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Oliveira RKF, Nyasulu PS, Iqbal AA, Hamdan Gul M, Ferreira EVM, Leclair JW, Htun ZM, Howard LS, Mocumbi AO, Bryant AJ, Tamuzi JL, Avdeev S, Petrosillo N, Hassan A, Butrous G, de Jesus Perez V. Cardiopulmonary disease as sequelae of long-term COVID-19: Current perspectives and challenges. Front Med (Lausanne) 2022; 9:1041236. [PMID: 36530872 PMCID: PMC9748443 DOI: 10.3389/fmed.2022.1041236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
COVID-19 infection primarily targets the lungs, which in severe cases progresses to cytokine storm, acute respiratory distress syndrome, multiorgan dysfunction, and shock. Survivors are now presenting evidence of cardiopulmonary sequelae such as persistent right ventricular dysfunction, chronic thrombosis, lung fibrosis, and pulmonary hypertension. This review will summarize the current knowledge on long-term cardiopulmonary sequelae of COVID-19 and provide a framework for approaching the diagnosis and management of these entities. We will also identify research priorities to address areas of uncertainty and improve the quality of care provided to these patients.
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Affiliation(s)
- Rudolf K. F. Oliveira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- *Correspondence: Rudolf K. F. Oliveira,
| | - Peter S. Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Adeel Ahmed Iqbal
- National Health System (NHS), Global Clinical Network, London, United Kingdom
| | - Muhammad Hamdan Gul
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States
| | - Eloara V. M. Ferreira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Zin Mar Htun
- Division of Pulmonary and Critical Care, National Institute of Health, University of Maryland, College Park, College Park, MD, United States
| | - Luke S. Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Ana O. Mocumbi
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
- Non-communicable Diseases Division, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Andrew J. Bryant
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Jacques L. Tamuzi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Sergey Avdeev
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Nicola Petrosillo
- Infection Prevention and Control-Infectious Disease Service, Foundation University Hospital Campus Bio-Medico, Rome, Italy
| | - Ahmed Hassan
- Department of Cardiology, Cairo University, Cairo, Egypt
| | - Ghazwan Butrous
- Medway School of Pharmacy, University of Kent at Canterbury, Canterbury, United Kingdom
| | - Vinicio de Jesus Perez
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University Medical Center, Stanford, CA, United States
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Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis. Sci Rep 2021; 11:17774. [PMID: 34493763 PMCID: PMC8423751 DOI: 10.1038/s41598-021-96955-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023] Open
Abstract
The Coronavirus Disease (COVID-19) pandemic imposed a high burden of morbidity and mortality. In COVID-19, direct lung parenchymal involvement and pulmonary microcirculation dysfunction may entail pulmonary hypertension (PH). PH and direct cardiac injury beget right ventricular dysfunction (RVD) occurrence, which has been frequently reported in COVID-19 patients; however, the prevalence of RVD and its impact on outcomes during COVID-19 are still unclear. This study aims to evaluate the prevalence of RVD and associated outcomes in patients with COVID-19, through a Systematic Review and Meta-Analysis. MEDLINE and EMBASE were systematically searched from inception to 15th July 2021. All studies reporting either the prevalence of RVD in COVID-19 patients or all-cause death according to RVD status were included. The pooled prevalence of RVD and Odds Ratio (OR) for all-cause death according to RVD status were computed and reported. Subgroup analysis and meta-regression were also performed. Among 29 studies (3813 patients) included, pooled prevalence of RVD was 20.4% (95% CI 17.1-24.3%; 95% PI 7.8-43.9%), with a high grade of heterogeneity. No significant differences were found across geographical locations, or according to the risk of bias. Severity of COVID-19 was associated with increased prevalence of RVD at meta-regression. The presence of RVD was found associated with an increased likelihood of all-cause death (OR 3.32, 95% CI 1.94-5.70). RVD was found in 1 out of 5 COVID-19 patients, and was associated with all-cause mortality. RVD may represent one crucial marker for prognostic stratification in COVID-19; further prospective and larger are needed to investigate specific management and therapeutic approach for these patients.
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Isgro G, Yusuff HO, Zochios V. The Right Ventricle in COVID-19 Lung Injury: Proposed Mechanisms, Management, and Research Gaps. J Cardiothorac Vasc Anesth 2021; 35:1568-1572. [PMID: 33546967 PMCID: PMC7810029 DOI: 10.1053/j.jvca.2021.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Graziella Isgro
- Department of Anesthesia and Intensive Care Medicine, Glenfield Hospital, University Hospitals of Leicester National Health Service Trust, Leicester, UK
| | - Hakeem O Yusuff
- Department of Anesthesia and Intensive Care Medicine, Glenfield Hospital, University Hospitals of Leicester National Health Service Trust, Leicester, UK; University of Leicester, Leicester, UK
| | - Vasileios Zochios
- Department of Critical Care Medicine, University Hospitals Birmingham National Health Service Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Birmingham Acute Care Research, Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, Birmingham, UK
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Abstract
While clinical characteristics exhibit that susceptibility to COVID-19 infection is equally likely between males and females, clinical outcomes show that males experience both a higher severity and fatality for COVID-19 infection than females. This review examines the evidence for these sex and gender differences and aims to illustrate possible mechanisms behind such sensitivity. Successful entry of SARS-CoV-2 into the body is dependent on the angiotensin-converting enzyme 2 (ACE2) receptor and the transmembrane protease serine 2 (TMPRSS2). Thus, sex-based differences in the expression of the ACE2 receptor and TMPRSS2 may explain the disparities in COVID-19 severity and fatality. Furthermore, these disparities may also be attributed to sex-based difference in immunological responses. Finally, the differences in clinical outcomes of COVID-19 infections between men and women may be due to gendered differences in behaviors, such as smoking, and prevalence to comorbidities. An understanding of the sex and gender sensitivities of COVID-19 infection is a necessary component towards the creation of effective treatment options and therapies for the virus. Graphical abstract.
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Affiliation(s)
- Shreya Mukherjee
- Department of Neurological Sciences, Rush University Medical Center, 1735 West Harrison St Suite Cohn 310, Chicago, IL 60612 USA ,Present Address: Honors Program in Medical Education, Northwestern University, Chicago, IL USA
| | - Kalipada Pahan
- Department of Neurological Sciences, Rush University Medical Center, 1735 West Harrison St Suite Cohn 310, Chicago, IL 60612 USA ,Division of Research and Development, Jesse Brown Veterans Affairs Medical Center, Chicago, IL USA
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Cao Y, Zhang M, Guo Y, Zhang Y. The overlooked chamber in coronavirus disease 2019. ESC Heart Fail 2020; 7:3483-3486. [PMID: 32964684 PMCID: PMC7754738 DOI: 10.1002/ehf2.12976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/01/2020] [Accepted: 08/10/2020] [Indexed: 01/05/2023] Open
Abstract
Coronavirus disease 2019 (COVID‐19) causes a pandemic around the globe. Debilitating and even deadly complications have occurred to the millions. A recent study reported 31% of right ventricular dilation in the hospitalized COVID‐19 patients, which is significantly associated with the mortality. Therefore, we sought to search for the lines of evidence in the literature that COVID‐19 may contribute to right heart dysfunction. The relevant literature and data from PubMed, Embase, Cochrane Library databases, and Web of Science were searched using the MeSH terms including ‘COVID‐19’, ‘SARS‐CoV‐2’, ‘novel coronavirus pneumonia’, ‘novel coronavirus’, ‘right heart failure’, ‘right heart dysfunction’, ‘pulmonary hypertension’, ‘pulmonary embolism’, and various combinations. The collected literature and data were sorted and summarized. Literature reports that angiotensin‐converting enzyme 2 (ACE2) is the host receptor mediating the cell entry of severe acute respiratory syndrome coronavirus 2. Clinical and experimental evidence shows that loss of function of ACE2 aggravates pulmonary hypertension and gain of function of ACE2 exerts protection on cardiopulmonary circulation. Moreover, the patients with COVID‐19 are more susceptible to pulmonary embolism and severe pneumonia‐induced acute respiratory distress syndrome. Therefore, COVID‐19 may cause right heart dysfunction by inducing pulmonary hypertension, pulmonary embolism, and acute respiratory distress syndrome. Particular attention should be paid to the function of the right heart, the overlooked chamber in COVID‐19. Blood gas analysis, laboratory test of cardiac injury markers, physical examination, and echocardiography should be performed to identify right heart failure as early as possible. Once the right heart failure is confirmed, the therapeutic modalities following the guidelines of European Society of Cardiology should be employed to reduce mortality.
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Affiliation(s)
- Yunshan Cao
- Department of Cardiology, Gansu Provincial Hospital, No. 204, Donggang West Road, Chengguan District, Lanzhou, Gansu, 730000, China.,Department of Cardiology, Shanxi Cardiovascular Hospital Affiliated With Shanxi Medical University, Yifen Street 18, Taiyuan, Shanxi, 030024, China
| | - Min Zhang
- Department of Pathology, Gansu Provincial Hospital, No. 204, Donggang West Road, Chengguan District, Lanzhou, Gansu, 730000, China
| | - Yanqing Guo
- Department of Cardiology, Shanxi Cardiovascular Hospital Affiliated With Shanxi Medical University, Yifen Street 18, Taiyuan, Shanxi, 030024, China
| | - Yan Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, No. 251, Fukang Road, Nankai District, Tianjin, 300384, China
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