OUP accepted manuscript

The Influence of Interatrial Conduction Disorders on Atrial Mechanical Function - Atrial Strain and Pulmonary Veins Reversal Flow in Patients with COVID-19

Background

The physiological activation of the left atrium (LA) happens through the Bachmann bundle, which is crucial for the heart's proper functioning. Bayes de Luna first described interatrial blocks (IABs) in 1979, noting their disruption of atrioventricular (AV) synchrony. This study aims to evaluate LA mechanics by analyzing LA strain in cases of normal and impaired interatrial conduction, focusing on retrograde flow in the pulmonary veins (PV).

Methods

The study included 51 patients who tested positive for SARS-CoV-2 and exhibited related symptoms. Six patients with persistent atrial fibrillation (AF) were excluded from the study (45 patients qualified in total: 23 males, 22 females; mean age 69.0 ± 12.9 years).

Results

IABs were more frequently observed in COVID-19 patients. Thus, they were included despite SARS-CoV-2 being a potential limitation of the study. All participants underwent clinical evaluation, electrocardiography (ECG) (200 mm/s ×256), and echocardiography to assess left ventricular ejection fraction (LVEF), mitral regurgitation (MR), LA volume, global and regional strain, and retrograde flow in the PV. A statistical dependency was found between LA global strain and P-wave morphology, MR, heart failure (HF), and paroxysmal atrial fibrillation (PAF). However, no clear correlation was found between retrograde flow in the PV and LA strain. The mean P-wave duration correlated with its morphology. Additionally, correlations were observed between P-wave morphology and hypertension, being overweight, and PAF.

Conclusions

LA mechanics are negatively influenced by IABs. LA global strain correlates with P-wave duration, ejection fraction (EF), and MR independently. Regional LA strain examination is potentially effective for assessing LA mechanics and complements precise ECG.

Cardiovascular Complications and Imaging in the Era of the COVID-19 Pandemic 2020 to Present

The COVID-19 pandemic has impacted the world that was not previously conceivable. In early 2020, hospitals on all continents were overwhelmed with patients afflicted with this novel virus, with unanticipated mortality worldwide. The virus has had a deleterious effect, particularly the respiratory and cardiovascular systems. Cardiovascular biomarkers demonstrated an array of cardiovascular insults from hypoxia to inflammatory and perfusion abnormalities of the myocardium to life-threatening arrhythmias and heart failure. Patients were at increased risk of a pro-thrombotic state early in the course of the disease. Cardiovascular imaging became a primary tool in diagnosing, prognosing and risk-stratifying patients. Transthoracic echocardiography became the initial imaging modality in management of cardiovascular implications. In addition to cardiac function, LV longitudinal strain (LVLS) and right ventricular free wall strain (RVFWS) were indicators of increased morbidly and mortality. Cardiac MRI has become the diagnostic cardiovascular imaging for myocardial injury and tissue evaluation in the age of COVID-19.

Did the COVID-19 Pandemic Affect Contrast Media-Induced Adverse Drug Reaction’s Reporting? A Pharmacovigilance Study in Southern Italy

Medical imaging is required for a complete clinical evaluation to identify lung involvement or pulmonary embolism during SARS-CoV-2 infection or pulmonary and cardiovascular sequelae. Contrast media (CM) have undoubtedly been useful in clinical practice due to their ability to improve medical imaging in COVID-19 patients. Considering their important use, especially in hospitalized COVID-19 patients, and that increased use of a medical tool could also be associated with its deeper knowledge, we chose to explore if new information emerged regarding CM safety profiles. We analyzed all Individual Case Safety Reports (ICSRs) validated by Campania Pharmacovigilance Regional Centre from 1 January 2018 to 31 December 2021 and reported a CM (ATC code V08) as a suspected drug. We compared CM-related reporting between 2 years before (period 1) and 2 years during (period 2) the COVID-19 pandemic. From our analysis, it emerged that, during the COVID-19 pandemic, CM-related ADR reporting decreased, but a significant increase in reporting of serious cases emerged. Serious ADRs were mainly related to iodinated CM (V08A ATC) compared to magnetic resonance imaging CM (V08C ATC). Cutaneous and respiratory disorders were the most frequently reported in both periods. No new or unknown ADRs were reported in the overall study period.