Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries

AIMS

Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality.

METHODS AND RESULTS

We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients.

CONCLUSION

Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.

The possibility of determining the systolic function of the left ventricle using a single-channel electrocardiogram monitor with photoplethysmography

Introduction

Assessment of the systolic function of the left ventricle is the basis for the timely diagnosis and treatment of various diseases of the cardiovascular system. Regular monitoring of the systolic function is very often necessary. Remote assessment of the left ventricular systolic function can provide more thorough and convenient monitoring of the patient's condition.

Purpose

The determination of the left ventricular systolic function using a single-channel electrocardiogram (ECG) monitor with photoplethysmography function.

Methods

The study prospectively included 400 patients aged 18 and over with various pathologies of the cardiovascular system. All study participants underwent echocardiography and the indicators of the left ventricular (LV) systolic function were determined: LV ejection fraction (LV EF), LV outflow tract velocity time integral (LVOT VTI). Recording of the electrocardiogram (I standard lead) and the photoplethysmogram (PPG) using a single-channel ECG monitor with photoplethysmography were performed in all patients. The single-channel electrocardiogram monitor is a portable electrocardiograph with photoplethysmography in the form of a smartphone case. The ECG and PPG parameters were calculated and compared with echocardiography. Models for assessing the LV systolic function were built based on the obtained ECG and PPG parameters using the random forest algorithm.

Results

A total of 400 ECG records and 400 PPG records were obtained. Then the parameters ECG and PPG were selected for constructing the models. We obtained three models for the ejection fraction (less than 55%, less than 40%, less than 30%) and two models for the LVOT VTI. The quality of each model was assessed by sensitivity, specificity, area under the ROC curve (AUC). For the model with the ejection fraction less than 55%, the AUC was 91.3% (0.844–0.982), sensitivity – 86.4%, specificity – 91.4%. AUC was 95.5% (0.903–1.000), sensitivity 100%, specificity 87.2% for the model with the ejection fraction less than 40%. For the model with the ejection fraction less than 30% AUC: 96.2% (0.900–1.000), sensitivity 100%, specificity 92.9%. Models for the LVOT VTI: less than 13cm (AUC: 77.6% (0.561–0.992), sensitivity 80%, specificity 78.1%) and less than 16cm (AUC: 78.2% (0.657–0.907), sensitivity 76.5%, specificity 77.4%).

Conclusions

The models obtained based on ECG and PPG parameters had sufficiently high accuracy. Thus, using the ECG and PPG, it is possible to assess the LV systolic function. Therefore, it will be possible to perform the remote monitoring of the systolic function of the left ventricle using portable the single-channel electrocardiogram monitor with photoplethysmography.

Funding Acknowledgement

Type of funding sources: None.

Accuracy of a cuffless blood pressure measurement with a single-channel electrocardiogram monitor with photoplethysmography

Introduction

The accurate assessment of the blood pressure (BP) allows to diagnose of the cardiovascular diseases and correct their treatment timely. Cuff-less BP measurement can be more convenient to use and can also provide the blood pressure monitoring using with telemedicine. In this study, we evaluated the cuff-less BP measurement method based on photoplethysmography.

Purpose

To evaluate the accuracy of cuffless blood pressure measurement using with the single-channel electrocardiogram (ECG) monitor with photoplethysmography pulse wave registration.

Methods

The study included 500 patients aged from 32 to 88 years (mean 64±7,9 years) with arterial hypertension. We used the single-channel electrocardiogram monitor with photoplethysmography, this device looks like a phone case and records electrocardiogram (I standard lead) and photoplethysmogram (PPG) simultaneously. For each patient, blood pressure was measured using a sphygmomanometer with a cuff (3 times and the mean value was calculated). Then within 1 minute after blood pressure measurement, an electrocardiogram and photoplethysmogram were recorded for 3 minutes using the single-channel electrocardiogram monitor with photoplethysmography. ECG and PPG were recorded from the patient's fingers in a sitting position. According to the combination of the electrocardiogram signal and the photoplethysmogram signal, using a special algorithm based on machine learning, the levels of systolic and diastolic blood pressure were calculated. We compared measurement of blood pressure obtained using with the sphygmomanometer and the single-channel electrocardiogram monitor with photoplethysmography.We used the Bland-Altman method for statistical data analysis.

Results

In total of 1000 blood pressure measurements were obtained from 500 patients. According to the Bland-Altman analysis of systolic pressure the average discrepancy was 3,49 mmHg, the standard deviation was 4,21, the standard error of the average was 0,61. One-sampled 2-sided t-test was −0,477 (confidence interval −2.83; −4.33). The average discrepancy for diastolic blood pressure was 3,1 mm Hg, the standard deviation was 3,61 mm Hg, standard error of the average 0,52, One-sampled 2-sided t-test was −0,455 (95% confidence interval −2,64; −4,18). The correlation of the systolic and diastolic pressure using with two measurement methods was 0,89 (p=0,001) and 0.87 (p=0,002), respectively.

Conclusion

There is not significant difference between the results of cuffless measurement of the blood pressure by the single-channel electrocardiogram monitor with photoplethysmography and cuff-based sphygmomanometer measurement in patients with cardiovascular diseases.

Funding Acknowledgement

Type of funding sources: None.

Multislice Computed Tomography Capabilities in Assessment of the Coronary Arteries Atherosclerotic Lesions

Until today, there are no universally accepted methods for detection of unstable atherosclerotic plaques, even though many recent studies were devoted to this issue. In this article we present modern possibilities of computed tomography in visualization of atherosclerotic coronary lesion, including the detection of unstable lesions, whot in turn, can help in diagnosing subclinical exacerbation of ischemic heart disease and in the stratification of risks of acute coronary events.

Noninvasive Assessment of Fractional Flow Reserve Using Mathematical Modeling of Coronary Flow

Nowadays an invasive evaluation of fractional flow reserve (FFR) is one of the main methods used for detecting lesions that cause ischemia. Invasively obtained FFR &lt;0.75 has the specificity of 100 %, and FFR &gt;0.80 has the sensitivity &gt;90 %. Recent achievements in computational fluid dynamics and computer simulations allow noninvasive assessment of FFR using data obtained by CT angiography performed according to standard protocol at rest without additional radiation, modification of image acquisition protocols, or added medications for vasodilatation. The present review covers the results of the DISCOVER, the NXT, the DEFACTO and the PLATFORM randomized multicenter studies as well as the prospects of using a noninvasive method for measuring FFR developed by specialists of the Institute of Numerical Mathematics in collaboration with specialists of the I. M. Sechenov First Moscow State Medical University.