INTRODUCTION

For detecting myocardial injury in severe and critical COVID-19, the electrocardiogram (ECG) is neither sensitive nor specific, but in a resource-poor environment, it remains relevant. Changes in the ECG can be a potential marker of severe and critical COVID 19 to be used for predicting not only disease severity but also the prognosis for recovery.

METHODS

The admitting and interval ECGs of 1333 COVID-19 patients were reviewed in a 2-year, single-center, retrospective cohort study. Each was evaluated for 29 predefined ECG patterns under the categories of rhythm; rate; McGinn-White and right ventricular, axis, and QRS abnormalities; ischemia/infarct patterns; and atrioventricular blocks before univariate and multivariate regression analyses for correlation with disease severity, need for advanced ventilatory support, and in-hospital mortality.

RESULTS

Of the 29 ECG patterns, 18 showed a significant association with the dependent variables on univariate analysis. Multivariate analysis revealed that atrial fibrillation, heart rate greater than 100 beats per minute, low QRS voltage, QTc of 500 milliseconds or greater, diffuse nonspecific T-wave changes, and “any acute anterior myocardial infarction” ECG patterns correlate with disease severity, need for advanced ventilatory support, and in-hospital mortality. S1Q3 and S1Q3T3 increased the odds of critical disease and need for high oxygen requirement by 2.5- to 3-fold. Fractionated QRS increased the odds of advanced ventilatory support.

CONCLUSION

The ECG can be useful for predicting the severity and outcome of more than moderate COVID-19. Their use can facilitate rapid triage, predict disease trajectory, and prompt a decision to intensify therapy early in the disease to make a positive impact on clinical outcomes.

Covid-19 ; Disease Severity ; Patient Acuity ; In-hospital Mortality ; Hospital Mortality

BACKGROUND

Despite revascularization and optimal medial therapy (OMT) residual ischemic mitral regurgitation (IMR) continues in a self-aggravating vicious cycle to affect prognosis and survival adversely. Mitral valve surgery in combination with coronary artery bypass graft remains a subject of debate due to the absence of a net overall benefit. Mitral valve transcatheter edge-to-edge repair (M-TEER) has been gaining grounds as a viable option from observational studies, but results from randomized controlled trials (RCTs) have yielded mixed results. Thus, this study was conducted to determine whether the current collective data support the efficacy of M-TEER with OMT versus OMT alone in patients with clinically significant IMR.

METHODS

A literature search from PubMed/MEDLINE, Cochrane Review Central, Clinical Trials Registry, ResearchGate, Mendeley, and Google Scholar for relevant RCTs and observational studies was conducted and reviewed independently by three reviewers. Published and unpublished studies indexed from inception until 2023 were included. The pooled estimates for the primary outcome of all-cause mortality and secondary outcomes of cardiac mortality and heart failure hospitalizations were measured using R Studio statistical software (R Foundation forStatistical Computing, Vienna, Austria).

RESULTS

Seven eligible studies (five observational and two RCTs) allocated 1610 IMR patients to M-TEER + OMT (n = 942) or OMT alone (n = 668). The effect estimate using random-effects model demonstrated M-TEER with OMT to significantly reduce 1-year (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.52–0.86; P = 0.002) and 2-year (OR, 0.50; 95% CI, 0.38–0.67; P < 0.00001) all-cause mortality. Cardiac mortality (OR, 0.58; 95% CI, 0.27–1.23; P = 0.15) and heart failure hospitalization (OR, 0.45; 95% CI, 0.18–1.13; P = 0.09) did not reach statistical significance between the treatment arms.

CONCLUSION

In patients with IMR, M-TEER on top of OMT was able to afford a 2-year allcause mortality advantage.

BACKGROUND

Postoperative atrial fibrillation (POAF) is the most common arrythmia to occur after cardiovascular surgery. Inflammation being pivotal in POAF perpetuation has been utilized as a therapeutic target. Owing to their anti-inflammatory and anti-oxidant effects, beta-blockers (BB) and N-acetylcysteine (NAC) became research interests in the pursuit for an effective POAF prevention strategy.

OBJECTIVE

To determine the efficacy of NAC plus BB versus BB alone in preventing POAF in cardiac surgery patients.

METHODOLOGY

A literature search using the following search engines: PubMed/Medline, Cochrane Review Central, Clinical Trials Registry, ResearchGate, Mendeley and Google Scholar for relevant randomized trials were conducted. Published and unpublished studies indexed from inception until 2023 were included. Three independent reviewers evaluated the randomized clinical trials (RCTs) for eligibility. The pooled estimates for POAF prevention as primary outcome and MACE, mortality, myocardial infarction, stroke, ICU LOS and hospital LOS as secondary outcomes were measured using the RStudio statistical software.

RESULTS

Seven eligible RCTs allocated 1069 cardiac surgery patients to NAC + BB (n=539) and BB alone (N = 530) treatment arms. The effect estimate using random effect model disclosed significantly reduced POAF events (RR 0.62, 95% CI [0.44, 0.86], p = 0.005) in those on NAC + BB. While no statistical difference between the study arms were demonstrated in reducing mortality (RR 0.63, 95% CI [0.23, 1.73], p = 0.37); myocardial infarction (RR 1.02, 95% CI [0.49, 2.13], p = 0.96); stroke (RR 0.95, 95% CI [0.24, 3.68], p = 0.94); ICU LOS (std. mean difference 0.14, 95% CI [-0.43, 0.70], p = 0.41), and hospital LOS (std. mean difference 0.08, 95% CI [-0.06, 0.21], p = 0.19).

CONCLUSION

Among cardiac surgery patients, the use of NAC in combination with BB compared with BB alone significantly reduced POAF.

Acetylcysteine ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Myocardial Infarction ; Omega-chloroacetophenone