Kap plan-mayor curve in contrast patients without myocardial injury (panel A) and in contrast patients without myocardial injury according to the presence or absence of major echocardiographic abnormality (panel B). * Abnormalities of wall motion, global left ventricular dysfunction, diastolic dysfunction, right ventricular dysfunction and the presence of pericardial fusion. Every event is censored 20 days after hospitalization. Credit: Mount Sinai Health System
Cardiac ultrasounds (also known as echocardiograms) provide the appearance of the heart and its effects. COVID-19 Virus on patients.
A new study by researchers at the Icon School of Medicine at Mount Sinai has identified a variety of cardiac structural damage experienced by Kovid-19 patients after a heart attack, including heart attack, pulmonary embolism, heart failure and myocarditis. . This abnormality is associated with an increased risk of death in hospitalized patients. Findings published October 26, 2020 Journal of the American College of Cardiology, Offering new insights that can help doctors better understand the mechanism of cardiovascular injury, leading to faster identification of at-risk patients and guidance on future treatments.
“More appropriate treatment, including anticoagulation and other approaches to hospitalized and hospitalized patients, may be prescribed as early as possible for structural abnormalities,” says author Valentin Fuster, MD, PhD, director of Mount Sinai Heart and physician-in-chief of Mount Sinai Hospital.
International, pre-experimental studies have elaborated on previous research on Mount Sinai showing that myocardial injury (heart damage) is prevalent in hospitalized patients with COVID-19 and is associated with an increased risk of mortality. That study focuses on patients’ troponin levels – proteins that are released when the heart muscle is damaged – and their results (truncated troponin levels mean more damage to the heart).
Cardiac structural abnormalities were present in approximately two-thirds of patients with covid-19 who underwent TTE. Cardiac structural abnormalities include right ventricular dysfunction, left ventricular wall motion disorders, global left ventricular dysfunction, diastolic dysfunction, and pericardial effusion. LV = left ventricular. Credit: Mount Sinai Health System
This new work looked at the presence of cardiac troponin elevation with the presence of echocardiographic abnormalities, and found that the combination was associated with worse prognosis and mortality than troponin elevation alone.
“The first and corresponding author of the Cardiology Fellow at Mount Sinai Hospital, Gennaro Giustino MD, explains,” Detailed echocardiographic and electrocardiographic data on the laboratory evidence of myocardial injury in COVID-19 and hospitalized patients. Is the study. “We found that among the Covid-19 patients who underwent transcerosic echocardiography, these cardiac structural disorders were diverse and present in about two-thirds of the patients.”
Researchers performed transcerosic echocardiographic (TTE) and electrocardiographic (TTE) and 305 adult patients with positive COVID-19 admitted to four New York City hospitals within the Mount Sinai Health System (Mount Sinai Hospital, Mount Sinai West, Mount Sinai Queens). , And Mount Sinai Beth Israel), Elmhurst Hospital in Queens and two hospitals in Milan, Italy between March and May 2020. The median age was 63 63 years and .2 67.7 per cent were men. 190 patients (62.6 percent) had evidence of myocardial injury; Of these, 118 suffered heart damage during hospitalization and 72 suffered myocardial injury during hospitalization. Researchers have found that patients with myocardial injury have a higher prevalence of electrocardiographic abnormalities, higher inflammatory biomarkers, and TTE abnormalities than patients without heart injury.
The abnormality was varied, with some patients showing multiple disorders. 26.3 percent had right ventricular dysfunction (which may be associated with pulmonary embolism and severe respiratory failure), 23.7 percent had regional left ventricular wall motion disorders (which may be associated with heart attack), and 18.4 percent had left ventricular dysfunction ( (Associated with heart failure / myocarditis), 13.2 percent had grade II or III diastolic dysfunction (a condition leading to a stiff cardiac chamber), and 7.2 percent had pericardial effusion (excess fluid around the heart that causes abnormal pumping of the heart). Have.
The study focused on hospital mortality and troponin elevation. It showed that troponin elevation was 5.2 percent in patients with myocardial injury without echocardiographic abnormalities, and 31.7 percent in patients with myocardial injury who also had echocardiographic abnormalities. The researchers adjusted for other major complications from COVID-19, including shock, acute respiratory distress syndrome, and renal failure.
“Our study shows that the echocardiogram is performed with consideration of appropriate personal protection, a useful and important tool for early identification of patients at high risk of COVID-19-related cardiac injury who may benefit from an invasive therapeutic approach prior to their hospitalization. The corresponding authors are Martin Goldam, MD, Arthur M. and Hilda A. Master Professor of Medicine (Cardiology) at the Ikahn School of Medicine at Mount Sinai. “Furthermore, because this is a new disease with delayed symptoms, we are evolutionary. We plan to follow up closely with these patients to evaluate and hopefully resolve these cardiac problems. “
“Echocardiograms have been shown to be invaluable in providing serious information to patients with multiple cardiac complaints. Echocardiography is the only imaging modality that can be carried to the bedside and used safely for patients with a ventilator, ”says Lori Croft, associate professor and MD, director of the Icahn School of Medicine in Mount Sinai. Echocardiography Laboratory at Mount Sinai Hospital. “Our findings will help guide the care of Covid-19 patients during critical times.”
Ref: 26 October October 2020, Journal of the American College of Cardiology.
