Comprehensive Left Ventricular Mechanics Analysis by Speckle Tracking Echocardiography in COVID-19

Background: Cardiac involvement and the consequences of inflammation induced by SARS-CoV2 infection could have catastrophic long-term consequences. Left ventricular mechanics could identify a specific pattern of myocardial fiber damage in patients infected with COVID-19. To our knowledge there are no publications referring to the global description of ventricular mechanics in patients with COVID-19. Objective: To describe left ventricular mechanics in hospitalized patients with COVID-19. Methods: In this cross-sectional study, we included 40 hospitalized patients with confirmed diagnostic of COVID-19, from April 11, 2020, to September 6, 2020. Demographic and laboratory data, clinical and echocardiographic characteristics were collected, as well as events during hospitalization. Left ventricular deformation was analyzed and reported. Results: Subclinical dysfunction was observed in 82.5% (left ventricular longitudinal strain [LVGLS] -17.05% and global circumferential strain [GCS] -18.6%) of the patients, likewise, the mean twist and apical rotation were preserved, and even increased as part of the compensating mechanism to maintain the ejection fraction. Conclusion: In patients hospitalized with COVID-19, despite having a normal left ventricular ejection fraction, subclinical myocardial damage was found, manifested by a decrease in Global Longitudinal Strain (GLS) and Global Circumferential Strain (GCS). This behavior is similar to that of cardiomyopathies in the early stage of the disease, and given the pathophysiological mechanisms involved in the disease, its long-term consequences should be monitored and evaluated.

Risk Factors for Starr-Edwards Prosthetic Valve Dysfunction: New Insights into an Old Prosthesis

Background: Starr-Edwards prosthetic valves were used for valve replacement, but due to their high thrombogenic risk, they were withdrawn from market. Nevertheless, there are some cases of Starr-Edwards prosthetic valve carriers that have shown long-term survival reaching up to 50 years. The objective of this study was to determine survival in 12 patients with mechanical Starr-Edwards?prosthetic valve and risk factors for predicting valve dysfunction. Methods: Cross-sectional study of patients who had valve replacement with a Starr-Edwards prosthetic valve in a single center from 1968 to 1990. Socio-demographic data, valvular dysfunction variables and mortality were recorded. Logistic regression models to determine valvular dysfunction were constructed. Survival was analyzed with Cox regression and Kaplan-Meier survival curves. Results: A total of 12 patients were analyzed. The median age was 59 years (48.5 - 64). Eleven patients had normal right and left ventricular function. The most common cause of valve replacement was rheumatic valve disease (75%) and it was more frequently in mitral position (50%). Valvular dysfunction was detected in 3 patients (25%). Atrial fibrillation had the highest association with valvular dysfunction (P = 0.005). Stroke was seen in 25% of the population and the overall mortality was 33.3%. Conclusions: The survival of patients with Starr-Edwards prosthetic valve was 66.66% in the 50-year follow-up. Atrial fibrillation had the highest association with prosthetic valvular dysfunction.