Doenças Cardiovasculares e Diagnóstico

The Novel Coronavirus Disease 19 (COVID-19) is a clinical syndrome caused by SARS-CoV-2. While the most regarded severe complication of COVID-19 is acute respiratory distress syndrome, the virus could have multiple impacts in other areas of the body, including the cardiovascular system. In this review, we will look at the cardiovascular manifestations of COVID-19, as described in the current literature.

There is no doubt that in the last 2 months during COVID-19 pandemic a smaller number of ST-elevation Myocardial Infarction (STEMI) and Stroke arrived to cardiological and neurological departments. The pathophysiology of STEMI in COVID-19 women is not fully understood; it could be thrombus recanalization, catecholamine storm or Type 2 Myocardial infarction in case of severe respiratory distress or direct myocardial damage (viral myocarditis). Because most of them have normal coronary arteries an invasive strategy with coronary angiography is important to rule out atherosclerotic severe coronary disease.

Background: There is conflicting data regarding the association between low levels of plasma vitamin D and ischemic heart disease (IHD). We aimed to investigate the relationship between plasma vitamin D levels and heart valve calcification in hospitalized patients with IHD versus non-IHD controls.

Methods: A prospective case control study comprising two age and gender-matched groups. The study group included consecutive patients hospitalized due to acute coronary syndrome (ACS); the control group included consecutive non- IHD patients hospitalized for non-cardiac causes. Blood samples for 25-hydroxyvitamin D level (25(OH)D) were drawn. An echocardiogram was performed during the first 3 days of hospitalization and reviewed for presence and degree of valvular calcification (VC).

Results: Forty patients with ACS and 40 controls (age 58 ± 11 years, 64% male in both groups) were included. Mean plasma 25(OH)D vitamin level in the entire cohort was 24.5 ± 8 ng/ml. Valve calcification rates were similar in ACS versus non-ACS group (28 vs. 21 had VC; 18 vs. 12 had aortic valve calcification (AVC); 21 vs. 14 had mitral valve calcification (MVC), respectively; p=NS for all). We found no significant relationship between vitamin D level and VC, AVC, or MVC rate or degree in the entire cohort and in each group alone (p=NS for all). There was a negative correlation between 25(OH)D levels and age in the ACS group (r=-0.399, p=0.012).

Conclusions: We did not find a significant relationship between plasma vitamin D levels and the rate or degree of calcification of either aortic/mitral/both valves in hospitalized patients with/without IHD.

Purpose: Optical coherence tomography (OCT) provides superior-resolution images than coronary angiography and accurately evaluates the vessel size and plaque morphology guiding the treatment strategy before and after stent implantations. Very limited data is available in the public domain in India on OCT-guided PCI. The aim of this study is to assess the safety and effectiveness of OCT-guided PCI in a real-world setting in India.

Methods: Records of patients ≥ 18 years who underwent OCT-guided PCI between April 2016 and December 2018 at KLE’s Hospital, Department of Cardiology and had one-year follow-up data were retrospectively analysed. All patients underwent pre- and post-PCI angiography and post-PCI OCT. The primary endpoint was post-PCI minimum stent area (MSA) and target lesion failure (TLF) at one year.

Results: A total of 204 patients with 299 coronary lesions were analysed. Pre-dilatation and post-dilatation were performed in 82% and 58% of cases, respectively. The mean MSA and stent expansion with OCT guidance was 4.57 ± 1.82 mm² and 81.80 ± 14.01%, respectively. No edge dissection, thrombus, abrupt closure, or perforation were observed on post-PCI angiography. OCT was useful in detecting stent malapposition (3%), stent dissection (1%), and tissue/thrombus prolapse (10%). Post-stenting optimisation was done in 8% of cases. Post-PCI OCT was associated with better clinical outcomes with a very low incidence of target lesion failure (TLF) at one year (1.5%).

Conclusions: Optical coherence tomography-guided PCI was safe and resulted in optimal MSA. It was also beneficial in detecting suboptimal stent deployment and optimising PCI with better clinical outcomes at one year after the index PCI.

Factor Xa inhibitors are approved for the prevention of clot formation in non-valvular atrial fibrillation and for treating deep venous thromboembolism and pulmonary embolism. This class of medications are known CYP3A4 and CYP2J2 inhibitors vulnerable to drug-drug interactions and are known to be risk factors for GI bleeding. Although not a common finding, these medications are possible risk factors for acute liver injury, as seen in our patient. We present an uncommon case of persistent Factor Xa Inhibitor induced liver injury in an Eastern Asian male.