Echocardiographic and Electrocardiographic Findings in COVID-19 Patients; A Cross-Sectional Study

Background: There are still many gaps in our knowledge regarding the direct cardiovascular injuries due to COVID-19 infection. In this study, we tried to find out the effect of SARS-CoV-2 infection on cardiac function in patients without any history of structural heart disease by electrocardiographic and echocardiographic evaluations.Methods: This was a cross-sectional study on patients with COVID-19 infection admitted to Imam Reza hospital, Mashhad, Iran between 14 April and 21 September 2020. COVID-19 infection was verified by a positive reverse-transcriptase polymerase chain reaction (PCR) assay for SARS-CoV-2 using nasopharyngeal/oropharyngeal samples. We enrolled all patients over 18 years old with definite diagnosis of COVID-19 infection. All patients underwent a comprehensive transthoracic echocardiography at the first week of admission. Clinical and imaging data were collected prospectively. Results: In total, 142 patients were enrolled in this study. The mean age of participants was 60.69± 15.70 years (range: 30-90 years). Most patients were male (82, 57.7%). Multivariate analysis showed that O2 saturation at admission was independently a predictor of re-hospitalization (P<0.001). RV size (P<0.001), dyslipidemia (P<0.001), ejection fraction (EF) (P<0.001), age (P=0.020), systolic blood pressure (P=0.001), O2 saturation (P=0.018) and diabetes (P=0.025) independently predicted 30-days mortality. Conclusion: Echocardiography can be used for risk assessment in patients with COVID-19, especially in those with previous history of diabetes and dyslipidemia. The infection could result in Ventricular dysfunction, even in those without previous history of structural heart disease.

Myocarditis in a Pediatric Patient with Campylobacter Enteritis: A Case Report and Literature Review

Myocarditis represents a potential complication of various infectious and noninfectious agents and a common diagnostic challenge for clinicians. Data regarding Campylobacter-associated myocarditis are limited. Here, a case of a 13-year-old female with Campylobacter jejuni gastroenteritis complicated by myocarditis is presented, followed by a literature review in order to retrieve information about Campylobacter-associated carditis in the pediatric population. A search on MEDLINE/PubMed yielded 7relevant cases in the last 20 years. Most of them (six/seven) were males and the mean age was 16.1 years. All patients presented with gastrointestinal symptoms followed in six/seven cases by chest pain within two to seven days. Campylobacter was isolated from stool cultures in six patients; abnormal electrocardiographic findings were detected in six; and abnormal echocardiographic findings in three of the cases. Five patients were treated with antibiotics. Full recovery was the clinical outcome in six patients, whereas one patient died. Concerning the nonspecific symptoms of patients with myocarditis, high clinical suspicion of this complication is necessary in cases where patients with a recent infection present with chest pain and elevated cardiac biomarkers.

220 Electrocardiographic findings and mortality in COVID-19 patients hospitalized in different clinical settings

Aims 12-lead electrocardiogram (ECG) still represents the first line approach for cardiovascular assessment even in patients with COVID-19. We therefore sought to describe and compare ECG findings in three different hospital settings: intensive care unit (ICU) (invasive ventilatory support), respiratory care unit (RCU) (non-invasive ventilatory support) and Covid-19 dedicated internal medicine unit (IMU) (oxygen supplement with or without high flow). Methods and results We retrospectively analysed the 12-lead ECGs of 1124 consecutive patients hospitalized for respiratory distress and COVID-19 in a single III level hospital. Age, gender, main clinical data and in-hospital survival were recorded. 548 patients were hospitalized in IMU, 361 in RCU, 215 in ICU. Arrhythmias in general were less frequently found in RCU (16% vs. 26%, P &lt; 0.001). Deaths occurred more frequently in ICU patients (43% vs. 20–21%, P &lt; 0.001). After pooling predictors of mortality (age, intensity of care setting, heart rate, ST-elevation, QTc prolongation, Q-waves, right bundle branch block, and atrial fibrillation), the risk of in-hospital death can be estimated by using a derived score. Three zones of mortality risk can be thus identified: &lt;5%, score &lt;5 points; 5–50% score 5–10, and &gt;50%, score &gt;10 points. The accuracy of the score assessed at ROC curve analysis was 0.791. Conclusions ECG differences at admission con be found in COVID-19 patients according to different clinical settings and intensity of care. A simplified score derived from few clinical and ECG variables may predict in-hospital mortality with a good accuracy.

Electrocardiographic findings in COVID-19: analysis of tele-ECGs in Moscow ECG IT Center

BACKGROUND: Coronavirus disease (COVID-19) affects the cardiovascular system and the primary damage to the respiratory system involved in the pathological process. However, in the available literature, the electrocardiography (ECG) analyses are based only on small-sample studies and case reports, which determine the relevance of larger-scale studies to clarify the nature and prevalence of ECG abnormalities in subjects with confirmed coronavirus infection. AIM: To determine the distribution of ECG changes in COVID-19 patients representing a non-selective population of Moscow residents. MATERIALS AND METHODS: We performed a retrospective analysis of ECGs from 42,799 patients from March 10, 2020 to March 10, 2021 with a verified diagnosis of COVID-19 was performed. The study included patients admitted to Moscow clinical hospitals connected to the ECG IT Center. A standard 12-lead ECG was obtained and transmitted via an Internet connection to the server of the ECG IT Center, where the ECG interpretation was performed. RESULTS: ECG changes were detected in 54% of patients. The most common cardiac arrhythmias were supraventricular extrasystole (12.6%) and atrial fibrillation (12.0%) reported in patients. Signs of the overloaded right heart were detected in 12.5% of cases, of which the ECG pattern of pulmonary embolism was confirmed in 485 patients (1.13%). Infarction ECG pattern was observed in 4.5% of patients, among which 3 cases of Brugada ECG pattern were reported. The incidence of ST-T changes was 2.2% of all study patients. Prolonged QT and QTc intervals were recorded in 540 patients (1.26%). In addition, individual cases of ventricular fibrillation, Frederick syndrome, and atrioventricular block of various degrees were reported. CONCLUSION: The distribution of incidence of ECG changes in COVID-19 was shown based on the data obtained. The high incidence of atrial fibrillation, which is a risk factor for thromboembolic complications, was confirmed. Moreover, a significant prevalence of ECG patterns of overloaded right heart was shown, some are associated with pulmonary embolism. Other reported ECG changes were characterized by a significantly lower prevalence, which does not reduce their clinical significance. The data obtained may be used to improve COVID-19 patient management strategy in the future.

Usefulness of a smartphone-based event recorder for ambulatory patients presenting with palpitations

Background Palpitations are a common complaint among patients seen by primary care physicians (16%). Recent technological advances have led to several novel electrocardiographic monitoring devices. AliveCor Kardia Mobile® (AliveCor, Inc., Mountain View, CA, USA) is a smartphone-based event recorder that allows take an electrocardiogram (ECG) recording during 30 seconds. The usefulness of this device has been studied in atrial fibrillation screening, however, its usefulness in the diagnosis of palpitations is not well known. Objective Evaluate the diagnostic yield of the AliveCor Kardia Mobile® device in unselected patients referred to the cardiologist for the study of palpitations. Methods Uni-centre retrospective study. From September 2018 to October 2020, consecutive patients with palpitations referred to cardiology department were included. After an initial evaluation it was decided monitoring ECG of these patients with this device if they had access to a compatible smartphone. They were instructed to record ECG when they had symptoms. ECG tracings and clinical characteristics were analysed. Results 152 patients were included. Mean age 42±15 years, 68% female. Most of the patients did not have heart disease and about 25% had a history of anxiety-depressive syndrome (Table 1). After monitoring, 31 (20%) patients had rhythm disturbances during symptoms, 82 (54%) patients had no rhythm disturbances related to the symptoms and 39 (26%) patients had no symptoms. Table 2 shows the electrocardiographic findings. Patients with palpitations of arrhythmic origin were older and presented less anxiety/depression (Table 1). Age was the only independent predictor of palpitations of arrhythmic origin (OR, × year: 1.03, 95% CI 1.01–1.06; p=0.035). Conclusions The AliveCor Kardia Mobile® device is easy to use and diagnosed the aetiology of palpitations in a high proportion of patients (74%) referred for specialist evaluation. FUNDunding Acknowledgement Type of funding sources: None.

A Phase 1 Study of the Safety, Tolerability, and Pharmacokinetics of Single and Multiple Oral Doses of V-7404 in Healthy Adult Volunteers

V-7404, a direct-acting enterovirus (EV) 3C protease inhibitor, is being developed as a treatment option for serious EV infections, including infections in immunodeficient people excreting vaccine-derived polioviruses. V-7404 may be combined with pocapavir (V-073), a capsid inhibitor, to treat these infections. A Phase 1 single ascending dose (SAD; N=36) and multiple ascending doses (MAD; N=40) study was conducted to assess the safety, tolerability, and pharmacokinetics (PK) of V-7404 in healthy adult volunteers following oral doses starting at 200 mg and escalating to 2000 mg once daily (QD) and 2000 mg twice daily (BID). Adverse events (AEs), vital signs, electrocardiographic findings, physical examinations, clinical laboratory values, and PK of blood samples were assessed. No notable differences in demographic and baseline characteristics were observed across the dose cohorts. A total of 35/36 participants (97.2%) completed the SAD study (1 withdrew in placebo group), and 37/41 participants (90.2%) completed the MAD study (1 withdrew from the 2000 mg QD and 3 withdrew from the 2000 mg BID cohorts). No serious AEs or deaths were reported. Treatment-emergent AEs were mild or moderate in severity. Oral doses of V-7404 in all cohorts were readily absorbed and showed no significant accumulation. PK exposure increased in an approximately dose proportional manner and appeared to be independent of time. Overall, V-7404 was well-tolerated and exhibited an acceptable safety and PK profile, supporting further clinical investigation of V-7404 for the treatment of serious EV infections.