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Am J Obstet Gynecol . New-Onset myocardial injury in COVID-19 Pregnant Patients: A Case Series of 15 Patients

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  • Am J Obstet Gynecol . New-Onset myocardial injury in COVID-19 Pregnant Patients: A Case Series of 15 Patients


    Am J Obstet Gynecol


    . 2020 Oct 21;S0002-9378(20)31206-0.
    doi: 10.1016/j.ajog.2020.10.031. Online ahead of print.
    New-Onset myocardial injury in COVID-19 Pregnant Patients: A Case Series of 15 Patients


    Brisandi Ruiz Mercedes 1 , Ayna Serwat 2 , Lena Naffaa 3 , Nairovi Ramirez 4 , Fatima Khalid 5 , Sofia B Steward 6 , Omar Gabriel Caro Feliz 7 , Mohamad Kassab 8 , Lina Karout 9



    Affiliations

    Abstract

    Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the new coronavirus responsible for the coronavirus disease (COVID-19), characterized by acute respiratory distress syndrome and atypical pneumonia. In non-pregnant women, studies have shown that SARS-CoV-2 causes cardiac injury, which can result in myocardial inflammation and damage. Despite many studies investigating the extent of cardiac compromise in severely ill COVID-19 patients, little is known regarding its impact on pregnant women.
    Objective: To illustrate the clinical, laboratory, radiological findings, and outcomes of COVID-19 pregnant patients who developed myocardial injury with ventricular dysfunction.
    Study design: We retrospectively reviewed the paper records of fifteen pregnant women with COVID-19, who developed myocardial injury on a single tertiary care hospital in the Dominican Republic. Patient's baseline characteristics, clinical picture, laboratory, and radiological findings were presented, and maternal and fetal outcomes were analyzed.
    Results: Of 154 pregnant patients diagnosed with COVID-19 at our hospital during the study period, 15 (9.7%), developed myocardial injury. These patients' mean age and gestational age were 29.87 5.83 and 32.31 3.68, respectively. 66.7% of patients presented with shortness of breath and 16.3% with palpitations. All patients were admitted to the intensive care unit, and 86.6% needed intubation. Patients developed myocardial injury confirmed with highly elevated troponin (34.6 [14.4-55.5 ng/ml]), and pro-BNP concentrations (209 [184-246 pg/ml]). Additionally, all patients developed left ventricular dysfunction demonstrated by an echocardiogram with a mean left ventricular ejection fraction (LVEF) of 37.67 6.4 %. Two patients that presented with palpitations passed away a few days after admission.
    Conclusion: Our study showed COVID-19 induced myocardial injury and left ventricular dysfunction in pregnant women with a 13.3% mortality rate which was attributed to malignant arrhythmias.

    Keywords: COVID-19; SARS-COV-2; cardiovascular disease; coronavirus; myocardial injury; pregnancy; ventricular dysfunction.


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