101
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Shah KS, Hale Hammond ME, Drakos SG, Anderson JL, Fang JC, Knowlton KU, Shaw RM. SARS-CoV-2 as an inflammatory cardiovascular disease: current knowledge and future challenges. Future Cardiol 2021; 17:1277-1291. [PMID: 33739142 PMCID: PMC7986052 DOI: 10.2217/fca-2020-0188] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/24/2020] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 is responsible for the 2020 global COVID-19 pandemic. In patients with COVID-19, multiple cardiovascular (CV) manifestations have been reported. SARS coronavirus 2 infection can lead to inflammatory CV disease first via takeover of the angiotensin-converting enzyme-2 enzyme as a cell receptor as well as the macrophage activation syndrome in severe illness. We review the CV manifestations of COVID-19 and therapeutics under investigation. We discuss the potential long-term CV sequelae after recovery from COVID-19 and the gaps in knowledge including the pathophysiological links between acute cardiac injury, myocardial inflammation and chronic cardiomyopathy. Future investigational efforts could result in significant diagnostic and therapeutic advances potentially impacting the broader field of chronic heart failure and cardiac recovery.
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Affiliation(s)
- Kevin S Shah
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | | | - Stavros G Drakos
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Nora Eccles Harrison Cardiovascular Research & Training Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Jeffrey L Anderson
- Intermountain Healthcare & University of Utah School of Medicine, Salt Lake City, UT 84107, USA
| | - James C Fang
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Kirk U Knowlton
- Intermountain Medical Center Heart Institute, Salt Lake City, UT. University of Utah School of Medicine, Salt Lake City, UT 84107, USA
| | - Robin M Shaw
- Nora Eccles Harrison Cardiovascular Research & Training Institute, University of Utah, Salt Lake City, UT 84112, USA
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102
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Long J, Luo Y, Wei Y, Xie C, Yuan J. The effect of cardiovascular disease and acute cardiac injury on fatal COVID-19: a meta-analysis. Am J Emerg Med 2021; 48:128-139. [PMID: 33895644 PMCID: PMC8056484 DOI: 10.1016/j.ajem.2021.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND With the continuance of the global COVID-19 pandemic, cardiovascular disease (CVD) and cardiac injury have been suggested to be risk factors for severe COVID-19. OBJECTIVE The aim is to evaluate the mortality risks associated with CVD and cardiac injury among hospitalized COVID-19 patients, especially in subgroups of populations in different countries. METHODS A comprehensive systematic literature search was performed using 9 databases from November 1, 2019 to November 9, 2020. Meta-analyses were performed for CVD and cardiac injury between non-survivors and survivors of COVID-19. RESULTS Although the prevalence of CVD in different populations was different, hospitalized COVID-19 patients with CVD were at a higher risk of fatal outcomes (OR = 2.72; 95% CI 2.35-3.16) than those without CVD. Separate meta-analyses of populations in four different countries also reached a similar conclusion that CVD was associated with an increase in mortality. Cardiac injury was common among hospitalized COVID-19 patients. Patients with cardiac injury had a significantly higher mortality risk than those without cardiac injury (OR = 13.25; 95% CI: 8.56-20.52). CONCLUSIONS Patients' CVD history and biomarkers of cardiac injury should be taken into consideration during the hospital stay and incorporated into the routine laboratory panel for COVID-19.
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Affiliation(s)
- Jiali Long
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
| | - Yefei Luo
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
| | - Yuehong Wei
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
| | - Chaojun Xie
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
| | - Jun Yuan
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
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103
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Leistman SC, Melaragno JI, Dokus MK, Martens JA, Salter MA, Hutchinson DJ, Hernandez-Alejandro R, Al-Judaibi B, Nickels MW. The Rochester Relapse Risk Scale: Developing a Standardized Approach to Predicting Substance Relapse in Liver Transplant Candidates. EXP CLIN TRANSPLANT 2021; 19:919-927. [PMID: 34545777 DOI: 10.6002/ect.2021.0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Substance abuse is a risk factor for nonadherence and graft failure after orthotopic liver transplant. This study aimed to evaluate the ability of an internally developed tool, the Rochester Relapse Risk Scale, to predict substance relapse in liver transplant candidates. MATERIALS AND METHODS This single-center, retrospective, observational study included adult patients evaluated for orthotopic liver transplant using the Rochester Relapse Risk Scale. Primary outcome was rate of substance relapse, as measured by the risk scale, which stratified patients into relapse risk levels based on the number of factors present. RESULTS In total, 303 patients (71.6% men, 90.4% White, median age of 55 years [interquartile range, 49-60 y]) were included. Median follow-up time was 212 days (interquartile range, 73-661 d). Seventy-four patients (24.4%) relapsed at 127 days (interquartile range, 55-461 d) after evaluation, with 60.8% who relapsed within 6 months. Relapse rates correlated with assigned risk level, with 8.3% relapsing at low, 19.0% at low-moderate, 25.3% at moderate, 33.8% at moderate-high, and 40.0% at high risk. High-risk cohorts had significantly shorter median time to relapse versus low-risk cohorts (104 vs 154 days; P = .001). CONCLUSIONS Assignment of relapse risk level according to the Rochester Relapse Risk Scale aligned with rates of relapse. Additional studies are needed to refine the tool, assess inter-rater reliability, and confirm findings in prospective, multicenter studies.
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Affiliation(s)
- Samantha C Leistman
- From the Department of Pharmacy, University of Rochester Medical Center, Rochester, USA
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104
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Girerd N, Chapet N, Roubille C, Roncalli J, Salvat M, Mouquet F, Lamblin N, Gueffet JP, Damy T, Galinier M, Tartiere JM, Janssen C, Berthelot E, Aguilhon S, Escamilla R, Roubille F. Vaccination for Respiratory Infections in Patients with Heart Failure. J Clin Med 2021; 10:jcm10194311. [PMID: 34640328 PMCID: PMC8509310 DOI: 10.3390/jcm10194311] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/23/2022] Open
Abstract
Bronchopulmonary infections are a major trigger of cardiac decompensation and are frequently associated with hospitalizations in patients with heart failure (HF). Adverse cardiac effects associated with respiratory infections, more specifically Streptococcus pneumoniae and influenza infections, are the consequence of inflammatory processes and thrombotic events. For both influenza and pneumococcal vaccinations, large multicenter randomized clinical trials are needed to evaluate their efficacy in preventing cardiovascular events, especially in HF patients. No study to date has evaluated the protective effect of the COVID-19 vaccine in patients with HF. Different guidelines recommend annual influenza vaccination for patients with established cardiovascular disease and also recommend pneumococcal vaccination in patients with HF. The Heart Failure group of the French Society of Cardiology recently strongly recommended vaccination against COVID-19 in HF patients. Nevertheless, the implementation of vaccination recommendations against respiratory infections in HF patients remains suboptimal. This suggests that a national health policy is needed to improve vaccination coverage, involving not only the general practitioner, but also other health providers, such as cardiologists, nurses, and pharmacists. This review first summarizes the pathophysiology of the interrelationships between inflammation, infection, and HF. Then, we describe the current clinical knowledge concerning the protective effect of vaccines against respiratory diseases (influenza, pneumococcal infection, and COVID-19) in patients with HF and finally we propose how vaccination coverage could be improved in these patients.
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Affiliation(s)
- Nicolas Girerd
- Centre d’Investigations Cliniques—INSERM CHRU de Nancy, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France;
| | - Nicolas Chapet
- Department of Clinical Pharmacy, CHU de Montpellier, 34295 Montpellier, France;
| | - Camille Roubille
- Department of Internal Medicine, CHU Montpellier, Montpellier University, PhyMedExp, 34295 Montpellier, France;
| | - Jérôme Roncalli
- Service de Cardiologie, CHU de Toulouse-Rangueil, Université Paul Sabatier–Toulouse III, 31400 Toulouse, France;
| | | | - Frédéric Mouquet
- Department of Cardiology, Hôpital Privé Le Bois, 59000 Lille, France;
| | - Nicolas Lamblin
- Institut Pasteur, Université Lille, Inserm, CHU Lille, U1167 Lille, France;
| | | | - Thibaud Damy
- Referral Center for Cardiac Amyloidoisis, Department of Cardiology, GHU Henri Mondor-APHP, IMRB 955, 94000 Créteil, France;
| | - Michel Galinier
- Fédération des Services de Cardiologie, CHU Toulouse-Rangueil, Faculté de Médecine, Toulouse, Université Paul Sabatier-Toulouse III, 31400 Toulouse, France;
| | | | - Cécile Janssen
- Centre Hospitalier Annecy Genevois, Infectious Diseases Unit, 74370 Annecy, France;
| | - Emmanuelle Berthelot
- Service de Cardiologie, Hôpital Bicêtre, AP-HP, University of Paris Sud, 94270 Le Kremlin-Bicêtre, France;
| | - Sylvain Aguilhon
- Cardiology Department, CHU de Montpellier, 34295 Montpellier, France;
| | - Roger Escamilla
- Service de Pneumologie, Hôpital Larrey, 31400 Toulouse, France;
| | - François Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France
- Correspondence:
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105
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Sokolski M, Trenson S, Sokolska JM, D'Amario D, Meyer P, Poku NK, Biering-Sørensen T, Højbjerg Lassen MC, Skaarup KG, Barge-Caballero E, Pouleur AC, Stolfo D, Sinagra G, Ablasser K, Muster V, Rainer PP, Wallner M, Chiodini A, Heiniger PS, Mikulicic F, Schwaiger J, Winnik S, Cakmak HA, Gaudenzi M, Mapelli M, Mattavelli I, Paul M, Cabac-Pogorevici I, Bouleti C, Lilliu M, Minoia C, Dauw J, Costa J, Celik A, Mewton N, Montenegro CEL, Matsue Y, Loncar G, Marchel M, Bechlioulis A, Michalis L, Dörr M, Prihadi E, Schoenrath F, Messroghli DR, Mullens W, Lund LH, Rosano GMC, Ponikowski P, Ruschitzka F, Flammer AJ. Heart failure in COVID-19: the multicentre, multinational PCHF-COVICAV registry. ESC Heart Fail 2021; 8:4955-4967. [PMID: 34533287 PMCID: PMC8653014 DOI: 10.1002/ehf2.13549] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022] Open
Abstract
Aims We assessed the outcome of hospitalized coronavirus disease 2019 (COVID‐19) patients with heart failure (HF) compared with patients with other cardiovascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia). We further wanted to determine the incidence of HF events and its consequences in these patient populations. Methods and results International retrospective Postgraduate Course in Heart Failure registry for patients hospitalized with COVID‐19 and CArdioVascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia) was performed in 28 centres from 15 countries (PCHF‐COVICAV). The primary endpoint was in‐hospital mortality. Of 1974 patients hospitalized with COVID‐19, 1282 had cardiovascular disease and/or risk factors (median age: 72 [interquartile range: 62–81] years, 58% male), with HF being present in 256 [20%] patients. Overall in‐hospital mortality was 25% (n = 323/1282 deaths). In‐hospital mortality was higher in patients with a history of HF (36%, n = 92) compared with non‐HF patients (23%, n = 231, odds ratio [OR] 1.93 [95% confidence interval: 1.44–2.59], P < 0.001). After adjusting, HF remained associated with in‐hospital mortality (OR 1.45 [95% confidence interval: 1.01–2.06], P = 0.041). Importantly, 186 of 1282 [15%] patients had an acute HF event during hospitalization (76 [40%] with de novo HF), which was associated with higher in‐hospital mortality (89 [48%] vs. 220 [23%]) than in patients without HF event (OR 3.10 [2.24–4.29], P < 0.001). Conclusions Hospitalized COVID‐19 patients with HF are at increased risk for in‐hospital death. In‐hospital worsening of HF or acute HF de novo are common and associated with a further increase in in‐hospital mortality.
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Affiliation(s)
- Mateusz Sokolski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Sander Trenson
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Justyna M Sokolska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Domenico D'Amario
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Philippe Meyer
- Cardiology Service, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Nana K Poku
- Cardiology Service, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mats C Højbjerg Lassen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer G Skaarup
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Eduardo Barge-Caballero
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), A Coruña, Spain
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Davide Stolfo
- Cardiovascular Department, University Hospital of Trieste - ASUGI, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, University Hospital of Trieste - ASUGI, Trieste, Italy
| | - Klemens Ablasser
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Viktoria Muster
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Markus Wallner
- Division of Cardiology, Medical University of Graz, Graz, Austria.,Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.,Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria
| | - Alessandra Chiodini
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Pascal S Heiniger
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Fran Mikulicic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Judith Schwaiger
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Stephan Winnik
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Huseyin A Cakmak
- Department of Cardiology, Mustafakemalpasa State Hospital, Bursa, Turkey
| | - Margherita Gaudenzi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Matthias Paul
- Heart Center Lucerne, Luzerner Kantonsspital (LUKS), Luzern, Switzerland
| | - Irina Cabac-Pogorevici
- Department of Cardiology, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Republic of Moldova
| | - Claire Bouleti
- Cardiology Department, Clinical Investigation Center (CIC) INSERM 1402, Poitiers Hospital, Poitiers University, Poitiers, France
| | - Marzia Lilliu
- Division of Infectious Diseases, Azienda ULSS 9, M. Magalini Hospital, Verona, Italy
| | - Chiara Minoia
- Emergency Department, Public Health Company Valle Olona, Busto Arsizio, Italy
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Doctoral School for Medicine and Life sciences, LCRC, UHasselt, Diepenbeek, Belgium
| | - Jérôme Costa
- Department of Cardiology, Reims University Hospital Centre, Reims, France
| | - Ahmet Celik
- Department of Cardiology, Mersin University Medical Faculty, Mersin, Turkey
| | - Nathan Mewton
- Cardiovascular Hospital Louis Pradel, Department of Heart Failure, Hospices Civils de Lyon, Lyon, France.,Clinical Investigation Center, Inserm 1407, Lyon, France.,CARMEN Inserm 1060, Claude Bernard University Lyon, Lyon, France
| | - Carlos E L Montenegro
- PROCAPE- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brazil
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Michal Marchel
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Aris Bechlioulis
- 2nd Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
| | - Lampros Michalis
- 2nd Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | | | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Daniel R Messroghli
- German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Berlin, Germany.,Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, UHasselt, Diepenbeek, Belgium
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
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106
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Goyal P, Reshetnyak E, Khan S, Musse M, Navi BB, Kim J, Allen LA, Banerjee S, Elkind MSV, Shah SJ, Yancy C, Michos ED, Devereux RB, Okin PM, Weinsaft JW, Safford MM. Clinical Characteristics and Outcomes of Adults With a History of Heart Failure Hospitalized for COVID-19. Circ Heart Fail 2021; 14:e008354. [PMID: 34517720 DOI: 10.1161/circheartfailure.121.008354] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is important to understand the risk for in-hospital mortality of adults hospitalized with acute coronavirus disease 2019 (COVID-19) infection with a history of heart failure (HF). METHODS We examined patients hospitalized with COVID-19 infection from January 1, 2020 to July 22, 2020, from 88 centers across the US participating in the American Heart Association's COVID-19 Cardiovascular Disease registry. The primary exposure was history of HF and the primary outcome was in-hospital mortality. To examine the association between history of HF and in-hospital mortality, we conducted multivariable modified Poisson regression models that included sociodemographics and comorbid conditions. We also examined HF subtypes based on left ventricular ejection fraction in the prior year, when available. RESULTS Among 8920 patients hospitalized with COVID-19, mean age was 61.4±17.5 years and 55.5% were men. History of HF was present in 979 (11%) patients. In-hospital mortality occurred in 31.6% of patients with history of HF, and 16.9% in patients without a history of HF. In a fully adjusted model, history of HF was associated with increased risk for in-hospital mortality (relative risk: 1.16 [95% CI, 1.03-1.30]). Among 335 patients with left ventricular ejection fraction, heart failure with reduced ejection fraction was significantly associated with in-hospital mortality in a fully adjusted model (heart failure with reduced ejection fraction relative risk: 1.40 [95% CI, 1.10-1.79]; heart failure with mid-range ejection fraction relative risk: 1.06 [95% CI, 0.65-1.73]; heart failure with preserved ejection fraction relative risk, 1.06 [95% CI, 0.84-1.33]). CONCLUSIONS Risk for in-hospital mortality was substantial among adults with history of HF, in large part due to age and comorbid conditions. History of heart failure with reduced ejection fraction may confer especially elevated risk. This population thus merits prioritization for the COVID-19 vaccine.
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Affiliation(s)
- Parag Goyal
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Evgeniya Reshetnyak
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Sadiya Khan
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (S.K., S.J.S., C.Y.)
| | - Mahad Musse
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Babak B Navi
- Department of Neurology, Feil Family Brain and Mind Research Institute (B.B.N.), Weill Cornell Medicine, New York, NY
| | - Jiwon Kim
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Larry A Allen
- Division of Cardiology, University of Colorado, Denver (L.A.A.)
| | - Samprit Banerjee
- Department of Population Science (S.B.), Weill Cornell Medicine, New York, NY
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (S.K., S.J.S., C.Y.)
| | - Clyde Yancy
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (S.K., S.J.S., C.Y.)
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (E.D.M.)
| | - Richard B Devereux
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Peter M Okin
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Jonathan W Weinsaft
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Monika M Safford
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
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107
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Kittleson MM, Chambers DC, Cypel M, Potena L. Covid-19 in recipients of heart and lung transplantation: Learning from experience. J Heart Lung Transplant 2021; 40:948-950. [PMID: 34246563 PMCID: PMC8188768 DOI: 10.1016/j.healun.2021.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Daniel C Chambers
- School of Clinical Medicine, The University of Queensland and Queensland Lung Transplant Program, Brisbane, Australia
| | - Marcelo Cypel
- Toronto Lung Transplant Program, University of Toronto, Toronto, Ontario, Canada
| | - Luciano Potena
- Heart Failure and Transplant Program, IRCCS Policlinico di Sant'Orsola, Bologna, Italy
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108
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Cascino TM, Desai AA, Kanthi Y. At a crossroads: coronavirus disease 2019 recovery and the risk of pulmonary vascular disease. Curr Opin Pulm Med 2021; 27:342-349. [PMID: 34127622 PMCID: PMC8373709 DOI: 10.1097/mcp.0000000000000792] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 (COVID-19) pandemic has led to almost 3,000,000 deaths across 139 million people infected worldwide. Involvement of the pulmonary vasculature is considered a major driving force for morbidity and mortality. We set out to summarize current knowledge on the acute manifestations of pulmonary vascular disease (PVD) resulting from COVID-19 and prioritize long-term complications that may result in pulmonary hypertension (PH). RECENT FINDINGS Acute COVID-19 infection can result in widespread involvement of the pulmonary vasculature, myocardial injury, evidence of persistent lung disease, and venous thromboembolism. Post COVID-19 survivors frequently report ongoing symptoms and may be at risk for the spectrum of PH, including group 1 pulmonary arterial hypertension, group 2 PH due to left heart disease, group 3 PH due to lung disease and/or hypoxia, and group 4 chronic thromboembolic PH. SUMMARY The impact of COVID-19 on the pulmonary vasculature is central to determining disease severity. Although the long-term PVD manifestations of COVID-19 are currently uncertain, optimizing the care of risk factors for PH and monitoring for the development of PVD will be critical to reducing long-term morbidity and improving the health of survivors.
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Affiliation(s)
- Thomas M Cascino
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ankit A Desai
- Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Yogendra Kanthi
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
- Laboratory of Vascular Thrombosis and Inflammation, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
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109
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Diaz‐Arocutipa C, Carvallo‐Castañeda D, Luis‐Ybañez O, Pariona M, Rivas‐Lasarte M, Álvarez‐García J. COVID-19 in heart transplant recipients during February-August 2020: A systematic review. Clin Transplant 2021; 35:e14390. [PMID: 34159650 PMCID: PMC8420345 DOI: 10.1111/ctr.14390] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic represents a major concern in immunosuppressed patients such as heart transplant recipients. Therefore, we performed a systematic review to summarize the clinical features, treatment, and outcomes of heart transplant recipients with COVID-19. We searched electronic databases from inception to January 11, 2021. Thirty-nine articles (22 case reports and 17 cohorts) involving 415 patients were included. The mean age was 59.9 ± 15.7 years and 77% of patients were men. In cohort studies including outpatients and inpatients, the hospitalization rate was 77%. The most common symptoms were fever (70%) and cough (67%). Inflammatory biomarkers (C-reactive protein and procalcitonin) were above the normal range. Forty-eight percent of patients presented with severe or critical COVID-19. Hydroxychloroquine (54%), azithromycin (14%), and lopinavir/ritonavir (14%) were the most commonly used drugs. Forty-nine percent of patients discontinued the baseline regimen of antimetabolites. In contrast, 59% and 73% continued the same regimen of calcineurin inhibitors and corticosteroids, respectively. Short-term mortality among cohorts limited to inpatients was 25%. Our review suggests that heart transplant recipients with COVID-19 exhibited similar demographic and clinical features to the general population. However, the prognosis was poor in these patients.
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Affiliation(s)
- Carlos Diaz‐Arocutipa
- Vicerrectorado de InvestigaciónUniversidad San Ignacio de LoyolaLimaPeru
- Programa de Atención Domiciliaria (PADOMI) – EsSaludLimaPeru
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS)LimaPeru
| | - Darla Carvallo‐Castañeda
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS)LimaPeru
- Puesto de Salud PacaycasaMinisterio de SaludAyacuchoPeru
| | - Odalis Luis‐Ybañez
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS)LimaPeru
- Facultad de Medicina de San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
| | - Marcos Pariona
- Departamento de CardiologíaHospital Nacional Edgardo Rebagliati MartinsLimaPeru
| | - Mercedes Rivas‐Lasarte
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante CardiacoHospital Universitario Puerta de HierroMadridSpain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridSpain
| | - Jesús Álvarez‐García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridSpain
- Unidad de Insuficiencia Cardíaca Avanzada. Servicio de Cardiología del Hospital Universitario Ramón y CajalMadridSpain
- Universidad Autónoma de BarcelonaBarcelonaSpain
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Bhatt AS, Adler ED, Albert NM, Anyanwu A, Bhadelia N, Cooper LT, Correa A, Defilippis EM, Joyce E, Sauer AJ, Solomon SD, Vardeny O, Yancy C, Lala A. Coronavirus Disease-2019 and Heart Failure: A Scientific Statement From the Heart Failure Society of America. J Card Fail 2021; 28:93-112. [PMID: 34481067 PMCID: PMC8408888 DOI: 10.1016/j.cardfail.2021.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Ankeet S Bhatt
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric D Adler
- Department of Cardiology, University of California, San Diego, California
| | - Nancy M Albert
- Nursing Institute and Heart, Vascular and Thoracic Institute; Cleveland Clinic, Cleveland, Ohio
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nahid Bhadelia
- Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts; Center for Emerging Infectious Diseases Policy and Research (CEID), Boston University, Boston, Massachusetts
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Ashish Correa
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ersilia M Defilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Emer Joyce
- Department of Cardiovascular Medicine, Mater University Hospital, and School of Medicine, University College Dublin, Ireland
| | - Andrew J Sauer
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Orly Vardeny
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, and University of Minnesota, Minneapolis
| | - Clyde Yancy
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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111
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Italia L, Tomasoni D, Bisegna S, Pancaldi E, Stretti L, Adamo M, Metra M. COVID-19 and Heart Failure: From Epidemiology During the Pandemic to Myocardial Injury, Myocarditis, and Heart Failure Sequelae. Front Cardiovasc Med 2021; 8:713560. [PMID: 34447795 PMCID: PMC8382715 DOI: 10.3389/fcvm.2021.713560] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
A close and intriguing relationship has been suggested between heart failure (HF) and coronavirus disease 2019 (COVID-19). First, COVID-19 pandemic represented a global public health emergency in the last year and had a catastrophic impact on health systems worldwide. Several studies showed a reduction in HF hospitalizations, ranging from 30 to 66% in different countries and leading to a subsequent increase in HF mortality. Second, pre-existing HF is a risk factor for a more severe clinical course of COVID-19 and an independent predictor of in-hospital mortality. Third, patients hospitalized for COVID-19 may develop both an acute decompensation of chronic HF and de-novo HF as a consequence of myocardial injury and cardiovascular (CV) complications. Myocardial injury occurred in at least 10% of unselected COVID-19 cases and up to 41% in critically ill patients or in those with concomitant CV comorbidities. Few cases of COVID-19-related acute myocarditis, presenting with severe reduction in the left ventricular (LV) ejection fraction and peculiar histopathological findings, were described. However, recent data suggested that COVID-19 may be associated with both systolic and diastolic LV dysfunction, with LV diastolic impairment, pulmonary hypertension, and right ventricular dysfunction representing the most frequent findings in echocardiographic studies. An overview of available data and the potential mechanisms behind myocardial injury, possibly leading to HF, will be presented in this review. Beyond the acute phase, HF as a possible long-term consequence of cardiac involvement in COVID-19 patients has been supposed and need to be investigated yet.
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Affiliation(s)
- Leonardo Italia
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Bisegna
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Edoardo Pancaldi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Lorenzo Stretti
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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112
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In-depth review of cardiopulmonary support in COVID-19 patients with heart failure. World J Cardiol 2021. [DOI: 10.4330/wjc.v13.i8.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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113
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Raffaello WM, Huang I, Budi Siswanto B, Pranata R. In-depth review of cardiopulmonary support in COVID-19 patients with heart failure. World J Cardiol 2021; 13:298-308. [PMID: 34589166 PMCID: PMC8436686 DOI: 10.4330/wjc.v13.i8.298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/13/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 infection has spread worldwide and causing massive burden to our healthcare system. Recent studies show multiorgan involvement during infection, with direct insult to the heart. Worsening of the heart function serves as a predictor of an adverse outcome. This finding raises a particular concern in high risk population, such as those with history of preexisting heart failure with or without implantable device. Lower baseline and different clinical characteristic might raise some challenge in managing either exacerbation or new onset heart failure that might occur as a consequence of the infection. A close look of the inflammatory markers gives an invaluable clue in managing this condition. Rapid deterioration might occur anytime in this setting and the need of cardiopulmonary support seems inevitable. However, the use of cardiopulmonary support in this patient is not without risk. Severe inflammatory response triggered by the infection in combination with the preexisting condition of the worsening heart and implantable device might cause a hypercoagulability state that should not be overlooked. Moreover, careful selection and consideration have to be met before selecting cardiopulmonary support as a last resort due to limited resource and personnel. By knowing the nature of the disease, the interaction between the inflammatory response and different baseline profile in heart failure patient might help clinician to salvage and preserve the remaining function of the heart.
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Affiliation(s)
| | - Ian Huang
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta 11420, Indonesia
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang 15810, Indonesia
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114
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Zdanyte M, Rath D. Cardiovascular Risk Assessment in COVID-19. Hamostaseologie 2021; 41:350-355. [PMID: 34380170 DOI: 10.1055/a-1539-8711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
COVID-19 bezeichnet eine der schlimmsten Krisen unserer Generation und stellt (nicht nur) für das Gesundheitssystem eine schwer bewältigbare Herausforderung dar. Mortalität und Morbidität sind im Vergleich zu anderen saisonalen Erkrankungen wie der Influenza deutlich erhöht. COVID-19 bedroht allerdings nicht die gesamte Bevölkerung in gleichem Maße. Hochrisikopatienten sind älter und leiden an kardiovaskulären Erkrankungen wie Bluthochdruck, Diabetes mellitus oder einer koronaren Herzerkrankung. Um das Risiko für einen schweren Erkrankungsverlaufs zu quantifizieren bedarf es einer multimodalen Herangehensweise. Verschiedene Risikostratifizierungssysteme stehen zu Verfügung um ungünstige Verläufe wie Intensivbehandlung oder Gesamtmortalität vorauszusagen. Biomarker wie Troponin-I, D-Dimere und NT pro-BNP kombiniert mit echokardiographischen Parametern wie links- und rechtsventrikulärer Pumpfunktion sowie pulmonalarteriellem Druck können hilfreich sein um Hochrisikopatienten zu identifizieren, die ein intensiviertes Monitoring und eine stringentere Behandlung benötigen. Da kardiovaskuläre Risikofaktoren und Komorbiditäten von großer Bedeutung zur Abschätzung des Verlaufs einer SARS-CoV-2 Infektion sind, könnten alle hospitalisierten COVID-19 Patienten von einer routinemäßigen kardiologischen Betreuung durch ein COVID-19-Heart-Team profitieren. Ein frühzeitiges Erkennen von (kardiovaskulären) Hochrisikopatienten könnte das Management erleichtern sowie die Prognose einer schweren SARS-CoV-2 Infektion verbessern.
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Affiliation(s)
- Monika Zdanyte
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Dominik Rath
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
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115
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Clinical characteristics and outcomes of patients with heart failure admitted to the intensive care unit with coronavirus disease 2019 (COVID-19): A multicenter cohort study. ACTA ACUST UNITED AC 2021; 7:100033. [PMID: 34308397 PMCID: PMC8288252 DOI: 10.1016/j.ahjo.2021.100033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/20/2021] [Accepted: 06/26/2021] [Indexed: 01/08/2023]
Abstract
Background Patients with underlying heart failure (HF) in the setting of COVID-19 who require admission to the intensive care unit (ICU) might present with a unique set of challenges. This study aims to extensively describe the characteristics and outcomes of patients with HF who were admitted to ICU with COVID-19. Methods We conducted a multicenter retrospective analysis for all adult patients with HF and an objectively confirmed diagnosis of COVID-19 who were admitted to ICUs between March 1 and August 31, 2020, in Saudi Arabia. Results A total of 723 critically ill patients with COVID-19 were admitted into ICUs during the study period: 59 patients with HF and 664 patients with no HF before admission to ICU. Patients with HF had statistically significant more comorbidities, including diabetes mellitus, hypertension, dyslipidemia, atrial fibrillation, and acute coronary syndrome. Moreover, higher baseline severity scores (APACHE II & SOFA score) and nutritional risk (NUTRIC score) were observed in HF patients. Overall, patients with HF had more in-hospital and ICU deaths in comparison to patients without HF: (64.3% vs. 44.6%, P-value <0.01) and (54.5% vs. 39%, P-value = 0.02), respectively. Patients with HF had a similar incidence of thrombosis, ICU length of stay, duration of mechanical ventilation, and hospital length of stay compared to patients with no HF. Conclusion In this study, patients with HF had more in-hospital and ICU deaths than patients with no HF. Thus, history of HF could be used to help direct case management during hospitalization and possibly dictate proactive COVID-19 care.
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116
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Badimon L, Robinson EL, Jusic A, Carpusca I, deWindt LJ, Emanueli C, Ferdinandy P, Gu W, Gyöngyösi M, Hackl M, Karaduzovic-Hadziabdic K, Lustrek M, Martelli F, Nham E, Potočnjak I, Satagopam V, Schneider R, Thum T, Devaux Y. Cardiovascular RNA markers and artificial intelligence may improve COVID-19 outcome: a position paper from the EU-CardioRNA COST Action CA17129. Cardiovasc Res 2021; 117:1823-1840. [PMID: 33839767 PMCID: PMC8083253 DOI: 10.1093/cvr/cvab094] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been as unprecedented as unexpected, affecting more than 105 million people worldwide as of 8 February 2020 and causing more than 2.3 million deaths according to the World Health Organization (WHO). Not only affecting the lungs but also provoking acute respiratory distress, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is able to infect multiple cell types including cardiac and vascular cells. Hence a significant proportion of infected patients develop cardiac events, such as arrhythmias and heart failure. Patients with cardiovascular comorbidities are at highest risk of cardiac death. To face the pandemic and limit its burden, health authorities have launched several fast-track calls for research projects aiming to develop rapid strategies to combat the disease, as well as longer-term projects to prepare for the future. Biomarkers have the possibility to aid in clinical decision-making and tailoring healthcare in order to improve patient quality of life. The biomarker potential of circulating RNAs has been recognized in several disease conditions, including cardiovascular disease. RNA biomarkers may be useful in the current COVID-19 situation. The discovery, validation, and marketing of novel biomarkers, including RNA biomarkers, require multi-centre studies by large and interdisciplinary collaborative networks, involving both the academia and the industry. Here, members of the EU-CardioRNA COST Action CA17129 summarize the current knowledge about the strain that COVID-19 places on the cardiovascular system and discuss how RNA biomarkers can aid to limit this burden. They present the benefits and challenges of the discovery of novel RNA biomarkers, the need for networking efforts, and the added value of artificial intelligence to achieve reliable advances.
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Affiliation(s)
- Lina Badimon
- Cardiovascular Science Program-ICCC, IR-Hospital de la Santa Creu i Santa Pau, Ciber CV, Autonomous University of Barcelona, Barcelona, Spain
| | - Emma L Robinson
- Department of Cardiology, School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amela Jusic
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, 1A-B rue Edison, L-1445 Strassen, Luxembourg
| | - Irina Carpusca
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, 1A-B rue Edison, L-1445 Strassen, Luxembourg
| | - Leon J deWindt
- Department of Molecular Genetics, Faculty of Science and Engineering, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Costanza Emanueli
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Péter Ferdinandy
- Cardiometabolic Research Group and MTA-SE System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest,Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Wei Gu
- Luxembourg Center for Systems Biomedicine, University of Luxembourg, Esch sur Alzette, Luxembourg
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | | | - Mitja Lustrek
- Department of Intelligent Systems, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Fabio Martelli
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Milan 20097, Italy
| | - Eric Nham
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ines Potočnjak
- Institute for Clinical Medical Research and Education, University Hospital Centre Sisters of Charity, Zagreb, Croatia
| | - Venkata Satagopam
- Luxembourg Center for Systems Biomedicine, University of Luxembourg, Esch sur Alzette, Luxembourg
| | - Reinhard Schneider
- Luxembourg Center for Systems Biomedicine, University of Luxembourg, Esch sur Alzette, Luxembourg
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover,Germany
- REBIRTH Center for Translational Regenerative Medicine, Hannover Medical School, Hannover, Germany
| | - Yvan Devaux
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, 1A-B rue Edison, L-1445 Strassen, Luxembourg
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Angeli F, Marazzato J, Verdecchia P, Balestrino A, Bruschi C, Ceriana P, Chiovato L, Dalla Vecchia LA, De Ponti R, Fanfulla F, La Rovere MT, Perego F, Scalvini S, Spanevello A, Traversi E, Visca D, Vitacca M, Bachetti T. Joint effect of heart failure and coronary artery disease on the risk of death during hospitalization for COVID-19. Eur J Intern Med 2021; 89:81-86. [PMID: 33933339 PMCID: PMC8055166 DOI: 10.1016/j.ejim.2021.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 12/20/2022]
Abstract
AIMS heart failure (HF) and coronary artery disease (CAD) are independent predictors of death in patients with COVID-19. The adverse prognostic impact of the combination of HF and CAD in these patients is unclear. METHODS AND RESULTS we analysed data from 954 consecutive patients hospitalized for SARS-CoV-2 in five Italian Hospitals from February 23 to May 22, 2020. The study was a systematic prospective data collection according to a pre-specified protocol. All-cause mortality during hospitalization was the outcome measure. Mean duration of hospitalization was 33 days. Mortality was 11% in the total population and 7.4% in the group without evidence of HF or CAD (reference group). Mortality was 11.6% in the group with CAD and without HF (odds ratio [OR]: 1.6, p = 0.120), 15.5% in the group with HF and without CAD (OR: 2.3, p = 0.032), and 35.6% in the group with CAD and HF (OR: 6.9, p<0.0001). The risk of mortality in patients with CAD and HF combined was consistently higher than the sum of risks related to either disorder, resulting in a significant synergistic effect (p<0.0001) of the two conditions. Age-adjusted attributable proportion due to interaction was 64%. Adjusting for the simultaneous effects of age, hypotension, and lymphocyte count did not significantly lower attributable proportion which persisted statistically significant (p = 0.0360). CONCLUSION The combination of HF and CAD exerts a marked detrimental impact on the risk of mortality in hospitalized patients with COVID-19, which is independent on other adverse prognostic markers.
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Italy.
| | - Jacopo Marazzato
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | | | | | | | - Luca Chiovato
- Istituti Clinici Scientifici Maugeri IRCCS, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, Italy
| | | | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | | | | | | | - Antonio Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Italy
| | | | - Dina Visca
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Italy
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Mok J, Malpartida JC, O'Dell K, Davis J, Gao C, Manyam H. Vascular comorbidities worsen prognosis of patients with heart failure hospitalised with COVID-19. Open Heart 2021; 8:openhrt-2021-001668. [PMID: 34127532 PMCID: PMC8206174 DOI: 10.1136/openhrt-2021-001668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/25/2021] [Indexed: 12/23/2022] Open
Abstract
Background Prior diagnosis of heart failure (HF) is associated with increased length of hospital stay (LOS) and mortality from COVID-19. Associations between substance use, venous thromboembolism (VTE) or peripheral arterial disease (PAD) and its effects on LOS or mortality in patients with HF hospitalised with COVID-19 remain unknown. Objective This study identified risk factors associated with poor in-hospital outcomes among patients with HF hospitalised with COVID-19. Methods Case–control study was conducted of patients with prior diagnosis of HF hospitalised with COVID-19 at an academic tertiary care centre from 1 January 2020 to 28 February 2021. Patients with HF hospitalised with COVID-19 with risk factors were compared with those without risk factors for clinical characteristics, LOS and mortality. Multivariate regression was conducted to identify multiple predictors of increased LOS and in-hospital mortality in patients with HF hospitalised with COVID-19. Results Total of 211 patients with HF were hospitalised with COVID-19. Women had longer LOS than men (9 days vs 7 days; p<0.001). Compared with patients without PAD or ischaemic stroke, patients with PAD or ischaemic stroke had longer LOS (7 days vs 9 days; p=0.012 and 7 days vs 11 days, p<0.001, respectively). Older patients (aged 65 and above) had increased in-hospital mortality compared with younger patients (adjusted OR: 1.04; 95% CI 1.00 to 1.07; p=0.036). Prior diagnosis of VTE increased mortality more than threefold in patients with HF hospitalised with COVID-19 (adjusted OR: 3.33; 95% CI 1.29 to 8.43; p=0.011). Conclusion Vascular diseases increase LOS and mortality in patients with HF hospitalised with COVID-19.
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Affiliation(s)
- Jacob Mok
- Internal Medicine, UTHSC College of Medicine Chattanooga, Chattanooga, Tennessee, USA
| | | | - Kimberly O'Dell
- Internal Medicine, UTHSC College of Medicine Chattanooga, Chattanooga, Tennessee, USA
| | - Joshua Davis
- Cardiovascular Disease, UTHSC College of Medicine Chattanooga, Chattanooga, Tennessee, USA
| | - Cuilan Gao
- Mathematics, The University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | - Harish Manyam
- Cardiovascular Disease, UTHSC College of Medicine Chattanooga, Chattanooga, Tennessee, USA.,Heart and Lung Institute, Erlanger Health System, Chattanooga, Tennessee, USA
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119
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Ruge M, Gomez JMD, du Fay de Lavallaz J, Hlepas A, Rahman A, Patel P, Hoster C, Lavani P, Nair GG, Jahan N, Alan Simmons J, Rao AK, Cotts W, Williams K, Volgman AS, Marinescu K, Suboc T. Impact of pre-existing heart failure on 60-day outcomes in patients hospitalized with COVID-19. ACTA ACUST UNITED AC 2021; 4:100022. [PMID: 34151308 PMCID: PMC8204812 DOI: 10.1016/j.ahjo.2021.100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background In the coronavirus disease 2019 (COVID-19) global pandemic, patients with cardiovascular disease represent a vulnerable population with higher risk for contracting COVID-19 and worse prognosis with higher case fatality rates. However, the relationship between COVID-19 and heart failure (HF) is unclear, specifically whether HF is an independent risk factor for severe infection or if other accompanying comorbidities are responsible for the increased risk. Methods This is a retrospective analysis of 1331 adult patients diagnosed with COVID-19 infection between March and June 2020 admitted at Rush University System for Health (RUSH) in metropolitan Chicago, Illinois, USA. Patients with history of HF were identified by International Classification of Disease, Tenth Revision (ICD-10) code assignments extracted from the electronic medical record. Propensity score matching was utilized to control for the numerous confounders, and univariable logistic regression was performed to assess the relationship between HF and 60-day morbidity and mortality outcomes. Results The propensity score matched cohort consisted of 188 patients in both the HF and no HF groups. HF patients did not have lower 60-day mortality (OR 0.81; p = 0.43) compared to patients without HF. However, those with HF were more likely to require readmission within 60 days (OR 2.88; p < 0.001) and sustain myocardial injury defined as troponin elevation within 60 days (OR 3.14; p < 0.05). Conclusions This study highlights the complex network of confounders present between HF and COVID-19. When balanced for these numerous factors, those with HF appear to be at no higher risk of 60-day mortality from COVID-19 but are at increased risk for morbidity.
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Affiliation(s)
- Max Ruge
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Joanne Michelle D Gomez
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - Jeanne du Fay de Lavallaz
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Alexander Hlepas
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Annas Rahman
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Priya Patel
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Clay Hoster
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Prutha Lavani
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - Gatha G Nair
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - Nusrat Jahan
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - J Alan Simmons
- Research Core, Rush University Medical Center, Chicago, IL, United States of America
| | - Anupama K Rao
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - William Cotts
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America.,Advocate Christ Medical Center, Oaklawn, IL, United States of America
| | - Kim Williams
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | | | - Karolina Marinescu
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - Tisha Suboc
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
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120
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Marcondes-Braga FG, Moura LAZ, Issa VS, Vieira JL, Rohde LE, Simões MV, Fernandes-Silva MM, Rassi S, Alves SMM, de Albuquerque DC, de Almeida DR, Bocchi EA, Ramires FJA, Bacal F, Rossi JM, Danzmann LC, Montera MW, de Oliveira MT, Clausell N, Silvestre OM, Bestetti RB, Bernadez-Pereira S, Freitas AF, Biolo A, Barretto ACP, Jorge AJL, Biselli B, Montenegro CEL, dos Santos EG, Figueiredo EL, Fernandes F, Silveira FS, Atik FA, Brito FDS, Souza GEC, Ribeiro GCDA, Villacorta H, de Souza JD, Goldraich LA, Beck-da-Silva L, Canesin MF, Bittencourt MI, Bonatto MG, Moreira MDCV, Avila MS, Coelho OR, Schwartzmann PV, Mourilhe-Rocha R, Mangini S, Ferreira SMA, de Figueiredo JA, Mesquita ET. Emerging Topics Update of the Brazilian Heart Failure Guideline - 2021. Arq Bras Cardiol 2021; 116:1174-1212. [PMID: 34133608 PMCID: PMC8288520 DOI: 10.36660/abc.20210367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Fabiana G. Marcondes-Braga
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Lídia Ana Zytynski Moura
- Pontifícia Universidade Católica de CuritibaCuritibaPRBrasilPontifícia Universidade Católica de Curitiba, Curitiba, PR – Brasil.
| | - Victor Sarli Issa
- Universidade da AntuérpiaBélgicaUniversidade da Antuérpia, – Bélgica
| | - Jefferson Luis Vieira
- Hospital do Coração de MessejanaFortalezaCEBrasilHospital do Coração de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE – Brasil.
| | - Luis Eduardo Rohde
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
- Hospital Moinhos de VentoPorto AlegreRSBrasilHospital Moinhos de Vento, Porto Alegre, RS – Brasil.
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brasil.
| | - Marcus Vinícius Simões
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoSão PauloSPBrasilFaculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, SP – Brasil.
| | - Miguel Morita Fernandes-Silva
- Universidade Federal do ParanáCuritibaPRBrasilUniversidade Federal do Paraná (UFPR), Curitiba, PR – Brasil.
- Quanta Diagnóstico por ImagemCuritibaPRBrasilQuanta Diagnóstico por Imagem, Curitiba, PR – Brasil.
| | - Salvador Rassi
- Universidade Federal de GoiásHospital das ClínicasGoiâniaGOBrasilHospital das Clínicas da Universidade Federal de Goiás (UFGO), Goiânia, GO – Brasil.
| | - Silvia Marinho Martins Alves
- Pronto Socorro Cardiológico de PernambucoRecifePEBrasilPronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE – Brasil.
- Universidade de PernambucoRecifePEBrasilUniversidade de Pernambuco (UPE), Recife, PE – Brasil.
| | - Denilson Campos de Albuquerque
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brasil.
| | - Dirceu Rodrigues de Almeida
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo (UNIFESP), São Paulo, SP – Brasil.
| | - Edimar Alcides Bocchi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Felix José Alvarez Ramires
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil.
| | - Fernando Bacal
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - João Manoel Rossi
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil.
| | - Luiz Claudio Danzmann
- Universidade Luterana do BrasilCanoasRSBrasilUniversidade Luterana do Brasil, Canoas, RS – Brasil.
- Hospital São Lucas da PUC-RSPorto AlegreRSBrasilHospital São Lucas da PUC-RS, Porto Alegre, RS – Brasil.
| | | | - Mucio Tavares de Oliveira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Nadine Clausell
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
| | - Odilson Marcos Silvestre
- Universidade Federal do AcreRio BrancoACBrasilUniversidade Federal do Acre, Rio Branco, AC – Brasil.
| | - Reinaldo Bulgarelli Bestetti
- Universidade de Ribeirão PretoDepartamento de MedicinaRibeirão PretoSPBrasilDepartamento de Medicina da Universidade de Ribeirão Preto (UNAERP), Ribeirão Preto, SP – Brasil.
| | | | - Aguinaldo F. Freitas
- Universidade Federal de GoiásHospital das ClínicasGoiâniaGOBrasilHospital das Clínicas da Universidade Federal de Goiás (UFGO), Goiânia, GO – Brasil.
| | - Andréia Biolo
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
| | - Antonio Carlos Pereira Barretto
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Antônio José Lagoeiro Jorge
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilFaculdade de Medicina da Universidade Federal Fluminense (UFF), Niterói, RJ – Brasil.
| | - Bruno Biselli
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Carlos Eduardo Lucena Montenegro
- Pronto Socorro Cardiológico de PernambucoRecifePEBrasilPronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE – Brasil.
- Universidade de PernambucoRecifePEBrasilUniversidade de Pernambuco (UPE), Recife, PE – Brasil.
| | - Edval Gomes dos Santos
- Universidade Estadual de Feira de SantanaFeira de SantanaBABrasilUniversidade Estadual de Feira de Santana, Feira de Santana, BA – Brasil.
- Santa Casa de Misericórdia de Feira de SantanaFeira de SantanaBABrasilSanta Casa de Misericórdia de Feira de Santana, Feira de Santana, BA – Brasil.
| | - Estêvão Lanna Figueiredo
- Instituto OrizontiBelo HorizonteMGBrasilInstituto Orizonti, Belo Horizonte, MG – Brasil.
- Hospital Vera CruzBelo HorizonteMGBrasilHospital Vera Cruz, Belo Horizonte, MG – Brasil.
| | - Fábio Fernandes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Fabio Serra Silveira
- Fundação Beneficência Hospital de CirurgiaAracajuSEBrasilFundação Beneficência Hospital de Cirurgia (FBHC-Ebserh), Aracaju, SE – Brasil.
- Centro de Pesquisa Clínica do CoraçãoAracajuSEBrasilCentro de Pesquisa Clínica do Coração, Aracaju, SE – Brasil.
| | - Fernando Antibas Atik
- Universidade de BrasíliaBrasíliaDFBrasilUniversidade de Brasília (UnB), Brasília, DF – Brasil.
| | - Flávio de Souza Brito
- Universidade Estadual Paulista Júlio de Mesquita FilhoSão PauloSPBrasilUniversidade Estadual Paulista Júlio de Mesquita Filho (UNESP), São Paulo, SP – Brasil.
| | - Germano Emílio Conceição Souza
- Hospital Alemão Oswaldo CruzSão PauloSPBrasilHospital Alemão Oswaldo Cruz, São Paulo, SP – Brasil.
- Hospital Regional de São José dos CamposSão PauloSPBrasilHospital Regional de São José dos Campos, São Paulo, SP – Brasil.
| | - Gustavo Calado de Aguiar Ribeiro
- Pontifícia Universidade Católica de CampinasCampinasSPBrasilPontifícia Universidade Católica de Campinas (PUCC), Campinas, SP – Brasil.
| | - Humberto Villacorta
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilFaculdade de Medicina da Universidade Federal Fluminense (UFF), Niterói, RJ – Brasil.
| | - João David de Souza
- Hospital do Coração de MessejanaFortalezaCEBrasilHospital do Coração de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE – Brasil.
| | - Livia Adams Goldraich
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
| | - Luís Beck-da-Silva
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brasil.
| | - Manoel Fernandes Canesin
- Universidade Estadual de LondrinaHospital UniversitárioLondrinaPRBrasilHospital Universitário da Universidade Estadual de Londrina, Londrina, PR – Brasil.
| | - Marcelo Imbroinise Bittencourt
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brasil.
- Hospital Universitário Pedro ErnestoRio de JaneiroRJBrasilHospital Universitário Pedro Ernesto, Rio de Janeiro, RJ – Brasil.
| | - Marcely Gimenes Bonatto
- Hospital Santa Casa de Misericórdia de CuritibaCuritibaPRBrasilHospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR – Brasil.
| | | | - Mônica Samuel Avila
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Otavio Rizzi Coelho
- Universidade Estadual de CampinasFaculdade de Ciências MédicasCampinasSPBrasilFaculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, SP – Brasil.
| | - Pedro Vellosa Schwartzmann
- Hospital Unimed Ribeirão PretoRibeirão PretoSPBrasilHospital Unimed Ribeirão Preto, Ribeirão Preto, SP – Brasil.
- Centro Avançado de PesquisaEnsino e Diagnóstico (CAPED)Ribeirão PretoSPBrasilCentro Avançado de Pesquisa, Ensino e Diagnóstico (CAPED), Ribeirão Preto, SP – Brasil.
| | - Ricardo Mourilhe-Rocha
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brasil.
| | - Sandrigo Mangini
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Silvia Moreira Ayub Ferreira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | | | - Evandro Tinoco Mesquita
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilFaculdade de Medicina da Universidade Federal Fluminense (UFF), Niterói, RJ – Brasil.
- Treinamento Edson de Godoy Bueno / UHGCentro de EnsinoRio de JaneiroRJBrasilCentro de Ensino e Treinamento Edson de Godoy Bueno / UHG, Rio de Janeiro, RJ – Brasil.
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121
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Gu H, Cirillo C, Nabeebaccus AA, Sun Z, Fang L, Xie Y, Demir O, Desai N, He L, Lü Q, Nakou E, O’Gallagher K, Tountas C, Marvaki A, Monaghan M, Perera D, Pericao A, Ryan M, Sinclair H, Stylianidis V, Victor K, Wang B, Wang J, Wang R, Wu C, Yang Y, Yuan H, Zhang D, Zhang Y, Faconti L, Papachristidis A, Zhang L, Carr-White G, Shah AM, Xie M, Chowienczyk P. First-Phase Ejection Fraction, a Measure of Preclinical Heart Failure, Is Strongly Associated With Increased Mortality in Patients With COVID-19. Hypertension 2021; 77:2014-2022. [PMID: 33966447 PMCID: PMC8115431 DOI: 10.1161/hypertensionaha.121.17099] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Presence of heart failure is associated with a poor prognosis in patients with coronavirus disease 2019 (COVID-19). The aim of the present study was to examine whether first-phase ejection fraction (EF1), the ejection fraction measured in early systole up to the time of peak aortic velocity, a sensitive measure of preclinical heart failure, is associated with survival in patients hospitalized with COVID-19. A retrospective outcome study was performed in patients hospitalized with COVID-19 who underwent echocardiography (n=380) at the West Branch of the Union Hospital, Wuhan, China and in patients admitted to King's Health Partners in South London, United Kingdom. Association of EF1 with survival was performed using Cox proportional hazards regression. EF1 was compared in patients with COVID-19 and in historical controls with similar comorbidities (n=266) who had undergone echocardiography before the COVID-19 pandemic. In patients with COVID-19, EF1 was a strong predictor of survival in each patient group (Wuhan and London). In the combined group, EF1 was a stronger predictor of survival than other clinical, laboratory, and echocardiographic characteristics including age, comorbidities, and biochemical markers. A cutoff value of 25% for EF1 gave a hazard ratio of 5.23 ([95% CI, 2.85-9.60]; P<0.001) unadjusted and 4.83 ([95% CI, 2.35-9.95], P<0.001) when adjusted for demographics, comorbidities, hs-cTnI (high-sensitive cardiac troponin), and CRP (C-reactive protein). EF1 was similar in patients with and without COVID-19 (23.2±7.3 versus 22.0±7.6%, P=0.092, adjusted for prevalence of risk factors and comorbidities). Impaired EF1 is strongly associated with mortality in COVID-19 and probably reflects preexisting, preclinical heart failure.
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Affiliation(s)
- Haotian Gu
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
| | - Chiara Cirillo
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Adam A. Nabeebaccus
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Zhenxing Sun
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Lingyun Fang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Yuji Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Ozan Demir
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Nishita Desai
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Lin He
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Qing Lü
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Eleni Nakou
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Kevin O’Gallagher
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Christos Tountas
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Apostolia Marvaki
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Mark Monaghan
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Divaka Perera
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Ana Pericao
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Matthew Ryan
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Hannah Sinclair
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Vasileios Stylianidis
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Kelly Victor
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Bin Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Rui Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Chun Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Yali Yang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Hongliang Yuan
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Danqing Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Yongxing Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Luca Faconti
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Alexandros Papachristidis
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Gerald Carr-White
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- Guy’s and St Thomas’ Hospital, London, United Kingdom (C.C., O.D., N.D., D.P., A. Pericao, M.R., H.S., V.S., K.V., L. Faconti, G.C.-W.)
| | - Ajay M. Shah
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
- King’s College London Hospital, London, United Kingdom (A.A.N., E.N., K.O., C.T., A.M., M.M., A. Papachristidis, A.M.S.)
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W., Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Z.S., L. Fang, Y.X., L.H., Q.L., B.W., J.W., R.W., C.W.,Y.Y., H.Y., D.Z., Y.Z., L.Z., M.X.)
| | - Phil Chowienczyk
- British Heart Foundation Centre, King’s College London, United Kingdom (H.G., A.A.N., O.D., K.O., M.M., D.P., M.R., L. Faconti, A. Papachristidis, G.C.-W., A.M.S., P.C.)
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Llàcer P, Manzano L, Fernández C, Moreno MC, Núñez J. Mid-term Prognostic Implication of hospitalized COVID-19 patients with Prior Heart Failure diagnosis. Eur J Intern Med 2021; 88:136-138. [PMID: 33676804 PMCID: PMC7906518 DOI: 10.1016/j.ejim.2021.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Pau Llàcer
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Madrid.
| | - Luis Manzano
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Madrid; Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Cristina Fernández
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Madrid
| | | | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
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Dökümcü E. The role of carbohydrate antigen 125 in COVID-19. Med Hypotheses 2021; 151:110590. [PMID: 33873150 PMCID: PMC8007193 DOI: 10.1016/j.mehy.2021.110590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/25/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an inflammatory process with complex pathophysiology and by affecting the cardiovascular system directly or indirectly that causes life threatening cardiac injuries. Therefore, clarifying the effects of this infection on the cardiovascular system is of importance in terms of the clinical course of the disease. The increases in cardiac and inflammatory biomarkers in COVID-19 have been associated with poor prognosis and mortality. However, there are no specific laboratory markers yet to assess the severity of the disease. In this context, the combination of available biomarkers is needed to better define the clinical course of this disease. Carbohydrate antigen 125 (CA-125) has become a remarkable marker in recent years as a result of the correlation of increasing levels in cardiovascular diseases with clinical, hemodynamic, echocardiographic parameters and its relation with mortality or re-hospitalization due to heart failure. These findings suggest that CA-125 might be useful biomarker to identify the damage mechanisms of COVID-19, monitoring the prognosis of the disease and the course of the treatment.
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Affiliation(s)
- Esra Dökümcü
- Medical Biochemistry Laboratory, Edirne Public Health Institution, Turkey.
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Zaccone G, Tomasoni D, Italia L, Lombardi CM, Metra M. Myocardial Involvement in COVID-19: an Interaction Between Comorbidities and Heart Failure with Preserved Ejection Fraction. A Further Indication of the Role of Inflammation. Curr Heart Fail Rep 2021; 18:99-106. [PMID: 33890193 PMCID: PMC8062114 DOI: 10.1007/s11897-021-00509-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF THE REVIEW Coronavirus Disease 2019 (COVID-19) and cardiovascular (CV) disease have a close relationship that emerged from the earliest reports. The aim of this review is to show the possible associations between COVID-19 and heart failure (HF) with preserved ejection fraction (HFpEF). RECENT FINDINGS In hospitalized patients with COVID-19, the prevalence of HFpEF is high, ranging from 4 to 16%, probably due to the shared cardio-metabolic risk profile. Indeed, comorbidities including hypertension, diabetes, obesity and chronic kidney disease - known predictors of a severe course of COVID-19 - are major causes of HFpEF, too. COVID-19 may represent a precipitating factor leading to acute decompensation of HF in patients with known HFpEF and in those with subclinical diastolic dysfunction, which becomes overt. COVID-19 may also directly or indirectly affect the heart. In otherwise healthy patients, echocardiographic studies showed that the majority of COVID-19 patients present diastolic (rather than systolic) impairment, pulmonary hypertension and right ventricular dysfunction. Such abnormalities are observed both in the acute or subacute phase of COVID-19. Cardiac magnetic resonance reveals myocardial inflammation and fibrosis in up to the 78% of patients in the chronic phase of the disease. These findings suggest that COVID-19 might be a novel independent risk factor for the development of HFpEF, through the activation of a systemic pro-inflammatory state. Follow-up studies are urgently needed to better understand long-term sequelae of COVID-19 inflammatory cardiomyopathy.
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Affiliation(s)
- Gregorio Zaccone
- Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy.
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Leonardo Italia
- Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Mario Lombardi
- Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Hill L, Lambrinou E, Moser DK, Beattie JM. The COVID-19 pandemic: challenges in providing supportive care to those with cardiovascular disease in a time of plague. Curr Opin Support Palliat Care 2021; 15:147-153. [PMID: 33843761 PMCID: PMC8183239 DOI: 10.1097/spc.0000000000000552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW COVID-19 has permeated the very essence of human existence and society and disrupted healthcare systems. The attrition stemming from this highly contagious disease particularly affects those rendered vulnerable by age and infirmity, including those with underlying cardiovascular disease. This article critically reviews how best to integrate supportive care into the management of those affected. RECENT FINDINGS Numerous studies have described the pathophysiology of COVID-19, including that specifically arising in those with cardiovascular disease. Potential treatment strategies have emerged but there is limited guidance on the provision of palliative care. A framework for implementation of this service needs to be developed, perhaps involving the training of non-specialists to deliver primary palliative care in the community, bolstered by the use of telemedicine. The appropriate use of limited clinical resources has engendered many challenging discussions and complex ethical decisions. Prospective implementation of future policies requires the incorporation of measures to assuage moral distress, burnout and compassion fatigue in healthcare staff who are psychologically and physically exhausted. SUMMARY Further research based on patient-centred decision making and advance care planning is required to ensure the supportive needs of COVID-19 patients with cardiovascular disease are adequately met. This research should focus on interventions applicable to daily healthcare practice and include strategies to safeguard staff well-being.
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Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | | | - Debra K. Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
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Coronavirus disease vaccination in heart failure: No time to waste. Arch Cardiovasc Dis 2021; 114:434-438. [PMID: 34099378 PMCID: PMC8141713 DOI: 10.1016/j.acvd.2021.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023]
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Panagides V, Vincent F, Weizman O, Jonveaux M, Trimaille A, Pommier T, Cellier J, Geneste L, Marsou W, Deney A, Attou S, Delmotte T, Fauvel C, Ezzouhairi N, Perin B, Zakine C, Levasseur T, Ma I, Chavignier D, Noirclerc N, Darmon A, Mevelec M, Karsenty C, Duceau B, Sutter W, Mika D, Pezel T, Waldmann V, Ternacle J, Cohen A, Bonnet G. History of heart failure in patients with coronavirus disease 2019: Insights from a French registry. Arch Cardiovasc Dis 2021; 114:415-425. [PMID: 34099379 PMCID: PMC8141712 DOI: 10.1016/j.acvd.2021.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although cardiovascular comorbidities seem to be strongly associated with worse outcomes in patients with coronavirus disease 2019 (COVID-19), data regarding patients with preexisting heart failure are limited. AIMS To investigate the incidence, characteristics and clinical outcomes of patients with COVID-19 with a history of heart failure with preserved or reduced ejection fraction. METHODS We performed an observational multicentre study including all patients hospitalized for COVID-19 across 24 centres in France from 26 February to 20 April 2020. The primary endpoint was a composite of in-hospital death or need for orotracheal intubation. RESULTS Overall, 2809 patients (mean age 66.4±16.9years) were included. Three hundred and seventeen patients (11.2%) had a history of heart failure; among them, 49.2% had heart failure with reduced ejection fraction and 50.8% had heart failure with preserved ejection fraction. COVID-19 severity at admission, defined by a quick sequential organ failure assessment score>1, was similar in patients with versus without a history of heart failure. Before and after adjustment for age, male sex, cardiovascular comorbidities and quick sequential organ failure assessment score, history of heart failure was associated with the primary endpoint (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.06-1.90; P=0.02). This result seemed to be mainly driven by a history of heart failure with preserved ejection fraction (HR: 1.61, 95% CI: 1.13-2.27; P=0.01) rather than heart failure with reduced ejection fraction (HR: 1.19, 95% CI: 0.79-1.81; P=0.41). CONCLUSIONS History of heart failure in patients with COVID-19 was associated with a higher risk of in-hospital death or orotracheal intubation. These findings suggest that patients with a history of heart failure, particularly heart failure with preserved ejection fraction, should be considered at high risk of clinical deterioration.
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Affiliation(s)
- Vassili Panagides
- Aix-Marseille Université, Intensive Care Unit, Hôpital Nord, AP-HM, 13015 Marseille, France
| | - Flavien Vincent
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, INSERM U1011, Institut Pasteur de Lille, EGID, Université de Lille, 59800 Lille, France
| | - Orianne Weizman
- Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, 54500 Vandœuvre-les-Nancy, France; Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, 75015 Paris, France
| | - Melchior Jonveaux
- Département de Cardiologie, Expert Valve Center, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, 94010 Créteil, France
| | - Antonin Trimaille
- Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Thibaut Pommier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Joffrey Cellier
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Laura Geneste
- Centre Hospitalier Universitaire d'Amiens-Picardie, 80000 Amiens, France
| | - Wassima Marsou
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, 59800 Lille, France
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Sabir Attou
- Centre Hospitalier Universitaire de Caen-Normandie, 14000 Caen, France
| | - Thomas Delmotte
- Centre Hospitalier Universitaire de Reims, 51100 Reims, France
| | - Charles Fauvel
- Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France
| | - Nacim Ezzouhairi
- University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Benjamin Perin
- Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, 54500 Vandœuvre-les-Nancy, France
| | - Cyril Zakine
- Clinique Saint-Gatien, 37540 Saint-Cyr-sur-Loire, France
| | - Thomas Levasseur
- Centre Hospitalier Intercommunal Fréjus-Saint-Raphaël, 83600 Fréjus, France
| | - Iris Ma
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | | | | | - Arthur Darmon
- Hôpital Bichat-Claude-Bernard, AP-HP, Université de Paris, 75018 Paris, France
| | - Marine Mevelec
- Centre Hospitalier Annecy Genevois, 74370 Épagny-Metz-Tessy, France
| | - Clément Karsenty
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Baptiste Duceau
- Département de Cardiologie, Expert Valve Center, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, 94010 Créteil, France
| | - Willy Sutter
- Département de Cardiologie, Expert Valve Center, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, 94010 Créteil, France
| | - Delphine Mika
- Université Paris-Saclay, INSERM, UMR-S 1180, 92296 Châtenay-Malabry, France
| | - Théo Pezel
- Hôpital Lariboisière, AP-HP, University of Paris, 75010 Paris, France
| | - Victor Waldmann
- Département de Cardiologie, Expert Valve Center, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, 94010 Créteil, France
| | - Julien Ternacle
- University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Québec G1V 4G5, Canada
| | | | - Guillaume Bonnet
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, 75015 Paris, France; University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
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Takabayashi K, Kitaguchi S, Yamamoto T, Takenaka K, Takenaka H, Fujita R, Okuda M, Nakajima O, Koito H, Terasaki Y, Kitamura T, Nohara R. Mode of death in elderly and super-elderly patients with acute heart failure: Insights from Japanese heart failure registry. Clin Cardiol 2021; 44:848-856. [PMID: 33963771 PMCID: PMC8207972 DOI: 10.1002/clc.23619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 12/27/2022] Open
Abstract
Background In Japan, both the prevalence of the elderly and super‐elderly and those of acute heart failure (AHF) have been increasing rapidly. Methods This registry was a prospective multicenter cohort, which enrolled a total of 1253 patients with AHF. In this study, 1117 patients' follow‐up data were available and were categorized into three groups according to age: <75 years old (nonelderly), 75–84 years old (elderly), and ≥ 85 years old (super‐elderly). The endpoint was defined as all‐cause death and each mode of death after discharge during the 3‐years follow‐up period. Results Based on the Kaplan–Meier analysis, a gradually increased risk of all‐cause death according to age was found. Among the three groups, the proportion of HF death was of similar trend; however, the proportion of infection death was higher in elderly and super‐elderly patients. After adjusting for potentially confounding effects using the Cox and Fine–Gray model, the hazard ratio (HR) of all‐cause death increased significantly in elderly and super‐elderly patients (HR, 2.60; 95% confidence interval [CI], 1.93–3.54 and HR, 5.04; 95% CI, 3.72–6.92, respectively), when compared with nonelderly patients. The highest sub‐distribution HR in detailed mode of death was infection death in elderly and super‐elderly patients (HR, 4.25; 95% CI, 1.75–10.33 and HR, 10.10; 95% CI, 3.78–27.03, respectively). Conclusions In this population, the risk of all‐cause death was found to increase in elderly and super‐elderly. Elderly patients and especially super‐elderly patients with AHF were at a higher risk for noncardiovascular death, especially infection death.
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Affiliation(s)
| | - Shouji Kitaguchi
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Takashi Yamamoto
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Kotoe Takenaka
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| | | | - Ryoko Fujita
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Miyuki Okuda
- Department of Internal medicine, Osaka Hospital, Osaka, Japan
| | - Osamu Nakajima
- Department of Cardiology, Hirakata City Hospital, Osaka, Japan
| | - Hitoshi Koito
- Department of Cardiology, Otokoyama Hospital, Kyoto, Japan
| | - Yuka Terasaki
- Department of Internal medicine, Arisawa General Hospital, Osaka, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ryuji Nohara
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
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129
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Alvarez-Garcia J, Jaladanki S, Rivas-Lasarte M, Cagliostro M, Gupta A, Joshi A, Ting P, Mitter SS, Bagiella E, Mancini D, Lala A. New Heart Failure Diagnoses Among Patients Hospitalized for COVID-19. J Am Coll Cardiol 2021; 77:2260-2262. [PMID: 33926664 PMCID: PMC8074874 DOI: 10.1016/j.jacc.2021.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 01/10/2023]
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130
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Abstract
Pre-existing heart failure (HF) in diagnosed patients with coronavirus disease 2019 (COVID-19) is associated with a close to two-fold increased mortality rate compared to COVID-19 patients without prior HF history. Moreover, based both on biomarker as well as imaging findings, widespread endothelial and cardiac injury seems to be present in many patients presenting with COVID-19, associated with adverse outcomes including new onset HF. Systematic echocardiographic studies in patients with COVID-19 indicate that the most common cardiac pathology is right ventricular (RV) dilatation (39%) over and above both left ventricular (LV) diastolic dysfunction (16%) and LV systolic dysfunction (10%). In addition, myocardial injury, assessed by magnetic resonance imaging (MRI), is observed in some 55% to 70% of patients recently recovered from COVID-19 even in those who didn't get very sick during the acute illness. These observations seem to indicate a potentially rather high risk of clinical HF emerging in patients post-COVID-19, warranting close long-term monitoring of patients during recovery. On the other hand, given the established adverse prognostic role that pre-existing HF plays as a comorbidity in the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, it not only seems important in the still ongoing COVID-19 pandemic that all patients with known HF should proactively be well controlled and treated according to current guidelines, but also additionally be considered for priority vaccination against the SARS-CoV-2 infection if not yet vaccinated.
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Affiliation(s)
- Eberhard Standl
- Forschergruppe Diabetes e.V. at Helmholtz Centre, Munich, Germany.
| | - Oliver Schnell
- Forschergruppe Diabetes e.V. at Helmholtz Centre, Munich, Germany
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131
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Greene SJ, Velazquez EJ, Anstrom KJ, Eisenstein EL, Sapp S, Morgan S, Harding T, Sachdev V, Ketema F, Kim DY, Desvigne-Nickens P, Pitt B, Mentz RJ. Pragmatic Design of Randomized Clinical Trials for Heart Failure: Rationale and Design of the TRANSFORM-HF Trial. JACC. HEART FAILURE 2021; 9:325-335. [PMID: 33714745 PMCID: PMC8087639 DOI: 10.1016/j.jchf.2021.01.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 02/08/2023]
Abstract
Randomized clinical trials are the foundation of evidence-based medicine and central to practice guidelines and patient care decisions. Nonetheless, randomized trials in heart failure (HF) populations have become increasingly difficult to conduct and are frequently associated with slow patient enrollment, highly selected populations, extensive data collection, and high costs. The traditional model for HF trials has become particularly difficult to execute in the United States, where challenges to site-based research have frequently led to modest U.S. representation in global trials. In this context, the TRANSFORM-HF (Torsemide Comparison with Furosemide for Management of Heart Failure) trial aims to overcome traditional trial challenges and compare the effects of torsemide versus furosemide among patients with HF in the United States. Loop diuretic agents are regularly used by most patients with HF and practice guidelines recommend optimal use of diuretic agents as key to a successful treatment strategy. Long-time clinical experience has contributed to dominant use of furosemide for loop diuretic therapy, although preclinical and small clinical studies suggest potential advantages of torsemide. However, due to the lack of appropriately powered clinical outcome studies, there is insufficient evidence to conclude that torsemide should be routinely recommended over furosemide. Given this gap in knowledge and the fundamental role of loop diuretic agents in HF care, the TRANSFORM-HF trial was designed as a prospective, randomized, event-driven, pragmatic, comparative-effectiveness study to definitively compare the effect of a treatment strategy of torsemide versus furosemide on long-term mortality, hospitalization, and patient-reported outcomes among patients with HF. (TRANSFORM-HF: ToRsemide compArisoN With furoSemide FORManagement of Heart Failure [TRANSFORM-HF]; NCT03296813).
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Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA. https://twitter.com/SJGreene_md
| | - Eric J Velazquez
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA. https://twitter.com/ericjvelazquez
| | - Kevin J Anstrom
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Shelly Sapp
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Shelby Morgan
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Tina Harding
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Vandana Sachdev
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Fassil Ketema
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Dong-Yun Kim
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Bertram Pitt
- Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.
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132
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Siniorakis E, Arvanitakis S, Katsianis A, Nikolopoulos I. Letter to the Editor: Impact of Cardiovascular Risk Factors and Cardiovascular Diseases on Outcomes in Patients Hospitalized with COVID-19 in Daegu Metropolitan City. J Korean Med Sci 2021; 36:e113. [PMID: 33876590 PMCID: PMC8055509 DOI: 10.3346/jkms.2021.36.e113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/12/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Antonios Katsianis
- Department of Cardiology, Sotiria Chest Diseases Hospital, Athens, Greece
| | - Ioannis Nikolopoulos
- Intensive Care Unit and Centre for Respiratory Failure, Sotiria Chest Diseases Hospital, Athens, Greece
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133
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Popiolek-Kalisz J, Kalisz G. Cardiac Resynchronization Therapy Remote Monitoring - COVID-19 Pandemic Experiences and Future Perspectives. Curr Probl Cardiol 2021; 47:100874. [PMID: 33994038 PMCID: PMC8052509 DOI: 10.1016/j.cpcardiol.2021.100874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/11/2021] [Indexed: 11/18/2022]
Abstract
Cardiac resynchronization therapy (CRT) is a well-established form of the treatment for heart failure (HF) in patients with left ventricle contraction dyssynchrony. Apart from typical in-office management, remote monitoring enables constant surveillance on both the patient's and the device's condition. This way, in case of any problems, clinical decisions could be made earlier leading to better outcome of CRT patients. COVID-19 pandemic with following lockdowns in many countries resulted in getting more attention on remote monitoring systems. The aim of this paper was to gather and summarize worldwide experiences from CRT remote monitoring during COVID-19 pandemic and point out future possibilities for HF patients treated with CRT. Already published experiences from remote monitoring of CRT devices during COVID-19 restrictions confirmed previous advantages of telemedical approach, however, more publications in this area would be helpful.
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Affiliation(s)
| | - Grzegorz Kalisz
- Department of Biopharmacy, Medical University of Lublin, Lublin, Poland
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134
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Meta-Analysis of Atrial Fibrillation in Patients With COVID-19. Am J Cardiol 2021; 144:152-156. [PMID: 33508269 PMCID: PMC7839388 DOI: 10.1016/j.amjcard.2021.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 02/07/2023]
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135
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Morin DP, Manzo MA, Pantlin PG, Verma R, Bober RM, Krim SR, Lavie CJ, Qamruddin S, Shah S, Tafur Soto JD, Ventura H, Price-Haywood EG. Impact of Preinfection Left Ventricular Ejection Fraction on Outcomes in COVID-19 Infection. Curr Probl Cardiol 2021; 46:100845. [PMID: 33994027 PMCID: PMC7972833 DOI: 10.1016/j.cpcardiol.2021.100845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 12/30/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has high infectivity and causes extensive morbidity and mortality. Cardiovascular disease is a risk factor for adverse outcomes in COVID-19, but baseline left ventricular ejection fraction (LVEF) in particular has not been evaluated thoroughly in this context. We analyzed patients in our state's largest health system who were diagnosed with COVID-19 between March 20 and May 15, 2020. Inclusion required an available echocardiogram within 1 year prior to diagnosis. The primary outcome was all-cause mortality. LVEF was analyzed both as a continuous variable and using a cutoff of 40%. Among 396 patients (67 ± 16 years, 191 [48%] male, 235 [59%] Black, 59 [15%] LVEF ≤40%), 289 (73%) required hospital admission, and 116 (29%) died during 85 ± 63 days of follow-up. Echocardiograms, performed a median of 57 (IQR 11-122) days prior to COVID-19 diagnosis, showed a similar distribution of LVEF between survivors and decedents (P = 0.84). Receiver operator characteristic analysis revealed no predictive ability of LVEF for mortality, and there was no difference in survival among those with LVEF ≤40% versus >40% (P = 0.49). Multivariable analysis did not change these relationships. Similarly, there was no difference in LVEF based on whether the patient required hospital admission (56 ± 13 vs 55 ± 13, P = 0.38), and patients with a depressed LVEF did not require admission more frequently than their preserved-LVEF peers (P = 0.87). A premorbid history of dyspnea consistent with symptomatic heart failure was not associated with mortality (P = 0.74). Among patients diagnosed with COVID-19, pre-COVID-19 LVEF was not a risk factor for death or hospitalization.
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Affiliation(s)
- Daniel P Morin
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA; Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA.
| | - Marc A Manzo
- Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Peter G Pantlin
- Internal Medicine Department, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Rashmi Verma
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA
| | - Robert M Bober
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA; Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Selim R Krim
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA; Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Carl J Lavie
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA; Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Salima Qamruddin
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA; Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Sangeeta Shah
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA; Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - José D Tafur Soto
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA; Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Hector Ventura
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA; Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Eboni G Price-Haywood
- Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA; Ochsner Center for Outcomes and Health Sciences Research, New Orleans, LA
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136
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Goerlich E, Minhas AS, Mukherjee M, Sheikh FH, Gilotra NA, Sharma G, Michos ED, Hays AG. Multimodality Imaging for Cardiac Evaluation in Patients with COVID-19. Curr Cardiol Rep 2021; 23:44. [PMID: 33721125 PMCID: PMC7957471 DOI: 10.1007/s11886-021-01483-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW A growing number of cardiovascular manifestations resulting from the novel SARS-CoV-2 coronavirus (COVID-19) have been described since the beginning of this global pandemic. Acute myocardial injury is common in this population and is associated with higher rates of morbidity and mortality. The focus of this review centers on the recent applications of multimodality imaging in the diagnosis and management of COVID-19-related cardiovascular conditions. RECENT FINDINGS In addition to standard cardiac imaging techniques such as transthoracic echocardiography, other modalities including computed tomography and cardiac magnetic resonance imaging have emerged as useful adjuncts in select patients with COVID-19 infection, particularly those with suspected ischemic and nonischemic myocardial injury. Data have also emerged suggesting lasting COVID-19 subclinical cardiac effects, which may have long-term prognostic implications. With the spectrum of COVID-19 cardiovascular manifestations observed thus far, it is important for clinicians to recognize the role, strengths, and limitations of multimodality imaging techniques in this patient population.
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Affiliation(s)
- Erin Goerlich
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
| | - Anum S. Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
| | - Farooq H. Sheikh
- Division of Cardiology, Department of Medicine, Medstar Washington Hospital Center, Washington, DC USA
| | - Nisha A. Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
| | - Erin D. Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287 USA
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137
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Wanyan T, Vaid A, De Freitas JK, Somani S, Miotto R, Nadkarni GN, Azad A, Ding Y, Glicksberg BS. Relational Learning Improves Prediction of Mortality in COVID-19 in the Intensive Care Unit. IEEE TRANSACTIONS ON BIG DATA 2021; 7:38-44. [PMID: 33768136 PMCID: PMC7990133 DOI: 10.1109/tbdata.2020.3048644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/29/2020] [Accepted: 12/21/2020] [Indexed: 05/04/2023]
Abstract
Traditional Machine Learning (ML) models have had limited success in predicting Coronoavirus-19 (COVID-19) outcomes using Electronic Health Record (EHR) data partially due to not effectively capturing the inter-connectivity patterns between various data modalities. In this work, we propose a novel framework that utilizes relational learning based on a heterogeneous graph model (HGM) for predicting mortality at different time windows in COVID-19 patients within the intensive care unit (ICU). We utilize the EHRs of one of the largest and most diverse patient populations across five hospitals in major health system in New York City. In our model, we use an LSTM for processing time varying patient data and apply our proposed relational learning strategy in the final output layer along with other static features. Here, we replace the traditional softmax layer with a Skip-Gram relational learning strategy to compare the similarity between a patient and outcome embedding representation. We demonstrate that the construction of a HGM can robustly learn the patterns classifying patient representations of outcomes through leveraging patterns within the embeddings of similar patients. Our experimental results show that our relational learning-based HGM model achieves higher area under the receiver operating characteristic curve (auROC) than both comparator models in all prediction time windows, with dramatic improvements to recall.
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Affiliation(s)
- Tingyi Wanyan
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- School of Informatics, Computing, and EngineeringIndiana UniversityBloomingtonIN47405USA
- School of InformationUniversity of Texas at AustinAustinTX78712USA
| | - Akhil Vaid
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Jessica K De Freitas
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Sulaiman Somani
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Riccardo Miotto
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Girish N. Nadkarni
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Ariful Azad
- School of Informatics, Computing, and EngineeringIndiana UniversityBloomingtonIN47405USA
| | - Ying Ding
- School of InformationUniversity of Texas at AustinAustinTX78712USA
- Dell Medical SchoolUniversity of Texas at AustinAustinTX78712USA
| | - Benjamin S. Glicksberg
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
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138
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Belarte-Tornero LC, Valdivielso-Moré S, Vicente Elcano M, Solé-González E, Ruíz-Bustillo S, Calvo-Fernández A, Subinara I, Cabero P, Soler C, Cubero-Gallego H, Vaquerizo B, Farré N. Prognostic Implications of Chronic Heart Failure and Utility of NT-proBNP Levels in Heart Failure Patients with SARS-CoV-2 Infection. J Clin Med 2021; 10:jcm10020323. [PMID: 33477268 PMCID: PMC7829899 DOI: 10.3390/jcm10020323] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 02/07/2023] Open
Abstract
Background: The prevalence and prognostic value of chronic heart failure (CHF) in the setting of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has seldom been studied. The aim of this study was to analyze the prevalence and prognosis of CHF in this setting. Methods: This single-center study included 829 consecutive patients with SARS-CoV-2 infection from February to April 2020. Patients with a previous history of CHF were matched 1:2 for age and sex. We analyze the prognostic value of pre-existing CHF. Prognostic implications of N terminal pro brain natriuretic peptide (NT-proBNP) levels on admission in the CHF cohort were explored. Results: A total of 129 patients (43 CHF and 86 non-CHF) where finally included. All-cause mortality was higher in CHF patients compared to non-CHF patients (51.2% vs. 29.1%, p = 0.014). CHF was independently associated with 30-day mortality (hazard ratio (HR) 2.3, confidence interval (CI) 95%: 1.26–2.4). Patients with CHF and high-sensitivity troponin T < 14 ng/L showed excellent prognosis. An NT-proBNP level > 2598 pg/mL on admission was associated with higher 30-day mortality in patients with CHF. Conclusions: All-cause mortality in CHF patients hospitalized due to SARS-CoV-2 infection was 51.2%. CHF was independently associated with all-cause mortality (HR 2.3, CI 95% 1.26–4.2). NT-proBNP levels could be used for stratification risk purposes to guide medical decisions if larger studies confirm this finding.
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Affiliation(s)
- Laia C. Belarte-Tornero
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (S.V.-M.); (E.S.-G.); (S.R.-B.); (A.C.-F.)
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
- Correspondence: (L.C.B.-T.); (N.F.)
| | - Sandra Valdivielso-Moré
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (S.V.-M.); (E.S.-G.); (S.R.-B.); (A.C.-F.)
| | | | - Eduard Solé-González
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (S.V.-M.); (E.S.-G.); (S.R.-B.); (A.C.-F.)
| | - Sonia Ruíz-Bustillo
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (S.V.-M.); (E.S.-G.); (S.R.-B.); (A.C.-F.)
- Department of Medicine, School of Medicine, Universidad Autonoma de Barcelona, 08003 Barcelona, Spain
| | - Alicia Calvo-Fernández
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (S.V.-M.); (E.S.-G.); (S.R.-B.); (A.C.-F.)
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
| | - Isaac Subinara
- CIBER Epidemiology and Public Health, IMIM-Parc de Salut Mar, 08003 Barcelona, Spain;
| | - Paula Cabero
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain;
| | - Cristina Soler
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
| | - Héctor Cubero-Gallego
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain;
| | - Beatriz Vaquerizo
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain;
- Department of Medicine, School of Medicine, Universidad Autonoma de Barcelona, 08003 Barcelona, Spain
| | - Núria Farré
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (S.V.-M.); (E.S.-G.); (S.R.-B.); (A.C.-F.)
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (P.C.); (C.S.); (H.C.-G.); (B.V.)
- Department of Medicine, School of Medicine, Universidad Autonoma de Barcelona, 08003 Barcelona, Spain
- Correspondence: (L.C.B.-T.); (N.F.)
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139
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DeFilippis EM, Psotka MA, Ibrahim NE. Promoting Health Equity in Heart Failure Amid a Pandemic. JACC. HEART FAILURE 2021; 9:74-76. [PMID: 33384065 PMCID: PMC7832813 DOI: 10.1016/j.jchf.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Ersilia M. DeFilippis
- Cardiology Division, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Nasrien E. Ibrahim
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,Address for correspondence: Dr. Nasrien E. Ibrahim, Massachusetts General Hospital, 55 Fruit Street, GRB-800, Boston, Massachusetts 02114, USA
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140
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Bhatt AS, Jering KS, Vaduganathan M, Claggett BL, Cunningham JW, Rosenthal N, Signorovitch J, Thune JJ, Vardeny O, Solomon SD. Clinical Outcomes in Patients With Heart Failure Hospitalized With COVID-19. JACC. HEART FAILURE 2021; 9:65-73. [PMID: 33384064 PMCID: PMC7833294 DOI: 10.1016/j.jchf.2020.11.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate in-hospital outcomes among patients with a history of heart failure (HF) hospitalized with coronavirus disease-2019 (COVID-19). BACKGROUND Cardiometabolic comorbidities are common in patients with severe COVID-19. Patients with HF may be particularly susceptible to COVID-19 complications. METHODS The Premier Healthcare Database was used to identify patients with at least 1 HF hospitalization or 2 HF outpatient visits between January 1, 2019, and March 31, 2020, who were subsequently hospitalized between April and September 2020. Baseline characteristics, health care resource utilization, and mortality rates were compared between those hospitalized with COVID-19 and those hospitalized with other causes. Predictors of in-hospital mortality were identified in HF patients hospitalized with COVID-19 by using multivariate logistic regression. RESULTS Among 1,212,153 patients with history of HF, 132,312 patients were hospitalized from April 1, 2020, to September 30, 2020. A total of 23,843 patients (18.0%) were hospitalized with acute HF, 8,383 patients (6.4%) were hospitalized with COVID-19, and 100,068 patients (75.6%) were hospitalized with alternative reasons. Hospitalization with COVID-19 was associated with greater odds of in-hospital mortality as compared with hospitalization with acute HF; 24.2% of patients hospitalized with COVID-19 died in-hospital compared to 2.6% of those hospitalized with acute HF. This association was strongest in April (adjusted odds ratio [OR]: 14.48; 95% confidence interval [CI]:12.25 to 17.12) than in subsequent months (adjusted OR: 10.11; 95% CI: 8.95 to 11.42; pinteraction <0.001). Among patients with HF hospitalized with COVID-19, male sex (adjusted OR: 1.26; 95% CI: 1.13 to 1.40) and morbid obesity (adjusted OR: 1.25; 95% CI: 1.07 to 1.46) were associated with greater odds of in-hospital mortality, along with age (adjusted OR: 1.35; 95% CI: 1.29 to 1.42 per 10 years) and admission earlier in the pandemic. CONCLUSIONS Patients with HF hospitalized with COVID-19 are at high risk for complications, with nearly 1 in 4 dying during hospitalization.
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Affiliation(s)
- Ankeet S Bhatt
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Karola S Jering
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Muthiah Vaduganathan
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Claggett
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan W Cunningham
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ning Rosenthal
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, USA
| | | | - Jens J Thune
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Orly Vardeny
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans' Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Scott D Solomon
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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141
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COVID-19 and Heart Failure: Harsh Reality of Pre-Existing Conditions. J Am Coll Cardiol 2020; 76:2349-2351. [PMID: 33183508 PMCID: PMC7831570 DOI: 10.1016/j.jacc.2020.09.588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 01/05/2023]
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142
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Rovas A, Osiaevi I, Buscher K, Sackarnd J, Tepasse PR, Fobker M, Kühn J, Braune S, Göbel U, Thölking G, Gröschel A, Pavenstädt H, Vink H, Kümpers P. Microvascular dysfunction in COVID-19: the MYSTIC study. Angiogenesis 2020; 24:145-157. [PMID: 33058027 PMCID: PMC7556767 DOI: 10.1007/s10456-020-09753-7] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/28/2020] [Indexed: 12/31/2022]
Abstract
RATIONALE Pre-clinical and autopsy studies have fueled the hypothesis that a dysregulated vascular endothelium might play a central role in the pathogenesis of ARDS and multi-organ failure in COVID-19. OBJECTIVES To comprehensively characterize and quantify microvascular alterations in patients with COVID-19. METHODS Hospitalized adult patients with moderate-to-severe or critical COVID-19 (n = 23) were enrolled non-consecutively in this prospective, observational, cross-sectional, multi-center study. Fifteen healthy volunteers served as controls. All participants underwent intravital microscopy by sidestream dark field imaging to quantify vascular density, red blood cell velocity (VRBC), and glycocalyx dimensions (perfused boundary region, PBR) in sublingual microvessels. Circulating levels of endothelial and glycocalyx-associated markers were measured by multiplex proximity extension assay and enzyme-linked immunosorbent assay. MEASUREMENTS AND MAIN RESULTS COVID-19 patients showed an up to 90% reduction in vascular density, almost exclusively limited to small capillaries (diameter 4-6 µm), and also significant reductions of VRBC. Especially, patients on mechanical ventilation showed severe glycocalyx damage as indicated by higher PBR values (i.e., thinner glycocalyx) and increased blood levels of shed glycocalyx constituents. Several markers of endothelial dysfunction were increased and correlated with disease severity in COVID-19. PBR (AUC 0.75, p = 0.01), ADAMTS13 (von Willebrand factor-cleaving protease; AUC 0.74, p = 0.02), and vascular endothelial growth factor A (VEGF-A; AUC 0.73, p = 0.04) showed the best discriminatory ability to predict 60-day in-hospital mortality. CONCLUSIONS Our data clearly show severe alterations of the microcirculation and the endothelial glycocalyx in patients with COVID-19. Future therapeutic approaches should consider the importance of systemic vascular involvement in COVID-19.
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Affiliation(s)
- Alexandros Rovas
- Department of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, University Hospital Münster, Albert-Schweitzer- Campus 1, 48149 Münster, Germany
| | - Irina Osiaevi
- Department of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, University Hospital Münster, Albert-Schweitzer- Campus 1, 48149 Münster, Germany
| | - Konrad Buscher
- Department of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, University Hospital Münster, Albert-Schweitzer- Campus 1, 48149 Münster, Germany
| | - Jan Sackarnd
- Department of Cardiology and Angiology, University Hospital Münster, Albert- Schweitzer-Campus 1, 48149 Münster, Germany
| | - Phil-Robin Tepasse
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Manfred Fobker
- Center for Laboratory Medicine, University Hospital Münster, Albert-Schweitzer- Campus 1, 48149 Münster, Germany
| | - Joachim Kühn
- Institute of Virology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Stephan Braune
- Departmenf of medical internal intensive care and emergency medicine, St. Franziskus-Hospital GmbH, 48145 Münster, Germany
| | - Ulrich Göbel
- Department of Anaesthesiology and Critical Care, St. Franziskus-Hospital GmbH, 48145 Münster, Germany
| | - Gerold Thölking
- Department of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, University Hospital Münster, Albert-Schweitzer- Campus 1, 48149 Münster, Germany
- Department of Internal Medicine and Nephrology, University Hospital Münster Marienhospital Steinfurt, 48565 Steinfurt, Germany
| | | | - Hermann Pavenstädt
- Department of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, University Hospital Münster, Albert-Schweitzer- Campus 1, 48149 Münster, Germany
| | - Hans Vink
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Philipp Kümpers
- Department of Medicine D, Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, University Hospital Münster, Albert-Schweitzer- Campus 1, 48149 Münster, Germany
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