First Case of COVID-19 Treated with Monoclonal Anti-Spike Antibodies in a Patient with Cystic Fibrosis in Romania

Patients with chronic lung conditions, including cystic fibrosis, may be prone to severe COVID-19. Therefore, therapeutic intervention should be prompt and tailored to all associated comorbidities. We report the case of a 17-year-old male adolescent with cystic fibrosis and multiple chronic conditions (bronchiectasis, exocrine pancreatic insufficiency, chronic multidrug resistant Pseudomonas aeruginosa colonization, nasal polyposis, chronic sinusitis, ventricular extrasystoles and multiple drug allergies), who presented with an acute episode of productive cough, and was confirmed with moderate COVID-19 based on positive RT-PCR for SARS-CoV-2 and lung imaging showing isolated foci of interstitial pneumonia. Intravenous treatment with the monoclonal antibody cocktail casirivimab and imdevimab was administered. The evolution was favorable, with rapid remission of the inflammatory syndrome and gradual decrease of cough, without progression to severe or critical COVID-19, but with complications such as repeated hemoptysis, which was due to the patient’s underlying conditions, and which required close monitoring for timely adjustment of the patient’s chronic treatment.

Incidence of cardiac arrhythmias in patients with COVID-19 infection according to 24-hour electrocardiogram monitoring

Cardiac arrhythmias in patients with COVID-19 infection may be due to many pathophysiological factors. Further study on the structure of arrhythmias in this category of patients will reveal clinically significant arrhythmias and select the optimal management. The aim: to determine the features of arrhythmias in patients with and without concomitant cardiovascular disease who suffered from COVID-19 infection based on the results of 24-hour electrocardiogram (ECG) monitoring. Materials and methods. 84 patients (45 men – 53.5 %, 39 women – 46.5 %) who had COVID-19 infection over 12 weeks previously were examined. Patients were divided into 2 groups – with and without a history of concomitant cardiovascular disease. The patient groups did not differ in age (P = 0.33) and sex (P = 0.58, P = 0.64). 24-hour ECG monitoring was performed on a Cardiosens K device (XAI-MEDICA, Kharkiv) according to the standard method. Results. Comparison of 12-channel ECG data did not reveal a significant difference in the incidence of single atrial (P = 0.13) and ventricular extrasystoles (P = 0.37) between the two groups, but sinus tachycardia was significantly more common in patients without concomitant cardiovascular disease (P = 0.022). According to 24-hour ECG monitoring, a significantly higher total number of arrhythmias, in particular, supraventricular extrasystoles (P = 0.009), high gradations of ventricular arrhythmias: paired ventricular extrasystoles (P = 0.041), ventricular bigeminy (P = 0.005), ventricular trigeminy (P = 0.004), ventricular salvos (P = 0.017) were detected significantly more frequently in patients with concomitant cardiovascular disease after COVID-19 infection than those in the comparison group. The results of 24-hour ECG monitoring also showed that patients without cardiovascular disease were significantly more likely to have inappropriate sinus tachycardia (P = 0.03) and postural orthostatic tachycardia (P = 0.04). Paroxysmal arrhythmias were significantly more common in patients with concomitant cardiovascular pathology, namely unstable (P = 0.002) and stable paroxysms of atrial tachycardia (P = 0.014), unstable paroxysms of monomorphic ventricular tachycardia (8.3 %), paroxysms of atrial fibrillation (6.2 %). Conclusions. 24-hour ECG monitoring should be advised in patients with COVID-19 infection and concomitant cardiovascular disease in addition to recording a standard 12-channel ECG to detect prognostically unfavorable cardiac arrhythmias, possible arrhythmogenic manifestations of post-COVID-19 syndrome and choose management tactics for these patients.

Long-term electrocardiographic monitoring in a cardiac surgery hospital: modern views and experience of application of telemonitoring system after coronary stenting

Background. Diseases of the cardiovascular system in recent decades have taken the lead. In Ukraine alone, mortality rates reach half a million annually. Today, continuous ECG monitoring is a routine study in patients hospitalized with cardiovascular disease. The purpose was to analyze the experience of long-term electrocardiographic monitoring in patients in the early postoperative period of coronary artery stenting. Materials and methods. The study included 24 patients with coronary heart disease who underwent routine coronary artery stenting. All patients underwent long-term ECG monitoring after the operation. Results. Among the patients in our study, single supraventricular extrasystoles were recorded in 17 % of patients in the early postoperative period, and episodes of single ventricular extrasystoles were recorded in all patients. There was no significant ST segment dislocation observed in any patient. Based on the observation of patients with cardiovascular events in the postoperative period, it was shown that the usage of round-the-clock automatic recording of ECG by using mobile devices improves the ability to timely diagnose (including urgent) recurrences. Conclusions. Recommendations on the feasibility of its usage in different regimens for patients with different disease were formulated.

Clinical and instrumental profile of patients with stage II essential hypertension with different forms of extrasystoles according to the level of apelin-13

Annotation. Essential hypertension (EH) is one of the leading causes of disability and mortality among cardiovascular diseases, so today new metabolic markers of cardiovascular risk are being actively studied. One of them is apelin-13. Objective – to evaluate the clinical and instrumental profile of patients with stage II hypertension with different forms of extrasystoles and different neurohumoral background – conditionally high/low serum apelin-13 levels. 156 patients with stage II essential hypertension were examined. 124 of them had frequent symptomatic extrasystoles, 32 patients had no arrhythmias and were considered to the comparison group. 30 practically healthy normotensive persons were considered to the control group. All patients underwent a complete clinical and anthropometric examination, blood pressure measurement, automatic daily blood pressure monitoring, daily electrocardiogram monitoring, echocardiography and the assessment of serum apelin-13 level. For statistical analysis, the procedure of non-linear data estimation was chosen, namely logistic regression or logit model. To form the basic statistical matrix of the analysis, we used clinical-instrumental and laboratory indicators, which passed a preliminary correlation analysis of Spearman with the level of apelin-13 serum and found a significant correlation (p<0.05). In the course of the logistic analysis at the final model, which allowed to predict “background of apelin” in patients with stage II EH entered 4 independent factors that revealed statistically significant (p<0.05) correlations with the initial parameter: the value of the systolic arterial pressure time index in%, the index of the left atrium in mm/m2, the average number of ventricular extrasystoles for 1 hour and the level of total cholesterol in plasma in mmol/l. The last indicator showed the least informativeness in predicting of the apelin-13 serum level. Interpreting the data of the obtained logit regression model, it should be said that in patients with EH of increasing the value of the systolic arterial pressure time index, the index of the left atrium and the average value of ventricular extrasystoles during 1 hour and decrease total cholesterol level in plasma increase the probability of determining relatively low (<920 pg/ml) and at the same time reduce the probability of determining a relatively high (≥920 pg/ml) level of apelin serum. These data also show that the highest informativeness in predicting the level of apelin-13 in patients with EH was the total number of ventricular extrasystole per hour. So, a high “apelin background” (≥920 pg/ml) in patients with EH will be accompanied by a benign course of the disease, so an increase serum apelin-13 in patients with EH should be considered as positive neurohumoral changes that promote cardioprotection, improve prognosis course of the disease and reduce cardiovascular risk.

Inflammatory Myopathy with Cardiac Involvement Associated with Anti-Mitochondrial Antibodies

Aim: Anti-mitochondrial antibodies (AMA) positive myositis is an atypical and rare form with various characteristics. We aim to highlight these specificities through this case report. Presentation of the Case: We present the case of a young woman diagnosed with frequent polymorphic ventricular extrasystoles and left ventricular dysfunction. Two years after, she developed asthenia and muscle weakness. Clinical and biological tests confirmed the diagnosis of myositis complicated by focal myocarditis. The immunological screening revealed negative antinuclear antibodies and positive AMA type anti-AMA-M2 and anti-M2-3E. A good clinical evolution was noted under corticosteroids and methotrexate. Discussion: Cases of primary biliary cholangitis (PBC) or positive AMA associated with other autoimmune diseases such as systemic scleroderma, Sjögren syndrome, rheumatoid arthritis and myositis have been reported. AMA’s pathogenic role on the musculoskeletal and cardiac systems remains to be clarified. Conclusion: Inflammatory myopathy associated with AMA is a rare and serious entity, characterized by a delayed diagnosis and frequent cardiac involvement, often indicating a heavy treatment.

Association between myocardial mechanical dispersion and ventricular arrhythmogenicity in Chagas cardiomyopathy.

Endemic Chagas diseaseis a major health concernin LatinAmerica. Ventricular arrhythmias (VA) is a hallmark of Chagas cardiomyopathy (ChC) associated with worse prognosis. To verify if there is an association between myocardial mechanical dispersion and ventricular arrhythmogenicity in CCM. This is a cross-sectional study involving 77 patients with CCM. Global longitudinal strain (GLS) and MD were evaluated by echocardiogram, derived from the speckle tracking technique. Myocardial MD was measured from the onset of the Q / R wave on electrocardiogram to the peak longitudinal strain in 16 segments of the left ventricle. Frequency and complexity of ventricular extrasystoles (VES) were assessed by dynamic electrocardiography. The density and complexity of VES and the presence of non-sustained ventricular tachycardias (NSVTs) increase as MD increases. In logistic regression, MD was the only variable associated with the presence of VES in pairs and bigeminy. In the univariate analysis, both MD and GLS were associated with the presence of NSVT (both, p < 0.01), and MD was independently associated with NSVT (OR 1.04, 95% CI: 1.004–1.201, p = 0.031). In Chagas cardiomyopathy, MD is associated with a higher density and complexity of ventricular extrasystoles, including NSVT.

COVID-19 cardiac injury and the use of colchicine

We report a case of cardiac injury in a 46-year-old man affected by COVID-19. The patient presented with shortness of breath and fever. ECG revealed sinus tachycardia with ventricular extrasystoles and T-wave inversion in anterior leads. Troponin T and N-terminal pro B-type natriuretic peptide were elevated. Transthoracic echocardiography showed severely reduced systolic function with an estimated left ventricle ejection fraction of 30%. A nasopharingeal swab was positive for SARS-CoV-2. On day 6, 11 days after onset of symptoms, the patient deteriorated clinically with new chest pain and type 1 respiratory failure. Treatment with colchicine 0.5 mg 8-hourly resulted in rapid clinical resolution. This case report highlights how cardiac injury can dominate the clinical picture in COVID-19 infection. The role of colchicine therapy should be further studied to determine its usefulness in reducing myocardial and possibly lung parenchymal inflammatory responses.

CLINICAL AND FUNCTIONAL FEATURES OF THE HEART CONDITION IN PATIENTS WITH STABLE ANGINA WITH CONCOMITANT BRONCHIAL ASTHMA

Objective: to analyze the frequency of the combination of coronary heart disease (CHD) and bronchial asthma (BA) in clinical practice and to identify the features of the clinical course of stable angina in concomitant BA of varying severity. Materials and methods. CHD patients with BA were divided into 3 groups depending on the severity of the BA course: Group 1 – CHD with mild persistent BA (38 patients), Group 2 – CHD with moderate persistent BA (52 patients), Group 3 – CHD with severe BA (21 patients). All patients underwent a general clinical examination, as well as daily ECG monitoring and echodopplercardiography (ECHODPCG). Results. The patients of the CHD/mild BA group manifested significant differences from the patients of CHD/moderate BA group (p<0.001) and from the CHD/severe BA group (p<0.001) in the level of systolic blood pressure (BP) and diastolic blood pressure, which increased with increasing BA severity. According to the ECHODPCG data, there were significant differences between the study groups concerning both the right and left parts of the heart. The data of 24-hour ECG monitoring confirm that the more severe the BA, the more pronounced the ischemic changes in the myocardium are, which suggests a more severe course of CHD. The number of supraventricular extrasystoles and ventricular extrasystoles in the patients with CHD with BA increases significantly with increasing severity of BA. The analysis of the lipid spectrum revealed that hypercholesterolemia increases with the progression of BA. Conclusion. The results of the study show that with an increase in the BA severity in the patients with a combination of BA and CHD there occur more pronounced changes in hemodynamics related to an increase in the level of systolic and diastolic blood pressure. Mutual aggravation and progression in the combination of bronchial asthma and arterial hypertension is based on the commonality of some links of pathogenesis. This can lead to the progression of heart failure and the early development of cardiorespiratory complications. The data indicate that the progression of BA severity is associated with acceleration of the heart rate, as well as with an increase in the frequency of detection of supraventricular and ventricular extrasystoles, and major myocardial remodeling affecting both the left and the right parts of the heart. This allows us to conclude that chronic inflammation in BA activates the renin-angiotensin-aldosterone and sympathoadrenal systems, which leads to the development of atherosclerosis and an increase in the severity of CHD.