News in brief: Aussie takotsubo case after COVID-19 vaccine; Colchicine reduces PCI inflammation; Can AI deliver faster and more sensitive diagnosis of aortic stenosis?

Thursday, 14 Oct 2021

First Aussie takotsubo case after COVID-19 vaccine

The first known case of takotsubo cardiomyopathy following an AstraZeneca COVID-19 vaccination has been reported in Australia.

The case was a 72 year-old man presenting to the ED with retrosternal chest pain with associated dyspnoea four days after his first dose of the vaccine. He also reported fatigue, low grade fever, myalgia and arthralgia.

Given a history of ischaemic heart disease, the patient was managed for acute coronary syndrome with dual antiplatelet therapy, including a P2Y12 antagonist.

“Transthoracic echocardiogram (6 days after vaccination) revealed new moderately severe segmental systolic dysfunction with an estimated ejection fraction of 37%–39% (reference value: >50%) with hyperdynamic base, akinesis of the mid-distal left ventricular segments and severe hypokinesis of the apical cap with apical ballooning, consistent with takotsubo cardiomyopathy,” the case report said.

The patient recovered relatively quickly and was discharged after a 7-day stay in the coronary care unit.

Dr Philip Crane and colleagues said in the case report that takotsubo cardiomyopathy was very rarely reported after vaccination.

“As such, the mechanism by which the ChAdOx1 nCov-19 vaccine in our patient may have resulted in transient myocardial stunning is unknown.”

They said the case demonstrates the need for vigilance when assessing acute coronary syndrome presentations post ChAdOx1 nCov-19 vaccination.

Read more in BMJ Case Reports

Colchicine reduces inflammation pre-PCI

Colchicine could help prevent percutaneous coronary intervention (PCI) -related myocardial injury by reducing pre-procedure inflammation, according to an Australian study.

The pilot study assessed colchicine’s anti-inflammatory effects in 75 PCI patients who received two doses (1 mg followed by 0.5 mg one hour later) of the drug or placebo, six to 24 hours before the procedure.

While overall inflammation was low across the population pre- and post-PCI (hsCrP < 1.4 mg/L), colchicine patients had “numerically lower levels of pre-PCI cytokines: IL-1β (P = 0.01), IL-6 (P = 0.02), IL-10 (P = 0.01), IFNγ (P = 0.01), TNFα (P = 0.02) and WBC-count (P = 0.04)”, the authors wrote in Cardiovascular Revascularization Medicine.

The drug failed to affect post-procedure inflammation, however, with both groups returning similar cytokine levels 38 hours after colchicine.

Treated patients were less likely to have PCI-related myocardial injury, experiencing a smaller change in post- and pre-PCI troponin levels (P = 0.02).

As a result, the authors suggested colchicine-reduced inflammation pre-PCI could play a role in preventing procedure-related myocardial injury.

Can AI deliver faster and more sensitive diagnosis of aortic stenosis?

A clinical trial to assess the performance of the artificial intelligence (AI)-based heart valve disease screening program ECHOiQ starts this month at St Vincent’s Clinic Sydney.

The enhanced screening program aims to detect the at-risk phenotype of severe aortic stenosis (AS) with far greater accuracy than is currently possible with current diagnostic methods.

The technology is expected to support improved diagnosis of potential heart valve replacement patients.

Objectives of the trial include determining the number and proportion of additional patients, compared to standard guidelines, that might benefit from being identified as ‘at-risk’ of mortality when ECHOiQ’s ESP is applied, and identification of the clinical characteristics of those additional patients.

The trial, led by St Vincent’s director of cardiology Professor Michael Feneley, will be conducted in partnership with the National Echo Database of Australia (NEDA).

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