Myocarditis is a significant cause of sudden cardiac death in competitive athletes and can occur with normal ventricular function.¹ Recent studies have raised concerns of myocardial inflammation after recovery from coronavirus disease 2019 (COVID-19), even in asymptomatic or mildly symptomatic patients.² Our objective was to investigate the use of cardiac magnetic resonance (CMR) imaging in competitive athletes recovered from COVID-19 to detect myocardial inflammation that would identify high-risk athletes for return to competitive play.

SARS-CoV-2, which causes COVID-19, has infected millions of people around the world, causing significant morbidity and mortality.¹ Competitive athletes are a unique population that may be at high risk for environmental and situational transmission of disease, and once infected, may be at risk for sudden cardiac death (SCD) during training and competition.^2-6 Viral myocarditis in asymptomatic people is a common cause of SCD, especially among those younger than 35 years.^7-10 The incidence of SCD in collegiate athletes has been estimated at 1:50 000 per year. Even a small number of events in a young and apparently healthy population has devastating consequences. This often receives broad attention and, in some circumstances, may be preventable.^6,11

We aimed to evaluate the utility of computed tomography angiography (CTA) for coronary compression (CC) prediction in patients with congenital heart disease undergoing balloon-expandable transcatheter pulmonary valve replacement (TPVR). Coronary compression is a serious complication of TPVR, but the value of preprocedural CTAs to assess CC risk is largely unexplored. In all, 586 patients underwent TPVR between January 2009 and July 2018. Adults with a pre-TPVR CTA and children with a CTA performed less than one year prior to TPVR were included. Patients with poor CTA image quality or with aborted cases due to reasons other than CC were excluded. Sixty-six patients were finally included. Cardiac anatomy was assessed via multiplanar reconstruction of CTAs. Coronary compression occurred in 9 (14%) of the 66 patients who underwent TPVR. Most CC cases (seven of nine) occurred in patients with conduits. Proximity of the right ventricular outflow tract (RVOT) landing zone to the coronary arteries and to the chest wall was a significant risk factor for compression (P < .001 and P = .019, respectively). Compression risk increased significantly if patients had an RVOT to coronary artery distance of ≤3 mm (P < .001) and an RVOT to chest wall distance of ≤8 mm (P = .026). Anomalous course of coronary arteries was another significant univariate risk factor (P = .003). Right ventricular outflow tract landing zone distance of ≤3 mm to a coronary artery, landing zone distance of ≤8 mm to the chest wall, and anomalous coronary arteries are associated with increased CC risk. Electrocardiogram gating may not be necessary if coronary arteries are opacified on CTAs. Larger studies are needed to explore and confirm these coronary artery compression risk factors.

Objectives While cardiac amyloidosis (CA) classically involves the left ventricle (LV), less is known about its impact on the right ventricle (RV) and pulmonary vasculature. We performed a retrospective analysis to identify the prevalence and types of pulmonary hypertension (PH) profiles in CA and to determine haemodynamic and cardiovascular magnetic resonance (CMR) predictors of major adverse cardiovascular events (MACE). Methods Patients with CA who underwent CMR and right heart catheterisation (RHC) within 1 year between 2010 and 2019 were included. Patients were assigned the following haemodynamic profiles based on RHC: no PH, precapillary PH, isolated postcapillary PH (IPCPH), or combined precapillary and postcapillary PH (CPCPH). The relationship between PH profile and MACE (death, heart failure hospitalisation) was assessed using survival analysis. CMR and RV parameters were correlated with MACE using Cox-regression analysis. Results A total of 52 patients were included (age 69±9 years, 85% men). RHC was performed during biopsy in 44 (85%) and for clinical indications in 8 (15%) patients. Rates of no PH, precapillary PH, IPCPH and CPCPH were 5 (10%), 3 (6%), 29 (55%) and 15 (29%), respectively. Haemodynamic PH profile did not correlate with risk of death (p=0.98) or MACE (p=0.67). Transpulmonary gradient (TPG) (HR 0.88, CI 0.80 to 0.97), RV, (HR 0.95, CI 0.92 to 0.98) and LV ejection fraction (HR 0.95, CI 0.92 to 0.98) were significantly associated with MACE. Conclusions PH is highly prevalent in CA, even at the time of diagnosis. While IPCPH was most common, CPCPH is not infrequent. TPG and RV ejection fraction (RVEF) are prognostic markers in this population.

Background: Data on the use of implanted hemodynamic monitoring (IHM) in patients with Fontan circulation are limited. This study reports our experience using the CardioMEMS HF system in adults with Fontan circulation. Methods and Results: This single‐center, retrospective study evaluated heart failure hospitalizations, procedural complications, and device‐related complications in patients with Fontan circulation referred for IHM placement (2015–2022). The association of pulmonary artery pressure (by most recent catheterization and median IHM pressure within 30 days of placement) with both death and follow‐up Model for End‐Stage Liver Disease Excluding International Normalized Ratio score were evaluated. Of 18 patients referred for IHM placement, 17 were successful (median age, 30 [range 21–48] years, 6 women). Procedural complications (access site hematomas, pulmonary artery staining) occurred in 3 patients, without device‐related procedural complications. In follow‐up (median, 35 [range, 6–83] months), 1 patient developed a pulmonary embolism (possibly device‐related). Heart failure hospitalizations/year were similar before and after IHM (median, 1 [interquartile range, 0–1.0] versus 0.6 [0–2.3]; P =0.268), though only 46% of heart failure hospitalizations had associated IHM transmissions. IHM pressures were associated with Model for End‐Stage Liver Disease Excluding International Normalized Ratio scores ( R ² =0.588, P <0.001), though catheterization pressures were not ( R ² =0.140, P =0.139). The long‐term mortality rate was 53% in this cohort. On unadjusted survival analysis, IHM pressures ≥18 mm Hg were associated with mortality (log rank P =0.041), which was not reproduced with catheterization pressures (log rank P =0.764). Conclusions: In patients with Fontan circulation, IHM did not reduce heart failure hospitalizations, though patient adherence to transmission was low. Device‐related complications were low. IHM pressures may better represent real‐life conditions compared with catheterization given associations with mortality and Model for End‐Stage Liver Disease Excluding International Normalized Ratio score.

Introduction: The COVID-19 pandemic has resulted in increased use of telemedicine. There are limited data on patient experience with telemedicine in adults with congenital heart disease (ACHD). We hypothesized that due to their complex medical history, ACHD would prefer in-person clinic visits over telemedicine. Methods: We conducted a nurse-administered telephone survey based on Agency for Healthcare Research and Quality recommendations to assess patient experience after ACHD telemedicine visits in the early part of the pandemic from March 2020 to June 2020. Results: Of 216 ACHD who had telemedicine visits, 136 (63%) agreed to participate in the survey. Mean age was 45 ± 18 years, majority (65%) being video encounters. Most (98%) patients expressed that the telemedicine visit was successful in addressing their health care needs. Only 21 (15%) patients reported technical issues. Most patients (76%) preferred telemedicine given testing was provided separately, 25 (18%) preferred in-person clinic visits, and 8 (6%) had no preference. Of the 25 patients over 65 years, 19 (76%) would choose telemedicine over the in-person clinic, and only 1 patient reported technical difficulties. Conclusion: ACHD reported a positive experience with telemedicine. Technical limitations were infrequent even among the elderly. The majority of patients felt that their health care needs were addressed and would consider telemedicine over clinic visits. These data are important as payors move away from supporting telemedicine and hospitals restructure, with and without ongoing COVID-19 concerns.