Trends and outcomes of acute coronary syndrome (ACS) in COVID-19 pandemic: Experience from a tertiary care centre introduction

s Indian Heart Journal 72 (2020) S1eS51 Objective: Cardiac sarcoidosis (CS) is known to manifest with conduction abnormalities, ventricular arrhythmias, and/or heart failure. We studied the clinical profile and its correlation with Cardiac Magnetic Resonance (CMR) imaging patterns in patients with CS. Methods: Clinical data and CMR findings of patients presented to our institute, and had a diagnosis of CS between 2005 and 2020, were retrospectivelyanalyzed. CS diagnosed based on 2014 HRS Expert ConsensusRecommendations. In those with complete CMR data, the pattern anddistribution of late Gadolinium enhancement (LGE) were correlated withthe major clinical presentations. Results: A total of 41 patients (30 males, mean age 49 ± 8.8 years) diagnosed tohave CS were included in this study. The presenting manifestations included: ventricular tachycardia (VT; 33%), acute heart failure (32%), complete heart block (25%), non-sustained VT / symptomatic ventricular premature complexes(VPC) (7.5%), supraventricular tachycardia (7%) and/ or sinus node dysfunction (2.5%). A diagnosis of CS was made after a median duration of 14.4 months since systemic sarcoidosis was recognized. The main symptoms of CS were dyspnoea (68%), palpitation (58%). Pulmonary (72%) and neurological involvement (18%) were the predominant systemic manifestations. QRS fragmentation was noted in ECG in 30%. In CMRI 94 % patients had LGE, that located in subepicardial (54%), midmyocardial (48.5%), transmural (39%), sub endocardial(15%), RV subendocardial (40%) and septal (70%) locations. Presence of septal LGE correlated with conduction abnormalities (p 1⁄4 0.035; 14/23 vs. 3/10 ). Presence of freewall LGE correlated with VT occurrence (14/24 vs. 1/8, p 1⁄4 0.024 ). QRSfragmentation in ECG correlated with presence of LV and RV free wallLGE (13/24 vs 0/11, p 1⁄4 0.015; sensitivity 54%, specificity 100%). MeanLVEF by CMRI was 40. ± 7.8 %, and a low ejection fraction correlatedwith occurrence of HF (p 1⁄4 0.041). These patients were followed up for amean duration of 3.8 ± 2.9 years. Four (10%) patients lost to follow up.A total of 4 (15%) new patients developed congestive heart failure onfollow up. Total 9 (22.5%) patients died on follow up. Multivariateanalysis revealed NYHA class, ESR, heart failure at presentation, andejection fraction during follow up, but not VT to be predictors ofmortality. Survival analysis showed that recurrent heart failure admission predicts early mortality. Conclusion: In cardiac sarcoidosis patients, presence of septal LGE in CMRIcorrelated with occurrence of conduction abnormalities while free wallLGE was more related to VT occurrence. Although arrhythmia was themost common presenting manifestation, clinical heart failure was seen in nearly 1/3rd of patients. High prevalence of heart failure and LGE onCMR, along with 23% mortality during the study period as noted in ourstudy, may indicate a delayed recognition of cardiacinvolvement in thenatural history of these patients.