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Purpose: Here, we describe cardiac magnetic resonance imaging (CMR) findings in patients with proven COVID-19 infection and presenting with cardiac problems both at presentation and in convalescence from a tertiary care center, in North India. A pertinent review of the literature is also discussed. Materials and Methods: Retrospective analysis of patients with real-time reverse transcriptase-polymerase chain reaction proven COVID-19 infection either at presentation or convalescence referred for CMR at our facility from January 2021 to December 2023 was done. CMR was performed on a 3T system (Ingenia, Philips Healthcare, Best, The Netherlands) and examinations were customized according to the clinical indications. Results: Retrospective analysis yielded 14 patients (4 at presentation; 10 in convalescence). Patients at presentation 4/14 had clinically presented with chest pain with raised troponins and electrographic abnormalities, while 10/14 patients had presented with clinical features of heart failure with two-dimensional transthoracic echocardiography demonstrating systolic dysfunction with reduced left ventricular ejection fraction. Out of 14, 4 patients at presentation, CMR showed features of acute myocarditis in three patients, while one had inferior wall myocardial infarction (MI) (this patient on catheter angiogram had aneurysmally dilated coronary arteries with thrombus and stenosis in the mid right coronary artery which was successfully stented). Out of 14, 10 patients on CMR had features of dilated cardiomyopathy (DCMP). Conclusion: Cardiac involvement in COVID-19 can have vivid clinicoradiological presentations with features of myocarditis and MI at presentation or DCMP in convalescence. CMR in such cases is a problem-solving tool where myocarditis is candidly differentiated from MI. Moreover, follow-up CMR demonstrates temporal changes in COVID-19-associated myocarditis and evaluation of cardiac structure and function in patients presenting with DCMP. [ABSTRACT FROM AUTHOR]

Summary: Background: Point‐of‐care echocardiography (POC‐Echo) is an essential intensive care hemodynamic monitoring tool. Aims: To assess POC‐Echo parameters [i.e., cardiac index (CI), systemic vascular resistance index (SVRI) and cirrhotic cardiomyopathy (CCM) markers] and serum biomarkers in predicting circulatory failure (need for vasopressors) and mortality in patients with acute‐on‐chronic liver failure (ACLF) having sepsis‐induced hypotension. Methods: We performed serial POC‐Echo within 6 hours (h) of presentation and subsequently at 24, 48 and 72 h in patients with ACLF and sepsis‐induced hypotension admitted to our liver intensive care unit. Clinical data, POC‐Echo data and serum biomarkers were collected prospectively. Results: We enrolled 120 patients [59% men, aged 49 ± 12 years, 56% alcohol‐related disease and median MELDNa of 30 (27–32)], of whom 68 (56.6%) had circulatory failure, with overall mortality of 60%. CCM was present in 52.5%. The predictors of circulatory failure were CI (aHR −1.5; p = 0.021), N‐terminal brain natriuretic peptide (aHR −1.1; p = 0.007) and CCM markers; e′ septal mitral velocity (aHR −0.5; p = 0.039) and E/e′ ratio (aHR −1.2; p = 0.045). Reduction in CI by 20% and SVRI by 15% at 72 h predicted mortality with a sensitivity of 84% and 72%, and specificity 76% and 65%, respectively (p < 0.001). The MELD‐CCM model and CLIF‐CCM model were computed as MELDNa + 1.815 × E/e′ (septal) + 0.402 × e′ (septal) and CLIF‐C ACLF + 1.815 × E/e′ (septal) + 0.402 × e′ (septal), respectively, based on multivariable logistic regression. Both scores outperformed MELDNa (z‐score = −2.073, p = 0.038) and CLIF‐C ACLF score (z score = −2.683, p‐value = 0.007), respectively, in predicting 90‐day mortality. Conclusion: POC‐Echo measurements such as CCM markers (E/e' and e' velocity) and change in CI reliably predict circulatory failure and mortality in ACLF with severe sepsis. CCM markers significantly enhanced the CLIF‐C ACLF and MELDNa predictive performance. [ABSTRACT FROM AUTHOR]

An 18-year male with no significant past medical history presented with features of right-sided heart failure. Haematological investigations revealed raised erythrocyte sedimentation rate (23 mm/h). Transthoracic echocardiography (TTE) demonstrated biventricular systolic dysfunction with thickened free wall of right ventricle (RV). Whole-body fluorodeoxyglucose (FDG) - positron emission tomography (PET) computed tomography (FDG-PET-CT) showed intensely increased FDG uptake in the thickened RV wall and an FDG avid lesion in the left medial temporal lobe. Cardiac magnetic resonance imaging (CMR) characterized thickening and suggested an infiltrative disease (isointense on TI, hyperintense on myocardial oedema sensitive sequence with transmural enhancement on late gadolinium sequence). Magnetic resonance imaging (MRI) brain showed a thick rim enhancing ring lesion in the body of hippocampus. Endomyocardial biopsy revealed moderately dense lymphomononuclear inflammation with the formation of granulomas. Since tuberculosis is endemic in our country and considering all laboratory, imaging and biopsy findings a working diagnosis of tuberculosis was considered, and standard anti-tubercular treatment was started. There was an improvement in clinical status and follow-up imaging (TTE, CMR, brain MRI and FDG-PET-CT) showed improvement in biventricular function with regression in myocardial thickening and resolution of brain lesion, confirming the diagnosis of tuberculosis. [ABSTRACT FROM AUTHOR]

【Abstract】Late vascular complications involving aorta are rare but devastating adversities following anterior thoracic spine operations are present. The current article describes our experience with one such patient who had an iatrogenic pseudoaneurysm of the thoracic aorta, mimick- ing infection. The patient was treated successfully follow- ing concomitant efforts by multidisciplinary experts with shunting. We wish to highlight upon the significance of recognizing the possible sinister consequences of a dan- gerously prominent spinal implant and the role of a suspi- cious surgeon in identifying these menacing complications at the right time. Key words: Fractures, bone; Aorta, thoracic; Aneurysm, false; Iatrogenic disease

Aims: Limited data on the uptake of guideline‐directed medical therapies (GDMTs) and the mortality of acute decompensated HF (ADHF) patients are available from India. The National Heart Failure Registry (NHFR) aimed to assess clinical presentation, practice patterns, and the mortality of ADHF patients in India. Methods and results: The NHFR is a facility‐based, multi‐centre clinical registry of consecutive ADHF patients with prospective follow‐up. Fifty three tertiary care hospitals in 21 states in India participated in the NHFR. All consecutive ADHF patients who satisfied the European Society of Cardiology criteria were enrolled in the registry. All‐cause mortality at 90 days was the main outcome measure. In total, 10 851 consecutive patients were recruited (mean age: 59.9 years, 31% women). Ischaemic heart disease was the predominant aetiology for HF (72%), followed by dilated cardiomyopathy (18%). Isolated right HF was noted in 62 (0.6%) participants. In eligible HF patients, 47.5% received GDMT. The 90 day mortality was 14.2% (14.9% and 13.9% in women and men, respectively) with a re‐admission rate of 8.4%. An inverse relationship between educational class based on years of education and 90 day mortality (high mortality in the lowest educational class) was observed in the study population. Patients with HF with reduced ejection fraction and HF with mildly reduced ejection fraction who did not receive GDMT experienced higher mortality (log‐rank P < 0.001) than those who received GDMT. Baseline educational class, body mass index, New York Heart Association functional class, ejection fraction, dependent oedema, serum creatinine, QRS > 120 ms, atrial fibrillation, mitral regurgitation, haemoglobin levels, serum sodium, and GDMT independently predicted 90 day mortality. Conclusion: One of seven ADHF patients in the NHFR died during the first 90 days of follow‐up. One of two patients received GDMT. Adherence to GDMT improved survival in HF patients with reduced and mildly reduced ejection fractions. Our findings call for innovative quality improvement initiatives to improve the uptake of GDMT among HF patients in India. [ABSTRACT FROM AUTHOR]