Cardiac magnetic resonance in COVID-19 positive and probable cases: A report from a high volume CMR centre in Ireland

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Coronavirus disease 2019 (COVID-19) infection can have multisystem involvements. The inflammation sequelae can cause myocarditis. The COVID-19 pandemic has impacted Ireland significantly. Understanding of myocardial involvement in COVID-19 is not fully elucidated but has been reported. The Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic in Ireland is a high volume CMR centre with approximately 4500 cases per year and accepting referral from all hospital in Ireland. These analyses are to describe the CMR findings in COVID-19 positive and probable cases attending the centre. Methods Consecutive 65 referrals with mention of "COVID-19" from March 2020 to December 2020 was assessed. 56 cases were included in this analysis. Cases were categorised as COVID-19 positive cases or probable (viral illness like symptoms) cases. The demography and CMR parameters were collected. Serial imaging of selected cases was included. Descriptive analyses methods were applied. Results In the period of 10 months, there was 49 COVID-19 positive cases (65.3% male; median age 49 [32 : 61] years) and 7 COVID-19 probable cases (42.9% male; median age 39 [37 : 59] years). In the COVID-19 positive cases, 25 had normal CMR, 11 has evidence of myocarditis, 1 with pericarditis, 2 with infarction/ischaemia, 3 with dilated cardiomyopathy, 2 with hypertrophic cardiomyopathy and 5 with other findings. There were 3 COVID-19 positive cases with serial imaging showing resolving myocarditis (100% female; median age 41 [30 : 47] years). 2 professional athletes with COVID-19 positive test showed no evidence of myocarditis. There are no significant differences in the age of male COVID-19 positive versus female group (p= 0.0752). Different demography and CMR parameters and tissue characterisation are described in Table 1 and Table 2. Conclusions The prevalence of myocarditis in this cohort is approximately 1 in 5 (21.4%). Within the COVID-19 positive cases, the prevalence is 22.4%. These observations may reflect selection bias for CMR referral in those with cardiac symptoms or cardiac enzymes leak.

Download Full-text

The underrepresentation of female participants in studies assessing the impact of high-dose exercise on cardiovascular outcomes: a scoping review

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.367 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

S Pallikadavath ◽

R Patel ◽

CL Kemp ◽

M Hafejee ◽

N Peckham ◽

...

Keyword(s):

Scoping Review ◽

High Volume ◽

Cardiovascular Outcomes ◽

High Dose ◽

Funding Sources ◽

Review Protocol ◽

The Mean ◽

The Impact ◽

Over Time ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular adaptations as a result of exercise conducted at high-intensity and high-volume are often termed the ‘Athlete’s heart’. Studies have shown that these cardiovascular adaptations vary between sexes. It is important that both sexes are well represented in this literature. However, many studies assessing the impact of high-dose exercise on cardiovascular outcomes under-recruit female participants. Purpose This scoping review aimed to evaluate the representation of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and demonstrate how this has changed over time. Methods The scoping review protocol as outlined by Arksey and O’Malley was used. OVID and EMBASE databases were searched and studies independently reviewed by two reviewers. Studies must have investigated the effects of high-dose exercise on cardiovascular outcomes. To assess how the recruitment of females has changed over time, two methods were used. One, the median study date was used to categorise studies into two groups. Two, studies were divided into deciles to form ten equal groups over the study period. Mean percentage of female recruitment and percentage of studies that failed to include females were calculated. Results Overall, 250 studies were included. Over half the studies (50.8%, n = 127) did not include female participants. Only 3.2% (n = 8) did not include male participants. Overall, mean percentage recruitment was 18.2%. The mean percentage of recruitment was 14.5% before 2011 and 21.8% after 2011. The most recent decile of studies demonstrated the highest mean percentage of female recruitment (29.3%) and lowest number of studies that did not include female participants (26.9%). Conclusion Female participants are significantly underrepresented in studies assessing cardiovascular outcomes caused by high-dose exercise. The most recent studies show that female recruitment may be improving, however, this still falls significantly short for equal representation. Risk factors, progression and management of cardiovascular diseases vary between sexes, hence, translating findings from male dominated data is not appropriate. Future investigators should aim to establish barriers and strategies to optimise fair recruitment. Mean percentage females recruited per study (%) Percentage studies that do not include women (%) Overall (n = 250) 18.2 50.8 (n = 127) Studies before 2011 (n = 121) 14.5 59.5 (n = 72) Studies after 2011 (n = 129) 21.8 42.6 (n = 55) Table 1: Female recruitment characteristics. The year 2011 (median study year) was chosen as this divides all included studies into two equal groups.

Download Full-text

Overcoming claustrophobia in cardiovascular magnetic resonance with medical hypnosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab090.039 ◽

2021 ◽

Vol 22 (Supplement_2) ◽

Author(s):

A Pavon ◽

C Chautems ◽

Y Odin ◽

D Arangalage ◽

T Rutz ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Observational Study ◽

Diagnostic Imaging ◽

Psychiatric Condition ◽

Funding Sources ◽

Cause Of Failure ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background the role of Cardiovascular Magnetic Resonance has gained the more and more importance in the field of cardiovascular disease. Claustrophobia remains a frequent cause of failure to complete a CMR. It is estimated that 2 million scans worldwide cannot be performed annually either due to premature termination or refusal of the patient to be scanned due to claustrophobia. In this setting, medical hypnosis may prove useful to overcome this main limitation. Methods we propose an observational study of consecutive patients referred to CMR and known for severe claustrophobia. Patients were proposed to undergo CMR examination with the help of medical hypnosis according to Milton H. Erickson’s method or with administration of mild sedation (lorazepam 2.5 mg). Results 20 severe claustrophobic patients were considered in the study. 1 patient was excluded due to psychiatric condition, 1 patient undergo to general anesthesia, 5 patients refused the examination. Among the 13 patients, 10 underwent medical hypnosis while 3 patients accepted to undergo to CMR examination with the administration of lorazepam 2.5 mg. All patients treated with medical hypnosis were able to complete the examination with a great tolerance and no sign of stress or anxiety were reported. CMR protocol was performed according to clinical request and was not different form non-claustrophobic patients. None of the patients treated with lorazepam 2.5mg was able to complete the exam. Conclusion we prove medical hypnosis to be safe and effective in controlling patients’ anxiety, allowing optimal diagnostic imaging quality without the need to adapt the examination. Further studies in larger populations are needed to confirm our results.

Download Full-text

Rising patients" adherence to CVD preventive treatment via medical and psychological counseling using remote technologies

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.319 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

OV Kopylova ◽

NA Sirota ◽

VM Yaltonsky

Keyword(s):

Risk Factors ◽

Medical Treatment ◽

Healthy Lifestyle ◽

Preventive Treatment ◽

Control Group ◽

Psychological Counselling ◽

Funding Sources ◽

Item Questionnaire ◽

Experimental Group ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Low adherence to healthy lifestyle and CVD preventive medical treatment is a seriouse problem in lowering of CVD morbidity and mortality. Using modern medical, psychological and remote technologies may help to increase patients" adherence. Purpose To study the efficacy of medical and psychological counselling using remote technologies in rising patients" adherence to CVD preventive treatment. Methods The study included 140 patients with risk factors for cardiovascular disease (RF CVD), who were divided into two comparable groups: group of medical and psychological counselling with the use of remote technologies (n = 70) and group of control (n = 70). The study lastet 12 months. Level of adherence was measured via standard Morisky-Green"s 4-item questionnaire as well as via additional questionnaire developed by authors for this study. Results Comparative analysis of the level of adherence in the two groups did not reveal statistically significant differences at baseline. After 12 months, the experimental group showed a statistically significant increase in adherence to preventive treatment compared with the control group (р=0,001) Conclusion(s) Medical and psychological counselling using remote technologies is an effective method for rising patients" adherence to CVD preventive medical treatment

Download Full-text

Factors associated with the practice of minimal counseling by medical residents

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.162 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

Z Bargaoui ◽

K Mzoughi ◽

I Zairi ◽

O Aouina

Keyword(s):

Analytical Study ◽

Smoking Status ◽

Public Health Problem ◽

Medical Residents ◽

Medical Studies ◽

Gender Ratio ◽

Online Questionnaire ◽

Prospective Data ◽

Funding Sources ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Smoking is a public health problem. Doctors have an important role in the fight against smoking, in particular through the minimum advice they can give. Purpose The aim of this work was to study the prevalence of the application of minimal advice by medical residents and to identify factors that may influence its practice. Methods We conducted a descriptive and analytical study with a prospective data collection that included 302 residents practicing in Tunisia and who agreed to respond to an online questionnaire submitted between February and March 2020. Results Residents mean age was of 28 ± 2 years and the gender ratio was 0.65. Sixty-four percent of residents were non-smokers. During their practice, 94% of residents systematically identified the patient"s smoking status and 61.9% were unfamiliar with the concept of minimal advice. The rate of application of the minimum advice by residents was 57.6%. In multivariate analysis, the factors influencing the application of minimum counseling were: gender (OR =0.321, p = 0.0001), knowledge of minimum counseling (OR = 2.808, p = 0.002) and having attended the minimum advice given by a senior (OR = 2.328, p = 0.0001). Conclusion The rate of application of the minimum advice remains low. Improving one"s theoretical and practical teaching during medical studies is essential.

Download Full-text

Impact of the COVID-19 pandemic on electrophysiological procedures at a national referral center

EP Europace ◽

10.1093/europace/euab116.042 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

A Cueva-Parra ◽

G Munoz-Benavides ◽

W Ortiz-Solis ◽

J Gomez-Flores ◽

MF Marquez ◽

...

Keyword(s):

Electronic Devices ◽

Referral Center ◽

Funding Sources ◽

Cardiac Implantable Electronic Devices ◽

Electrophysiological Studies ◽

Electrophysiological Procedures ◽

The Impact ◽

Large Groups ◽

Made In ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background - Introduction: The COVID-19 pandemic has generated serious repercussions on the health system, reducing the number of all cardiology procedures worldwide. Objectives Describe the impact of the COVID-19 pandemic on the procedures performed by the electrophysiology department in a national referral center. Methods We made a retrospective review of our data base and we compared procedures made in the last 3 years since 2017 to 2019 with the procedures made in the 2020. We divide the procedures into two large groups: Cardiac Implantable Electronic Devices (CIED) related procedures (which included implants, revisions, changes, upgrades and extractions) and electrophysiological studies and ablations (which included conventional and complex procedures). Other types of procedures were no included. Results There was a significant reduction in all procedures, the average of procedures performed in the last 3 previous years was 467 (there were 479 in 2017, 411 in 2018 and 511 in 2019), while in 2020 we performed only 319 (p = 0.01); this represents a reduction of 33.4% in the total number of procedures performed in our center. There was no statistical difference regarding the CIED related procedures, the average of procedures of the last 3 previous years was 174 (there were 186 in 2017, 148 in 2018 and 188 in 2019), and in 2020 we performed 189 procedures, this value is near to the average of the last 3 previous years and very close to the value of the 2019 (p = 0.46). Regarding the electrophysiological studies and ablations, the average of procedures of the last 3 previous years was 293 (there were 293 in 2017, 263 in 2018 and 323 in 2019), while in 2020 we performed only 129 procedures, considerably decreasing compared to the previous years (p < 0.01). The reduction in the electrophysiological studies and ablations was 55.97%. The most affected months were April, May and June. Conclusions The COVID-19 pandemic considerably affected the number of electrophysiological procedures in our center, reducing it by 33.4% compared to the previous years. The reduction of procedures fundamentally affected the electrophysiological studies and ablations, reducing them by 55.97%. The number of CIED related procedures were no affected. Electrophysiological procedures Procedures2017201820192017-2019 average2020CIED related procedures186148188174189Electrophysiological studies and ablations293263323293129Total479411511467319Comparative table of the electrophysiological procedures performed in our center in recent years.Abstract Figure. Comparison of the procedures.

Download Full-text

Electrocardiographic characteristics of patients with coronavirus disease 2019 (COVID-2019) related pneumonia at first presentation

EP Europace ◽

10.1093/europace/euab116.023 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

U Nguyen ◽

M Strik ◽

S Abu-Arib ◽

A Bruekers ◽

T Nguyen ◽

...

Keyword(s):

Clinical Presentation ◽

Negative Group ◽

Male Mortality ◽

Funding Sources ◽

Atrial Enlargement ◽

Study Population ◽

Polymerase Chain ◽

Repolarization Abnormalities ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Purpose To evaluate electrocardiographic (ECG) characteristics at first presentation in patients with possible coronavirus disease (COVID-19) pneumonia. Methods and results 356 patients presenting at the emergency room with possible COVID-19 pneumonia based on clinical presentation and computed tomography findings were included and subdivided into a COVID-19 positive group ([COVID-19-positive], n = 231, 65%) and a COVID-19 negative group ([COVID-19-negative], n = 125, 35%) based on polymerase chain reaction tests. The study population was predominantly middle aged-elderly (67 ± 14 year; n = 235, 66% male). Mortality rate was 24% after 1-month follow-up. There were no significant (NS) differences in sex, age, and mortality between the COVID-19-positive and COVID-19-negative group. Atrial fibrillation (AF) was common (9%), though its prevalence was NS (regression analyses adjusted for age and sex) different in the COVID-19-positive vs. the COVID-19-negative group. ECG characteristics reflecting atrial enlargement and repolarization abnormalities were frequently present (<38% and 14% respectively). No significant differences were found between the COVID-19-positive vs. the COVID-19-negative group for the majority of morphological ECG characteristics (Figure 1 for more detailed data). Conclusion AF and ECG characteristics reflecting atrial enlargement and repolarization abnormalities are commonly present in COVID-19 patients. The prevalence of these ECG characteristics however do NS differ from their COVID-19-negative counterparts. Abstract Figure.

Download Full-text

Impact of air pollution on mortality due to cerebrovascular diseases

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.177 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

L Kuzma ◽

EJ Dabrowski ◽

A Kurasz ◽

M Swieczkowski ◽

H Bachorzewska-Gajewska ◽

...

Keyword(s):

Air Pollution ◽

Cold Season ◽

Cerebrovascular Diseases ◽

Term Effect ◽

Short Term ◽

Short Term Effect ◽

Funding Sources ◽

Specific Mortality ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background The short-term effect of air pollution on cardiovascular mortality is well-documented but a scarce number of studies focus on cause-specific mortality in low-polluted areas. Purpose We decided to distinguish deaths due to cerebrovascular disease (CbVD) from a region widely known as the Green Lungs of Poland to assess the short-term effect of air pollution on CbVD mortality. Methods The analysis with almost 4,500,000 person-years of follow-up with a time-stratified case-crossover design was performed. Results are reported as odds ratio (OR) associated with an increase in interquartile range (IQR) of air pollution. Results In the overall analysis of the studied region PM2.5 had an impact on increased CbVD mortality at LAG 0 (OR 1.046, 95% CI 1.013 – 1.080, P = 0.006), LAG 0-1 (1.048, 1.002-1.082, P = 0.040), and LAG 0-3 (1.052, 1.015-1.090, P = 0.006). The influence of PM10 was noted at LAG 0 (1.041, 1.002-1.082, P = 0.040). CbVD mortality in Bialystok was increased by exposure to PM10 at LAG 0 (1.05, 1.00-1.09, P = 0.048) and CO at LAG 1 (1.07, 1.00-1.14, P = 0.04). Additionally, an effect of CO was observed in cold season at LAG 1 (1.09, 1.02-1.17, P = 0.02), LAG 0-1 (1.08, 1.00-1.016, P = 0.04), and LAG 0-3 (1.09, 1.01-1.18, P = 0.04). In Suwalki, an impact of PM2.5 was also observed. Conclusions A short-term increase in air pollutants concentrations, especially in PM2.5 and CO, had an influence on CbVD mortality. Mortality rates were significantly increased in cold season. We also found heterogeneity in the influence of major contributors on mortality between analyzed cities.

Download Full-text

Long term stability of the subcutaneous cardioverter defibrillator implanted by means of the intermuscular two incision technique

EP Europace ◽

10.1093/europace/euab116.403 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

G Bisignani ◽

A Bisignani ◽

AL Cavaliere ◽

M Lovecchio ◽

S Valsecchi ◽

...

Keyword(s):

Thoracic Wall ◽

Fat Tissue ◽

Cardioverter Defibrillator ◽

Long Term Stability ◽

Funding Sources ◽

Incision Technique ◽

Post Implantation ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background To ensure effective defibrillation with the subcutaneous implantable cardioverter defibrillator (S-ICD), both the lead and the generator must be adequately positioned extrathoracically. We assessed the long-term adequacy of the S-ICD system position and its stability in a group of patients who received the S-ICD by means of the two-incision intermuscular technique. Methods The PRAETORIAN score uses chest radiography to provide feedback on S-ICD positioning, and identifies patients with high defibrillation thresholds. We compared radiographs taken immediately after implantation and on 12-month follow-up examination. Results We analyzed data from 38 patients with the S-ICD generator positioned in an intermuscular pocket. The median PRAETORIAN score was 38 [25th to 75th percentile: 30 to 60]. Two (5%) patients had a score of 90 (intermediate risk of conversion failure). The thickness of the adipose tissue between the coil and the sternum was ≤1 coil width in 72% of patients, the generator was on, or posterior to, the midline in 94% of patients, and the amount of fat tissue between the generator and the thoracic wall was less than the generator width in 78% of patients. No generator or electrode dislodgments were detected on analyzing radiographs collected at the 12-month visit. In all patients, assessment of the PRAETORIAN score confirmed the values calculated on post-implantation analysis. During follow-up, no ineffective therapies, sudden cardiac or device-related deaths occurred. Conclusions The position of the S-ICD system implanted using the two-incision intermuscular technique was adequate at the time of implantation and remained stable after 12 months.

Download Full-text

Salivary Gland Focus Score is Associated with Myocardial Fibrosis in Primary Sjögren’s Syndrome Assessed by a Cardiac Magnetic Resonance Approach

The Journal of Rheumatology ◽

10.3899/jrheum.200352 ◽

2020 ◽

pp. jrheum.200352

Author(s):

Atsuma Nishiwaki ◽

Hitomi Kobayashi ◽

Natsumi Ikumi ◽

Yasuyuki Kobayashi ◽

Isamu Yokoe ◽

...

Keyword(s):

Salivary Gland ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Myocardial Fibrosis ◽

High Intensity ◽

Primary Sjögren’S Syndrome ◽

Primary Sjogren’S Syndrome ◽

Focus Score ◽

Cardiac Symptoms ◽

Lv Mass

Objective The risk of clinically manifested major cardiovascular events in primary Sjögren's syndrome (pSS) remains unclear. This study aimed to assess myocardial fibrosis in pSS and investigate the associated disease characteristics by cardiac magnetic resonance (CMR) imaging. Methods We performed a cross-sectional study of patients with pSS without cardiac symptoms. Labial gland biopsy was documented in 44 patients (85%). Patients without cardiovascular risk factors underwent contrast-enhanced CMR. Late gadolinium enhancement (LGE) was used to assess myocardial fibrosis. Myocardial edema was assessed using T2- weighted imaging (T2-WI). We compared the left ventricular (LV) geometry and function between the groups with and without LGE. Furthermore, we explored the associations of CMR abnormalities with pSS characteristics. Results Fifty-two women with pSS (median age: 55, interquartile range: 47.0–65.7 years) were enrolled in the study. LGE was observed in 10 patients (19%), two of whom showed high intensity on T2-WI. High intensity on T2-WI was observed in three patients (5.8%). LV mass index and LV mass/end-diastolic volume tended to be higher in the LGE-positive group than in the LGE-negative group (p = 0.078 and 0.093, respectively). Salivary gland focus score (FS) ≥3 was independently associated with LGE-positive in the multivariable analysis (odds ratio: 11.21, 95% confidence interval: 1.18–106.80). Conclusion Subclinical myocardial fibrosis, as detected by CMR, was frequent in patients with pSS without cardiac symptoms. Abnormal CMR findings were associated with salivary gland FS ≥3.

Download Full-text