Is cardiac involvement prevalent in highly trained athletes after SARS-CoV-2 infection? A cardiac magnetic resonance study using sex-matched and age-matched controls

ObjectivesTo investigate the cardiovascular consequences of SARS-CoV-2 infection in highly trained, otherwise healthy athletes using cardiac magnetic resonance (CMR) imaging and to compare our results with sex-matched and age-matched athletes and less active controls.MethodsSARS-CoV-2 infection was diagnosed by PCR on swab tests or serum immunoglobulin G antibody tests prior to a comprehensive CMR examination. The CMR protocol contained sequences to assess structural, functional and tissue-specific data.ResultsOne hundred forty-seven athletes (94 male, median 23, IQR 20–28 years) after SARS-CoV-2 infection were included. Overall, 4.7% (n=7) of the athletes had alterations in their CMR as follows: late gadolinium enhancement (LGE) showing a non-ischaemic pattern with or without T2 elevation (n=3), slightly elevated native T1 values with or without elevated T2 values without pathological LGE (n=3) and pericardial involvement (n=1). Only two (1.4%) athletes presented with definite signs of myocarditis. We found pronounced sport adaptation in both athletes after SARS-CoV-2 infection and athlete controls. There was no difference between CMR parameters, including native T1 and T2 mapping, between athletes after SARS-CoV-2 infection and the matched athletic groups. Comparing athletes with different symptom severities showed that athletes with moderate symptoms had slightly greater T1 values than athletes with asymptomatic and mildly symptomatic infections (p<0.05). However, T1 mapping values remained below the cut-off point for most patients.ConclusionAmong 147 highly trained athletes after SARS-CoV-2 infection, cardiac involvement on CMR showed a modest frequency (4.7%), with definite signs of myocarditis present in only 1.4%. Comparing athletes after SARS-CoV-2 infection and healthy sex-matched and age-matched athletes showed no difference between CMR parameters, including native T1 and T2 values.

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

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.

A CROSS-SECTIONAL STUDY OF CARDIAC INVOLVEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS IN AN TERTIARY CARE CENTRE WITH EMPHASIS ON 2-D ECHOCARDIOGRAPHY

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune inammatory rheumatologic disease. Its exact etiology is unknown and it can affect several organs—including skin, joints, kidneys, and many other organs. One of the organs reported to be involved in SLE is heart.1 The American Heart Association includes patients with SLE, especially women, as a high-risk group for cardiovascular diseases. Objectives: Find out cardiac involvement in patients of SLE. There is any relationship of cardiac involvement with the disease activity of SLE (SLEDAI-2K) Material And Methodology: Study Design: An observational cross-sectional study. Study settings and timeline: An 18 months Hospital Based study. Place of study: Department of General Medicine, RGKMCH. Period of study: 18 Months, from January 2018 to June 2019. Study population: The patients admitted in inpatients wards of Department of General Medicine and also OPD patients of R G Kar Medical College and Hospital who will fulll the inclusion criteria. Results And Analysis: In patients with active disease, 29(53.7%) patients had rst presentation. 25(46.3%) patients had rst presentation but disease activity was low. Association of rst presentation with disease activity was statistically signicant (p=0.0000406378). In patients with active disease, 36(66.7%) patients had cardiac involvement in any form. In patients with low disease activity, 11(50.0%) patients had cardiac involvement. Association of cardiac involvement with disease activity was not statistically signicant (p=0.2730132774). Out of total 47 patients with cardiac involvement, 27(57.4%) patients had pericardial involvement. Summary And Conclusion: Cardiac involvement is frequently seen in systemic lupus erythematosus patients, 61.8% in our study. Pericardium, myocardium, endocardium all can be involved in SLE. Pericardium is most commonly involved. Pulmonary hypertension, valvular abnormality, diastolic dysfunction, systolic dysfunction all are found in SLE. Echocardiography is an non –invasive excellent tool to evaluate the SLE patients for any cardiac involvement and serial screening of the patients. All cardiac manifestations are observed in active SLE patients in higher frequency but only pericardial involvement with disease activity is statistically signicant.

Subclinical pericarditis long after SARS-CoV-2 infection: a case report

We describe a rare complication of COVID-19 long after infection in a 76-years-old man presented to the Emergency Department with dyspnea and palpitations. A 12-lead Electrocardiogram (ECG) showed sinus tachycardia PR depression in the inferior leads associated with an apparent pseudo ST elevation. In the absence of elevation of inflammatory indices, considering the lack of symptoms neither NSAIDs nor colchicine were prescribed, and the patient was referred for clinical follow-up. After ten days ECG documented initial reduction of the widespread concave STE and PR depression, and the 1-month follow- up visit, the patient was asymptomatic with unremarkable physical examination, and a 12-lead ECG showed almost complete normalization of the ST and PR segments. Although pericardial involvement after COVID-19 infection has been already described, the incidence of subclinical pericarditis has not and may have implications for the monitoring of patients with uncomplicated COVID-19 infection managed as outpatients.

Massive Pericardial Effusion as The First Manifestation of Childhood Non-Hodgkin’s Lymphoma: A Case Report

Although one of the serious manifestations of advanced malignancies is pericardial involvement, pericardial involvement of lymphoma is extremely rare. We present a case of a 6-year-old girl arriving at the hospital with dyspnea and pleuritic chest pain, which is eventually diagnosed with massive pericardial effusion due to mediastinal non-Hodgkin lymphoma.

Derrame pericárdico asociado con Síndrome de DRESS. Reporte de caso

Introduction. DRESS syndrome (Drug Reaction with Eosinophilia and Systemic symptoms) consists of the rare, but serious and potentially fatal, occurrence of a set of signs and symptoms associated with the consumption of certain types of drugs. This syndrome is characterized by having a heterogeneous clinical manifestation that, in many cases, causes multisystemic involvement. Case presentation. 24-year-old man from Calarcá, Colombia, who visited the emergency department of the local hospital due to a three-day unquantified intermittent fever associated with asthenia, adynamia, anorexia, headache, myalgia, odynophagia and upper abdominal pain, and who, due to his condition and laboratory results, was referred to the Clínica Central del Quindío. The patient, 20 days before the initial evaluation, had been prescribed pharmacological treatment with NSAIDs and phenytoin due to severe cranioencephalic trauma; he also presented generalized skin rash, elevated transaminases and moderate eosinophilia. Complementary studies reported mild pericardial effusion, so DRESS syndrome was suspected and corticosteroid therapy was started, and the complete remission of the disease was achieved. Conclusion. Although DRESS syndrome has a low incidence, it should always be suspected, especially in patients with cardiac and pericardial involvement. In this case, the pericardial involvement stands out, demonstrating that people with this syndrome may present with rare manifestations, but with a serious impact on their health, since they may considerably increase adverse outcomes and mortality risk.

Proton Beam Therapy for Thymic Carcinoma with Pericardial Involvement

Purpose Thymic malignancies are the most common anterior mediastinal tumors. Advanced thymic carcinoma treatment relies on chemotherapy and definitive radiation therapy when possible. However, pericardial involvement is problematic for radiation therapy treatment planning owing to significant cardiac radiation exposure. We report the first case of definitive proton beam therapy (PBT) for an advanced thymic carcinoma with pericardial invasion. Materials and Methods We report the case of a 69-year-old patient treated with definitive radiation therapy for a stage IVB thymic carcinoma with pericardial invasion. Mean doses delivered to critical organs at risk were compared between deep inspiration breath-hold (DIBH) volumetric modulated arc therapy (VMAT) and DIBH-PBT. Results When compared to DIBH-VMAT, DIBH-PBT reduced the mean doses delivered to the heart by 3.72 Gy (19.0% dose reduction), to the right lung by 5.9 Gy (41.7% dose reduction), to the left lung by 3.63 Gy (19.0% dose reduction), and to the esophagus by 3.57 Gy (21.3% dose reduction). Despite an early mediastinal relapse after 3.0 months, our patient is still alive after a 14-month follow-up, without any radiation-induced cardiac adverse events and is undergoing pembrolizumab-based immunotherapy. Conclusion Proton beam therapy is an option for definitive irradiation of thymic malignancies invading the pericardium; in this situation, PBT reduces doses to the heart and may help to reduce cardiotoxicity when compared with photon techniques.