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Sequeira A, Feradov D, Almeida SO. Unlocking the gates: Uptake of cardiac CT and barriers to wider adoption among primary care providers. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00401-5. [PMID: 39117509 DOI: 10.1016/j.jcct.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024]
Affiliation(s)
- A Sequeira
- University of South Florida Morsani College of Medicine, Heart and Vascular Institute at Tampa General Hospital, 2 Tampa General Cir, Tampa, FL 33606, United States.
| | - D Feradov
- University of South Florida Morsani College of Medicine, Heart and Vascular Institute at Tampa General Hospital, 2 Tampa General Cir, Tampa, FL 33606, United States
| | - S O Almeida
- University of South Florida Morsani College of Medicine, Heart and Vascular Institute at Tampa General Hospital, 2 Tampa General Cir, Tampa, FL 33606, United States
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2
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Picano E, Pierard L, Peteiro J, Djordjevic-Dikic A, Sade LE, Cortigiani L, Van De Heyning CM, Celutkiene J, Gaibazzi N, Ciampi Q, Senior R, Neskovic AN, Henein M. The clinical use of stress echocardiography in chronic coronary syndromes and beyond coronary artery disease: a clinical consensus statement from the European Association of Cardiovascular Imaging of the ESC. Eur Heart J Cardiovasc Imaging 2024; 25:e65-e90. [PMID: 37798126 DOI: 10.1093/ehjci/jead250] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
Since the 2009 publication of the stress echocardiography expert consensus of the European Association of Echocardiography, and after the 2016 advice of the American Society of Echocardiography-European Association of Cardiovascular Imaging for applications beyond coronary artery disease, new information has become available regarding stress echo. Until recently, the assessment of regional wall motion abnormality was the only universally practiced step of stress echo. In the state-of-the-art ABCDE protocol, regional wall motion abnormality remains the main step A, but at the same time, regional perfusion using ultrasound-contrast agents may be assessed. Diastolic function and pulmonary B-lines are assessed in step B; left ventricular contractile and preload reserve with volumetric echocardiography in step C; Doppler-based coronary flow velocity reserve in the left anterior descending coronary artery in step D; and ECG-based heart rate reserve in non-imaging step E. These five biomarkers converge, conceptually and methodologically, in the ABCDE protocol allowing comprehensive risk stratification of the vulnerable patient with chronic coronary syndromes. The present document summarizes current practice guidelines recommendations and training requirements and harmonizes the clinical guidelines of the European Society of Cardiology in many diverse cardiac conditions, from chronic coronary syndromes to valvular heart disease. The continuous refinement of imaging technology and the diffusion of ultrasound-contrast agents improve image quality, feasibility, and reader accuracy in assessing wall motion and perfusion, left ventricular volumes, and coronary flow velocity. Carotid imaging detects pre-obstructive atherosclerosis and improves risk prediction similarly to coronary atherosclerosis. The revolutionary impact of artificial intelligence on echocardiographic image acquisition and analysis makes stress echo more operator-independent and objective. Stress echo has unique features of low cost, versatility, and universal availability. It does not need ionizing radiation exposure and has near-zero carbon dioxide emissions. Stress echo is a convenient and sustainable choice for functional testing within and beyond coronary artery disease.
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Affiliation(s)
- Eugenio Picano
- Institute of Clinical Physiology of the National Research Council, CNR, Via Moruzzi 1, 56124 Pisa, Italy
| | - Luc Pierard
- University of Liège, Walloon Region, Belgium
| | - Jesus Peteiro
- CHUAC-Complexo Hospitalario Universitario A Coruna, CIBER-CV, University of A Coruna, 15070 La Coruna, Spain
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, University Clinical Centre of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center UPMC Heart & Vascular Institute, Pittsburgh, PA, USA
| | | | | | - Jelena Celutkiene
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, 43100 Parma, Italy
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy
| | - Roxy Senior
- Imperial College, UK
- Royal Brompton Hospital Imperial College London, UK
- Northwick Park Hospital, London, UK
| | - Aleksandar N Neskovic
- Department of Cardiology, University Clinical Hospital Center Zemun-Belgrade Faculty of Medicine, University of Belgrade, Serbia
| | - Michael Henein
- Department of Public Health and Clinical Medicine Units: Section of Medicine, Umea University, Umea, Sweden
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Kirkpatrick JN, Swaminathan M, Adedipe A, Garcia-Sayan E, Hung J, Kelly N, Kort S, Nagueh S, Poh KK, Sarwal A, Strachan GM, Topilsky Y, West C, Wiener DH. American Society of Echocardiography COVID-19 Statement Update: Lessons Learned and Preparation for Future Pandemics. J Am Soc Echocardiogr 2023; 36:1127-1139. [PMID: 37925190 DOI: 10.1016/j.echo.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The COVID-19 pandemic has evolved since the publication of the initial American Society of Echocardiography (ASE) statements providing guidance to echocardiography laboratories. In light of new developments, the ASE convened a diverse, expert writing group to address the current state of the COVID-19 pandemic and to apply lessons learned to echocardiography laboratory operations in future pandemics. This statement addresses important areas specifically impacted by the current and future pandemics: (1) indications for echocardiography, (2) application of echocardiographic services in a pandemic, (3) infection/transmission mitigation strategies, (4) role of cardiac point-of-care ultrasound/critical care echocardiography, and (5) training in echocardiography.
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Affiliation(s)
| | | | | | | | - Judy Hung
- Massachusetts General Hospital, Boston, Massachusetts
| | - Noreen Kelly
- Sanger Heart Institute, Charlotte, North Carolina
| | - Smadar Kort
- Stony Brook University Medical Center, Stony Brook, New York
| | | | - Kian Keong Poh
- Department of Cardiology, National University of Singapore, Singapore
| | - Aarti Sarwal
- Wake Forest Baptist Health Center, Winston-Salem, North Carolina
| | - G Monet Strachan
- Division of Cardiology, University of California, San Francisco, California
| | - Yan Topilsky
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Cathy West
- Royal Brompton Hospital, London, United Kingdom
| | - David H Wiener
- Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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4
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Sirico D, Spigariol G, Mahmoud HT, Basso A, Cuppini E, Avesani M, Sabatino J, Castaldi B, Di Salvo G. Acute Changes in Right Ventricular Function in Pediatric Patients with Pulmonary Valve Stenosis Undergoing Percutaneous Valvuloplasty: A Speckle-Tracking Study. J Clin Med 2023; 12:4344. [PMID: 37445378 DOI: 10.3390/jcm12134344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Pulmonary valve stenosis determines multiple effects on the right ventricular dimension and function. Percutaneous balloon valvuloplasty is the treatment of choice in severe pulmonary valve stenosis in patients of all ages. However, little is known regarding right ventricular function immediate changes after percutaneous balloon dilation. Pediatric patients with isolated pulmonary valve stenosis represent a pure clinical model of chronic RV pressure overload not affected by other confounders or comorbidities. AIM OF THE STUDY This study seeks to explore right ventricle (RV) mechanics in pediatric patients early after percutaneous balloon pulmonary valvuloplasty (BPV) for valvar pulmonary stenosis (PS). MATERIALS AND METHODS Forty-three pediatric patients (19 males), mean age 3.2 ± 4.9 years old, with severe pulmonary valve stenosis and indication for percutaneous balloon valvuloplasty were recruited. All patients underwent standard transthoracic echocardiography (TTE), and speckle-tracking echocardiography (STE) with an analysis of right ventricle free-wall longitudinal strain (RVFWLS) one day before and one day after the procedure. For each patient, we collected invasive parameters during the interventional procedure before and after BPV. RESULTS After the procedure, there was an immediate significant reduction in both peak-to-peak transpulmonary gradient (peak-to-peak PG) and ratio between the right ventricle and aortic systolic pressure (RV/AoP) with a drop of ∆29.3 ± 14.67 mmHg and ∆0.43 ± 0.03, respectively. Post-procedural echocardiography showed peak and mean transvalvar pressure gradient drop (∆50 ± 32.23 and ∆31 ± 17.97, respectively). The degree of pulmonary valve regurgitation was mild in 8% of patients before the procedure, affecting 29% of our patients post-BPV (p = 0.007). The analysis of right ventricular mechanics showed a significant improvement of fractional area change (FAC) immediately after BPV (40.11% vs. 44.42%, p = 0.01). On the other hand, right ventricular longitudinal systolic function parameters, TAPSE and global RVFWLS, did not improve significantly after intervention. The segmental analysis of the RVFWLS showed a significant regional increase in the myocardial deformation of the apical segments. CONCLUSIONS Percutaneous BPV represents an efficient and safe procedure to relieve severe pulmonary valve stenosis. The analysis of the right ventricular function on echocardiography demonstrated an immediate global systolic function improvement, while longitudinal systolic function was persistently impaired 24 h after intervention, possibly due to the necessity of a longer recovery time.
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Affiliation(s)
- Domenico Sirico
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Giulia Spigariol
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Heba Talat Mahmoud
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Alessia Basso
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Elena Cuppini
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Martina Avesani
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Jolanda Sabatino
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
- Experimental Cardiology, Paediatric Research Institute (IRP), Città della Speranza, University of Padova, 35122 Padua, Italy
| | - Biagio Castaldi
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
| | - Giovanni Di Salvo
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy
- Experimental Cardiology, Paediatric Research Institute (IRP), Città della Speranza, University of Padova, 35122 Padua, Italy
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Petrovic D, Benzon B, Srsen S, Polic B, Vukovic Novogradec A, Milic P, Markic J. The Impact of Vitamin D Levels on Clinical Manifestations of Multisystem Inflammatory Syndrome in Children: A Cross-Sectional Study. Life (Basel) 2023; 13:674. [PMID: 36983830 PMCID: PMC10057472 DOI: 10.3390/life13030674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Hyperinflammatory response that resembles Kawasaki disease may develop in children after COVID-19 disease, and it is called multisystem inflammatory syndrome in children. The cause of MIS-C is dysregulated innate immune response and a subsequent cytokine storm that results in endothelial damage. It has been determined that low levels of serum 25(OH)D increase the risk of developing immune-related diseases and disorders. METHODS To determine the incidence of hypovitaminosis D, and a possible correlation between 25(OH)D levels and the clinical severity of MIS-C, 21 patients hospitalized in the University Hospital of Split due to MIS-C were evaluated. RESULTS Hypovitaminosis D was detected in 95% of MIS-C patients. We found a significant relationship between the severity of MIS-C and 25(OH)D levels, as patients with more severe MIS-C had lower 25(OH)D. MIS-C patients with lower vitamin D levels had worse systolic and diastolic function of the left ventricle according to echocardiograms. There was no relationship between 25(OH)D levels and the tested laboratory inflammatory and cardiac markers. CONCLUSION Hypovitaminosis D is very common in children with MIS-C and influences the severity of the disease. VD could be a new potential biomarker in MIS-C, and VD replacement therapy should be considered early on in the treatment of MIS-C.
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Affiliation(s)
- Davor Petrovic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | - Benjamin Benzon
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | - Sasa Srsen
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | - Branka Polic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | | | - Petra Milic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
| | - Josko Markic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
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Panajotu A, Vecsey-Nagy M, Jermendy ÁL, Boussoussou M, Vattay B, Kolossváry M, Zs. Dombrády Ö, Csobay-Novák C, Merkely B, Szilveszter B. Coronary CTA Amidst the COVID-19 Pandemic: A Quicker Examination Protocol with Preserved Image Quality Using a Dedicated Cardiac Scanner. Diagnostics (Basel) 2023; 13:406. [PMID: 36766511 PMCID: PMC9914678 DOI: 10.3390/diagnostics13030406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
There has been an ongoing debate on the means to minimize the time patients spend at health care providers during the COVID-19 pandemic. We propose a strategy relying solely on intravenous (i.v.) beta-blocker administration for heart-rate (HR) control prior to coronary CT angiography (CCTA). We aimed to assess a potential difference in CCTA image quality (IQ) after implementation of a modified strategy compared to our standard protocol of oral premedication during the first wave of COVID-19. We analyzed CCTA examinations conducted one year before (n = 1511) and after (n = 1064) implementation of this new regime. Examinations were performed both on our 256-slice multidetector CT (MDCT) and dedicated cardiac CT (DCCT) scanners. We used a four-point Likert scale (excellent/good/moderate/non-diagnostic) for IQ assessment of the coronaries. We detected a significant increase in mean HR during examinations on both CT scanners (MDCT: 62.4 ± 10.0 vs. 65.3 ± 9.7, p < 0.001; DCCT: 61.7 ± 15.2 vs. 65.0 ± 10.7, p < 0.001). The rate of moderate/non-diagnostic IQ significantly increased on the MDCT (192/1005, 19.1% vs. 144/466, 30.9%, p < 0.001), while this ratio did not change significantly on the DCCT (62/506, 12.3% vs. 84/598, 14.0%, p = 0.38). The improved temporal resolution of DCCT allows the stand-alone use of i.v. premedication with preserved IQ; hence, the duration of visits can be shortened.
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Affiliation(s)
- Alexisz Panajotu
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Milán Vecsey-Nagy
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | | | | | - Borbála Vattay
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, 29. Haller Street, 1096 Budapest, Hungary
- Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Bécsi út 96/b, 1034 Budapest, Hungary
| | - Örs Zs. Dombrády
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Csaba Csobay-Novák
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
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Hays AG, Choi AD, Lopez-Mattei J, Mukherjee M. Editorial: Multimodality imaging in cardiomyopathy. Front Cardiovasc Med 2023; 9:1082023. [PMID: 36712276 PMCID: PMC9875132 DOI: 10.3389/fcvm.2022.1082023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Affiliation(s)
- Allison G. Hays
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Andrew D. Choi
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC, United States
| | - Juan Lopez-Mattei
- Heart and Vascular Institute, Lee Health Hospital, Fort Myers, FL, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States,*Correspondence: Monica Mukherjee ✉
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Laino ME, Ammirabile A, Motta F, De Santis M, Savevski V, Francone M, Chiti A, Mannelli L, Selmi C, Monti L. Advanced Imaging Supports the Mechanistic Role of Autoimmunity and Plaque Rupture in COVID-19 Heart Involvement. Clin Rev Allergy Immunol 2023; 64:75-89. [PMID: 35089505 PMCID: PMC8796606 DOI: 10.1007/s12016-022-08925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 01/26/2023]
Abstract
The cardiovascular system is frequently affected by coronavirus disease-19 (COVID-19), particularly in hospitalized cases, and these manifestations are associated with a worse prognosis. Most commonly, heart involvement is represented by myocarditis, myocardial infarction, and pulmonary embolism, while arrhythmias, heart valve damage, and pericarditis are less frequent. While the clinical suspicion is necessary for a prompt disease recognition, imaging allows the early detection of cardiovascular complications in patients with COVID-19. The combination of cardiothoracic approaches has been proposed for advanced imaging techniques, i.e., CT scan and MRI, for a simultaneous evaluation of cardiovascular structures, pulmonary arteries, and lung parenchyma. Several mechanisms have been proposed to explain the cardiovascular injury, and among these, it is established that the host immune system is responsible for the aberrant response characterizing severe COVID-19 and inducing organ-specific injury. We illustrate novel evidence to support the hypothesis that molecular mimicry may be the immunological mechanism for myocarditis in COVID-19. The present article provides a comprehensive review of the available evidence of the immune mechanisms of the COVID-19 cardiovascular injury and the imaging tools to be used in the diagnostic workup. As some of these techniques cannot be implemented for general screening of all cases, we critically discuss the need to maximize the sustainability and the specificity of the proposed tests while illustrating the findings of some paradigmatic cases.
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Affiliation(s)
- Maria Elena Laino
- grid.417728.f0000 0004 1756 8807Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Angela Ammirabile
- grid.417728.f0000 0004 1756 8807Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesca Motta
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy ,grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Maria De Santis
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy ,grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Victor Savevski
- grid.417728.f0000 0004 1756 8807Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Francone
- grid.417728.f0000 0004 1756 8807Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Arturo Chiti
- grid.417728.f0000 0004 1756 8807Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Carlo Selmi
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy ,grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Lorenzo Monti
- grid.417728.f0000 0004 1756 8807Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Myocardial perfusion imaging in the era of COVID-19: a systematic review. Clin Transl Imaging 2022; 11:165-197. [PMID: 36536657 PMCID: PMC9750842 DOI: 10.1007/s40336-022-00531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE As COVID-19 was uncovered, it became evident that specific individuals could experience multi-organ complications for quite a while after infection. Among them, there were several cardiovascular complications. Myocardial perfusion imaging single photon emission computed tomography (MPI SPECT) can be utilized to detect and evaluate cardiac problems regardless of whether COVID caused them. By examining all publications relevant to the impacts of the pandemic on SPECT MPI imaging, we aimed to understand how the COVID pandemic affected different aspects of the MPI, how intense these effects were, and what the consequences were. METHOD On the 6th of June, 2022, a four-domain search strategy was developed and implemented by searching the following databases: PubMed, SCOPUS, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials. The retrieved records have been put through two levels of screening. The search for forward and backward citations provided more results. RESULTS This study contained 32 papers, divided into the following three categories: 1. Case reports and series; 2. A comparison of the number of MPIs conducted before and after the pandemic; and 3. SPECT MPI findings. CONCLUSION We observed through the article review that CT scans performed in combination with MPI are crucial and should be interpreted within the context of COVID, especially during outbreaks. Moreover, we discovered that in the initial months of the pandemic, the number of SPECT MPIs performed globally decreased, with the fall being more significant in some countries, primarily in low- to middle-income regions. Lastly, we found that individuals with a history of COVID-19 may be more prone to having MPIs that demonstrate abnormalities, such as ischemia.
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Maranduca MA, Tanase DM, Cozma CT, Dima N, Clim A, Pinzariu AC, Serban DN, Serban IL. The Impact of Angiotensin-Converting Enzyme-2/Angiotensin 1-7 Axis in Establishing Severe COVID-19 Consequences. Pharmaceutics 2022; 14:pharmaceutics14091906. [PMID: 36145655 PMCID: PMC9505151 DOI: 10.3390/pharmaceutics14091906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/24/2022] [Accepted: 09/03/2022] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has put a tremendous stress on the medical community over the last two years. Managing the infection proved a lot more difficult after several research communities started to recognize the long-term effects of this disease. The cellular receptor for the virus was identified as angiotensin-converting enzyme-2 (ACE2), a molecule responsible for a wide array of processes, broadly variable amongst different organs. Angiotensin (Ang) 1-7 is the product of Ang II, a decaying reaction catalysed by ACE2. The effects observed after altering the level of ACE2 are essentially related to the variation of Ang 1-7. The renin-angiotensin-aldosterone system (RAAS) is comprised of two main branches, with ACE2 representing a crucial component of the protective part of the complex. The ACE2/Ang (1-7) axis is well represented in the testis, heart, brain, kidney, and intestine. Infection with the novel SARS-CoV-2 virus determines downregulation of ACE2 and interrupts the equilibrium between ACE and ACE2 in these organs. In this review, we highlight the link between the local effects of RAAS and the consequences of COVID-19 infection as they arise from observational studies.
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Affiliation(s)
- Minela Aida Maranduca
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700115 Iasi, Romania
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Daniela Maria Tanase
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700115 Iasi, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristian Tudor Cozma
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence:
| | - Nicoleta Dima
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700115 Iasi, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andreea Clim
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alin Constantin Pinzariu
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dragomir Nicolae Serban
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ionela Lacramioara Serban
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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11
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Abraham S, Manohar SA, Patel R, Saji AM, Dani SS, Ganatra S. Strategies for Cardio-Oncology Care During the COVID-19 Pandemic. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022; 24:137-153. [PMID: 36090762 PMCID: PMC9446588 DOI: 10.1007/s11936-022-00965-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 12/15/2022]
Abstract
Purpose of review The COVID-19 pandemic has disrupted healthcare and has disproportionately affected the marginalized populations. Patients with cancer and cardiovascular disease (cardio-oncology population) are uniquely affected. In this review, we explore the current data on COVID-19 vulnerability and outcomes in these patients and discuss strategies for cardio-oncology care with a focus on healthcare innovation, health equity, and inclusion. Recent findings The growing evidence suggest increased morbidity and mortality from COVID-19 in patients with comorbid cancer and cardiovascular disease. Additionally, de novo cardiovascular complications such as myocarditis, myocardial infarction, arrhythmia, heart failure, and thromboembolic events have increasingly emerged, possibly due to an accentuated host immune response and cytokine release syndrome. Summary Patient-centric policies are helpful for cardio-oncology surveillance like remote monitoring, increased use of biomarker-based surveillance, imaging modalities like CT scan, and point-of-care ultrasound to minimize the exposure for high-risk patients. Abundant prior experience in cancer therapy scaffolded the repurposed use of corticosteroids, IL-6 inhibitors, and Janus kinase inhibitors in the treatment of COVID-19 infection. COVID-19 vaccine timing and dose frequency present a challenge due to overlapping toxicities and immune cell depletion in patients receiving cancer therapies. The SARS-CoV-2 pandemic laid bare social and ethnic disparities in healthcare but also steered in innovation to combat problems of patient outreach, particularly with virtual care. In the recovery phase, the backlog in cardio-oncology care, interplay of cancer therapy-related side effects, and long COVID-19 syndrome are crucial issues to address.
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Affiliation(s)
- Sonu Abraham
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 USA
| | | | - Rushin Patel
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 USA
| | - Anu Mariam Saji
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA USA
| | - Sourbha S. Dani
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 USA
| | - Sarju Ganatra
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 USA
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12
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Thompson RC, Phillips LM, Dilsizian V, Gutierrez DP, Einstein AJ, Crews SF, Skali H, Jih FKY, Dondi M, Gimelli A, Bateman TM, Al-Mallah MH, Ghesani M, Dorbala S, Calnon DA. Update on guidance and best practices for nuclear cardiology laboratories during the coronavirus disease 2019 (COVID-19) pandemic: Emphasis on transition to chronic endemic state. An information statement from ASNC, IAEA, and SNMMI. J Nucl Cardiol 2022; 29:2013-2018. [PMID: 35499661 PMCID: PMC9059683 DOI: 10.1007/s12350-022-02984-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Randall C Thompson
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA.
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA.
| | - Lawrence M Phillips
- Division of Cardiology, NYU Langone Medical Center, New York, NY, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Society of Nuclear Medicine and Molecular Imaging (SNMMI), Reston, VA, USA
| | - Diana Paez Gutierrez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
- International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Suzanne F Crews
- Nuclear Cardiology, Northeast Georgia Health System, Gainesville, GA, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Hicham Skali
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Department of Medicine. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Felix Keng Yung Jih
- National Heart Centre, Singapore, Singapore
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Maurizio Dondi
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
- International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Timothy M Bateman
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
- Society of Nuclear Medicine and Molecular Imaging (SNMMI), Reston, VA, USA
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Munir Ghesani
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
- Society of Nuclear Medicine and Molecular Imaging (SNMMI), Reston, VA, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Department of Medicine. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
| | - Dennis A Calnon
- OhioHealth Heart and Vascular Physicians, Columbus, OH, USA
- American Society of Nuclear Cardiology (ASNC), Fairfax, VA, USA
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13
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Sirico D, Di Chiara C, Costenaro P, Bonfante F, Cozzani S, Plebani M, Reffo E, Castaldi B, Donà D, Da Dalt L, Giaquinto C, Di Salvo G. Left ventricular longitudinal strain alterations in asymptomatic or mildly symptomatic paediatric patients with SARS-CoV-2 infection. Eur Heart J Cardiovasc Imaging 2022; 23:1083-1089. [PMID: 34219155 DOI: 10.1093/ehjci/jeab127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/10/2021] [Indexed: 01/07/2023] Open
Abstract
AIMS Compared with adult patients, clinical manifestations of children's coronavirus disease-2019 (COVID-19) are generally perceived as less severe. The objective of this study was to evaluate cardiac involvement in previously healthy children with asymptomatic or mildly symptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. METHODS AND RESULTS We analysed a cohort of 53 paediatric patients (29 males, 55%), mean age 7.5 ± 4.7 years, who had a confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or only mildly symptomatic for COVID-19. Patients underwent standard transthoracic echocardiogram and speckle tracking echocardiographic study at least 3 months after diagnosis. Thirty-two age, sex, and body surface area comparable healthy subjects were used as control group. Left ventricular ejection fraction was within normal limits but significantly lower in the cases group compared to controls (62.4 ± 4.1% vs. 65.2 ± 5.5%; P = 0.012). Tricuspid annular plane systolic excursion (20.1 ± 3 mm vs. 19.8 ± 3.4 mm; P = 0.822) and left ventricular (LV) global longitudinal strain (-21.9 ± 2.4% vs. -22.6 ± 2.5%; P = 0.208) were comparable between the two groups. Regional LV strain analysis showed a significant reduction of the LV mid-wall segments strain among cases compared to controls. Furthermore, in the cases group, there were 14 subjects (26%) with a regional peak systolic strain below -16% (-2.5 Z score in our healthy cohort) in at least two segments. These subjects did not show any difference regarding symptoms or serological findings. CONCLUSION SARS-CoV-2 infection may affect left ventricular deformation in 26% of children despite an asymptomatic or only mildly symptomatic acute illness. A follow-up is needed to verify the reversibility of these alterations and their impact on long-term outcomes.
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Affiliation(s)
- Domenico Sirico
- Department for Women's and Children's Health, University Hospital of Padova, Pediatric and Congenital Cardiology Unit, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Costanza Di Chiara
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Paola Costenaro
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Francesco Bonfante
- Laboratory of Experimental Animal Models, Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università 10, 35020 Legnaro, Italy
| | - Sandra Cozzani
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Elena Reffo
- Department for Women's and Children's Health, University Hospital of Padova, Pediatric and Congenital Cardiology Unit, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Biagio Castaldi
- Department for Women's and Children's Health, University Hospital of Padova, Pediatric and Congenital Cardiology Unit, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Daniele Donà
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Liviana Da Dalt
- Department for Women's and Children's Health, University Hospital of Padova, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Carlo Giaquinto
- Department for Women's and Children's Health, University Hospital of Padova, Division of Pediatric Infectious Diseases, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Giovanni Di Salvo
- Department for Women's and Children's Health, University Hospital of Padova, Pediatric and Congenital Cardiology Unit, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
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14
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Al Helali S, Sandokji H, Al Moughari A, Al Ghamdi H, Assiri T, Al Amri H. Successful use of ultraslow thrombolytic therapy in stuck mechanical aortic valve in a patient with COVID-19; a case report. Int J Surg Case Rep 2022; 95:107233. [PMID: 35617737 PMCID: PMC9121637 DOI: 10.1016/j.ijscr.2022.107233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE COVID-19 represents a new challenge for patients with prosthetic valve, through increasing the risk of thrombosis and reducing the frequency of anticoagulation follow up visits. CASE PRESENTATION A 37-year-old male patient on aspirin and warfarin for a mechanical aortic valve (AV, St Jude size 21 mm), presented with generalized fatigue and loss one of the mechanical heart sounds for 10 days. Urgent fluoroscopy showed stuck one of the AV leaflets in a closed and opening positions. Echocardiography showed high peak and mean AV gradients. The patient was confirmed with COVID-19 with fever on the day of admission. Cardiac CT with contrast showed stuck right (posterior) disc with a 6 × 4 mm thrombus surrounded by pannus formation. The patient was started on ultraslow thrombolytic therapy (alteplase 1 mg, every hour for 25 h, followed by 6 h of unfractionated heparin). Repeated fluoroscopy showed normal opening and closure of both discs. Repeated echocardiography showed a significant reduction in the peak and mean AV gradients back to baselines. The patient was discharged after 7 days with INR 3.0 for two consecutive days. The patient was asymptomatic with stable INR in three- and six-month follow-up visits. Transthoracic ultrasound demonstrated normally functioning mechanical AV. CLINICAL DISCUSSION Accurate and timely diagnosis of stuck mechanical AV requires high suspicion and timely diagnostic aids. CONCLUSION Full recovery can be achieved after one cycle of ultraslow thrombolytic therapy. Further supportive data are still needed before recommending thrombolytic therapy as a successful alternative to surgery in COVID-19 patients.
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Affiliation(s)
| | | | | | | | - Turki Assiri
- Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
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15
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Al-Mallah M, Naqvi TZ. Unbiased COVID-19 Pandemic With Biased Global Recovery. J Am Coll Cardiol 2022; 79:2018-2020. [PMID: 35589163 DOI: 10.1016/j.jacc.2022.03.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Mouaz Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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16
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Einstein AJ, Hirschfeld C, Williams MC, Vitola JV, Better N, Villines TC, Cerci R, Shaw LJ, Choi AD, Dorbala S, Karthikeyan G, Lu B, Sinitsyn V, Ansheles AA, Kudo T, Bucciarelli-Ducci C, Nørgaard BL, Maurovich-Horvat P, Campisi R, Milan E, Louw L, Allam AH, Bhatia M, Sewanan L, Malkovskiy E, Cohen Y, Randazzo M, Narula J, Morozova O, Pascual TN, Pynda Y, Dondi M, Paez D. Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19. J Am Coll Cardiol 2022; 79:2001-2017. [PMID: 35589162 PMCID: PMC9109706 DOI: 10.1016/j.jacc.2022.03.348] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/21/2022] [Accepted: 03/10/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown. OBJECTIVES The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide. METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery. RESULTS Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing. CONCLUSIONS Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing.
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Affiliation(s)
- Andrew J. Einstein
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA,Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA,Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA,Address for correspondence: Dr Andrew J. Einstein, Columbia University Irving Medical Center, Seymour, Paul and Gloria Milstein Division of Cardiology, 622 West 168th Street, PH 10-203, New York, New York 10032, USA
| | - Cole Hirschfeld
- Division of Cardiology, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michelle C. Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Nathan Better
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Leslee J. Shaw
- Blavatnik Family Women’s Health Research Institute, Mount Sinai Medical Center, New York, New York, USA
| | - Andrew D. Choi
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | | | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bin Lu
- National Center for Cardiovascular Diseases, Beijing, China
| | - Valentin Sinitsyn
- University Hospital, Lomonosov Moscow State University, Moscow, Russian Federation
| | - Alexey A. Ansheles
- National Medical Research Center of Cardiology of Healthcare Ministry, Moscow, Russian Federation
| | | | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys’ and St Thomas NHS Trust and King’s College London, London, United Kingdom
| | | | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | | | | | - Lizette Louw
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - Mona Bhatia
- Fortis Escorts Heart Institute, New Delhi, India
| | - Lorenzo Sewanan
- Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Eli Malkovskiy
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA,Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Yosef Cohen
- Technion Israel Institute of Technology, Haifa, Israel
| | - Michael Randazzo
- Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jagat Narula
- Mount Sinai Medical Center, New York, New York, USA
| | - Olga Morozova
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | | | - Yaroslav Pynda
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Maurizio Dondi
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
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17
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Cardiovasc Res 2022; 118:1385-1412. [PMID: 34864874 PMCID: PMC8690255 DOI: 10.1093/cvr/cvab342] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular disease (CVD) in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, reported here, focuses on the epidemiology, pathophysiology, and diagnosis of cardiovascular (CV) conditions that may be manifest in patients with COVID-19. The second part, which will follow in a later edition of the journal, addresses the topics of care pathways, treatment, and follow-up of CV conditions in patients with COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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Affiliation(s)
- Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Freiburgstrasse 4, 3010 Bern, Switzerland
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Hospital Clínic
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- ECGen, the Cardiogenetics Focus Group of EHRA
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
- Yale University School of Medicine, New Haven, CT, USA
| | - Elijah R Behr
- ECGen, the Cardiogenetics Focus Group of EHRA
- Cardiology Clinical Academic Group, Institute of Molecular and Clinical Sciences, St George's, University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | - Sergio Berti
- U.O.C. Cardiologia Diagnostica e Interventistica, Dipartimento Cardiotoracico, Fondazione Toscana G. Monasterio - Ospedale del Cuore G. Pasquinucci, Massa, Italy
| | - Héctor Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Davide Capodanno
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco" University of Catania, Catania, Italy
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Center, IRCCS Gruppo MultiMedica, Sesto San Giovanni, Milan, Italy
| | | | - Jean-Philippe Collet
- Sorbonne Université, ACTION study group, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Thomas Cuisset
- Département de Cardiologie, CHU Timone, Marseille, France
- INSERM, UMR1062, Nutrition, Obesity and Risk of Thrombosis, Marseille, France
- Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Hypertension Research Center, Federico II University Hospital, Naples, Italy
| | - Victoria Delgado
- Heart Lung Centrum, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Uhasselt, Diepenbeek, Belgium
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
- Maria Cecilia Hospital, GVM Care&Research, Cotignola (RA), Ravenna, Italy
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Arif Elvan
- Isala Heart Center, Zwolle, The Netherlands
| | - José R González-Juanatey
- Cardiology Department, University Hospital, IDIS, CIBERCV, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mauro Gori
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
| | - Diederick Grobbee
- Julius Global Health, the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Medicine, Jagiellonian University College of Medicine, Kraków, Poland
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Gerhard Hindricks
- Department of Internal Medicine/Cardiology/Electrophysiology, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
- Leipzig Heart Institute (LHI), Leipzig, Germany
| | - Borja Ibanez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Nicole Karam
- Université de Paris, PARCC, INSERM, Paris, France
- European Hospital Georges Pompidou, Paris, France
| | - Hugo Katus
- Department of Internal Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Fredrikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ulf Landmesser
- Department of Cardiology, Charite University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | | | - Sergio Leonardi
- University of Pavia, Pavia, Italy
- Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | | | - Josepa Mauri
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Health Department of the Government of Catalonia, Barcelona, Spain
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Nuccia Morici
- Unità di Cure Intensive Cardiologiche e De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi, Milan, Italy
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anna Sonia Petronio
- Cardiothoracic and Vascular Department, University of Pisa, Ospedale Cisanello, Pisa, Italy
| | - Marija M Polovina
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Tatjana Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Intensive Arrhythmia Care, Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | | | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Susanna Price
- Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College, London, UK
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Oriol Rodríguez-Leor
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Health Department of the Government of Catalonia, Barcelona, Spain
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Rafael Romaguera
- Servicio de Cardiología, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine (Cardiology) and Cologne Cardiovascular Research Center (CCRC), Heart Center at the University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Andrea Sarkozy
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Uhasselt, Diepenbeek, Belgium
| | - Petar Seferovic
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Michele Senni
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
| | - Francesco R Spera
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, Pieve Emanuele - Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano - Milan, Italy
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute (LHI), Leipzig, Germany
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luccia Torracca
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, Pieve Emanuele - Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano - Milan, Italy
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Arthur A Wilde
- ECGen, the Cardiogenetics Focus Group of EHRA
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
- Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
- Department of Clinical Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London, London, UK
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18
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Eur Heart J 2022; 43:1033-1058. [PMID: 34791157 PMCID: PMC8690026 DOI: 10.1093/eurheartj/ehab696] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/08/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular disease (CVD) in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, reported here, focuses on the epidemiology, pathophysiology, and diagnosis of cardiovascular (CV) conditions that may be manifest in patients with COVID-19. The second part, which will follow in a later edition of the journal, addresses the topics of care pathways, treatment, and follow-up of CV conditions in patients with COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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19
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Javaid A, Saleh Y, Ahmed AI, Saad JM, Malahfji M, Al-Mallah MH. Noninvasive Imaging for Patients with COVID-19 and Acute Chest Pain. Methodist Debakey Cardiovasc J 2022; 17:5-15. [PMID: 34992719 PMCID: PMC8680163 DOI: 10.14797/mdcvj.1040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 12/19/2022] Open
Abstract
Acute chest pain is a common presentation in patients with COVID-19. Although noninvasive cardiac imaging modalities continue to be important cornerstones of management, the pandemic has brought forth difficult and unprecedented challenges in the provision of timely care while ensuring the safety of patients and providers. Clinical practice has adapted to these challenges, with several recommendations and societal guidelines emerging on the appropriate use of imaging modalities. In this review, we summarize the current evidence base on the use of noninvasive cardiac imaging modalities in COVID-19 patients with acute chest pain, with a focus on acute coronary syndromes.
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Affiliation(s)
- Awad Javaid
- Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas School of Medicine, Las Vegas, NV, US
| | - Yehia Saleh
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, US
| | | | - Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, US
| | - Maan Malahfji
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, US
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20
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Al-Mallah MH. The Way Ahead: Life After COVID-19. Methodist Debakey Cardiovasc J 2022; 17:83-88. [PMID: 34992726 PMCID: PMC8680109 DOI: 10.14797/mdcvj.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
Much has changed in the 2 years since the start of the coronavirus disease 19 (COVID-19) pandemic. The need for social distancing catalyzed the digitization of healthcare delivery and medical education—from telemedicine and virtual conferences to online residency/fellowship interviews. Vaccine development, particularly in the field of mRNA technology, led to widespread availability of safe and effective vaccines. With improved survival from acute infection, the healthcare system is dealing with the ever-growing cohort of patients with lingering symptoms. In addition, social media platforms have fueled a plethora of misinformation campaigns that have adversely affected prevention and control measures. In this review, we examine how COVID-19 has reshaped the healthcare system, and gauge its potential effects on life after the pandemic.
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21
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Sirico D, Basso A, Sabatino J, Reffo E, Cavaliere A, Biffanti R, Cerutti A, Castaldi B, Zulian F, Da Dalt L, Di Salvo G. OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:1066-1074. [PMID: 35639926 PMCID: PMC9384104 DOI: 10.1093/ehjci/jeac096] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 11/14/2022] Open
Abstract
Aims Methods and results Conclusion
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Affiliation(s)
- D Sirico
- Corresponding author. Tel: +39 3388121632, E-mail:
| | - A Basso
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - J Sabatino
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - E Reffo
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - A Cavaliere
- Institute of Radiology, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - R Biffanti
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - A Cerutti
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - B Castaldi
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - F Zulian
- Pediatric Rheumatology Unit, Department for Women's and Children's Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - L Da Dalt
- Pediatric Emergency Unit, Department for Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - G Di Salvo
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
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22
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Impact of COVID-19 on Cardiovascular Disease Presentation, Emergency Department Triage and Inpatient Cardiology Services in a Low- to Middle-Income Country – Perspective from a Tertiary Care Hospital of Pakistan. Glob Heart 2021; 16:86. [PMID: 35141127 PMCID: PMC8698227 DOI: 10.5334/gh.1084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/15/2021] [Indexed: 12/15/2022] Open
Abstract
Aims: To identify the changes in cardiovascular disease presentation, emergency room triage and inpatient diagnostic and therapeutic pathways. Methods: We conducted a retrospective cohort study at the Aga Khan University Hospital, Karachi. We collected data for patients presenting to the emergency department with cardiovascular symptoms between March–July 2019 (pre-COVID period) and March–July 2020 (COVID period). The comparison was made to quantify the differences in demographics, clinical characteristics, admission, diagnostic and therapeutic procedures, and in-hospital mortality between the two periods. Results: Of 2976 patients presenting with cardiac complaints to the emergency department (ED), 2041(69%) patients presented during the pre-COVID period, and 935 (31%) patients presented during the COVID period. There was significant reduction in acute coronary syndrome (ACS) (8% [95% CI 4–11], p < 0.001) and heart failure (↓6% [95% CI 3–8], p < 0.001). A striking surge was noted in Type II Myocardial injury (↑18% [95% CI 20–15], p < 0.001) during the pandemic. There was reduction in cardiovascular admissions (coronary care unit p < 0.01, coronary step-down unit p = 0.03), cardiovascular imaging (p < 0.001), and procedures (percutaneous coronary intervention p = 0.04 and coronary angiography p = 0.02). No significant difference was noted in mortality (4.7% vs. 3.7%). The percentage of patients presenting from rural areas declined significantly during the COVID period (18% vs. 14%, p = 0.01). In the subgroup analysis of sex, we noticed a falling trend of intervention performed in females during the COVID period (8.2% male vs. 3.3 % female). Conclusions: This study shows a significant decline in patients presenting with Type I myocardial infarction (MI) and a decrease in cardiovascular imaging and procedures during the COVID period. There was a significant increase noted in Type II MI.
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23
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Conte E, Mushtaq S, Mancini ME, Annoni A, Formenti A, Muscogiuri G, Gaudenzi Asinelli M, Gigante C, Collet C, Sonck J, Guglielmo M, Baggiano A, Cosentino N, Denora M, Belmonte M, Agalbato C, Esposito AA, Assanelli E, Bartorelli AL, Pepi M, Pontone G, Andreini D. Cardiac Care of Non-COVID-19 Patients During the SARS-CoV-2 Pandemic: The Pivotal Role of CCTA. Front Cardiovasc Med 2021; 8:775115. [PMID: 34901235 PMCID: PMC8652066 DOI: 10.3389/fcvm.2021.775115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of this study is to evaluate the potential use of coronary CT angiography (CCTA) as the sole available non-invasive diagnostic technique for suspected coronary artery disease (CAD) during the coronavirus disease 2019 (COVID-19) pandemic causing limited access to the hospital facilities. Methods and Results: A consecutive cohort of patients with suspected stable CAD and clinical indication to non-invasive test was enrolled in a hub hospital in Milan, Italy, from March 9 to April 30, 2020. Outcome measures were obtained as follows: cardiac death, ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina. All the changes in medical therapy following the result of CCTA were annotated. A total of 58 patients with a mean age of 64 ± 11 years (36 men and 22 women) were enrolled. CCTA showed no CAD in 14 patients (24.1%), non-obstructive CAD in 30 (51.7%) patients, and obstructive CAD in 14 (24.1%) patients. Invasive coronary angiography (ICA) was considered deferrable in 48 (82.8%) patients. No clinical events were recorded after a mean follow-up of 376.4 ± 32.1 days. Changes in the medical therapy were significantly more prevalent in patients with vs. those without CAD at CCTA. Conclusion: The results of the study confirm the capability of CCTA to safely defer ICA in the majority of symptomatic patients and to correctly identify those with critical coronary stenoses necessitating coronary revascularization. This characteristic could be really helpful especially when the hospital resources are limited
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Affiliation(s)
- Edoardo Conte
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | | | - Andrea Annoni
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Alberto Formenti
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Giuseppe Muscogiuri
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | | | - Carlo Gigante
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Marco Guglielmo
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Andrea Baggiano
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Nicola Cosentino
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Marialessia Denora
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Marta Belmonte
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Cecilia Agalbato
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Andrea Alessandro Esposito
- Foundation Istituto di Ricerca e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Emilio Assanelli
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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24
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Shaw LJ, Chandrashekhar Y. What Is of Recent Interest in Cardiac Imaging?: Insights From the JACC Family of Journals. J Am Coll Cardiol 2021; 78:2387-2391. [PMID: 34857099 PMCID: PMC8629342 DOI: 10.1016/j.jacc.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jin C, Luo X, Qian S, Zhang K, Gao Y, Zhou R, Cen P, Xu Z, Zhang H, Tian M. Positron emission tomography in the COVID-19 pandemic era. Eur J Nucl Med Mol Imaging 2021; 48:3903-3917. [PMID: 34013405 PMCID: PMC8134823 DOI: 10.1007/s00259-021-05347-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/29/2021] [Indexed: 12/24/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has become a major public health problem worldwide since its outbreak in 2019. Currently, the spread of COVID-19 is far from over, and various complications have roused increasing awareness of the public, calling for novel techniques to aid at diagnosis and treatment. Based on the principle of molecular imaging, positron emission tomography (PET) is expected to offer pathophysiological alternations of COVID-19 in the molecular/cellular perspectives and facilitate the clinical management of patients. A number of PET-related cases and research have been reported on COVID-19 over the past one year. This article reviews the current studies of PET in the diagnosis and treatment of COVID-19, and discusses potential applications of PET in the development of management strategy for COVID-19 patients in the pandemic era.
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Affiliation(s)
- Chentao Jin
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Xiaoyun Luo
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Shufang Qian
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Kai Zhang
- Laboratory for Pathophysiological and Health Science, RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo, Japan
| | - Yuanxue Gao
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Rui Zhou
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Peili Cen
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Zhoujiao Xu
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China.
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China.
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.
| | - Mei Tian
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China.
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
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26
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Ciampi Q, Zagatina A, Cortigiani L, Wierzbowska-Drabik K, Kasprzak JD, Haberka M, Djordjevic-Dikic A, Beleslin B, Boshchenko A, Ryabova T, Gaibazzi N, Rigo F, Dodi C, Simova I, Samardjieva M, Barbieri A, Morrone D, Lorenzoni V, Prota C, Villari B, Antonini-Canterin F, Pepi M, Carpeggiani C, Pellikka PA, Picano E. Prognostic value of stress echocardiography assessed by the ABCDE protocol. Eur Heart J 2021; 42:3869-3878. [PMID: 34449837 PMCID: PMC8486488 DOI: 10.1093/eurheartj/ehab493] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/04/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022] Open
Abstract
AIM The aim of this study was to assess the prognostic value of ABCDE-SE in a prospective, large scale, multicentre, international, effectiveness study. Stress echocardiography (SE) was recently upgraded to the ABCDE protocol: step A, regional wall motion abnormalities; step B, B lines; step C, left ventricular contractile reserve; step D, Doppler-based coronary flow velocity reserve in left anterior descending coronary artery; and step E, electrocardiogram-based heart rate reserve. METHODS AND RESULTS From July 2016 to November 2020, we enrolled 3574 all-comers (age 65 ± 11 years, 2070 males, 58%; ejection fraction 60 ± 10%) with known or suspected chronic coronary syndromes referred from 13 certified laboratories. All patients underwent clinically indicated ABCDE-SE. The employed stress modality was exercise (n = 952, with semi-supine bike, n = 887, or treadmill, n = 65 with adenosine for step D) or pharmacological stress (n = 2622, with vasodilator, n = 2151; or dobutamine, n = 471). SE response ranged from score 0 (all steps normal) to score 5 (all steps abnormal). All-cause death was the only endpoint. Rate of abnormal results was 16% for A, 30% for B, 36% for C, 28% for D, and 37% for E steps. During a median follow-up of 21 months (interquartile range: 13-36), 73 deaths occurred. Global X2 was 49.5 considering clinical variables, 50.7 after step A only (P = NS (not significant)) and 80.6 after B-E steps (P < 0.001 vs. step A). Annual mortality rate ranged from 0.4% person-year for score 0 up to 2.7% person-year for score 5. CONCLUSION ABCDE-SE allows an effective prediction of survival in patients with chronic coronary syndromes.
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Affiliation(s)
- Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Angela Zagatina
- Cardiology Department, Saint Petersburg State University Hospital, Russian Federation
| | | | | | | | - Maciej Haberka
- Department of Cardiology, SHS, Medical University of Silesia, Katowice, Poland
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Tamara Ryabova
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Fausto Rigo
- Cardiology Department, Ospedale di Dolo-Venice, Venice, Italy
| | - Claudio Dodi
- Cardiology Department, Ospedale di Cremona, Cremona, Italy
| | - Iana Simova
- Cardiology Department, Heart and Brain Center of Excellence, University Hospital, Pleven, Sofia, Bulgaria
| | - Martina Samardjieva
- Cardiology Department, Heart and Brain Center of Excellence, University Hospital, Pleven, Sofia, Bulgaria
| | | | | | | | | | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Francesco Antonini-Canterin
- Highly Specialized Rehabilitation Hospital Motta di Livenza, Cardiac Prevention and Rehabilitation Unit, Treviso, Italy.,Italian Society of Echocardiography and Cardiovascular Imaging, Milano, Italy
| | - Mauro Pepi
- Italian Society of Echocardiography and Cardiovascular Imaging, Milano, Italy.,Cardiology Division, Fondazione Cardiologica Monzino, Milano, Italy
| | - Clara Carpeggiani
- Biomedicine Department, CNR, Institute of Clinical Physiology, Via Moruzzi 1, Building C- Room 130, 56124 Pisa, Italy
| | | | - Eugenio Picano
- Biomedicine Department, CNR, Institute of Clinical Physiology, Via Moruzzi 1, Building C- Room 130, 56124 Pisa, Italy
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27
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Richter D, Guasti L, Koehler F, Squizzato A, Nistri S, Christodorescu R, Dievart F, Gaudio G, Asteggiano R, Ferrini M. Late phase of COVID-19 pandemic in General Cardiology. A position paper of the ESC Council for Cardiology Practice. ESC Heart Fail 2021; 8:3483-3494. [PMID: 34170086 PMCID: PMC8427022 DOI: 10.1002/ehf2.13466] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/06/2021] [Accepted: 05/23/2021] [Indexed: 01/08/2023] Open
Abstract
Cardiovascular (CV) engagement in coronavirus disease 2019 (COVID-19) is a huge determinant of prognosis during the acute phase of the disease. However, little is known about the potential chronic implications of the late phase of COVID-19 and about the appropriate approach to these patients. Heart failure, type 1 and type 2 myocardial infarction, arrhythmias, myocarditis, pulmonary fibrosis, and thrombosis have been shown to be related to severe acute respiratory syndrome coronavirus 2 infection, and a 'long COVID-19' illness has been recognized with fatigue, chest pain, and dyspnoea among the most frequent symptoms reported after discharge from hospital. This paper focuses on some open questions that cardiologists are going to face during the next months in a general cardiology outpatient clinic, in particular how to evaluate a 'post-COVID' patient during follow-up of CV complications of the acute phase and how to manage new CV symptoms that could be the consequence, at least in part, of heart/vessels and/or lung involvement of the previous virus infection. Present symptoms and signs, history of previous CV disease (both preceding COVID-19 and occurring during viral infection), and specific laboratory and imaging measurements during the acute phase may be of interest in focusing on how to approach the clinical evaluation of a post-COVID patient and how to integrate in our standard of care the new information on COVID-19, possibly in a multidisciplinary view. Dealing with the increased COVID-associated CV risk burden and becoming acquainted with potential new e-cardiology approaches aimed at integrating the cardiology practice are relevant new challenges brought by severe acute respiratory syndrome coronavirus 2 infection and its sequelae.
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Affiliation(s)
| | | | - Friedrich Koehler
- Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular TelemedicineCharité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | | | - Stefano Nistri
- CMSR Veneto Medica—Cardiology ServiceAltavilla VicentinaItaly
| | | | | | | | - Riccardo Asteggiano
- University of Insubria, ASST dei Sette LaghiVareseItaly
- LARC (Laboratorio Analisi e Ricerca Clinica)TurinItaly
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28
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Hirschfeld CB, Shaw LJ, Williams MC, Lahey R, Villines TC, Dorbala S, Choi AD, Shah NR, Bluemke DA, Berman DS, Blankstein R, Ferencik M, Narula J, Winchester D, Malkovskiy E, Goebel B, Randazzo MJ, Lopez-Mattei J, Parwani P, Vitola JV, Cerci RJ, Better N, Raggi P, Lu B, Sergienko V, Sinitsyn V, Kudo T, Nørgaard BL, Maurovich-Horvat P, Cohen YA, Pascual TNB, Pynda Y, Dondi M, Paez D, Einstein AJ. Impact of COVID-19 on Cardiovascular Testing in the United States Versus the Rest of the World. JACC Cardiovasc Imaging 2021; 14:1787-1799. [PMID: 34147434 PMCID: PMC8374310 DOI: 10.1016/j.jcmg.2021.03.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/01/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-U.S. institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. BACKGROUND The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. METHODS Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. RESULTS Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. CONCLUSIONS We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection.
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Affiliation(s)
- Cole B Hirschfeld
- Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA
| | - Leslee J Shaw
- Weill Cornell Medical College and New York-Presbyterian Hospital, New York, New York, USA
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Ryan Lahey
- Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA
| | - Todd C Villines
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Sharmila Dorbala
- Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrew D Choi
- George Washington University School of Medicine, Washington, DC, USA
| | - Nishant R Shah
- Division of Cardiology, Department of Medicine, Brown University Alpert Medical School, Providence, Rhode Island, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Madison, Wisconsin, USA
| | - Daniel S Berman
- Departments of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ron Blankstein
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maros Ferencik
- Division of Cardiovascular Medicine, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Jagat Narula
- Mount Sinai Medical Center, New York, New York, USA
| | - David Winchester
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Eli Malkovskiy
- Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA; Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA
| | - Benjamin Goebel
- Weill Cornell Medical College and New York-Presbyterian Hospital, New York, New York, USA
| | - Michael J Randazzo
- Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA
| | - Juan Lopez-Mattei
- Departments of Cardiology and Thoracic Imaging, MD Anderson Cancer Center, Houston, Texas, USA
| | - Purvi Parwani
- Department of Cardiology, Loma Linda University Health, Loma Linda, California, USA
| | - Joao V Vitola
- Quanta Diagnostico por Imagem, Curitiba, Paraná, Brazil
| | | | - Nathan Better
- Royal Melbourne Hospital and University of Melbourne, Victoria, Australia
| | - Paolo Raggi
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Bin Lu
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Vladimir Sergienko
- National Medical Research Center of Cardiology of Health care Ministry, Moscow, Russian Federation
| | - Valentin Sinitsyn
- University Hospital, Lomonosov Moscow State University, Moscow, Russian Federation
| | | | | | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Yosef A Cohen
- Technion Israel Institute of Technology, Haifa, Israel
| | | | | | | | - Diana Paez
- International Atomic Energy Agency, Vienna, Austria
| | - Andrew J Einstein
- Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA; Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA.
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29
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Picano E, Ciampi Q, Cortigiani L, Arruda-Olson AM, Borguezan-Daros C, de Castro e Silva Pretto JL, Cocchia R, Bossone E, Merli E, Kane GC, Varga A, Agoston G, Scali MC, Morrone D, Simova I, Samardjieva M, Boshchenko A, Ryabova T, Vrublevsky A, Palinkas A, Palinkas ED, Sepp R, Torres MAR, Villarraga HR, Preradović TK, Citro R, Amor M, Mosto H, Salamè M, Leeson P, Mangia C, Gaibazzi N, Tuttolomondo D, Prota C, Peteiro J, Van De Heyning CM, D’Andrea A, Rigo F, Nikolic A, Ostojic M, Lowenstein J, Arbucci R, Haber DML, Merlo PM, Wierzbowska-Drabik K, Kasprzak JD, Haberka M, Camarozano AC, Ratanasit N, Mori F, D’Alfonso MG, Tassetti L, Milazzo A, Olivotto I, Marchi A, Rodriguez-Zanella H, Zagatina A, Padang R, Dekleva M, Djordievic-Dikic A, Boskovic N, Tesic M, Giga V, Beleslin B, Di Salvo G, Lorenzoni V, Cameli M, Mandoli GE, Bombardini T, Caso P, Celutkiene J, Barbieri A, Benfari G, Bartolacelli Y, Malagoli A, Bursi F, Mantovani F, Villari B, Russo A, De Nes M, Carpeggiani C, Monte I, Re F, Cotrim C, Bilardo G, Saad AK, Karuzas A, Matuliauskas D, Colonna P, Antonini-Canterin F, Pepi M, Pellikka PA. Stress Echo 2030: The Novel ABCDE-(FGLPR) Protocol to Define the Future of Imaging. J Clin Med 2021; 10:3641. [PMID: 34441937 PMCID: PMC8397117 DOI: 10.3390/jcm10163641] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
With stress echo (SE) 2020 study, a new standard of practice in stress imaging was developed and disseminated: the ABCDE protocol for functional testing within and beyond CAD. ABCDE protocol was the fruit of SE 2020, and is the seed of SE 2030, which is articulated in 12 projects: 1-SE in coronary artery disease (SECAD); 2-SE in diastolic heart failure (SEDIA); 3-SE in hypertrophic cardiomyopathy (SEHCA); 4-SE post-chest radiotherapy and chemotherapy (SERA); 5-Artificial intelligence SE evaluation (AI-SEE); 6-Environmental stress echocardiography and air pollution (ESTER); 7-SE in repaired Tetralogy of Fallot (SETOF); 8-SE in post-COVID-19 (SECOV); 9: Recovery by stress echo of conventionally unfit donor good hearts (RESURGE); 10-SE for mitral ischemic regurgitation (SEMIR); 11-SE in valvular heart disease (SEVA); 12-SE for coronary vasospasm (SESPASM). The study aims to recruit in the next 5 years (2021-2025) ≥10,000 patients followed for ≥5 years (up to 2030) from ≥20 quality-controlled laboratories from ≥10 countries. In this COVID-19 era of sustainable health care delivery, SE2030 will provide the evidence to finally recommend SE as the optimal and versatile imaging modality for functional testing anywhere, any time, and in any patient.
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Affiliation(s)
- Eugenio Picano
- CNR, Biomedicine Department, Institute of Clinical Physiology, 56100 Pisa, Italy; (M.D.N.); (C.C.)
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy; (Q.C.); (B.V.)
| | | | - Adelaide M. Arruda-Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
| | | | | | - Rosangela Cocchia
- Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, 80100 Naples, Italy; (R.C.); (E.B.)
| | - Eduardo Bossone
- Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, 80100 Naples, Italy; (R.C.); (E.B.)
| | - Elisa Merli
- Department of Cardiology, Ospedale per gli Infermi, Faenza, 48100 Ravenna, Italy;
| | - Garvan C. Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
| | - Albert Varga
- Institute of Family Medicine, Szeged University Medical School, University of Szeged, 6720 Szeged, Hungary; (A.V.); (G.A.)
| | - Gergely Agoston
- Institute of Family Medicine, Szeged University Medical School, University of Szeged, 6720 Szeged, Hungary; (A.V.); (G.A.)
| | | | - Doralisa Morrone
- Cardiothoracic Department, University of Pisa, 56100 Pisa, Italy;
| | - Iana Simova
- Heart and Brain Center of Excellence, Cardiology Department, University Hospital, Medical University, 5800 Pleven, Bulgaria; (I.S.); (M.S.)
| | - Martina Samardjieva
- Heart and Brain Center of Excellence, Cardiology Department, University Hospital, Medical University, 5800 Pleven, Bulgaria; (I.S.); (M.S.)
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, 634009 Tomsk, Russia; (A.B.); (T.R.); (A.V.)
| | - Tamara Ryabova
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, 634009 Tomsk, Russia; (A.B.); (T.R.); (A.V.)
| | - Alexander Vrublevsky
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, 634009 Tomsk, Russia; (A.B.); (T.R.); (A.V.)
| | - Attila Palinkas
- Internal Medicine Department, Elisabeth Hospital, 6800 Hódmezővásárhely, Hungary;
| | - Eszter D. Palinkas
- Albert Szent-Gyorgyi Clinical Center, Department of Internal Medicine, Division of Non-Invasive Cardiology, University Hospital, 6725 Szeged, Hungary; (R.S.); (E.D.P.)
| | - Robert Sepp
- Albert Szent-Gyorgyi Clinical Center, Department of Internal Medicine, Division of Non-Invasive Cardiology, University Hospital, 6725 Szeged, Hungary; (R.S.); (E.D.P.)
| | | | - Hector R. Villarraga
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
| | - Tamara Kovačević Preradović
- Clinic of Cardiovascular Diseases, University Clinical Centre of the Republic of Srpska, 78 000 Banja Luka, Bosnia and Herzegovina; (T.K.P.); (T.B.)
| | - Rodolfo Citro
- Cardiology Department and Echocardiography Lab, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84100 Salerno, Italy;
| | - Miguel Amor
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires C1221, Argentina; (M.A.); (H.M.); (M.S.)
| | - Hugo Mosto
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires C1221, Argentina; (M.A.); (H.M.); (M.S.)
| | - Michael Salamè
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires C1221, Argentina; (M.A.); (H.M.); (M.S.)
| | - Paul Leeson
- RDM Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, University of Oxford, Oxford OX3 9DU, UK;
| | - Cristina Mangia
- CNR, ISAC-Institute of Sciences of Atmosphere and Climate, 73100 Lecce, Italy;
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, 43100 Parma, Italy; (N.G.); (D.T.)
| | - Domenico Tuttolomondo
- Cardiology Department, Parma University Hospital, 43100 Parma, Italy; (N.G.); (D.T.)
| | - Costantina Prota
- Cardiology Department, Vallo della Lucania Hospital, 84100 Salerno, Italy;
| | - Jesus Peteiro
- CHUAC-Complexo Hospitalario Universitario A Coruna, CIBER-CV, University of A Coruna, 15070 La Coruna, Spain;
| | | | - Antonello D’Andrea
- UOC Cardiologia/UTIC/Emodinamica, PO Umberto I, Nocera Inferiore (ASL Salerno)—Università Luigi Vanvitelli della Campania, 84014 Salerno, Italy; (A.D.); (P.C.)
| | - Fausto Rigo
- Department of Cardiology, Dolo Hospital, 30031 Venice, Italy;
| | - Aleksandra Nikolic
- Department of Noninvasive Cardiology, Institute for Cardiovascular Diseases Dedinje, School of Medicine, Belgrade 11000, Serbia; (A.N.); (M.O.)
| | - Miodrag Ostojic
- Department of Noninvasive Cardiology, Institute for Cardiovascular Diseases Dedinje, School of Medicine, Belgrade 11000, Serbia; (A.N.); (M.O.)
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (J.L.); (R.A.); (D.M.L.H.); (P.M.M.)
| | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (J.L.); (R.A.); (D.M.L.H.); (P.M.M.)
| | - Diego M. Lowenstein Haber
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (J.L.); (R.A.); (D.M.L.H.); (P.M.M.)
| | - Pablo M. Merlo
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (J.L.); (R.A.); (D.M.L.H.); (P.M.M.)
| | - Karina Wierzbowska-Drabik
- Department of Cardiology, Bieganski Hospital, Medical University, 91-347 Lodz, Poland; (K.W.-D.); (J.D.K.)
| | - Jaroslaw D. Kasprzak
- Department of Cardiology, Bieganski Hospital, Medical University, 91-347 Lodz, Poland; (K.W.-D.); (J.D.K.)
| | - Maciej Haberka
- Department of Cardiology, SHS, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Ana Cristina Camarozano
- Medicine Department, Hospital de Clinicas UFPR, Federal University of Paranà, Curitiba 80000-000, Brazil;
| | - Nithima Ratanasit
- Department of Medicine, Division of Cardiology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Fabio Mori
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Maria Grazia D’Alfonso
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Luigi Tassetti
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Alessandra Milazzo
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Iacopo Olivotto
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Alberto Marchi
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | | | - Angela Zagatina
- Cardiology Department, Saint Petersburg State University Hospital, 199034 Saint Petersburg, Russia;
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
| | - Milica Dekleva
- Clinical Cardiology Department, Clinical Hospital Zvezdara, Medical School, University of Belgrade, Belgrade 11000, Serbia;
| | - Ana Djordievic-Dikic
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Nikola Boskovic
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Milorad Tesic
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Vojislav Giga
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Branko Beleslin
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Giovanni Di Salvo
- Division of Pediatric Cardiology, University Hospital, 35100 Padua, Italy;
| | | | - Matteo Cameli
- Division of Cardiology, University Hospital, 53100 Siena, Italy; (M.C.); (G.E.M.)
| | - Giulia Elena Mandoli
- Division of Cardiology, University Hospital, 53100 Siena, Italy; (M.C.); (G.E.M.)
| | - Tonino Bombardini
- Clinic of Cardiovascular Diseases, University Clinical Centre of the Republic of Srpska, 78 000 Banja Luka, Bosnia and Herzegovina; (T.K.P.); (T.B.)
| | - Pio Caso
- UOC Cardiologia/UTIC/Emodinamica, PO Umberto I, Nocera Inferiore (ASL Salerno)—Università Luigi Vanvitelli della Campania, 84014 Salerno, Italy; (A.D.); (P.C.)
| | - Jelena Celutkiene
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
| | - Andrea Barbieri
- Noninvasive Cardiology, University Hospital, 43100 Parma, Italy;
| | - Giovanni Benfari
- Cardiology Department, University of Verona, 37121 Verona, Italy;
| | - Ylenia Bartolacelli
- Paediatric Cardiology and Adult Congenital Heart Disease Unit, S. Orsola-Malpighi Hospital, 40100 Bologna, Italy;
| | - Alessandro Malagoli
- Nephro-Cardiovascular Department, Division of Cardiology, Baggiovara Hospital, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Francesca Bursi
- ASST Santi Paolo e Carlo, Presidio Ospedale San Paolo, 20100 Milano, Italy;
| | - Francesca Mantovani
- Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, Cardiology, 42100 Reggio Emilia, Italy;
| | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy; (Q.C.); (B.V.)
| | - Antonello Russo
- Association for Public Health “Salute Pubblica”, 72100 Brindisi, Italy;
| | - Michele De Nes
- CNR, Biomedicine Department, Institute of Clinical Physiology, 56100 Pisa, Italy; (M.D.N.); (C.C.)
| | - Clara Carpeggiani
- CNR, Biomedicine Department, Institute of Clinical Physiology, 56100 Pisa, Italy; (M.D.N.); (C.C.)
| | - Ines Monte
- Echocardiography Laboratory, Cardio-Thorax-Vascular Department, “ Policlinico Vittorio Emanuele”, Catania University, 95100 Catania, Italy;
| | - Federica Re
- Ospedale San Camillo, Cardiology Division, 00100 Rome, Italy;
| | - Carlos Cotrim
- Heart Center, Hospital da Cruz Vermelha, Lisbon, and Medical School of University of Algarve, 1549-008 Lisbon, Portugal;
| | - Giuseppe Bilardo
- UOC di Cardiologia, ULSS1 DOLOMITI, Presidio Ospedaliero di Feltre, 32032 Belluno, Italy;
| | - Ariel K. Saad
- División de Cardiología, Hospital de Clínicas José de San Martín, Buenos Aires C1120, Argentina;
| | - Arnas Karuzas
- Ligence Medical Solutions, 49206 Vilnius, Lithuania; (A.K.); (D.M.)
| | | | - Paolo Colonna
- Cardiology Hospital, Policlinico University Hospital of Bari, 70100 Bari, Italy;
- Italian Society of Echocardiography and Cardiovascular Imaging, 20138 Milan, Italy; (F.A.-C.); (M.P.)
| | - Francesco Antonini-Canterin
- Italian Society of Echocardiography and Cardiovascular Imaging, 20138 Milan, Italy; (F.A.-C.); (M.P.)
- Cardiac Prevention and Rehabilitation Unit, Highly Specialized Rehabilitation Hospital Motta di Livenza, Motta di Livenza, 31045 Treviso, Italy
| | - Mauro Pepi
- Italian Society of Echocardiography and Cardiovascular Imaging, 20138 Milan, Italy; (F.A.-C.); (M.P.)
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
| | - Patricia A. Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
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Reshaping of Italian Echocardiographic Laboratories Activities during the Second Wave of COVID-19 Pandemic and Expectations for the Post-Pandemic Era. J Clin Med 2021; 10:jcm10163466. [PMID: 34441762 PMCID: PMC8397129 DOI: 10.3390/jcm10163466] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiology divisions reshaped their activities during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to analyze the organization of echocardiographic laboratories and echocardiography practice during the second wave of the COVID-19 pandemic in Italy, and the expectations for the post-COVID era. METHODS We analyzed two different time periods: the month of November during the second wave of the COVID-19 pandemic (2020) and the identical month during 2019 (November 2019). RESULTS During the second wave of the COVID-19 pandemic, the hospital activity was partially reduced in 42 (60%) and wholly interrupted in 3 (4%) echocardiographic laboratories, whereas outpatient echocardiographic activity was partially reduced in 41 (59%) and completely interrupted in 7 (10%) laboratories. We observed an important change in the organization of activities in the echocardiography laboratory which reduced the operator-risk and improved self-protection of operators by using appropriate personal protection equipment. Operators wore FFP2 in 58 centers (83%) during trans-thoracic echocardiography (TTE), in 65 centers (93%) during transesophageal echocardiography (TEE) and 63 centers (90%) during stress echocardiography. The second wave caused a significant reduction in number of echocardiographic exams, compared to November 2019 (from 513 ± 539 to 341 ± 299 exams per center, -34%, p < 0.001). On average, there was a significant increase in the outpatient waiting list for elective echocardiographic exams (from 32.0 ± 28.1 to 45.5 ± 44.9 days, +41%, p < 0.001), with a reduction of in-hospital waiting list (2.9 ± 2.4 to 2.4 ± 2.0 days, -17%, p < 0.001). We observed a large diffusion of point-of-care cardiac ultrasound (88%), with a significant increase of lung ultrasound usage in 30 centers (43%) during 2019, extended to all centers in 2020. Carbon dioxide production by examination is an indicator of the environmental impact of technology (100-fold less with echocardiography compared to other cardiac imaging techniques). It was ignored in 2019 by 100% of centers, and currently it is considered potentially crucial for decision-making in cardiac imaging by 65 centers (93%). CONCLUSIONS In one year, major changes occurred in echocardiography practice and culture. The examination structure changed with extensive usage of point-of-care cardiac ultrasound and with lung ultrasound embedded by default in the TTE examination, as well as the COVID-19 testing.
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Early Echocardiographic and Cardiac MRI Findings in Multisystem Inflammatory Syndrome in Children. J Clin Med 2021; 10:jcm10153360. [PMID: 34362141 PMCID: PMC8348478 DOI: 10.3390/jcm10153360] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 12/24/2022] Open
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) is a known severe condition affecting children previously exposed to SARS-CoV-2. The aim of our study was to describe the early cardiac abnormalities in patients with MIS-C, evaluated by speckle tracking echocardiography (STE) and cardiac MRI (CMR). Clinical, laboratory and microbiological data were measured for all patients. All children underwent standard transthoracic echocardiography, STE with analysis of left ventricle global longitudinal strain (GLS). Seventeen (75%) of the children were evaluated with CMR. Twenty-three patients (13M, 10F) were recruited, mean age was 8.1 ± 4 years. Cardiovascular symptoms were present in 10 (43.5%). Nine children (39.1%) shared Kawasaki Disease-like symptoms. Four patients (17.4%) needed ICU admission. In-hospital survival was 100%. TnI was elevated in 15 (65.2%) and BNP in 20 (86.9%) patients. The median time to STE evaluation was 8 days and to CMR was 18 days after fever onset. Mean LVEF was 59 ± 10%. Coronary dilation was observed in six (26.1%) patients. STE showed a reduced mean LVGLS (-17 ± 4.3%). LGE with a non-ischemic pattern was evident in six out of seventeen patients (35.2%). The elevation of myocardial necrosis markers, the reduction of LVGLS and the presence of LGE on CMR in about a quarter of MIS-C patients supports the hypothesis of a post-viral immune-mediated myocarditis-like pathogenesis.
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Afshar-Oromieh A, Prosch H, Schaefer-Prokop C, Bohn KP, Alberts I, Mingels C, Thurnher M, Cumming P, Shi K, Peters A, Geleff S, Lan X, Wang F, Huber A, Gräni C, Heverhagen JT, Rominger A, Fontanellaz M, Schöder H, Christe A, Mougiakakou S, Ebner L. A comprehensive review of imaging findings in COVID-19 - status in early 2021. Eur J Nucl Med Mol Imaging 2021; 48:2500-2524. [PMID: 33932183 PMCID: PMC8087891 DOI: 10.1007/s00259-021-05375-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023]
Abstract
Medical imaging methods are assuming a greater role in the workup of patients with COVID-19, mainly in relation to the primary manifestation of pulmonary disease and the tissue distribution of the angiotensin-converting-enzyme 2 (ACE 2) receptor. However, the field is so new that no consensus view has emerged guiding clinical decisions to employ imaging procedures such as radiography, computer tomography (CT), positron emission tomography (PET), and magnetic resonance imaging, and in what measure the risk of exposure of staff to possible infection could be justified by the knowledge gained. The insensitivity of current RT-PCR methods for positive diagnosis is part of the rationale for resorting to imaging procedures. While CT is more sensitive than genetic testing in hospitalized patients, positive findings of ground glass opacities depend on the disease stage. There is sparse reporting on PET/CT with [18F]-FDG in COVID-19, but available results are congruent with the earlier literature on viral pneumonias. There is a high incidence of cerebral findings in COVID-19, and likewise evidence of gastrointestinal involvement. Artificial intelligence, notably machine learning is emerging as an effective method for diagnostic image analysis, with performance in the discriminative diagnosis of diagnosis of COVID-19 pneumonia comparable to that of human practitioners.
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Affiliation(s)
- Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland.
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Cornelia Schaefer-Prokop
- Department of Radiology, Meander Medical Center, Amersfoort, Netherlands
- Department of Medical Imaging, Radboud University, Nijmegen, Netherlands
| | - Karl Peter Bohn
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Ian Alberts
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Clemens Mingels
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Majda Thurnher
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Paul Cumming
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Kuangyu Shi
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Alan Peters
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Silvana Geleff
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Adrian Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes T Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Matthias Fontanellaz
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stavroula Mougiakakou
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) spread rapidly around the world in the early months of 2020 before the COVID-19 outbreak was officially declared a pandemic in March 2020. Worldwide volumes of non-emergent testing, such as cardiac PET and SPECT, decreased dramatically at the beginning of the lockdown as health systems attempted to limit the spread of the COVID-19 virus. Published reports of increasing cardiovascular mortality compared to months prior to the pandemic raised concerns that lack of access to appropriate cardiovascular testing was adversely affecting patient outcomes. Medical societies published guidance for the best practices of cardiovascular nuclear medicine laboratories to address this emerging cardiovascular epidemic. These nuclear cardiology expert consensus recommendations were remarkably consistent with those from other health organizations and heavily emphasized patient triage, screening of symptoms, strict PPE usage, and limiting patient dwell time in the nuclear medicine lab by favoring shorter testing protocols. Survey responses indicated that nuclear medicine labs took heed of these recommendations and adjusted practices to meet the cardiovascular needs of their population while minimizing transmission risk.
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Affiliation(s)
- Richard A Mills
- Saint Luke's Mid America Heart Institute and The University of Missouri, Kansas City, MO
| | - Randall C Thompson
- Saint Luke's Mid America Heart Institute and The University of Missouri, Kansas City, MO.
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Imaging Cardiovascular Inflammation in the COVID-19 Era. Diagnostics (Basel) 2021; 11:diagnostics11061114. [PMID: 34207266 PMCID: PMC8233709 DOI: 10.3390/diagnostics11061114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/29/2022] Open
Abstract
Cardiac complications are among the most frequent extrapulmonary manifestations of COVID-19 and are associated with high mortality rates. Moreover, positive SARS-CoV-2 patients with underlying cardiovascular disease are more likely to require intensive care and are at higher risk of death. The underlying mechanism for myocardial injury is multifaceted, in which the severe inflammatory response causes myocardial inflammation, coronary plaque destabilization, acute thrombotic events, and ischemia. Cardiac magnetic resonance (CMR) imaging is the non-invasive method of choice for identifying myocardial injury, and it is able to differentiate between underlying causes in various and often challenging clinical scenarios. Multimodal imaging protocols that incorporate CMR and computed tomography provide a complex evaluation for both respiratory and cardiovascular complications of SARS-CoV2 infection. This, in relation to biological evaluation of systemic inflammation, can guide appropriate therapeutic management in every stage of the disease. The use of artificial intelligence can further improve the diagnostic accuracy of these imaging techniques, thus enabling risk stratification and evaluation of prognosis. The present manuscript aims to review the current knowledge on the possible modalities for imaging COVID-related myocardial inflammation or post-COVID coronary inflammation and atherosclerosis.
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Thompson RC, Lehenbauer KR. The Cardiovascular Imaging Community's Response to the COVID-19 Pandemic. JACC Cardiovasc Imaging 2021; 14:1800-1803. [PMID: 34147460 PMCID: PMC9436476 DOI: 10.1016/j.jcmg.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Randall C Thompson
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri, Kansas City, Kansas City, Missouri, USA.
| | - Kyle R Lehenbauer
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri, Kansas City, Kansas City, Missouri, USA
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Jain R, Kroboth S, Ignatowski D, Khandheria BK. Seroprevalence of SARS-CoV-2 Antibody in Echocardiography and Stress Laboratory. J Patient Cent Res Rev 2021; 8:146-150. [PMID: 33898648 PMCID: PMC8060043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Transesophageal echocardiography is an aerosol-generating procedure, and exercise stress testing is a potentially aerosol-generating activity. Concern has been raised about heightened risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among health care personnel participating in these procedures. We aimed to investigate the prevalence of past coronavirus disease 2019 (COVID-19) infection in echocardiography and stress laboratory staff. METHODS All staff who worked in the echocardiography and stress laboratories of one high-traffic urban hospital from March 15, 2020, to June 15, 2020, were asked to voluntarily participate. Those willing to participate were consented, and past COVID-19 infection was confirmed by a SARS-CoV-2 IgG antibody test (ARCHITECT, Abbott Laboratories) from June 15, 2020, to July 3, 2020. Clinical data were collected from the electronic medical record, and self-reported symptoms were documented with a participant survey. RESULTS A total of 43 staff members (86.0% of 50 total laboratory staff) participated. A majority of participants were less than 40 years old (69.8%), were White (86.0%), and were women (79.1%); mean body mass index was 24.9 ± 4.7 kg/m2. Of the 43 staff members tested for past COVID-19 infection, 3 (7.0%) had a positive SARS-CoV-2 IgG antibody result. There were no unique features in the 3 SARS-CoV-2 antibody-positive subjects; of these, 2 had known prior COVID-19 infection and 1 was asymptomatic. CONCLUSIONS This study provides clinical data on the seroprevalence of SARS-CoV-2 antibody in echocardiography and stress laboratory staff who regularly participate in a variety of procedures that are or may be aerosol-generating.
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Affiliation(s)
- Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers; University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | - Stacie Kroboth
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI
| | - Denise Ignatowski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers; University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | - Bijoy K. Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers; University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
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Medranda GA, Fazlalizadeh H, Case BC, Yerasi C, Zhang C, Rappaport H, Shea C, Weintraub WS, Waksman R. Implications of Left Ventricular Function on Short-Term Outcomes in COVID-19 Patients With Myocardial Injury. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 29:45-49. [PMID: 34049818 PMCID: PMC8023790 DOI: 10.1016/j.carrev.2021.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Myocardial injury is a complication of coronavirus disease 2019 (COVID-19). We describe a large multi-center experience of COVID-19 patients with myocardial injury, examining the prognostic role left ventricular function plays on short-term outcomes. METHODS/MATERIALS We included adult COVID-19 patients admitted to our health system with evidence of myocardial injury and who underwent a transthoracic echocardiogram (TTE) during index admission. Patients were dichotomized into those with reduced ejection fraction (EF; <50%) and preserved EF (≥50%). RESULTS Across our 11-hospital system, 5032 adult patients were admitted with COVID-19 from March-September 2020. Of these, 235 had evidence of myocardial injury (troponin ≥1 ng/mL). Included were 134 patients who underwent TTE, of whom 43.3% (n = 58) had reduced EF and 56.7% (n = 76) preserved EF. A subset of 6 patients had newly reduced EF, with 5 demonstrating evidence of stress cardiomyopathy and subsequently dying. Overall, mortality was high in those with reduced EF and preserved EF (in-hospital: 34.5% vs. 28.9%; p = 0.494; 6 months: 63.6% vs. 50.0%; p = 0.167; Kaplan-Meier estimates: p = 0.2886). Readmissions were frequent in both groups (30 days: 22.2% vs. 26.0%; p = 0.162; 6 months: 52.0% vs. 54.5%; p = 0.839). CONCLUSIONS Many COVID-19 patients admitted with evidence of myocardial injury did not undergo TTE. For those who did, short-term mortality was high. Patients who survived hospitalization had frequent readmissions. In patients with newly reduced EF, most had evidence of stress cardiomyopathy and expired. Larger studies are needed to fully evaluate the prognosis of COVID-19 patients with evidence of myocardial injury and left ventricular dysfunction.
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Affiliation(s)
- Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
| | - Hooman Fazlalizadeh
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
| | - Hank Rappaport
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
| | - Corey Shea
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
| | - William S Weintraub
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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Covas P, Ismail H, Krepp J, Choi BG, Lewis JF, Katz RJ, Choi AD. Contemporary Cardiovascular Imaging Advancements and Social Media. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23:25. [PMID: 33746507 PMCID: PMC7958098 DOI: 10.1007/s11936-021-00902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Social media (SoMe) as a means of knowledge dissemination has grown significantly in cardiovascular imaging in recent years. This media platform allows for a free exchange of ideas, the development of new communities, and the ability to disseminate advancements rapidly. While the social media platforms offer limitless potential, their public domain necessitates several important suggestions around best practices. RECENT FINDINGS In cardiovascular imaging, specific hashtags have emerged to encompass the major modalities to include #EchoFirst, #YesCCT, #WhyCMR, and #CVNuc. Cardiovascular imaging journals have established major presences in the social media space as an avenue to present novel, high-quality, peer-reviewed content to new audiences. SUMMARY This review paper aims to introduce basic concepts in social media and cardiovascular imaging while highlighting recent topics of high importance, influence, and attention in cardiovascular imaging to include the ISCHEMIA trial, COVID-19, structural imaging, and multimodality advances from throughout 2020.
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Affiliation(s)
- Pedro Covas
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Haneen Ismail
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Joseph Krepp
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Brian G. Choi
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Jannet F. Lewis
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Richard J. Katz
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Andrew D. Choi
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
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Goerlich E, Minhas AS, Mukherjee M, Sheikh FH, Gilotra NA, Sharma G, Michos ED, Hays AG. Multimodality Imaging for Cardiac Evaluation in Patients with COVID-19. Curr Cardiol Rep 2021; 23:44. [PMID: 33721125 PMCID: PMC7957471 DOI: 10.1007/s11886-021-01483-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW A growing number of cardiovascular manifestations resulting from the novel SARS-CoV-2 coronavirus (COVID-19) have been described since the beginning of this global pandemic. Acute myocardial injury is common in this population and is associated with higher rates of morbidity and mortality. The focus of this review centers on the recent applications of multimodality imaging in the diagnosis and management of COVID-19-related cardiovascular conditions. RECENT FINDINGS In addition to standard cardiac imaging techniques such as transthoracic echocardiography, other modalities including computed tomography and cardiac magnetic resonance imaging have emerged as useful adjuncts in select patients with COVID-19 infection, particularly those with suspected ischemic and nonischemic myocardial injury. Data have also emerged suggesting lasting COVID-19 subclinical cardiac effects, which may have long-term prognostic implications. With the spectrum of COVID-19 cardiovascular manifestations observed thus far, it is important for clinicians to recognize the role, strengths, and limitations of multimodality imaging techniques in this patient population.
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Affiliation(s)
- Erin Goerlich
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
| | - Anum S. Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
| | - Farooq H. Sheikh
- Division of Cardiology, Department of Medicine, Medstar Washington Hospital Center, Washington, DC USA
| | - Nisha A. Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
| | - Erin D. Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
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Schmermund A, Breitbart P, Eckert J, Magedanz A, Schmidt M, Voigtländer T. 2020: Entwicklungen in der kardialen Computertomographie. DER KARDIOLOGE 2021. [PMCID: PMC7921831 DOI: 10.1007/s12181-021-00454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Die Entwicklung der kardialen Computertomographie (CT) im Jahr 2020 war durch 3 dominante Schwerpunkte im Bereich der koronaren Bildgebung gekennzeichnet: 1) die prognostische Bedeutung der Plaquebildung, 2) die Möglichkeit ihrer volumetrischen Quantifizierung und 3) den Bedeutungsgewinn in den Leitlinien, verstärkt durch die zunehmende Anwendung in der Therapie von strukturellen Herzerkrankungen. Die Veröffentlichung der Ergebnisse von ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) hat den Blick auf die anatomische Charakterisierung der koronaren Herzkrankheit gelenkt, die Visualisierung der koronaren Plaquebildung. Nicht zuletzt als Ergebnis von „machine learning“/künstlicher Intelligenz hat sich die Möglichkeit herauskristallisiert, die koronare Plaquebildung automatisiert und volumetrisch zu erfassen. Diese beiden Entwicklungen haben die Frage nach der prognostischen Dominanz des Ischämienachweises aufgeworfen, der sekundär aus der Plaquebildung resultiert. Auch hat sich das Verständnis der Pathophysiologie der koronaren Herzerkrankung verändert: Die Ausprägung des (nicht verkalkten) Plaquevolumens, seine Lokalisierung und Dynamik scheinen als Merkmale der Vulnerabilität im Vergleich zur Fokussierung auf ein großes Atherom oder expansives Remodeling einzelner Plaques bedeutsamer zu sein. In den Leitlinien ist die koronare CT-Angiographie (CTA) sowohl bei den akuten Koronarsyndromen ohne ST-Hebung als auch den chronischen Koronarsyndromen an die erste Stelle gerückt – gleichberechtigt mit den klassischen bildgebenden Ischämietests. Unabhängig davon gewinnt die kardiale CT zunehmend an Bedeutung für die Therapieplanung von Vitien (insbesondere der Aorten- und Trikuspidalklappe), aber auch anderer struktureller Herzerkrankungen (z. B. Verschluss des linken Vorhofohrs, LAA).
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Affiliation(s)
- Axel Schmermund
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Philipp Breitbart
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Joachim Eckert
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Annett Magedanz
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Marco Schmidt
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Thomas Voigtländer
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
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Beck ALDS, Barberato SH, de Almeida ALC, Grau CRPDC, Lopes MMU, Lima RDSL, Cerci RJ, Albricker ACL, Barros FS, Oliveira AJ, de Lira EB, Miglioranza MH, Vieira MLC, Pena JLB, Strabelli TMV, Bihan DCDSL, Tsutsui JM, Rochitte CE. Position Statement on Indications and the Safe Reintroduction of Cardiovascular Imaging Methods in the COVID-19 Scenario - 2021. Arq Bras Cardiol 2021; 116:659-678. [PMID: 33909785 PMCID: PMC8159553 DOI: 10.36660/abc.20210133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Adenalva Lima de Souza Beck
- Universitária de CardiologiaInstituto de Cardiologia do Distrito FederalBrasíliaDFBrasilInstituto de Cardiologia do Distrito Federal - Fundação Universitária de Cardiologia, Brasília, DF – Brasil,Hospital Sírio-LibanêsBrasíliaDFBrasilHospital Sírio-Libanês, Brasília, DF – Brasil
| | - Silvio Henrique Barberato
- CardioEco - Centro de DiagnósticoCuritibaPRBrasilCardioEco - Centro de Diagnóstico Cardiovascular, Curitiba, PR – Brasil,Quanta Diagnóstico e TerapiaCuritibaPRBrasilQuanta Diagnóstico e Terapia, Curitiba, PR – Brasil
| | - André Luiz Cerqueira de Almeida
- Santa Casa de Misericórdia de Feira de SantanaFeira de SantanaBABrasilSanta Casa de Misericórdia de Feira de Santana, Feira de Santana, BA – Brasil
| | - Claudia R. Pinheiro de Castro Grau
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil,Grupo FleurySão PauloSPBrasilGrupo Fleury, São Paulo, SP – Brasil
| | - Marly Maria Uellendahl Lopes
- Universidade Estadual PaulistaSão PauloSPBrasilUniversidade Estadual Paulista (Unesp), São Paulo, SP – Brasil,Diagnósticos da AméricaSão PauloSPBrasilDiagnósticos da América SA (Dasa), São Paulo, SP – Brasil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ – Brasil
| | - Rodrigo Júlio Cerci
- Quanta Diagnóstico e TerapiaCuritibaPRBrasilQuanta Diagnóstico e Terapia, Curitiba, PR – Brasil
| | - Ana Cristina Lopes Albricker
- Instituto Mineiro de UltrassonografiaBelo HorizonteMGBrasilInstituto Mineiro de Ultrassonografia (IMEDE), Belo Horizonte, MG – Brasil
| | | | - Alessandra Joslin Oliveira
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Edgar Bezerra de Lira
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Marcelo Haertel Miglioranza
- Hospital Mãe de DeusPorto AlegreRSBrasilPrevencor – Hospital Mãe de Deus, Porto Alegre, RS – Brasil,Fundação Universitária de CardiologiaInstituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul – Fundação Universitária de Cardiologia, Porto Alegre, RS – Brasil
| | - Marcelo Luiz Campos Vieira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil,Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas GeraisBelo HorizonteMGBrasilFaculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG – Brasil,Hospital Felício RochoBelo HorizonteMGBrasilHospital Felício Rocho, Belo Horizonte, MG – Brasil
| | - Tânia Mara Varejão Strabelli
- Hospital Sírio-LibanêsBrasíliaDFBrasilHospital Sírio-Libanês, Brasília, DF – Brasil,Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - David Costa de Souza Le Bihan
- Diagnósticos da AméricaSão PauloSPBrasilDiagnósticos da América SA (Dasa), São Paulo, SP – Brasil,Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Jeane Mike Tsutsui
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil,Hospital do CoraçãoSão PauloSPBrasilHospital do Coração (HCor), São Paulo, SP – Brasil,Hospital Pró-CardíacoRio de JaneiroRJBrasilHospital Pró-Cardíaco, Rio de Janeiro, RJ – Brasil
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Blankstein R, Chandrashekhar Y. New Insights on COVID-19 and the Heart. JACC Cardiovasc Imaging 2021; 14:706-708. [PMID: 33663773 PMCID: PMC7920531 DOI: 10.1016/j.jcmg.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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43
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Khalique OK, Veillet-Chowdhury M, Choi AD, Feuchtner G, Lopez-Mattei J. Cardiac computed tomography in the contemporary evaluation of infective endocarditis. J Cardiovasc Comput Tomogr 2021; 15:304-312. [PMID: 33612424 DOI: 10.1016/j.jcct.2021.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/11/2021] [Accepted: 02/09/2021] [Indexed: 01/20/2023]
Abstract
Increasing data have accumulated on the role of Cardiac Computed Tomography (CCT) in infective endocarditis (IE) with high accuracy for large vegetations, perivalvular complications and for exclusion of coronary artery disease to avoid invasive angiography. CCT can further help to clarify the etiology of infective prosthetic valve dysfunction (e.g. malposition, abscess, leak, vegetation or mass). Structural interventions have increased the relevance of CCT in valvular heart disease and have amplified its use. CCT may be ideally integrated into a multimodality approach that incorporates a central role of transesophageal echocardiography (TEE) with 18-FDG PET and/or cardiac magnetic resonance in individually selected cases, guided by the Heart Team. The coronavirus-19 (COVID-19) pandemic has resulted in renewed attention to CCT as a safe alternative or adjunct to TEE in selected patients. This review article provides a comprehensive, contemporary review on CCT in IE to include scan optimization, characteristics of common IE findings on CCT, published data on the diagnostic accuracy of CCT, multimodality imaging comparison, limitations and future technical advancements.
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Affiliation(s)
- Omar K Khalique
- Structural Heart and Valve Center, Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Mahdi Veillet-Chowdhury
- Advanced Cardiovascular Imaging, Division of Cardiology, Wellspan Health System, York, PA, USA
| | - Andrew D Choi
- Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, USA
| | - Gudrun Feuchtner
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
| | - Juan Lopez-Mattei
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Thoracic Imaging, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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44
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Prevalence of abnormal SPECT myocardial perfusion imaging during the COVID-19 pandemic. Eur J Nucl Med Mol Imaging 2021; 48:2447-2454. [PMID: 33416952 PMCID: PMC7791164 DOI: 10.1007/s00259-020-05123-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023]
Abstract
Purpose The aim of this study is to evaluate the rate of abnormal myocardial perfusion imaging (MPI) studies at a single medical center during the COVID-19 pandemic compared to prior to the pandemic. Methods We retrospectively studied stress single-photon emission computed tomography (SPECT)-MPI studies performed during the peak of COVID-19 restrictions at the University of Alabama Medical Center in comparison to the same time period in 2019. Results SPECT-MPI volume was reduced from 553 per month in 2019 to 105 per month in 2020. The proportion of abnormal SPECT-MPI for the 2020 cohort (61 ± 13 years, 48% men, 41% black) was not different from the 2019 cohort (62 ± 12 years, 48% men, 42% black) (31% vs. 27%, p = 0.4). Similar proportion of patients in the 2 cohorts had abnormal myocardial perfusion, moderate-large perfusion defects, myocardial ischemia, myocardial scar, and abnormal left ventricular ejection fraction. The proportion of abnormal SPECT-MPIs was not different based on whether patients were evaluated face-to-face or by telemedicine (28% vs. 27%, p > 0.9) but was higher for cardiology providers (40% vs. 20%, p < 0.001). Conclusions There was a significant reduction in the number of SPECT-MPI studies performed during the peak restrictions from the pandemic. Despite this restriction, the rate of abnormal studies remained stable. Our study suggests that it remains difficult to predict which patients will have abnormal SPECT-MPI even when providers and stress laboratories are forced to prioritize the performance of studies to high-yield patients.
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Singh V, Choi AD, Leipsic J, Aghayev A, Earls JP, Blanke P, Steigner M, Shaw Phd LJ, Di Carli MF, Villines TC, Blankstein R. Use of cardiac CT amidst the COVID-19 pandemic and beyond: North American perspective. J Cardiovasc Comput Tomogr 2021; 15:16-26. [PMID: 33248903 PMCID: PMC7661966 DOI: 10.1016/j.jcct.2020.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022]
Abstract
The COVID-19 pandemic has affected patient care deliver throughout the world, resulting in a greater emphasis on efficiently and safety. In this article, we discuss the experiences of several North American centers in utilizing cardiac CT during the pandemic. We also provide a case-based overview which highlights the advantages of cardiac CT in evaluating the following scenarios: (1) patients with possible myocardial injury versus myocardial infarction; (2) patients with acute chest pain; (3) patients with stable chest pain; (4) patients with possible intracardiac thrombus; (5) patients with valvular heart disease. For each scenario, we also provide an overview of various societies recommendations which have highlighted the use of cardiac CT during different phases of the COVID-19 pandemic. We hope that the advantages of cardiac CT that have been realized during the pandemic can help promote wider adoption of this technique and improved coverage and payment by payors.
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Affiliation(s)
- Vasvi Singh
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Cardiovascular Imaging Program, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, MA, USA
| | - Andrew D Choi
- Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Jonathon Leipsic
- Departments of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James P Earls
- Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Philipp Blanke
- Departments of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Michael Steigner
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Leslee J Shaw Phd
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Cardiovascular Imaging Program, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, MA, USA
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Cardiovascular Imaging Program, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, MA, USA.
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46
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Sengupta PP, Chandrashekhar YS. Cardiac Involvement in the COVID-19 Pandemic: Hazy Lessons From Cardiac Imaging? JACC Cardiovasc Imaging 2020; 13:2480-2483. [PMID: 33153538 PMCID: PMC7547566 DOI: 10.1016/j.jcmg.2020.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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47
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Bittencourt MS, Generoso G, Melo PHMCD, Peixoto D, Miranda ÉJFPD, Mesquita ET, Brandão AA, Saraiva JFK, Barberato SH, Bacal F, Lopes MACQ. Statement - Protocol for the Reconnection of Cardiology Services with Patients During the COVID-19 Pandemic - 2020. Arq Bras Cardiol 2020; 115:776-799. [PMID: 33111878 PMCID: PMC8386987 DOI: 10.36660/abc.20201004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | | | | | - Driele Peixoto
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP - Brasil
| | | | - Evandro Tinoco Mesquita
- Universidade Federal Fluminense (UFF), Niterói, RJ - Brasil
- Centro de Ensino e Treinamento Edson de Godoy Bueno / UHG, Rio de Janeiro, RJ - Brasil
| | - Andréa Araujo Brandão
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM/UERJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
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48
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Picano E, Zagatina A, Wierzbowska-Drabik K, Borguezan Daros C, D’Andrea A, Ciampi Q. Sustainability and Versatility of the ABCDE Protocol for Stress Echocardiography. J Clin Med 2020; 9:E3184. [PMID: 33008112 PMCID: PMC7601661 DOI: 10.3390/jcm9103184] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/19/2022] Open
Abstract
For the past 40 years, the methodology for stress echocardiography (SE) has remained basically unchanged. It is based on two-dimensional, black and white imaging, and is used to detect regional wall motion abnormalities (RWMA) in patients with known or suspected coronary artery disease (CAD). In the last five years much has changed and RWMA is not enough on its own to stratify patient risk and dictate therapy. Patients arriving at SE labs often have comorbidities and are undergoing full anti-ischemic therapy. The SE positivity rate based on RWMA fell from 70% in the eighties to 10% in the last decade. The understanding of CAD pathophysiology has shifted from a regional hydraulic disease to a systemic biologic disease. The conventional view of CAD encouraged the use of coronary anatomic imaging for diagnosis and the oculo-stenotic reflex for the deployment of therapy. This has led to a clinical oversimplification that ignores the lessons of pathophysiology and epidemiology, and in fact, CAD is not synonymous with ischemic heart disease. Patients with CAD may also have other vulnerabilities such as coronary plaque (step A of ABCDE-SE), alveolar-capillary membrane and pulmonary congestion (step B), preload and contractile reserve (step C), coronary microcirculation (step D) and cardiac autonomic balance (step E). The SE methodology based on two-dimensional echocardiography is now integrated with lung ultrasound (step B for B-lines), volumetric echocardiography (step C), color- and pulsed-wave Doppler (step D) and non-imaging electrocardiogram-based heart rate assessment (step E). In addition, qualitative assessment based on the naked eye has now become more quantitative, has been improved by contrast and based on cardiac strain and artificial intelligence. ABCDE-SE is now ready for large scale multicenter testing in the SE2030 study.
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Affiliation(s)
- Eugenio Picano
- Biomedicine Department, CNR Institute of Clinical Physiology, 56124 Pisa, Italy
| | - Angela Zagatina
- Cardiology Department, Saint Petersburg State University Clinic, Saint Petersburg State University, 199034 Saint Petersburg, Russia;
| | - Karina Wierzbowska-Drabik
- First Department and Chair of Cardiology, Bieganski Hospital, Medical University, 90926 Lodz, Poland;
| | | | | | - Quirino Ciampi
- Cardiolody Division, Fatebenefratelli Hospital, 82100 Benevento, Italy;
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Ng MY, Ferreira VM, Leung ST, Yin Lee JC, Ho-Tung Fong A, To Liu RW, Man Chan JW, Wu AKL, Lung KC, Crean AM, Fan-Ngai Hung I, Siu CW. Patients Recovered From COVID-19 Show Ongoing Subclinical Myocarditis as Revealed by Cardiac Magnetic Resonance Imaging. JACC Cardiovasc Imaging 2020; 13:2476-2478. [PMID: 33153536 PMCID: PMC7455163 DOI: 10.1016/j.jcmg.2020.08.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 02/08/2023]
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