Background
Myocardial injury is a complication of coronavirus disease 2019 (COVID-19). We describe a large multi-center experience of COVID-19 patients with myocardial injury, examining the prognostic role left ventricular function plays on short-term outcomes.
Methods/Materials
We included adult COVID-19 patients admitted to our health system with evidence of myocardial injury and who underwent a transthoracic echocardiogram (TTE) during index admission. Patients were dichotomized into those with reduced ejection fraction (EF; <50%) and preserved EF (
>
50%).
Results
Across our 11-hospital system, 5032 adult patients were admitted with COVID-19 from March-September 2020. Of these, 235 had evidence of myocardial injury (troponin
>
1 ng/mL). Included were 134 patients who underwent TTE, of whom 43.3% (n=58) had reduced EF and 56.7% (n=76) preserved EF. A subset of 6 patients had newly reduced EF, with 5 demonstrating evidence of stress cardiomyopathy and subsequently dying. Overall, mortality was high in those with reduced EF and preserved EF (in-hospital: 34.5% vs. 28.9%; p=0.494; 6 months: 63.6% vs. 50.0%; p=0.167; Kaplan-Meier estimates: p=0.2886). Readmissions were frequent in both groups (30 days: 22.2% vs. 26.0%; p=0.162; 6 months: 52.0% vs. 54.5%; p=0.839).
Conclusions
Many COVID-19 patients admitted with evidence of myocardial injury did not undergo TTE. For those who did, short-term mortality was high. Patients who survived hospitalization had frequent readmissions. In patients with newly reduced EF, most had evidence of stress cardiomyopathy and expired. Larger studies are needed to fully evaluate the prognosis of COVID-19 patients with evidence of myocardial injury and left ventricular dysfunction.
Aims
Neurogenic stunned myocardium (NSM) has heterogeneous presentations for acute ischemic stroke (AIS) and aneurysmal subarachnoid hemorrhage (SAH). We sought to better define NSM and differences between AIS and SAH by evaluating individual left ventricular (LV) functional patterns by speckle tracking echocardiography (STE).
Methods
We evaluated consecutive patients with SAH and AIS. Via STE, LV longitudinal strain (LS) values of basal, mid, and apical segments were averaged and compared. Different multivariable logistic regression models were created by defining stroke subtype (SAH or AIS) and functional outcome as dependent variables.
Results
One hundred thirty‐four patients with SAH and AIS were identified. Univariable analyses using the chi‐squared test and independent samples t‐test identified demographic variables and global and regional LS segments with significant differences. In multivariable logistic regression analysis, when comparing AIS to SAH, AIS was associated with older age (OR 1.07, 95% CI 1.02–1.13, p = 0.01), poor clinical condition on admission (OR 7.74, 95% CI 2.33–25.71, p < 0.001), decreased likelihood of elevated admission serum troponin (OR .09, 95% CI .02–.35, p < 0.001), and worse LS basal segments (OR 1.18, 95% CI 1.02–1.37, p = 0.03).
Conclusion
In patients with neurogenic stunned myocardium, significantly impaired LV contraction by LS basal segments was found in patients with AIS but not with SAH. Individual LV segments in our combined SAH and AIS population were also not associated with clinical outcomes. Our findings suggest that strain echocardiography may identify subtle forms of NSM and help differentiate the NSM pathophysiology in SAH and AIS.
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