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Infection with SARS-CoV-2, the virus that causes COVID, is associated with numerous potential secondary complications. Global efforts have been dedicated to understanding the myriad potential cardiovascular sequelae which may occur during acute infection, convalescence, or recovery. Because patients often present with nonspecific symptoms and laboratory findings, cardiac imaging has emerged as an important tool for the discrimination of pulmonary and cardiovascular complications of this disease. The clinician investigating a potential COVID-related complication must account not only for the relative utility of various cardiac imaging modalities but also for the risk of infectious exposure to staff and other patients. Extraordinary clinical and scholarly efforts have brought the international medical community closer to a consensus on the appropriate indications for diagnostic cardiac imaging during this protracted pandemic. In this review, we summarize the existing literature and reference major societal guidelines to provide an overview of the indications and utility of echocardiography, nuclear imaging, cardiac computed tomography, and cardiac magnetic resonance imaging for the diagnosis of cardiovascular complications of COVID.

AIMS: Mitral valve prolapse (MVP) is a common valvular heart disease with a prevalence of >2% in the general adult population. Despite this high incidence, there is a limited understanding of the molecular mechanism of this disease, and no medical therapy is available for this disease. We aimed to elucidate the genetic basis of MVP in order to better understand this complex disorder.METHODS AND RESULTS: We performed a meta-analysis of six genome-wide association studies that included 4884 cases and 434 649 controls. We identified 14 loci associated with MVP in our primary analysis and 2 additional loci associated with a subset of the samples that additionally underwent mitral valve surgery. Integration of epigenetic, transcriptional, and proteomic data identified candidate MVP genes including LMCD1, SPTBN1, LTBP2, TGFB2, NMB, and ALPK3. We created a polygenic risk score (PRS) for MVP and showed an improved MVP risk prediction beyond age, sex, and clinical risk factors.CONCLUSION: We identified 14 genetic loci that are associated with MVP. Multiple analyses identified candidate genes including two transforming growth factor-β signalling molecules and spectrin β. We present the first PRS for MVP that could eventually aid risk stratification of patients for MVP screening in a clinical setting. These findings advance our understanding of this common valvular heart disease and may reveal novel therapeutic targets for intervention.KEY QUESTION: Expand our understanding of the genetic basis for mitral valve prolapse (MVP). Uncover relevant pathways and target genes for MVP pathophysiology. Leverage genetic data for MVP risk prediction.KEY FINDING: Sixteen genetic loci were significantly associated with MVP, including 13 novel loci. Interesting target genes at these loci included LTBP2, TGFB2, ALKP3, BAG3, RBM20, and SPTBN1. A risk score including clinical factors and a polygenic risk score, performed best at predicting MVP, with an area under the receiver operating characteristics curve of 0.677.TAKE-HOME MESSAGE: Mitral valve prolapse has a polygenic basis: many genetic variants cumulatively influence pre-disposition for disease. Disease risk may be modulated via changes to transforming growth factor-β signalling, the cytoskeleton, as well as cardiomyopathy pathways. Polygenic risk scores could enhance the MVP risk prediction.

To characterize global and segmental circumferential systolic strain (CS) measured by cardiac MRI in athletes after SARS-CoV-2 infection.This retrospective observational cohort study included 188 soldiers and collegiate athletes referred for cardiac MRI after SARS-CoV-2 infection (C19+) between July 2020 and February 2021 and a control group of 72 soldiers, collegiate, and high school athletes who underwent cardiac MRI from May 2019 to February 2020, prior to the first SARS-CoV-2 case detected in our region (C19-). Global and segmental CS were measured by feature tracking, then compared between each group using unadjusted and multivariable- adjusted models. Acute myocarditis was diagnosed according to the modified Lake Louise criteria and the location of pathologic late gadolinium enhancement (LGE) was ascertained.Among the 188 C19+ athletes (median age, 25 years [IQR, 23-30]; 131 men), the majority had mild illness. Global CS significantly differed between C19+ and C19- groups, with a median of -24.0 (IQR -25.8, -21.4) versus. -25.0 (-28.0, -22.4), respectively (p = .009). This difference in CS persisted following adjustment for age, sex, body mass index, heart rate, and systolic blood pressure β coefficient 1.29 [95% CI: 0.20, 2.38], p = .02). In segmental analysis, the basal- and mid- inferoseptal, septal and inferolateral segments were significantly different (p.05), which had a higher frequency of post-COVID late gadolinium enhancement. The global and segmental differences were similar after exclusion of athletes with myocarditis.Among athletes, SARS-CoV-2 infection was associated with a small but statistically significant reduced CS.

BACKGROUND Nonchicken wing left atrial appendage (LAA) morphology is associated with higher risk for stroke in patients with atrial fibrillation (AF) than chicken wing (CW) morphology. OBJECTIVE Assess whether LAA morphology predicts the formation of LAA thrombus independent of age, sex, presenting rhythm, left ventricular ejection fraction (LVEF), or anticoagulant use. METHODS A cross-sectional analysis was performed on patients prospectively enrolled in the Vanderbilt LAA Registry or presenting for transesophageal echocardiogram (TEE) between January 1, 2015, and November 1, 2017 (n = 306). Two physicians independently reviewed TEEs interpreted as having LAA thrombus. Determination of LAA morphology, ejection velocity, and presence of thrombus (n = 102) were based on 0°, 45°, 90°, and 135° TEE views. The control cohort (n = 204) included consecutive AF patients undergoing TEE without LAA thrombus. RESULTS LAA morphology in patients with LAA thrombus was: 35% windsock, 47% broccoli, and 12% CW. Windsock (odds ratio [OR], 4.0; 95% confidence interval [CI]: 1.7-9.3, p = .001) and broccoli (OR, 6.6; 95% CI: 2.6-16.6; p

Background The use of cardiac implantable electronic devices (CIEDs) has expanded dramatically over the past decade, but net clinical benefit has been curtailed by increasing infectious complications. In particular, CIED-related infectious endocarditis (IE) is a serious condition with significant morbidity and mortality. Methods We performed a single-center, retrospective study between July 2006 and February 2011 with CIED-related IE, defined by either lead vegetations detected on echocardiography or by fulfilling Duke criteria for definite endocarditis. Clinical parameters and outcomes were detailed by electronic medical record review and vital status was confirmed by the Social Security Death Index. Results Eighty patients (median age 67, interquartile range 56–75, 58 M/22 F) were diagnosed with CIED-related IE. Overall mortality was 36% with a median time to death of 95 days from presentation. Over half (52%) of the deaths were infection related with a median time to death of 29 days. Multivariate analysis showed methicillin-resistant Staphylococcus aureus (MRSA) infection (odds ratio [OR] 0.158; 95% confidence interval [CI], 0.047–0.534; P = .003) and concomitant valve endocarditis (OR 0.141, CI 0.041–0.491, P = .002) independently predicted mortality. Conclusion In this contemporary series, all-cause mortality in patients with CIED-related IE was high with a short time to death from onset of infection. MRSA and concomitant valve infection were the most powerful independent predictors of mortality.

Background: Surgical aortic valve replacement (SAVR) results in higher AV gradients than transcatheter AVR (TAVR), yet calculated left ventricular (LV) mass regresses faster and greater after SAVR vs. TAVR. We examined why LV mass regression is greater after SAVR. Methods: Serial echocardiographic studies of high-risk patients with severe aortic stenosis (AS) randomized to SAVR vs. TAVR with the CoreValve bioprosthesis were analyzed by an echocardiographic core laboratory blinded to treatment and outcomes. Measurements followed established guidelines and LV mass was calculated using the formula of Devereux and colleagues. Results: Echo data were available in 389 TAVR and 353 SAVR patients, whose baseline LVEDD, PWT, SWT, LV mass, and stroke volume (SV) as well as AS severity were similar. At discharge after SAVR, LV mass reduction was significant (227.45 ± 65.02 to 215.08 ± 59.02 g [p = 0.002]) due to decreased LVEDD (5.01 ± 0.64 to 4.81 ± 0.65 cm [p < 0.001]) associated with reduced SV (72.6 ± 27.0 mL to 58.9 ± 21.1 mL (p = 0.015]). PWT and SWT were unchanged. However, after TAVR, all these variables remained similar. At 1 year, LV mass, SV and LVEDD remained smaller following SAVR vs. TAVR. There was a trend toward higher 30-day mortality in patients with greater LV mass reduction in SAVR (4.7% vs. 0.8 %; p = 0.058) which was not observed after TAVR. Conclusion: The greater reduction in LV mass calculated after SAVR vs. TAVR is due to a smaller postoperative LVEDD and is associated with significantly reduced SV. There was a tendency for increased 30-day mortality associated with greater reduction in calculated LV mass after SAVR.

Background The degree of aortic insufficiency (AI) after transcatheter aortic valve replacement (TAVR) has been identified as a predictor of increased mortality. Since even mild AI is associated with increased mortality in some studies, accurate quantification of post-TAVR AI is critical. Assessment of AI by echocardiography is typically performed by visual inspection and semi-quantitative methods. Most post-TAVR AI is paravalvular, however echocardiography has limited ability to quantify multiple eccentric paravalvular jets. Using flow quantification methods, cardiac MRI (CMR) may more accurately quantify AI severity post-TAVR and therefore more accurately assess risk in this population. Methods Twenty-three patients who underwent TAVR with a SAPIEN prosthesis were studied. All patients underwent an intraoperative transesophageal echocardiogram (TEE), as well as a post-procedure transthoracic echocardiogram (TTE) and CMR. Paravalvular AI by TTE and TEE was graded using color Doppler by quantifying the circumferential extent of AI as a percentage of the aortic annulus (none 30%) following recommendations from the Valve Academic Research Consortium. AI severity by CMR was quantified as the regurgitant fraction of forward aortic flow based on previously published recommendations (none 48%). Results The mean age was 79 +/- 10 years; 52% were men. TTE and CMR were performed at 1 [1-1] and 4 [1-4] days postTAVR respectively (median [IQR]). The left ventricular ejection fraction (LVEF) by CMR was 65 +/- 10%. AI severity by TTE was none in 9 (39.1%), trace in 11 (47.8%), and mild in 3 (13%) patients. TEE identified trace central AI in 6 patients (26%). Paravalvular AI by TEE was none in 4 (17.4%), trace in 14 (60.9%), and mild in 5 (21.7%) patients. AI by CMR was none in 2 (8.7%), trace in 5 (21.7%), mild in 13 (56.5%), and moderate in 3 (13%) patients; (Figure 1). A higher proportion of patients with mild or greater AI was identified by CMR (16/23, 70%) compared to TTE (3/23, 13%) and TEE (5/23, 22%); (Figure 2). Conclusions

Background: The WATCHMAN left atrial appendage occluder (LAAO) prevents thromboembolism in non-valvular atrial fibrillation patients. Transesophageal echocardiography (TEE) is the recommended modality for preoperative sizing of the LAA and thrombus exclusion. Patients evaluated for WATCHMAN with

As the assessment of aortic valve disease has evolved over the last 60 years, newer methods have largely added to our armamentarium rather than replacing previous ones. In 1951, the Gorlins recognized that what could be measured—pressure gradients—depends not only on orifice size but also on