SARS-CoV-2 Cardiac Involvement in Young Competitive Athletes

Background: Cardiac involvement among hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is common and associated with adverse outcomes. The objective of this study was to determine the prevalence and clinical implications of SARS-CoV-2 cardiac involvement in young competitive athletes. Methods: In this prospective multicenter observational cohort study with data from 42 colleges/universities, we assessed the prevalence, clinical characteristics, and outcomes of SARS-CoV-2 cardiac involvement among collegiate athletes in the United States. Data were collected from September 1, 2020 to December 31, 2020. The primary outcome was the prevalence of definite, probable, or possible SARS-CoV-2 cardiac involvement based on imaging definitions adapted from the Updated Lake Louise Criteria. Secondary outcomes included the diagnostic yield of cardiac testing, predictors for cardiac involvement, and adverse cardiovascular events or hospitalizations. Results: Among 19,378 athletes tested for SARS-CoV-2 infection, 3018 (mean age 20 years [SD,1 year]; 32% female) tested positive and underwent cardiac evaluation. A total of 2820 athletes underwent at least one element of cardiac 'triad' testing [12-lead electrocardiography (ECG), troponin, and/or transthoracic echocardiography(TTE)] followed by cardiac magnetic resonance (CMR) if clinically indicated. In contrast, primary screening CMR was performed in 198 athletes. Abnormal findings suggestive of SARS-CoV-2 cardiac involvement were detected by ECG (21/2999,0.7%), cardiac troponin (24/2719,0.9%), and TTE (24/2556,0.9%). Definite, probable, or possible SARS-COV-2 cardiac involvement was identified in 21/3018 (0.7%) athletes, including 15/2820 (0.5%) who underwent clinically indicated CMR (n=119) and 6/198 (3.0%) who underwent primary screening CMR. Accordingly, the diagnostic yield of CMR for SARS-COV-2 cardiac involvement was 4.2 times higher for a clinically indicated CMR (15/119,12.6%) versus a primary screening CMR (6/198,3.0%). After adjustment for race and sex, predictors of SARS-CoV-2 cardiac involvement included cardiopulmonary symptoms (OR:3.1,95% CI:1.2,7.7) or at least one abnormal triad test (OR:37.4,95% CI:13.3,105.3). Five (0.2%) athletes required hospitalization for non-cardiac complications of SARS-CoV-2. During clinical surveillance (median follow-up 113 days [IQR=90,146]), there was one (0.03%) adverse cardiac event likely unrelated to SARS-CoV-2 infection. Conclusions: SARS-CoV-2 infection among young competitive athletes is associated with a low prevalence of cardiac involvement and a low risk of clinical events in short term follow-up.

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The Transfusion Services Committee—Responsibilities and Response to Adverse Transfusion Events

Hematology ◽

10.1182/asheducation-2005.1.483 ◽

2005 ◽

Vol 2005 (1) ◽

pp. 483-490 ◽

Cited By ~ 9

Author(s):

Ira A. Shulman ◽

Sunita Saxena

Keyword(s):

Performance Improvement ◽

Review Process ◽

High Volume ◽

The United States ◽

Adverse Outcomes ◽

Data Driven ◽

Medicaid Program ◽

And Performance ◽

To Receive

Abstract Healthcare institutions in the United States must review blood transfusion practices and adverse outcomes in order to receive payments from the Centers for Medicare/Medicaid program, but it is not required for a specific committee to be assigned to oversee the review process. Regardless of the group or individuals responsible, the review process must include a program of quality assessment and performance improvement that is ongoing, hospital-wide, and data-driven, reflects the complexity of the hospital’s organization and services, and involves all hospital departments and services (including those contracted). To be most effective, the performance improvement activity should be prioritized around high-risk, high-volume activities and/or in problem-prone areas. Even if a hospital elects not to receive payments from Medicare, it must still comply with applicable sections of the Code of Federal Regulations pertaining to transfusion services such as the follow up of adverse outcomes of transfusion.

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SARS-CoV-2 infection and return to play in junior competitive athletes: is systematic cardiac screening needed?

British Journal of Sports Medicine ◽

10.1136/bjsports-2021-104764 ◽

2021 ◽

pp. bjsports-2021-104764

Author(s):

Luna Cavigli ◽

Michele Cillis ◽

Veronica Mochi ◽

Federica Frascaro ◽

Nicola Mochi ◽

...

Keyword(s):

Pericardial Effusion ◽

Cardiac Involvement ◽

Return To Play ◽

Cardiac Complications ◽

Duration Of Symptoms ◽

Cardiac Screening ◽

Cardiac Symptoms ◽

Junior Athletes ◽

Competitive Athletes ◽

Pericardial Involvement

BackgroundSARS-CoV-2 infection might be associated with cardiac complications in low-risk populations, such as in competitive athletes. However, data obtained in adults cannot be directly transferred to preadolescents and adolescents who are less susceptible to adverse clinical outcomes and are often asymptomatic.ObjectivesWe conducted this prospective multicentre study to describe the incidence of cardiovascular complications following SARS-CoV-2 infection in a large cohort of junior athletes and to examine the effectiveness of a screening protocol for a safe return to play.MethodsJunior competitive athletes suffering from asymptomatic or mildly symptomatic SARS-CoV-2 infection underwent cardiac screening, including physical examination, 12-lead resting ECG, echocardiogram and exercise ECG testing. Further investigations were performed in cases of abnormal findings.ResultsA total of 571 competitive junior athletes (14.3±2.5 years) were evaluated. About half of the population (50.3%) was mildly symptomatic during SARS-CoV-2 infection, and the average duration of symptoms was 4±1 days. Pericardial involvement was found in 3.2% of junior athletes: small pericardial effusion (2.6%), moderate pericardial effusion (0.2%) and pericarditis (0.4%). No relevant arrhythmias or myocardial inflammation was found in subjects with pericardial involvement. Athletes with pericarditis or moderate pericardial effusion were temporarily disqualified, and a gradual return to play was achieved after complete clinical resolution.ConclusionsThe prevalence of cardiac involvement was low in junior athletes after asymptomatic or mild SARS-CoV-2 infection. A screening strategy primarily driven by cardiac symptoms should detect cardiac involvement from SARS-CoV-2 infection in most junior athletes. Systematic echocardiographic screening is not recommended in junior athletes.

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Clinical, Cardiological and Serologic Follow-Up of Chagas Disease in Children and Adolescents from the Amazon Region, Brazil: Longitudinal Study

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed5030139 ◽

2020 ◽

Vol 5 (3) ◽

pp. 139

Author(s):

Ana Neves Pinto ◽

Vera Valente ◽

Sebastião Valente ◽

Tamires Motta ◽

Ana Ventura

Keyword(s):

Children And Adolescents ◽

Chagas Disease ◽

Acute Phase ◽

Cardiac Involvement ◽

Cardiac Injury ◽

Antibody Test ◽

Amazon Region ◽

Cardiac Complications ◽

Epidemiologic Profile

Background: Outbreaks of Chagas disease (CD) by foodborne transmission is a problem related to deforestation, exposing people to triatomines infected by T. cruzi, in the Amazon region. Once involving long-time follow-up, the treatment efficacy of the CD during its acute phase is still unknown. The authors aim to describe the clinical and epidemiologic profile of children and adolescents with CD, as well as treatment and cardiac involvement during the follow-up. Methods: A descriptive cohort study was conducted from 1998 to 2013 among children and adolescents up to 18 years-old with confirmed diagnosis of CD. All participants met the criteria of CD in the acute phase. Results: A total of 126 outpatients were included and received treatment and follow-up examinations during a medium period of 10.9 years/person. Most of them (68.3%) had their diagnosis established during oral transmission outbreaks. The diagnostic method with the most positive results rate (80.9%) was the IgM class anti-T. cruzi antibody test as an acute phase marker, followed by the thick blood smears (60.8%). Acute myopericarditis was demonstrated in 18.2% of the patients, most of them with favorable evolution, though 2.4% (3/126) persisted with cardiac injury observed at the end point of the follow-up. Conclusions: Antibodies against T. cruzi persisted in 54.8% of sera from the patients without prognostic correlation with cardiac involvement. Precocious treatment can decrease potential cardiac complications and assure good treatment response, especially for inhabitants living in areas with difficult accessibility.

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P2733Prognostic value of cardiac dysautonomia in AL amyloidosis

European Heart Journal ◽

10.1093/eurheartj/ehz748.1050 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Nicol ◽

A Cescau ◽

M Baudet ◽

S Harel ◽

B Royer ◽

...

Keyword(s):

Mayo Clinic ◽

Cardiac Involvement ◽

Nyha Class ◽

Adverse Outcomes ◽

Blood Levels ◽

Al Amyloidosis ◽

Class Iii ◽

Cardiac Denervation ◽

A Prospective Study

Abstract Introduction Cardiac involvement is the major prognostic factor in patients with light chain amyloidosis (AL). Cardiac dysautonomia can occur early in amyloidosis and can be assess by Iodine-123-metaiodobenzylguanidine (123I-MIBG) scintigraphy. Its prognostic value has been shown in TTR amyloidosis but is unknown in AL amyloidosis. We aimed to evaluate the prognosis impact of cardiac dysautonomia in patients with AL amyloidosis. Methods We carried out a prospective study in consecutive patients with biopsy-proven AL amyloidosis. All patients underwent clinical examination, EKG, echocardiography, cardiac MRI and biological tests. The 2012 Mayo clinic prognostic classification was calculated by using blood levels of NT-proBNP, cardiac T troponin and the differential of free light chains as recommended. The sympathetic cardiac innervation was assessed by using 123I-MIBGscintigraphy and measurement of the heart-to-mediastinum uptake ratio (late H/M) in the anterior view of the chest. A cardiac denervation was defined by late H/M <1.8 4h after injection of 3 MBq/kg of 123I-MIBG. The primary end-point was all-cause mortality during follow-up. Results Fifty consecutive patients with AL amyloidosis were included. The median age was 68 years old [58–73]. By using both echocardiography and MRI, cardiac involvement was diagnosed in 33 patients (66%) and thirteen of these patients were NYHA class III or IV. By using Mayo clinic classification, patients were I, II, III and IV classes in 9 (18%), 14 (28%), 16 (32%) and 11 (22%) cases respectively. According to echocardiographic data, the median wall thickness of left ventricle was 13 mm [12–15]. The late H/M was 1.51 [1.33–1.67]. Cardiac denervation was found in 44 patients (88%). The 6 patients (12%) with a normal late H/M had no cardiac amyloidosis involvement. During a median follow-up of 24 months, 9 patients (18%) died. The area under the ROC curve of late H/M for predicting death was 0.74 (CI 95% 0.58–0.86). According to this curve, the best threshold was 1.44 and 7 of the 9 patients who died had late H/M ≤1.44. The figure shows the 2 year-survival according to late H/M. Late H/M ≤1.44 predicted all-cause death irrespective of the Mayo clinic classification: HR 8.0 (CI 95% 2.1–63) after adjustment on the Mayo clinic score (p=0.005). In addition, unplanned hospitalization for heart failure occurred in 8 patients with late H/M ≤1.44 versus 3 patients with late H/M >1.44 (p=0.03). Survival according to late H/M Conclusion Late H/M ≤1.44 is predictive of adverse outcomes in patients with AL amyloidosis, independently of the Mayo Clinic prognostic classification.

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Autologous Stem Cell Transplantation Improves Survival For High Risk Cardiac Amyloidosis

Blood ◽

10.1182/blood.v122.21.3341.3341 ◽

2013 ◽

Vol 122 (21) ◽

pp. 3341-3341

Author(s):

Piyanuch Kongtim ◽

Muzaffar H. Qazilbash ◽

Jatin J. Shah ◽

Robert Z. Orlowski ◽

Amir Hamdi ◽

...

Keyword(s):

Induction Chemotherapy ◽

Light Chain ◽

Cardiac Involvement ◽

Troponin I ◽

Troponin T ◽

Cardiac Complications ◽

Cardiac Responses ◽

History Of ◽

Related Mortality

Abstract Cardiac involvement in light chain amyloidosis (AL) predicts poor prognosis and is associated with higher treatment related mortality and morbidity during autologous stem cell transplantation (ASCT). We studied the outcomes of AL patients with cardiac involvement undergoing ASCT at our center between January 2002 and December 2012. Out of a total of 264 AL patients, 53 patients had cardiac involvement according to the International Consensus Criteria (Gertz M et al. AJH 2005) and 27 underwent ASCT. Cardiac staging was assessed using the Revised Prognostic Staging System for Light Chain Amyloidosis (Kumar S et al, JCO 2012). Hematologic and cardiac responses were evaluated before and at 1 year after ASCT using the guidelines established by the 10th International Symposium on Amyloid and Amyloidosis (Gertz M et al. AJH 2005). The median age of the patients was 53 years (range 36-74) with a median duration from diagnosis to ASCT of 6 months (range 3-95). The estimated median follow up for the entire cohort was 41 months (range 6-173). Twenty-four patients (89%) had an additional organ involvement, besides heart. Cardiac stage ≥3 was seen in 14 patients. The median troponin-T, Troponin-I, BNP and NT-proBNP levels and free light chain difference (FCL-diff) were 0.054 ng/ml, 0.05 ng/ml, 376 pg/ml, 1888 pg/ml, and 116.4 mg/l respectively (table1). Twenty-four patients (89%) received induction chemotherapy and 22 of those (81%) received novel chemotherapy agents. Eighteen patients (66.6%) achieved at least PR prior to ASCT. Four patients (14.8%) received reduced doses melphalan conditioning (140-180 mg/m2). One-year transplant related mortality (TRM) was 3.7% (1 patient died at day 11 post-transplant due to cardiac event). At 1-year post ASCT, overall HR was seen in 24 patients (89%) (CR=26% and PR=63%) while 3 patients (11%) had cardiac responses. At the time of last follow up, 17 patients (63%) were alive. The median overall survival (OS) from diagnosis and from ASCT was 58 months (95% CI; 46-69) and 46 months (95% CI; 36-55) respectively (figure1). The median progression free survival (PFS) was 25 months (95% CI; 6-44). Cumulative incidence of hematologic relapse at 3 year was 38.5% (95%CI 23.7-62.5). Cardiac progression at last follow up was seen in 1 patient (3.7%). Negative factors affecting OS included lack of induction therapy prior to ASCT and NT-proBNP more than 5000 pg/ml. We conclude that ASCT is well tolerated in patients with high-risk cardiac amyloidosis and the incorporation of induction therapy can improve overall outcomes of these patients.Figure1.Overall SurvivalFigure1. Overall SurvivalTable1Patient CharacteristicsBaseline characteristicsTotal (N=27)Interquartile rangeMedian age (year)5336-71Gender: male (%)20 (74.1)Median time from diagnosis to transplant, (month)63-95Receive induction chemotherapy (%)24 (88.9)Receive novel induction chemotherapy (%)22 (81.5)Light chain type (%)-Kappa-Lambda.6 (22.2) 21 (77.8)Other organ involvement (%)24 (88.9)History of cardiac complications prior ASCT (%)17 (63)History of cardiac complications after ASCT (%)20 (74.1)ICU admission prior ASCT (%)3 (11.1)Cardiac event prior ASCT (%)17 (62.9%)Median FLC-diff (mg/l) (N=15)116.415-1168Median EF (%) (N=19)6030-82Median IVS (mm.) (N=14)1.350.7-2.1Median Troponin-T (ng/ml) (N=20)0.0190.01-0.22Median Troponin-I (ng/ml) (N=19)0.060.03-9.09Median BNP (pg/ml) (N=23)37615.2-1782Median NT-proBNP (pg/ml) (N=12)1888.519-9911Median serum calcium (mg/dl)9.27-11Median serum albumin (g/dl)3.92.4Median Creatinine (mg/dl)1.01-9Median B2 microglobulin (mg/l)3.151-15Median 24-hr urine protein (mg)574120-36006Median serum M protein (g/dl)0.50-4Median LDH (IU/l)377146-770Median BM plasma cell (%)110-58Cardiac stage at diagnosis.Stage 11Stage 25Stage 36Stage 48Cardiac stage at transplant.Stage 13Stage 25Stage 34Stage 46 Disclosures: No relevant conflicts of interest to declare.

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Abstract 19671: Contemporary Patterns of Utilization and Safety Outcomes of Catheter Ablation of Atrial Flutter in the United States

Circulation ◽

10.1161/circ.132.suppl_3.19671 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Dhaval Pau ◽

Nileshkumar J Patel ◽

Apurva O Badheka ◽

Abhishek Deshmukh ◽

Juan Viles-Gonzalez

Keyword(s):

Catheter Ablation ◽

Atrial Flutter ◽

Hospital Volume ◽

Vascular Complications ◽

The United States ◽

Adverse Outcomes ◽

Hospital Death ◽

Cardiac Complications ◽

Complication Rates ◽

Safety Outcomes

Introduction: Atrial flutter ablation has been increasingly offered as first line therapy and has been safely performed over the past few decades. However, limited data exists regarding current utilization and trends in adverse outcomes arising from this procedure. The aim of our study was to examine the frequency of adverse events attributable to atrial flutter (AFL) ablation and the influence of hospital volume on safety outcomes. Hypothesis: We hypothesize an association between hospital volume and adverse outcomes. Methods: With the use of the Nationwide Inpatient Sample, we identified 89,638 AFL patients treated with catheter ablation from 2000-2011. We investigated common complications including cardiac perforation and tamponade, pneumothorax, stroke, transient ischemic attack, vascular access complications, and in-hospital death. We defined these complications by using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Results: The overall frequency of complications was 3.17%, with combined cardiac complications (1.44%) being the most frequent. Cardiac complications were followed by vascular complications (0.78%), respiratory complications (0.88%), and neurological complications (0.05%). The in-hospital mortality was 0.17%. Low hospital volume (<50 procedures) was significantly associated with increased adverse outcomes. In addition, there was a small, insignificant rise in overall complication rates over time. Conclusions: The overall complication rate was 3.17% in patients undergoing AFL ablation. There was a significant association between low hospital volume and increased adverse outcomes. This suggests a need for future research into identifying the safety measures in AFL ablations and instituting appropriate interventions to improve overall AFL ablation outcomes.

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Isolated Increased Nuchal Translucency in First Trimester Ultrasound Scan: Diagnostic Yield of Prenatal Microarray and Outcome of Pregnancy

Frontiers in Medicine ◽

10.3389/fmed.2021.737936 ◽

2021 ◽

Vol 8 ◽

Author(s):

Kyra E. Stuurman ◽

Marjolein H. van der Mespel-Brouwer ◽

Melanie A. J. Engels ◽

Mariet W. Elting ◽

Shama L. Bhola ◽

...

Keyword(s):

Diagnostic Yield ◽

Normal Karyotype ◽

First Trimester ◽

Nuchal Translucency ◽

Adverse Outcomes ◽

Genetic Syndromes ◽

Postnatal Outcome ◽

First Trimester Ultrasound ◽

Increased Nuchal Translucency

Background: Increased nuchal translucency (NT) is associated with aneuploidy. When the karyotype is normal, fetuses are still at risk for structural anomalies and genetic syndromes. Our study researched the diagnostic yield of prenatal microarray in a cohort of fetuses with isolated increased NT (defined as NT ≥ 3.5 mm) and questioned whether prenatal microarray is a useful tool in determining the adverse outcomes of the pregnancy.Materials and Methods: A prospective study was performed, in which 166 women, pregnant with a fetus with isolated increased NT (ranging from 3.5 to 14.3 mm with a mean of 5.4 mm) were offered karyotyping and subsequent prenatal microarray when karyotype was normal. Additionally, all ongoing pregnancies of fetuses with normal karyotype were followed up with regard to postnatal outcome. The follow-up time after birth was maximally 4 years.Results: Totally, 149 of 166 women opted for prenatal testing. Seventy-seven fetuses showed normal karyotype (52%). Totally, 73 of 77 fetuses with normal karyotype did not show additional anomalies on an early first trimester ultrasound. Totally, 40 of 73 fetuses received prenatal microarray of whom 3 fetuses had an abnormal microarray result: two pathogenic findings (2/40) and one incidental carrier finding. In 73 fetuses with an isolated increased NT, 21 pregnancies showed abnormal postnatal outcome (21/73, 28.8%), 29 had a normal outcome (29/73, 40%), and 23 were lost to follow-up (23/73, 31.5%). Seven out of 73 live-born children showed an adverse outcome (9.6%).Conclusions: Prenatal microarray in fetuses with isolated increased NT had a 5% (2/40) increased diagnostic yield compared to conventional karyotyping. Even with a normal microarray, fetuses with an isolated increased NT had a 28.8% risk of either pregnancy loss or an affected child.

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Early Disseminated Lyme Carditis Inducing High-Degree Atrioventricular Block

Case Reports in Cardiology ◽

10.1155/2020/5309285 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Connor C. Kerndt ◽

John A. Bills ◽

Zaid J. Shareef ◽

Alexander M. Balinski ◽

Daniel F. Summers ◽

...

Keyword(s):

Erythema Migrans ◽

The United States ◽

Outdoor Exposure ◽

Clinical Suspicion ◽

Adverse Outcomes ◽

Av Block ◽

Lyme Carditis ◽

High Degree ◽

Electrocardiogram Ecg

Lyme disease is the most common tick-borne illness in the United States due to Borrelia burgdorferi infection. This case demonstrates a 20-year-old male patient presenting with complaints of annular skin rash, malaise, fever, and lightheadedness after significant outdoor exposure. Physical exam revealed multiple large targetoid lesions on the back and extremities. The rash had raised borders and centralized clearing consistent with erythema migrans chronicum. Electrocardiogram (ECG) revealed a high-degree atrioventricular (AV) block. The patient was started on intravenous ceftriaxone due to clinical suspicion for Lyme carditis. ELISA and Western blot tests were reactive for Lyme IgM and IgG, confirming the diagnosis. The AV block resolved by hospital day four and the patient was discharged with outpatient follow-up. Early identification of disease allowed for effective treatment with no adverse outcomes or sequelae.

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Clinical characteristics, visceral involvement, and mortality in at-risk or early diffuse systemic sclerosis: a longitudinal analysis of an observational prospective multicenter US cohort

Arthritis Research & Therapy ◽

10.1186/s13075-021-02548-1 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Sara Jaafar ◽

Alain Lescoat ◽

Suiyuan Huang ◽

Jessica Gordon ◽

Monique Hinchcliff ◽

...

Keyword(s):

At Risk ◽

Systemic Sclerosis ◽

Immunosuppressive Therapy ◽

Longitudinal Analysis ◽

Cardiac Involvement ◽

Rna Polymerase Iii ◽

Case Fatality ◽

The United States ◽

Gastrointestinal Dysmotility

Abstract Background Early diffuse cutaneous systemic sclerosis (dcSSc) has the highest case fatality among rheumatic diseases. We report baseline characteristics, current immunosuppressive therapies, progression of skin and internal organ involvement, and mortality in a multicenter prospective cohort from the United States (US) of America. Methods We performed a longitudinal analysis of participants from 12 US centers, from April 2012 to July 2020. All participants had early dcSSc or were at-risk for dcSSc, with ≤2 years since the first non-Raynaud’s phenomenon (RP) symptom. Results Three hundred one patients were included with a baseline median disease duration of 1.2 years since RP and a mean modified skin score of 21.1 units. At baseline, 263 (87.3%) had definite dcSSc and 38 (12.7%) were classified as at-risk; 112 (49.6%) patients were positive for anti-RNA polymerase III antibodies. The median follow-up duration was 24.5 months (IQR = 10.3–40.7 months). One hundred ninety (63.1%) participants were treated with an immunosuppressive therapy, of which mycophenolate mofetil was most used at baseline and follow-up. Of 38 who were classified as at-risk at baseline, 27 (71%) went on to develop dcSSc; these patients were characterized by higher baseline mean HAQ-DI (0.8 versus 0.4, p = 0.05) and higher baseline mRSS (8.8 versus 4.4, p < 0.01) in comparison with those who remained as limited cutaneous SSc. In the overall cohort, 48 participants (21.1%) had clinically significant worsening of skin fibrosis, mainly occurring in the first year of follow-up; 41 (23.3%) had an absolute forced vital capacity decline of ≥10%. Twenty participants (6.6%) died, of which 18 died in the first 3 years of follow-up. Cardiac involvement (33.3%), gastrointestinal dysmotility (22.2%), and progressive interstitial lung disease (ILD) (16.7%) were the main causes of death. Conclusion This US cohort highlights the management of early SSc in the current era, demonstrating progression of skin and lung involvement despite immunosuppressive therapy and high mortality due to cardiac involvement.

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Post corona infection cardiac abnormalities and the risk for sudden cardiac death

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.371 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

J Van Hattum ◽

JL Spies ◽

SM Verwijs ◽

GC Verwoert ◽

SM Boekholdt ◽

...

Keyword(s):

Cardiac Involvement ◽

Cardiac Complications ◽

Myocardial Inflammation ◽

Weighted Mean ◽

Comprehensive Overview ◽

Physically Active ◽

Course Of Illness ◽

Cardiac Abnormalities ◽

Active Population

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Dutch Olympic Committee*Dutch Sports Federation (NOC*NSF) Amsterdam Movement Sciences (AMS) Most studies investigating the cardiotropic effects of SARS-CoV-2 focus on cardiac complications in severely ill patients. Little is known about eventual sustained cardiac involvement after recovery from COVID-19, especially in patients with a moderate or mild course of illness. Furthermore, as physical exercise can potentially worsen the prognosis of patients with COVID-19 peri- or myocarditis, cardiac involvement in athletes or in the physically active population warrants investigation. Finally, the risk of arrhythmias in such individuals remains largely unknown. We aim to provide a comprehensive overview of myocardial and pericardial involvement after SARS-CoV-2 infection, long-term cardiac sequelae after infection, and risks of SCD/SCD in a predominantly healthy/physical active population, including athletes. We performed a systematic PubMed and MedRxiv search through December 19th, 2020, with the combined terms or synonyms for: COVID-19, SARS-CoV-2, cardiovascular imaging, cardiac MRI, athletes. Exclusion criteria were: no CMR investigations reported, ≥1 comorbidities, age ≤16 years, and reviews. Two investigators independently screened and assessed all identified manuscripts, and additionally searched for reported arrhythmia outcomes. The initial search yielded 127 papers; after extensive review, we included a total of nine papers comprising 607 recovered post-COVID patients/athletes. The table summarises the main CMR findings. No study reported arrhythmias except for Ho et al. who found 18% undefined arrhythmias at baseline. In 5 studies in 201 patients, the weighted mean for the prevalence of elevated T1 was 55%, elevated T2 48%, myocardial LGE 35%, and pericardial LGE 17%. One study (Knight et al.) did not report T1 and T2 measurements. Ho et al. and Ming-Yen et al. found respectively 40% and 19% of patients to meet the Lake Louise Criteria (LLC) for myocarditis; Puntmann et al. reported that 60% had active myocardial inflammation. Second, in 1 study in 139 healthcare workers, the mean for the prevalence of elevated T1 was 42%, T2 4%, LGE 30%, and 5% met LCC for myocarditis. Third, in 3 studies in 96 athletes, the weighted mean for the prevalence of elevated T1 was 21%, T2 24%, myocardial LGE 4%, and pericardial LGE 29%. Brito et al., Clark et al. and Rajpal et al. reported that respectively 0%, 5% and 15% met the LCC for myocarditis. Studies investigating peri- and myocardial sequelae after SARS-CoV-2 infection report varying prevalences of cardiac abnormalities. Such studies are limited in numbers, generally include a low number of individuals, and report no follow-up; only 1 study reported non-specified arrhythmia outcomes. Based on the available studies, the short-term risk for post-COVID-19 SCD due to arrhythmias caused by myocardial inflammation appears to be low. Prospective investigations in larger, well-defined populations, including longer-term follow up and arrhythmia monitoring, are urgently needed. Abstract Figure.

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