Abstract 15983: New Left Ventricular Systolic Dysfunction in Hospitalized Patients With Covid-19

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Celeste S Witting ◽  
Jayson Baman ◽  
Eric Cantey ◽  
Baljash Cheema ◽  
Arvind Nishtala ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Hospitalized Patients ◽  
Categorical Variables ◽  
Ventricular Systolic Dysfunction ◽  
Unequal Variance ◽  
Icu Admission ◽  
Lv Dysfunction

Introduction: Left ventricular systolic dysfunction (LVSD) has been observed in COVID-19 and is thought to be multifactorial. The epidemiology of stress cardiomyopathy in these patients has not been studied. Methods: Transthoracic echocardiograms (TTE) were evaluated in consecutive COVID-19 patients admitted to a large tertiary care center in Chicago, Illinois. Subjects with new LVEF ≤50% with prior normal LVEF or unknown baseline LVEF were compared to those with LVEF >50% or previously known LVSD. InterTAK scores were calculated for all patients with new LVSD, and a cutoff of 50 was used to delineate the likelihood of stress-induced cardiomyopathy. Two-tailed student t-test of unequal variance and Chi-squared testing were used for analysis of continuous and categorical variables, respectively, with p<0.05 considered statistically significant. Results: Of hospitalized patients with COVID-19 (n=982), 231 (23.5%) underwent TTE. Thirty patients (13.0%) were found to have new LVSD. Patients with new LVSD had higher peak troponin and rates of ICU admission and incidence of in-hospital mortality compared to patients without new LVSD (Table). Ten patients (33%) with new LVSD had InterTAK scores ≥50. Compared to those with low InterTAK scores, these patients were more likely to be female, have lower peak d-dimer, and a trend towards lower troponin as well as rates of ICU admission and mortality. Only two patients with new LV dysfunction were noted to have Takotsubo patterns on TTE. Conclusions: In hospitalized patients with COVID-19, new LVSD was rare but associated with an increased risk of critical illness requiring intensive care, intubation and in-hospital mortality. The etiology of new LVSD in COVID-19 is likely multifactorial, but those with LV dysfunction likely secondary to stress-induced cardiomyopathy have a trend towards improved mortality.

Abstract 18294: Left Ventricular Systolic Dysfunction Early After Resuscitation From Cardiac Arrest is Associated With Shockable Arrest Rhythm

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jacob C Jentzer ◽  
Hussein Abu-Daya ◽  
Asher Shafton ◽  
Meshe Chonde ◽  
Didier Chalhoub ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Troponin I ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Mitral Annulus Velocity ◽  
Fractional Shortening

Introduction: Left ventricular systolic dysfunction (LVSD) is common after resuscitation from cardiac arrest (CA). The association of echocardiographic LVSD with cardiac rhythm during CA is not well described. Hypothesis: Patients with a shockable rhythm (VT/VF) will have a greater degree of LVSD by echocardiography after CA. Methods: Prospective registry of patients resuscitated from CA underwent transthoracic echocardiography (TTE) within 24 hours after CA. We determined 2D measurements, LVEF, spectral Doppler of mitral inflow and LV outflow, systolic and diastolic tissue Doppler of the mitral annulus velocity, and tricuspid plane annular excursion (TAPSE). We collected data on in-hospital mortality as well as vasopressor doses and troponin I levels. TTE parameters and clinical characteristics were compared between patients with a shockable (VT/VF) arrest rhythm and a non-shockable (asystole/PEA) arrest rhythm and between survivors and non-survivors using t-tests and ANOVA. Results: Of the 55 patients, the 23 (42%) with shockable CA rhythms had significantly higher LV end-systolic dimension (4.1cm vs. 3.3cm, p = 0.0073), lower LV fractional shortening (0.15 vs. 0.28, p <0.0001), and lower LVEF both by visual estimate (36.2% vs. 52.3%, p = 0.0012) and by Simpson’s biplane method (37.5% vs. 52.3%, p = 0.0506). Other measured TTE parameters did not differ between groups, including TAPSE (shockable 1.53 vs. non-shockable 1.82, p = 0.1731). Admission and peak 24 hour vasopressor requirements did not differ between groups. Peak troponin levels were higher (22.26 vs. 3.88, p = 0.0198) in patients with shockable CA rhythms, but admission troponin levels were no different (0.88 vs. 0.51, p = 0.1527). TTE parameters did not differ between survivors and non-survivors (visual LVEF 47.0% vs. 44.2%, p = 0.5968; LV fractional shortening 0.19 vs. 0.25, p = 0.0916). Conclusions: Patients with shockable CA rhythms have more severe LVSD on 24 hour echocardiography despite similar vasopressor requirements and admission troponin levels. Echocardiographic parameters at 24 hours did not predict in-hospital mortality. Early echocardiography after CA appears more useful for differentiating primary CA rhythm than for predicting mortality.

Impact of New-Onset Left Ventricular Dysfunction on Outcomes in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock

2016 ◽  
Vol 33 (12) ◽  
pp. 680-686 ◽  
Author(s):  
Saraschandra Vallabhajosyula ◽  
Shane M. Gillespie ◽  
David W. Barbara ◽  
Nandan S. Anavekar ◽  
Juan N. Pulido
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Diastolic Dysfunction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Secondary Outcomes ◽  
Sepsis And Septic Shock

Background: Left ventricular systolic dysfunction (LVSD) and LV diastolic dysfunction (LVDD) are commonly seen in severe sepsis and septic shock; however, their role in patients with concurrent invasive mechanical ventilation (IMV) is less well defined. Methods: This was a prospective observational study on all patients admitted to all the intensive care units (ICUs) at Mayo Clinic, Rochester from August 2007 to January 2009. All adult patients with severe sepsis and septic shock and concurrent IMV without prior heart failure underwent transthoracic echocardiography within 24 hours. Patients with active pregnancy, prior congenital or valvular heart disease, and prosthetic cardiac valves were excluded. Left ventricular systolic dysfunction was defined as LV ejection fraction (LVEF) <50% and LVDD as E/e′ >15. Primary outcome was hospital mortality, and secondary outcomes included IMV duration, ICU length of stay (LOS), and total LOS. Two-tailed P value of <.05 was considered statistically significant. Results: In a total of 106 patients, 58 (54.7%) met our inclusion criteria, with 17 (29.3%), 11 (19.0%), and 5 (8.6%) having LVSD, LVDD, and both, respectively. The cohorts with and without LVSD and LVDD did not differ significantly in their baseline characteristics and laboratory and ventilatory parameters. Compared to those without LVSD, patients with LVSD had higher LV end-systolic diameters but were not different in their left atrial diameters or E/e′ ratio. Patients with LVDD had a higher E velocity and E/e′ ratio compared to those without LVDD. Hospital mortality was not different in patients with and without LVSD (8 [47%] vs 21 [51%], P = 1.00) and LVDD (8 [73%] vs 21 [45%], P = .18). Secondary outcomes were not different between the 2 groups. Conclusion: Left ventricular systolic or diastolic dysfunction did not influence in-hospital outcomes in patients with severe sepsis and septic shock and concurrent IMV.

Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhage

2006 ◽  
Vol 105 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Nader Banki ◽  
Alexander Kopelnik ◽  
Poyee Tung ◽  
Michael T. Lawton ◽  
Daryl Gress ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Recovery Rate ◽  
Time Course ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Cardiac Injury ◽  
Left Ventricular ◽  
Lv Function ◽  
Ventricular Systolic Dysfunction ◽  
Lv Dysfunction

Object Subarachnoid hemorrhage (SAH) has been associated with cardiac injury and left ventricular (LV) dysfunction. The incidence and natural history of neurocardiogenic injury after SAH remains poorly understood. The objective of this study was to describe the incidence, time course, recovery rate, and segmental patterns of LV dysfunction after SAH. Methods Echocardiography was performed three times over a 7-day period in 173 patients with SAH. The incidence of global (ejection fraction [EF] < 50%) and segmental (any regional wall-motion abnormality [RWMA]) LV dysfunction was measured. The time course of LV dysfunction was determined by comparing the prevalence of LVEF less than 50% and RWMA at 0 to 2, 3 to 5, and 6 to 8 days after SAH. The recovery rate was defined as the proportion of patients with partial or complete normalization of function. The distribution of RWMAs among 16 LV segments was also determined. An LVEF less than 50% was found in 15% of patients, and 13% had an RWMA with a normal LVEF. There was a trend toward increased dysfunction at 0 to 2 days after SAH, compared with 3 to 8 days after SAH. Recovery of LV function was observed in 66% of patients. The most frequently abnormal LV segments were the basal and middle ventricular portions of the anteroseptal and anterior walls. The apex was rarely affected. Conclusions Left ventricular systolic dysfunction occurs frequently after SAH and usually improves over time. The observed segmental patterns of LV dysfunction often do not correlate with coronary artery distributions.

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