Background Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data. Objectives This study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19. Methods We conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization. Results A total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities. Conclusions Among patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.

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Gerbode defect, left ventricular to right atrial communicationLeft ventricular to right atrial (LV-RA) communications were first described in the 19th century by Thurman. 1 It was not until 1958, however, that interest in this lesion was renewed following the publication by Gerbode et al. 2 of a series of five patients who underwent successful surgical repair. We present herein a case of an acquired Gerbode defect discovered in a young female during pregnancy.A 30-year-old asymptomatic female was referred to our hospital's cardiology clinic for evaluation of a murmur discovered by her obstetrician in her 18th week of an otherwise uncomplicated pregnancy. At the age of 17, the patient underwent operative repair of a perimembranous ventricular septal defect (VSD). She remained asymptomatic postoperatively and did not seek medical attention until she became pregnant. On examination, there was wide splitting of the second heart sound and a grade 3/6 systolic murmur which was best heard along the left sternal border. A 12-lead electrocardiogram demonstrated normal sinus rhythm at 75 beats per minute with an incomplete right bundle branch block.

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