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Background: The long coronavirus disease 2019 (COVID-19) syndrome is defined as persistent physical, cognitive and/or psychological symptoms that continue for more than 12 weeks following the acute illness.Methods: In all, 2,646 patients were randomly selected from all individuals who were diagnosed with COVID-19. They were interviewed so as to assess the persistence of symptoms and health-related quality of life. Blood investigations were also taken.Results: The median (interquartile range (IQR)) age was 44 (31–55) years and 48.6% were males. Five per cent had been hospitalised. Follow-up was for a median of 142 days (IQR: 128–161). Twenty-two per cent of the participants claimed that they were feeling worse than they felt before COVID-19. The most common symptoms were anosmia, ageusia, fatigue, shortness of breath, headaches and myalgia. The Short Form-36 questionnaire revealed that 16.4% felt that they were somewhat worse than in the previous year and that hospitalised patients fared worse in all domains except for role-emotional. New-onset diabetes was similar to the rate of undiagnosed diabetes in the background population. Hospitalised patients had significantly higher liver transaminases, fasting plasma glucose, glycated haemoglobin, uric acid, red cell distribution width, mean platelet volume, triglyceride levels and troponin levels but lower estimated glomerular filtration rate and high-density lipoprotein-cholesterol at follow-up.Discussion: A significant proportion of patients were symptomatic at a median follow-up of 142 days and felt worse than 1 year previously. Hospitalised patients had more biochemical and haematological abnormalities compared to non-hospitalised ones, suggesting ongoing inflammation in subjects who were more severely affected by the disease.

Aim: This study aimed to investigate the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on all types of acute cardiac admissions (ACAs) and cardiac mortality in Malta. Methods: Number, characteristics and delay to presentation of ACAs to our institution during the study period (28 February–30 April 2020) were compared with the corresponding 2019 period. Non-parametric correlation analyses between daily SARS-CoV-2 cases in Malta, Italy and the UK and daily ACAs were performed. Differences in cardiac death distribution (community vs. in-hospital) during the two periods were analysed. Results: There was a significant decline in daily ACAs in 2020 (median 3 [IQR 3]) vs. 2019 (median 5 [IQR 4]), p< 0.001. Patient characteristics were comparable. Delay to presentation for 2020 ACAs was significantly higher across all categories (ST-elevation myocardial infarction [STEMI] median: 2019 [1 h, IQR 1] vs. 2020 [4 h, IQR 43.8], p= 0.009; non-ST-elevation-acute coronary syndrome [NSTE-ACS] median: 2019 [4 h, IQR 71] vs. 2020 [48 h, IQR 199], p= 0.001; non-ACS median: 2019 [24 h, IQR 95] vs. 2020 [84 h, IQR 499.8], p< 0.001). There was a significant negative correlation between ACAs and daily Malta SARS-CoV-2 infection cases (rs= −0.298, p= 0.018) but not with cases in Italy and the UK when controlling for Malta cases. Significantly more cardiac deaths occurred in the community in 2020 (107, 61.8%) compared to 2019 (87, 46.8%) (p= 0.004). Conclusion: Fear of SARS-CoV-2 infection led to a significant avoidance of acute cardiac care with an accompanying rise in community cardiac deaths, suggesting a need for better public education on recognising and addressing cardiovascular symptoms.

Gestational diabetes is known to be associated with increased risk for future maternal cardiovascular disease. However, it is not known which gestational glycemic parameters mediate this risk. The study's aim was to assess the relationship between gestational glycemic parameters and gestational diabetes with future cardiometabolic status.

IntroductionRed blood cell distribution width (RDW) is a novel independent marker of cardiovascular disease including heart failure, coronary artery disease and myocardial ischaemia. The aim of the study was to investigate a possible relationship between RDW and myocardial scar burden, as assessed by a MIBI viability scan. A secondary objective was to assess whether there is an association between RDW and left ventricular ejection fraction (LVEF).MethodsThe study comprised 123 subjects with ischaemic heart disease who underwent a myocardial viability scan between June 2008 and July 2014. Haemoglobin, mean corpuscular volume, RDW, platelet count, mean platelet volume (MPV), estimated glomerular filtration rate, fasting blood glucose, liver and lipid profiles were evaluated for all patients. The extent of myocardial scarring and LVEF were noted. Data were analysed using IBM SPSS Statistics 22.0. Univariate followed by multivariate analyses were performed to assess for independent predictors of myocardial scarring and LVEF, respectively.ResultsThe mean age of the study population was 63.5 years; most of the subjects were men. The median LVEF was 31% and median percentage of myocardial scarring was 8.7%. Multivariate analyses revealed that RDW, HDL-cholesterol and alanine transaminase were independent predictors of myocardial scarring while RDW, MPV, LDL-cholesterol and gamma-glutamyl transpeptidase were independent predictors of LVEF.ConclusionsIncreased RDW is an independent predictor both of myocardial scar burden and of impaired left ventricular function in subjects with coronary artery disease.

Despite a generalized belief that women are protected from cardiovascular disease, this remains the leading cause of death in women. This review focuses on differences in symptomatology, diagnostic modalities and therapeutic strategies in women with regard to cardiovascular disease.

Introduction:Long COVID syndrome is defined as physical, cognitive and psychological symptoms that persist for over 12 weeks following the acute illness and are not explained by other diagnosis.Aim:To assess medical and health-related quality of life (HR QOL) outcomes at medium-term follow-up in subjects previously infected with COVID-19.Methods:2646 patients who were diagnosed with COVID-19 infection were randomly selected. They were interviewed to assess for symptoms and HR QOL using a post-COVID questionnaire and Short Form Survey (SF-36) respectively. Blood investigations were taken.Results:The median age was 44 years (IQR 31-55), 49% were males. 5% were hospitalised and 1% intubated. Smokers comprised 17%, 10% were ex-smokers. 17% suffered from hypertension, 11% hyperlipidaemia, ischaemic heart disease was present in 2%, heart failure in 1%, obesity in 18%, chronic kidney disease in 0.2%, chronic respiratory disease in 7% and type 2 diabetes mellitus (DM) in 7%.Median time to follow up was 142 days (IQR 128-161). 22% of participants claimed they felt worse than before. Most common symptoms were anosmia (55%), abnormal taste (53%), fatigue (23%), dyspnoea (23%), headache (20%) and myalgia (15%). The SF-36 survey showed that hospitalized patients fared worse in all domains except for role-emotional.New onset DM was diagnosed in 50 patients, similar to the rate of undiagnosed DM in the population. Hospitalised patients had significantly higher liver transaminases, FPG, HbA1c, uric acid, RDW, MPV, triglyceride levels and troponin levels but lower eGFR and HDL-cholesterol at follow-up. The differences in RDW, MPV, triglyceride, GGT and FPG remained significant after adjusting for confounders (Table 1).Conclusions:A significant proportion of post-COVID patients were symptomatic at medium-term follow-up. Hospitalised patients had more biochemical and haematological abnormalities, suggesting ongoing inflammation in those more severely affected.

Peripartum cardiomyopathy is a form of dilated cardiomyopathy of indeterminate aetiology occurring in late pregnancy or the months following delivery. This article reviews current knowledge of its pathophysiology, therapeutic strategies and prognosis, as well as new treatments and future directions.

Coronary chronic total occlusions occur in a third of patients with coronary artery disease but percutaneous coronary intervention is attempted in a minority. The benefits and limitations of percutaneous coronary intervention for chronic total occlusion are discussed together with suggested management and future directions.

Stress echocardiography and nuclear stress imaging are important non-invasive tools in clinical cardiology. This review discusses the uses, strengths and limitations of these imaging modalities and looks at whether stress echocardiography can actually replace nuclear stress imaging.

Introduction:Cascade family screening in inherited heart disease is often reserved for probands with a clinical diagnosis. This study assessed the yield of family screening in a national cardiac screening program, comparing a clinical and a clinical/genetic screening algorithm.Methods:2708 teens (14-16 years) participated in a national cardiac screening program. Probands with suspected or confirmed inherited cardiac disease were evaluated clinically and genetically (216 cardiac gene panel). Relatives were subjected to a standard clinical screening protocol. Segregation analysis (Sanger sequencing) was performed in families with gene positive (G+) probands (VUS, likely or definite pathogenic mutations as per ACMJ criteria). Cascade screening was limited to a) first degree relatives and/or b) G+ individuals in the presence or absence (not exceeding two generations) of a clinical phenotype. A standard clinical algorithm (family screening in probands with a pre-clinical or clinical diagnosis) was compared with a genetic lead algorithm.Results:2(0.1%) probands were diagnosed with a cardiac phenotype (n=1 HCM, n=1 LQTS). Another 17(0.6%) probands had evidence of pre-clinical disease. 81 relatives (60.5% female) underwent evaluation, mean age 41.1±16.7 at first evaluation. 11 families (57.9%) were G+. 54(66.7%) were first degree relatives. 12(14.2%) were screened because of a phenotype in the proband, 57(70.4%) because of a pre-clinical ECG. Another 12(14.8%) were screened because of the family genotype, translating into a 7.4% higher referral rate. The diagnostic yield was higher in the presence of a proband phenotype (41.7% vs 4.3%, p=0.001). Using a standard clinical algorithm, the diagnostic yield of family screening was 10.1% (n=2 HCM, n=5 LQTS). Adding genetics to the algorithm identified another individual (n=1 DCM), equating to a mildly decreased overall yield of 9.9%. The yield between both algorithms was not significantly different (p=0.956).Conclusion:The yield of family screening in probands with a pre-clinical phenotype or clinical diagnosis was 10.1%. This was similar (9.9%) when incorporating genetic testing in the algorithm. The added benefit of systematic genetic testing in a family screening program is limited.

We evaluated the sensitivity and specificity of exercise-induced ST segment elevation for the detection of residual myocardial viability.

Williams' syndrome is a rare condition that is associated with severe cardiovascular manifestations. We report a patient with Williams' syndrome who also has isolated obstruction of the right ventricular infundibulum, an association that, to the best of our knowledge, has not been previously reported.