Introduction: Left atrium (LA) dilates and its function decreases as a chronic secondary change in hypertrophic cardiomyopathy (HCM). LA strain is a more sensitive measure of LV filling pressure than LA volume and can be used to predict the functional capacity in HCM. Objective: To analyse LA strain in patients with HCM and its correlation with exercise tolerance. Methods: A total of 113 patients with HCM were enrolled. All patients underwent detailed clinical evaluation, 24-hour Holter monitoring, exercise stress testing, two dimensional echocardiography with LA strain analysis using speckle tracking imaging. Assessment of functional capacity was done in terms of metabolic equivalents (METS). HCM patients with METS > 6.0 were included in group A while those with METS ≤ 6.0 were included group B. Correlation of various parameters of LA strain (LASr, LAScd and LASct) was done with functional capacity. Results: Mean age of the study population was 47±10.77 years with majority of them being males (71.9%). Group B patients had significantly lower LASr (12.95 ±8.61% vs 22.16±16%; P<0.001), LAScd (-7.28 ±6.29% vs -12.74±8.40%; P<0.001) and LASct (-7.44 ±4.46 vs -11.19±6.53; P<0.001). Multivariable linear regression analysis reported LASr to be an independent predictor of METs (P = 0.04). LASr was strongest echocardiographic predictor of reduced METS with an AUC of 0.78 (95% CI: 0.68 to 0.88), sensitivity of 71.8% and specificity of 82.9%. Conclusion: LA strain parameters are associated with functional capacity in patients with HCM with lower LA strain values being associated with poor functional capacity.

Objective: To evaluate for cardiac involvement in recovered COVID-19 patients using cardiac magnetic resonance imaging (MRI). Methods: A total of 30 subjects recently recovered from COVID-19 and abnormal left ventricular global longitudinal strain were enrolled. Routine investigations, inflammatory markers and cardiac MRI were done at baseline with follow-up scan at 6 months in individuals with abnormal baseline scan. Additionally, 20 age-and sex-matched individuals were enrolled as healthy controls (HCs). Results: All 30 enrolled subjects were symptomatic during active COVID-19 disease and were categorized as mild: 11 (36.7%), moderate: 6 (20%) and severe: 13 (43.3%). Of the 30 patients, 16 (53.3%) had abnormal CMR findings. Myocardial edema was reported in 12 (40%) patients while 10 (33.3%) had LGE. No difference was observed in terms of conventional LV parameters however, COVID-19 recovered patients had significantly lower right ventricular (RV) ejection fraction, RV stroke volume and RV cardiac index compared to HCs. Follow-up scan was abnormal in 4/16 (25%) with LGE persisting in 3 patients. Myocardial T1 (1284 + 43.8 ms vs 1147.6 + 68.4 ms; P<0.0001) and T2 values (50.8+16.7 ms vs 42.6+3.6 ms; P=0.04) were significantly higher in post COVID-19 subjects compared to HCs. Similarly, T1 and T2 values of severe COVID-19 patients were significantly higher compared to mild and moderate cases. Conclusions: An abnormal CMR was seen in half of recovered patients with persistent abnormality in one-fourth at six months. Our study suggests a need for closer follow-up among recovered subjects in order to evaluate for long term cardiovascular sequalae.

Pseudoaneurysm of ascending aorta following cardiac surgery is a very rare and life threatening entity due to risk of exsanguination from its rupture. This is a case report of a 39 year old male patient who presented with impending rupture of ascending aorta pseudoaneurysm following mitral valve replacement. He underwent urgent reoperation under femoro-femoral cardiopulmonary bypass and deep hypothermic circulatory arrest. The pseudoaneurysm was excised and repaired with pericardial patch. He was discharged after an uneventful postoperative course.

Objectives: Myocardial injury during active coronavirus disease-2019 (COVID-19) infection is well described however, its persistence during recovery is unclear. We assessed left ventricle (LV) global longitudinal strain (GLS) using speckle tracking echocardiography (STE) in COVID-19 recovered patients and studied its correlation with various parameters.Methods: A total of 134 subjects within 30-45 days post recovery from COVID-19 infection and normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers (on admission) and comprehensive echocardiography including STE were done for all. Results: Of the 134 subjects, 121 (90.3%) were symptomatic during COVID-19 illness and were categorized as mild: 61 (45.5%), moderate: 50 (37.3%) and severe: 10 (7.5%) COVID-19 illness. Asymptomatic COVID-19 infection was reported in 13 (9.7%) patients. Subclinical LV and right ventricle (RV) dysfunction were seen in 40 (29.9%) and 14 (10.5%) patients respectively. Impaired LVGLS was reported in 1 (7.7%), 8 (13.1%), 22 (44%) and 9 (90%) subjects with asymptomatic, mild, moderate and severe disease respectively. LVGLS was significantly lower in patients recovered from severe illness (mild: -21 ± 3.4%; moderate: -18.1 ± 6.9%; severe: -15.5 ± 3.1%; P < 0.0001). Subjects with reduced LVGLS had significantly higher interleukin-6 (P < 0.0001), C-reactive protein (P = 0.001), lactate dehydrogenase (P = 0.009) and serum ferritin (P = 0.03) levels during index admission. Conclusions: Subclinical LV dysfunction was seen in nearly a third of recovered COVID-19 patients while 10.5% had RV dysfunction. Our study suggests a need for closer follow-up among COVID-19 recovered subjects to elucidate long-term cardiovascular outcomes.