The direct and indirect adverse effects of SARS-CoV-2 infection on the cardiovascular system, including myocarditis, are of paramount importance. These not only affect the disease course but also determine clinical outcomes and recovery. In this review, the authors aimed at providing an update on the incidence of Coronavirus disease-2019 (COVID-19)-associated myocarditis. Our knowledge and experience relevant to this area continues to evolve rapidly since the beginning of the pandemic. It is crucial for the scientific and medical community to stay abreast of current information. Contrasting early reports, recent data suggest that the overall incidence of SARS-CoV-2-associated myocarditis is relatively low, yet infected individuals are at a substantially increased risk. Therefore, understanding the pathophysiology and diagnostic evaluation, including the use of serum biomarkers and imaging modalities, remain important. This review aims to summarize the most recent data in these areas as they relate to COVID-19-associated myocarditis. Given its increasing relevance, a brief update is included on the proposed mechanisms of myocarditis in COVID-19 vaccine recipients.
Purpose: The SARS-CoV-2 pandemic is changing healthcare delivery around the world with hospital systems experiencing a dramatic decline in patient volumes. Surveying our center’s heart failure (HF) clinic population, we aimed to understand our patients’ perception of coronavirus disease 2019 (COVID-19) and care delivery preferences. Methods: Patients with chronic HF presenting either in-person or virtually were approached to complete a ten question, anonymous, voluntary survey. Acutely decompensated patients and heart transplant recipients were excluded. Results: 109 patients completed the survey. Average age was 62 ± 14 years, 67% were male, and 59% had HF with reduced ejection fraction (HFrEF). Overall, patients were worried about contracting COVID-19 and believed they were prone to more severe infection given their underlying HF. However, they were not hesitant to initiate healthcare contact for symptoms and preferred in-person appointments over virtual visits. Although the difference did not reach statistical significance, female patients and those with HF with preserved ejection fraction (HFpEF) were more concerned. Conclusions: Patients with HF are concerned about their increased risk of contracting COVID-19. However, they are actively seeking healthcare contact and prefer in-person over virtual visits.
coagulopathies, infections, and procedural-related complications. Results: We identified 10 COVID-19 patients with ARDS treated with ECMO. The mean age was 45 years and 70% were male. The racial composition of the patients consisted of Blacks (30%) and Hispanics (70%). Comorbidities included hypertension (40%), diabetes mellitus (50%), and hyperlipidemia (20%). Eight patients were treated with VV-ECMO, and the remaining patients with VA-ECMO. Hospital-acquired infections including ventilator-associated pneumonia and bacteremia were reported in 50% and 30%, respectively. Hemorrhage requiring transfusion was reported in all 10 patients, with 60% of patients having bleeding from a gastrointestinal source. 70% of patients developed thrombocytopenia, and 20% developed a clot within the ECMO circuit. Coagulation disorders reported, included heparin-induced thrombocytopenia (20%), deep vein thrombosis (30%), and pulmonary embolism (20%). 90% of patients died, and 1 patient was discharged to a long-term acute care hospital (See Table 1 for outcomes). Conclusion: Despite using ECMO as rescue therapy, mortality among COVID-19 patients who developed ARDS remained high in minority groups. Further studies are needed to investigate management of COVID-19 related complications.
Introduction Sleep related breathing disorders, including central sleep apnea (CSA), are frequent in patients with heart failure however, only limited data is known about the effect of left ventricular assist device (LVAD) placement on OSA and even less about the accuracy of home sleep apnea testing in this population (HSAT). Performing the gold standard polysomnography (PSG) is challenging in this cohort due to logistics, especially during the COVID-19 pandemic. Extending HSAT to the LVAD population would be beneficial, yet initial tests with the WatchPat® were deemed inconclusive. We decided to evaluate the validity of NOX-T3 device for HSAT compared to PSG. Methods This was a single center prospective, observational study that included LVAD patients who screened positive on the STOP-BANG questionnaire. A sleep study was indicated based on consultation with a sleep physician and a standard PSG was ordered. During the PSG, the NOX-T3 was also applied with the results analyzed and compared after test completion. Results In this preliminary analysis, 4 patients (3 male, 1 female) with a LVAD completed a PSG along with the NOX-T3. The overall severity of sleep apnea indicated by apnea hypopnea index during the PSG and the respiratory event index during the NOX-T3 were similar in this small cohort. In 2 of the 4 patients, the oximetry finding (minutes with oxygen saturations at or below 88%) were also similar during both the PSG and the NOX-T3. Conclusion Based on this preliminary analysis, data obtained with the NOX-T3 system were valid and compared well to the standard of care PSG in patients with a LVAD. We plan to enroll at least 10 patients in this ongoing trial, further studies will be needed to validate these results. Performing HSAT with the NOX-T3 in this unique population if PSG is not feasible would be of significant value given the morbidity of sleep apnea in this population. Support (if any)
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