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Biventricular strain by speckle tracking echocardiography in COVID-19: findings and possible prognostic implications

Krishnamoorthy, Parasuram; Croft, Lori B; Ro, Richard; Anastasius, Malcolm; Zhao, Wenli; Giustino, Gennaro; Argulian, Edgar; Goldman, Martin E; Sharma, Samin K; Kini, Annapoorna; Lerakis, Stamatios
The COVID-19 infection adversely affects the cardiovascular system. Transthoracic echocardiography has demonstrated diagnostic, prognostic and therapeutic utility. We report biventricular myocardial strain in COVID-19. Methods: Biventricular strain measurements were performed for 12 patients. Patients who were discharged were compared with those who needed intubation and/or died. Results: Seven patients were discharged and five died or needed intubation. Right ventricular strain parameters were decreased in patients with poor outcomes compared with those discharged. Left ventricular strain was decreased in both groups but was not statistically significant. Conclusion: Right ventricular strain was decreased in patients with poor outcomes and left ventricular strain was decreased regardless of outcome. Right ventricular strain measurements may be important for risk stratification and prognosis. Further studies are needed to confirm these findings.
PMCID:7405100
PMID: 32749151
ISSN: 1744-8298
CID: 5285252

Insights into functional mitral regurgitation using transillumination rendering

Ramirez, Roberto H; Ro, Richard; Lerakis, Stamatios; Argulian, Edgar
Secondary mitral regurgitation has been originally explained by tethering of the structurally normal mitral leaflets or by mitral annular dilation after atrial remodeling. Advances in echocardiography have provided more insights into functional anatomy of the mitral valve leaflets as active participants in this entity.
PMID: 33963775
ISSN: 1540-8175
CID: 5285282

Two cases of acute endocarditis misdiagnosed as COVID-19 infection

Hayes, Dena E; Rhee, David W; Hisamoto, Kazuhiro; Smith, Deane; Ro, Richard; Vainrib, Alan F; Bamira, Daniel; Zhou, Fang; Saric, Muhamed
The COVID-19 pandemic has presented countless new challenges for healthcare providers including the challenge of differentiating COVID-19 infection from other diseases. COVID-19 infection and acute endocarditis may present similarly, both with shortness of breath and vital sign abnormalities, yet they require very different treatments. Here, we present two cases in which life-threatening acute endocarditis was initially misdiagnosed as COVID-19 infection during the height of the pandemic in New York City. The first was a case of Klebsiella pneumoniae mitral valve endocarditis leading to papillary muscle rupture and severe mitral regurgitation, and the second a case of Streptococcus mitis aortic valve endocarditis with heart failure due to severe aortic regurgitation. These cases highlight the importance of careful clinical reasoning and demonstrate how cognitive errors may impact clinical reasoning. They also underscore the limitations of real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 testing and illustrate the ways in which difficulty interpreting results may also influence clinical reasoning. Accurate diagnosis of acute endocarditis is critical given that surgical intervention can be lifesaving in unstable patients.
PMID: 33715241
ISSN: 1540-8175
CID: 4817282

A FAREWELL TO ARDS: PAPILLARY MUSCLE RUPTURE FROM INFECTIVE ENDOCARDITIS MASQUERADING AS COVID PNEUMONIA [Meeting Abstract]

Medamana, John L.; Leone, Sarah; Vani, Anish; Jaspan, Vita; Ro, Richard; Kadosh, Bernard; Hisamoto, Kazuhiro; Smilowitz, Nathaniel
ISI:000647487501990
ISSN: 0735-1097
CID: 5264832

Characterization of Myocardial Injury in Patients With COVID-19

Giustino, Gennaro; Croft, Lori B; Stefanini, Giulio G; Bragato, Renato; Silbiger, Jeffrey J; Vicenzi, Marco; Danilov, Tatyana; Kukar, Nina; Shaban, Nada; Kini, Annapoorna; Camaj, Anton; Bienstock, Solomon W; Rashed, Eman R; Rahman, Karishma; Oates, Connor P; Buckley, Samantha; Elbaum, Lindsay S; Arkonac, Derya; Fiter, Ryan; Singh, Ranbir; Li, Emily; Razuk, Victor; Robinson, Sam E; Miller, Michael; Bier, Benjamin; Donghi, Valeria; Pisaniello, Marco; Mantovani, Riccardo; Pinto, Giuseppe; Rota, Irene; Baggio, Sara; Chiarito, Mauro; Fazzari, Fabio; Cusmano, Ignazio; Curzi, Mirko; Ro, Richard; Malick, Waqas; Kamran, Mazullah; Kohli-Seth, Roopa; Bassily-Marcus, Adel M; Neibart, Eric; Serrao, Gregory; Perk, Gila; Mancini, Donna; Reddy, Vivek Y; Pinney, Sean P; Dangas, George; Blasi, Francesco; Sharma, Samin K; Mehran, Roxana; Condorelli, Gianluigi; Stone, Gregg W; Fuster, Valentin; Lerakis, Stamatios; Goldman, Martin E
BACKGROUND:Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data. OBJECTIVES/OBJECTIVE:This study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19. METHODS:We conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization. RESULTS:A total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities. CONCLUSIONS:Among patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.
PMID: 33121710
ISSN: 1558-3597
CID: 4646832

Characteristics and Outcomes of Patients Deferred for Transcatheter Aortic Valve Replacement Because of COVID-19

Ro, Richard; Khera, Sahil; Tang, Gilbert H L; Krishnamoorthy, Parasuram; Sharma, Samin K; Kini, Annapoorna; Lerakis, Stamatios
PMID: 32997121
ISSN: 2574-3805
CID: 5285262

Recent clinical trials in valvular heart diseases

Goel, Sunny; Ro, Richard; Lerakis, Stamatios; Khera, Sahil
PURPOSE OF REVIEW/OBJECTIVE:In recent years, no other field of cardiology has experienced a greater influx of transformational therapeutic options as valvular heart disease. The present review discusses the landmark trials published in the last 18 months that have shaped the modern day management of valvular heart diseases. RECENT FINDINGS/RESULTS:There have been several landmark trials in recent years, which have expanded the indications for transcatheter aortic valve replacement to low-risk surgical patients and the use of MitraClip for patients with functional mitral regurgitation. Options for transcatheter management of right-sided valvular disease also continue to evolve, including promising results from early feasibility studies. SUMMARY/CONCLUSIONS:The development of novel transcatheter therapies for valvular heart disease has expanded the armamentarium of physicians treating patients with valvular heart disease. The present review will focus on the recent (within 2 years) trials in this field of interest.
PMID: 32398605
ISSN: 1531-7080
CID: 4482282

A Novel Method to Quantify Leaflet Insertion During Transcatheter Mitral Valve Repair With the MitraClip [Letter]

Tang, Gilbert H L; Ro, Richard J; Sengupta, Aditya; Khera, Sahil; Sharma, Samin K; Kini, Annapoorna; Lerakis, Stamatios
PMID: 32222438
ISSN: 1876-7605
CID: 4482272

Murphy's Law or Domino Effect: Severe Aortic Annular Calcification in Transcatheter Aortic Valve Replacement

Ro, Richard; Tang, Gilbert H L; Khera, Sahil; Krishnamoorthy, Parasuram; Sharma, Samin K; Kini, Annapoorna; Lerakis, Stamatios
PMID: 32208736
ISSN: 1942-0080
CID: 4482262

Echocardiographic Imaging for Transcatheter Tricuspid Edge-to-Edge Repair

Ro, Richard; Tang, Gilbert H L; Seetharam, Karthik; Khera, Sahil; Sharma, Samin K; Kini, Annapoorna S; Lerakis, Stamatios
PMID: 32089056
ISSN: 2047-9980
CID: 4482252