Background
No data are available about whether Coronavirus disease 2019 (COVID‐19) pandemic have led to changes in clinical profiles or results of exercise testing once the usual activity was ...reassumed, as well as if wearing a facemask has any impact on the tests. The aim of this study is to evaluate differences in the patients referred to exercise stress testing in the context of COVID‐19 pandemic and analyse the feasibility and results of these tests wearing a facemask.
Methods
We included all patients referred for an exercise test from 1 June to 30 September 2020 and compared them with the patients attended within the same period in 2019 before and after propensity score matching. All patients referred in 2020 wore a facemask.
Results
A total of 854 patients were included: 398 in the 2020 group and 456 in 2019. No significant differences in baseline characteristics of the patients were observed, with the exception of dyspnoea, which was nearly twice as high in 2020 as compared with 2019. Regarding the results of the tests, no differences were observed, with almost 80% of maximal tests, similar functional capacity and over a 20% of positive exercise tests in both groups. These results remained after propensity score matching.
Conclusion
COVID‐19 pandemic has not changed the clinical profile of patients referred to exercise testing. In addition, performing exercise testing wearing a facemask is feasible, with no influence in functional capacity and clinical results.
CASE RESOLUTION The procedure was performed under general anesthesia and with the administration of the standard dose of sodium heparin to prevent thrombosis or systemic embolisms (high risk ...considering the patient's condition) via venous femoral access. This procedure was planned using 3D reconstruction through rotational angiography (figure 1 and video 1 of the supplementyary data). Embolization was guided using the roadmapping technique that merges the 3D reconstruction simultaneously while overlapped to the 2D reconstruction in the x-ray image projection required during multiple occlusion device implantations. Figure 1. 3D reconstruction of a pulmonary arteriovenous malformation from data obtained from the rotational angiography performed. The medical equipment used during the procedure included 4-Fr guide-catheters (using JR4 or MP catheters based on the anatomical needs of each patient), coils (Concerto Coil System 5/20 mm; Medtronic, United States), and vascular occluder devices (4 mm to 8 mm Amplatzer Vascular Plug from; Abbott, United States). A staged occlusion strategy was planned that started with the peripheral closure of the arteriovenous malformations (AVMs) using coils followed by the closure of nutrient vessels with coils and vascular plugs. Indeed, according to former studies, both devices combined are associated with a low rate of recanalization after embolization.1 This is the approach that...
CASE PRESENTATION Among other causes, arteriovenous malformations (AVMs) can be congenital and associated with Rendu-Osler-Weber disease. It is a conglomerate of anomalous vessels of variable size ...and number characterized by the lack of an intermediate normal capillary network between the arterial and the venous circuits. Its prevalence is of approximately 1 AVM for every 2600 individuals, and it is a significant cause of morbidity and mortality. The percutaneous closure of AVMs is the standard of care established. However, there is a significant rate of recanalization of AVMs at the long-term follow-up due to the recanalization of the main occluded vessel and the formation of collateral circulation towards the vascular tangle. A few articles already published support sequential embolization to reduce the risk of the latter. This article describes the percutaneous closure of 1 AMV in a pediatric patient using a technique of sequential embolization through rotational angiography, 3D analysis, and roadmapping (technique based on merging the 3D reconstruction acquired through rotational angiography and x-ray images in such a way that reconstruction acts as a «map» or «flight plan» during the procedure). In our opinion this experience is very interesting because, as far as we know, its use has not been described regarding...
Coronary artery disease (CAD) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI). However, its prognostic significance and its management remains controversial.
...This study sought to determine whether the presence of CAD, its complexity, and angiography-guided percutaneous coronary intervention (PCI) are associated with outcomes after TAVI.
All patients undergoing TAVI at a tertiary referral center between 2008 and 2018 were included in a prospective observational study. Baseline SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score (SS) and a residual SS after PCI were calculated. The endpoints on the 5 year follow-up were all-cause mortality and a composite of mayor cardiovascular adverse events (MACE).
In 379 patients, the presence of CAD and its complexity were not significantly associated with worse 5-year survival after TAVI, with a mortality for SS0 of 45%; for SS 1-22 of 36.5% (HR 0.77; 95% CI 0.53-1.11, p = 0.15) and for SS > 22 of 42.1% (HR 1.24; 95% CI 0.59-2.63, p = 0.57). Regarding the combined event of MACE, there were also no statistically significant differences between patients with CAD and without CAD (56.8% in patients without CAD and 54.9% in patients with CAD; HR 1.06; 95% CI 0.79-1.43, p = 0.7). Angiography-guided PCI or completeness of revascularization was not associated with different outcomes.
In the present analysis, neither the presence nor the extent of CAD, nor the degree of revascularization, was associated with a prognostic impact in patients undergoing TAVI at 5-year follow-up.
RESOLUCIÓN DEL CASO El procedimiento se realizó bajo anestesia general y con la administración de heparina sódica según la pauta habitual para evitar trombosis o embolias sistémicas (riesgo alto ...teniendo en cuenta la patología de la paciente), con un abordaje femoral venoso. La planificación de la intervención se realizó utilizando una reconstrucción tridimensional mediante angiografía rotacional (figura 1 y vídeo 1 del material adicional) y guiando la embolización con la técnica de roadmapping, que permite fusionar la reconstrucción tridimensional simultáneamente y superpuesta a la bidimensional en la proyección escópica requerida durante los múltiples implantes de dispositivos oclusores. Figura 1. Reconstrucción tridimensional de la malformación arteriovenosa pulmonar analizando los datos obtenidos de la angiografía rotacional. El material para la intervención consistió en catéteres guía de 4 Fr (utilizando catéter JR4 o MP en función de las necesidades anatómicas), coils (Concerto Coil System 5/20 mm; Medtronic, Estados Unidos) y oclusores vasculares (Amplatzer Vascular Plug de 4 a 8 mm; Abbott, Estados Unidos). La estrategia de oclusión se planificó de manera secuencial, procediendo inicialmente al cierre periférico de la malformación arteriovenosa (MAV) mediante coils seguida del cierre de los vasos nutricios mediante coils y oclusores vasculares, ya que dicha combinación ha demostrado presentar...
PRESENTACIÓN DEL CASO Las malformaciones arteriovenosas (MAV) pueden tener, entre otros, un origen congénito asociado a la enfermedad de Rendu-Osler-Weber, tratándose de un conglomerado de vasos ...anómalos de tamaño y número variable, caracterizado por la ausencia de una red capilar normal intermedia entre el circuito arterial y el venoso. La prevalencia de las MAV es de aproximadamente 1 por cada 2.600 individuos, y es una importante causa de morbimortalidad. El cierre percutáneo de las MAV es el tratamiento de elección establecido. No obstante, en el seguimiento a largo plazo existe una tasa significativa de recanalización de la MAV, tanto por recanalización del vaso principal ocluido como por la formación de la circulación colateral hacia el ovillo vascular. Hay artículos que apoyan la embolización secuencial para reducir el riesgo de esta última. En este caso se describe la oclusión percutánea de una MAV en una paciente en edad pediátrica con una técnica de embolización secuencial con la ayuda de la angiografía rotacional, el análisis tridimensional y el roadmapping (técnica consistente en fusionar la reconstrucción tridimensional conseguida con la angiografía rotacional y la escopia radiológica, actuando la reconstrucción como un «mapa» u «hoja de ruta» durante el procedimiento). Se trata de una experiencia que...
Introduction and objectives
Vaccines against SARS-CoV-2 have been a major scientific and medical achievement in the control of the COVID-19 pandemic. However, very infrequent cases of inflammatory ...heart disease have been described as adverse events, leading to uncertainty in the scientific community and in the general population.
Methods
The Vaccine–Carditis Registry has included all cases of myocarditis and pericarditis diagnosed within 30 days after COVID-19 vaccination since August 1, 2021 in 29 centers throughout the Spanish territory. The definitions of myocarditis (probable or confirmed) and pericarditis followed the consensus of the Centers for Disease Control and the Clinical Practice Guidelines of the European Society of Cardiology. A comprehensive analysis of clinical characteristics and 3-month evolution is presented.
Results
From August 1, 2021, to March 10, 2022, 139 cases of myocarditis or pericarditis were recorded (81.3% male, median age 28 years). Most cases were detected in the 1st week after administration of an mRNA vaccine, the majority after the second dose. The most common presentation was mixed inflammatory disease (myocarditis and pericarditis). 11% had left ventricular systolic dysfunction, 4% had right ventricular systolic dysfunction, and 21% had pericardial effusion. In cardiac magnetic resonance studies, left ventricular inferolateral involvement was the most frequent pattern (58%). More than 90% of cases had a benign clinical course. After a 3-month follow-up, the incidence of adverse events was 12.78% (1.44% mortality).
Conclusions
In our setting, inflammatory heart disease after vaccination against SARS-CoV-2 predominantly affects young men in the 1st week after the second dose of RNA-m vaccine and presents a favorable clinical course in most cases.
Graphical abstract
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