Electrocardiographic changes in non-hospitalised children with COVID-19

2022 ◽  
pp. 1-7
Author(s):  
Howard J. Heching ◽  
Anmol Goyal ◽  
Brian Harvey ◽  
Lindsey Malloy-Walton ◽  
Christopher Follansbee ◽  
...  
Keyword(s):  
Disease Severity ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Entire Cohort ◽  
Cardiology Clinic ◽  
Atrial Enlargement ◽  
Electrocardiographic Changes ◽  
Electrocardiographic Abnormalities ◽  
Over Time

Abstract Objectives: Many children diagnosed with COVID-19 infections did not require hospitalisation. Our objective was to analyse electrocardiographic changes in children with asymptomatic, mild or moderate COVID-19 who did not require hospitalisation Methods: All children are seen in a paediatric cardiology clinic who had asymptomatic, mild or moderate COVID-19 that did not require hospitalisation and had at least one electrocardiogram after their diagnosis were included in this retrospective analysis. Records were reviewed to determine COVID-19 disease severity and presence of Long COVID. Rhythm assessment, atrial enlargement, ventricular hypertrophy, PR/QRS/QT interval duration and ST-T wave abnormalities were analysed by a paediatric electrophysiologist. Clinically ordered echocardiograms were reviewed for signs of myopericarditis (left ventricular ejection fraction and pericardial effusion) on any subject with an electrocardiographic abnormality. Results: Of the 82 children meeting inclusion criteria (14.4 years, range 1–18 years, 57% male), 17 patients (21%) demonstrated electrocardiographic changes. Ten patients (12%) had electrocardiogram of borderline significance, which included isolated mild PR prolongation or mild repolarisation abnormalities. The other seven patients (9%) had concerning electrocardiographic findings consisting of more significant repolarisation abnormalities. None of the patients with an abnormal electrocardiogram revealed any echocardiographic abnormality. All abnormal electrocardiograms normalised over time except in two cases. Across the entire cohort, greater COVID-19 disease severity and long COVID were not associated with electrocardiographic abnormalities. Conclusions: Electrocardiographic abnormalities are present in a minority of children with an asymptomatic, mild or moderate COVID-19 infection. Many of these changes resolved over time and no evidence of myopericarditis was present on echocardiography.

scholarly journals Temporal trends in outcome and patient characteristics in dilated cardiomyopathy, data from the Swedish Heart Failure Registry 2003–2015

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Helen Sjöland ◽  
Jonas Silverdal ◽  
Entela Bollano ◽  
Aldina Pivodic ◽  
Ulf Dahlström ◽  
...  
Keyword(s):  
Heart Failure ◽  
Dilated Cardiomyopathy ◽  
Temporal Trends ◽  
Physical Symptoms ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Continuous Change ◽  
Ventricular Ejection Fraction ◽  
Increased Risk ◽  
Over Time

Abstract Background Temporal trends in clinical composition and outcome in dilated cardiomyopathy (DCM) are largely unknown, despite considerable advances in heart failure management. We set out to study clinical characteristics and prognosis over time in DCM in Sweden during 2003–2015. Methods DCM patients (n = 7873) from the Swedish Heart Failure Registry were divided into three calendar periods of inclusion, 2003–2007 (Period 1, n = 2029), 2008–2011 (Period 2, n = 3363), 2012–2015 (Period 3, n = 2481). The primary outcome was the composite of all-cause death, transplantation and hospitalization during 1 year after inclusion into the registry. Results Over the three calendar periods patients were older (p = 0.022), the proportion of females increased (mean 22.5%, 26.4%, 27.6%, p = 0.0001), left ventricular ejection fraction was higher (p = 0.0014), and symptoms by New York Heart Association less severe (p < 0.0001). Device (implantable cardioverter defibrillator and/or cardiac resynchronization) therapy increased by 30% over time (mean 11.6%, 12.3%, 15.1%, p < 0.0001). The event rates for mortality, and hospitalization were consistently decreasing over calendar periods (p < 0.0001 for all), whereas transplantation rate was stable. More advanced physical symptoms correlated with an increased risk of a composite outcome over time (p = 0.0043). Conclusions From 2003 until 2015, we observed declining mortality and hospitalizations in DCM, paralleled by a continuous change in both demographic profile and therapy in the DCM population in Sweden, towards a less affected phenotype.

P6237Clinical utility of echocardiographic left-ventricular ejection fraction monitoring for cardiotoxicity risk assessment in patients with HER2+ early breast cancer undergoing trastuzumab-based therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Posch ◽  
T Glantschnig ◽  
S Firla ◽  
M Smolle ◽  
M Balic ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
One Year ◽  
Over Time

Abstract Background Monitoring left-ventricular ejection fraction (LVEF) is a routinely-practiced strategy to survey patients with breast cancer (BC) towards cardiotoxic treatment effects. However, whether the LVEF as a single measurement or as a trajectory over time is truly sufficient to identify patients at high risk for cardiotoxicity is currently debated. Purpose To quantify the prognostic impact of LVEF and its change over time for predicting cardiotoxicity in women with HER2+ early BC. Methods We analyzed 1,136 echocardiography reports from 185 HER2+ early BC patients treated with trastuzumab ± chemoimmunoendocrine therapy in the neoadjuvant/adjuvant setting (Table 1). Cardiotoxicity was defined as a 10% decline in LVEF below 50%. Results Median baseline LVEF was 64% (25th-75th percentile: 60–69). Nineteen patients (10%) experienced cardiotoxicity (asymptomatic n=12, symptomatic n=7, during treatment n=19, treatment modification/termination n=14), Median time to cardiotoxicity was 6.7 months, and median LVEF decline in patients with cardiotoxicity was 18%. One-year cardiotoxicity risk was 7.6% in the 35 patients with a baseline LVEF≥60% and 24.5% in the 150 patients with a baseline LVEF<60% (Hazard Ratio (HR)=3.45, 95% CI: 1.35–8.75, Figure 1). During treatment, LVEF declined significantly faster in patients who developed cardiotoxicity than in patients without cardiotoxicity (1.3%/month vs. 0.1%/month, p<0.0001). A higher rate of LVEF decrease predicted for higher cardiotoxicity risk (HR per 0.1%/month higher LVEF decrease/month=2.50, 95% CI: 1.31–4.76, p=0.005), and cardiotoxicity risk increased by a factor of 1.7 per 5% absolute LVEF decline from baseline to first follow-up (HR=1.70, 95% CI: 1.30–2.38, p<0.0001). Thirty-six patients (19%) developed an LVEF decline of at least 5% from baseline to first follow-up (“early LVEF decline”). One-year cardiotoxicity risk was 6.8% in those without early LVEF decline and a baseline LVEF≥60% (n=117), 15.7% in those without an early LVEF decline and a baseline LVEF<60% (n=65), and 66.7% in those with an early LVEF decline and a baseline LVEF<60% (n=3), respectively (log-rank p<0.0001). Table 1. Baseline characteristics Age (years, median [IQR]) 55 [49–65] Estrogen receptor positive (n, %) 124 (67%) Neoadjuvant setting (n, %) 103 (56%) Figure 1. Risk of Cardiotoxicity. Conclusion Both a single LVEF measurement and the rate of LVEF decrease strongly predict cardiotoxicity in early BC patients undergoing HER2-targeted therapy. Routine LVEF monitoring identifies individuals at high risk of cardiotoxicity that may benefit from more sensitive screening techniques such as strain imaging.

scholarly journals Circulating CD34+/KDR+ endothelial progenitor cells are reduced in chronic heart failure patients as a function of Type D personality

2009 ◽  
Vol 117 (4) ◽  
pp. 165-172 ◽  
Author(s):  
Emeline M. Van Craenenbroeck ◽  
Johan Denollet ◽  
Bernard P. Paelinck ◽  
Paul Beckers ◽  
Nadine Possemiers ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Disease Severity ◽  
Left Ventricular ◽  
Type D Personality ◽  
Left Ventricular Ejection ◽  
Endothelial Progenitor ◽  
Ventricular Ejection Fraction ◽  
Type D ◽  
Migratory Capacity

The aim of the present study was to assess whether EPC (endothelial progenitor cell) number/function might be an explanatory factor for the observed relationship between Type D personality (a joint tendency towards negative affectivity and social inhibition) and poor cardiovascular prognosis. We also assessed whether the effect of a single exercise bout on EPC number/function was affected by Type D personality. A total of 35 sedentary men with CHF (chronic heart failure; left ventricular ejection fraction ≤45%) underwent CPET (cardiopulmonary exercise testing) and personality assessment with the 14-item Type D scale. CD34+/KDR (kinase insert domain-containing receptor)+ cells were quantified by flow cytometry before and immediately after CPET. Migration of early EPC towards VEGF (vascular endothelial growth factor) and SDF-1α (stromal-cell-derived factor-1α) was investigated. Type D (n=10) and non-Type D (n=25) patients were comparable with regards to demographics, disease severity and Framingham risk factor score. Circulating EPC numbers were reduced by 54% in Type D compared with non-Type D patients (0.084±0.055 and 0.183±0.029% of lymphocytes respectively; P=0.006). Exercise led to a 60% increase in EPC in Type D patients, whereas the EPC number remained unchanged in the non-Type D group (P=0.049). Baseline migratory capacity was related to disease severity, but was not different between Type D and non-Type D patients. Exercise induced a highly significant enhancement of migratory capacity in both groups. In conclusion, reduced EPC numbers might explain the impaired cardiovascular outcome in Type D patients. The larger increase in circulating EPCs observed in these patients suggests that acute exercise elicits a more pronounced stimulus for endothelial repair.

scholarly journals Effects of patient characteristics and comorbidities on temporal trends of low-flow, low-gradient aortic stenosis phenotypes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Sen ◽  
T Manning ◽  
K Innes-Jones ◽  
C Neil ◽  
T.H Marwick
Keyword(s):  
Risk Factors ◽  
Aortic Stenosis ◽  
Temporal Trends ◽  
Left Ventricular ◽  
Low Flow ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
Over Time

Abstract Background Aortic stenosis (AS) is a common primary heart valve disease in the elderly. Low-flow, low-gradient (LFLG) AS is an increasingly important phenotype. Purpose To evaluate the temporal changes in incidence of severe AS phenotypes: paradoxical LFLG, classical LFLG and non-LFLG and explore risk factors that contribute to temporal trends. Methods We analyzed 25,507 consecutive transthoracic echocardiograms over 6½ years between 2013 and 2019 divided into deciles. LFLG-AS was defined as mean transvalvular pressure gradient &lt;40 mmHg and stroke volume index (SVi) &lt;35 mL/m2, aortic valve area (AVA) &lt;1 cm2 or indexed AVA &lt;0.6 cm2/m2, with either normal (paradoxical LFLG) or decreased (&lt;40%; classical LFLG) left ventricular ejection fraction. Trends and associations with patients characteristics and comorbidities were assessed over time in deciles. Results Of 891 cases that fulfilled severe AS criteria, there were 536 cases of LFLG-AS (85 classical and 451 paradoxical LFLG-AS). There was a statistically significant increase in incidence of paradoxical LFLG-AS between each time interval (p&lt;0.0001), while significant reduction in incidence of non-LFLG-AS (p=0.009) that was not seen with classical LFLG-AS (p=0.7) (Figure). More comprehensive echocardiographic assessment of relevant parameters over time assisted with identification of LFLG-AS cases. Intrinsic patient factors such as age and E/e' contributed towards the increasing trend of paradoxical LFLG-AS. There was a rising population aged over 70 years (p=0.01). Multivariate logistic regression analysis showed that age, sex, E/e', obesity, atrial fibrillation and heart rate were potential risk factors responsible for temporal trend towards rising paradoxical LFLG-AS incidence. There was also a gradual increase in number of patients with low transvalvular flow rate (&lt;200mL/s) over time (p=0.04). Conclusion The incidence of paradoxical LFLG-AS is rising in a hospital echocardiogram service. The parallel increase in LV filling pressure and age in AS patients suggests the increment in LFLG-AS is related to changes to the LV myocardium. Subtypes of aortic stenosis over time Funding Acknowledgement Type of funding source: None

Abstract 398: Use Of Guideline-Directed Medical Therapy For Patients Hospitalized With Heart Failure In The Veterans Health Care System, 2013-2017

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Paul L Hess ◽  
Paula Langner ◽  
Gary K Grunwald ◽  
Paul A Heidenreich ◽  
P. M Ho
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Medical Therapy ◽  
Beta Blocker ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Free Care ◽  
Va Hospitals ◽  
Over Time

Background: Guidelines issued by the American Heart Association and American College of Cardiology recommend the use of key heart failure (HF) medications. Contemporary use of HF medications in Veterans Affairs (VA) hospitals is unknown. Methods: Using national administrative data maintained by the Corporate Data Warehouse, we identified all patients admitted with a primary diagnosis of HF who were discharged from a VA hospital between January 1, 2013, and December 29, 2017, and had a left ventricular ejection fraction ≤ 40% by echocardiography. Left ventricular ejection fraction was extracted from the medical record using natural language processing with high precision and sensitivity. Rates of guideline-directed medical therapy use at hospital discharge were assessed overall and over time. Defect-free care was defined as use of any beta-blocker and an angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), or angiotensin receptor neprilysin inhibitor (ARNI). Use of an evidence-based beta-blocker (bisoprolol, carvedilol, or metoprolol succinate) and an aldosterone antagonist were also evaluated. Results: A total of 13,767 patients from 126 sites with HF with reduced ejection fraction underwent 18,769 hospitalizations (1.4 hospitalizations/patient). Their mean age was 70.7 (standard deviation 11.4) years, the predominant sex was male (98.3%), and the principle race/ethnicity was white (67.2%). Defect-free HF care was achieved during 13,941 (74.2%) hospitalizations. A beta-blocker was prescribed during 17,196 (91.6%), and an ACEI, ARB, or ARNI was prescribed during 14,626 (77.9%). An evidence-based blocker was prescribed during 17,057 (90.9%) hospitalizations, and an aldosterone antagonist during 6,934 (36.9%). Defect-free care decreased over time from 76.4% in 2013 to 71.9% in 2017 owing to a reduction in ACEI/ARB/ARNI use from 80.2% in 2013 to 76.0% in 2017. Rates of use of other HF medications were stable over time ( Figure 1 ). Conclusions: The majority of patients hospitalized with heart failure in VA hospitals receive defect-free HF care. However, rates of defect-free HF care have decreased over time. Opportunities to improve the use of HF medical therapy use exist.

Abstract 248: Prospective Study of Ventricular Function and Survival in Acute Phase of Chagas Disease: An Animal Experimental Model

2020 ◽  
Vol 127 (Suppl_1) ◽  
Author(s):  
Arthur L Vargas ◽  
Beatriz P Dias ◽  
Henrique T Moreira ◽  
Denise M Tanaka ◽  
Edgard C Oliveira Filho ◽  
...  
Keyword(s):  
Ventricular Function ◽  
Experimental Model ◽  
Chagas Disease ◽  
Acute Phase ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Vector Transmission ◽  
Ventricular Ejection Fraction ◽  
Over Time ◽  
Animal Experimental Model

Background: Acute Cardiomyopathy secondary to Chagas disease is often subclinical when related to vector transmission. However, cases related to non-vector transmission as in patients submitted to cardiac transplant may have fatal outcomes. This study aimed to assess survival during the acute phase of Chagas disease and its relation to the ventricular function in an animal experimental model. Methods: Female Syrian hamsters (n=45) were separated in two groups: control group (CG):15 animals injected with saline solution; and infected group (IG): 30 animals inoculated with 3,5x10 4 trypomastigote forms of Trypanosoma cruzi,Y strain . Both groups were monitored daily and submitted to echocardiography with equipment dedicated to small animals (Vevo® 2100) in two different moments: baseline (before infection) and 15 days post infection. Left ventricular ejection fraction (LVEF) and global longitudinal myocardial strain (GLS) of left ventricle were measured. The IG was divided into animals with and without clinical sign (CS+) of disease: weight or fur loss, mucous wounds and lethargy. ANOVA for mixed models was used to compare the ventricular function parameters among groups over time. Survival analysis was studied using Kaplan-Meier curves and logrank test. Results: Total time follow up was 60 days. LVEF in IG was significantly reduced through time (53.80 ± 4.95 to 43.55 ± 12.10%) compared to CG (57.86 ± 7.52 to 59.73 ± 5.87%) (p=0.002). There was also a significant reduction of GLS (-18.97 ± 3.94 to -12.44 ± 4.79%) in the IG compared to CG (-19.58 ± 4.03 to -19.67 ± 4.04%) (p=0.012). Twelve animals from IG died (40.00%,12 out of 30) compared to one from CG (6.66%, 1 out of 15). Eleven out of the 12 dead animals from IG, presented, before, clinical signs (CS+). Survival was significant reduced in the IG compared to CG over time (p=0.02) (Figure 1). Conclusion: Reduced survival during the acute phase of experimental model of Chagas disease is related to the significant reduction of left ventricular function. The mortality rate in the IG is higher in the group which presents CS+.

Abstract 265: Genetic Polymorphisms in Angiotensinogen Gene as Potential Modifiers of Hypertrophic and Dilated Cardiomyopathy Phenotypes

2012 ◽  
Vol 111 (suppl_1) ◽  
Author(s):  
Bindu Rani ◽  
Ajay Bahl ◽  
Madhu Khullar
Keyword(s):  
Dilated Cardiomyopathy ◽  
Disease Severity ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Disease Heterogeneity ◽  
Ventricular Ejection Fraction ◽  
Increased Risk ◽  
Significant Difference ◽  
Agt Gene

Background: Hypertrophic Cardiomyopathy (HCM) and Dilated cardiomyopathy (DCM) are diseases of mutant sarcomeric proteins. However, there is marked variation in disease severity and progression, even among patients with identical causal mutation. The renin- angiotensin system plays a major role in the pathophysiology of heart failure and genetic variations in these genes may modulate the risk of disease and be partly responsible for the disease heterogeneity and severity. OBJECTIVE: To evaluate the association of angiotensinogen (AGT) gene polymorphisms (T174M and M235T) with risk of developing severe disease phenotype in HCM and DCM patients. MATERIAL AND METHODS: 275 prospectively enrolled patients (122 HCM and 153 DCM) and 200 normal controls were genotyped for T174M and M235T polymorphisms of AGT gene. Effect of AGT genotypes on interventricular septum thickness and left ventricular ejection fraction (LVEF) were analyzed using linear regression model. RESULTS: We observed significantly higher prevalence of 235T allele in DCM patients which was associated with increased risk of DCM (OR 2.37, CI 1.07-5.25, p=0.04), however T174M polymorphism did not show a significant association with risk of DCM (OR 1.1, CI 0.65-1.84, p=0.79). The frequency of 174M allele was significantly higher in HCM patients as compared to controls and associated with increased risk of HCM (OR 1.95, CI 1.16-3.25, p=0.01), but no significant association of M235T polymorphism was observed with HCM (OR=1.10, CI 0.54-2.22,p=0.8). We did not observe any significant difference in mean LVEF in DCM patients carrying either M235 allele or 235T allele (M235: 27.22±7.13; 235T: 28.60±10.40; p=0.6) or carrying T174 allele or 174M allele (28.83±10.34 vs 28.09±9.93; p=0.7). No significant difference in left ventricular hypertrophy (LVH, mean septal thickness) was observed between 235T and M235 allele carriers [(24.07±5.16mm vs 23.26±6.04mm, p=0.6] or between 174M and T174 allele carriers (T174: 23.41±5.12mm, 174M: 22.83±7.17mm; p=0.6) in HCM patients. CONCLUSION: The variant AGT M235T and AGT T174M alleles confer increased risk of DCM and HCM respectively, but do not appear to be associated with disease severity or progression in these patients.

P2456Role of left atrial volume as simple and early predictor of cardiotoxicity

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L F Cerrito ◽  
A Schiavone ◽  
C Bergamini ◽  
M Dal Porto ◽  
G Benfari ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Systolic Arterial Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Routine Practice ◽  
Ventricular Ejection Fraction ◽  
Changes Over Time ◽  
Over Time

Abstract Background It is crucial to predict and early detect Trastuzumab (TZ)-related cardiotoxicity (CT) in patients with HER2-positive breast cancer (BC). Although baseline left atrial (LA) volume and its changes over time assessed by echocardiography have been used as prognostic tool in various clinical conditions, up to now there are no well-defined LA-based parameters predictive of chemotherapy-related dysfunction. Aim To define the role of increased baseline LA indexed volumes (LAVI) and its changes over time as early predictors of TZ-related CT in a larger and well characterized cohort of BC patients. Methods HER-2 positive BC patients receiving TZ were retrospectively recruited. Patients underwent consecutive transthoracic echocardiography at baseline and then every three months. CT was defined as decrease in left ventricular ejection fraction (LVEF) to a value <50% or a decrease of >10 percentage points from baseline, according to our oncology unit. Results Eligible patients were 280, mean age 56±12 years. Mean follow-up (FU) was 15±5 months and CT occurred in 64 patients (22,9%). Baseline LAVI showed to be associated with development of CT (p=0,003), and to predict its onset, Odds Ratio (OR) per 5 ml/mq LAVI increase 1,32 (95% CI 1,07: 1,62), p=0,006. After multivariate adjustment (age, systolic arterial pressure, anthracycline treatment) baseline LAVI remained an independent predictor of CT: OR 1,25 (95% CI 1,00- 1,56), p=0,04. LAVI showed an increasing trend that has been evident since the very beginning (at three months) and continued over time. LAVI dilation appeared to be small on average, but became significant in patients with subsequent CT (Figure 1). Early LAVI dilation (0–3 months) was able to predict CT OR 1.22 (CI 1.03–1.47) p=0.02 per 5 ml/mq increase, Even when adjusted for baseline LAVI, age, and systolic arterial pressure, OR 1.31 (CI 1.07–1.58), p=0.004. In patients who had mitral regurgitation at baseline, there was no significant worsening of regurgitation overtime. Conclusion Baseline LAVI, as assessed by routine practice, provides an incremental predictive value about CT risk over the other known clinical features. On top, LAVI dilation over time seems to begin before LVEF decreases, and hence could anticipate the development of left ventricular dysfunction. Even if LAVI is a simple and well known echocardiographic measurement, it could be used in this newborn context to stratify patients after validation with prospective studies.

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