Cardiomyopathy in COVID-19 Survivors: Mechanism, Management, and Prevention

Coronavirus disease (COVID-19) caused by infection of SARS-CoV-2 as of April 2020 has been confirmed  in more than 2.3 million people, with more than 150 thousands deaths across the globe. It has been known that COVID-19 patients with underlying cardiovascular diseases and its risks including: hypertension, diabetes, coronary artery disease, and cerebrovascular diseases may develop more severe respiratory track symptoms requiring intensive care. Some patients may presenting with myocarditis or acute cardiomyopathy, which has high mortality and morbidity. There was also evidence of myocardial Injury with an increase of troponin in one-third of those infected by covid-19.  It is conceivable that among those who recover from COVID-19 infection, there is a risk of developing further cardiomypathy once the pandemic receding in the future. It is important to pay attention to this survivor group since the pandemic may be lasting for longer period. Optimal medical treatment and comprehensive prevention should be taken to manage those high risk patients of developing cardiomyopathy during hospital care as well post discharge. These includes provide best available COVID-19 drugs, cardiovascular medications, and social preventive measures.Coronavirus disease (COVID-19) caused by infection of SARS-CoV-2 as of April 2020 has been confirmed  in more than 2.3 million people, with more than 150 thousands deaths across the globe. It has been known that COVID-19 patients with underlying cardiovascular diseases and its risks including: hypertension, diabetes, coronary artery disease, and cerebrovascular diseases may develop more severe respiratory track symptoms requiring intensive care. Some patients may presenting with myocarditis or acute cardiomyopathy, which has high mortality and morbidity. There was also evidence of myocardial Injury with an increase of troponin in one-third of those infected by covid-19.  It is conceivable that among those who recover from COVID-19 infection, there is a risk of developing further cardiomypathy once the pandemic receding in the future. It is important to pay attention to this survivor group since the pandemic may be lasting for longer period. Optimal medical treatment and comprehensive prevention should be taken to manage those high risk patients of developing cardiomyopathy during hospital care as well post discharge. These includes provide best available COVID-19 drugs, cardiovascular medications, and social preventive measures

Menilai Doppler Jaringan pada Gagal Jantung: Perlukah ?

Gagal jantung kongestif (C?F) telah diketahui merupakan penyakit kardiovaskular yang menjadi masalah kesehatan di Indonesia maupun di banyak negara lainnya. Berbagai metode diagnostik dikembangkan untuk penegakan diagnosis dan evaluasi tata laksana pasien. Pemeriksaan peptida natriuretik seperti Brain natriuretic peptide (BNP) maupun N-terminal pro-BNP (NT-BNP) telah umum dilakukan untuk kep-erluan diagnostik maupun evaluasi terapi CHF. Akan tetapi pemeriksaan biomarker tersebut relatif mahal, terutama bila dilakukan secara serial untuk mengetahui keberhasilan terapi. Pada CHF timbulnya gejala dan tanda telah diketahui terkait dengan tingginya tekanan baji pul-monal (PCWP). Keberhasilan terapi dan perbaikan klinis, kapasitas fungsional serta prognosis pasien CHF tentunya juga terkait dengan seberapa jauh terapi yang diberikan mampu menurunkan PCWP tersebut

Right Ventricular Function Assessment Using Speckle Tracking Method In Chronic Obstructive Pulmonary Disease

Background In daily practice, evaluation of RV useful in patients with COPD because of its affect prognostic value. Invasive and non-invasive imaging in the evaluation of RV function has several limitations because RV geometry. Speckle tracking is a modality of echocardiography. Speckle tracking can determine strain of myocardium. When compared with strain derived Tissue Doppler, Speckle tracking strain independent of angle so that the measurement of strain to be more reliable. And so far RV assessment with Speckle tracking is still a less investigated. Is there any difference between RV function on echocardiography examination using Speckle tracking methods with varying degrees of COPD? Methods Cross-sectional study conducted in 59 people with COPD who had performed spirometry examination for the classification of severity COPD. Then the patient performed an echocardiography examination using Speckle tracking methods. Then Data will analyze by testing the difference between Speckle tracking and the severity of COPD and also between Speckle track-ing and pulmonary hypertension. Result There COPD subjects 10.2% and 37.3% mild COPD subject was, with men more than women. There were no significant differences between the severity of COPD and right ventricular function using Speckle tracking method. There is a global strain value was higher in non-pulmonary hyper-tension subjects when compared with pulmonary hypertension subjects but the difference was not significant (p = 0.09). Conclusion There were no significant differences between the severity of COPD and RV function using Speckle tracking methods

Endovascular management of aortic aneurysm with severe neck angulation and/or iliac artery tortuosity using multiple stiff wire technique: a case series [version 2; peer review: 2 approved]

Background Suitable aortic neck is one of the essential components for thoracic endovascular aortic repair (TEVAR) and endovascular aortic repair (EVAR). Advanced techniques were developed to adjust and compromise the aneurysm neck angulation but with adding additional devices and complexity to the procedure. We proposed a simple technique to modify severe neck angulation and/or iliac artery tortuosity by using the multiple stiff wire (MSW) technique. Method Two femoral accesses were required for the MSW technique. A guidewire with a support catheter was inserted through the right and left femoral arteries and positioned in the abdominal or thoracic aorta. Wire exchanges were done with extra stiff wire in both femoral accesses. It can be considered to add multiple stiff wires to align the torturous neck / iliac artery. Delivery of the stent graft main body can be done via one of the accesses. Result Six patients with different aortic pathology were admitted to our hospital. Four patients undergo EVAR procedure and two patients undergo TEVAR procedure. All patients had aortic neck angulation problems with one patient having iliac artery tortuosity. MSW technique was performed on the patients with good results. Follow-up CTA after 3 months revealed a good stent position without stent migration and no endoleak was found in all but one patient. Conclusion MSW technique is a simple and effective technique to modify aortic neck/iliac artery angulation in TEVAR or EVAR procedure

Methylenetetrahydrofolate Reductase C677T Gene Polymorphism as a Risk Factor for Hypertension in a Rural Population

Hypertension remains a public health burden despite advances in its management. Hence, the search for further risk stratification tools and prevention and new treatment approaches continues. Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism is associated with hypertension. Interestingly, riboflavin, as a cofactor of MTHFR, may control blood pressure in patients with mutant MTHFR variants. These double benefits of a risk stratification tool and treatment approach make it interesting. Because this polymorphism depends on ethnicity and geographic region, we aimed to determine the association between MTHFR C677T gene polymorphism and hypertension in a rural Indonesian-Sundanese population. This population-based case-control study included 213 hypertensive subjects and 202 nonhypertensive subjects as controls. The TaqMan assay was used to determine the MTHFR C677T genotypes. The odds ratio (OR) with 95% confidence interval (CI) was used to assess the risk of association. There was a significant difference in MTHFR C677T allele frequencies between the hypertensive and control groups (62.9% CC, 34.3% CT, 2.8% TT vs. 77.7% CC, 20.8% CT, 1.5% TT; p=0.004) and between mutant (TT and CT) and wild-type genotypes (CC) (p=0.001). The mutant genotype was associated with a risk of hypertension (OR 2.1; 95% CI 1.3–3.5) when adjusted for age, body mass index, waist circumference, and diabetes mellitus. The mutant of the MTHFR C677T gene increases the risk of hypertension in rural Indonesian-Sundanese population. These findings may be used in future studies to evaluate the effect of riboflavin supplementation in this population

Insiden gejala menetap dan gambaran ekokardiografi pasca infensi COVID-19 ringan

Background: Survived from COVID-19 infection, some patients yet have residual symptoms. Multi-organ and mechanisms of disease can be involved. The data regarding echocardiographic dimension and function of the cardiac in the COVID-19 survivors remains scarce. Method: This was a descriptive cross-sectional study that involves a total of 63 subjects. Subjects were employees and medical residents at National Cardiovascular Center Harapan Kita, who previously get infected by COVID-19. Each subject was examined transthoracic echocardiography once at the time of recruitment. Echocardiographic parameters obtained in this study included dimension and systolic function of the left ventricle and right ventricle, global longitudinal strain by 2D speckle tracking echocardiography, and myocardial work index. Result: More than a half of the subjects experienced persistent symptoms after recovery from COVID-19 infection and mainly was fatigue (33.3%). The timing of data acquisition on the median was 32 days after the negative of the COVID-19 test result. 2D echocardiography measurement of left ventricle indicated mean of end-diastolic diameter and end-systolic diameter was 45 mm and 27 mm, respectively. The mean ejection fraction (EF) of the left ventricle by Simpson’s biplane method was 61%. The median of tricuspid annular plane systolic excursion (TAPSE) parameter was 23 mm and the fractional area change (FAC) parameter was 39%. The mean of global longitudinal strain (GLS) was -19.6%.   Conclusion: After recovery from COVID-19 infection, some survivors may have post-acute infectious consequences of COVID-19 such as fatigue, dyspnea, and malaise. However, echocardiographic findings in those patients with mild symptoms, including 2D echocardiography, myocardial strain analysis, and myocardial work index, indicate normal dimension and systolic function in both left ventricle and right ventricle

Increase in the risk of clopidogrel resistance and consequent TIMI flow impairment by DNA hypomethylation of CYP2C19 gene in STEMI patients undergoing primary percutaneous coronary intervention (PPCI)

Abstract Clopidogrel resistance is an important risk factor of ischemic event recurrence after optimal antiplatelet therapy. This study aims to investigate the role of CYP2C19 gene DNA methylation as one of the epigenetic factors for the risk of clopidogrel resistance in STEMI patients undergoing PPCI. ST‐segment elevation myocardial infarction (STEMI) patients undergoing PPCI were pretreated with clopidogrel, and their platelet function was measured using VerifyNow™ assay. The criteria for high on‐treatment platelet reactivity (HPR) were defined according to the expert consensus criteria (PRU >208). DNA methylation of the CYP2C19 gene was performed using bisulfite genomic sequencing technology. Furthermore, clinical, laboratory, and angiographic data including TIMI flow were collected. Among 122 patients, clopidogrel resistance was found in 22%. DNA methylation level percentage was lower in the clopidogrel resistance group (76.7 vs. 88.8, p‐value .038). But, the <50% methylation group was associated with increased risk of clopidogrel resistance (OR =4.5, 95%CI =2.1–9.3, p‐value = .018). This group was also found to have suboptimal post‐PCI TIMI flow (OR =3.4 95%CI =1.3–8.7, p‐value =.045). The lower DNA methylation level of the CYP2C19 gene increases the risk of clopidogrel resistance and subsequent poorer clinical outcome

Detecting Left Heart Failure in Echocardiography through Machine Learning: A Systematic Review

Background: Heart failure remains a considerable burden to healthcare in Asia. Early intervention, mainly using echocardiography, to assess cardiac function is crucial. However, due to limited resources and time, the procedure has become more challenging during the COVID-19 pandemic. On the other hand, studies have shown that artificial intelligence (AI) is highly potential in complementing the work of clinicians to diagnose heart failure accurately and rapidly. Methods: We systematically searched Europe PMC, ProQuest, Science Direct, PubMed, and IEEE following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and our inclusion and exclusion criteria. The 14 selected works of literature were then assessed for their quality and risk of bias using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). Results: A total of 2105 studies were retrieved, and 14 were included in the analysis. Five studies posed risks of bias. Nearly all studies included datasets in the form of 3D (three dimensional) or 2D (two dimensional) images, along with apical four-chamber (A4C) and apical two-chamber (A2C) being the most common echocardiography views used. The machine learning algorithm for each study differs, with the convolutional neural network as the most common method used. The accuracy varies from 57% to 99.3%. Conclusions: To conclude, current evidence suggests that the application of AI leads to a better and faster diagnosis of left heart failure through echocardiography. However, the presence of clinicians is still irreplaceable during diagnostic processes and overall clinical care; thus, AI only serves as complementary assistance for clinicians