Background: Global longitudinal strain (GLS) imaging by echocardiography is an objective, well validated and cost-effective modality for detecting subtle left ventricular function abnormalities. Aim: We assessed the prevalence of subtle myocardial dysfunction among patients clinically recovered from COVID-19 using echocardiographic strain imaging. Results: Amongst 101 post COVID-19 patients (76% males, mean age 55.45±11.14 years), prevalence of diabetes mellitus, hypertension and dyslipidemia was comparable to 30 controls. The average GLS was significantly lesser in post COVID patients (-16.21 ± 1.96 vs -18.49 ± 1.64, p = 0.004) and significantly higher proportion of post COVID patients had GLS > -18% (43% vs 22.58%, p =0.001) as compared to controls. The RV free wall longitudinal strain (RVFLS) was also lower in the patient group (22.35 ± 4.69 vs 24.19 ± 4.11, p =0.004) and 21.7% post COVID-19 patients had impaired RV FWLS (> -20%) vs controls (6.6%). Average GLS was significantly lesser in severe post COVID patients (viz -14.25 ± 1.92 vs -16.63 ± 1.61 vs -17.63 ± 1.91, p < 0.0001, respectively among severe, moderate and mild COVID-19 patients. On performing regression analysis, severity of COVID-19 (OR 7.762) was a significant predictor of impaired GLS. Conclusion: Despite clinical recovery and normal LVEF, post COVID-19 patients had significantly lower LV GLS and RV FWLS. Those with severe COVID-19 infection, had worse LV GLS and RV FWLS as compared to those with milder infection. This study reiterates the importance of speckle tracking echocardiography as an important imaging modality for detection of subclinical myocardial dysfunction in the post COVID-19 recovered patients.

Background: Left atrial appendage (LAA) function assessment is often overlooked in patients with heart failure and reduced ejection fraction (HFrEF), regardless of its etiology (ischemic or non-ischemic cardiomyopathy). With trans-thoracic tissue doppler echocardiographic (TDE), we compared LAA wall velocity with the conventional echocardiographic and biochemical parameters of heart failure by evaluating LVEF, LV GLS, E/e’ and serum NT pro-BNP level. Methods and Results: We evaluated 154 stable HFrEF patients with LVEF ≤ 40%. The mean age was 55.71 ± 12.48 years, with 59.09% being male and 40.91% female. Among them, 77.27% had dilated cardiomyopathy (DCMP), and 22.72% had ischemic cardiomyopathy (ICMP). The mean LVEF was 29.87 ± 5.8, LV GLS was -8.46 ± 2.74, mitral E/e’ was 13.33 ± 2.74, and LAA wall velocity was 14.26 ± 5.56. The mean NT pro-BNP level was 980.51 ± 611.77. Correlation analysis showed that LAA wall velocity significantly correlated with LVEF (r = 0.634, p < 0.001), had an inverse correlation with LV GLS (r = -0.671, p < 0.001), mitral E/e’ (r = -0.756, p < 0.001), and NT pro-BNP (r = -0.659, p = 0.007). Conclusion: TDE LAA wall velocity is a valuable and feasible method for evaluating HFrEF patients. Lower LAA wall velocity is associated with reduced LVEF, impaired LV GLS, elevated left ventricular filling pressure (E/e’), and higher NT pro-BNP levels.

Cardiac pacing is the only effective therapy for patients with symptomatic brady-arrhythmia. Traditional right ventricular apical pacing causes electrical and mechanical dyssynchrony resulting in left ventricular dysfunction, recurrent heart failure and atrial arrhythmias. Physiological pacing activates the normal cardiac conduction thereby providing synchronized contraction of ventricles. Though His bundle pacing (HBP) acts as an ideal physiological pacing modality, it is technically challenging and associated with troubleshooting issues during follow up. Left bundle branch pacing (LBBP) has been suggested as an effective alternative to overcome the limitations of HBP as it provides low and stable pacing threshold, lead stability and correction of distal conduction system disease. This paper will focus on the implantation technique, troubleshooting, clinical implications and a review of published literature of LBBP