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Swiss Re — Technical Presentation (2021)

16 slides from Swiss Re's technical presentation, Sep 22, 2021

  1. Slide 1: Heart involvement in COVID-19: What is the risk of long-term consequences?

    Heart involvement in COVID-19: What is the risk of long-term consequences? Patricia A. Pellikka, MD Betty Knight Scripps Professor of Cardiovascular Disease Clinical Research Vice Chair, Academic Affairs and Faculty Development Department of Cardiovascular Medicine Director, Ultrasound Research Cent

  2. Slide 2: Disclosures

    Disclosures • Research grants: Ultromics, GE Healthcare, Lantheus Medical, Bracco, Oxthera, NHLBI, American Society of Echocardiography • Scientific Advisory Board: Ultromics, Bracco, Lantheus Medical

  3. Slide 3: Cardiovascular effects of COVID-19

    Cardiovascular effects of COVID-19 • 187 hospitalized patients in Wuhan1 • Elevated troponin levels in 28% • In hospital mortality: 7.6% without underlying CVD & normal TnT 13.3% with CVD and normal TnT 37.5% without CVD but ↑ TnT 69.4% for CVD and ↑ TnTs 1 Guo T, JAMA Cardiol 2020 ©2011 MFMER

  4. Slide 4: Mechanisms of cardiac injury – RV involvement

    Mechanisms of cardiac injury – RV involvement Hypoxemia (ARDS, pulmonary embolism) Shock Acute coronary syndrome Myocarditis Stress cardiomyopathy Adverse right ventricular remodeling related to doubling in mortality (Kim JACC 2021) Pellikka PA, Naqvi T : JACC 2021 ©2011 MFMER

  5. Slide 5: Cardiac Abnormalities in COVID-19 and Relationship to Outcome

    Cardiac Abnormalities in COVID-19 and Relationship to Outcome • Clinically-indicated echo in 179 COVID-19 inpatients at 10 MC sites • Age 60± 17 years; 60% men • Events within 30 days in 70 (39%) patients including prolonged hospitalization in 43 (24%) & death in 27 (15%) Krishna H, Pellikka PA, et

  6. Slide 6: Cardiac Abnormalities in COVID-19 and Relationship to Outcome

    Cardiac Abnormalities in COVID-19 and Relationship to Outcome • Left ventricular ejection fraction < 50% in 29 (16%), regional wall motion abnormalities in 26 (15%), and right ventricular systolic pressure (RVSP) >35 mm Hg in 44% • Myocardial injury (troponin elevation + new ventricular dysfunction

  7. Slide 7: Myocardial injury: Mayo Clinic cohort

    Myocardial injury: Mayo Clinic cohort Non-ST elevation myocardial infarction: 6 pts Stress cardiomyopathy: 3 Myocarditis: 2 Ischemic cardiomyopathy after cardiac arrest, prior CABG: 1 Stress cardiomyopathy/myocarditis: 1 77 yo woman with stress cardiomyopathy ©2011 MFMER

  8. Slide 8: Cardiac Abnormalities in COVID-19 and Relationship to Outcome

    Cardiac Abnormalities in COVID-19 and Relationship to Outcome • Prior echo available in 36 (20%) : pre-existing abnormalities were seen in 28 (78%) of these • In a multivariable age-adjusted model, AUC 0.81, prior cardiovascular disease, troponin, D- dimer, and RVSP were related to events at 30 days

  9. Slide 9: Myocardial injury in patients in NYC and Milan

    305 pts NYC, Milan • Troponin ↑ in 62% Picture placeholder • Any major echo Central Illustration: Spectrum of echocardiographic abnormalities in abnormality: RWMA, patients with biomarker evidence of global LV dyfunction, myocardial injury and coronavirus disease-2019. RV dysfunction, pericardial ef

  10. Slide 10: Prognostic impact of prior heart failure in pts hospitalized with COVID-19

    Prognostic impact of prior heart failure in pts hospitalized with COVID-19 Placeholder for Fig 3 • Pts with hx HF had Forest Plot of the Effect of a History of HF on Outcomes in Patients Admitted longer length of stay: for COVID-19 8 vs 6 d After a multivariable logistic regression adjusting for age

  11. Slide 11: Indirect consequences of the pandemic

    Indirect consequences of the pandemic Placeholder for Fig 1 Incidence of Hospitalization for Acute MI before and during the Covid-19 • Hospitals shut down or Pandemic in 2020 and during the Same with limited access Period in 2019, Relative to the Incidence of Hospitalization for Covid-19. Data from

  12. Slide 12: Outcomes of Cardiovascular Magnetic Resonance Imaging in Pts Recently Recovered From COVID-19

    Outcomes of Cardiovascular Magnetic Resonance Imaging in Pts Recently Recovered From COVID-19 • 100 pts recently recovered from severe COVID- 19, University Hospital Frankfurt • Mean age 49, median time from diagnosis to CMR 71 days (64-92) • CMR abnormal in 78%, inflammation in 60% Puntmann: JAMA C

  13. Slide 13: Follow up after COVID-19

    Follow up after • Sequelae after moderate or COVID-19 severe COVID-19 • Perception of decline in exercise capacity, increased shortness of breath. Deconditioning vs damage (heart or lungs)? • Heart failure with preserved ejection fraction? Similar cardiometabolic risk profile (DM, obesity, aging) ©2

  14. Slide 14: Open questions on long-term cardiac sequelae

    • Will there be long-term cardiac sequelae? Pulmonary hypertension, heart failure • Role of advanced imaging (stress echo, strain, CMR) • Can artificial intelligence (applied to ECG or echo) identify pts at risk of poor outcome? ©2011 MFMER

  15. Slide 15: Summary

    Summary • Cardiac involvement in COVID-19 is varied • Right ventricular enlargement, dilatation and elevated pressures are associated with poor short-term outcomes • Caution in attributing cardiac abnormalities to COVID-19; some pre-existing • Further information is needed regarding long- term cardi

  16. Slide 16: Questions and Comments

    Questions and Comments [email protected] @pattypellikka ©2011 MFMER

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