Cardiopulmonary Abnormalities Research Articles

Understanding exercise (in)tolerance in sickle cell disease: impacts of hemolysis and exercise training on skeletal muscle oxygen delivery.

Sickle cell disease (SCD) is characterized by central (cardiac) and peripheral vascular dysfunctions, significantly diminishing exercise capacity and quality of life. Although central cardiopulmonary abnormalities in SCD are known to reduce exercise capacity and quality of life; the impact of hemolysis and subsequent cell-free hemoglobin (Hb)-mediated peripheral vascular abnormalities on those outcomes are not fully understood. Despite the recognized benefits of exercise training for cardiovascular health and clinical management in chronic diseases like heart failure, there remains substantial debate on the advisability of regular physical activity for patients with SCD. This is primarily due to concerns that prolonged and/or high-intensity exercise might trigger metabolic shifts leading to vaso-occlusive crises. As a result, exercise recommendations for patients with SCD are often vague or nonexistent, reflecting a gap in knowledge about the mechanisms of exercise intolerance and the impact of exercise training on SCD-related health issues. This mini-review sheds light on recent developments in understanding how SCD affects exercise tolerance, with a special focus on the roles of hemolysis and the release of cell-free hemoglobin in altering cardiovascular and skeletal muscle function. Also highlighted here is the emerging research on the therapeutic effects and safety of exercise training in patients with SCD. In addition, the review identifies future research opportunities to fill existing gaps in our understanding of exercise (in)tolerance in SCD.

Chronic e-cigarette use in young adults is associated with reduced cardiopulmonary function at rest and during exercise

E-cigarette aerosols produce contaminant particles that have the potential to impair cardiopulmonary function. However, the current understanding of the impact of e-cigarette use on cardiopulmonary function remains inconclusive. Exercise represents a stress on the cardiopulmonary system and may help identify cardiopulmonary dysfunction in chronic e-cigarette users. Consequently, the purpose of this study was to investigate if e-cigarette users exhibit cardiopulmonary abnormalities under physiological stress of exercise. To further investigate pulmonary vascular responses, the secondary purpose of the study was to examine how diffusing capacity (DLCO), pulmonary capillary blood volume (VC), and membrane diffusing capacity (DM) respond to positional changes, as the transition from the upright to supine position should increase DLCO, VC, and DM, secondarily to increased perfusion pressure. We hypothesized that e-cigarette users would exhibit impaired cardiopulmonary function during exercise and reduced pulmonary vascular responsiveness to postural changes. Six chronic e-cigarette (e-cig) users (age: 24±5yrs, 5±2 years of e-cigarette use) with <5 pack years of traditional cigarette smoking history and six non-smoking controls who were age-, height-, and sex-matched completed two experimental trials. Day 1: Pulmonary function test and cardiopulmonary exercise test. Day 2: multiple fraction of inspired oxygen DLCO technique to quantify DLCO, VC, and DM at rest in the upright and supine positions. Resting pulmonary function was not significantly different between groups. The change in DLCO from upright to supine was significantly lower in e-cig users compared to controls (Control: 7.61±2.32 ml/min/mmHg vs. E-cig: 3.17±2.09 ml/min/mmHg; p=0.01), due to a smaller change in VC ( p=0.03), which suggests reduced pulmonary vascular distention in e-cig users. V̇O2peak was significantly lower in e-cig users compared to controls (Control: 4.4±1.2 L/min vs. E-cig: 2.6 ±0.7 L/min; p=0.01). E-cig users exhibited significantly elevated V̇E/ V̇CO2nadir ( p=0.02) indicating worse ventilatory effciency, and greater dyspnea relative to power output ( p=0.02) compared to controls. Preliminary findings suggest that e-cigarette use is associated with normal resting lung function but reduced pulmonary vascular distensibility. Further, e-cigarette users demonstrate ventilatory ineffciency and greater exertional dyspnea along with exercise intolerance. Canadian Institutes of Health Research. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Extra-Skeletal Manifestations in Osteogenesis Imperfecta Mouse Models.

Osteogenesis imperfecta (OI) is a rare heritable connective tissue disorder of skeletal fragility with an incidence of roughly 1:15,000. Approximately 85% of the pathogenic variants responsible for OI are in the type I collagen genes, COL1A1 and COL1A2, with the remaining pathogenic OI variants spanning at least 20 additional genetic loci that often involve type I collagen post-translational modification, folding, and intracellular transport as well as matrix incorporation and mineralization. In addition to being the most abundant collagen in the body, type I collagen is an important structural and extracellular matrix signaling molecule in multiple organ systems and tissues. Thus, OI disease-causing variants result not only in skeletal fragility, decreased bone mineral density (BMD), kyphoscoliosis, and short stature, but can also result in hearing loss, dentinogenesis imperfecta, blue gray sclera, cardiopulmonary abnormalities, and muscle weakness. The extensive genetic and clinical heterogeneity in OI has necessitated the generation of multiple mouse models, the growing awareness of non-skeletal organ and tissue involvement, and OI being more broadly recognized as a type I collagenopathy.This has driven the investigation of mutation-specific skeletal and extra-skeletal manifestations and broadened the search of potential mechanistic therapeutic strategies. The purpose of this review is to outline several of the extra-skeletal manifestations that have recently been characterized through the use of genetically and phenotypically heterogeneous mouse models of osteogenesis imperfecta, demonstrating the significant potential impact of OI disease-causing variants as a collagenopathy (affecting multiple organ systems and tissues), and its implications to overall health.

Echocardiographic nomograms for left ventricular parameters in 13,454 infants

Abstract Background Cardiac dimensions and function are key parameters in the management of children with cardiopulmonary abnormalities and are important predictors of clinical outcome. In particular, left ventricular (LV) dimensions and function are important predictors of clinical outcome and prognosis. In pediatric echocardiography, nomograms are essential in the separation of normal variation from pathological conditions and ascertaining normal growth. However, data from cohorts of newborns are limited, and current nomograms remain an insufficient approximation of the range of values that should be considered normal. Purpose We developed nomograms and Z scores for two-dimensional echocardiographic measurements of LV structure and function in a large group of healthy newborns. Methods Our study population included newborns from a large population study of newborns (n >25,000) who were born at term to healthy mothers, had a systematic transthoracic echocardiogram (TTE) performed within 30 days of birth, and with no signs of any major congenital heart diseases. We developed nomograms for 10 LV parameters by modelling these parameters as a function of body surface area (BSA) through joint modelling of the mean, standard deviation, skewness, and kurtosis. We then evaluated the impact of infant sex and age at time of echocardiography on the model fit. Results The 13,454 infants in the study population (48.5% females), had a median age of 12 days at TTE for both boys and girls (interquartile range IQR 8–15 and 8–12 days, respectively), and a median BSA of 0.23 m2 (IQR 0.22 m2 - 0.24 m2). All nomograms had acceptable goodness-of-fit within strata of sex. In contrast, model fit was worse for infants examined <7 days of age, compared with those examined from 7 to 30 days of age, necessitating the creation of separate nomograms for the two age groups. Examples of the plotted Z scores of one of the 10 LV parameters is shown in the figure. Conclusions We provide a large normative dataset and Z scores for echocardiographic measures of LV structure and function in neonates. Normative data is crucial in the management of patients with heart disease and these results provide a needed tool for evaluation of LV size and function in the newborn population.Plotted Z scores of the IVSd

Lone atrial fibrillation: A case report on a rare complication of pregnancy

Atrial fibrillation (AF) is one of the most common arrhythmias and is a rare phenomenon seen in pregnant patients unless there is an underlying cardiopulmonary abnormality. Lone AF in pregnancy is a diagnosis of exclusion. A thorough workup including history, physical examination, imaging, and laboratory workup should be done diligently to exclude cardiopulmonary diseases (like hypertensive heart disease, congenital heart disease, valvular heart disease, asthma or chronic obstructive pulmonary disease, pulmonary embolism, rheumatic heart disease) and non-cardiac diseases (such as hyperthyroidism or electrolyte abnormalities or medications). There are very few case reports and studies published so far on this topic. This case report is on a pregnant patient without any significant past medical history who developed new-onset lone AF without any known cause and was managed with Diltiazem, which resulted in chemical cardioversion of atrial fibrillation with rapid ventricular rate to normal sinus rhythm.

Reducing Overutilization of High-flow Nasal Cannula in Children with Bronchiolitis.

Bronchiolitis is a leading cause of pediatric hospitalizations. A high-flow nasal cannula (HFNC) does not significantly improve clinical outcomes and is associated with increased costs and intensive care unit (ICU) utilization. Despite this, hospitals continue to overuse HFNC in children with bronchiolitis. We aimed to reduce HFNC initiation in children hospitalized with bronchiolitis by 20 percentage points within 6 months. This study included patients aged 1 month to 2 years diagnosed with bronchiolitis, excluding patients with prematurity less than 32 weeks or preexisting cardiopulmonary, genetic, congenital, or neuromuscular abnormalities. Measures included HFNC utilization, length of stay, length of oxygen supplementation (LOOS), ICU transfers, and emergency department (ED) revisits and readmissions. For our primary intervention, we implemented a HFNC initiation protocol incorporating a respiratory scoring system, a multidisciplinary care-team huddle, and an emphasis on supportive care. Staff education, electronic health record integration, and audit and feedback were used to support implementation. Statistical process control charts were used to track metrics. We analyzed 325 hospitalizations (126 baseline and 199 postintervention). The proportion of children hospitalized with bronchiolitis who received HFNC decreased from a mean of 82% to 60% within 1 month of implementation. Length of stay decreased from a median of 54 to 42 hours, and length of oxygen supplementation decreased from 50 to 38 hours. There were no significant changes in ICU transfers, 7-day ED revisits, or readmissions. Implementing a HFNC initiation protocol can safely reduce the overutilization of HFNC in children hospitalized with bronchiolitis.

Management of Anesthesia in Pre-Eclamptic Patients with Covid 19 Infection

Background: Pregnant women with immunological and cardiopulmonary system abnormalities may experience more severe symptoms from respiratory virus infections. Objectives: The aim of this study was to assess the management of anesthesia in pre eclamptic patients with covid 19 infection. Methods: This cross-sectional descriptive study was carried out in the Department of Anaesthesia, Uttara Adhunik Medical College Hospital, during October 2020 to September 2021. A total of 50 pregnant women with pre-eclampsia and had positive polymerase chain reaction (PCR) test for COVID-19 with nasopharyngeal swabs were included in the study irrespective of age and patients who were not willing to participate were and who were clinically suspected (such as a clinical situation or travel history) but tested negative for COVID-19 excluded from this study. Statistical analyses of the results were be obtained by using window based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-22), where required. Results: The mean age of the patients was 26± 2.0 years. 36% patients were within 26-31 weeks of gestational age, 40% patients were within 32-36 weeks of gestational age, 20% patients were within 37-42 weeks of gestational age, and only 4% had more than 42 weeks of gestational age. About 60% patients had mild pre-eclampsia and 40% had severe pre-eclampsia. 98% patients had given spinal anesthesia and 2% had given epidural type of anesthesia. The indication for caesarian section was 50% for severe pre-eclampsia, 25% for uterine rupture in pre-eclampsia and 25% for previous caesarean section. The mean Hemoglobin was 12.17 ± 1.70, mean Aspartate aminotransferase was 28.05 ± 21.11, mean Alanine aminotransferase, was 17.06 ± 12.98, mean Creatine was 0.68 ± 0.71, mean C-reactive protein was 2.10 ± 2.33 and mean D-Dimer was 3.00 ± 2.26. About 60% of the patients were fit to discharge within 4 days and 40% within 5 days. Conclusion: Preeclampsia as one of pregnancy related complications is a notable burden of adverse health. Regional anaesthesia is not considered to be prohibited by the diagnosis of COVID-19 alone. In conclusion, COVID-19-infected pregnant women should be managed by specialised teams in a multidisciplinary facility, and all medical personnel involved in the caesarean section should be careful to use Level-3 PPE equipment. Due to the increased risk of infection and morbidity in general anaesthesia in pregnant women with COVID-19, regional anaesthesia becomes more prevalent. We also noted that there is no umbilical chord transmission from mother to child.

Abstract #1408090: A Case of Rapid-Onset Obesity with Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation in a 5-Year-Old Boy

With an estimated prevalence of less than 1000 in the U.S, rapid onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) is an exceedingly rare but fatal syndrome that surfaces abruptly in previously healthy infants or children aged 1 month-11 years. Due to the wide range of symptom variability, onset, and obscure documentation, it is often overlooked and misdiagnosed by clinicians, leading to inadequate treatment and consequent early mortality secondary to cardio-pulmonary arrest. The etiology is currently unknown, though some sources and clinical trials have postulated an underlying autoimmune mechanism directed at the brain. We aim to present a potential inciting event in addition to a promising treatment response for ROHHAD syndrome in this case study. This case describes a 5-year-old male who presents to the pediatrician with a chief complaint of 2 years rapid, incessant weight gain and fatigue following an adenoviral infection at 3 years of age. He had previously been evaluated at numerous specialists with preliminary diagnoses of hypothyroidism and diabetes insipidus, despite inconsistent response to dietary restrictions, exercise and levothyroxine therapy. Diagnosis of ROHHAD syndrome was finally confirmed with a sleep study that revealed severe obstructive sleep apnea (OSA). After continuous positive airway pressure (CPAP) intervention, the patient has reported stable weight maintenance as well as significant improvement in energy levels. The diagnosis of ROHHAD syndrome is often missed due to the many physiological processes affected. Subsequent involvement of many specialists creates focus on the individual endocrine abnormalities and often results in nominal clinical improvement. The presentation of rapid onset obesity in a child between the ages of 1 month to 11 years with concurrent widespread endocrine abnormalities such as hypothyroidism, short stature, puberty delay, hyperprolactinemia and overlying sleep apnea should raise suspicion and place ROHHAD syndrome in the differential. Positive sleep study results complete the clinical picture and indicate the need for CPAP, which in this case has shown to significantly slow weight gain and improve energy levels. Early intervention with CPAP may even help slow the onset of cardiopulmonary abnormalities and increase patient survival. It is critical to establish a multidisciplinary team only after the syndrome is clinically confirmed that may include a primary care physician, endocrinologist, pulmonologist, and many more, working coherently to optimize care and patient quality of life. Patients with a confirmed diagnosis may also benefit from referral to a center with expertise in ROHHAD syndrome, such as Ann and Robert H. Lurie Children’s Hospital of Chicago. More research is needed to determine whether adenovirus may contribute to a potential autoimmune mechanism that triggers the onset of ROHHAD syndrome in susceptible individuals.

Age, sex and angiographic type-related phenotypic differences in inpatients with Takayasu arteritis: A 13-year retrospective study at a national referral center in China.

We aimed to investigate the demographic characteristics, vascular involvement, angiographic patterns, complications, and associations of these variables in a large sample of TAK patients at a national referral center in China. The medical records of TAK patients discharged from 2008 to 2020 were retrieved from the hospital discharge database using ICD-10 codes. Demographic data, vascular lesions, Numano classifications and complications were collected and analyzed. The median age at onset was 25 years in 852 TAK patients (670 female, 182 male). Compared with the females, the male patients were more likely to have type IV and were more likely to have iliac (24.7% vs. 10.0%) and renal artery (62.7% vs. 53.9%) involvement. They also had a higher prevalence of systemic hypertension (62.1% vs. 42.4%), renal dysfunction (12.6% vs. 7.8%) and aortic aneurysm (AA) (8.2% vs. 3.6%). The childhood-onset group was more likely to have involvement of the abdominal aorta (68.4% vs. 52.1%), renal artery (69.0% vs. 51.8%) and superior mesenteric artery (41.5% vs. 28.5%), and they were more likely to have type IV, V and hypertension than the adult-onset group. After adjusting for sex and age at onset, the patients with type II were associated with an increased risk of cardiac dysfunction (II vs. I: OR = 5.42; II vs. IV: OR = 2.63) and pulmonary hypertension (II vs. I: OR = 4.78; II vs. IV: OR = 3.95) compared with those with types I and IV. Valvular abnormalities (61.0%) were observed to be most prevalent in patients with type IIa. The patients with Type III were associated with a higher risk of aortic aneurysm (23.3%) than the patients with types IV (OR = 11.00) and V (OR = 5.98). The patients with types III and IV were more commonly complicated with systemic hypertension than the patients with types I, II and V. P < 0.05 in all of the above comparisons. Sex, adult/childhood presentation and Numano angiographic type were significantly associated with differences in phenotypic manifestations, especially cardiopulmonary abnormalities, systemic hypertension, renal dysfunction and aortic aneurysm.

Exertional Cardiac and Pulmonary Vascular Hemodynamics in Patients With Heart Failure With Reduced Ejection Fraction

BackgroundExertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF), but quantitative data regarding exertional hemodynamics are lacking. ObjectivesWe sought to characterize exertional cardiopulmonary hemodynamics in patients with HFrEF. MethodsWe studied 35 patients with HFrEF (59 ± 12 years old, 30 males) who completed invasive cardiopulmonary exercise testing. Data were collected at rest, at submaximal exercise and at peak effort on upright cycle ergometry. Cardiovascular and pulmonary vascular hemodynamics were recorded. Fick cardiac output (Qc) was determined. Hemodynamic predictors of peak oxygen uptake (VO2) were identified. ResultsLeft ventricular ejection fraction and cardiac index were 23% ± 8% and 2.9 ± 1.1 L/min/m2, respectively. Peak VO2 was 11.8 ± 3.3 mL/kg/min, and the ventilatory efficiency slope was 53 ± 13. Right atrial pressure increased from rest to peak exercise (4 ± 5 vs 7 ± 6 mmHg,). Mean pulmonary arterial pressure increased from rest to peak exercise (27 ± 13 vs 38 ± 14 mmHg). Pulmonary artery pulsatility index increased from rest to peak exercise, while pulmonary arterial capacitance and pulmonary vascular resistance declined. ConclusionsPatients with HFrEF suffer from marked increases in filling pressures during exercise. These findings provide new insight into cardiopulmonary abnormalities contributing to impairments in exercise capacity in this population. Clinical Trial Registrationclinicaltrials.gov identifier: NCT03078972

COVID-19 and its continuing burden after 12 months: a longitudinal observational prospective multicentre trial.

Recovery trajectories from coronavirus disease 2019 (COVID-19) call for longitudinal investigation. We aimed to characterise the kinetics and status of clinical, cardiopulmonary and mental health recovery up to 1 year following COVID-19. Clinical evaluation, lung function testing (LFT), chest computed tomography (CT) and transthoracic echocardiography were conducted at 2, 3, 6 and 12 months after disease onset. Submaximal exercise capacity, mental health status and quality of life were assessed at 12 months. Recovery kinetics and patterns were investigated by mixed-effect logistic modelling, correlation and clustering analyses. Risk of persistent symptoms and cardiopulmonary abnormalities at the 1-year follow-up were modelled by logistic regression. Out of 145 CovILD study participants, 108 (74.5%) completed the 1-year follow-up (median age 56.5 years; 59.3% male; 24% intensive care unit patients). Comorbidities were present in 75% (n=81). Key outcome measures plateaued after 180 days. At 12 months, persistent symptoms were found in 65% of participants; 33% suffered from LFT impairment; 51% showed CT abnormalities; and 63% had low-grade diastolic dysfunction. Main risk factors for cardiopulmonary impairment included pro-inflammatory and immunological biomarkers at early visits. In addition, we deciphered three recovery clusters separating almost complete recovery from patients with post-acute inflammatory profile and an enrichment in cardiopulmonary residuals from a female-dominated post-COVID-19 syndrome with reduced mental health status. 1 year after COVID-19, the burden of persistent symptoms, impaired lung function, radiological abnormalities remains high in our study population. Yet, three recovery trajectories are emerging, ranging from almost complete recovery to post-COVID-19 syndrome with impaired mental health.

Cardiopulmonary Long-Term Sequelae in Patients after Severe COVID-19 Disease

We aimed to identify cardiopulmonary long-term effects after severe COVID-19 disease as well as predictors of Long-COVID in a prospective registry. A total of 150 consecutive, hospitalized patients (February 2020 and April 2021) were included six months post hospital discharge for a clinical follow-up. Among them, 49% experienced fatigue, 38% exertional dyspnea and 75% fulfilled criteria for Long-COVID. Echocardiography detected reduced global longitudinal strain (GLS) in 11% and diastolic dysfunction in 4%. Magnetic resonance imaging revealed traces of pericardial effusion in 18% and signs of former pericarditis or myocarditis in 4%. Pulmonary function was impaired in 11%. Chest computed tomography identified post-infectious residues in 22%. Whereas fatigue did not correlate with cardiopulmonary abnormalities, exertional dyspnea was associated with impaired pulmonary function (OR 3.6 [95% CI: 1.2-11], p = 0.026), reduced GLS (OR 5.2 [95% CI: 1.6-16.7], p = 0.003) and/or left ventricular diastolic dysfunction (OR 4.2 [95% CI: 1.03-17], p = 0.04). Predictors of Long-COVID included length of in-hospital stay (OR: 1.15 [95% CI: 1.05-1.26], p = 0.004), admission to intensive care unit (OR cannot be computed, p = 0.001) and higher NT-proBNP (OR: 1.5 [95% CI: 1.05-2.14], p = 0.026). Even 6 months after discharge, a majority fulfilled criteria for Long-COVID. While no associations between fatigue and cardiopulmonary abnormalities were found, exertional dyspnea correlated with impaired pulmonary function, reduced GLS and/or diastolic dysfunction.

An Echocardiographic Evaluation of Cardiopulmonary Evaluation of Cardiopulmonary Functions in Patients with Cirrhosis of Liver and Correlation with Severity of Disease

BACKGROUND Cirrhosis is the end result of varieties of chronic liver disease. A large proportion of patients with cirrhosis develop cardiopulmonary complication. The aim of this study was to evaluate the cardiopulmonary functions of patient with cirrhosis of liver and to correlate these abnormalities with CTP and MELD score.&#x0D; METHODS The study involved 81 cirrhotic patients admitted in Department of Gastroenterology of TUTH over a period of one year. The diagnosis of cirrhosis was established and clinical evaluation and investigation done.&#x0D; RESULTS The mean age of cirrhotic patients included in the study was 52 years. Alcohol was most common cause of cirrhosis (75.31%). The mean CTP score and MELD score was 10.02±1.77 and 23.59±7.53 respectively. Thirty patients (37.03%) had prolonged QTc interval, which had statistically significant association with alcohol as etiology of cirrhosis (p = 0.04). More than half (50.62%) of patients had diastolic dysfunction but it was not statistically significantly associated with CTP and MELD-Na score. Seven patients had evidence of intrapulmonary shunting, which had statistically significant association with MELD-Na score (p =0.01). Similarly, total 5 patients (6.17%) had PPHTN but there was no statistically significant association with CTP and MELD-Na score. Seventeen patients had dilated left atrium with no statistically significant association with CTP score and MELD-Na score.&#x0D; CONCLUSION There was significant incidence of cardiopulmonary abnormalities in cirrhotic patients. Every patient with decompensated cirrhosis irrespective of severity of disease should be evaluated for cardiopulmonary complication with a noninvasive, real-time, rapid imaging transthoracic contrast echocardiography.

Cardiovascular parameters on computed tomography are independently associated with in-hospital complications and outcomes in level-1 trauma patients

BackgroundIn-hospital complications after trauma may result in prolonged stays, higher costs, and adverse functional outcomes. Among reported risk factors for complications are pre-existing cardiopulmonary comorbidities. Objective and quick evaluation of cardiovascular risk would be beneficial for risk assessment in trauma patients. Studies in non-trauma patients suggested an independent association between cardiovascular abnormalities visible on routine computed tomography (CT) imaging and outcomes. However, whether this applies to trauma patients is unknown.PurposeTo assess the association between cardiopulmonary abnormalities visible on routine CT images and the development of in-hospital complications in patients in a level-1 trauma center.MethodsAll trauma patients aged 16 years or older with CT imaging of the abdomen, thorax, or spine and admitted to the UMC Utrecht in 2017 were included. Patients with an active infection upon admission or severe neurological trauma were excluded. Routine trauma CT images were analyzed for visible abnormalities: pulmonary emphysema, coronary artery calcifications, and abdominal aorta calcification severity. Drug-treated complications were scored. The discharge condition was measured on the Glasgow Outcome Scale.ResultsIn total, 433 patients (median age 50 years, 67% male, 89% ASA 1–2) were analyzed. Median Injury Severity Score and Glasgow Coma Scale score were 9 and 15, respectively. Seventy-six patients suffered from at least one complication, mostly pneumonia (n = 39, 9%) or delirium (n = 19, 4%). Left main coronary artery calcification was independently associated with the development of any complication (OR 3.9, 95% CI 1.7–8.9). An increasing number of calcified coronary arteries showed a trend toward an association with complications (p = 0.07) and was significantly associated with an adverse discharge condition (p = 0.02). Pulmonary emphysema and aortic calcifications were not associated with complications.ConclusionCoronary artery calcification, visible on routine CT imaging, is independently associated with in-hospital complications and an adverse discharge condition in level-1 trauma patients. The findings of this study may help to identify trauma patients quickly and objectively at risk for complications in an early stage without performing additional diagnostics or interventions.

Cardiopulmonary long-term effects in patients after hospitalization due to COVID-19 infection

Abstract Background Multiple studies have described acute effects of the Covid-19 infection on the heart, but little is known about the long-term cardiac and pulmonary effects and complications after recovery. The aim of this analysis was to deliver a comprehensive report of symptoms and possible long-term impairments after hospitalization because of Covid-19 infection as well as to try to identify predictors for Long-Covid. Methods This was a prospective, multicenter registry study. Patients with verified Covid-19 infection, who were treated as in-patients at our dedicated Covid hospital (Clinic Favoriten), have been included in this study. In all patients, testing was performed approximately 6 months post discharge. During the study visit the following tests and investigations were performed: detailed patient history and clinical examination, transthoracic echocardiography, electrocardiography, cardiac magnetic resonance imaging (MRI), chest computed tomography (CT) scan, lung function test and a comprehensive list of laboratory parameters including cardiac bio markers. Results Between July 2020 and October 2021, 150 patients were recruited. Sixty patients (40%) were female and the average age was 53.5±14.5 years. Of all patients, 92% had been admitted to our general ward and 8% had a severe course of disease, requiring admission to our intensive care unit. Six months after discharge the majority of patients still experienced symptoms and 75% fulfilled the criteria for Long-Covid. Only 24% were completely asymptomatic (figure 1). Echocardiography detected reduced global longitudinal strain (GLS) in 11%. Cardiac MRI revealed pericardial effusion in 18%. Furthermore, cardiac MRI showed signs of former peri- or myocarditis in 4%. Pulmonary CT scans identified post-infectious residues, such as bilateral ground glass opacities and fibrosis in 22%. Exertional dyspnea was associated with either reduced forced vital capacity measured during pulmonary function tests in 11%, with reduced GLS and/or diastolic dysfunction, thus providing evidence for a cardiac and/or pulmonary cause. Independent predictors for Long-Covid were markers of a more severe disease course like length of in-hospital stay, admission to an intensive care unit, type of ventilation as well as higher NT-proBNP and/or troponin levels. Conclusion Even 6 months after recovery from Covid-19 infection, the majority of previously hospitalized patients still suffer from at least one symptom, such as chronic fatigue and/or exertional dyspnea. While there was no association between fatigue and cardiopulmonary abnormalities, impaired lung function, reduced GLS and/or diastolic dysfunction were significantly more prevalent in patients presenting with exertional dyspnea. On chest CT approximately one fifth of all patients showed post infectious changes in chest CT including evidence for myo- and pericarditis as well as accumulation of pericardial effusions. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Major fund

Scimitar Syndrome: About A Case Report and Review of the Literature

Scimitar syndrome or Felson's veno-lobar syndrome is a very rare condition, characterised by the association of cardiopulmonary abnormalities namely an abnormal right pulmonary venous return which is most commonly located in the inferior vena cava. We present an observation of a seven-month-old female infant who presented with acute dyspnoea. The diagnosis was suspected on chest X-ray and confirmed on CT scan which showed a single large right pulmonary vein draining into the right atrium with a scimitar pattern in sagittal section associated with dextrocardia and pulmonary sequestration. The prognosis is related to the extent of the left-right shunt and associated malformations.

Alveolar Dead Space Is Augmented During Exercise in Patients With Heart Failure With Preserved Ejection Fraction

Patients with heart failure with preserved ejection fraction (HFpEF) exhibit many cardiopulmonary abnormalities that could result in V˙/Q˙ mismatch, manifesting as an increase in alveolar dead space (VDalveolar) during exercise. Therefore, we tested the hypothesis that VDalveolar would increase during exercise to a greater extent in patients with HFpEF compared with control participants. Do patients with HFpEF develop VDalveolar during exercise? Twenty-three patients with HFpEF and 12 control participants were studied. Gas exchange (ventilation [V˙E], oxygen uptake [V˙o2], and CO2 elimination [V˙co2]) and arterial blood gases were analyzed at rest, twenty watts (20W), and peak exercise. Ventilatory efficiency (evaluated as the V˙E/V˙co2 slope) also was measured from rest to 20W in patients with HFpEF. The physiologic dead space (VDphysiologic) to tidal volume (VT) ratio (VD/VT) was calculated using the Enghoff modification of the Bohr equation. VDalveolar was calculated as: (VD / VT× VT) - anatomic dead space. Data were analyzed between groups (patients with HFpEF vscontrol participants) across conditions (rest, 20W, and peak exercise) using a two-way repeated measures analysis of variance and relationships were analyzed using Pearson correlation coefficient. VDalveolar increased from rest (0.12 ± 0.07 L/breath) to 20W (0.22 ± 0.08 L/breath) in patients with HFpEF (P< .01), whereas VDalveolar did not change from rest (0.01 ± 0.06 L/breath) to 20W (0.06 ± 0.13 L/breath) in control participants (P= .19). Thereafter, VDalveolar increased from 20W to peak exercise in patients with HFpEF (0.37 ± 0.16 L/breath; P< .01 vs20W) and control participants (0.19 ± 0.17 L/breath; P= .03 vs20W). VDalveolar was greater in patients with HFpEF compared with control participants at rest, 20W, and peak exercise (main effect for group, P< .01). Moreover, the increase in VDalveolar correlated with the V˙E/V˙co2 slope (r= 0.69; P< .01), which was correlated with peak V˙o2peak (r= 0.46; P< .01) in patients with HFpEF. These data suggest that the increase in V˙/Q˙ mismatch may be explained by increases in VDalveolar and that increases in VDalveolar worsens ventilatory efficiency, which seems to be a key contributor to exercise intolerance in patients with HFpEF.

Vascular Disorders of Pregnancy Increase Susceptibility to Neonatal Pulmonary Hypertension in High-Altitude Populations.

Preeclampsia and fetal growth restriction increase cardiopulmonary disease risk for affected offspring and occur more frequently at high-altitude (≥2500 m). Retrospective studies indicate that birth to a preeclampsia woman at high altitude increases the risk of pulmonary hypertension (PH) in later life. This prospective study asked whether preeclampsia with or without fetal growth restriction exaggerated fetal hypoxia and impaired angiogenesis in the fetal lung, leading to neonatal cardiopulmonary circulation abnormalities and neonatal or infantile PH. We studied 79 maternal-infant pairs (39 preeclampsia, 40 controls) in Bolivia (3600-4100 m). Cord blood erythropoietin, hemoglobin, and umbilical artery and venous blood gases were measured as indices of fetal hypoxia. Maternal and cord plasma levels of angiogenic (VEGF [vascular endothelial growth factor]) and antiangiogenic (sFlt1 [soluble fms-like tyrosine kinase]) factors were determined. Postnatal echocardiography (1 week and 6-9 months) assessed pulmonary hemodynamics and PH. Preeclampsia augmented fetal hypoxia and increased the risk of PH in the neonate but not later in infancy. Pulmonary abnormalities were confined to preeclampsia cases with fetal growth restriction. Maternal and fetal plasma sFlt1 levels were higher in preeclampsia than controls and positively associated with PH. The effect of preeclampsia with fetal growth restriction to increase fetal hypoxia and sFlt1 levels may impede normal development of the pulmonary circulation at high altitude, leading to adverse neonatal pulmonary vascular outcomes. Our observations highlight important temporal windows for the prevention of pulmonary vascular disease among babies born to highland residents or those with exaggerated hypoxia in utero or newborn life.

Abnormal exercise adaptation after varying severities of COVID-19: A controlled cross-sectional analysis of 392 survivors

ABSTRACT The multisystem impairment promoted by COVID-19 may be associated with a reduction in exercise capacity. Cardiopulmonary abnormalities can change across the acute disease severity spectrum. We aimed to verify exercise physiology differences between COVID-19 survivors and SARS-CoV-2-naïve controls and how illness severity influences exercise limitation. A single-centre cross-sectional analysis of prospectively collected data from COVID-19 survivors who underwent cardiopulmonary exercise testing (CPET) in their recovery phase (x = 50[36;72] days). Patients with COVID-19 were stratified according to severity as mild [M-Cov (outpatient)] vs severe/critical [SC-Cov(inpatients)] and were compared with SARS-CoV-2-naïve controls (N-Cov). Collected information included demographics, anthropometrics, previous physical exercise, comorbidities, lung function test and CPET parameters. A multivariate logistic regression analysis was performed to identify low aerobic capacity (LAC) predictors post COVID-19. Of the 702 included patients, 310 (44.2%), 305 (43.4%) and 87 (12.4%) were N-Cov, M-Cov and SC-Cov, respectively. LAC was identified in 115 (37.1%), 102 (33.4%), and 66 (75.9%) of N-CoV, M-CoV and SC-CoV, respectively (p < 0.001). SC-Cov were older, heavier with higher body fat, more sedentary lifestyle, more hypertension and diabetes, lower forced vital capacity, higher prevalence of early anaerobiosis, ventilatory inefficiency and exercise-induced hypoxia than N-Cov. M-Cov had lower weight, fat mass, and coronary disease prevalence and did not demonstrate more CEPT abnormalities than N-Cov. After adjustment for covariates, SC-Cov was an independent predictor of LAC (OR = 2.7; 95% CI, 1.3-5.6). Almost two months after disease onset, SC-CoV presented several exercise abnormalities of oxygen uptake, ventilatory adaptation and gas exchange, including a high prevalence of LAC. Highlights Weeks after the acute disease phase, one-third of mild and three-quarters of severe and critical patients with COVID-19 presented a reduced aerobic capacity. Previous studies including SARS-CoV-1 survivors observed much lower values. A severe or critical COVID-19 case was an independent predictor for low aerobic capacity. In our sample, pre-COVID-19 exercise significantly reduced the odds of post-COVID-19 low aerobic capacity. Even severe or critical patients who exercised regularly had a prevalence of low aerobic capacity 2.5 times lower than those who did not have this routine before sickening.

Progressive multifocal fibrosing neuropathy: description of a novel disease

Entrapment peripheral neuropathies are clinically characterized by sensory impairment and motor deficits. They are usually caused by mechanical injuries, but they are also a frequent manifestation of metabolic diseases, toxic agent exposure, or systemic fibrotic disorders. Here we describe the clinical, radiological, and histopathological features of a novel progressive fibrotic disorder characterized by progressive multifocal fibrosing neuropathy. We identified two patients who presented with severe and progressive peripheral neuropathic symptoms sequentially affecting multiple sites. These patients presented with severe and progressive multifocal, sequentially additive peripheral neuropathic symptoms. Extensive nerve conduction and radiological studies showed the sequential development of multifocal motor and sensory peripheral neuropathy in the absence of any exposure to known infectious, inflammatory, or fibrotic triggers and the lack of family history of compression neuropathies. Extensive clinical and laboratory test evaluation failed to support the diagnosis of any primary inflammatory or genetic peripheral neuropathy and there was no evidence of any systemic fibrosing disorder including Systemic Sclerosis, lacking cutaneous fibrotic changes and cardiopulmonary abnormalities. The clinical course was progressive with sequential development of motor and sensory deficits of upper and lower extremities displaying proximal predominance. Histopathological study of tissues obtained during nerve release surgeries showed severe perineural fibrosis with marked accumulation of thick collagen bundles encroaching the peripheral nerves. There was no evidence of vasculitic, inflammatory, or vascular fibroproliferative lesions. We suggest that the clinical findings described here represent a previously undescribed fibrotic disorder affecting peripheral nerves, and we propose the descriptive term "Progressive Multifocal Fibrosing Neuropathy" to refer to this novel disorder. Despite the inherent limitations of this early description, we hope this is would contribute to the identification of additional cases.