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Background/purpose Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a highly contagious and lethal virus, devastating healthcare systems throughout the world. Following a period of stability, the coronavirus disease 2019 (COVID-19) pandemic appears to be re-intensifying globally. As the virus continues to evolve, so does our understanding of its implications on ST-segment elevation myocardial infarction (STEMI). We sought to describe a single center STEMI experience at one of the epicenters during the COVID-19 pandemic. Methods/materials We conducted a retrospective, observational study comparing STEMI patients during the pandemic period (March 1, 2020 to August 31, 2020) to those with STEMI during the pre-pandemic period (March 1, 2019 to August 31, 2019) at NYU Langone Hospital – Long Island, a tertiary care center in Nassau County, New York. Additionally, we describe our subset of COVID-19 patients with STEMI during the pandemic. Results The acute myocardial infarction (AMI) team was activated for a total of 183 patients during both periods. There were a similar number of AMI team activations during the pandemic period (n = 93) compared to the pre-pandemic period (n = 90). Baseline characteristics did not differ during both periods however, infection control measures and additional investigation were required to clarify the diagnosis during the pandemic, resulting in a signal towards longer door-to-balloon times (95.9 min vs. 74.4 min, p = 0.0587). We observed similar inpatient length of stay (LOS) (3.6 days vs. 5.0 days, p = 0.0901) and mortality (13.2% vs. 9.2%, p = 0.5876). There was a total of 6 COVID-19 positive patients who presented with STEMI, of which 4 were emergently taken to the cardiac catheterization laboratory with successful percutaneous coronary intervention (PCI) performed in 3 patients. The 2 patients who were not offered primary PCI expired, as both were treated medically, one with thrombolytics. Conclusions Our single center study, in New York, at one of the epicenters of the pandemic, demonstrated a similar number of AMI team activations, mimicking the seasonal variability seen in 2019, but with a signal towards longer door-to-balloon time. Despite this, inpatient LOS and mortality remained similar., Highlights • The ongoing COVID-19 pandemic continues to evolve, as does our understanding of its implications on STEMI. • Our study demonstrated similar AMI activations but longer door-to-balloon times during the pandemic compared to the pre-pandemic period. • As we continue to manage these pandemic patients, despite longer door-to-balloon times, primary PCI remains the standard of care for STEMI.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged the highly contagious and lethal virus, devastating healthcare systems throughout the world. The ongoing coronavirus disease 2019 (COVID-19) pandemic continues to rapidly evolve, as does our understanding of its implications on the cardiovascular system. The purpose of our study was to describe a single center STEMI experience at the epicenter of the COVID-19 pandemic. Methods: This was a retrospective, observational study, which included consecutive suspected STEMI patients from March 1 2020 through May 31 2020 compared to with the same time period in 2019, at a tertiary referral center in New York. Cohort 1 (2019 pre-pandemic period) included all patients with suspected STEMI from March 1 2019 to May 31 2019. Cohort 2 (2020 pandemic period) included all patients with suspected STEMI from March 1 2020 to May 31 2020. Statistical analysis was performed using t-test and chi-squared test. Results: Cohort 2 saw a similar number (n=46) of acute myocardial infarction (AMI) team activations when compared to cohort 1 (n=42) (Figure 1). As expected during the pandemic, infection control measures and additional investigation were required to clarify the diagnosis in cohort 2 resulting in significantly longer door to balloon times (96.3 minutes vs. 72.7 minutes, p=0.0307). Despite this, we observed similar inpatient length of stay (4.3 days vs. 4.9 days, p=0.1807) and mortality (11.1% vs. 12.1%, p=0.5141). Conclusions: Our single center study, at the epicenter of the pandemic, demonstrated similar AMI team activations compared to 2019, but longer door-to-balloon time. Despite this, inpatient length of stay and mortality remained unchanged. As we continue to manage these patients amidst this dynamic pandemic, our approach should continue to focus on the safety of healthcare workers with an understanding that primary PCI remains the standard of care for patients with STEMI.

Background: Mitral regurgitation (MR) frequently accompanies aortic stenosis (AS). Several studies have reported that certain patients see improvement in their MR following transcatheter aortic valve replacement (TAVR) alone using earlier generation valves. The purpose of this study was to determine the predictors and short-term outcome impact of MR in patients undergoing TAVR using all generation valves across all risk groups. Methods: In this retrospective, study from 2012-2019, we reviewed data on 1,626 low, intermediate and high-risk patients who underwent TAVR. Included were patients with baseline MR who underwent transfemoral TAVR. We excluded prior valve replacement and aborted TAVR. Our primary outcome was persistence or worsening of baseline MR post-TAVR. Additional endpoints included an inpatient composite (intensive care unit length of stay >24 hours, post-TAVR length of stay >2 days and inpatient death), 30-day composite (30-day death or 30-day readmission) and 1-year composite (1-year death or readmission). Results: Of the 1,626 patients screened, 552 had significant baseline MR (>moderate), which improved in 79.7% of patients. Female patients, those with higher right ventricular systolic pressures and those who underwent TAVR using earlier generation valves were more likely to have persistence or worsening of significant baseline MR. Patients whose significant baseline MR (>moderate) persisted or worsened, had higher rates (92.2 vs. 84.1%, p=0.0343) of our inpatient composite and higher rates (36.6% vs. 25.5%, p=0.0243) of our 1-year composite when compared to patients whose significant baseline MR (>moderate) improved post-TAVR. Conclusions: Our study identifies certain clinical characteristics, which could help identify the subset of patients who may require closer post-procedural follow-up and warrant possible staged mitral valve intervention post-TAVR across all risk groups.

The dilemma of the patient with both AS and LVOTO is now commonly encountered in clinical practice; indeed, physicians must be aware of the complex interaction and coexistent nature of both diseases, especially as both HOCM and TAVR have increased in awareness and prevalence. Importantly, the clinician must be aware of the complex interplay hemodynamically, with the two diseases confusing the TTE imaging and potentially affecting each other anatomically and clinically. There is no set guideline on how to approach this from a surgical or percutaneous approach, but we have outlined a set of recommendations which should serve the clinician and patient well. The three cases that are presented illustrate that methodical diagnosis in addition to the order of treatment do indeed matter. In the first case, there was AS and an underestimated LVOT gradient that was also present. Once the AS was corrected, the true LVOT gradient potential was evidenced and she decompensated, likely because there was a rapid decrease in afterload. Patients with concomitant LVOTO are not able to adjust quickly to the hemodynamic changes created by the rapid decline in afterload, as, for example, in HOCM patients who receive nitroglycerin. The second case demonstrated that when the LVOTO was severe and the AS nonsignificant (mild or moderate), the patient was able to live without symptoms for several years after successful alcohol septal ablation (ASA). She eventually needed an aortic valve and mitral valve replacement but that was postponed for several years until the AS became more significant, and the surgical risk was lowered by the elimination of the need for concomitant myectomy. In the last case, the patient was able to have both an ASA and TAVR within 3 months of each other without hemodynamic compromise. Indeed, this latter therapy sequence may be the best way to treat patients with both diseases in the future, as both ASA and TAVR continue to evolve into intermediate and lower-risk patient populations and the safety of ASA continues to be evident.

[Figure][1] A 56-year-old male with coronary artery disease presented with angina, nonspecific electrocardiographic changes, and elevated troponins. Coronary angiography revealed total occlusion of a stent in the circumflex artery, where another was deployed—his 67th stent. The patient had

Myocarditis secondary to H1N1 influenza has been described in children, but only very rarely in adults. We describe a 36-year-old man with no significant medical history who presented with flu-like symptoms of 3-week duration. When he sought medical attention, he was already manifesting heart failure secondary to fulminant myocarditis, along with multiorgan failure. Despite aggressive management, including circulatory support with a catheter-based mechanical cardiac assist device (Impella 2.5 Cardiac Assist Device, Abiomed, Danvers, MA) as a bridge to cardiac transplant, and aggressive antiviral and antibacterial therapy, the patient died of cardiac arrest. An H1N1 polymerase chain reaction postmortem assay produced positive results, and a diagnosis of fulminant viral myocarditis and multiorgan system failure was established.

This study was designed to determine the effect of multimodal intervention and the prevention of back injury, and to evaluate the adverse side effects of using a lumbosacral corset in the workplace. Subjects were 90 male warehouse workers randomly selected from over 800 employees at a grocery distribution center. Subjects were assigned to three groups: true controls, no back school, no brace orthoses; back school only; and back school plus wearing a custom molded lumbosacral orthosis. Comparisons of pre-testing and 6-month follow-up post-testing for abdominal strength, cognitive data, work injury incidence and productivity and use of health care services were evaluated. Controls and training-only group showed no changes in strength productivity or lost time. Orthoses and training-group showed no changes in strength productivity or accident rate; however, they showed substantially less lost time. This study supports the concept of using education and prophylactic bracing to prevent back injury and reduce time loss. It appears that the use of intermittent prophylactic bracing has no adverse affects on abdominal muscle strength and may contribute to decreased lost time from work injuries.

Skill at using tools depends on somatosensory and visual information being integrated into a body schema. “Calibration,” defined as the ability to accurately localize a limb in space, and “recalibration,” the ability to accurately localize a limb plus tool in space, are proposed as intermediate stages between the development of manipulative prehension and the acquisition of skilled tool usage. Each of these depends upon body scheme information. The ability to recalibrate muscular output for different weights and lengths of tools was investigated. It was hypothesized that such recalibration is an intermediate stage of skill that should be developed prior to extensive practice with tools themselves. A total of 48 normal children, ranging in age from 4.0 to 8.11 years, served as subjects. Test instruments included the Southern California Motor Accuracy Test (MAC) and three tests of recalibration skills. These three tests involved touching a target with the tip of the index finger and with the tips of both a short and a long tool. Results were as hypothesized. Older children performed significantly better than younger children on all tests of hand and tool skill. Ability to use a tool appears to increase with increased ability to recalibrate. Skill in using the hand as a tool appears to develop earlier than skill in recalibrating for short / light tools, which precedes skill at recalibrating for longer / heavier tools.

This study involved the content analysis of tape-recorded interviews in an attempt to validate criteria used for evaluating outcomes of counseling. A reputation (sociometric) inventory was used to select three types of students: socially effective, aggressive, and withdrawn. Each student was interviewed by a trained interviewer, and the content of interviews was analyzed according to topics discussed and affect associated with the topics. In general, socially effective students discussed a significantly greater number of topics than either the aggressive or withdrawn students. Few significant differences were found in positive- to negative-affect ratios but the socially effective did generally display more positive affect than the other groups. Though this study failed to validate this technique for appraising outcomes of counseling, the investigators believe that it has promise sufficient for further research.