Background: Sex differences have been demonstrated in the acute phase of COVID-19. Women (F) were found to be less prone to develop a severe disease than men (M), but few studies have assessed sex-differences in Long-COVID-19 syndrome. Methods: The aim of this prospective/retrospective study was to characterize the long-term consequences of this infection based on sex. For this purpose, we enrolled 223 patients (89 F and 134 M) who were infected by SARS-CoV-2. In the acute phase of the illness, F reported the following symptoms more frequently than M: weakness, dysgeusia, anosmia, thoracic pain, palpitations, diarrhea, and myalgia—all without significant differences in breathlessness, cough, and sleep disturbance. Results: After a mean follow-up time of 5 months after the acute phase, F were significantly more likely than M to report dyspnea, weakness, thoracic pain, palpitations, and sleep disturbance but not myalgia and cough. At the multivariate logistic regression, women were statistically significantly likely to experience persistent symptoms such as dyspnea, fatigue, chest pain, and palpitations. On the contrary, myalgia, cough, and sleep disturbance were not influenced by sex. Conclusion: We demonstrated that F were more symptomatic than M not only in the acute phase but also at follow-up. Sex was found to be an important determinant of Long-COVID-19 syndrome because it is a significant predictor of persistent symptoms in F, such as dyspnea, fatigue, chest pain, and palpitations. Our results suggest the need for long-term follow-up of these patients from a sex perspective to implement early preventive and personalized therapeutic strategies.

Oropharyngeal dysphagia (OD) is a widespread clinical condition among older adults. Although it represents a risk factor for malnutrition, dehydration and aspiration pneumonia, its assessment and contribution to functional decline is often ignored. The aim of the present study was to estimate the prevalence of OD in a large population of non-institutionalized older people and to evaluate its relationship with malnutrition and physical function. 10-item Eating Assessment Tool (EAT-10) and Mini Nutritional Assessment Short Form (MNA-SF) were used to identify the risk of dysphagia and malnutrition. Short Physical Performance Battery (SPPB) and hand-grip strength were used as functional endpoints. The relationship between risk of dysphagia and functional outcomes was tested in a multivariate regression analysis adjusted for age and sex (Model 1) and for other confounders including Mini Mental State Examination (MMSE) and polypharmacy (Model 2). Mean age of 773 subjects (61.3% female) was 81.97 years. The percentage of participants at risk of dysphagia (EAT ≥ 3) was 30.1%, 37.8% of subjects was malnourished (MNA-SF < 8), 46.2% was at risk of malnutrition (MNA-SF:8-11). EAT-10 was significantly and negatively associated to MNA-SF (β = -0.47 ± 0.06, p < 0.0001) and the strength of the relationship was attenuated but still statistically significant in the multivariate model (β = -0.28 ± 0.07, p < 0.0001). A significant and negative relationship was found between EAT-10 and SPPB and hand-grip strength in Model 1 (β = -0.25 ± 0.05, p < 0.0001) and Model 2 (β = -0.07 ± 0.03, p < 0.0001). After categorization of risk of dysphagia in two groups (at risk and not at risk), MNA-SF, SPPB and hand-grip strength were independently associated with higher risk of dysphagia (OR = 0.91, 95%CI = 0.83-0.99, p = 0.03; OR = 0.83, 95%CI = 0.77-0.89, p < 0.0001; OR = 0.96, 95%CI = 0.92-0.99, p = 0.02, respectively). In a large group of outpatient older individuals, we observed a significant negative association between risk of dysphagia and nutritional and physical performance, suggesting that the screening of OD, possibly supported by its assessment, should be implemented in the geriatric setting to potentially prevent the functional decline.

Previous studies using Doppler Tissue Echocardiography (DTE) have suggested that the early-diastolic myocardial velocity behaves as a relatively load-independent index of left ventricular relaxation in patients with cardiac diseases; it is not ascertained if this holds true also in normal human hearts. We assessed the influence of a progressive reduction of preload, obtained by Lower Body Negative Pressure (LBNP), on the diastolic and systolic myocardial waves compared to the inflow patterns estimated in left and right ventricles in nine healthy subjects. LBNP caused a significant decrease in end-diastolic volume, stroke volume and systolic arterial pressure, whilst heart rate increased only at maximum preload reduction; meridional end-systolic stress did not change significantly. The early (E') and late (A') myocardial velocities, at mitral and tricuspid annulus, decreased similarly during lower body suction, so that E'/A' ratio did not change. However, due to reduced early (E) but unchanged late (A) diastolic velocities, the E/A ratio of inflow patterns decreased. Systolic (S') myocardial velocities also decreased during LBNP. LBNP induced greater changes of myocardial diastolic and systolic velocities in the right than in the left ventricle. In this study, myocardial E', A' and S' velocities, in both the left and the right ventricle, were significantly affected by preload in healthy subjects. Our results support the usefulness of the E'/A' ratio as a relatively load-independent index of diastolic function.

Background: Data on cardiac alterations such as left ventricular (LV) hypertrophy, diastolic dysfunction, and lower stroke volume in patients with COPD are discordant. In this study, we investigated whether early structural and functional cardiac changes occur in patients with COPD devoid of manifest cardiovascular disease, and we assessed their associations with clinical and functional features. Methods: Forty-nine patients with COPD belonging to all Global Initiative for Chronic Obstructive Lung Disease (GOLD) classes were enrolled and compared with 36 controls. All subjects underwent clinical history assessment, lung function testing, blood pressure measurement, electrocardiography, and conventional and Doppler tissue echocardiography. Patients were also subjected to computed tomography to quantify emphysema score. Results: Patients with COPD had lower LV cavity associated with a marked increase in relative wall thickness (RWT), suggesting concentric remodeling without significant changes in LV mass. RWT was significantly associated with ratio of the forced expiratory volume in 1 second to the forced vital capacity and emphysema score and was the only cardiac parameter that – after multivariate analysis – significantly correlated with COPD conditions in all individuals. Receiver operating characteristic curve analysis showed that RWT (with a cutoff point of 0.42) predicted the severity of COPD with 83% specificity and 56% sensitivity (area under the curve =0.69, 95% confidence interval =0.59–0.81). Patients with COPD showed right ventricular to be functional but no structural changes. Conclusion: Patients with COPD without evident cardiovascular disease exhibit significant changes in LV geometry, resulting in concentric remodeling. In all individuals, RWT was significantly and independently related to COPD. However, its prognostic role should be determined in future studies.