151
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Joyce E. COVID-19, myocarditis, and the other side of the bed. Eur J Heart Fail 2020; 22:2187-2189. [PMID: 33225553 PMCID: PMC7753580 DOI: 10.1002/ejhf.2062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Emer Joyce
- Department of Cardiovascular Medicine, Mater University Hospital, Dublin, Ireland
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152
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Rassaf T, Totzeck M, Mahabadi AA, Hendgen-Cotta U, Korste S, Settelmeier S, Luedike P, Dittmer U, Herbstreit F, Brenner T, Klingel K, Hasenberg M, Walkenfort B, Gunzer M, Schlosser T, Weymann A, Kamler M, Schmack B, Ruhparwar A. Ventricular assist device for a coronavirus disease 2019-affected heart. ESC Heart Fail 2020; 8:162-166. [PMID: 33219613 PMCID: PMC7753611 DOI: 10.1002/ehf2.13120] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/06/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is challenging the care for cardiovascular patients, resulting in serious consequences with increasing mortality in pre-diseased heart failure patients. In the current state of the pandemic, the physiopathology of COVID-19 affecting pre-diseased hearts and the management of terminal heart failure in COVID-19 patients remain unclear. We outline the findings of a young COVID-19 patient suffering from idiopathic cardiomyopathy who was treated for acute multi-organ failure and required cardiac surgery with implantation of a temporary right ventricular and durable left ventricular assist device (LVAD). For deeper translational insights, we used in-depth tissue analysis by electron and light sheet fluorescence microscopy revealing evidence for spatial distribution of severe acute respiratory syndrome coronavirus 2 in the heart. This indicates that in-depth analysis may represent a valuable tool in understanding indistinct clinical cases. We conclude that COVID-19 directly affects pre-diseased hearts, but the consequences can be treated successfully with LVAD implantation.
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Affiliation(s)
- Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Amir A Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Ulrike Hendgen-Cotta
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Sebastian Korste
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Stephan Settelmeier
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, Essen, Germany
| | - Frank Herbstreit
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany
| | - Karin Klingel
- Department of Cardiopathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Mike Hasenberg
- Institute for Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Bernd Walkenfort
- Institute for Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Matthias Gunzer
- Institute for Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Thomas Schlosser
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
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153
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Matsushita K, Marchandot B, Carmona A, Curtiaud A, El Idrissi A, Trimaille A, Kibler M, Cardi T, Heger J, Hess S, Reydel A, Jesel L, Ohlmann P, Morel O. Increased susceptibility to SARS-CoV-2 infection in patients with reduced left ventricular ejection fraction. ESC Heart Fail 2020; 8:380-389. [PMID: 33205916 PMCID: PMC7753539 DOI: 10.1002/ehf2.13083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/03/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
Aims Cardiovascular disease has been recognized as a major determinant of coronavirus disease 2019 (COVID‐19) vulnerability and severity. Angiotensin‐converting enzyme (ACE) 2 is a functional receptor for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and is up‐regulated in patients with heart failure. We sought to examine the potential association between reduced left ventricular ejection fraction (LVEF) and the susceptibility to SARS‐CoV‐2 infection. Methods and results Of the 1162 patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention between February 2014 and October 2018, we enrolled 889 patients with available clinical follow‐up data. Follow‐up was conducted by telephone interviews 1 month after the start of the French lockdown which began on 17 March 2020. Patients were divided into two groups according to LVEF <40% (reduced LVEF) (n = 91) or ≥40% (moderately reduced + preserved LVEF) (n = 798). The incidence of COVID‐19‐related hospitalization or death was significantly higher in the reduced LVEF group as compared with the moderately reduced + preserved LVEF group (9% vs. 1%, P < 0.001). No association was found between discontinuation of ACE‐inhibitor or angiotensin‐receptor blockers and COVID‐19 test positivity. By multivariate logistic regression analysis, reduced LVEF was an independent predictor of COVID‐19 hospitalization or death (odds ratio: 6.91, 95% confidence interval: 2.60 to 18.35, P < 0.001). Conclusions In a large cohort of patients with previous ACS, reduced LVEF was associated with increased susceptibility to COVID‐19. Aggressive COVID‐19 testing and therapeutic strategies may be considered for patient with impaired heart function.
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Affiliation(s)
- Kensuke Matsushita
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Benjamin Marchandot
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Adrien Carmona
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Anais Curtiaud
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Anis El Idrissi
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Antonin Trimaille
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Marion Kibler
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Thomas Cardi
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Joe Heger
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Sebastien Hess
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Antje Reydel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Laurence Jesel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Patrick Ohlmann
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Olivier Morel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
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154
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Frangogiannis NG. The significance of COVID-19-associated myocardial injury: how overinterpretation of scientific findings can fuel media sensationalism and spread misinformation. Eur Heart J 2020; 41:3836-3838. [PMID: 33006608 PMCID: PMC7599034 DOI: 10.1093/eurheartj/ehaa727] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Nikolaos G Frangogiannis
- The Wilf Family Cardiovascular Research Institute, Department of Medicine (Cardiology), Albert Einstein College of Medicine, 1300 Morris Park Avenue, Forchheimer G46B, Bronx, NY 10461, USA
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155
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COVID-19 and Microvascular Disease: Pathophysiology of SARS-CoV-2 Infection With Focus on the Renin-Angiotensin System. Heart Lung Circ 2020; 29:1596-1602. [PMID: 32972810 PMCID: PMC7467122 DOI: 10.1016/j.hlc.2020.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/26/2020] [Accepted: 08/14/2020] [Indexed: 02/08/2023]
Abstract
The recently described severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people, with thousands of fatalities. It has prompted global efforts in research, with focus on the pathophysiology of coronavirus disease-19 (COVID-19), and a rapid surge of publications. COVID-19 has been associated with a myriad of clinical manifestations, including the lungs, heart, kidneys, central nervous system, gastrointestinal system, skin, and blood coagulation abnormalities. The endothelium plays a key role in organ dysfunction associated with severe infection, and current data suggest that it is also involved in SARS-CoV-2-induced sepsis. This critical review aimed to address a possible unifying mechanism underlying the diverse complications of COVID-19: microvascular dysfunction, with emphasis on the renin-angiotensin system. In addition, research perspectives are suggested in order to expand understanding of the pathophysiology of the infection.
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156
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Posso M, Comas M, Román M, Domingo L, Louro J, González C, Sala M, Anglès A, Cirera I, Cots F, Frías VM, Gea J, Güerri-Fernández R, Masclans JR, Noguès X, Vázquez O, Villar-García J, Horcajada JP, Pascual J, Castells X. Comorbidities and Mortality in Patients With COVID-19 Aged 60 Years and Older in a University Hospital in Spain. Arch Bronconeumol 2020; 56:756-758. [PMID: 33994638 PMCID: PMC7657606 DOI: 10.1016/j.arbr.2020.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Margarita Posso
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Cristina González
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Infection Control Program, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - María Sala
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Albert Anglès
- Medical Documentation Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Isabel Cirera
- Emergency Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Francesc Cots
- Management Control Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Víctor-Manuel Frías
- Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar, Barcelona, Spain
| | - Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar-IMIM, DCEXS, UPF, CIBERES, ISCiii, Barcelona, Spain
| | | | | | - Xavier Noguès
- Department of Internal Medicine, Hospital del Mar. IMIM, CIBERFES, Barcelona, Spain
| | - Olga Vázquez
- Department of Geriatrics, Hospital del Mar-IMIM, Barcelona, Spain
| | | | - Juan Pablo Horcajada
- Infection Control Program, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Department of Infectious Diseases, Hospital del Mar-IMIM, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
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157
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Arcari L, Luciani M, Cacciotti L, Musumeci MB, Spuntarelli V, Pistella E, Martolini D, Manzo D, Pucci M, Marone C, Melandri S, Ansalone G, Santini C, Martelletti P, Volpe M, De Biase L. Incidence and determinants of high-sensitivity troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients. Intern Emerg Med 2020; 15:1467-1476. [PMID: 32986136 PMCID: PMC7520380 DOI: 10.1007/s11739-020-02498-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Myocardial involvement in the course of coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. The aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia. METHODS In this multicenter observational study, we analyzed data from n = 111 patients. Cardiac biomarkers subgroups were identified according to values beyond reference range. RESULTS Increased hs-Troponin and NP were found in 38 and 56% of the cases, respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and had more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03, respectively). Both hs-Troponin and NP were higher in patients with in-hospital mortality (p = 0.001 and p = 0.002, respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B = 0.419, p = 0.001; B = - 0.212, p = 0.013; and B = 0.179, p = 0.037, respectively) and of NP with age and previous CVD (B = 0.480, p < 0.001; and B = 0.253, p = 0.001, respectively). CONCLUSIONS Myocardial involvement at admission is common in COVID-19 pneumonia. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point toward existing different mechanisms leading to their elevation in this setting.
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Affiliation(s)
- Luca Arcari
- Department of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177, Rome, Italy.
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy.
| | - Michelangelo Luciani
- Internal Medicine Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Luca Cacciotti
- Department of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177, Rome, Italy
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Maria Beatrice Musumeci
- Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Cardiology Unit, Sapienza University of Rome, Rome, Italy
- Heart Failure Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Covid Unit, Sapienza University of Rome, Rome, Italy
| | - Valerio Spuntarelli
- Internal Medicine Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Emergency Medicine, Department of Clinical and Molecular Medicine, Covid Unit, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Eleonora Pistella
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Dario Martolini
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Daniele Manzo
- Department of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177, Rome, Italy
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
| | | | - Claudio Marone
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Serena Melandri
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Gerardo Ansalone
- Department of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177, Rome, Italy
| | - Claudio Santini
- Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Paolo Martelletti
- Internal Medicine Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Emergency Medicine, Department of Clinical and Molecular Medicine, Covid Unit, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Volpe
- Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Cardiology Unit, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Luciano De Biase
- Heart Failure Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Covid Unit, Sapienza University of Rome, Rome, Italy
- Heart Failure Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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158
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Keri VC, Hooda A, Kodan P, R L B, Jorwal P, Wig N. Intricate interplay between Covid-19 and cardiovascular diseases. Rev Med Virol 2020; 31:e2188. [PMID: 33128859 DOI: 10.1002/rmv.2188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Covid-19 disease can involve any organ system leading to myriad manifestations and complications. Cardiovascular manifestations are being increasingly recognised with the improved understanding of the disease. Acute coronary syndrome, myocarditis, arrhythmias, cardiomyopathy; heart failure and thromboembolic disease have all been described. The elderly and those with prior cardiac diseases are at an increased risk of mortality. Overlapping symptomatology, ability of drugs to cause QTc interval (start of Q wave to the end of T wave) prolongation on electrocardiogram and arrhythmias, potential drug interactions, the need to recognise patients requiring urgent definitive management and provide necessary bedside interventions without increasing the risk of nosocomial spread have made the management challenging. In the background of a pandemic, non-Covid-19 cardiac patients are affected by delayed treatment and nosocomial exposure. Triaging using telemedicine and artificial intelligence along with utilization of bedside rapid diagnostic tests to detect Covid-19 could prove helpful in this aspect.
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Affiliation(s)
- Vishakh C Keri
- Infectious Diseases, Department of Medicine and Microbiology, AIIMS, New Delhi, India
| | - Amit Hooda
- Department of Cardiology, Mount Sinai Hospital, New York, USA
| | - Parul Kodan
- Department of Medicine, Lady Hardinge Medicine College and RML Hospital, New Delhi, India
| | - Brunda R L
- Department of Emergency Medicine, AIIMS, New Delhi, India
| | | | - Naveet Wig
- Department of Medicine, AIIMS, New Delhi, India
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159
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Severino P, D’Amato A, Pucci M, Infusino F, Adamo F, Birtolo LI, Netti L, Montefusco G, Chimenti C, Lavalle C, Maestrini V, Mancone M, Chilian WM, Fedele F. Ischemic Heart Disease Pathophysiology Paradigms Overview: From Plaque Activation to Microvascular Dysfunction. Int J Mol Sci 2020; 21:E8118. [PMID: 33143256 PMCID: PMC7663258 DOI: 10.3390/ijms21218118] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023] Open
Abstract
Ischemic heart disease still represents a large burden on individuals and health care resources worldwide. By conventions, it is equated with atherosclerotic plaque due to flow-limiting obstruction in large-medium sized coronary arteries. However, clinical, angiographic and autoptic findings suggest a multifaceted pathophysiology for ischemic heart disease and just some cases are caused by severe or complicated atherosclerotic plaques. Currently there is no well-defined assessment of ischemic heart disease pathophysiology that satisfies all the observations and sometimes the underlying mechanism to everyday ischemic heart disease ward cases is misleading. In order to better examine this complicated disease and to provide future perspectives, it is important to know and analyze the pathophysiological mechanisms that underline it, because ischemic heart disease is not always determined by atherosclerotic plaque complication. Therefore, in order to have a more complete comprehension of ischemic heart disease we propose an overview of the available pathophysiological paradigms, from plaque activation to microvascular dysfunction.
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Affiliation(s)
- Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Andrea D’Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Mariateresa Pucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Fabio Infusino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Francesco Adamo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Lucrezia Netti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Giulio Montefusco
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Cristina Chimenti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - William M. Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA;
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
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Tomasoni D, Adamo M, Italia L, Branca L, Chizzola G, Fiorina C, Lupi L, Inciardi RM, Cani DS, Lombardi CM, Curello S, Metra M. Impact of COVID-2019 outbreak on prevalence, clinical presentation and outcomes of ST-elevation myocardial infarction. J Cardiovasc Med (Hagerstown) 2020; 21:874-881. [PMID: 32941325 DOI: 10.2459/jcm.0000000000001098] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIMS The aim of this study was to report the prevalence, clinical features and outcomes of patients with ST-elevation myocardial infarction (STEMI) hospitalized during the Corona-Virus Disease 2019 (COVID-19) outbreak compared with those admitted in a previous equivalent period. METHODS AND RESULTS Eighty-five patients admitted for STEMI at a high-volume Italian centre were included. Patients hospitalized during the COVID-19 outbreak (21 February-10 April 2020) (40%) were compared with those admitted in pre-COVID-19 period (3 January-20 February 2020) (60%). A 43% reduction in STEMI admissions was observed during the COVID-19 outbreak compared with the previous period. Time from symptom onset to first medical contact (FMC) and time from FMC to primary percutaneous coronary intervention (PPCI) were longer in patients admitted during the COVID-19 period compared with before [148 (79-781) versus 130 (30-185) min; P = 0.018, and 75 (59-148)] versus 45 (30-70) min; P < 0.001]. High-sensitive troponin T levels on admission were also higher. In-hospital mortality was 12% in the COVID-19 phase versus 6% in the pre-COVID-19 period. Incidence of the composite end-point, including free-wall rupture, severe left ventricular dysfunction, left ventricular aneurysm, severe mitral regurgitation and pericardial effusion, was higher during the COVID-19 than the pre-COVID-19 period (19.6 versus 41.2%; P = 0.030; odds ratio = 2.87; 95% confidence interval 1.09-7.58). CONCLUSION The COVID-19 pandemic had a significant impact on the STEMI care system reducing hospital admissions and prolonging revascularization time. This translated into a worse patient prognosis due to more STEMI complications.
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Affiliation(s)
- Daniela Tomasoni
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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161
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Iaccarino G, Grassi G, Borghi C, Carugo S, Fallo F, Ferri C, Giannattasio C, Grassi D, Letizia C, Mancusi C, Minuz P, Perlini S, Pucci G, Rizzoni D, Salvetti M, Sarzani R, Sechi L, Veglio F, Volpe M, Muiesan ML. Gender differences in predictors of intensive care units admission among COVID-19 patients: The results of the SARS-RAS study of the Italian Society of Hypertension. PLoS One 2020; 15:e0237297. [PMID: 33022004 PMCID: PMC7537902 DOI: 10.1371/journal.pone.0237297] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The global rate of intensive care unit (ICU) admission during the COVID-19 pandemic varies within countries and is among the main challenges for health care systems worldwide. Conflicting results have been reported about the response to coronavirus infection and COVID-19 outcomes in men and women. Understanding predictors of intensive care unit admission might be of help for future planning and management of the disease. METHODS AND FINDINGS We designed a cross-sectional observational multicenter nationwide survey in Italy to understand gender-related clinical predictors of ICU admission in patients with COVID-19. We analyzed information from 2378 charts of Italian patients certified for COVID-19 admitted in 26 hospitals. Three hundred ninety-five patients (16.6%) required ICU admission due to COVID19 infection, more frequently men (74%), with a higher prevalence of comorbidities (1,78±0,06 vs 1,54±0,03 p<0.05). In multivariable regression model main predictors of admission to ICU are male gender (OR 1,74 95% CI 1,36-2,22 p<0.0001) and presence of obesity (OR 2,88 95% CI 2,03-4,07 p<0.0001), chronic kidney disease (OR: 1,588; 95%, 1,036-2,434 p<0,05) and hypertension (OR: 1,314; 95% 1,039-1,662; p<0,05). In gender specific analysis, obesity, chronic kidney disease and hypertension are associated with higher rate of admission to ICU among men, whereas in women, obesity (OR: 2,564; 95% CI 1,336-4.920 p<0.0001) and heart failure (OR: 1,775 95% CI: 1,030-3,057) are associated with higher rate of ICU admission. CONCLUSIONS Our study demonstrates that gender is the primary determinant of the disease's severity among COVID-19. Obesity is the condition more often observed among those admitted to ICU within both genders. TRIAL REGISTRATION Clinicaltrials.gov: NCT04331574.
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Affiliation(s)
- Guido Iaccarino
- Dept. of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Claudio Borghi
- Dept. of Medicine and Surgery Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Francesco Fallo
- Clinica Medica 3, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Claudio Ferri
- Dept. of Clinical Medicine, Public Health, Life and Environment Sciences, University of L’Aquila, L’Aquila, Italy
| | - Cristina Giannattasio
- Cardiology 4, "A. De Gasperis" Department, ASST GOM Niguarda Ca' Granda Hospital, Milan, Italy
| | - Davide Grassi
- Dept. of Clinical Medicine, Public Health, Life and Environment Sciences, University of L’Aquila, L’Aquila, Italy
| | - Claudio Letizia
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Costantino Mancusi
- Dept. of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Pietro Minuz
- Department of Medicine, Section of Internal Medicine C, University of Verona, Verona, Italy
| | - Stefano Perlini
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Giacomo Pucci
- Section of Internal Medicine Terni, Department of Medicine, University of Perugia, Terni, Italy
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia-Internal Medicine ASST Spedali Civili PO Montichiari, Brescia, Italy
| | - Massimo Salvetti
- Dept. of Clinical & Experimental Sciences, Medicina 2, ASST Spedali Civili Brescia, University of Brescia, Brescia, Italy
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, Italian National Research Centre on Aging, Hospital “U. Sestilli”, IRCCS-INRCA, University “Politecnica Delle Marche”, Ancona, Italy
| | - Leonardo Sechi
- Department of Medicine, University of Udine, Udine, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Massimo Volpe
- Clinical and Molecular Medicine Department, Rome and IRCCS Neuromed, Sapienza University Sant’Andrea Hospital, Pozzilli (IS), Italy
| | - Maria Lorenza Muiesan
- Dept. of Clinical & Experimental Sciences, Medicina 2, ASST Spedali Civili Brescia, University of Brescia, Brescia, Italy
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162
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Baba R, Oki K, Itcho K, Kobuke K, Nagano G, Ohno H, Yoneda M, Hattori N. Angiotensin-converting enzyme 2 expression is not induced by the renin-angiotensin system in the lung. ERJ Open Res 2020; 6:00402-2020. [PMID: 33043048 PMCID: PMC7533374 DOI: 10.1183/23120541.00402-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/27/2020] [Indexed: 01/14/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has developed into a pandemic with significant morbidity and mortality. SARS-CoV-2 has been reported to invade lung epithelium via the angiotensin-converting enzyme 2 (ACE2) receptor using its glycosylated cell surface spike protein [1]. ACE2 expression in the heart and kidney is regulated by the renin–angiotensin system (RAS), especially angiotensin II (A-II), which is catalysed from angiotensin I (A-I) by angiotensin-converting enzyme (ACE) [2]. In a cohort study in the early period of the COVID-19 outbreak in Wuhan in China, hypertension was found in 30% of the patients and was identified as the most common comorbidity [3]. It has recently been reported that RAS inhibitors are not associated with the severity of COVID-19 in a meta-analysis that included nine studies comprising 3936 patients with hypertension and COVID-19 [4]. The most serious concerns for the use of RAS inhibitors may be related to their role in development of or exacerbation of COVID-19, as suggested in a recent review by Ingrahamet al. [5]. However, the alteration in ACE2 expression in pulmonary cells has not been studied. Pulmonary expression of angiotensin-converting enzyme 2, which is a receptor of severe acute respiratory syndrome coronavirus 2, is not regulated by angiotensin II or renin–angiotensin system inhibitors #COVID19https://bit.ly/3fkopuO
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Affiliation(s)
- Ryuta Baba
- Dept of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenji Oki
- Dept of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kiyotaka Itcho
- Dept of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhiro Kobuke
- Dept of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Gaku Nagano
- Dept of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Haruya Ohno
- Dept of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masayasu Yoneda
- Dept of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Dept of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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163
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Lisi L, Lacal PM, Barbaccia ML, Graziani G. Approaching coronavirus disease 2019: Mechanisms of action of repurposed drugs with potential activity against SARS-CoV-2. Biochem Pharmacol 2020; 180:114169. [PMID: 32710969 PMCID: PMC7375972 DOI: 10.1016/j.bcp.2020.114169] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023]
Abstract
On March 11, 2020, the World Health Organization (WHO) declared the severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2) a global pandemic. As of July 2020, SARS-CoV-2 has infected more than 14 million people and provoked more than 590,000 deaths, worldwide. From the beginning, a variety of pharmacological treatments has been empirically used to cope with the life-threatening complications associated with Corona Virus Disease 2019 (COVID-19). Thus far, only a couple of them and not consistently across reports have been shown to further decrease mortality, respect to what can be achieved with supportive care. In most cases, and due to the urgency imposed by the number and severity of the patients' clinical conditions, the choice of treatment has been limited to repurposed drugs, approved for other indications, or investigational agents used for other viral infections often rendered available on a compassionate-use basis. The rationale for drug selection was mainly, though not exclusively, based either i) on the activity against other coronaviruses or RNA viruses in order to potentially hamper viral entry and replication in the epithelial cells of the airways, and/or ii) on the ability to modulate the excessive inflammatory reaction deriving from dysregulated host immune responses against the SARS-CoV-2. In several months, an exceptionally large number of clinical trials have been designed to evaluate the safety and efficacy of anti-COVID-19 therapies in different clinical settings (treatment or pre- and post-exposure prophylaxis) and levels of disease severity, but only few of them have been completed so far. This review focuses on the molecular mechanisms of action that have provided the scientific rationale for the empirical use and evaluation in clinical trials of structurally different and often functionally unrelated drugs during the SARS-CoV-2 pandemic.
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Affiliation(s)
- Lucia Lisi
- Dipartimento di Bioetica e Sicurezza, Sezione di Farmacologia, Catholic University Medical School, 00168 Rome, Italy
| | | | | | - Grazia Graziani
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
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164
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Treatment of Multi-Drug Resistant Gram-Negative Bacterial Pathogenic Infections. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.3.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The multidrug-resistant Gram-negative bacteria (MDR-GNB) infections in severely infected patients present numerous difficulties in terms of treatment failure where antibiotics cannot arrest such drug resistant bacteria. Based on the patient’s medical history and updated microbiological epidemiology data, an effective empirical treatment remains critical for optimal results to safeguard human health. The aim of this manuscript is to review management of MDR-Gram negative pathogenic bacterial infections. Quick diagnosis and narrow antimicrobial spectrum require rapid and timely diagnosis and effective laboratories in accordance with antimicrobial stewardship (AS) principles. Worldwide, there is an increased emergence of Carbapenem-resistant Enterobacteriaceae (CRE), Pseudomonas aeruginosa, and Acinetobacter baumannii. Recently, novel therapeutic options, such as meropenem/vaborbactam, ceftazidime/avibactam, ceftolozane/tazobactam, eravacycline and plazomicin became accessible to effectively counteract severe infections. Optimally using these delays the emergence of resistance to novel therapeutic agents. Further study is required, however, due to uncertainties in pharmacokinetic/pharmacodynamics optimization of dosages and therapeutic duration in severely ill patients. The novel agents should be verified for (i) action on carbapenem resistant Acinetobacter baumannii; (ii) action on CRE of β-lactam/β-lactamase inhibitors dependence on type of carbapenemase; (iii) emergence of resistance to novel antibacterials and dismiss selective pressure promoting development of resistance. Alternative treatments should be approached alike phage therapy or antibacterial peptides. The choice of empirical therapy is complicated by antibiotic resistance and can be combated by accurate antibiotic and their combinations usage, which is critical to patient survival. Noteworthy are local epidemiology, effective teamwork and antibiotic stewardship to guarantee that medications are utilized properly to counter the resistance.
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165
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Lam KW, Chow KW, Vo J, Hou W, Li H, Richman PS, Mallipattu SK, Skopicki HA, Singer AJ, Duong TQ. Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated With Positive Clinical Outcome. J Infect Dis 2020; 222:1256-1264. [PMID: 32702098 PMCID: PMC7454718 DOI: 10.1093/infdis/jiaa447] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background This study investigated continued and discontinued use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) during hospitalization of 614 hypertensive laboratory-confirmed COVID-19 patients. Methods Demographics, comorbidities, vital signs, laboratory data, and ACEi/ARB usage were analyzed. To account for confounders, patients were substratified by whether they developed hypotension and acute kidney injury (AKI) during the index hospitalization. Results Mortality (22% vs 17%, P > .05) and intensive care unit (ICU) admission (26% vs 12%, P > .05) rates were not significantly different between non-ACEi/ARB and ACEi/ARB groups. However, patients who continued ACEi/ARBs in the hospital had a markedly lower ICU admission rate (12% vs 26%; P = .001; odds ratio [OR] = 0.347; 95% confidence interval [CI], .187–.643) and mortality rate (6% vs 28%; P = .001; OR = 0.215; 95% CI, .101–.455) compared to patients who discontinued ACEi/ARB. The odds ratio for mortality remained significantly lower after accounting for development of hypotension or AKI. Conclusions These findings suggest that continued ACEi/ARB use in hypertensive COVID-19 patients yields better clinical outcomes.
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Affiliation(s)
- Katherine W Lam
- Department of Radiology, Renaissance School of Medicine, Stony Brook University, New York, New York, USA
| | - Kenneth W Chow
- Department of Radiology, Renaissance School of Medicine, Stony Brook University, New York, New York, USA
| | - Jonathan Vo
- Department of Radiology, Renaissance School of Medicine, Stony Brook University, New York, New York, USA
| | - Wei Hou
- Department of Radiology, Renaissance School of Medicine, Stony Brook University, New York, New York, USA
| | - Haifang Li
- Department of Radiology, Renaissance School of Medicine, Stony Brook University, New York, New York, USA
| | - Paul S Richman
- Department of Medicine, Renaissance School of Medicine, Stony Brook University, New York, New York, USA
| | - Sandeep K Mallipattu
- Department of Medicine, Renaissance School of Medicine, Stony Brook University, New York, New York, USA
| | - Hal A Skopicki
- Department of Medicine, Renaissance School of Medicine, Stony Brook University, New York, New York, USA
| | - Adam J Singer
- Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook University, New York, New York, USA
| | - Tim Q Duong
- Department of Radiology, Renaissance School of Medicine, Stony Brook University, New York, New York, USA
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166
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Lupi L, Adamo M, Inciardi RM, Metra M. ACE2 down-regulation may contribute to the increased thrombotic risk in COVID-19. Eur Heart J 2020; 41:3200. [PMID: 32691039 PMCID: PMC7454504 DOI: 10.1093/eurheartj/ehaa583] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Laura Lupi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo M Inciardi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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167
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COVID-19 and the World with Co-Morbidities of Heart Disease, Hypertension and Diabetes. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.3.01] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Newly emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) pandemic has now spread across the globe in past few months while affecting 26 million people and leading to more than 0.85 million deaths as on 2nd September, 2020. Severity of SARS-CoV-2 infection increases in COVID-19 patients due to pre-existing health co-morbidities. This mini-review has focused on the three significant co-morbidities viz., heart disease, hypertension, and diabetes, which are posing high health concerns and increased mortality during this ongoing pandemic. The observed co-morbidities have been found to be associated with the increasing risk factors for SARS-CoV-2 infection and COVID-19 critical illness as well as to be associated positively with the worsening of the health condition of COVID-19 suffering individuals resulting in the high risk for mortality. SARS-CoV-2 enters host cell via angiotensin-converting enzyme 2 receptors. Regulation of crucial cardiovascular functions and metabolisms like blood pressure and sugar levels are being carried out by ACE2. This might be one of the reasons that contribute to the higher mortality in COVID-19 patients having co-morbidities. Clinical investigations have identified higher levels of creatinine, cardiac troponin I, alanine aminotransferase, NT-proBNP, creatine kinase, D-dimer, aspartate aminotransferase and lactate dehydrogenase in patients who have succumbed to death from COVID-19 as compared to recovered individuals. More investigations are required to identify the modes behind increased mortality in COVID-19 patients having co-morbidities of heart disease, hypertension, and diabetes. This will enable us to design and develop suitable therapeutic strategies for reducing the mortality. More attention and critical care need to be paid to such high risk patients suffering from co-morbidities during COVID-19 pandemic.
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168
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Samidurai A, Das A. Cardiovascular Complications Associated with COVID-19 and Potential Therapeutic~Strategies. Int J Mol Sci 2020; 21:ijms21186790. [PMID: 32947927 PMCID: PMC7554795 DOI: 10.3390/ijms21186790] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19), an infectious disease with severe acute respiratory syndrome, has now become a worldwide pandemic. Despite the respiratory complication, COVID-19 is also associated with significant multiple organ dysfunction, including severe cardiac impairment. Emerging evidence reveals a direct interplay between COVID-19 and dire cardiovascular complications, including myocardial injury, heart failure, heart attack, myocarditis, arrhythmias as well as blood clots, which are accompanied with elevated risk and adverse outcome among infected patients, even sudden death. The proposed pathophysiological mechanisms of myocardial impairment include invasion of SARS-CoV-2 virus via angiotensin-converting enzyme 2 to cardiovascular cells/tissue, which leads to endothelial inflammation and dysfunction, de-stabilization of vulnerable atherosclerotic plaques, stent thrombosis, cardiac stress due to diminish oxygen supply and cardiac muscle damage, and myocardial infarction. Several promising therapeutics are under investigation to the overall prognosis of COVID-19 patients with high risk of cardiovascular impairment, nevertheless to date, none have shown proven clinical efficacy. In this comprehensive review, we aimed to highlight the current integrated therapeutic approaches for COVID-19 and we summarized the potential therapeutic options, currently under clinical trials, with their mechanisms of action and associated adverse cardiac events in highly infectious COVID-19 patients.
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Affiliation(s)
| | - Anindita Das
- Correspondence: ; Tel.: +1-804-628-5519; Fax: +1-804-828-8700
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169
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Ye Q, Lu D, Shang S, Fu J, Gong F, Shu Q, Mao J. Crosstalk between coronavirus disease 2019 and cardiovascular disease and its treatment. ESC Heart Fail 2020; 7:3464-3472. [PMID: 32935928 PMCID: PMC7754975 DOI: 10.1002/ehf2.12960] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023] Open
Abstract
People with cardiovascular disease (CVD) often contract coronavirus disease 2019 (COVID-19). However, the interaction between COVID-19 and CVD is unclear. In this systematic review, the available evidence for the crosstalk between COVID-19 and CVD and its treatment was analysed. A search was performed in the electronic databases MEDLINE and EMBASE. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects human cells via angiotensin-converting enzyme 2. SARS-CoV-2 can cause CVD by inducing cytokine storms, creating an imbalance in the oxygen supply and demand and disrupting the renin-angiotensin-aldosterone system; SARS-CoV-2 infection can also lead to the development of CVD through the side effects of therapeutic drugs, psychological factors, and aggravation of underlying CVD. The most common CVDs caused by SARS-CoV-2 infection are acute myocardial injury, arrhythmia, and heart failure. Studies have found that there is an interaction between COVID-19 and CVD. Underlying CVD is associated with a high risk of mortality in patients with COVID-19. SARS-CoV-2 infection can also cause new-onset CVD. Clinicians need to pay close attention to cardiovascular complications during the diagnosis and treatment of patients with COVID-19 to reduce patient mortality.
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Affiliation(s)
- Qing Ye
- National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Dezhao Lu
- College of Life Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shiqiang Shang
- National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Junfen Fu
- National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Fangqi Gong
- National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Qiang Shu
- National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Jianhua Mao
- National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
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170
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Inciardi RM, Adamo M, Lupi L, Metra M. Atrial fibrillation in the COVID-19 era: simple bystander or marker of increased risk? Eur Heart J 2020; 41:3094. [PMID: 32699894 PMCID: PMC7454538 DOI: 10.1093/eurheartj/ehaa576] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Riccardo M Inciardi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Laura Lupi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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171
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Perillo M, Francisco RC, Garcia TG, Teixeira MF, Bassaneze B, de Albuquerque LCA, Alô ROB, Colombo C, Ghorayeb N. Sports in Covid-19 Times: Heart Alert. Arq Bras Cardiol 2020; 115:303-307. [PMID: 33027363 PMCID: PMC9363079 DOI: 10.36660/abc.20200652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Marcos Perillo
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | - Ricardo Contesini Francisco
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
- Hospital do CoraçãoSão PauloSPBrasilHospital do Coração, São Paulo, SP - Brasil
| | - Thiago Ghorayeb Garcia
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
- Hospital do CoraçãoSão PauloSPBrasilHospital do Coração, São Paulo, SP - Brasil
| | - Mateus Freitas Teixeira
- Universidade Federal FluminenseNiteróiRJBrasilUniversidade Federal Fluminense, Niterói, RJ - Brasil
- Clube de Regatas Vasco da GamaRio de JaneiroRJBrasilClube de Regatas Vasco da Gama, Rio de Janeiro, RJ - Brasil
| | - Bruno Bassaneze
- Hospital do CoraçãoSão PauloSPBrasilHospital do Coração, São Paulo, SP - Brasil
| | | | - Rodrigo Otávio Bougleux Alô
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
- Hospital Geral de São MateusSão PauloSPBrasilHospital Geral de São Mateus, São Paulo, SP - Brasil
| | - Clea Colombo
- Faculdade de Medicina São Leopoldo MandicCampinasSPBrasilFaculdade de Medicina São Leopoldo Mandic, Campinas, SP - Brasil
| | - Nabil Ghorayeb
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
- Hospital do CoraçãoSão PauloSPBrasilHospital do Coração, São Paulo, SP - Brasil
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172
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Triposkiadis F, Starling RC, Xanthopoulos A, Butler J, Boudoulas H. Renin-angiotensin-system inhibition in the context of corona virus disease-19: experimental evidence, observational studies, and clinical implications. Heart Fail Rev 2020; 26:381-389. [PMID: 32875490 PMCID: PMC7462660 DOI: 10.1007/s10741-020-10022-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 01/29/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is due to severe acute respiratory syndrome coronavirus (SARS-CoV)-2 which binds and enters the host cells through the angiotensin-converting enzyme (ACE)2. While the potential for benefit with the use of renin-angiotensin-aldosterone system inhibitors (RAASi) and the risks from stopping them is more evident, potential harm by RAΑSi may also be caused by the increase in the activity of the ACE2 receptor, the inefficient counter regulatory axis in the lungs in which the proinflammatory prolyloligopeptidase (POP) is the main enzyme responsible for the conversion of deleterious angiotensin (ANG) II to protective ANG [1-7] and the proinflammatory properties of ACE2(+) cells infected with SARS-CoV-2. Acknowledging the proven RAΑSi benefit in patients with several diseases such as hypertension, heart failure, coronary disease, and diabetic kidney disease in the non-COVID-19 era, it is a reasonable strategy in this period of uncertainty to use these agents judiciously with careful consideration and to avoid the use of RAASi in select patients whenever possible, until definitive evidence becomes available.
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Affiliation(s)
- Filippos Triposkiadis
- Department of Cardiology, Larissa University General Hospital, PO Box 1425, 411 10, Larissa, Greece. .,University of Thessaly, Volos, Greece.
| | - Randall C Starling
- Kaufman Center for Heart Failure and Recovery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Xanthopoulos
- Department of Cardiology, Larissa University General Hospital, PO Box 1425, 411 10, Larissa, Greece
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Harisios Boudoulas
- Department of Medicine/Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
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173
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Toner L, Koshy AN, Ko J, Driscoll A, Farouque O. Clinical Characteristics and Trends in Heart Failure Hospitalizations: An Australian Experience During the COVID-19 Lockdown. JACC-HEART FAILURE 2020; 8:872-875. [PMID: 33004116 PMCID: PMC7418698 DOI: 10.1016/j.jchf.2020.05.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/04/2022]
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174
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Cruces P, Retamal J, Hurtado DE, Erranz B, Iturrieta P, González C, Díaz F. A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:494. [PMID: 32778136 PMCID: PMC7416996 DOI: 10.1186/s13054-020-03197-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/22/2020] [Indexed: 12/16/2022]
Abstract
Deterioration of lung function during the first week of COVID-19 has been observed when patients remain with insufficient respiratory support. Patient self-inflicted lung injury (P-SILI) is theorized as the responsible, but there is not robust experimental and clinical data to support it. Given the limited understanding of P-SILI, we describe the physiological basis of P-SILI and we show experimental data to comprehend the role of regional strain and heterogeneity in lung injury due to increased work of breathing. In addition, we discuss the current approach to respiratory support for COVID-19 under this point of view.
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Affiliation(s)
- Pablo Cruces
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile.,Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago, Chile
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Santiago, Chile.,Instituto de Ingeniería Biológica y Médica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniel E Hurtado
- Department of Structural and Geotechnical Engineering, School of Engineering Pontificia Universidad Católica de Chile, Santiago, Chile.,Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile
| | - Benjamín Erranz
- Centro de Medicina Regenerativa, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Pablo Iturrieta
- Department of Structural and Geotechnical Engineering, School of Engineering Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos González
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
| | - Franco Díaz
- Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago, Chile. .,Unidad de Paciente Crítico Pediátrico, Hospital Clínico La Florida Dra. Eloísa Díaz Insunza, Santiago, Chile. .,Instituto de Ciencias e Innovacion en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile.
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175
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Adamo M, Lombardi CM, Metra M. June 2020 at a glance: focus on COVID-19, quality of life and comorbidities. Eur J Heart Fail 2020; 22:917-918. [PMID: 32731308 DOI: 10.1002/ejhf.1515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, Cardio-thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Carlo Mario Lombardi
- Cardiac Catheterization Laboratory and Cardiology, Cardio-thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, Cardio-thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
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176
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Nogueira PJ, de Araújo Nobre M, Costa A, Ribeiro RM, Furtado C, Bacelar Nicolau L, Camarinha C, Luís M, Abrantes R, Vaz Carneiro A. The Role of Health Preconditions on COVID-19 Deaths in Portugal: Evidence from Surveillance Data of the First 20293 Infection Cases. J Clin Med 2020; 9:E2368. [PMID: 32722159 PMCID: PMC7464004 DOI: 10.3390/jcm9082368] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/08/2020] [Accepted: 07/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It is essential to study the effect of potential co-factors on the risk of death in patients infected by COVID-19. The identification of risk factors is important to allow more efficient public health and health services strategic interventions with a significant impact on deaths by COVID-19. This study aimed to identify factors associated with COVID-19 deaths in Portugal. METHODS A national dataset with the first 20,293 patients infected with COVID-19 between 1 January and 21 April 2020 was analyzed. The primary outcome measure was mortality by COVID-19, measured (registered and confirmed) by Medical Doctors serving as health delegates on the daily death registry. A logistic regression model using a generalized linear model was used for estimating Odds Ratio (OR) with 95% confidence intervals (95% CI) for each potential risk indicator. RESULTS A total of 502 infected patients died of COVID-19. The risk factors for increased odds of death by COVID-19 were: sex (male: OR = 1.47, ref = female), age ((56-60) years, OR = 6.01; (61-65) years, OR = 10.5; (66-70) years, OR = 20.4; (71-75) years, OR = 34; (76-80) years, OR = 50.9; (81-85) years, OR = 70.7; (86-90) years, OR = 83.2; (91-95) years, OR = 91.8; (96-104) years, OR = 140.2, ref = (0-55)), Cardiac disease (OR = 2.86), Kidney disorder (OR = 2.95), and Neuromuscular disorder (OR = 1.58), while condition (None (absence of precondition); OR = 0.49) was associated with a reduced chance of dying after adjusting for other variables of interest. CONCLUSIONS Besides age and sex, preconditions justify the risk difference in mortality by COVID-19.
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Affiliation(s)
- Paulo Jorge Nogueira
- IMPSP—Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.F.); (L.B.N.); (A.V.C.)
- Laboratório de Biomatemática, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
- ISBE—Instituto de Saúde Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- ISAMB—Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
| | - Miguel de Araújo Nobre
- Clínica Universitária de Estomatologia, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
- UEPID—Unidade de Epidemiologia, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.C.); (M.L.); (R.A.)
| | - Andreia Costa
- ISAMB—Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
- ESEL—Escola Superior de Enfermagem de Lisboa, Polo Calouste Gulbenkian Avenida Prof Egas Moniz, 1600-190 Lisboa, Portugal
- CRC-W—Católica Research Centre for Psychological, Family and Social Wellbeing, Universidade Católica Portuguesa, Palma de Cima, 1649-023 Lisboa, Portugal
| | - Ruy M. Ribeiro
- Laboratório de Biomatemática, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
- ISAMB—Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
| | - Cristina Furtado
- IMPSP—Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.F.); (L.B.N.); (A.V.C.)
- UEPID—Unidade de Epidemiologia, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.C.); (M.L.); (R.A.)
- National Institute of Health Dr. Ricardo Jorge, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Leonor Bacelar Nicolau
- IMPSP—Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.F.); (L.B.N.); (A.V.C.)
- ISAMB—Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
| | - Catarina Camarinha
- UEPID—Unidade de Epidemiologia, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.C.); (M.L.); (R.A.)
| | - Márcia Luís
- UEPID—Unidade de Epidemiologia, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.C.); (M.L.); (R.A.)
| | - Ricardo Abrantes
- UEPID—Unidade de Epidemiologia, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.C.); (M.L.); (R.A.)
| | - António Vaz Carneiro
- IMPSP—Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.F.); (L.B.N.); (A.V.C.)
- ISBE—Instituto de Saúde Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Cochrane Portugal, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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177
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Inciardi RM, Solomon SD, Ridker PM, Metra M. Coronavirus 2019 Disease (COVID-19), Systemic Inflammation, and Cardiovascular Disease. J Am Heart Assoc 2020; 9:e017756. [PMID: 32677478 PMCID: PMC7660796 DOI: 10.1161/jaha.120.017756] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Riccardo M Inciardi
- Institute of Cardiology Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Italy
| | - Scott D Solomon
- Cardiovascular Division Brigham and Women's Hospital, and Harvard Medical School Boston MA
| | - Paul M Ridker
- Division of Preventive Medicine Center for Cardiovascular Disease Prevention Brigham and Women's Hospital, and Harvard Medical School Boston MA
| | - Marco Metra
- Institute of Cardiology Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Italy
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178
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Posso M, Comas M, Román M, Domingo L, Louro J, González C, Sala M, Anglès A, Cirera I, Cots F, Frías VM, Gea J, Güerri-Fernández R, Masclans JR, Noguès X, Vázquez O, Villar-García J, Horcajada JP, Pascual J, Castells X. Comorbidities and Mortality in Patients With COVID-19 Aged 60 Years and Older in a University Hospital in Spain. Arch Bronconeumol 2020; 56:756-758. [PMID: 32782092 PMCID: PMC7365099 DOI: 10.1016/j.arbres.2020.06.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Margarita Posso
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Cristina González
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Infection Control Program, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - María Sala
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Albert Anglès
- Medical Documentation Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Isabel Cirera
- Emergency Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Francesc Cots
- Management Control Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Víctor-Manuel Frías
- Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar, Barcelona, Spain
| | - Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar-IMIM, DCEXS, UPF, CIBERES, ISCiii, Barcelona, Spain
| | | | | | - Xavier Noguès
- Department of Internal Medicine, Hospital del Mar. IMIM, CIBERFES, Barcelona, Spain
| | - Olga Vázquez
- Department of Geriatrics, Hospital del Mar-IMIM, Barcelona, Spain
| | | | - Juan Pablo Horcajada
- Infection Control Program, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Department of Infectious Diseases, Hospital del Mar-IMIM, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain.
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179
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Zhang Y, Coats AJ, Zheng Z, Adamo M, Ambrosio G, Anker SD, Butler J, Xu D, Mao J, Khan MS, Bai L, Mebazaa A, Ponikowski P, Tang Q, Ruschitzka F, Seferovic P, Tschöpe C, Zhang S, Gao C, Zhou S, Senni M, Zhang J, Metra M. Management of heart failure patients withCOVID‐19: a joint position paper of the Chinese Heart Failure Association & National Heart Failure Committee and the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2020; 22:941-956. [PMID: 32463543 DOI: 10.1002/ejhf.1915] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | | | - Zhe Zheng
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of Brescia Brescia Italy
| | - Giuseppe Ambrosio
- Division of CardiologyUniversity of Perugia School of Medicine Perugia Italy
| | - Stefan D. Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site BerlinCharité Universitätsmedizin Berlin Berlin Germany
| | - Javed Butler
- Department of MedicineUniversity of Mississippi Medical Center Jackson MS USA
| | - Dingli Xu
- Key Laboratory for Organ Failure Research, Department of CardiologyNanfang Hospital, Southern Medical University, Guangzhou Regenerative Medicine and Health Guangdong Laboratory Guangzhou China
| | - Jingyuan Mao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine Tianjin China
| | | | - Ling Bai
- Department of Cardiovascular MedicineThe First Affiliated Hospital of Xi'an Jiaotong University Xi'an China
| | - Alexandre Mebazaa
- Université de Paris, Paris, France; U942 Inserm – MASCOT and Department of Anaesthesia and Critical CareUniversity Hospitals Saint Louis‐Lariboisière, APHP Paris France
| | - Piotr Ponikowski
- Center for Heart DiseasesUniversity Hospital, Medical University Wroclaw Poland
| | - Qizhu Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research InstituteWuhan University, Hubei Key Laboratory of Cardiology Wuhan China
| | - Frank Ruschitzka
- University Heart CentreUniversity Hospital Zurich Zurich Switzerland
| | - Petar Seferovic
- Clinic of Endocrinology, Diabetes and Metabolic DiseasesBelgrade University Medical Center Belgrade Serbia
| | - Carsten Tschöpe
- Department of Cardiology, Campus Virchow KlinikumCharite ‐ Universitaetsmedizin Berlin Berlin Germany
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College & Chinese Academy of Medical SciencePeking Union Medical College Hospital Beijing China
| | - Chuanyu Gao
- Department of Cardiology, Henan Provincial People's HospitalFuwai Central China Cardiovascular Hospital Zhengzhou China
| | - Shenghua Zhou
- Department of CardiologyThe Second Xiangya Hospital of Central South University Changsha China
| | - Michele Senni
- Cardiology Division, Cardiovascular DepartmentPapa Giovanni XXIII Hospital Bergamo Italy
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of Brescia Brescia Italy
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180
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Ata F, Montoro-Lopez MN, Awouda S, Elsukkar AMA, Badr AMH, Patel AAAH. COVID-19 and Heart Failure: The Big Challenge. Heart Views 2020; 21:187-192. [PMID: 33688410 PMCID: PMC7898990 DOI: 10.4103/heartviews.heartviews_122_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 12/15/2022] Open
Abstract
Patients with chronic heart failure (HF) are among the most vulnerable populations in the COVID era. HF patients infected with COVID-19 are at a significant risk of severe illness and death. They usually present with shortness of breath and radiologic signs of an acute decompensation, which can mask the manifestations of COVID-19. Delay in the diagnosis increases the risk of individual poor outcomes and jeopardizes healthcare workers if protective and isolation measures are not established promptly. Furthermore, the COVID-19 pandemic is forcing health-care systems to modify the delivery of care to patients. Outpatient services are being done virtually, and elective procedures postponed. These may have an impact on the quality of life and survival of chronic HF patients. We present two cases of patients with the previous history of HF who developed an acute exacerbation secondary to COVID-19 infection. In this review, we focused on the main challenges physicians face when dealing with COVID-19 in chronic HF patients at the individual and system levels.
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Affiliation(s)
- Fateen Ata
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maria Nieves Montoro-Lopez
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Samah Awouda
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdallah M Abu Elsukkar
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amr Mohamed Hamed Badr
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Salzano A, D'Assante R, Stagnaro FM, Valente V, Crisci G, Giardino F, Arcopinto M, Bossone E, Marra AM, Cittadini A. Heart failure management during the COVID-19 outbreak in Italy: a telemedicine experience from a heart failure university tertiary referral centre. Eur J Heart Fail 2020; 22:1048-1050. [PMID: 32463534 PMCID: PMC7283833 DOI: 10.1002/ejhf.1911] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesca M Stagnaro
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valeria Valente
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giulia Crisci
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Federica Giardino
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Alberto M Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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Market M, Angka L, Martel AB, Bastin D, Olanubi O, Tennakoon G, Boucher DM, Ng J, Ardolino M, Auer RC. Flattening the COVID-19 Curve With Natural Killer Cell Based Immunotherapies. Front Immunol 2020; 11:1512. [PMID: 32655581 PMCID: PMC7324763 DOI: 10.3389/fimmu.2020.01512] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022] Open
Abstract
Natural Killer (NK) cells are innate immune responders critical for viral clearance and immunomodulation. Despite their vital role in viral infection, the contribution of NK cells in fighting SARS-CoV-2 has not yet been directly investigated. Insights into pathophysiology and therapeutic opportunities can therefore be inferred from studies assessing NK cell phenotype and function during SARS, MERS, and COVID-19. These studies suggest a reduction in circulating NK cell numbers and/or an exhausted phenotype following infection and hint toward the dampening of NK cell responses by coronaviruses. Reduced circulating NK cell levels and exhaustion may be directly responsible for the progression and severity of COVID-19. Conversely, in light of data linking inflammation with coronavirus disease severity, it is necessary to examine NK cell potential in mediating immunopathology. A common feature of coronavirus infections is that significant morbidity and mortality is associated with lung injury and acute respiratory distress syndrome resulting from an exaggerated immune response, of which NK cells are an important component. In this review, we summarize the current understanding of how NK cells respond in both early and late coronavirus infections, and the implication for ongoing COVID-19 clinical trials. Using this immunological lens, we outline recommendations for therapeutic strategies against COVID-19 in clearing the virus while preventing the harm of immunopathological responses.
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Affiliation(s)
- Marisa Market
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Leonard Angka
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Andre B. Martel
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Donald Bastin
- Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Oladunni Olanubi
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Gayashan Tennakoon
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Dominique M. Boucher
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Juliana Ng
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michele Ardolino
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada
- Centre for Infection, Immunity, and Inflammation, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca C. Auer
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
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Bean DM, Kraljevic Z, Searle T, Bendayan R, Kevin O, Pickles A, Folarin A, Roguski L, Noor K, Shek A, Zakeri R, Shah AM, Teo JT, Dobson RJ. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are not associated with severe COVID-19 infection in a multi-site UK acute hospital trust. Eur J Heart Fail 2020; 22:967-974. [PMID: 32485082 PMCID: PMC7301045 DOI: 10.1002/ejhf.1924] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS The SARS-CoV-2 virus binds to the angiotensin-converting enzyme 2 (ACE2) receptor for cell entry. It has been suggested that angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB), which are commonly used in patients with hypertension or diabetes and may raise tissue ACE2 levels, could increase the risk of severe COVID-19 infection. METHODS AND RESULTS We evaluated this hypothesis in a consecutive cohort of 1200 acute inpatients with COVID-19 at two hospitals with a multi-ethnic catchment population in London (UK). The mean age was 68 ± 17 years (57% male) and 74% of patients had at least one comorbidity. Overall, 415 patients (34.6%) reached the primary endpoint of death or transfer to a critical care unit for organ support within 21 days of symptom onset. A total of 399 patients (33.3%) were taking ACEi or ARB. Patients on ACEi/ARB were significantly older and had more comorbidities. The odds ratio for the primary endpoint in patients on ACEi and ARB, after adjustment for age, sex and co-morbidities, was 0.63 (95% confidence interval 0.47-0.84, P < 0.01). CONCLUSIONS There was no evidence for increased severity of COVID-19 in hospitalised patients on chronic treatment with ACEi or ARB. A trend towards a beneficial effect of ACEi/ARB requires further evaluation in larger meta-analyses and randomised clinical trials.
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Affiliation(s)
- Daniel M. Bean
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Health Data Research UK LondonUniversity College LondonLondonUK
| | - Zeljko Kraljevic
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Thomas Searle
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Rebecca Bendayan
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College LondonLondonUK
| | - O'Gallagher Kevin
- King's College Hospital NHS Foundation TrustLondonUK
- School of Cardiovascular Medicine & SciencesKing's College London British Heart Foundation Centre of ExcellenceLondonUK
| | - Andrew Pickles
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Amos Folarin
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Health Data Research UK LondonUniversity College LondonLondonUK
- Institute of Health InformaticsUniversity College LondonLondonUK
- NIHR Biomedical Research CentreUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Lukasz Roguski
- Health Data Research UK LondonUniversity College LondonLondonUK
- Institute of Health InformaticsUniversity College LondonLondonUK
- NIHR Biomedical Research CentreUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Kawsar Noor
- Health Data Research UK LondonUniversity College LondonLondonUK
- Institute of Health InformaticsUniversity College LondonLondonUK
- NIHR Biomedical Research CentreUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Anthony Shek
- Department of Clinical NeuroscienceInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Rosita Zakeri
- King's College Hospital NHS Foundation TrustLondonUK
- School of Cardiovascular Medicine & SciencesKing's College London British Heart Foundation Centre of ExcellenceLondonUK
| | - Ajay M. Shah
- King's College Hospital NHS Foundation TrustLondonUK
- School of Cardiovascular Medicine & SciencesKing's College London British Heart Foundation Centre of ExcellenceLondonUK
| | - James T.H. Teo
- King's College Hospital NHS Foundation TrustLondonUK
- Department of Clinical NeuroscienceInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Richard J.B. Dobson
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Health Data Research UK LondonUniversity College LondonLondonUK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College LondonLondonUK
- Institute of Health InformaticsUniversity College LondonLondonUK
- NIHR Biomedical Research CentreUniversity College London Hospitals NHS Foundation TrustLondonUK
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185
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Lee WH, Chen YC, Chen SC, Chen CJ, Hsu PC, Tsai WC, Chu CY, Lee CS, Lin TH, Voon WC, Kuo CH, Su HM. Cardiovascular disease management during the coronavirus disease 2019 pandemic. Int J Med Sci 2020; 17:1340-1344. [PMID: 32624690 PMCID: PMC7330658 DOI: 10.7150/ijms.46484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/21/2020] [Indexed: 12/17/2022] Open
Abstract
Based on clinical presentation, pathophysiology, high infectivity, high cardiovascular involvement, and therapeutic agents with cardiovascular toxicity of coronavirus disease 2019 (COVID-19), regular cardiovascular treatment is being changing greatly. Despite angiotensin-converting enzyme 2 serving as the portal for infection, the continuation of clinically indicated renin-angiotensin-aldosterone blockers is recommended according to the present evidence. Fibrinolytic therapy can be considered a reasonable option for the relatively stable ST segment elevation myocardial infarction (STEMI) patient with suspected or known COVID-19. However, primary percutaneous coronary intervention is still the standard of care in patients with definite STEMI if personal protective equipment is available and cardiac catheterization laboratory has a good infection control. In patients with elevated cardiac enzymes, it is very important to differentiate patients with Type 2 myocardial infarction or myocarditis from those with true acute coronary syndromes because invasive percutaneous intervention management in the former may be unnecessary, especially if they are hemodynamically stable. Finally, patients with baseline QT prolongation or those taking QT prolonging drugs must be cautious when treating with lopinavir/ritonavir and hydroxychloroquine for COVID-19.
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Affiliation(s)
- Wen-Hsien Lee
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Chih Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chang-Jen Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Po-Chao Hsu
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Chung Tsai
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chun-Yuan Chu
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chee-Siong Lee
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tsung-Hsien Lin
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Chol Voon
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chao-Hung Kuo
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ho-Ming Su
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
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Sistema renina-angiotensina-aldosterona y COVID19. Implicaciones clínicas. REVISTA ESPAÑOLA DE CARDIOLOGÍA SUPLEMENTOS 2020. [PMCID: PMC7668217 DOI: 10.1016/s1131-3587(20)30032-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
La pandemia ocasionada por la rápida expansión del SARS-CoV-2 ha producido la mayor crisis sanitaria de la época moderna. La estrecha relación del virus con la enzima de conversión de la angiotensina ha suscitado un torrente de especulaciones por el posible papel del sistema renina-angiotensina-aldosterona (SRAA) en la regulación de la infección. La alerta generada ha cuestionado el empleo de fármacos inhibidores del SRAA, tanto los inhibidores de la enzima de conversión de la angiotensina como los antagonistas del receptor de la angiotensina II. Esta situación ha motivado la publicación de varios estudios que no han encontrado asociación entre el uso de inhibidores del SRAA y una mayor susceptibilidad a la infección o a una peor evolución clínica. En esta revisión se abordan los aspectos más relevantes de la interacción del SARS-CoV-2 con el SRAA y las implicaciones clínicas en torno al uso de inhibidores del SRAA durante la pandemia.
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187
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Polverino F, Stern DA, Ruocco G, Balestro E, Bassetti M, Candelli M, Cirillo B, Contoli M, Corsico A, D'Amico F, D'Elia E, Falco G, Gasparini S, Guerra S, Harari S, Kraft M, Mennella L, Papi A, Parrella R, Pelosi P, Poletti V, Polverino M, Tana C, Terribile R, Woods JC, Di Marco F, Martinez FD. Comorbidities, Cardiovascular Therapies, and COVID-19 Mortality: A Nationwide, Italian Observational Study (ItaliCO). Front Cardiovasc Med 2020; 7:585866. [PMID: 33195473 PMCID: PMC7583635 DOI: 10.3389/fcvm.2020.585866] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/19/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Italy has one of the world's oldest populations, and suffered one the highest death tolls from Coronavirus disease 2019 (COVID-19) worldwide. Older people with cardiovascular diseases (CVDs), and in particular hypertension, are at higher risk of hospitalization and death for COVID-19. Whether hypertension medications may increase the risk for death in older COVID 19 inpatients at the highest risk for the disease is currently unknown. Methods: Data from 5,625 COVID-19 inpatients were manually extracted from medical charts from 61 hospitals across Italy. From the initial 5,625 patients, 3,179 were included in the study as they were either discharged or deceased at the time of the data analysis. Primary outcome was inpatient death or recovery. Mixed effects logistic regression models were adjusted for sex, age, and number of comorbidities, with a random effect for site. Results: A large proportion of participating inpatients were ≥65 years old (58%), male (68%), non-smokers (93%) with comorbidities (66%). Each additional comorbidity increased the risk of death by 35% [adjOR = 1.35 (1.2, 1.5) p < 0.001]. Use of ACE inhibitors, ARBs, beta-blockers or Ca-antagonists was not associated with significantly increased risk of death. There was a marginal negative association between ARB use and death, and a marginal positive association between diuretic use and death. Conclusions: This Italian nationwide observational study of COVID-19 inpatients, the majority of which ≥65 years old, indicates that there is a linear direct relationship between the number of comorbidities and the risk of death. Among CVDs, hypertension and pre-existing cardiomyopathy were significantly associated with risk of death. The use of hypertension medications reported to be safe in younger cohorts, do not contribute significantly to increased COVID-19 related deaths in an older population that suffered one of the highest death tolls worldwide.
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Affiliation(s)
- Francesca Polverino
- University of Arizona, Tucson, AZ, United States
- Lovelace Respiratroy Research Institute, Albuquerque, NM, United States
- *Correspondence: Francesca Polverino
| | | | | | | | - Matteo Bassetti
- San Martino Hospital Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Marcello Candelli
- Agostino Gemelli University Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | | | - Filippo D'Amico
- Azienda Socio Sanitaria Territoriale Bergamo EST, Seriate, Italy
| | | | - Giuseppe Falco
- Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Sergio Harari
- Department of Medical Sciences, San Giuseppe Hospital MultiMedica IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Monica Kraft
- University of Arizona, Tucson, AZ, United States
| | | | | | - Roberto Parrella
- Department of Infectious Diseases, Colli Hospital, Naples, Italy
| | - Paolo Pelosi
- San Martino Hospital Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | | | - Mario Polverino
- Mauro Scarlato Hospital, Azienda Sanitaria Locale Salerno, Scafati, Italy
| | | | | | - Jason C. Woods
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | | | | | - The ItaliCO study groupPolverinoF.MD, PhDSternD.MSPolverinoM.MDD'AmicoF.MDD'EliaE.MD, PhDAgarossiA.MDAgatiS.MDAgosteoE.MDAndo'F.MDAndreoniM.MDAngelilloIF.DDS, MPHArcoleoG.MDArenaC.MDBaiamonteP.MDBalestroE.MDBallL.MD, PhDBanfiP.MDBartolettiG.MDBartolottaR.RNBassettiM.MD, PhDBattagliniD.MDBellanM.MD, PhDBenzoniI.MD, PhDBertoliniR.MDBevilacquaM.MDBezziM.MDBiancoA.MDBisbanoA.MDBobbioF.MDBocchialiniG.MDBonettiF.MDBoniF.MDBonifaziM.MDBorgonovoG.MDBorre'S.MDBosioM.MDBrachiniG.MDBrunettiI.MDCalagnaL.CalòF.CandelliM.MD, PhDCapuozzoA.MDCarrT.MDCastellaniA.MDCatalanoF.MD, PhDCataniaG.MDCatenaE.MDCattaneoM.CattelanA.MDCerutiV.MDChiumientoF.MDCicchittoG.MDCirilloB.MDConfalonieriM.MDConfalonieriP.MDContoliM.MD, PhDCoppolaN.MD, PhDCorsicoA.MDCosentinaR.MDCostantinoR.MDCrimiC.MD, PhDCurràA.MDD'AbbraccioM.MDDalbeniA.MDDaleffeF.MDDavideR.MDDel DonnoM.MDDi MarcoF.MD, PhDDi PastenaF.MDDi PernaF.MDDi RosaZ.MDDi SabatinoA.MDElesbaniO.MDEliaD.MDEspositoV.MD, PhDFabianiL.MDFalcoG.MDFaloG.MDFanelliC.MDFantinA.MDFerrignoF.MDFiorentinoG.MDFranceschiF.MD, PhDFronzaM.MDGardini GardenghiG.MDGaspariniS.MDGiacobbeD.R.MDGiannottiC.MDGiannottiG.MDGidariA.MDGiovanardiF.MD, PhDGnerreP.MDGonnelliF.MDGrazianoM.MDGrecoS.MDGrossoA.PhDGuarinoS.MDGuerraS.MD, PhDHarariS.MDIannarelliA.MDImitazioneP.MDIngleseF.MDIodiceV.MDIzzoA.MDLa GrecaC.MDKraftM.MDLaxA.MDLegittimoF.MDLeoA.MDLeoneS.MDLepidiniV.MDLetoM.RNLicataF.MDLocatiF.MDLoriniL.MDLucchettiB.MDMaidaI.MDMaceraM.MDManzilloE.MDMarchA.MDMascheroniD.MDMastroianniA.MDMauroI.MDMazzitelliM.MDMazzucaE.MDMennellaL.MDMichelettoC.MDMingoliA.MDMinuzP.MDMoioliM.MDMontiL.MDMorgagniR.MD, PhDMucciL.MDMuselliM.MDNegriS.MDNobileC.G.A.MDOldaniS.MDOlivieriC.MDPapiA.MDParatiG.MDParodiL.MDParrellaR.MD, PhDPastorelliE.MDPatrunoV.MDPellegrinoF.MDPelosiP.MD, FERSPengoM.F.MD, PhDPepeD.MDPerottiA.MDPetrinoR.MDPetrucciM.MDPianeR.M.MDPignataroG.MD, PhDPinoM.MDPirisiM.MDPolettiV.MDPorruF.MDPuglieseF.MDPunziR.MDRamaroliD.A.MDRobbaC.MD, PhDRostagnoR.MDRuoccoG.MDSabatiniU.MDSainaghiP.P.MD, PhDSaltonF.MDSalzanoC.MDSanduzziA.MDSanduzzi ZamparelliS.MDSangiovanniV.MDSantopuoliD.MDSapienzaP.MDSarmatiL.MDSchiaroliE.MDScienzaF.MDSenniM.MDSerchisuL.PhDSgherziS.MDSodduD.MDSorannaD.MDSorinoC.MD, PhDSpadaroS.MDStirpeE.MDTanaC.MDTardivoS.MDTartagliaS.MDTeopompiE.MDTerribileR.MDTomchaneyM.TorelliE.MDTorlascoC.MDTortiC.MDTupputiE.MDUgolinelliC.MDVatrellaA.MDVersaceA.G.MDVillaniM.MDVincenzoL.MDVoltaC.A.MDVoraphaniN.MDWoodsJ.C.PhDZekajE.MDZoppellariR.MDMartinezF.D.MD
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