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Sun X, Xie N, Guo M, Qiu X, Chen H, Liu H, Li H. Establishment of a Nomogram for Predicting Early Death in Viral Myocarditis. Cardiol Res Pract 2021; 2021:9947034. [PMID: 34055404 PMCID: PMC8133858 DOI: 10.1155/2021/9947034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This research aimed to establish a nomogram for predicting early death in viral myocarditis (VMC) patients. METHOD A total of 362 consecutive VMC patients in Fujian Medical University Affiliated First Quanzhou Hospital between January 1, 2009, and December 31, 2019, were included. A least absolute shrinkage and selection operator (LASSO) regression model was used to detect the risk factors that most consistently and correctly predicted early death in VMC. The performance of the nomogram was assessed by calibration, discrimination, and clinical utility. RESULT 9 factors were screened by LASSO regression analysis for predicting the early death of VMC. Combined with the actual clinical situation, the heart failure (HF) (OR: 2.13, 95% CI: 2.76-5.95), electrocardiogram (ECG) (OR: 6.11, 95% CI: 1.05-8.66), pneumonia (OR: 3.62, 95% CI: 1.43-9.85), brain natriuretic peptide (BNP) (OR: 4.66, 95% CI: 3.07-24.06), and lactate dehydrogenase (LDH) (OR: 1.90, 95% CI: 0.19-9.39) were finally used to construct the nomogram. The nomogram's C-index was 0.908 in the training cohort and 0.924 in the validation cohort. And the area under the receiver operating characteristic curve of the nomogram was 0.91 in the training cohort and 0.924 in the validating cohort. Decision curve analysis (DCA) also showed that the nomogram was clinically useful. CONCLUSION This nomogram achieved an good prediction of the risk of early death in VMC patients.
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Affiliation(s)
- Xuejun Sun
- Department of Cardiovascular Surgery, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China
| | - Naxin Xie
- Department of Cardiovascular Surgery, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China
| | - Mengling Guo
- Department of Medical Record, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China
| | - Xuelian Qiu
- Department of Pharmacy, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China
| | - Hongwei Chen
- Department of Cardiovascular Surgery, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China
| | - Haibo Liu
- Department of Cardiovascular Surgery, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China
| | - Hongmu Li
- Department of Cardiovascular Surgery, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China
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152
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Manolis AS, Manolis AA, Manolis TA, Melita H. COVID-19 and Acute Myocardial Injury and Infarction: Related Mechanisms and Emerging Challenges. J Cardiovasc Pharmacol Ther 2021; 26:399-414. [PMID: 33949887 DOI: 10.1177/10742484211011026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the era of the coronavirus disease 2019 (COVID-19) pandemic, acute cardiac injury (ACI), as reflected by elevated cardiac troponin above the 99th percentile, has been observed in 8%-62% of patients with COVID-19 infection with highest incidence and mortality recorded in patients with severe infection. Apart from the clinically and electrocardiographically discernible causes of ACI, such as acute myocardial infarction (MI), other cardiac causes need to be considered such as myocarditis, Takotsubo syndrome, and direct injury from COVID-19, together with noncardiac conditions, such as pulmonary embolism, critical illness, and sepsis. Acute coronary syndromes (ACS) with normal or near-normal coronary arteries (ACS-NNOCA) appear to have a higher prevalence in both COVID-19 positive and negative patients in the pandemic compared to the pre-pandemic era. Echocardiography, coronary angiography, chest computed tomography and/or cardiac magnetic resonance imaging may render a correct diagnosis, obviating the need for endomyocardial biopsy. Importantly, a significant delay has been recorded in patients with ACS seeking advice for their symptoms, while their routine care has been sharply disrupted with fewer urgent coronary angiographies and/or primary percutaneous coronary interventions performed in the case of ST-elevation MI (STEMI) with an inappropriate shift toward thrombolysis, all contributing to a higher complication rate in these patients. Thus, new challenges have emerged in rendering a diagnosis and delivering treatment in patients with ACI/ACS in the pandemic era. These issues, the various mechanisms involved in the development of ACI/ACS, and relevant current guidelines are herein reviewed.
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Affiliation(s)
- Antonis S Manolis
- First Department of Cardiology, 68989Athens University School of Medicine, Athens, Greece
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153
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Patel RP, Parikh R, Gunturu KS, Tariq RZ, Dani SS, Ganatra S, Nohria A. Cardiotoxicity of Immune Checkpoint Inhibitors. Curr Oncol Rep 2021; 23:79. [PMID: 33937956 PMCID: PMC8088903 DOI: 10.1007/s11912-021-01070-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/25/2022]
Abstract
Purpose of Review Immune checkpoint inhibitors (ICIs) have improved the survival of several cancers. However, they may cause a wide range of immune-related adverse events (irAEs). While most irAEs are manageable with temporary cessation of ICI and immunosuppression, cardiovascular toxicity can be associated with high rates of morbidity and mortality. As ICIs evolve to include high-risk patients with preexisting cardiovascular risk factors and disease, the risk and relevance of ICI-associated cardiotoxicity may be even higher. Recent Findings Several cardiovascular toxicities such as myocarditis, stress cardiomyopathy, and pericardial disease have been reported in association with ICIs. Recent findings also suggest an increased risk of atherosclerosis with ICI use. ICI-associated myocarditis usually occurs early after initiation and can be fulminant. A high index of suspicion is required for timely diagnosis. Prompt treatment with high-dose corticosteroids is shown to improve outcomes. Summary Although the overall incidence is rare, ICI cardiotoxicity, particularly myocarditis, is associated with significant morbidity and mortality, making it a major therapy-limiting adverse event. Early recognition and prompt treatment with the cessation of ICI therapy and initiation of high-dose corticosteroids are crucial to improve outcomes. Cardio-oncologists will need to play an important role not just in the management of acute cardiotoxicity but also to reduce the risk of long-term sequelae.
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Affiliation(s)
- Rushin P Patel
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Rohan Parikh
- Vascular Medicine Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Krishna S Gunturu
- Cancer Survivorship Program, Division of Hematology Oncology, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Rana Zouveenoor Tariq
- Division of Cardiovascular Medicine, Indiana University Health, Bloomington, IN, USA
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.
| | - Anju Nohria
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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154
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Dixit NM, Churchill A, Nsair A, Hsu JJ. Post-Acute COVID-19 Syndrome and the cardiovascular system: What is known? AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2021; 5:100025. [PMID: 34192289 PMCID: PMC8223036 DOI: 10.1016/j.ahjo.2021.100025] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023]
Abstract
Post-Acute COVID-19 Syndrome (PACS) is defined by persistent symptoms >3-4 weeks after onset of COVID-19. The mechanism of these persistent symptoms is distinct from acute COVID-19 although not completely understood despite the high incidence of PACS. Cardiovascular symptoms such as chest pain and palpitations commonly occur in PACS, but the underlying cause of symptoms is infrequently known. While autopsy studies have shown that the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) rarely causes direct myocardial injury, several syndromes such as myocarditis, pericarditis, and Postural Orthostatic Tachycardia Syndrome have been implicated in PACS. Additionally, patients hospitalized with acute COVID-19 who display biomarker evidence of myocardial injury may have underlying coronary artery disease revealed by the physiological stress of SARS-CoV-2 infection and may benefit from medical optimization. We review what is known about PACS and the cardiovascular system and propose a framework for evaluation and management of related symptoms.
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Key Words
- ACE2, angiotensin converting enzyme-2
- AF/AFL, atrial fibrillation or flutter
- CBT, cognitive behavioral therapy
- CFS, Chronic Fatigue Syndrome
- CMR, cardiac magnetic resonance imaging
- CRP, C-reactive protein
- CV, cardiovascular
- Cardiology
- Coronavirus Disease 2019
- ECG, electrocardiography
- ECV, extracellular volume
- LGE, late gadolinium enhancement
- Long COVID
- Long-Haul COVID
- MCAS, Mast Cell Activation Syndrome
- MERS, Middle East Respiratory Syndrome
- POTS, Post-Acute COVID-19 Syndrome
- SARS-COV-1, Severe Acute Respiratory Syndrome Coronavirus-1
- SARS-CoV-2
- T1MI, type 1 myocardial infarction
- T2MI, type 2 myocardial infarction
- TTT, tilt table testing
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Affiliation(s)
- Neal M. Dixit
- Department of Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Austin Churchill
- School of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Ali Nsair
- Department of Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, USA,Division of Cardiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Jeffrey J. Hsu
- Department of Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, USA,Division of Cardiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, USA,Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA,Corresponding author at: UCLA Center for Health Sciences, A2-237, 650 Charles E. Young Dr. South, Los Angeles, CA 90095-1679, USA
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155
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Abstract
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 has affected the health of people across the globe. Cardiovascular diseases (CVDs) have a significant relationship with COVID-19, both as a risk factor and prognostic indicator, and as a complication of the disease itself. In addition to predisposing to CVD complications, the ongoing pandemic has severely affected the delivery of timely and appropriate care for cardiovascular conditions resulting in increased mortality. The etiology behind the cardiac injury associated with severe acute respiratory syndrome coronavirus-2 is likely varied, including coronary artery disease, microvascular thrombosis, myocarditis, and stress cardiomyopathy. Further large-scale investigations are needed to better determine the underlying mechanism of myocardial infarction and other cardiac injury in COVID-19 patients and to determine the incidence of each type of cardiac injury in this patient population. Telemedicine and remote monitoring technologies can play an important role in optimizing outcomes in patients with established CVD. In this article, we summarize the various impacts that COVID-19 has on the cardiovascular system, including myocardial infarction, myocarditis, stress cardiomyopathy, thrombosis, and stroke.
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Affiliation(s)
| | - Gayatri Pemmasani
- †Departments of Medicine and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY
| | - Srikanth Yandrapalli
- †Departments of Medicine and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY
| | - William H. Frishman
- †Departments of Medicine and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY
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156
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A novel coronavirus meets the cardiovascular system: Society for Cardiovascular Pathology Symposium 2021. Cardiovasc Pathol 2021; 53:107336. [PMID: 33895311 PMCID: PMC8062417 DOI: 10.1016/j.carpath.2021.107336] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022] Open
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157
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Dedè L, Regazzoni F, Vergara C, Zunino P, Guglielmo M, Scrofani R, Fusini L, Cogliati C, Pontone G, Quarteroni A. Modeling the cardiac response to hemodynamic changes associated with COVID-19: a computational study. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:3364-3383. [PMID: 34198390 DOI: 10.3934/mbe.2021168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Emerging studies address how COVID-19 infection can impact the human cardiovascular system. This relates particularly to the development of myocardial injury, acute coronary syndrome, myocarditis, arrhythmia, and heart failure. Prospective treatment approach is advised for these patients. To study the interplay between local changes (reduced contractility), global variables (peripheral resistances, heart rate) and the cardiac function, we considered a lumped parameters computational model of the cardiovascular system and a three-dimensional multiphysics model of cardiac electromechanics. Our mathematical model allows to simulate the systemic and pulmonary circulations, the four cardiac valves and the four heart chambers, through equations describing the underlying physical processes. By the assessment of conventionally relevant parameters of cardiac function obtained through our numerical simulations, we propose a computational model to effectively reveal the interactions between the cardiac and pulmonary functions in virtual subjects with normal and impaired cardiac function at baseline affected by mild or severe COVID-19.
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Affiliation(s)
- Luca Dedè
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | | | - Christian Vergara
- LABS, Dipartimento di Chimica, Materiali e Ingegneria Chimica, Politecnico di Milano, Milan, Italy
| | - Paolo Zunino
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | | | | | | | | | | | - Alfio Quarteroni
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
- (Professor Emeritus) Institute of Mathematics, Ecole Polytechnique Fédérale de Lausanne, Switzerland
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158
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Blankstein R, Chandrashekhar Y. New Insights on COVID-19 and the Heart. JACC Cardiovasc Imaging 2021; 14:706-708. [PMID: 33663773 PMCID: PMC7920531 DOI: 10.1016/j.jcmg.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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