Influenza and pneumococcal vaccine prescription for adults during COVID-19 first wave in three regions of Argentina

Immunizations for influenza and pneumococcus are effective interventions in reducing morbidity and mortality. The objective of this study was to describe the vaccination rates in volunteers from three regions of Argentina during the COVID-19 pandemic. In 2020, 3853 adults were surveyed, 61.6 % were females, 45 % were aged between 40 and 60 and 18.6 % were > 60 years old. The commonest comorbidities were hypertension (12.9 %), dyslipidemia (8.5 %), and smokers or former smokers (9.2 %). The global influenza vaccination rate was 37.7 %, pneumococcal vaccination 24.7 %, and both 17.8 %. Multivariable regression showed that the vaccination rate increased with age and the presence of comorbidities. However, in the subgroup with indications for both vaccines, 71.7 % had the influenza vaccine, 59 % had the pneumococcal vaccine, and 28.3 % received neither. Our study suggests that influenza and pneumococcal vaccine percentages in high-risk patients in Argentina remain sub-optimal. Immunizations with proven reductions in morbimortality could have also been relegated during the COVID pandemic.

Abnormal echocardiographic findings after COVID-19 infection: a multicenter registry

The Coronavirus Disease 2019 (COVID-19) pandemic has transformed health systems worldwide. There is conflicting data regarding the degree of cardiovascular involvement following infection. A registry was designed to evaluate the prevalence of echocardiographic abnormalities in adults recovered from COVID-19. We prospectively evaluated 595 participants (mean age 45.5 ± 14.9 years; 50.8% female) from 10 institutions in Argentina and Brazil. Median time between infection and evaluation was two months, and 82.5% of participants were not hospitalized for their infection. Echocardiographic studies were conducted with General Electric equipment; 2DE imaging and global longitudinal strain (GLS) of both ventricles were performed. A total of 61.7% of the participants denied relevant cardiovascular history and 41.8% had prolonged symptoms after resolution of COVID-19 infection. Mean left ventricular ejection fraction (LVEF) was 61.0 ± 5.5% overall. In patients without prior comorbidities, 8.2% had some echocardiographic abnormality: 5.7% had reduced GLS, 3.0% had a LVEF below normal range, and 1.1% had wall motion abnormalities. The right ventricle (RV) was dilated in 1.6% of participants, 3.1% had a reduced GLS, and 0.27% had reduced RV function. Mild pericardial effusion was observed in 0.82% of participants. Male patients were more likely to have new echocardiographic abnormalities (OR 2.82, p = 0.002). Time elapsed since infection resolution (p = 0.245), presence of symptoms (p = 0.927), or history of hospitalization during infection (p = 0.671) did not have any correlation with echocardiographic abnormalities. Cardiovascular abnormalities after COVID-19 infection are rare and usually mild, especially following mild infection, being a low GLS of left and right ventricle, the most common ones in our registry. Post COVID cardiac abnormalities may be more frequent among males.

Abnormal echocardiographic findings after COVID-19 infection: a multicenter registry

Background

The Coronavirus Disease 2019 (COVID-19) pandemic has transformed health systems worldwide. There is conflicting data regarding the degree of cardiovascular involvement following infection, generating uncertainty in patients and an additional healthcare burden with increased diagnostic testing. A registry was designed to evaluate the prevalence of echocardiographic abnormalities in Latin American adults recovered from COVID-19.

Methods

We prospectively evaluated 595 participants (mean age 45.5±14.9 years; 50.8% female) from 10 institutions in Argentina and Brazil. Echocardiographic studies were conducted with General Electric equipment; 2DE imaging and global longitudinal strain (GLS) of both ventricles were performed. Comparisons between groups were made with Chi-square, Fisher and Student's t-test. Logistic regression was performed to determine variables associated with abnormal echocardiogram findings.

Results

A total of 61.7% of the participants denied any relevant cardiovascular medical history. Table 1 summarizes the comorbidities of the included patients. The majority of patients (82.5%) had the disease at home or in an out-of-hospital center. Of the patients who required hospitalization, 15.3% were in a general ward, 1.9% in intensive care and 0.3% required mechanical ventilation during the disease. The median time between infection and performance of the echocardiographic study was two months (IQR 1–3 months). Among patients who reported symptoms following COVID-19 recovery (41.8%), the most frequently reported was dyspnea (47.4%), followed by mild symptoms such as asthenia, arterial hypertension or palpitations (32.9%), 12.9% referred chest pain, 6% of patients reported dyspnea and chest pain, and 0.8% reported various other symptoms. The mean left ventricular ejection fraction (LVEF) was 61.0±5.5% and the mean left atrial volume was 33.1±13.2 ml/m². In patients without prior comorbidities, 8.2% had some echocardiographic abnormality (Figure 1). We found no significant differences in LVEF between symptomatic and asymptomatic patients (61.4% versus 60.6% respectively, p=0.104). Symptomatic patients showed slightly reduced GLS (−20.3% versus −20.9%, p=0.012) with a trend in the same direction in the RV free wall GLS (−25.6% versus −26.3%, p=0.103).

Male patients were more likely to have any new echocardiographic abnormalities (OR 2.82, p=0.002). Time elapsed since infection resolution (p=0.245), the presence of symptoms (p=0.927), or history of hospitalization during infection (p=0.671) did not have any correlation with echocardiographic abnormalities. The difference between sexes remains unchanged after adjusting for left atrial volume, wall thicknesses, diastolic function and abnormal wall motion.

Conclusion

Our results suggest that cardiovascular abnormalities after COVID-19 infection are rare and usually mild, especially in cases of mild disease. These abnormalities may be more frequent among males

Funding Acknowledgement

Type of funding sources: None.

Exercise-Induced Cardiac Fatigue in Recreational Ultramarathon Runners at Moderate Altitude: Insights From Myocardial Deformation Analysis

Background

Controversy exists on the actual occurrence of exercise-induced cardiac fatigue (EICF) with ultraendurance exercise, as well as on whether factors such as age or training status might predispose to this condition. The present study aimed to assess the occurrence of EICF among recreational ultramarathon runners, as well as to determine potential predictive factors.

Methods

Nineteen male recreational runners (42 ± 12yrs) participated in a 55-km trial race at moderate altitude (1,800–2,500 m). Participants were evaluated before and after the race using Doppler echocardiography and myocardial deformation analysis. EICF was determined as a reduction >5% of either left ventricular global longitudinal strain (LVGLS) or right ventricular free wall strain (RVFWS). Demographical (age, body mass index), training (training experience, volume and intensity), competition (finishing time, relative intensity) and biochemical variables (blood lactate, creatine kinase [CK] and CK-MB) were assessed as predictors of EICF.

Results

A significant reduction in LVGLS (20.1 ± 2.1% at baseline vs. 18.8 ± 2.4% at post-race, p = 0.026), but not in RVFWS (27.4 ± 7.0 vs. 24.6 ± 5.3%, p = 0.187), was observed after the race. EICF was present in 47 and 71% of the participants attending to the decrease in LVGLS and RVFWS, respectively. No associations were found between any of the analyzed variables and EICF except for age, which was associated with the magnitude of decrement of RVFWS (r = 0.58, p = 0.030).

Conclusions

Ultramarathon running at moderate altitude seems to induce EICF in a considerable proportion of recreational athletes.

[Immunizations in adults with cardiovascular disease. Summary of the Consensus of the Argentine Cardiology Society]

Cardiovascular diseases are the leading cause of death in most regions of the world, usually followed by infectious diseases. For decades, infections in general, and particularly those involving the respiratory system, have been known to be associated with an increased risk of cardiovascular and cerebrovascular events, and their consequent morbidity and mortality. Although vaccines are an excellent strategy in the prevention of infectious diseases, the proportion of immunized adults in our country is frankly deficient. Multiple barriers contribute to perpetuating this problem, within which the lack of prescription of the same by professionals who care for vulnerable populations occupies a central place. Patients with cardiovascular disease represent a particularly risky subpopulation. The spectrum of pathologies that can trigger respiratory infections is wide: development or worsening of heart failure, arrhythmias, acute coronary syndromes and cerebrovascular diseases, among the main ones. The role of immunoprophylaxis with influenza, pneumococcal and tetanus vaccine in patients with different heart diseases is addressed here, evaluating the evidence supporting its use, and placing special emphasis on practical aspects of its use, such as adverse effects, contraindications and special care situations, such as congenital heart disease in adults, heart transplantation, anticoagulation or egg allergy. Thus, this document aims to assist in decision-making for any doctor involved in the care of patients with cardiovascular disease.