Cardiovascular Involvement In Patients Research Articles

The glycosylated hemoglobin level and the severity of cardiovascular involvement in patients with the first episode of acute coronary syndrome.

The current study was carried out aiming at investigating the relationship between glycosylated hemoglobin level and coronary atherosclerosis in patients with the first episode of acute coronary syndrome. This case-control study evaluated 450 patients with the first episode of acute coronary syndrome in Ayatollah Rouhani Hospital in Babol (Iran) from 2011 to 2018. Based on glycosylated hemoglobin, patients were divided into three groups of non-diabetic, pre-diabetic, and diabetic (n=150 in each group). Since SYNTAX score and Gensini score are employed to evaluate the extent of cardiovascular disease and predict CVD in patients with CAD over long-term follow-up, we calculated SYNTAX score and Gensini score based on angiographic results. Concerning the factors related to the severity of cardiovascular involvement, the results revealed no significant difference between the diabetic and pre-diabetic groups in terms of the frequency of patients in terms of SYNTAX score, Gensini score, and the number of vessels involved (0.142 and 87, respectively, and P=0.102). However, this difference between the diabetic and non-diabetic groups, as well as between the pre-diabetic and non-diabetic groups was statistically significant (respectively for SYNTAX score, p< 0.001 and P=0.001; for Gensini score, P=0.013 and P=0.019; and for the number of vessels involved P=0.001and p<0.001). According to the findings of the current study, since there was no significant difference between diabetic and pre-diabetic patients in terms of the components indicating the severity of cardiovascular involvement, pre-diabetes itself may be associated with the severity of cardiovascular involvement as a predisposing factor.

Prevalence of Cardiovascular Involvement in Patients With COVID-19 Disease

Background: Coronaviruses are a huge family of viruses that lead to various diseases from a common cold to more unadorned illnesses for example SARS-CoV and MERS-CoV. Common symptoms of this infection include respiratory symptoms. In addition, this disease can also manifest with an acute cardiovascular (CV) syndrome. The aim of this study was to determine the frequency of CV involvement in patients with COVID-19 disease admitted to Afzalipour Hospital in Kerman. Methods: In this study, all patients who were diagnosed with COVID-19 disease and were hospitalized and monitored due to disease conditions were eligible to enter the study. At the beginning of the patient’s hospitalization, the patients’ vital signs were recorded and the first 12-lead electrocardiography was taken. Then, patients underwent cardiac monitoring and echocardiography at the beginning of hospitalization and afterwards during the course of disease. Preliminary tests including biochemistry, blood cell count, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) and troponin were also performed for patients. Results: The mean age of patients with COVID-19 was 55.63 years and 20.2% of them had a history of heart disease. More than half of these patients were men. Ejection fraction was normal in 87.8% of patients. There was a significant relationship between diastolic dysfunction grade and the history of heart disease (P=0.02). Conclusion: Since the incidence of underlying diseases such as diabetes, hypertension and cardiac disorders can raise the risk of corona viruses’ disease and also increase the mortality rate of this disease in these people, it is suggested that more attention be paid to the observance of health protocols for people with underlying diseases, and that people with underlying diseases be given priority in vaccinating against this disease.

Cardiovascular Involvement in Patients with Autosomal Dominant Polycystic Kidney Disease: A Review.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease with a prevalence of 1:400 to 1:1,000 in Caucasians. It is caused by mutations in the PKD1 gene located on chromosome 16p13.3 (in about 85% cases) as well as in the PKD2 gene on chromosome 4q13-23. In the Polish population, the disease is associated with PKD1 mutations in 84% of the ADPKD-affected families. PKD1 and PKD2 genes encode the proteins polycystin-1 (PC1) and polycystin-2 (PC2), respectively. The presence of kidney cysts is a characteristic feature in the ADPKD patients. But in the ADPKD patients, cardiovascular abnormalities, such as hypertension (HT) with higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) values, higher left ventricular mass (LVM), intracranial (ICAN) and extracranial aneurysms, and cardiac valve defects, are significantly more common than in the general population. According to the literature data, both higher LVM and vascular dysfunction already occur in children and young adults with normal renal function and without HT. Moreover, biventricular diastolic dysfunction, endothelial dysfunction, increased carotid intima-media thickness, and impaired coronary flow velocity reserve are present even in young patients with ADPKD who have normal HT and well-preserved renal function. In patients with ADPKD, hypertension has some specific features; in the youngest age group of children, the prevalence of hypertension is greater if their parents suffer from hypertension; in normotensive young ADPKD-diagnosed individuals, ambulant SBP and DBP values were significantly higher than in age- and gender-matched controls; hypertension appears at least 10 years earlier than spontaneous HT in general population. In adults, HT is often diagnosed before any substantial reduction in the GFR, and a lower nocturnal dip in BP in comparison to hypertensives in the general population. PKD1 and PKD2 gene products (PC1 and PC2 proteins) have been shown to assemble at the plasma membrane and to regulate calcium (Ca2+) entry. A defect in Ca2+ binding mediated by mutations in polycystin proteins is a hypothetical factor contributing to left ventricular mass increase. Altered intracellular Ca2+ handling contributes importantly to impaired contractility associated with heart failure. Impairment of intracellular Ca2+ homeostasis and mitochondrial function has been implicated in the development of LVH. It can be assumed that the cause of LVH in ADPKD patients is the natural course of this disease with developing HT and deteriorating kidney function, which may be influenced by the presence of PKD1- and PKD2-mutated gene products: PC1 and PC2 proteins.

Cardiac magnetic resonance assessment of cardiac involvement in autoimmune diseases.

Cardiac magnetic resonance (CMR) is emerging as the modality of choice to assess early cardiovascular involvement in patients with autoimmune rheumatic diseases (ARDs) that often has a silent presentation and may lead to changes in management. Besides being reproducible and accurate for functional and volumetric assessment, the strength of CMR is its unique ability to perform myocardial tissue characterization that allows the identification of inflammation, edema, and fibrosis. Several CMR biomarkers may provide prognostic information on the severity and progression of cardiovascular involvement in patients with ARDs. In addition, CMR may add value in assessing treatment response and identification of cardiotoxicity related to therapy with immunomodulators that are commonly used to treat these conditions. In this review, we aim to discuss the following objectives: •Illustrate imaging findings of multi-parametric CMR approach in the diagnosis of cardiovascular involvement in various ARDs;•Review the CMR signatures for risk stratification, prognostication, and guiding treatment strategies in ARDs;•Describe the utility of routine and advanced CMR sequences in identifying cardiotoxicity related to immunomodulators and disease-modifying agents in ARDs;•Discuss the limitations of CMR, recent advances, current research gaps, and potential future developments in the field.

Risk factors of cardiovascular involvement in patients with Behcet's disease

ObjectivesBehcet's disease (BD) is a multi-systemic inflammatory vasculitis which may be life-threatening if combined with cardiovascular problems. The aim of the study was to identify potential risk factors associated with cardiovascular involvement in BD. MethodsWe reviewed the medical databases of a single center. All BD patients identified as fulfilling the 1990 International Study Group criteria or the International Criteria for Behcet's Disease criteria. Cardiovascular involvement, clinical manifestations, laboratory features, and treatments were recorded. The relationship between parameters and cardiovascular involvement was analyzed. Results111 BD patients were included: 21 (18.9%) had documented cardiovascular involvement (CV BD group) and 99 (81.1%) had no cardiovascular involvement (non-CV BD group). Compared with non-CV BD, the proportion of males and smokers were significantly increased in CV BD (p = 0.024 and p < 0.001, respectively). Levels of activated partial thromboplastin time (APTT), cardiac troponin I and C-reactive protein were significantly higher (p = 0.001, p = 0.031, and p = 0.034, respectively) in the CV BD group. Cardiovascular involvement was associated with smoking state, the presence of papulopustular lesions, and higher APTT in multivariate analyzed (p = 0.029, p = 0.021, and p = 0.006, respectively). The ROC curve showed that APTT predicts the risk of cardiovascular involvement (p < 0.01) at a cut-off value of 33.15 s with a sensitivity of 57.1% and specificity of 82.2%. ConclusionCardiovascular involvement in BD patients was associated with gender, smoking state, the presence of papulopustular lesions, and higher APTT. All patients newly diagnosed with BD should be systematically screened for cardiovascular involvement.

At the Heart of Eosinophilic Granulomatosis with Polyangiitis: into Cardiac and Vascular Involvement.

To provide an overview of existing literature on pathogenetic and clinical aspects of cardiac and vascular involvement in eosinophilic granulomatosis with polyangiitis (EGPA). In EGPA, cardiac and vascular involvement are more common than previously thought. However, no international recommendations on the topic are available yet. Herein, we summarize the existing evidence on the topic and propose a diagnostic approach for cardiac involvement in EGPA. The prevalence of cardiovascular involvement in patients with EGPA varies greatly among published studies, ranging between 3.1-18.7% for occlusive arterial disease, 5.8-30% for venous thrombosis and 17-92% for heart involvement. Cardiac involvement in EGPA is associated with high mortality even though manifestations are heterogeneous. In principle, every anatomical structure of the heart can be involved, and EGPA-related heart disease may be completely asymptomatic at first. A careful diagnostic work-up for early detection and prompt treatment initiation is therefore required. While cardiac manifestations are more common in anti-neutrophil cytoplasmic antibodies (ANCA)-negative patients, arterial and venous thrombotic events are not linked to ANCA status but correlate closely with disease activity and accumulate at disease onset. Thrombotic events (mainly venous) are considerably more frequent in EGPA than in the general population contributing substantially to morbidity and highlighting the importance of developing specific prevention strategies for patients who are diagnosed with EGPA.

Cardiovascular manifestations identified by multi-modality imaging in patients with long COVID.

BackgroundThe possibility of permanent cardiovascular damage causing cardiovascular long COVID has been suggested; however, data are insufficient. This study investigated the prevalence of cardiovascular disorders, particularly in patients with cardiovascular long COVID using multi-modality imaging.MethodsA total of 584 patients admitted to the hospital due to COVID-19 between January 2020 and September 2021 were initially considered. Upon outpatient follow-up, 52 (9%) were suspected to have cardiovascular long COVID, had complaints of chest pain, dyspnea, or palpitations, and were finally enrolled in this study. This study is registered with the Japanese University Hospital Medical Information Network (UMIN 000047978).ResultsOf 52 patients with long COVID who were followed up in the outpatient clinic for cardiovascular symptoms, cardiovascular disorders were present in 27% (14/52). Among them, 15% (8/52) had myocardial injury, 8% (4/52) pulmonary embolisms, and 4% (2/52) both. The incidence of a severe condition (36% [5/14] vs. 8% [3/38], p = 0.014) and in-hospital cardiac events (71% [10/14] vs. 24% [9/38], p = 0.002) was significantly higher in patients with cardiovascular disorders than in those without. A multivariate logistic regression analysis revealed that a severe condition (OR, 5.789; 95% CI 1.442–45.220; p = 0.017) and in-hospital cardiac events (OR, 8.079; 95% CI 1.306–25.657; p = 0.021) were independent risk factors of cardiovascular disorders in cardiovascular long COVID patients.ConclusionsSuspicion of cardiovascular involvement in patients with cardiovascular long COVID in this study was approximately 30%. A severe condition during hospitalization and in-hospital cardiac events were risk factors of a cardiovascular sequalae in CV long COVID patients.

Analysis of cardiac manifestation and treatment of multisystem inflammatory syndrome in children related to SARS-CoV-2.

Cardiovascular manifestations are common (35-100%) in the multisystem inflammatory syndrome in children. Our study aimed to analyze treatment impact and cardiovascular involvement in patients with multisystem inflammatory syndrome in children. The retrospective cohort included 81 patients treated between April 2020 and December 2021 (9.3±4.6 years). Elevated cardiac troponin I and pro-B-type natriuretic peptide were observed in 34.2% and 88.5% of patients, respectively. Myocardial dysfunction was observed in 50.6%. Children older than 10 years had a 4-fold increased risk of myocardial dysfunction (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.4-8.9; p=0.006). A moderate negative correlation was proved between left ventricle ejection fraction and C-reactive protein (rr = - 0.48; p < 0.001). More than one-fifth of the patients presented with shock. Coronary artery dilatation was observed in 6.2% of patients. Mild pericardial effusion was detected in 27.1% of children. On standard electrocardiogram, 52.6% of children had negative T waves in the inferior and/or precordial leads; transient QTc prolongation was registered in 43% of patients. Treatment failure was observed in 19 patients. Patients initially treated with intravenous immunoglobulins had 10-fold higher chances for treatment failure than patients treated with corticosteroids (OR 10.6, 95% CI 3,18 - 35.35; p < 0.001). Cardiovascular manifestations were observed in more than half of the patients, with acute myocardial dysfunction being the most common, especially in children older than 10 years. We established a negative association between the degree of elevation of inflammatory markers and left ventricular ejection fraction. Patients treated with intravenous immunoglobulins who had cardiovascular manifestations had treatment failures more frequently than patients treated with corticosteroids.

Cardiovascular Involvement in Patients Recovered from COVID-19: Reality or Fantasy?

Background: COVID-19 infection has been associated with cardiovascular complications in 7-28% of hospitalized patients, with the diagnosis based on biomarkers elevation. Subclinical cardiac involvement in outpatients recovered from COVID-19 represents a growing concern, as well as mid- or long-term cardiovascular effects. Objective: The aim of the present study was to determine the usefulness of detecting cardiovascular involvement in outpatients recovered from COVID-19, and its association with symptoms and risk factors. Methods: Between September 2020 and March 2021, 668 patients &gt;18 years were prospectively included. All the patients had to have COVID-19 confirmed diagnosis by a positive reverse transcription-polymerase chain reaction (RT-PCR) test in a respiratory tract sample COVID-19. They were evaluated with physical examination, electrocardiogram (ECG) and Doppler echocardiography. Patients with symptoms suggestive of risk or abnormal findings on ECG or echocardiogram underwent cardiac magnetic resonance imaging (CMRI) with gadolinium-based contrast agent. Results: Mean age was 42.9 ± 14.9 years and 56.9% were women; 12.9% were hypertensive, 4.3% were diabetic and 6.9% obese. Overall, 57.6% had no cardiovascular risk factors and only 4.2% had a history of cardiovascular disease. The disease was mild in 73.2%; 16.3% required hospitalization and 1.05% needed mechanical ventilation. Only 5 patients had myocarditis diagnosed by CMRI, and both pericardial effusion and abnormal repolarization were significantly associated with myocarditis (p &lt; 0.0001). Conclusions: Abnormal ECG or echocardiographic findings were uncommon in our cohort. The diagnosis of viral myocarditis was made in 5 cases with clinical signs and symptoms, and was confirmed by CMRI.

Clinical characteristics and predictors for cardiovascular system involvement in patients with Behçet's disease.

The purpose of this study is to analyse the clinical characteristics of Behçet's disease (BD) patients in China with or without cardiovascular system involvement, and to develop a risk model to identify factors related to cardiovascular involvement in BD. This retrospective cohort study, using the information on BD in Shenzhen People's Hospital from January 2000 to December 2021, included 95 patients; BD patients without cardiovascular system involvement (n=63) and with cardiovascular system involvement (n=32). Patients with BD who were males and had a combination of hypertension and a longer duration of disease were more likely to have cardiovascular involvement (p < 0.05). Compared to patients without cardiovascular involvement, manifestations of genital ulcers are rarely observed in those with cardiovascular involvement (60.32% vs. 37.50%, p=0.035). The binary logistic regression analysis found that ascending aortic widening and a history of hypertension were independent risk factors for BD with cardiovascular system involvement (OR=1.277, 95% CI 1.09, 1.495, p=0.002; OR=11.578, 95% CI 1.308, 102.639, p=0.028). The established prediction model indicated that can help to predict the likelihood of cardiovascular involvement in a patient with BD. Cardiovascular involvement in BD is not rare at all, however, it is often underreported due to a lack of specificity. BD patients who are male, have a history of combined hypertension, and have a long duration of disease should be focused on the presence of combined cardiovascular system involvement, with particular attention to the patient's ascending aortic internal diameter.

Serum Elabela level is significantly increased in patients with acromegaly.

Although the bioactive peptides associated with the apelinergic system are known to be associated with heart failure and ischemic heart disease, there are no data on their association with acromegaly. We aimed to investigate the change in serum Elabela levels, a novel peptide of the apelinergic system, in patients with acromegaly. Our study included 30 treatment naive patients who were recently diagnosed with acromegaly, and 50 age-and-sex-matched healthy controls. In addition to routine history, physical examination and laboratory examinations, serum Elabela level was measured. Participants were divided into two groups as individuals with and without acromegaly and compared to each other. Diastolic blood pressure (DBP) and systolic blood pressure (SBP) were found to be higher in patients with acromegaly. Serum glucose, Hs-CRP, NT-proBNP, insulin-like growth factor-1, growth hormone and serum Elabela levels were higher in patients with acromegaly (p < 0.05 for each). Left ventricular ejection fraction (LV-EF) was found to be lower in patients with acromegaly than the patients in healthy control group (p < 0.05). In multivariate analysis; age, systolic blood pressure, NT-proBNP, Insulin-like growth factor 1 and growth hormone levels were found to be very closely and positively related to serum Elabela level (p < 0.05 for each). Serum Elabela level can be used as an early and objective indicator of early cardiovascular involvement in patients with acromegaly. Further research is needed to clarify the role of serum Elabela levels on cardiovascular system in acromegaly patients.

P424 SMALL HEART AND SINGLE CORONARY ARTERY IN A YOUNG PATIENT WITH CHRONIC FATIGUE SYNDROME: A CASE REPORT

Abstract Introduction Chronic fatigue syndrome/Myalgic encephalomyelitis (CFS/ME) is a clinically defined condition reported mostly in adults, characterized by severe and disabling fatigue limiting normal daily activities for at least 6 months accompanied by multiple unexplained symptoms including self–reported impairments in concentration and short–term memory, sleep disturbances, and musculoskeletal pain. Although rarely considered to have cardiac dysfunction, CFS/ME patients frequently have reduced stroke volume with a significant inverse relation between cardiac output and post–exertional malaise severity. We describe a case of a young man affected by CFS/ME and small heart with incidental findings of anomalous origin of the left main coronary artery (LMCA). Case Presentation A 19–year–old Caucasian male presented to our clinic complaining weakness, lack of concentration and excessive daytime sleepiness. Medical history included CFS/ME, D hypovitaminosis, inflammatory bowel disease associated with pancreatic insufficiency. Physical examination including cardiovascular auscultation was unremarkable, with normal blood pressure and heart rate. Electrocardiogram showed sinus rhythm at 75 bpm without any repolarization abnormalities. Echocardiogram revealed reduced diameters of left ventricle (LV) (end–diastolic diameter 36 mm), normal aortic root dimensions and, in a five–chamber apical view, a binary structure that seemed to cross the aorta perpendicularly to its long axis. Cardiac magnetic resonance (CMR) found significantly reduced LV stroke volume (34 ml/m2; normal values 44–68 ml/m2) and end–diastolic volume (57 ml/m2; normal values 68–103 ml/m2) together with reduced end–diastolic wall mass (51 g/m2; normal values 59–93 g/m2). Also, right ventricle (RV) volumes were reduced: stroke volume (32 ml/m2; normal values 40–72 ml/m2), end–diastolic volume (62 ml/m2; normal values 68–114 ml/m2). In addition, the exam confirmed the anomalous origin of LMCA stemming from the proximal segment of right coronary artery and following a retro–aortic course. Conclusions Not sufficient consideration was given to cardiovascular involvement in patients with CFS/ME, although many of signs and symptoms are suggestive of cardiovascular dysfunction. This case highlights that CFS/ME together with small heart is a condition possible also in young people. More studies and reports could be necessary to better define the association with cardiac congenital anomalies and CFS/ME.

Cardiovascular involvement in patients with COVID-19: a systematic review of prevalence studies

In this commentary, Hamer, Phoong, Harrison and Hill critically appraise a systematic review of the prevalence, nature, and rate of cardiovascular involvement in patients with suspected or confirmed COVID-19.

Laboratory features of cardiovascular injury in COVID-19 and other acute respiratory viral infections

The article presents data from a study of specific cardiac markers in patients with acute respiratory viral infection (ARVI) or coronavirus disease 2019 (COVID-19). COVID-19 caused by severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) is characterized by cardiovascular injury. However, with other ARVIs, the prevalence of heart involvement is also high and, according to the literature data, is about 20%. At the same time, laboratory characteristics of these lesions have significant differences in ARVI and COVID-19, which necessitates different approaches to therapy.Aim. To determine the most significant markers for the diagnosis of cardiovascular involvement in patients with COVID-19.Material and methods. A total of 60 patients were included in the study: main group (n=30), COVID-19 was laboratory confirmed; comparison group (n=30), other ARVI pathogens were verified. The groups were completely comparable in sex, age and severity of disease course. The average values of troponin, creatine kinase MB, N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer were compared in patients of both groups in the acute disease phase, corresponding from 1 to 8 days from the symptoms’ onset. Data analysis was performed using a two-sided independent samples t-test using SPSS Statistics version 23.Results. The higher levels of troponin-I and D-dimer were significantly more common in the main group. The mean value of creatine kinase MB did not exceed the upper limits of reference values. There were no significant differences in NTproBnP levels between the groups. At the same time, in both groups, its level significantly exceeded the age reference values.Conclusion. The most effective markers of cardiovascular complications in COVID-19 patients should be considered troponin-I, D-dimer and NT-proBNP. Early diagnosis and laboratory monitoring in dynamics is important for the timely detection of cardiac pathology and alteration of therapy regimen.

Prevalence of cardiac involvement in home-based recovered coronavirus disease 2019 (COVID-19) patients: a retrospective observational study.

ObjectiveCoronavirus disease 2019 (COVID-19) has a risk of cardiac arrhythmia, acute coronary syndrome, heart failure and myocarditis, and the prognosis of COVID-19 has been associated with cardiovascular symptoms. However, there has not been enough information about cardiovascular involvement in patients who had recovered home-based mild symptoms of COVID-19 infection. Therefore, this study evaluates the prevalence of cardiac involvement and associated factors in home-based recovered COVİD-19 patients.Subject and methods.A total of 64 participants who applied to cardiology outpatient clinics with cardiac symptoms after recovering from COVID infection were recorded between April and December 2020. The patients were divided into two according to cardiovascular involvement in the cardiovascular magnetic resonance (CMR) imaging results.ResultsNo significant difference between the two groups regarding age and co‐morbidities. Patients with cardiac involvement had higher C-reactive protein compared to without cardiac involvement patients. A total of 46 patients who recently recovered from COVID-19 had abnormal CMR findings such as myocardial late gadolinium enhancement or pericardial enhancement. In addition, the left ventricular ejection fraction and stroke volume were significantly lower in the cardiac involvement patients.ConclusionWe demonstrate cardiac involvement in 46 patients (71%) with recent COVID-19, independent of pre-existing conditions. This indicates that there may be widespread cardiac involvement without high troponin values or severe clinical symptoms.

Cardiovascular Involvement in Patients with 2019 Novel Coronavirus Disease.

2019 novel coronavirus disease (COVID-19) is caused by the infection of severe acute respiratory syndrome novel coronavirus (SARS-CoV-2). It is characterized by substantial respiratory symptoms and complicated with widespread other organ injuries. Cardiovascular impairment is one of the notable extrapulmonary manifestations, in terms of the deterioration of pre-existing cardiovascular diseases and newly onset acute events. We hereby review the high-quality reports about cardiovascular involvement in COVID-19 and summarize the main clinical characteristics of cardiac relevance for the all the first line clinical physicians. Additionally, the possible underlying mechanisms and the rationale for the application of specific medications, such as renin-angiotensin-aldosterone system inhibitors and hydroxychloroquine are also discussed.

Imaging of COVID-19: An update of current evidences

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been reported as a global emergency. As respiratory dysfunction is a major clinical presentation of COVID-19, chest computed tomography (CT) plays a central role in the diagnosis and management of patients with COVID-19. Recent advances in imaging approaches using artificial intelligence have been essential as a quantification and diagnostic tool to differentiate COVID-19 from other respiratory infectious diseases. Furthermore, cardiovascular involvement in patients with COVID-19 is not negligible and may result in rapid worsening of the disease and sudden death. Cardiac magnetic resonance imaging can accurately depict myocardial involvement in SARS-CoV-2 infection. This review summarizes the role of the radiology department in the management and the diagnosis of COVID-19, with a special emphasis on ultra-high-resolution CT findings, cardiovascular complications and the potential of artificial intelligence.

Left ventricular systolic dyssynchrony index and endothelial dysfunction parameters as subclinical predictors of cardiovascular involvement in patients with beta‐thalassemia major

Cardiovascular iron load is the leading cause of morbidity and mortality in beta-thalassemia major (β-TM). However, many patients remain asymptomatic until the late stage. In this cross-sectional study, we investigated the role of three-dimensional (3D) echocardiography and endothelial dysfunction parameters in asymptomatic β-TM patients, and the relationship between these parameters and cardiac magnetic resonance imaging (MRI) T2* value. A total of 51 asymptomatic β-TM patients receiving regular blood transfusions were divided into two groups based on cardiac MRI-T2* values (MRI-T2*<20ms and ≥20ms), which MRI-T2*<20ms determines myocardial iron load and evaluated by two-dimensional (2D) and 3D-echocardiography including endothelial dysfunction parameters. The relationships between ferritin levels, 2D and 3D-echocardiography measurements, endothelial dysfunction parameters, and cardiac MRI-T2* values were investigated. All left ventricle ejection fraction (LVEF) obtained by 2D-echocardiography were normal (≥50%). LVEF-3D (53.25±2.33 vs. 58.81+1.02), SDI12 (6.53±0.56 vs. 2.85+0.48), and SDI16 (7.65±0.75 vs. 3.26+0.49) were significantly different and negatively correlated between groups with MRI-T2*<20ms and ≥20ms, respectively. Flow-mediated dilatation (FMD) (6.08%±0.34% vs. 14.46%±1.12), aortic strain (7.79%±2.19% vs. 12.76%±4.19), ferritin levels were significantly different and negatively correlated between groups with MRI-T2*<20ms and ≥20ms, respectively. Higher ferritin, SDI12/16 were significant independent predictors of MR-T2*<20ms. SDI16>5.5, SDI12>4.3 predicted MRI-T2*<20ms with a sensitivity of 92%, specificity of 81% (AUC 0.85, P<.001), and sensitivity of 92%, specificity of 78% (AUC 0.83, P<.001), respectively. SDI12/16 calculated by 3D-echocardiography may be a promising predictors of cardiovascular iron load and, decreased LVEF-3D, FMD, and aortic strain might be good indicators of subclinical cardiovascular involvement of β-TM.

Electrocardiographic findings in non-critical patients with coronavirus disease-2019

Background/Aim: Cardiovascular involvement in patients with coronavirus disease 2019 (COVID-19) is closely related to the course of the disease; however, this issue has not been adequately studied in Turkey. Thus, we aimed to investigate the electrocardiography (ECG) findings in noncritical patients with COVID-19 in Turkey. Methods: This retrospective cohort study was conducted on non-critical patients with COVID-19 with no history of any cardiac disease. The laboratory parameters and ECG findings of the patients at the time of admission were analyzed. Results: In total, 100 patients with a mean age of 56.8 (16.7) years were included in the study, among which 54 were males. The rate of patients having at least one abnormal ECG finding, ST segment pathology, and elevated troponin level were 58%, 26%, and 48%, respectively. The respiratory rate and mean troponin level were higher and the mean lymphocyte count was lower in patients with ST segment pathology than in patients without. The respiratory rate, fibrinogen level, and incidence of T negativity and abnormal ECG findings were higher, and the lymphocyte count was lower in patients with elevated troponin levels than in patients with normal troponin levels (P0.03 mg/mL (P

Cardiovascular involvement after liver transplantation: role of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis

Patients submitted to liver transplantation (LT) are exposed to high risk of cardiovascular (CV) complications which are the main determinants of both short-term and long-term morbidity and mortality in LT. Non-alcoholic fatty liver disease (NAFLD) is a very frequent condition in general population and is associated with a high risk of cardiovascular disease (CVD) which represents the first cause of death of these patients. NAFLD is predicted to become the first indication to LT and nowadays is also frequently detected in patients submitted to LT for other indications. Thus, the risk of CVD in patients submitted to LT is forecasted to increase in the next years. In this review the extent of CV involvement in patients submitted to LT and the role of NAFLD, either recurring after transplantation or as de novo presentation, in increasing CV risk is analysed. The risk of developing metabolic alterations, including diabetes, hypertension, dyslipidemia and weight gain, all manifestations of metabolic syndrome, occurring in the first months after LT, is depicted. The different presentations of cardiac involvement, represented by early atherosclerosis, coronary artery disease, heart failure and arrhythmias in patients with NAFLD submitted to LT is described. In addition, the tools to detect cardiac alterations either before or after LT is reported providing the possibility for an early diagnosis of CVD and an early therapy able to reduce morbidity and mortality for these diseases. The need for long-term concerted multidisciplinary activity with dietary counseling and exercise combined with drug treatment of all manifestations of metabolic syndrome is emphasized.