cirugía , Fosfolípidos/administración & dosificación , Cardiopatía Reumática/cirugía , Hexafluoruro de Azufre/administración & dosificación , Cardiomiopatía de Takotsubo/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/fisiopatología , Estenosis de la Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/fisiopatología , Valor Predictivo de las Pruebas , Cardiopatía Reumática/diagnóstico por imagen , Cardiopatía Reumática/fisiopatología , Cardiomiopatía de Takotsubo/etiología , Cardiomiopatía de Takotsubo/fisiopatología , Cardiomiopatía de Takotsubo/terapia , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
Background: We aimed to explore the value of combining real-time three-dimensional echocardiography (RT-3DE) and myocardial contrast echocardiography (MCE) in the left ventricle (LV) evaluating myocardial dysfunction in type 2 diabetes mellitus (T2DM) patients. Patients and Methods: A total of 58 T2DM patients and 32 healthy individuals were selected for this study. T2DM patients were further divided into T2DM without microvascular complications (n = 29) and T2DM with microvascular complications (n = 29) subgroups. All participants underwent RT-3DE and MCE. The standard deviation (SD) and the maximum time difference (Dif) of the time to the minimum systolic volume (Tmsv) of the left ventricle were measured by RT-3DE. MCE was performed to obtain the perfusion measurement of each segment of the ventricular wall, including acoustic intensity (A), flow velocity (ß), and A·ß. Results: There were significant differences in all Tmsv indices except for Tmsv6-Dif among the three groups (all P < 0.05). After heart rate correction, all Tmsv indices of the T2DM with microvascular complications group were prolonged compared with the control group (all P < 0.05). The parameters of A, ß, and A·ß for overall segments showed a gradually decreasing trend in three groups, while the differences between the three groups were statistically significant (all P < 0.01). For segmental evaluation of MCE, the value of A, ß, and A·ß in all segments showed a decreasing trend and significantly differed among the three groups (all P < 0.05). Conclusions: The RT-3DE and MCE can detect subclinical myocardial dysfunction and impaired myocardial microvascular perfusion. Left ventricular dyssynchrony occurred in T2DM patients with or without microvascular complications and was related to left ventricular dysfunction. Myocardial perfusion was reduced in T2DM patients, presenting as diffuse damage, which was aggravated by microvascular complications in other organs.