Материалом для исследования послужили данные 80 аутопсий пациентов, страдавших инфекцией COVID-19. При помощи макро- и микроскопического исследований продемонстрированы особенности патологических процессов в различных органах. Полученные данные в сочетании со сведениями из литературы позволяют сделать выводы о закономерностях поражения внутренних органов и систем организма, а также высказать предположения об отдельных звеньях патогенеза COVID-19. Обсуждается танатогенез при данном заболевании и основные причины смерти, к которым относятся: острая сердечно-легочная недостаточность, острая почечная недостаточность, тромбоэмболия легочной артерии, шок с полиорганной недостаточностью и сепсис. Подчеркивается чрезвычайная важность проведения аутопсий, которые несут неоценимую информацию о морфологическом субстрате данной инфекции, тесно связанном с возможными клиническими проявлениями.
Abstract Background the COVID19 pandemic has resulted in worldwide morbidity at unprecedented scale. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or nonspecific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities and mortality. Methods We retrospectively studied 204 consecutive patients hospitalized at NYU Langone Health with COVID19. Serial ECG tracings were evaluated in conjunction with laboratory data including Troponin. Mortality was analyzed in respect to the degree of Troponin elevation and the presence of ECG changes including ST elevation, ST depression or T wave inversion. Results Mortality increased in parallel with increase in Troponin elevation groups and reached 60% when Troponin was >1 ng/ml. In patients with mild Troponin rise (0.05 – 1.00 ng/ml) the presence of ECG abnormality resulted in significantly greater mortality. Conclusion ECG repolarization abnormalities may represent a marker of clinical severity in patients with mild elevation in Troponin values. This finding can be used to enhance risk stratification in patients hospitalized with COVID19.
Abstract Background The emergence of the COVID-19 pandemic has resulted in over two million affected and over 150 thousand deaths to date. There is no known effective therapy for the disease. Initial reports suggesting the potential benefit of Hydroxychloroquine/Azithromycin (HY/AZ) have resulted in massive adoption of this combination worldwide. However, while the true efficacy of this regimen is unknown, initial reports have raised concerns regarding the potential risk of QT prolongation and induction of torsade de pointes (TdP). Methods This is a multicenter retrospective study of 251 patients with COVID-19 treated with HY/AZ. We reviewed ECG tracings from baseline and until 3 days after completion of therapy to determine the progression of QTc and incidence of arrhythmia and mortality. Results QTc prolonged in parallel with increasing drug exposure and incompletely shortened after its completion. Extreme new QTc prolongation to > 500 ms, a known marker of high risk for TdP had developed in 15.9% of patients. One patient developed TdP requiring emergent cardioversion. Seven patients required premature termination of therapy. The baseline QTc of patients exhibiting QTc prolongation of > 60 ms was normal. Conclusion The combination of HY/AZ significantly prolongs the QTc in patients with COVID-19. This prolongation may be responsible for life threating arrhythmia in the form of TdP. This risk mandates careful consideration of HY/AZ therapy in lights of its unproven efficacy. Strict QTc monitoring should be performed if the regimen is given.
Background: The COVID-19 pandemic has resulted in worldwide morbidity at unprecedented scale. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or non-specific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities, and mortality. Methods: We retrospectively studied 204 consecutive patients hospitalized at NYU Langone Health with COVID-19. Serial ECG tracings were evaluated in conjunction with laboratory data including Troponin. Mortality was analyzed in respect to the degree of Troponin elevation and the presence of ECG changes including ST elevation, ST depression or T wave inversion. Results: Mortality increased in parallel with increase in Troponin elevation groups and reached 60% when Troponin was >1 ng/ml. In patients with mild Troponin rise (0.05–1.00 ng/ml) the presence of ECG abnormality and particularly T wave inversions resulted in significantly greater mortality. Conclusion: ECG repolarization abnormalities may represent a marker of clinical severity in patients with mild elevation in Troponin values. This finding can be used to enhance risk stratification in patients hospitalized with COVID-19.
There is no known effective therapy for patients with coronavirus disease 2019 (COVID-19). Initial reports suggesting the potential benefit of hydroxychloroquine/azithromycin (HY/AZ) have resulted in massive adoption of this combination worldwide. However, while the true efficacy of this regimen is unknown, initial reports have raised concerns about the potential risk of QT interval prolongation and induction of torsade de pointes (TdP).
Introduction: Left atrial posterior wall (LAPW) isolation is associated with favorable outcomes for catheter ablation of persistent atrial fibrillation (PEAF). Techniques for LAPW isolation include ablation at the periphery with or without high density ablation within the LAPW. The proportion of LA isolated by the lesion set also varies greatly. The optimal technique to achieve LAPW isolation is not clear. Objective: To assess impact of ablation lesion density within and dimensions of the LAPW isolation region on arrhythmia recurrence in catheter ablation of PEAF. Methods: LAPW lesion density and surface area relative to total LA surface area were calculated using electroanatomic maps of 110 consecutive patients undergoing LAPW isolation for PEAF (CARTO 3, Biosense Webster, Inc.). LAPW isolation was performed at the discretion of 5 experienced operators after voltage mapping. LAPW PV entrance and exit block were confirmed. Arrhythmia recurrence at two years was assessed by Kaplan-Meier analysis. Results: LAPW lesion density ranged from 0% - 99%. The proportion of LA surface area isolated ranged from 35% - 75%. There was no significant difference in arrhythmia-free survival stratified by median LAPW ablation density (31% vs. 27%, p=0.8) or median proportion of electrically-isolated LA surface area (31% vs. 27%, p=0.8%). Voltage map-guided LAPW isolation did not significantly decrease arrhythmia recurrence (29% vs. 28%, p=1). Conclusion: Neither the density of ablation within nor the dimensions of the LAPW isolated region predicted arrhythmia-free survival for catheter ablation of PEAF. Voltage map-guided LAPW isolation resulted in similar ablation efficacy regardless of LA scar burden.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)