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Fabry disease is a rare X-linked lysosomal storage disorder caused by a deficiency in the lysosomal enzyme, galactosidase A, that can result in a progressive increase in the left ventricle (LV) wall thickness from glycosphingolipid deposition leading to myocardial fibrosis, conduction abnormalities, arrhythmias, and heart failure. We present a case of a patient with advanced Fabry cardiomyopathy, in whom a small LV apical aneurysm was incidentally discovered on abdominal imaging, which could have easily evaded detection on standard transthoracic echocardiography. The LV apex should be thoroughly interrogated in patients with Fabry cardiomyopathy, as the finding of LV aneurysm could have important management implications with respect to the prevention of stroke and sudden cardiac death.
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Cardiomiopatias , Doença de Fabry , Aneurisma Cardíaco , Arritmias Cardíacas , Ecocardiografia , Humanos , MiocárdioRESUMO
In the midst of the COVID-19 pandemic, unprecedented pressure has been added to healthcare systems around the globe. Imaging is a crucial component in the management of COVID-19 patients. Point-of-care ultrasound (POCUS) such as hand-carried ultrasound emerges in the COVID-19 era as a tool that can simplify the imaging process of COVID-19 patients, and potentially reduce the strain on healthcare providers and healthcare resources. The preliminary evidence available suggests an increasing role of POCUS in diagnosing, monitoring, and risk-stratifying COVID-19 patients. This scoping review aims to delineate the challenges in imaging COVID-19 patients, discuss the cardiopulmonary complications of COVID-19 and their respective sonographic findings, and summarize the current data and recommendations available. There is currently a critical gap in knowledge in the role of POCUS in the COVID-19 era. Nonetheless, it is crucial to summarize the current preliminary data available in order to help fill this gap in knowledge for future studies.
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COVID-19/diagnóstico , Pulmão/diagnóstico por imagem , Pandemias , Sistemas Automatizados de Assistência Junto ao Leito/normas , Ultrassonografia/métodos , COVID-19/epidemiologia , HumanosRESUMO
OBJECTIVE: To keep health care providers, in response to the ongoing coronavirus disease 2019 (COVID-19) pandemic, informed about the medications that have been proposed to treat the disease and the evidence supporting their use. QUALITY OF EVIDENCE: A narrative review of medications most widely used to treat COVID-19 was conducted, outlining the best available evidence for each pharmacologic treatment to date. Searches were performed in PubMed, EMBASE, and MEDLINE using key words COVID-19 and treatment, as well as related terms. Relevant research studies conducted in human populations and cases specific to patients with COVID-19 were included, as were relevant hand-searched papers and reviews. Only articles in English and Chinese were included. MAIN MESSAGE: While current management of patients with COVID-19 largely involves supportive care, without a widely available vaccine, practitioners have also resorted to repurposing medications used for other indications. This has caused considerable controversy, as many of these treatments have limited clinical evidence supporting their use and therefore pose implications for patient safety, drug access, and public health. For instance, medications such as hydroxychloroquine and chloroquine, lopinavir-ritonavir, nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers gained widespread media attention owing to hype, misinformation, or misinterpretation of research evidence. CONCLUSION: Given the severity of the pandemic and the potential broad effects of implementing safe and effective treatment, this article provides a narrative review of the current evidence behind the most widely used medications to treat COVID-19 in order to enable health care practitioners to make informed decisions in the care of patients with this life-threatening disease.
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Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antivirais/uso terapêutico , Tratamento Farmacológico da COVID-19 , Medicina Baseada em Evidências , Imunoglobulinas/uso terapêutico , Cloroquina/uso terapêutico , Quimioterapia Combinada , Humanos , Hidroxicloroquina/uso terapêuticoRESUMO
Focused cardiac ultrasonography is performed by clinicians at the bedside and is used in time-sensitive scenarios to evaluate a patient's cardiovascular status when comprehensive echocardiography is not immediately available. This simplified cardiac ultrasonography is often performed by noncardiologists using small, portable devices to augment the physical examination, triage patients, and direct management in both critical care and outpatient settings. However, as the use of focused cardiac ultrasonography continues to expand, careful consideration is required regarding training, scope of practice, impact on patient outcomes, and medicolegal implications. In this review, we examine some of the challenges with rapid uptake of this technique and explore the benefits and potential risk of focused cardiac ultrasonography. We propose possible mechanisms for cross-specialty collaboration, quality improvement, and oversight.
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Cardiopatias/diagnóstico por imagem , Coração/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia/métodos , HumanosRESUMO
Pulmonary artery sarcoma is a rare malignant neoplasm. Here, we describe a patient with a pulmonary artery sarcoma, which was only subtly visible and therefore not fully appreciated on initial transthoracic echocardiogram. Characterization of the tumor was aided by the use of multimodality imaging that included computed tomography, magnetic resonance imaging, and positron emission tomography. Familiarity with its appearance on multiple imaging modalities including echocardiography is important to ensure timely diagnosis, although the optimal treatment strategy is still unknown, and the prognosis remains poor.
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Imagem Multimodal/métodos , Artéria Pulmonar/diagnóstico por imagem , Sarcoma/diagnóstico por imagem , Neoplasias Vasculares/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Ecocardiografia , Evolução Fatal , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia por Emissão de Pósitrons , Artéria Pulmonar/cirurgia , Sarcoma/cirurgia , Tomografia Computadorizada por Raios X , Neoplasias Vasculares/cirurgia , Adulto JovemRESUMO
Formation of an intramural left atrial hematoma (ILAH) is a rare complication of coronary artery stenting. Rapid diagnosis with noninvasive multimodality imaging can potentially be lifesaving. We report a case of ILAH that resulted in left ventricular inflow obstruction and pericardial tamponade in a 55-year-old male who presented with hemodynamic instability and worsening dyspnea three weeks after seemingly uncomplicated left circumflex artery stenting. We demonstrate features on transthoracic echocardiography with contrast and cardiac computed tomography that were used for diagnosis and management.
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Angiografia Coronária/métodos , Ecocardiografia/métodos , Átrios do Coração/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Stents/efeitos adversos , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/efeitos adversos , Reperfusão Miocárdica/instrumentação , Doenças Raras/diagnóstico por imagem , Doenças Raras/etiologiaRESUMO
OBJECTIF: En réponse à la pandémie actuelle de maladie à coronavirus 2019 (COVID-19), garder les médecins au fait des médicaments qui ont été proposés pour combattre la maladie, et des données probantes à l'appui de leur utilisation. SOURCES D'INFORMATION: Une revue narrative des médicaments les plus fréquemment utilisés pour combattre la COVID-19 a été réalisée, afin de souligner les meilleures données probantes disponibles concernant chaque traitement pharmacologique jusqu'ici. Des recherches ont été effectuées sur PubMed, EMBASE et MEDLINE à l'aide des mots-clés anglais COVID-19 et treatment, ainsi que d'autres mots-clés connexes. Ont été inclus les études pertinentes menées auprès de populations humaines et des cas de patients atteints de la COVID-19, ainsi que les articles et revues relevés à la main. Seuls les articles rédigés en anglais et en chinois ont été retenus. MESSAGE PRINCIPAL: Alors que la prise en charge actuelle des patients atteints de la COVID-19 consiste principalement en soins de soutien, sans accès aux vaccins, les praticiens se sont tournés vers des médicaments utilisés dans d'autres indications. Cela a causé une grande controverse, puisque des données cliniques limitées étayaient l'utilisation de beaucoup de ces traitements, et cela pouvait se répercuter sur la sécurité du patient, l'accès aux médicaments et la santé publique. Par exemple, les médicaments tels que l'hydroxychloroquine et la chloroquine, le lopinavir-ritonavir, les anti-inflammatoires non stéroïdiens, les inhibiteurs de l'enzyme de conversion de l'angiotensine et les antagonistes des récepteurs de l'angiotensine ont capté l'attention des médias en raison de la médiatisation, de la mésinformation ou de la mauvaise interprétation des données de recherche. CONCLUSION: Vu la gravité de la pandémie et les vastes effets éventuels de l'adoption de traitements sûrs et efficaces, cet article se veut être une revue narrative des données probantes actuelles étayant les médicaments les plus utilisés pour le traitement de la COVID-19 afin de permettre aux professionnels de la santé de prendre des décisions éclairées en matière de soins pour les patients qui sont atteints de cette maladie potentiellement mortelle.
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Tratamento Farmacológico da COVID-19 , COVID-19 , Tratamento Farmacológico , Preparações Farmacêuticas , COVID-19/epidemiologia , Humanos , SARS-CoV-2RESUMO
AIM: Echocardiographic methods for estimating right atrial (RA) volume have not been standardized. Our aim was to evaluate two-dimensional (2D) echocardiographic methods of RA volume assessment, using RA volume by magnetic resonance imaging (MRI) as the reference. METHODS AND RESULTS: Right atrial volume was assessed in 51 patients (mean age 63 ± 14 years, 33 female) who underwent comprehensive 2D echocardiography and cardiac MRI for clinically indicated reasons. Echocardiographic RA volume methods included (1) biplane area length, using four-chamber view twice (biplane 4C-4C); (2) biplane area length, using four-chamber and subcostal views (biplane 4C-subcostal); and (3) single plane Simpson's method of disks (Simpson's). Echocardiographic RA volumes as well as linear RA major and minor dimensions were compared to RA volume by MRI using correlation and Bland-Altman methods, and evaluated for inter-observer reproducibility and accuracy in discriminating RA enlargement. All echocardiography volumetric methods performed well compared to MRI, with Pearson's correlation of 0.98 and concordance correlation ≥0.91 for each. For bias and limits of agreement, biplane 4C-4C (bias -4.81 mL/m(2) , limits of agreement ±9.8 mL/m(2) ) and Simpson's (bias -5.15 mL/m(2) , limits of agreement ±10.1 mL/m(2) ) outperformed biplane 4C-subcostal (bias -8.36 mL/m(2) , limits of agreement ±12.5 mL/m(2) ). Accuracy for discriminating RA enlargement was higher for all volumetric methods than for linear measurements. Inter-observer variability was satisfactory across all methods. CONCLUSIONS: Compared to MRI, biplane 4C-4C and single plane Simpson's are highly accurate and reproducible 2D echocardiography methods for estimating RA volume. Linear dimensions are inaccurate and should be abandoned.
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Ecocardiografia/métodos , Imageamento por Ressonância Magnética/métodos , Volume Sistólico/fisiologia , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND AND PURPOSE: Several accepted algorithms exist to characterize the risk of thromboembolism in atrial fibrillation. We performed a comparative analysis to assess the predictive value of 9 such schemes. METHODS: In a longitudinal community-based cohort study from Olmsted County, Minnesota, 2720 residents with atrial fibrillation were followed up for 4.4±3.6 years±SD from 1990 to 2004. Risk factors were identified using a diagnostic index integrated with the electronic medical record. Thromboembolism and cardiovascular event data were collected and analyzed. RESULTS: We identified 350 validated thromboembolic events in our cohort. Multivariable analysis identified age >75 years (odds ratio, 2.08; P<0.0001), female sex (odds ratio, 1.45; P=0.0015), history of hypertension (odds ratio, 3.07; P<0.0001), diabetes mellitus (odds ratio, 1.58; P=0.0003), and history of heart failure (odds ratio, 1.50; P=0.0102) as significant predictors of clinical thromboembolism. The Stroke Prevention in Atrial Fibrillation (SPAF; hazard ratio, 2.75; c=0.659), CHADS2-revised (hazard ratio, 3.48; c=0.654), and CHADS2-classical (hazard ratio, 2.90; c=0.653) risk schemes were most accurate in risk stratification. The low-risk cohort within the CHA2DS2-VASc scheme had the lowest event rate among all low-risk cohorts (0.11 per 100 person-years). CONCLUSIONS: A direct comparison of 9 risk schemes reveals no profound differences in risk stratification accuracy for high-risk patients. Accurate prediction of low-risk patients is perhaps more valuable in determining those unlikely to benefit from oral anticoagulation therapy. Among our cohort, CHA2DS2-VASc performed best in this purpose.
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Fibrilação Atrial/complicações , Acidente Vascular Cerebral/etiologia , Tromboembolia/etiologia , Idoso , Algoritmos , Fibrilação Atrial/epidemiologia , Pressão Sanguínea/fisiologia , Estudos de Coortes , Feminino , Seguimentos , Guias como Assunto , Frequência Cardíaca/fisiologia , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia , Tromboembolia/epidemiologiaRESUMO
Atrial fibrillation (AF) and heart failure (HF) are two epidemics of the century that have a close and complex relationship. The mechanisms underlying this association remain an area of ongoing intense research. In this review, we will describe the relationship between these two public health concerns, the mechanisms that fuel the development and perpetuation of both, and the evolving concepts that may revolutionize our approach to this dual epidemic.
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Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Comorbidade , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Prevenção Primária , Prognóstico , Fatores de RiscoRESUMO
BACKGROUND: Physical inactivity contributes to atherosclerotic processes, which manifest as increased arterial stiffness. Arterial stiffness is associated with myocardial demand and coronary perfusion and is a risk factor for stroke and other adverse cardiac outcomes. Poststroke mobility limitations often lead to physical inactivity and sedentary behaviors. This exploratory study aimed to identify functional correlates, reflective of daily physical activity levels, with arterial stiffness in community-dwelling individuals >1 year poststroke. METHODS: Carotid-femoral pulse wave velocity (cfPWV) was measured in 35 participants (65% men; mean ± SD age 66.9 ± 6.9 years; median time poststroke 3.7 years). Multivariable regression analyses examined the relationships between cfPWV and factors associated with daily physical activity: aerobic capacity (VO2 peak), gait speed, and balance ability (Berg Balance Scale). Age and the use of antihypertensive medications, known to be associated with pulse wave velocity, were also included in the model. RESULTS: Mean cfPWV was 11.2 ± 2.4 m/s. VO2 peak and age were correlated with cfPWV (r = -0.45 [P = .006] and r = 0.46 [P = .004], respectively). In the multivariable regression analyses, age and the use of antihypertensive medication accounted for 20.4% of the variance of cfPWV, and the addition of VO2 peak explained an additional 4.5% of the variance (R2 = 0.249). CONCLUSIONS: We found that arterial stiffness is elevated in community-dwelling, ambulatory individuals with stroke relative to healthy people. Multivariable regression analysis suggests that aerobic capacity (VO2 peak) may contribute to the variance of cfPWV after accounting for the effects of age and medication use. Whether intense risk modification and augmented physical activity will improve arterial stiffness in this population remains to be determined.
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Doenças Cardiovasculares/etiologia , Vida Independente , Limitação da Mobilidade , Atividade Motora , Comportamento Sedentário , Acidente Vascular Cerebral/complicações , Rigidez Vascular , Idoso , Idoso de 80 Anos ou mais , Colúmbia Britânica , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Estudos Transversais , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Consumo de Oxigênio , Prognóstico , Análise de Onda de Pulso , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular CerebralRESUMO
Left ventricular (LV) geometric patterns aid clinicians in the diagnosis and prognostication of various cardiomyopathies. The aim of this study is to assess the accuracy and reproducibility of LV dimensions and wall thickness using deep learning (DL) models. A total of 30,080 unique studies were included; 24,013 studies were used to train a convolutional neural network model to automatically assess, at end-diastole, LV internal diameter (LVID), interventricular septal wall thickness (IVS), posterior wall thickness (PWT), and LV mass. The model was trained to select end-diastolic frames with the largest LVID and to identify four landmarks, marking the dimensions of LVID, IVS, and PWT using manually labeled landmarks as reference. The model was validated with 3,014 echocardiographic cines and the accuracy of the model was evaluated with a test set of 3,053 echocardiographic cines. The model accurately measured LVID, IVS, PWT, and LV mass compared to study report values with a mean relative error of 5.40%, 11.73%, 12.76%, and 13.93%, respectively. The ð 2 of the model for the LVID, IVS, PWT, and the LV mass was 0.88, 0.63, 0.50, and 0.87, respectively. The novel DL model developed in this study was accurate for LV dimension assessment without the need to select end-diastolic frames manually. DL automated measurements of IVS and PWT were less accurate with greater wall thickness. Validation studies in larger and more diverse populations are ongoing.
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BACKGROUND: Automated rhythm detection on echocardiography through artificial intelligence (AI) has yet to be fully realized. We propose an AI model trained to identify atrial fibrillation (AF) using apical 4-chamber (AP4) cines without requiring electrocardiogram (ECG) data. METHODS: Transthoracic echocardiography studies of consecutive patients ≥ 18 years old at our tertiary care centre were retrospectively reviewed for AF and sinus rhythm. The study was first interpreted by level III-trained echocardiography cardiologists as the gold standard for rhythm diagnosis based on ECG rhythm strip and imaging assessment, which was also verified with a 12-lead ECG around the time of the study. AP4 cines with three cardiac cycles were then extracted from these studies with the rhythm strip and Doppler information removed and introduced to the deep learning model ResNet(2+1)D with an 80:10:10 training-validation-test split ratio. RESULTS: 634 patient studies (1205 cines) were included. After training, the AI model achieved high accuracy on validation for detection of both AF and sinus rhythm (mean F1-score = 0.92; AUROC = 0.95). Performance was consistent on the test dataset (mean F1-score = 0.94, AUROC = 0.98) when using the cardiologist's assessment of the ECG rhythm strip as the gold standard, who had access to the full study and external ECG data, while the AI model did not. CONCLUSIONS: AF detection by AI on echocardiography without ECG appears accurate when compared to an echocardiography cardiologist's assessment of the ECG rhythm strip as the gold standard. This has potential clinical implications in point-of-care ultrasound and stroke risk stratification.
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BACKGROUND: Systemic hypertension is a major risk factor for heart disease and stroke. Data regarding temporal relationship of left atrial (LA) remodeling to onset of hypertension are sparse. We aimed to quantitate LA structural and functional remodeling in newly diagnosed hypertensive patients. METHOD: We prospectively identified 380 patients with newly diagnosed systemic hypertension naive to drug therapy, and 380 age-matched control subjects without any history or evidence of hypertension. History or evidence of prior cardiovascular events, congenital or valvular heart disease, and renal dysfunction were exclusion criteria. Prevalence of LA enlargement, LA mechanical dysfunction expressed in total emptying fraction, left ventricular (LV) diastolic dysfunction, LV hypertrophy, and their interrelationships were assessed. RESULTS: Of the 380 newly diagnosed hypertensive patients, 285 (75%) had LA enlargement, 308 (81%) had LA mechanical dysfunction, and 19 (5%) had LVH. Diastolic dysfunction was present in 334 (88%) of the patients. Compared to the controls, the hypertensive group had larger maximal, minimal, and pre-A LA volumes (all P < 0.001). Total and active LA emptying fraction were significantly reduced (both P < 0.001). Total LA emptying fraction was strongly associated with systolic blood pressure [per 10 mmHg, HR 0.94 (0.89-0.98); P < 0.001], with stepwise decrease in LA emptying fraction of 6%, 10%, and 16% from the lowest (141-150 mmHg) to the top tertile of systolic blood pressure (>160 mmHg). CONCLUSION: In this drug-naive cohort with newly diagnosed hypertension, LA structural and functional remodeling, and LV diastolic dysfunction were common findings prior to initiation of drug treatment. LVH was uncommon. Impairment of LA mechanical function was evident even in the mildly hypertensive subgroup.
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Remodelamento Atrial , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/epidemiologia , Colúmbia Britânica/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de RiscoRESUMO
PURPOSE: There is lack of validated methods for quantifying the size of pleural effusion from standard transthoracic (TTE) windows. The purpose of this study is to determine whether pleural effusion (Peff) measured from routine two-dimensional (2D) TTE views correlate with chest radiograph (CXR). MATERIALS AND METHODS: We retrospectively identified all inpatients who underwent a TTE and CXR within 2 days in a large tertiary care center. Peff was measured on TTE from parasternal long axis (PLAX), apical four-chamber (A4C), and subcostal views and on CXR. Logistic regression models were used determine optimal cut points to predict moderate or greater Peff. RESULTS: In 200 patients (mean age 69.3 ± 14.3 years, 49.5% female), we found statistically significant associations between Peff size assessed by all TTE views and CXR, with weak to moderate correlation (PLAX length: 0.21 (95% CI [0.05, 0.35]); PLAX depth: 0.21 (95% CI [0.05, 0.35]); A4C left: 0.31 (95% CI [0.13, 0.46]); A4C right: 0.39 (95% CI [0.17, 0.57]); subcostal: 0.38 (95% CI [0.07, 0.61]). The best TTE thresholds for predicting moderate or greater left-sided Peff on CXR was PLAX length left > = 8.6 cm (sensitivity 78%, specificity 54%, PPV 26%, and NPV 92%). The best TTE thresholds for predicting moderate or greater right-sided Peff on CXR was A4C right > = 2.6 cm (sensitivity 87%, specificity 60%, PPV 37%, and NPV 94%). CONCLUSIONS: We identified statistically significant associations with Peff size measured on TTE and CXR. The predictive ability of TTE to identify moderate or large pleural effusion is limited.
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Ecocardiografia , Derrame Pleural , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Masculino , Estudos Retrospectivos , Ecocardiografia/métodos , Reprodutibilidade dos TestesRESUMO
We sought to determine the cardiac ultrasound view of greatest quality using a machine learning (ML) approach on a cohort of transthoracic echocardiograms (TTE) with abnormal left ventricular (LV) systolic function. We utilize an ML model to determine the TTE view of highest quality when scanned by sonographers. A random sample of TTEs with reported LV dysfunction from 09/25/2017-01/15/2019 were downloaded from the regional database. Component video files were analyzed using ML models that jointly classified view and image quality. The model consisted of convolutional layers for extracting spatial features and Long Short-term Memory units to temporally aggregate the frame-wise spatial embeddings. We report the view-specific quality scores for each TTE. Pair-wise comparisons amongst views were performed with Wilcoxon signed-rank test. Of 1,145 TTEs analyzed by the ML model, 74.5% were from males and mean LV ejection fraction was 43.1 ± 9.9%. Maximum quality score was best for the apical 4 chamber (AP4) view (70.6 ± 13.9%, p<0.001 compared to all other views) and worst for the apical 2 chamber (AP2) view (60.4 ± 15.4%, p<0.001 for all views except parasternal short-axis view at mitral/papillary muscle level, PSAX M/PM). In TTEs scanned by professional sonographers, the view with greatest ML-derived quality was the AP4 view.
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Ecocardiografia , Disfunção Ventricular Esquerda , Masculino , Humanos , Valor Preditivo dos Testes , Ecocardiografia/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Volume Sistólico , Aprendizado de MáquinaRESUMO
BACKGROUND: There is limited data on the residual echocardiographic findings including strain analysis among post-coronavirus disease (COVID) patients. The aim of our study is to prospectively phenotype post-COVID patients. METHODS: All patients discharged following acute COVID infection were systematically followed in the post-COVID-19 Recovery Clinic at Vancouver General Hospital and St. Paul's Hospital. At 4-18 weeks post diagnosis, patients underwent comprehensive echocardiographic assessment. Left ventricular ejection fraction (LVEF) was assessed by 3D, 2D Biplane Simpson's, or visual estimate. LV global longitudinal strain (GLS) was measured using a vendor-independent 2D speckle-tracking software (TomTec). RESULTS: A total of 127 patients (53% female, mean age 58 years) were included in our analyses. At baseline, cardiac conditions were present in 58% of the patients (15% coronary artery disease, 4% heart failure, 44% hypertension, 10% atrial fibrillation) while the remainder were free of cardiac conditions. COVID-19 serious complications were present in 79% of the patients (76% pneumonia, 37% intensive care unit admission, 21% intubation, 1% myocarditis). Normal LVEF was seen in 96% of the cohort and 97% had normal right ventricular systolic function. A high proportion (53%) had abnormal LV GLS defined as < 18%. Average LV GLS of septal and inferior segments were lower compared to that of other segments. Among patients without pre-existing cardiac conditions, LVEF was abnormal in only 1.9%, but LV GLS was abnormal in 46% of the patients. CONCLUSIONS: Most post-COVID patients had normal LVEF at 4-18 weeks post diagnosis, but over half had abnormal LV GLS.
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Left atrial (LA) volume and function are robust markers of cardiovascular risks and adverse cardiac outcomes. With advances in imaging technology, including tissue Doppler, strain, and strain rate imaging, we can now determine LA volume and function more precisely and this is anticipated to augment our ability to risk stratify, incremental to clinical risk profiling. There is increasing evidence that LA remodeling is treatable and is reversible. Serial LA volume and function assessment may provide a simple and quantifiable way of determining severity of risk and treatment impact. While reverse LA remodeling is expected to improve cardiac outcomes, data to confirm this remain forthcoming.