Effect of COVID-19 medications on corrected QT interval and induction of torsade de pointes: Results of a multicenter national survey

Background: There are some data showing that repurposed drugs used for the Coronavirus disease-19 (COVID-19) have potential to increase the risk of QTc prolongation and torsade de pointes (TdP), and these arrhythmic side effects have not been adequately addressed in COVID-19 patients treated with these repurposed medications. Methods: This is the prospective study of 2403 patients hospitalised at 13 hospitals within the COVID-19 epicentres of the Iran. These patients were treated with chloroquine, hydroxychloroquine, lopinavir/ritonavir, atazanavir/ritonavir, oseltamivir, favipiravir and remdesivir alone or in combination with azithromycin. The primary outcome of the study was incidence of critical QTc prolongation, and secondary outcomes were incidences of TdP and death. Results: Of the 2403 patients, 2365 met inclusion criteria. The primary outcome of QTc � 500 ms and �QTc � 60 ms was observed in 11.2 and 17.6 of the patients, respectively. The secondary outcomes of TdP and death were reported in 0.38 and 9.8 of the patients, respectively. The risk of critical QT prolongation increased in the presence of female gender, history of heart failure, treatment with hydroxychloroquine, azithromycin combination therapy, simultaneous furosemide or beta-blocker therapy and acute renal or hepatic dysfunction. However, the risk of TdP was predicted by treatment with lopinavir-ritonavir, simultaneous amiodarone or furosemide administration and hypokalaemia during treatment. Conclusion: This cohort showed significant QTc prolongation with all COVID-19 medications studied, however, life-threatening arrhythmia of TdP occurred rarely. Among the repurposed drugs studied, hydroxychloroquine or lopinavir-ritonavir alone or in combination with azithromycin clearly demonstrated to increase the risk of critical QT prolongation and/or TdP. © 2021 John Wiley & Sons Ltd

Assessment and comparison of electrocardiographic characteristics of left bundle branch block between patients with and without severe left ventricular dysfunction

Objective: There is a greater risk of mortality and morbidity for patients with left bundle branch block (LBBB). In most cases, LBBB is accompanied by left ventricular dysfunction. We investigated the electrocardiographic characteristics of LBBB patients with and without congestive heart failure to determine parameters for the follow-up of this group of patients. Method: In this cross-sectional study, all patients who referred to our tertiary center with LBBB (with preserved left ventricular function) candidated for cardiac resynchronization therapy were included between January 2007 and January 2008. Electrocardiographic characteristics such as QRS notching, intrinsicoid deflection, and QRS duration were compared between two groups. Result: Seventy-five patients were enrolled (mean age = 60.20±12.55 years, range=18-77). There was a statistically significant relationship between QRS notching in the precordial leads and severe left ventricular dysfunction (72.7 of patients with severe left ventricular dysfunction vs. 27.8 of patients with preserved left ventricular function; p value=0.04). The relationship between QRS notching in the limb leads and severe left ventricular dysfunction was not statistically significant (70.7 in patients with severe left ventricular dysfunction vs. 29.3 in patients with preserved left ventricular function; p value >0.05). Our study showed a significant relationship between QRS wave duration in the precordial and limb leads and severe left ventricular dysfunction (p value 0.05). Conclusion: QRS wave fragmentation (presence of a notch in R or S) may be associated with inactivation and dyssynchronization, both of which can reflect ischemic condition. There are reports of a correlation between this disorder and dyssynchronization; this can be one of the causes of the pathophysiology of congestive heart failure. Increase in QRS duration in the ECG was strongly associated with some changes in left ventricular function and structure, which can be allied to congestive heart failure. Also, dyssynchronization due to LBBB can increase the risk of congestive heart failure

Clinical profile and outcome of familial versus non-familial atrial fibrillation

Background: There is paucity of information on clinical characteristics and outcome of patients with familial atrial fibrillation (AF). The present study was aimed to compare clinical profile and outcome of familial AF with those of non-familial AF. Methods: Between February 2017 and February 2018, we enrolled 738 participants (60 men, median age, 51 years in familial AF vs. 61 years in non-familial AF) from Iranian Registry of AF. All patients were followed for 12 months. Clinical characteristics and main outcome measures for AF patients were obtained from patient's medical records. Results: A positive history of AF in first-degree relative was reported in 15.3 of our AF population. Familial AF group were significantly younger than non-familial group (p = 0.001). Concomitant sinus node dysfunction and cardiomyopathies were more common in familial AF group (p = 0.02, p = 0.004, respectively). Patients with familial AF were also likely to receive cardiac devices and AF catheter ablation (all p 0.05). Conclusions: Familial AF patients were more likely to have associated rhythm disorders and dilated cardiomyopathies. Cardiac interventions were also more common in familial patients. However, they did not differ significantly in their long-term outcome. © 2020 Elsevier B.V

Clinical profile and outcome of familial versus non-familial atrial fibrillation

Background: There is paucity of information on clinical characteristics and outcome of patients with familial atrial fibrillation (AF). The present study was aimed to compare clinical profile and outcome of familial AF with those of non-familial AF. Methods: Between February 2017 and February 2018, we enrolled 738 participants (60 men, median age, 51 years in familial AF vs. 61 years in non-familial AF) from Iranian Registry of AF. All patients were followed for 12 months. Clinical characteristics and main outcome measures for AF patients were obtained from patient's medical records. Results: A positive history of AF in first-degree relative was reported in 15.3 of our AF population. Familial AF group were significantly younger than non-familial group (p = 0.001). Concomitant sinus node dysfunction and cardiomyopathies were more common in familial AF group (p = 0.02, p = 0.004, respectively). Patients with familial AF were also likely to receive cardiac devices and AF catheter ablation (all p 0.05). Conclusions: Familial AF patients were more likely to have associated rhythm disorders and dilated cardiomyopathies. Cardiac interventions were also more common in familial patients. However, they did not differ significantly in their long-term outcome. © 2020 Elsevier B.V

Economic evaluation of programs against COVID-19: A systematic review

Background: The COVID-19 pandemic has become a public health emergency and raised global concerns in about 213 countries without vaccines and with limited medical capacity to treat the disease. The COVID-19 has prompted an urgent search for effective interventions, and there is little information about the money value of treatments. The present study aimed to summarize economic evaluation evidence of preventing strategies, programs, and treatments of COVID-19. Material and methods: We searched Medline/PubMed, Cochrane Library, Web of Science Core Collection, Embase, Scopus, Google Scholar, and specialized databases of economic evaluation from December 2019 to July 2020 to identify relevant literature to economic evaluation of programs against COVID-19. Two researchers screened titles and abstracts, extracted data from full-text articles, and did their quality assessment by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Then, quality synthesis of results was done. Results: Twenty-six studies of economic evaluations met our inclusion criteria. The CHEERS scores for most studies (n = 9) were 85 or higher (excellent quality). Eight studies scored 70 to 85 (good quality), eight studies scored 55 to 70 (average quality), and one study < 55 (poor quality). The decision-analytic modeling was applied to twenty-three studies (88) to evaluate their services. Most studies utilized the SIR model for outcomes. In studies with long-time horizons, social distancing was more cost-effective than quarantine, non-intervention, and herd immunity. Personal protective equipment was more cost-effective in the short-term than non-intervention. Screening tests were cost-effective in all studies. Conclusion: The results suggested screening tests and social distancing to be cost-effective alternatives in preventing and controlling COVID-19 on a long-time horizon. However, evidence is still insufficient and too heterogeneous to allow any definite conclusions regarding costs of interventions. Further research as are required in the future. © 2020 IJS Publishing Group Lt

Using carotid-subclavian artery index and isthmus-descending aorta ratio with cardiac MR for the detection of coarctation

Background: The diagnosis of the coarctation of the aorta is difficult in the presence of complex cardiac defects, congenital disease, or poor echocardiographic window. The carotidsubclavian artery index (CSAI) and the isthmus-descending aorta ratio (I/D) have been used in echocardiography in many studies, but only a few studies have utilized cardiac magnetic resonance imaging (MRI) for the detection of coarctation. Method: In this prospective cohort study, all MRI cases (aged 0-40) with a diagnosis of coarctation between 2010 and 2011 were reviewed. The MRI measurement of the aortic arch was performed in order to calculate the CSAI and the I/D ratio. The CSAI is the ratio of the distal aortic arch diameter to the distance between the left carotid artery and the left subclavian artery and is highly suggestive of a coarctation when it is less than 1.5. The I/D ratio is defined as the diameter of the isthmus to the descending aorta and suggests an aortic coarctation when it is less than 0.64. Results: Sixty-five patients with coarctation had a lower CSAI than the controls (84) (1.27±0.06 vs. 2.82± 0.9; P 0.05). A cut-off point of 1.5 had 96 sensitivity and 76 specificity in the detection of the coarctation of the aorta. The positive and negative predictive values were 84.4 and 94.1, respectively. Conclusion: The association between both indices improved sensitivity and permitted the diagnosis of coarctation in all the patients based solely on cardiac MRI measurements. The CSAI and I/D ratio, independent of clinical status, associated anomalies, age, and sex, are useful tools for detecting aortic coarctation via cardiac MRI. ©2014, Iranian Heart Journal . All rights reserved

Is there any correlation between cerebrospinal fluid and serum c-reactive protein in neonates suspected to meningitis?

Background: Meningitis is a common life threatening infection in neonatal period. Diagnostic value of CSF-CRP level in bacterial meningitis in children and adults has been studied worldwide, but there are limited studies on CSF-CRP in neonatal meningitis. This study conducted to assess any relation between CSF-CRP and plasma CRP levels and abnormal CSF findings in neonates suspected to meningitis. Methods: Seventy five hospitalized neonates suspected to meningitis were enrolled in this cross sectional study. All infants were gone through a complete sepsis workup including blood and CSF CRP. Results: CSF-CRP level had statistically significant correlation with serum WBC (p= 0.048) and also poor correlation with CSF protein level (p= 0.054). Serum CRP level had statistically significant correlation with CSF WBC (p= 0.008). Conclusion: No correlation found between CSF and serum CRP levels of patients in this study. Although, CSF-CRP is a rapid and easy to interpret test, it can be performed alongside CSF cytology and biochemical analysis, smear and culture as a confirmatory test for definite diagnosis of neonatal meningitis. © 2020, Kerman University of Medical Sciences. All rights reserved

Association between ECG changes in patients with ST-elevation myocardial infarction with and without collateral coronary vessels

Background- Myocardial infarction (MI) is the leading cause of morbidity and cardiovascular mortality. The presence of collateral coronary vessels is believed to be a good prognostic factor. Accordingly, this study was performed to compare electrocardiographic (ECG) changes in MI patients with and without collaterals. Methods and Materials- This study was performed as a cross-sectional study among 200 patients admitted for MI in a training hospital in 2011 and 2012. The study population was divided into two categories: patients with collateral coronary vessels and those without them. ECG findings were compared between the two groups. Results- Among the ECG findings, only the QRS pattern in V1 was associated with the presence of collateral vessels. Abnormal QRS axis, pathological Q wave, persistent ST increase/decrease, QRS notch, PR interval, and QRS duration were not related to the presence of collateral vessels (p value > 0.05). Conclusions- According to our results, it may be concluded that ECG changes are not related to the presence of collateral coronary vessels in angiographic assessment. It is recommended that further studies be carried out with evaluation of ECG and after one-month catheterization results of patients to obtain more definite results

Predictors of newly detected atrial fibrillation following dual-chamber permanent pacemaker

Background and aim: Silent atrial fibrillation (AF) detection with stored EGMs (SAFE) registry may identify patients at increased risk for stroke and death. This study evaluated the clinical predictors of newly detected atrial fibrillation in patients following dual-chamber permanent pacemaker (PPM) implantation and time course of AF incidence and development in a general pacemaker population with AF or without AF. Methods: We evaluated 318 patients without documented AF who received dual-chamber PPMs with features that permit detection and storage of information about the date, time of onset, and duration of multiple, sequential episodes of AF. Patients were followed up for one month, six months, and one year. All demographic and clinical data were determined and assessed following PPM implantation. Results: Totally, 318 patients with dual-chamber PPMs were enrolled. New incidence of AF was 18.9. Of these patients, new AF occurrence during a one-month period after PPM implantation was 4.5, after 6 months was 22.7, and after one year of follow-up was 82.1. Also, 57.8 of the new cases of AF experienced several atrial high rate episodes. Greater than 90 cumulative ventricular pacing was a significant predictor - with a risk of 1.6 in the occurrence of AF. Other factors influencing the incidence of AF after the implantation of dual-chamber pulse generators were heart failure, underling sinus node disorder, left ventricular dysfunction, P wave shape showing left atrial enlargement, and severity of ventricular disease. Conclusion: AF episodes develop significantly after dual-chamber PPM implantation in a great number of patients. In this study, the effect of the underlying disease of sinus node, P wave form in the ECG, left ventricular dysfunction, valvular disease, and greater than 90 cumulative right ventricular pacing were determined as factors influencing the incidence of AF after dual-chamber PPM implantation. Also, the risk of AF incidence after one year in our patients with dual-chamber PPMs had an increase. Therefore, we would suggest that the cumulative percentage of ventricular pacing be decreased with a new method to prevent AF incidence

Intravenous magnesium sulfate: new method in prevention of contrast-induced nephropathy in primary percutaneous coronary intervention

Background: Contrast-induced acute kidney injury (CI-AKI) is an adverse consequence of percutaneous coronary interventions which results in significant morbidity and mortality and adds to the costs of diagnostic and interventional cardiology procedures. Various pathophysiological mechanisms have been proposed for CI-AKI and various agents tested for its prevention. There is currently a general agreement that adequate pre-procedural hydration constitutes the cornerstone of prevention, yet there are reports of the use of some other agents with various efficacies. We prospectively tested IV magnesium sulfate (Mg) for CI-AKI prevention. Method and design: This study is a prospective, randomized, open-labeled, single-center clinical trial. We randomly assigned 122 consecutive patients to two groups. The first group was the control group with routine treatment (n = 64), and second group was the study group with routine treatment plus IV magnesium sulfate 1 g just before the procedure (n = 62). Serum creatinine was measured before the procedure and 2 days after the procedure. The primary end point was the occurrence of CI-AKI within 48 h. CI-AKI was defined as 0.5 mg/dl or more increase in serum creatinine or 25 or more increase above baseline serum creatinine. There was no difference in definition if both of these parameters were present. Results: The control and study groups were comparable in the overall predicted risk of CI-AKI. Also, the type and volume of the contrast were not significantly different between the two groups. Following angioplasty, CI-AKI occurred in 17 (26.6 ) patients in the control group and nine (14.5 ) patients in the study group; there was a significant reduction in CI-AKI in the study group (P = 0.01). Additionally, there was no mortality or a need for hemodialysis in either group. Conclusion: In primary PCI patients, the prophylactic use of intravenous Mg can be recommended to be added to traditional hydration for CI-AKI prevention. © 2014, Springer Science+Business Media Dordrecht