Health-care workers are thought to be highly exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to investigate the prevalence of antibodies against SARS-CoV-2 ...in health-care workers and the proportion of seroconverted health-care workers with previous symptoms of COVID-19.
In this observational cohort study, screening was offered to health-care workers in the Capital Region of Denmark, including medical, nursing, and other students who were associated with hospitals in the region. Screening included point-of-care tests for IgM and IgG antibodies against SARS-CoV-2. Test results and participant characteristics were recorded. Results were compared with findings in blood donors in the Capital Region in the study period.
Between April 15 and April 23, 2020, we screened 29 295 health-care workers, of whom 28 792 (98·28%) provided their test results. We identified 1163 (4·04% 95% CI 3·82–4·27) seropositive health-care workers. Seroprevalence was higher in health-care workers than in blood donors (142 3·04% of 4672; risk ratio RR 1·33 95% CI 1·12–1·58; p<0·001). Seroprevalence was higher in male health-care workers (331 5·45% of 6077) than in female health-care workers (832 3·66% of 22 715; RR 1·49 1·31–1·68; p<0·001). Frontline health-care workers working in hospitals had a significantly higher seroprevalence (779 4·55% of 16 356) than health-care workers in other settings (384 3·29% of 11 657; RR 1·38 1·22–1·56; p<0·001). Health-care workers working on dedicated COVID-19 wards (95 7·19% of 1321) had a significantly higher seroprevalence than other frontline health-care workers working in hospitals (696 4·35% of 15 983; RR 1·65 1·34–2·03; p<0·001). 622 53·5% of 1163 seropositive participants reported symptoms attributable to SARS-CoV-2. Loss of taste or smell was the symptom that was most strongly associated with seropositivity (377 32·39% of 1164 participants with this symptom were seropositive vs 786 2·84% of 27 628 without this symptom; RR 11·38 10·22–12·68). The study is registered at ClinicalTrials.gov, NCT04346186.
The prevalence of health-care workers with antibodies against SARS-CoV-2 was low but higher than in blood donors. The risk of SARS-CoV-2 infection in health-care workers was related to exposure to infected patients. More than half of seropositive health-care workers reported symptoms attributable to COVID-19.
Lundbeck Foundation.
Abstract
Aims
Left atrial (LA) function assessed by two-dimensional speckle-tracking echocardiography has shown increasing clinical and prognostic significance. We sought to establish age- and ...sex-based normative values of LA strain in the general population and to assess the prognostic yield of lower limits of normality of LA strain in relation to future atrial fibrillation (AF).
Methods and results
We determined normative values of peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and LA strain during the conduit phase (LACS) in 1641 healthy participants included in the fifth Copenhagen City Heart Study. In a secondary analysis, a validation cohort of 2016 participants, regardless of health status, were included to assess the prognostic value of the established reference values. In the healthy cohort, median age was 46 years (interquartile range 32–57), 62% were female. Median PALS, PACS, and LACS and corresponding limits of normality in the healthy participants were 39.4% (23.0–67.6%), 15.5% (6.4–28.0%), and 23.7% (8.8–44.8%), respectively. There was a tendency of lower values of PALS and LACS in males and older participants, while PACS tended to increase with advancing age. The established lower limits of normality showed high specificity (range 93–94%) regarding future AF, implying a low risk of developing AF in participants with LA strain above the lower limits of normality in their respective sex and age group.
Conclusion
We report normal values for LA strain stratified by sex and age. The lower limits of normality showed high specificity regarding future AF.
Graphical Abstract
Left atrial (LA) enlargement predicts cardiovascular risk. The prognostic value of left atrial peak reservoir strain (LA RS) by two-dimensional speckle tracking in the general population is currently ...unknown. This study sought to determine the prognostic value of LA RS in the general population.
A total of 385 participants without atrial fibrillation, heart failure (HF), and ischaemic heart disease (IHD) had an echocardiogram including left ventricular and LA speckle-tracking analysis performed. LA RS was averaged from the three apical views. The endpoint was a composite of incident IHD, HF, or cardiovascular death. Median follow-up was 12.6 years (interquartile-range 11.5-12.8 years). Follow-up was 100%. Fifty-one participants (13.3%) reached the composite outcome. LA RS was a univariable predictor of outcome hazard ratio (HR) 1.25, 95% confidence interval (95% CI) 1.09-1.43; P = 0.002. However, LA RS did not remain an independent predictor of outcome after adjustment for clinical parameters. The prognostic value was modified by sex (P = 0.011). LA RS predicted the composite outcome in women but not in men when adjusting for clinical parameters (women: HR 1.46, 95% CI 1.05-2.02; P = 0.025) (men: HR 0.96, 95% CI 0.81-1.14; P = 0.65). Further adjustment for echocardiographic parameters did not significantly alter the results. LA RS added incremental prognostic information in addition to SCORE and the American Heart Association/American College of Cardiology Pooled Cohort Equation in women only.
LA RS is a univariable predictor of cardiovascular morbidity and mortality in the general population. However, the prognostic value of LA RS is modified by sex. LA RS is an independent predictor of outcome in women but not in men.
Background Cardiovascular disease remains a leading cause of death. Right ventricular ( RV ) function is a strong predictor of outcome in many cardiovascular diseases, but its significance is often ...neglected. Little is known about the prognostic value of RV systolic function in the general population. Therefore, we aimed to determine the prognostic value of RV systolic function, evaluated by tricuspid annular plane systolic excursion ( TAPSE ), in predicting cardiovascular death ( CVD ) in the general population. Methods and Results A total of 1039 participants from the general population without heart failure or atrial fibrillation had an echocardiogram performed and TAPSE measured. The end point was CVD . During a median follow-up of 12.7 years (interquartile range, 12.0-12.9 years), 69 participants (6.6%) experienced CVD , whereas 162 participants (15.6%) experienced non-CVD. Decreasing RV systolic function, assessed as TAPSE , was a univariable predictor of CVD (hazard ratio, 1.13; 95% CI , 1.07-1.20; P<0.001, per 1-mm decrease). TAPSE remained an independent predictor of CVD after adjusting for clinical and echocardiographic parameters (hazard ratio, 1.08; 95% CI , 1.01-1.15; P=0.017, per 1-mm decrease). Furthermore, in net reclassification analysis, decreasing RV systolic function, assessed as TAPSE, significantly improved risk classification with respect to CVD when added to established cardiovascular risk factors from the Systematic Coronary Risk Evaluation chart or a modified version of the American Heart Association/American College of Cardiology Pooled Cohort Equation. Decreasing RV systolic function, assessed as TAPSE , did not predict non-CVD, indicating specificity for CVD . Conclusions RV systolic function, as assessed by TAPSE , is associated with CVD in the general population. In the general population, assessment of RV systolic function may provide novel prognostic information about the risk of CVD .
Abstract
Background
Left atrial (LA) strain parameters have been demonstrated to be valuable predictors of atrial fibrillation (AF) in several patient cohorts. The purpose of this study was to ...investigate whether LA strain, assessed by two-dimensional speckle-tracking echocardiography, can be used to predict the development of AF in the general population.
Methods and results
This prospective longitudinal study included 4466 participants from the fifth Copenhagen City Heart Study. All participants underwent a health examination, including echocardiographic measurements of LA strain. Participants with prevalent AF at baseline were excluded. The primary endpoint was incident AF. During a median follow-up period of 5.3 years, 154 (4.3%) participants developed AF. In univariable analysis, peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and LA strain during the conduit phase were significantly associated with the development of AF. PALS hazard ratio (HR) 1.05, 95% confidence interval (CI) (1.03–1.07), P < 0.001, per 1% decrease and PACS (HR 1.08, 95% CI (1.05–1.12), P < 0.001, per 1% decrease remained independent predictors of AF in multivariable analysis. In addition, PALS and PACS remained significantly associated with AF development even in participants with normal-sized atria and normal left ventricular (LV) systolic function.
Conclusion
In the general population, PALS and PACS independently predict incident AF. These findings remained consistent even in participants with normal-sized LA and normal LV systolic function.
Graphical Abstract
Wall Motion Score Index (WMSI) is a simple method to quantify global and regional systolic function on echocardiography. We sought to investigate the prognostic importance of global and regional WMSI ...for the development of incident heart failure (HF) in the general population.
We included adults without HF or ischemic heart disease from the 4th Copenhagen City Heart Study (2001–2003). At baseline, participants underwent an echocardiography and physical examination and completed a self-administered health questionnaire. WMSI was assessed by conventional echocardiography using a 16-segment model obtaining WMSI assessments for the anterior, lateral, inferior, septal, and posterior left ventricular (LV) walls and calculating a global WMSI. The primary endpoint was incident HF.
Among 3415 participants (mean age 58 years, 42% male, 45% with hypertension), 83 (2.4%) had hypo-, a-, or dyskinesia of at least one LV wall segment at baseline. During a median follow-up of 15.4 years, 297 (8.7%) participants developed HF. After adjusting for important clinical variables, LV ejection fraction and E/A, hypo-, a- or dyskinesia of at least one segment in any of the LV regional walls was associated with a higher risk of incident HF (HR 3.63, 95% CI 2.15–6.12, p < 0.001). Similarly, global WMSI was independently associated with a higher risk of HF (HR 1.38 per 0.1 increase, 95%CI 1.22–1.56, p < 0.001).
Wall motion abnormalities in any regional LV wall and global WMSI were associated with incident HF in this general population cohort independent of various baseline clinical data, LV ejection fraction and E/A.
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•3,415 participants from the general population without heart failure or ischemic heart disease were included.•Wall motion score index was assessed by echocardiography at baseline using a 16 segment model.•83 participants (2.4%) had hypo-, a-, or dyskinesia of at least one left ventricular segment at baseline.•During a median follow-up of 15.4 years (IQR 11.9-16.0), 297 participants (8.7%) developed incident heart failure.•Hypo-, a-, or dyskinesia of ≥1 segment in any left ventricular wall was associated with a higher risk of incident heart failure.
Left atrial enlargement predicts incident atrial fibrillation (AF). However, the prognostic value of peak atrial longitudinal strain (PALS) for predicting incident AF in participants from the general ...population is currently unknown. Our aim was to investigate if PALS can be used to predict AF and ischaemic stroke in the general population.
A total of 400 participants from the general population underwent a health examination, including two-dimensional speckle tracking echocardiography of the left atrium. The primary endpoint was incident AF at follow-up. All participants with known AF and prior stroke at baseline were excluded (n = 54). The secondary endpoint consisted of the composite of AF and ischaemic stroke. During a median follow-up of 16 years, 36 participants (9%) were diagnosed with incident AF and 30 (7%) experienced an ischaemic stroke, resulting in 66 (16%) experiencing the composite outcome. PALS was a univariable predictor of AF per 5% decrease: hazard ratio (HR) 1.42; 95% confidence interval (CI) (1.19-1.69), P < 0.001. However, the prognostic value of PALS was modified by age (P = 0.002 for interaction). After multivariable adjustment PALS predicted AF in participants aged <65 years per 5% decrease: HR 1.46; 95% CI (1.06-2.02), P = 0.021. In contrast, PALS did not predict AF in participants aged ≥65 years after multivariable adjustment per 5% decrease: HR 1.05; 95% CI (0.81-1.35), P = 0.72. PALS also predicted the secondary endpoint in participants aged <65 years and the association remained significant after multivariable adjustment.
In a low-risk general population, PALS provides novel prognostic information on the long-term risk of AF and ischaemic stroke in participants aged <65 years.
Abstract
Aims
Assessing left atrial (LA) size and function is an important part of the echocardiographic examination. We sought to assess how LA size and function develop over time, and which ...clinical characteristics promote atrial remodelling.
Methods and results
We examined longitudinal changes of the LA between two visits in the Copenhagen City Heart Study (n = 1065). The median time between the examinations was 10.4 years. LA measurements included: maximal LA volume (LAVmax), minimal LA volume (LAVmin), and LA emptying fraction (LAEF). Clinical and echocardiographic accelerators were determined from linear regression. The value of LA remodelling for predicting incident atrial fibrillation (AF) and heart failure (HF) was examined by Cox proportional hazards regressions. During follow-up, LAVmax and LAVmin significantly increased by 8.3 and 3.5 mL/m2, respectively. LAEF did not change. Age and AF were the most impactful clinical accelerators of LA remodelling with standardized beta-coefficients of 0.17 and 0.28 for changes in LAVmax, and 0.18 and 0.38 for changes in LAVmin, respectively. Left ventricular (LV) systolic function, diameter, and mass were also significant accelerators of LA remodelling. Changes in both LAVmax and LAVmin were significantly associated with incident AF n = 46, ΔLAVmax: HR = 1.06 (1.03–1.09), P < 0.001 and ΔLAVmin: HR = 1.14 (1.10–1.18), P < 0.001, per 1 mL/m2 increase and HF n = 27, ΔLAVmax: HR = 1.08 (1.04–1.12), P < 0.001 and ΔLAVmin: HR = 1.13 (1.09–1.18), P < 0.001, per 1 mL/m2 increase.
Conclusion
Both maximal and minimal LA volume increase over time. Clinical accelerators included age and AF. LV structure and systolic function also accelerate LA remodelling. LA remodelling poses an increased risk of clinical outcomes.
Graphical Abstract
Reduced left ventricular function, assessed by global longitudinal strain (GLS), is sometimes observed in asymptomatic patients with diabetes mellitus (DM) and is often present in patients with ...diabetes-related microvascular complications. Our aim was to assess the association between microvascular complications, coronary artery plaque burden (PB) and GLS in asymptomatic patients with DM and non-obstructive coronary artery disease (CAD).
This cross-sectional study included patients with DM without any history, symptoms or objective evidence of obstructive CAD. All patients were identified in the outpatient Clinic of Endocrinology at Odense University Hospital Svendborg. An echocardiography and a coronary computed tomography angiography were performed to assess GLS and the degree of CAD, respectively. A coronary artery stenosis < 50% was considered non-obstructive. A linear regression model was used to evaluate the impact of potential confounders on GLS with adjustment of body mass index (BMI), mean arterial pressure (MAP), microvascular complications, type of diabetes, tissue Doppler average early diastolic mitral annulus velocity (e') and PB.
Two hundred and twenty-two patients were included, of whom 172 (77%) had type 2 DM and 50 (23%) had type 1 diabetes. One hundred and eleven (50%) patients had microvascular complications. GLS decreased as the burden of microvascular complications increased (P-trend = 0.01): no microvascular complications, GLS (- 16.4 ± 2.5%), 1 microvascular complication (- 16.0 ± 2.5%) and 2-3 microvascular complications (- 14.9 ± 2.8%). The reduction in GLS remained significant after multivariable adjustment (β 0.50 95% CI 0.11-0.88, p = 0.01). BMI (β 0.12 95% CI 0.05-0.19) and MAP (β 0.05 95% CI 0.01-0.08) were associated with reduced GLS. In addition, an increased number of microvascular complications was associated with increased PB (β 2.97 95% CI 0.42-5.51, p = 0.02) in a univariable linear regression model, whereas there was no significant association between PB and GLS.
The burden of microvascular complications was associated with reduced GLS independent of other cardiovascular risk factors in asymptomatic patients with DM and non-obstructive CAD. In addition, the burden of microvascular complications was associated with increasing PB, whereas PB was not associated with GLS.
Abstract
Aims
It has previously been demonstrated that the ratio of early mitral inflow velocity to global diastolic strain rate (E/e′sr) is a significant predictor of cardiac events in specific ...patient populations. The utility of this measurement to predict cardiovascular events in a general population has not been evaluated.
Methods and results
A total of 1238 participants in a general population study underwent a health examination including echocardiography where global longitudinal strain (GLS) and E/e′sr were determined. The primary endpoint was the composite of incident heart failure (HF), acute myocardial infarction (AMI) or cardiovascular death (CVD). During follow-up (median 11 years), 140 (11.3%) participants reached the composite endpoint. E/e′sr was associated with adverse outcome HR 1.17 95% CI (1.13–1.21); P < 0.001, per 10 cm increase. After multivariable adjustment for echocardiographic and clinical parameters, E/e′sr remained an independent predictor of the composite endpoint HR 1.08, 95% CI (1.02–1.13); P = 0.003 as opposed to E/e′ HR 1.03, 95% CI (0.99–1.06); P = 0.11 per 1 unit increase. Global longitudinal strain modified the relationship between E/e′sr and outcome (P for interaction = 0.015). E/e′sr was a stronger predictor in participants with good systolic function as determined by GLS (GLS > 18%) after multivariable adjustment, when compared to participants with reduced systolic function (GLS < 18%) HR 1.28 95% CI (1.06–1.54); P = 0.011, and HR 1.08 95% CI (1.02–1.14); P = 0.012, respectively). E/e′sr provided incremental information Harrell’s C-index: 0.839 (0.81–0.87) vs. 0.844 (0.82–0.87); P = 0.045 beyond the SCORE risk chart.
Conclusion
In the general population, E/e′sr provides independent and incremental prognostic information regarding cardiovascular morbidity and mortality. Additionally, E/e′sr is a stronger predictor of cardiac events than E/e′.
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