Diagnostic Performance Between Chest CT Severity Score and Initial Reverse Transcription-Polymerase Chain Reaction (RT-PCR) Cycle Values in COVID-19 Patients and Their Relation With the Clinical Status of Patients.

INTRODUCTION: Reverse transcription-polymerase chain reaction (RT-PCR) is used as a standard test for the diagnosis of SARS-CoV-2 viral RNA from nasopharyngeal aspirates. However, this method lacks sensitivity and cannot assess disease severity. A CT scan of the thorax provides a CT severity score (CT-SS), which depicts lung involvement and disease severity. This study aims to investigate the diagnostic value of chest CT compared with RT-PCR cycle threshold (Ct) values in COVID-19 and relate it clinically with the disease severity of patients. METHODS: This retrospective observational study was conducted in a tertiary center from April 2021 to March 2022. We included 511 patients who had tested RT-PCR positive for COVID-19, were hospitalized, and had undergone high-resolution CT (HRCT) thorax. Data was collected from patient records regarding name, age, sex, admission data, baseline investigations including Ct value, management, and outcome. HRCT was reviewed to assess lung involvement and calculate CT-SS. Data was analyzed using SPSS Statistics version 25 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.). RESULT: The mean age of patients was 50.4 ± 13.7 years, and the majority (67.5%) were male. Gender-wise, there was no difference in RT-PCR cycle threshold (Ct) values; however, CT-SS was significantly higher in males (17.5 ± 4.8 vs.10.5 ± 6.6, t=-13.6, p<0.0001). ICU admission was needed for 34.8% of patients, and they had a significantly lower Ct value (21.7 ± 3.3 vs. 22.8 ± 3.7, t=21.10, p<0.0001) and higher CT-SS (16.3 ± 4.5 vs. 6.7 ± 5.1, t=-3.32, p=0.001). CONCLUSION: Ct values could not differentiate between moderate and severe patients. CT-SS was not related to the viral load at admission. Patients who succumbed had significantly lower Ct values and higher CT-SS.

Hughes‒Stovin Syndrome.

We present an extremely rare case of Hughes‒Stovin syndrome, of which we believe <60 cases have been reported in English medical literature. We wish to draw the attention of our fellow cardiologists to consider this when coming across patients with pulmonary artery aneurysm in their clinical practice. Appropriate treatment, if instituted promptly and early in the course of the disease, has the potential to induce remission.

Pulmonary Hypertension, an Echo Assessment: Is it Arterial or Venous?

Introduction: Pulmonary hypertension (PH) is characterized by pulmonary vascular remodeling, right heart failure, and reduced survival. PH can be PH without left ventricular (LV) dysfunction - pulmonary arterial hypertension (PAH) - (Dana point Class I) and PH with LV dysfunction - pulmonary venous hypertension (PVH) - (Dana point Class II). Whatever the underlying cardiac disease, the presence of PH in patients with heart failure is associated with poor prognosis. Right ventricular dysfunction by ventricular interdependence can cause LV dysfunction. Objective: We aim to provide a distinction between PAH and PVH by echocardiography. Methods: Retrospective cross-sectional single-center data of 1075 subjects having PH as defined by echocardiography was collected. These were segregated into mild, moderate, and severe categories. The same cohort of PH subjects was also segregated by E/e' derived pulmonary capillary wedge pressure (PCWP) values. Echocardiographic measurements and effort tolerance in Mets were analyzed. Data for 707 normal subjects were taken from an earlier published study on normative echocardiographic measurements of healthy Indians. Results: Our findings show that PAH and PVH can be distinguished using PCWP value >15 mmHg obtained by applying Nagueh's formulaon E/e'. Conclusion: We recommend that PCWP derived from E/e' should be reported with pulmonary artery systolic pressure measurement to distinguish between PAH and PVH.

Global longitudinal strain, ejection fraction, effort tolerance and normal echocardiography measurements in healthy Indians.

INTRODUCTION: Normative comprehensive echocardiographic measurements data for healthy Indians are not available while data for American and European population is available from American Society of echocardiography and European Society of Cardiology/European Association of Cardio-Vascular Imaging and their publications. Available studies of Indian subjects are small and report only limited measurements with focus on left ventricular (LV) volumes. OBJECTIVE: We aim to provide comprehensive normative echocardiographic data for healthy Indians from a large sample size. METHODS: A retrospective cross-sectional single-center study of 707 healthy Indian adults age and sex segregated which presented detailed and comprehensive echocardiographic measurements including two-dimensional, M-mode, tissue Doppler imaging, speckle tracking echocardiography, chamber volumes, LV ejection fraction (LVEF), global longitudinal strain (GLS), segmental longitudinal strain and effort tolerance. RESULTS: Our findings show healthy Indians, as compared to US and European population, to have higher relative wall thickness. LV volumes, LV mass, LVEF and effort tolerance that were within American Society of Echocardiography described ranges for chamber quantification. Higher GLS values were observed in Indian population compared to European and American population. Women had higher LVEF and GLS values as compared to men and both showed a gradual decline with aging. CONCLUSION: We present normal reference values for echocardiographic measurements in healthy Indian population, which could be used for future reference and comparison work.