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Introduction In chronic kidney disease (CKD) patients, the case fatality rate caused by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is higher than in the general population [1]. In patients hospitalised with COVID 19, right heart dysfunction is present in 20% of the cases, associated with an increased risk of all-cause death [2]. Purpose CARDIO-SCARS in CKD is a currently ongoing multi-center observational match controlled trial that aims to assess the cardiovascular (CV) risk in a CKD (stages 3 to 5), dialysis and kidney transplant population, following SARS-CoV-2 infection, by using clinical evaluation, various techniques and novel biomarkers (ClinicalTrials.gov Identifier NCT05125913). We hereby report the main baseline echocardiographic parameters that assess the right ventricular (RV) function. Methods We conducted a cross-sectional study that included 263 patients with CKD (dialysis, transplantation or eGFR <60 ml/min/1.73 m2). For assessing RV function, 5 parameters were measured: fractional area change (FAC, %), tricuspid annular plane systolic excursion (TAPSE, mm), tricuspid S' wave (S tric, cm/s), Tei index and right ventricular free wall longitudinal strain (RVFWLS, %). Patients in atrial fibrillation, with a permanent pacemaker or with a poor acoustic window were excluded. Results Our study included 263 patients with CKD, divided in two groups: 168 patients post COVID-19 (94 in dialysis, 38 post kidney transplantation and 36 with CKD) and 95 patients in the control group (57 in dialysis, 30 post kidney transplantation and 8 with CKD).The mean age was 57.3±15.4 years (median 60 years old), 55.2% of the patients were males, 24% were diabetic and 9.5% were smokers. The mean duration of dialysis in the COVID-19 group was 63.8 months vs. 62.6 months in the control group. In the COVID group, the echocardiography was performed at a mean distance of 2.2±2.1 months after testing positive for SARS-CoV-2.All the parameters of RV function were better in the control group (FAC (%): 43.6±11 vs. 41.3±11; TAPSE (mm): 23.2±6.9 vs. 21.4±4.9; S tric (cm/s): 13.4±3.4 vs. 13±3.1; Tei index: 0.5±0.2 vs. 0.6±0.2; RVFWLS (%): −20.1±3.8 vs. −18.6±5.1. After performing a two-sample t-Test, statistical significance was reached only for TAPSE, Tei index and RVFWLS (0.008, 0.0001 and 0.006, respectively). Conclusions Our study is the first to describe echocardiographic alterations post-COVID in a CKD population. All CKD patients had lower values of RV parameters than those reported in the general population. Still, the CKD COVID group had lower values than CKD control group, with the same magnitude as the changes reported in the general population [3,4]. The evolution of these parameters and their prognostic significance is of interest, regarding long-term CV sequelae of COVID-19. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Ministry of Research and Innovation, CNCS-UEFISCDI

BACKGROUND AND AIMS Despite impressive improvements in treatment strategies, heart failure (HF) morbidity and mortality remain substantially high worldwide. Muscle wasting is common and is associated with increased morbidity and mortality in patients with HF. The aim of the study was to determine muscle mass, by bioimpedance spectroscopy (BIS), and to identify factors associated with decreased muscle mass in this population. METHOD This was a prospective observational study of outpatient adults referred for clinically indicated transthoracic echocardiograms at an academic hospital between 2016 and 2018. A left ventricular ejection fraction below 45% was required for inclusion (HFrEF). Muscle mass was assessed using BIS (with the body composition monitor—BCM® device). RESULTS Our study included 151 patients. The mean age and eGFR values of the population at baseline were 67.1 years and 66.5 mL/min/1.73 m2. The median levels for lean tissue index (LTI, lean tissue mass/height2) were 11.3 (IQR 9.4–12.9) kg/m2. LTI was positively associated with eGFR and negatively associated with uric acid, ST-2 and galectin-3 levels. Including all these variables in a stepwise multivariable regression only eGFR and ST-2 remained independently associated with LTI (see Table 1). Based on the LTI median value, we also divided the patients into two groups—group 1 (LTI ≤ 11.3 kg/m2) and group 2 (LTI > 11.3 kg/m2). In the univariable logistic regression age, using the haemoglobin, eGFR and ST-2 levels predicted the group appurtenance. Including all these variables in a stepwise multivariable logistic regression, only eGFR and eGFR remained independently associated with LTI groups (see Table 2). CONCLUSION A better understanding of the factors associated with decreased muscle mass is needed to develop preventive strategies for muscle wasting in patients with HF. Muscle mass, as measured by the BCM and expressed as the LTI, is strongly associated with eGFR.

Background and Aims COVID-19 is associated with myocardial injury and in previous studies, patients with right ventricular dysfunction had an increased risk of all-cause death. In the general population, there is evidence that right ventricular strain improves at 6 months after COVID-19, but data about the course of other myocardial performance parameters are limited. Method CARDIO-SCARS in CKD is a currently ongoing observational cohort study that aims to assess the cardiovascular risk in a CKD (stages 3 to 5), dialysis and kidney transplant population following SARS-CoV2 infection, by using clinical evaluation, various techniques and both endothelial dysfunction and myocardial injury biomarkers (ClinicalTrial.gov Identifier NCT05125913). We hereby report the evolution of the main echocardiographic myocardial performance parameters at 6 months from COVID-19 disease. Results Our study included 222 patients (134 in the COVID-19 group and 88 in the control group). In the COVID-19 group, the echocardiography was performed at a mean distance of 2.21±1.9 months after testing positive for SARS-CoV-2. The mean age at baseline was 58.81±15.2 years and 53.41±14.14 years for the COVID-19 group and control group respectively. Atrial fibrillation, heart failure, ischemic heart disease and diabetes were more prevalent in the COVID-19 group. When analyzing the mean absolute difference between baseline and 6 months echocardiographic parameters using a two-sample t-Test, statistically significant results were observed for the left ventricular (LV) ejection fraction (EF), LV Tei Index, right ventricular (RV) Tei Index and RV free wall longitudinal strain (RVFWLS) as follows: Δ LVEF was 0.70±7.97% and -2.44±7.30% (p = 0.005), ΔLV Tei index was -0.04±0.19 and 0.0007± 0.11 (p = 0.024), Δ RV Tei index was -0.04±0.17 and 0.009±0.20 (p = 0.034) and ΔRVFWLS was -1.68±4.36% and -0.32±3.34% (p = 0.039) for the COVID-19 group and the control group respectively. Conclusion Our study is the first to describe the evolution of echocardiographic parameters post-COVID in a CKD population. Despite worse demographic and echocardiographic characteristics at baseline, patients from the COVID-19 group had a better evolution at 6 months, when compared to the control group. Both right and left ventricular myocardial performance indices improved for the COVID-19 patients and worsened for the control group.

IntroductionChronic heart failure (HF) represents a major global public health problem, and despite significant advances in diagnosis and management over the past two decades, HF patients still have a poor prognosis. The aim of the study was to evaluate the relationship between lung congestion, as assessed by lung ultrasonography (LUS), bioimpedance spectroscopy, body fluid compartments, and echocardiographic parameters, and to determine the effect of these associations on all-cause mortality in HF patients.Material and methodsEligible patients with a left ventricular ejection fraction (LVEF) below 45% were identified via daily echocardiography assessments. Lung ultrasonography was performed with patients in the supine position, for a total of 28 sites per complete examination. The extracellular water (ECW) was determined using a BIS device.ResultsOur study included 122 patients (67.2% males) with a mean age of 67.2 years. In the multivariable linear regression analysis, including all the univariable predictors of lung congestion, only New York Heart Association (NYHA) class, ECW, estimated glomerular filtration rate (eGFR), and LVEF levels maintained an independent association with the number of B-lines. During the follow-up, 33 patients died. In multivariable Cox analysis, a B-line number of at least 15 remained significantly associated with all-cause mortality, independently of age, sex, diabetes, LVEF, estimated glomerular filtration rate, C-reactive protein, N-terminal pro-brain natriuretic peptide, or ECW values (adjusted HR = 3.84, 95% CI: 1.12–13.09).ConclusionsWe show for the first time in HF patients that pulmonary congestion, as assessed by LUS, is associated with the severity of NYHA class, LVEF, eGFR, and ECW, and it identifies those at increased risk of death.