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Cao T, Liu F, Yao Y, Sun D, Wang R, Cao J, Meng J, Zhang L, Li W. A Novel Scale System Based on the Frailty Index and Laboratory Indicators for the Short-Term Prognosis of Patients with Acute Myocardial Infarction: A Retrospective Cohort Study. Clin Interv Aging 2024; 19:1597-1606. [PMID: 39355280 PMCID: PMC11444054 DOI: 10.2147/cia.s469480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 09/06/2024] [Indexed: 10/03/2024] Open
Abstract
Objective Current scoring systems for short-term prognosis in patients with acute myocardial infarction (AMI) lack coverage of risk factors and have limitations in risk stratification. The aim of this study was to develop a novel assessment system based on laboratory indicators and frailty quantification to better infer short-term prognosis and risk indication in patients with AMI. Methods A total of 365 patients with MI from January 2022 to June 2023 in Northern Jiangsu Province Hospital were included. The primary endpoint was all-cause mortality and major adverse cardiac events (MACE) during follow-up. A novel scoring model ranging from 0 to 12 was constructed, and the predictive ability of this scoring system was evaluated using the area under the receiver operating characteristic curve (AUC). Results During follow-up, 68 patients experienced MACE. Five scoring indicators were selected through multivariate logistic regression analysis, resulting in a composite score with an AUC of 0.925, demonstrating good prognostic accuracy. Conclusion The novel prognostic assessment system, which integrates age, Stress Hyperglycemia Ratio (SHR), Neutrophil to Lymphocyte Ratio (NLR), lactate, and frailty score, exhibits good predictive value for short-term MACE in patients with acute myocardial infarction and may enable more accurate risk classification for future use in MI patient risk management.
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Affiliation(s)
- Tianqing Cao
- Shanghai Tenth People’s Hospital, Clinical Medical College of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Fei Liu
- Department of Cardiology, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, People’s Republic of China
| | - Yan Yao
- Department of Cardiology, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, People’s Republic of China
| | - Danghong Sun
- Department of Cardiology, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, People’s Republic of China
| | - Rong Wang
- Department of Pulmonology, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, People’s Republic of China
| | - Junxia Cao
- Department of Pulmonology, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, People’s Republic of China
| | - Jie Meng
- Department of Cardiology, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, People’s Republic of China
| | - Ling Zhang
- Department of Nursing, Changshu No.2 People’s Hospital/Affiliated Changshu Hospital of Nantong University, Changshu, Jiangsu, People’s Republic of China
| | - Weiming Li
- Shanghai Tenth People’s Hospital, Clinical Medical College of Nanjing Medical University, Nanjing, People’s Republic of China
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Furmanek S, Salunkhe V, Pahwa S, Samanapally H, Nathala P, Xu Q, Han Y, Huang EC, Ali T, Deepti F, Glynn A, McGuffin T, Huang JJ, Farah I, Jones CM, Ramirez JA, Clifford SP, Arnold FW, Kong M, Roser L, Huang J. Association between echocardiographic features, troponin levels, and survival time in hospitalized COVID-19 patients with cardiovascular events. JOURNAL OF ANESTHESIA AND TRANSLATIONAL MEDICINE 2024; 3:36-44. [PMID: 38993392 PMCID: PMC11238549 DOI: 10.1016/j.jatmed.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Introduction This study aims to explore the predictive roles of echocardiographic parameters and biomarkers in determining outcomes among hospitalized COVID-19 patients experiencing cardiovascular events. Methods A retrospective cohort study was conducted involving 49 COVID-19 patients who encountered cardiovascular events during hospitalization and underwent echocardiography. Our findings revealed notable associations between echocardiographic parameters and survival time. Results A decrease in left ventricular ejection fraction (LVEF) of 10% was linked to a 20% reduction in survival time (TR: 0.80, 95% CI: 0.67 - 0.96, p = .017). Similarly, an increase in left ventricular (LV) volume by 10 mL was associated with a 9% decrease in survival time (TR: 0.91, 95% CI: 0.84 - 0.98, p = .011). Moreover, an increase in left atrial (LA) volume by 10 mL corresponded to an 8% decrease in survival time (TR: 0.92, 95% CI: 0.86 - 0.99, p = .026). Additionally, each 1 cm increase in right ventricular (RV) diameter was linked to a 22% reduction in survival time (TR: 0.78, 95% CI: 0.61 - 0.99, p = .043). Furthermore, a 10 mL increase in right atrial (RA) volume was associated with a 12% decrease in survival time (TR: 0.88, 95% CI: 0.78 - 0.98, p = .017). Notably, a tenfold rise in troponin levels was linked to a 33% decrease in survival time (TR: 0.67, 95% CI: 0.48 - 0.93, p = .014). Conclusions Our study emphasizes the significant associations between various echocardiographic parameters and troponin levels with reduced survival time among COVID-19 patients experiencing cardiovascular events. These findings highlight the potential utility of echocardiography and troponin assessment in predicting outcomes and guiding management strategies in this patient population.
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Affiliation(s)
- Stephen Furmanek
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
- Norton Infectious Diseases Institute, Norton Healthcare, 234 E Gray St, Louisville, KY 40202, USA
| | - Vidyulata Salunkhe
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Siddharth Pahwa
- Department of Cardiovascular & Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Louisville, KY 40202, USA
| | - Harideep Samanapally
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Pavani Nathala
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Qian Xu
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY 40202, USA
- Biometrics and Data Science, Fosun Pharma, Beijing 100026, China
| | - Yuchen Han
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY 40202, USA
| | - Emma C Huang
- Department of Anesthesiology, Duke University, Durham, NC 27710, USA
| | - T'shura Ali
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Fnu Deepti
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Alex Glynn
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Trevor McGuffin
- School of Nursing, University of Louisville, 555 S Floyd St, Louisville, KY 40202, USA
| | - Justin J Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, 530 S Jackson St, Louisville, KY 40202, USA
| | - Ian Farah
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, 530 S Jackson St, Louisville, KY 40202, USA
| | - Christopher M Jones
- Division of Transplantation, Department of Surgery, University of Louisville, 323 E Chestnut St, Louisville, KY 40202, USA
| | - Julio A Ramirez
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
- Norton Infectious Diseases Institute, Norton Healthcare, 234 E Gray St, Louisville, KY 40202, USA
| | - Sean P Clifford
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, 530 S Jackson St, Louisville, KY 40202, USA
| | - Forest W Arnold
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY 40202, USA
| | - Lynn Roser
- School of Nursing, University of Louisville, 555 S Floyd St, Louisville, KY 40202, USA
| | - Jiapeng Huang
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, 530 S Jackson St, Louisville, KY 40202, USA
- Department of Pharmacology & Toxicology, University of Louisville, 505 S Hancock St, Louisville, KY 40202, USA
- Department of Cardiovascular & Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Louisville, KY 40202, USA
- Center for Integrative Environmental Health Sciences, University of Louisville, 500 S Preston St, Louisville, KY 40202, USA
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Yugar-Toledo JC, Yugar LBT, Sedenho-Prado LG, Schreiber R, Moreno H. Pathophysiological effects of SARS-CoV-2 infection on the cardiovascular system and its clinical manifestations-a mini review. Front Cardiovasc Med 2023; 10:1162837. [PMID: 37260945 PMCID: PMC10229057 DOI: 10.3389/fcvm.2023.1162837] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/18/2023] [Indexed: 06/02/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 may have a mild presentation, with few symptoms, or progress to a severe condition, characterized by generalized inflammation, systemic microvascular involvement, coagulopathy, and pulmonary and cardiovascular complications. Men present with more severe symptoms than women, especially men who are older and who present with comorbidities such as hypertension, diabetes mellitus, and a history of atherosclerotic diseases. Owing to its association with endothelial dysfunction, inflammation, thrombosis, and microvascular obstruction, SARS-CoV-2 infection can cause lesions in several organs, including the myocardium and the coronary arterial bed, which can result in clinical manifestations involving the cardiovascular system. In this mini review, we summarize the effects of SARS-CoV-2 infection on the cardiovascular system in both children and adults and characterize the various clinical manifestations associated with this disease.
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Affiliation(s)
| | | | | | - Roberto Schreiber
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Heitor Moreno
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
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Torabizadeh C, Iloonkashkooli R, Haghshenas H, Fararouei M. Prevalence of Cardiovascular Complications in Coronavirus Disease 2019 adult Patients: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:243-267. [PMID: 37791325 PMCID: PMC10542931 DOI: 10.30476/ijms.2022.93701.2504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/03/2022] [Accepted: 04/26/2022] [Indexed: 10/05/2023]
Abstract
Background It has been found that the new coronavirus can affect various parts of the cardiovascular system. Cardiovascular complications caused by coronavirus disease 2019 (COVID-19) are often serious and can increase the mortality rate among infected patients. This study aimed to investigate the prevalence of cardiovascular complications in COVID-19 adult patients. Methods A systematic review and meta-analysis of observational studies published in English were conducted between December 2019 and February 2021. A complete search was performed in PubMed (PubMed Central and MEDLINE), Google Scholar, Cochrane Library, Science Direct, Ovid, Embase, Scopus, CINAHL, Web of Science, and WILEY, as well as BioRXiv, MedRXiv, and gray literature. A random effect model was used to examine the prevalence of cardiovascular complications among COVID-19 patients. The I2 test was used to measure heterogeneity across the included studies. Results A total of 74 studies involving 34,379 COVID-19 patients were included for meta-analysis. The mean age of the participants was 61.30±14.75 years. The overall pooled prevalence of cardiovascular complications was 23.45%. The most prevalent complications were acute myocardial injury (AMI) (19.38%, 95% CI=13.62-26.81, test for heterogeneity I2=97.5%, P<0.001), arrhythmia (11.16%, 95% CI=8.23-14.96, test for heterogeneity I2=91.5%, P<0.001), heart failure (HF) (7.56%, 95% CI=4.50-12.45, test for heterogeneity I2=96.3%, P<0.001), and cardiomyopathy (2.78%, 95% CI=0.34-9.68). The highest pooled prevalence of cardiac enzymes was lactate dehydrogenase (61.45%), troponin (23.10%), and creatine kinase-myocardial band or creatine kinase (14.52%). Conclusion The high prevalence of serious cardiovascular complications in COVID-19 patients (AMI, arrhythmia, and HF) necessitates increased awareness by healthcare administrators.
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Affiliation(s)
- Camellia Torabizadeh
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hajar Haghshenas
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- HIV/AIDs Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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5
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Bailey E, Frishman WH. Mild-to-Moderate COVID-19 Infection and Myocarditis: A Review. Cardiol Rev 2023; 31:173-175. [PMID: 35576368 DOI: 10.1097/crd.0000000000000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has taken a massive toll on healthcare systems internationally. Severe illness has been seen in a range of patient populations, but those living with cardiovascular disease have suffered to a greater extent, likely because of their comorbidities. In patients with diabetes, hypertension, heart failure, and other chronic illnesses, COVID-19 has manifested severe illnesses such as coagulopathies, myocarditis, and arrhythmias, complicating the disease course for those already suffering from underlying illness. There have been numerous studies done exploring the cardiovascular complications of COVID-19. Some of the more concerning findings have revealed a correlation between severe illness and the increasing likelihood for developing cardiovascular manifestations. However, what is more concerning were the studies revealing the presence of myocarditis and other cardiac sequelae in previously healthy patients with mild or asymptomatic COVID-19. The goal of this article is to review the literature to compile information available about whether there is a significant risk of myocarditis in those patients who do not develop severe initial COVID-19 disease.
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Affiliation(s)
- Eric Bailey
- From the Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - William H Frishman
- Departments of Medicine and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY
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6
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De Michieli L, Jaffe AS, Sandoval Y. Use and Prognostic Implications of Cardiac Troponin in COVID-19. Heart Fail Clin 2023; 19:163-176. [PMID: 36863808 PMCID: PMC9973555 DOI: 10.1016/j.hfc.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Myocardial injury is common in patients with COVID-19 and is associated with an adverse prognosis. Cardiac troponin (cTn) is used to detect myocardial injury and assist with risk stratification in this population. SARS-CoV-2 infection can play a role in the pathogenesis of acute myocardial injury due to both direct and indirect damage to the cardiovascular system. Despite the initial concerns about an increased incidence of acute myocardial infarction (MI), most cTn increases are related to chronic myocardial injury due to comorbidities and/or acute nonischemic myocardial injury. This review will discuss the latest findings on this topic.
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Affiliation(s)
- Laura De Michieli
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA,Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, Padova 35128, Italy
| | - Allan S. Jaffe
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA,Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Yader Sandoval
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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7
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Flores R, Pires O, Alves J, Pereira VH. An Echocardiographic Insight Into Post-COVID-19 Symptoms. Cureus 2023; 15:e38039. [PMID: 37228525 PMCID: PMC10207971 DOI: 10.7759/cureus.38039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has frequent acute cardiovascular manifestations, but long-term sequelae are yet to be described. Our main objective is to describe the echocardiographic findings of patients with a previous SARS-CoV-2 infection. METHODS A single-center prospective study was conducted. Patients who tested positive for SARS-CoV-2 were selected and submitted to a transthoracic echocardiogram six months after infection. A complete echocardiographic assessment was performed, including tissue Doppler, E/E' ratio, and ventricular longitudinal strain. Patients were divided into two subgroups according to their need for admission to the ICU. RESULTS A total of 88 patients were enrolled. The mean values and respective standard deviations of the echocardiographic parameters were as follows: left ventricular ejection fraction 60.8 ± 5.9%; left ventricular longitudinal strain 17.9 ± 3.6%; tricuspid annular plane systolic excursion 22.1 ± 3.6 mm; a longitudinal strain of the free wall of the right ventricle 19.0 ± 6.0%. We found no statistically significant differences between subgroups. CONCLUSIONS At the six-month follow-up, we found no significant impact of past SARS-CoV-2 infection on the heart using echocardiography parameters.
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Affiliation(s)
- Rui Flores
- Cardiology, Hospital de Braga, Braga, PRT
| | - Olga Pires
- Internal Medicine, Hospital de Braga, Braga, PRT
| | - Joana Alves
- Infectious Disease, Hospital of Braga, Braga, PRT
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Karna ST, Thaware P, Singh P. COVID-19 with peripartum cardiomyopathy: a case report. AIN-SHAMS JOURNAL OF ANESTHESIOLOGY 2022. [PMCID: PMC8771168 DOI: 10.1186/s42077-021-00204-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background The world has been facing the novel coronavirus SARS-CoV-2 pandemic. The novel coronavirus primarily affects the lungs but also affects multiple organ systems including the cardiovascular system causing myocarditis, cardiomyopathy, and arrhythmias. Cardiomyopathy has been reported in patients with COVID-19; however, prognosis of peripartum cardiomyopathy in a patient with COVID-19 is still unexplored. More knowledge is required to understand the incidence of cardiomyopathy due to novel coronavirus SARS-CoV-2. Case presentation We report a case of peripartum cardiomyopathy gravida 2 parity 2 COVID-19 confirmed patient who underwent an emergency preterm lower segment caesarean section (LSCS) for severe pre-eclampsia and intra-uterine growth retardation (IUGR) and landed up in acute congestive cardiac failure with pulmonary oedema. A postpartum 32 years female presented to our institute, a dedicated COVID-19 hospital with tachycardia, hypertension, anasarca, tachypnea with desaturation on room air. She had undergone emergency caesarean section for severe preeclampsia with intrauterine growth retardation. On post-operative day 2 (POD2), she complained of shortness of breath. On POD 3 she tested positive RT-PCR for COVID-19 infection. She responded to treatment with steroids. However, on POD6, She developed severe pulmonary oedema with poor ejection fraction necessitating endotracheal intubation and pressure control ventilation. Congestive cardiac failure was managed with diuretics and digoxin. Gradually oxygenation improved. She was electively ventilated for 3 days. Gradually, ejection fraction improved with the resolution of B lines. On the 9th POD, after a successful spontaneous breathing trial, she was extubated and non-invasive ventilation with bi-level positive airway pressure was attached. The patient was gradually tapered off of the non-invasive ventilation over 2 days. On the 11th post-operative day, she was maintaining oxygen saturation on nasal prongs and was sent to the ward. Conclusions We recommend early use of bedside lung ultrasonography; echocardiography and close cardiovascular monitoring in severe COVID-19 infected pregnant patients who present with shortness of breath, tachypnea, and hypertensive disorders of pregnancy and previous cardiac abnormalities for expedite management and improved prognosis. An ideal case scenario for extubation may not be present, non-invasive ventilation with bi-level positive airway pressure post-extubation helps in patients with peripartum cardiomyopathy.
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Lee KY, Hwang BH, Kim CJ, Sa YK, Choi Y, Kim JJ, Choo EH, Lim S, Choi IJ, Park MW, Oh GC, Yang IH, Yoo KD, Chung WS, Chang K. Prognostic Impact of the HFA-PEFF Score in Patients with Acute Myocardial Infarction and an Intermediate to High HFA-PEFF Score. J Clin Med 2022; 11:jcm11154589. [PMID: 35956205 PMCID: PMC9369752 DOI: 10.3390/jcm11154589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 12/04/2022] Open
Abstract
This study aimed to investigate the efficacy of the HFA-PEFF score in predicting the long-term risks in patients with acute myocardial infarction (AMI) and an HFA-PEFF score ≥ 2. The subjects were divided according to their HFA-PEFF score into intermediate (2−3 points) and high (4−6 points) score groups. The primary outcome was all-cause mortality. Of 1018 patients with AMI and an HFA-PEFF score of ≥2, 712 (69.9%) and 306 (30.1%) were classified into the intermediate and high score groups, respectively. Over a median follow-up of 4.8 (3.2, 6.5) years, 114 (16.0%) and 87 (28.4%) patients died in each group. Multivariate Cox regression identified a high HFA-PEFF score as an independent predictor of all-cause mortality [hazard ratio (HR): 1.53, 95% CI: 1.15−2.04, p = 0.004]. The predictive accuracies for the discrimination and reclassification were significantly improved (C-index 0.750 [95% CI 0.712−0.789]; p = 0.049 and NRI 0.330 [95% CI 0.180−0.479]; p < 0.001) upon the addition of a high HFA-PEFF score to clinical risk factors. The model was better at predicting combined events of all-cause mortality and heart failure readmission (C-index 0.754 [95% CI 0.716−0.791]; p = 0.033, NRI 0.372 [95% CI 0.227−0.518]; p < 0.001). In the AMI cohort, the HFA-PEFF score can effectively predict the prognosis of patients with an HFA-PEFF score of ≥2.
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Affiliation(s)
- Kwan Yong Lee
- Cardiovascular Center and Cardiology Division, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Byung-Hee Hwang
- Cardiovascular Center and Cardiology Division, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-2-2258-1139; Fax: +82-2-2258-1142
| | - Chan Jun Kim
- Cardiovascular Center and Cardiology Division, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeonbu 11765, Korea
| | - Young Kyoung Sa
- Cardiovascular Center and Cardiology Division, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul 07345, Korea
| | - Young Choi
- Cardiovascular Center and Cardiology Division, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Jin-Jin Kim
- Cardiovascular Center and Cardiology Division, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Eun-Ho Choo
- Cardiovascular Center and Cardiology Division, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Sungmin Lim
- Cardiovascular Center and Cardiology Division, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeonbu 11765, Korea
| | - Ik Jun Choi
- Cardiovascular Center and Cardiology Division, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon 21431, Korea
| | - Mahn-Won Park
- Cardiovascular Center and Cardiology Division, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
| | - Gyu Chul Oh
- Cardiovascular Center and Cardiology Division, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - In-Ho Yang
- Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul 05278, Korea
| | - Ki Dong Yoo
- Cardiovascular Center and Cardiology Division, St. Vincent’s Hospital, The Catholic University of Korea, Suwon 16247, Korea
| | - Wook Sung Chung
- Cardiovascular Center and Cardiology Division, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Kiyuk Chang
- Cardiovascular Center and Cardiology Division, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
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Iorio A, Lombardi CM, Specchia C, Merlo M, Nuzzi V, Ferraro I, Peveri G, Oriecuia C, Pozzi A, Inciardi RM, Carubelli V, Bellasi A, Canale C, Camporotondo R, Catagnano F, Dalla Vecchia L, Giovinazzo S, Maccagni G, Mapelli M, Margonato D, Monzo L, Provenzale G, Sarullo F, Tomasoni D, Ameri P, Gnecchi M, Leonardi S, Agostoni P, Carugo S, Danzi GB, Guazzi M, La Rovere MT, Mortara A, Piepoli M, Porto I, Volterrani M, Sinagra G, Senni M, Metra M. Combined Role of Troponin and Natriuretic Peptides Measurements in Patients With Covid-19 (from the Cardio-COVID-Italy Multicenter Study). Am J Cardiol 2022; 167:125-132. [PMID: 35063263 PMCID: PMC8767953 DOI: 10.1016/j.amjcard.2021.11.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022]
Abstract
Data concerning the combined prognostic role of natriuretic peptide (NP) and troponin in patients with COVID-19 are lacking. The aim of the study is to evaluate the combined prognostic value of NPs and troponin in hospitalized COVID-19 patients. From March 1, 2020 to April 9, 2020, consecutive patients with COVID-19 and available data on cardiac biomarkers at admission were recruited. Patients admitted for acute coronary syndrome were excluded. Troponin levels were defined as elevated when greater than the 99th percentile of normal values. NPs were considered elevated if above the limit for ruling in acute heart failure (HF). A total of 341 patients were included in this study, mean age 68 ± 13 years, 72% were men. During a median follow-up period of 14 days, 81 patients (24%) died. In the Cox regression analysis, patients with elevated both NPs and troponin levels had higher risk of death compared with those with normal levels of both (hazard ratio 2.94; 95% confidence interval 1.31 to 6.64; p = 0.009), and this remained significant after adjustment for age, gender, oxygen saturation, HF history, and chronic kidney disease. Interestingly, NPs provided risk stratification also in patients with normal troponin values (hazard ratio 2.86; 95% confidence interval 1.21 to 6.72; p = 0.016 with high NPs levels). These data show the combined prognostic role of troponin and NPs in COVID-19 patients. NPs value may be helpful in identifying patients with a worse prognosis among those with normal troponin values. Further, NPs’ cut-point used for diagnosis of acute HF has a predictive role in patients with COVID-19.
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Cardiac biomarkers alterations in patients with SARS-CoV-2 infection. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2022; 60:6-13. [PMID: 34610232 DOI: 10.2478/rjim-2021-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Indexed: 12/21/2022]
Abstract
Reliable biomarkers are necessary for the risk stratification of patients infected with SARS-CoV-2. This novel coronavirus is now established to affect several organs in addition to the lungs, most prominently the heart. This is achieved through direct damage to the myocardium and indirect immune-associated effects during the cytokine storm. We performed a literature review aiming to identify the prognostic value of alterations of cardiac biomarkers in SARS-CoV-2 infection. Cardiac biomarkers are significantly elevated in patients with severe COVID-19 and are independent predictors of mortality. High-sensitivity troponin I and T are correlated with multiple inflammatory indexes and poor outcomes. Although cut-off values have been established for most of cardiac biomarkers, lower limits for troponins may have better prognostic values and longitudinal monitoring of cardiac biomarkers can help the clinician assess the patient's course. Additional measurements of NT-proBNP, can detect the subgroup of patients with poor prognosis.
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12
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Affiliation(s)
- Laura De Michieli
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, Padova 35128, Italy
| | - Allan S Jaffe
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Yader Sandoval
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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13
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Nuevo-Ortega P, Reina-Artacho C, Dominguez-Moreno F, Becerra-Muñoz VM, Ruiz-Del-Fresno L, Estecha-Foncea MA. Prognosis of COVID-19 pneumonia can be early predicted combining Age-adjusted Charlson Comorbidity Index, CRB score and baseline oxygen saturation. Sci Rep 2022; 12:2367. [PMID: 35149742 PMCID: PMC8837655 DOI: 10.1038/s41598-022-06199-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 12/30/2021] [Indexed: 12/21/2022] Open
Abstract
In potentially severe diseases in general and COVID-19 in particular, it is vital to early identify those patients who are going to progress to severe disease. A recent living systematic review dedicated to predictive models in COVID-19, critically appraises 145 models, 8 of them focused on prediction of severe disease and 23 on mortality. Unfortunately, in all 145 models, they found a risk of bias significant enough to finally "not recommend any for clinical use". Authors suggest concentrating on avoiding biases in sampling and prioritising the study of already identified predictive factors, rather than the identification of new ones that are often dependent on the database. Our objective is to develop a model to predict which patients with COVID-19 pneumonia are at high risk of developing severe illness or dying, using basic and validated clinical tools. We studied a prospective cohort of consecutive patients admitted in a teaching hospital during the "first wave" of the COVID-19 pandemic. Follow-up to discharge from hospital. Multiple logistic regression selecting variables according to clinical and statistical criteria. 404 consecutive patients were evaluated, 392 (97%) completed follow-up. Mean age was 61 years; 59% were men. The median burden of comorbidity was 2 points in the Age-adjusted Charlson Comorbidity Index, CRB was abnormal in 18% of patients and basal oxygen saturation on admission lower than 90% in 18%. A model composed of Age-adjusted Charlson Comorbidity Index, CRB score and basal oxygen saturation can predict unfavorable evolution or death with an area under the ROC curve of 0.85 (95% CI 0.80-0.89), and 0.90 (95% CI 0.86 to 0.94), respectively. Prognosis of COVID-19 pneumonia can be predicted without laboratory tests using two classic clinical tools and a pocket pulse oximeter.
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Affiliation(s)
- Pilar Nuevo-Ortega
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain.
| | - Carmen Reina-Artacho
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Francisco Dominguez-Moreno
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Victor Manuel Becerra-Muñoz
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Ruiz-Del-Fresno
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Maria Antonia Estecha-Foncea
- Intensive Care Unit, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
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14
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Yildiz C, Karabulut D, Erdal G, Hergünsel G, Karabulut U, Binboğa E, Isiksacan N. NOTCH and tumor necrosis factor-alpha converting enzyme levels could be used in COVID-19 for risk stratification. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2022. [DOI: 10.4103/injms.injms_52_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Boyesen EO, Balsby IM, Henriksen M, Christensen R, Rasmussen JH, Nielsen FE, Nygaard H, Friis-Hansen LJ, Nielsen SD, Thudium RF, Porsberg C, Kristensen LE, Bliddal H. Triage Strategies Based on C-Reactive Protein Levels and SARS-CoV-2 Tests among Individuals Referred with Suspected COVID-19: A Prospective Cohort Study. J Clin Med 2021; 11:jcm11010201. [PMID: 35011944 PMCID: PMC8745759 DOI: 10.3390/jcm11010201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023] Open
Abstract
C-reactive protein (CRP) has prognostic value in hospitalized patients with COVID-19; the importance of CRP in pre-hospitalized patients remains to be tested. Methods: Individuals with symptoms of COVID-19 had a SARS-CoV-2 PCR oropharyngeal swab test, and a measurement of CRP was performed at baseline, with an upper reference range of 10 mg/L. After 28 days, information about possible admissions, oxygen treatments, transfers to the ICU, or deaths was obtained from the patient files. Using logistic regression, the prognostic value of the CRP and SARS-CoV-2 test results was evaluated. Results: Among the 1006 patients included, the SARS-CoV-2 PCR test was positive in 59, and the CRP level was elevated (>10 mg/L) in 131. In total, 59 patients were hospitalized, only 3 of whom were SARS-CoV-2 positive, with elevated CRP (n = 2) and normal CRP (n = 1). The probability of being hospitalized with elevated CRP was 4.21 (95%CI 2.38–7.43, p < 0.0001), while the probability of being hospitalized with SARS-CoV-2 positivity alone was 0.85 (95%CI 0.26–2.81, p = 0.79). Conclusions: CRP is not a reliable predictor for the course of SARS-CoV-2 infection in pre-hospitalized patients. CRP, while not a SARS-CoV-2 positive test, had prognostic value in the total population of patients presenting with COVID-19-related symptoms.
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Affiliation(s)
- Erika Olivia Boyesen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen, Denmark; (E.O.B.); (I.M.B.); (M.H.); (R.C.); (L.E.K.)
| | - Ida Maria Balsby
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen, Denmark; (E.O.B.); (I.M.B.); (M.H.); (R.C.); (L.E.K.)
| | - Marius Henriksen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen, Denmark; (E.O.B.); (I.M.B.); (M.H.); (R.C.); (L.E.K.)
| | - Robin Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen, Denmark; (E.O.B.); (I.M.B.); (M.H.); (R.C.); (L.E.K.)
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, 5000 Odense, Denmark
| | - Jens Henning Rasmussen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg Frederiksberg Hospital, 2400 Copenhagen, Denmark; (J.H.R.); (F.E.N.); (H.N.)
| | - Finn Erland Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg Frederiksberg Hospital, 2400 Copenhagen, Denmark; (J.H.R.); (F.E.N.); (H.N.)
| | - Hanne Nygaard
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg Frederiksberg Hospital, 2400 Copenhagen, Denmark; (J.H.R.); (F.E.N.); (H.N.)
| | - Lennart Jan Friis-Hansen
- Department of Clinical Biochemistry, Bispebjerg Frederiksberg Hospital, 2400 Copenhagen, Denmark;
| | - Susanne Dam Nielsen
- Department of Infectious Diseases 8632, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (S.D.N.); (R.F.T.)
| | - Rebekka Faber Thudium
- Department of Infectious Diseases 8632, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (S.D.N.); (R.F.T.)
| | - Celeste Porsberg
- Department of Pulmonary Medicine, Bispebjerg Frederiksberg Hospital, 2400 Copenhagen, Denmark;
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen, Denmark; (E.O.B.); (I.M.B.); (M.H.); (R.C.); (L.E.K.)
| | - Henning Bliddal
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen, Denmark; (E.O.B.); (I.M.B.); (M.H.); (R.C.); (L.E.K.)
- Correspondence: ; Tel.: +45-3816-4158
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16
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Martocchia A, Bruscia C, Conforti G, Falangone F, Marini V, Pennica A, Pezzuto A, March MR, Sentimentale A, Spuntarelli V, Tafaro L, Ricci A, Simmaco M, Sesti G, Preissner R, Martelletti P. Comparison of Computerized Prescription Support Systems in COVID-19 Patients: INTERCheck and Drug-PIN. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 4:3. [PMID: 34977463 PMCID: PMC8710931 DOI: 10.1007/s42399-021-01079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 10/29/2022]
Abstract
The coronavirus disease 19 (COVID-19) infection requires major efforts in healthcare systems, due to the high risk of mortality, particularly in subjects with significant comorbidity (≥ 2 pathologies) and polypharmacy (≥ 5 drugs). The treatment of COVID-19 needs a careful evaluation, to reduce the risk of potentially adverse drug reactions. The aim of the study was to examine the use of computerized prescription support in the management and treatment of the COVID-19 infection. We evaluated n.33 patients (51% females) admitted to the west COVID Low-Medium Intensity of Care of Sant'Andrea Hospital during the period March-April 2020 and n.42 subjects (50% females) admitted to the Internal Medicine ward (as control group), by INTERCheck® and Drug-PIN®. The comorbidity (n. pathologies), polypharmacy (n. drugs), and total INTERCheck score in COVID-19 patients and controls were, respectively (mean ± standard deviation): 5.8 ± 3.8, 7.9 ± 4.5, and 9.2 ± 7.1 and 6.8 ± 2.6, 8.0 ± 2.6, and 4.9 ± 3.8 (statistically significant for comorbidity p < 0.01 and INTERCheck score p < 0.01). The correlation between the scores obtained by the INTERCheck and Drug-PIN software was statistically significant, either at admission (p < 0.0000001) or during hospitalization (p < 0.00000001). Both the computerized prescription support systems, INTERCheck® and Drug-PIN®, are useful to better characterize the patients and to ameliorate the drugs prescriptions in COVID-19 infection, with particular attention to the elderly population.
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Affiliation(s)
- Antonio Martocchia
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
| | - Clara Bruscia
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
| | - Giulia Conforti
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
| | - Francesca Falangone
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
| | - Valentina Marini
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
| | - Alfredo Pennica
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
| | - Aldo Pezzuto
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
| | | | - Alberto Sentimentale
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
| | - Valerio Spuntarelli
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
| | - Laura Tafaro
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
| | - Alberto Ricci
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
| | - Maurizio Simmaco
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
| | - Giorgio Sesti
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
| | - Robert Preissner
- Institute of Physiology and Science-IT, Charité–Universitätsmedizin Berlin, Corporate Member of Freie, Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Paolo Martelletti
- Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1032, 00189 Rome, Italy
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17
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Ghidini S, Gasperetti A, Winterton D, Vicenzi M, Busana M, Pedrazzini G, Biasco L, Tersalvi G. Echocardiographic assessment of the right ventricle in COVID-19: a systematic review. Int J Cardiovasc Imaging 2021; 37:3499-3512. [PMID: 34292433 PMCID: PMC8295549 DOI: 10.1007/s10554-021-02353-6] [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: 05/23/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022]
Abstract
Cardiac involvement has been frequently reported in COVID-19 as responsible of increased morbidity and mortality. Given the importance of right heart function in acute and chronic respiratory diseases, its assessment in SARS-CoV-2 infected patients may add prognostic accuracy. Transthoracic echocardiography has been proposed to early predict myocardial injury and risk of death in hospitalized patients. This systematic review presents the up-to-date sum of literature regarding right ventricle ultrasound assessment. We evaluated commonly used echocardiographic parameters to assess RV function and discussed their relationship with pathophysiological mechanisms involved in COVID-19. We searched Medline and Embase for studies that used transthoracic echocardiography for right ventricle assessment in patients with COVID-19.
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Affiliation(s)
- Simone Ghidini
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dario Winterton
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Marco Vicenzi
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mattia Busana
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Giovanni Pedrazzini
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Luigi Biasco
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, Ciriè, Italy
| | - Gregorio Tersalvi
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland.
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Sankt-Anna-Strasse 32, 6006, Lucerne, Switzerland.
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Arcari L, Luciani M, Cacciotti L, Pucci M, Musumeci MB, Pietropaolo L, Spuntarelli V, Negro A, Camastra G, Bentivegna E, Marazzi G, Sighieri C, Ansalone G, Santini C, Martelletti P, Volpe M, De Biase L. Coronavirus disease 2019 in patients with cardiovascular disease: clinical features and implications on cardiac biomarkers assessment. J Cardiovasc Med (Hagerstown) 2021; 22:832-839. [PMID: 34482324 DOI: 10.2459/jcm.0000000000001252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Previous cardiovascular disease (CVD) and myocardial involvement are common in coronavirus disease-19 (COVID-19). We investigated relationships between CVD, cardiac biomarkers and outcome in COVID-19. METHODS We analyzed n = 252 patients from a multicenter study and provided comparison according to the presence or absence of underlying CVD. Cardiac biomarkers high-sensitivity Troponin [upper reference of normality (URN) 35 pg/ml for Troponin I and 14 pg/ml for Troponin T] and natriuretic peptides (Nt-pro-B-type natriuretic peptide, URN 300 pg/ml and B-type natriuretic peptide, URN 100 pg/ml) were both available in n = 136. RESULTS Mean age was 69 ± 16 years (56% men, 31% with previous CVD). Raised hs-Troponin and natriuretic peptides were detected in 36 and 50% of the cases respectively. Age, chronic obstructive pulmonary disease, hemoglobin, hs-Troponin and natriuretic peptides were independently associated with underlying CVD (P < 0.05 for all). Compared with the normal biomarkers subgroups, patients with isolated hs-Troponin elevation had higher in-hospital mortality (31 vs. 4%, P < 0.05), similar CVD prevalence (15 vs. 11%) and trend towards higher D-dimer (930 vs. 397 ng/ml, P = 0.140). Patients with both biomarkers elevated had higher age, D-dimer, CVD and in-hospital mortality prevalence compared with other subgroups (all P < 0.05 for trend). Outcome analysis revealed previous CVD [model 1: OR 2.72 (95% CI 1.14-6.49), P = 0.024. model 2: OR 2.65 (95% CI 1.05-6.71), P = 0.039], hs-Troponin (log10) [OR 2.61 (95% CI 1.21-5.66), P = 0.015] and natriuretic peptides (log10) [OR 5.84 (95%CI 2.43-14), P < 0.001] to be independently associated with in-hospital mortality. CONCLUSION In our population, previous CVD was part of a vulnerable phenotype including older age, comorbidities, increased cardiac biomarkers and worse prognosis. Patients with isolated increase in hs-Troponin suffered higher mortality rates despite low prevalence of CVD, possibly explained by higher COVID-19-related systemic involvement.
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Affiliation(s)
- Luca Arcari
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital
| | | | - Luca Cacciotti
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital
| | | | - Maria Beatrice Musumeci
- Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome
| | | | | | | | | | | | - Giuseppe Marazzi
- Covid Unit, Heart Failure Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Cinzia Sighieri
- Covid-Internal Medicine Unit, Madre Giuseppina Vannini Hospital
| | | | - Claudio Santini
- Covid-Internal Medicine Unit, Madre Giuseppina Vannini Hospital
| | | | - Massimo Volpe
- Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome
| | - Luciano De Biase
- Covid Unit, Heart Failure Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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19
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CHA2DS2-VASc score in patients with COVID-19 pneumonia and its relationship with biomarkers of thrombosis, inflammation and myocardial injury. Blood Coagul Fibrinolysis 2021; 33:188-192. [PMID: 34693913 DOI: 10.1097/mbc.0000000000001098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CHA2DS2-VASc score associates with worse prognosis in coronavirus-disease-19 (COVID-19). This study investigated laboratory correlates of increasing CHA2DS2-VASc in patients with COVID-19. Patients with COVID-19 were stratified by CHA2DS2-VASc (Group 1: CHA2DS2-VASc 0-1; Group 2: CHA2DS2-VASc 2-3; Group 3: CHA2DS2-VASc ≥4). We found stepwise increase of D-dimer, hs-Troponin and in-hospital mortality across groups (all P < 0.01). D-dimer and hs-Troponin remained independently associated with CHA2DS2-VASc (B = 0.145, P = 0.03; B = 0.320, P < 0.001, respectively). We found significant correlations between D-dimer and C-reactive protein (CRP) in Group 1 and 2, not in Group3 (r2 = 0.103, P = 0.005; r2 = 0.226, P = 0.001; r2 = 0.021, P = 0.253 respectively), and between D-dimer and hs-Troponin in group 2 and 3, not in Group 1 (r2 = 0.122, P = 0.003; r2 = 0.120, P = 0.007; r2 = 0.006, P = 0.514 respectively). In our cohort, CHA2DS2-VASc was independently associated with D-dimer and hs-Troponin increase. Variable relationships of D-dimer with hs-Troponin and CRP within different CHA2DS2-VASc strata suggest multiple mechanisms to be responsible for D-dimer increase in COVID-19.
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20
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Arcari L, Ciolina F, Cacciotti L, Danti M, Camastra G, Manzo D, Musarò S, Pironi B, Marazzi G, Santini C, Ansalone G, Sbarbati S. Semiquantitative ChestCT Severity Score Predicts Failure of Noninvasive Positive-Pressure Ventilation in Patients Hospitalized for COVID-19 Pneumonia. J Cardiothorac Vasc Anesth 2021; 36:2278-2286. [PMID: 34627709 PMCID: PMC8434692 DOI: 10.1053/j.jvca.2021.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 12/21/2022]
Abstract
Objective Noninvasive positive-pressure ventilation (NPPV) emerged as an efficient tool for treatment of COVID-19 pneumonia. The factors influencing NPPV failure still are elusive. The aim of the study was to investigate the relationships between semiquantitative chest computed tomography (CT) scoring and NPPV failure and mortality in patients with COVID-19. Design Observational study. Setting Nonintensive care setting. Participants A total of 112 patients consecutively admitted for COVID-19 pneumonia. Interventions Usual care including various degrees of respiratory support. Measurements and Main Results The semiquantitative CT score was calculated at hospital admission. Subgroups were identified according to the ventilation strategy used (oxygen delivered by Venturi mask n = 53; NPPV-responder n = 38; NPPV-failure n = 21). The study's primary endpoint was the use of NPPV. The secondary endpoints were NPPV failure and in-hospital death, respectively. CT score progressively increased among groups (six v nine v 14, p < 0.05 among all). CT score was an independent predictor of all study endpoints (primary endpoint: 1.25 [95% confidence interval {CI} 1.1-1.4], p = 0.001; NPPV failure: 1.41 [95% CI 1.18-1.69], p < 0.001; in-hospital mortality: 1.21 [95% CI 1.07-1.38], p = 0.003). According to receiver operator characteristics curve analysis, CT score was the most accurate variable for prediction of NPPV failure (area under the curve 0.862 with p < 0.001; p < 0.05 v other variables). Conclusions The authors reported the common and effective use of NPPV in patients with COVID-19 pneumonia. In the authors’ population, a semiquantitative chest CT analysis at hospital admission accurately identified those patients responding poorly to NPPV.
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Affiliation(s)
- Luca Arcari
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy.
| | | | - Luca Cacciotti
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | | | - Giovanni Camastra
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Daniele Manzo
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Salvatore Musarò
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Bruno Pironi
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | | | - Claudio Santini
- Covid-Internal Medicine Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Gerardo Ansalone
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
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21
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Abstract
There has been strong evidence of myocardial injury in coronavirus disease 2019 (COVID-19) patients with significantly elevated serum cardiac troponin (cTn). While the exact mechanism of injury is unclear, possible suggested pathological mechanisms of injury are discussed. These include increased susceptibility of the myocardium and endothelium to viral invasion, underlying hyperinflammatory state and subsequent cytokine storm, a hypercoagulable and prothrombotic state, and indirect myocardial injury due to hypoxemia. As a result of these pathological mechanisms in COVID-19 patients, cTn may be elevated largely due to myocarditis, microangiopathy or myocardial infarction. The utility of cTn as a biomarker for measuring myocardial injury in these patients and assessing its ability as a prognostic factor for clinical outcome is also discussed.
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Affiliation(s)
- Chan W Kim
- Cardiology Department, & The Department of Medicine, Westchester Medical Center & New York Medical College, Valhalla, NY 10595, USA
| | - Wilbert S Aronow
- Cardiology Department, & The Department of Medicine, Westchester Medical Center & New York Medical College, Valhalla, NY 10595, USA
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22
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Ashraf H, Soleimani A, Kazemi saeid A, Sadat Naseri A, Majidi F, Peirovi N, Karbalai Saleh S. Troponin I biomarker as a strong prognostic factor for predicting COVID-19 mortality: A systematic review. World J Meta-Anal 2021; 9:342-352. [DOI: 10.13105/wjma.v9.i4.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/03/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The increase in circulating Troponin-I in the blood of patients suffering coronavirus disease 2019 (COVID-19) can be a strong prognostic factor for predicting disease poorer outcome.
AIM To review the literatures to approve this claim systematically.
METHODS Two blinded reviewers independently screened the titles and abstracts of the manuscripts using the keywords and deeply searching the databanks including PubMed, Scopus, Google Scholar, and Web of knowledge, followed by profoundly appraisement of the full texts to assess the inclusion appropriateness.
RESULTS The manuscripts entered into our final assessment were categorized as the two groups including 10 manuscripts describing and comparing death and disease-related complications between the subgroups of patients with raised serum troponin level and those with normal ranges of this biomarker and 7 manuscripts comparing the mean level of serum troponin concentration across the survived and non-survived groups. Comparing outcome of COVID-19 disease in the groups with raised troponin level and normal level of this markers showed increased the likelihood of death [hazard ratio (HR) = 4.967, P < 0.001], acute respiratory distress syndrome (HR = 5.914, P < 0.001), acute kidney injury (HR = 3.849, P < 0.001), and intensive care unit (ICU) admission (HR = 3.780, P < 0.001) following raise of troponin. The pooled analysis showed significantly higher concentration of this marker in the survived group compared to non-survived group (weighted mean differences of 22.278, 95%CI: 15.647 to 28.927, P < 0.001).
CONCLUSION Raising troponin-I on admission can be linked to the increase risk for in-hospital death, acute respiratory distress syndrome, kidney injury, and ICU admission by 4.9, 5.9, 3.8, and 3.7 times as compared to those with initial normal troponin-I concentration. Thus, raising baseline value of troponin-I can be used as a prognostic factor for poor outcome of COVID-19.
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Affiliation(s)
- Haleh Ashraf
- Department of Cardiology, Tehran University of Medical Sciences, Tehran 1136746911, Iran
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, zip code 1411713138
| | - Abbas Soleimani
- Department of Cardiology, Tehran University of Medical Sciences, Tehran 1136746911, Iran
| | - Ali Kazemi saeid
- Department of Cardiology, Tehran University of Medical Sciences, Tehran 1136746911, Iran
| | - Azadeh Sadat Naseri
- Department of Cardiology, Tehran University of Medical Sciences, Tehran 1136746911, Iran
| | - Fazeleh Majidi
- Reserch and Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran 1136746911, Iran
| | - Niloufar Peirovi
- Reserch and Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran 1136746911, Iran
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Specific Risk Factors for Fatal Outcome in Critically Ill COVID-19 Patients: Results from a European Multicenter Study. J Clin Med 2021; 10:jcm10173855. [PMID: 34501301 PMCID: PMC8432209 DOI: 10.3390/jcm10173855] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: The aim of our study was to identify specific risk factors for fatal outcome in critically ill COVID-19 patients. (2) Methods: Our data set consisted of 840 patients enclosed in the LEOSS registry. Using lasso regression for variable selection, a multifactorial logistic regression model was fitted to the response variable survival. Specific risk factors and their odds ratios were derived. A nomogram was developed as a graphical representation of the model. (3) Results: 14 variables were identified as independent factors contributing to the risk of death for critically ill COVID-19 patients: age (OR 1.08, CI 1.06–1.10), cardiovascular disease (OR 1.64, CI 1.06–2.55), pulmonary disease (OR 1.87, CI 1.16–3.03), baseline Statin treatment (0.54, CI 0.33–0.87), oxygen saturation (unit = 1%, OR 0.94, CI 0.92–0.96), leukocytes (unit 1000/μL, OR 1.04, CI 1.01–1.07), lymphocytes (unit 100/μL, OR 0.96, CI 0.94–0.99), platelets (unit 100,000/μL, OR 0.70, CI 0.62–0.80), procalcitonin (unit ng/mL, OR 1.11, CI 1.05–1.18), kidney failure (OR 1.68, CI 1.05–2.70), congestive heart failure (OR 2.62, CI 1.11–6.21), severe liver failure (OR 4.93, CI 1.94–12.52), and a quick SOFA score of 3 (OR 1.78, CI 1.14–2.78). The nomogram graphically displays the importance of these 14 factors for mortality. (4) Conclusions: There are risk factors that are specific to the subpopulation of critically ill COVID-19 patients.
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Tang Y, Hu L, Liu Y, Zhou B, Qin X, Ye J, Shen M, Wu Z, Zhang P. Possible mechanisms of cholesterol elevation aggravating COVID-19. Int J Med Sci 2021; 18:3533-3543. [PMID: 34522180 PMCID: PMC8436106 DOI: 10.7150/ijms.62021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/04/2021] [Indexed: 12/23/2022] Open
Abstract
Importance: Despite the availability of a vaccine against the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), humans will have to live with this virus and the after-effects of the coronavirus disease 2019 (COVID-19) infection for a long time. Cholesterol plays an important role in the infection and prognosis of SARS-CoV-2, and the study of its mechanism is of great significance not only for the treatment of COVID-19 but also for research on generic antiviral drugs. Observations: Cholesterol promotes the development of atherosclerosis by activating NLR family pyrin domain containing 3 (NLRP3), and the resulting inflammatory environment indirectly contributes to COVID-19 infection and subsequent deterioration. In in vitro studies, membrane cholesterol increased the number of viral entry sites on the host cell membrane and the number of angiotensin-converting enzyme 2 (ACE2) receptors in the membrane fusion site. Previous studies have shown that the fusion protein of the virus interacts with cholesterol, and the spike protein of SARS-CoV-2 also requires cholesterol to enter the host cells. Cholesterol in blood interacts with the spike protein to promote the entry of spike cells, wherein the scavenger receptor class B type 1 (SR-B1) plays an important role. Because of the cardiovascular protective effects of lipid-lowering therapy and the additional anti-inflammatory effects of lipid-lowering drugs, it is currently recommended to continue lipid-lowering therapy for patients with COVID-19, but the safety of extremely low LDL-C is questionable. Conclusions and Relevance: Cholesterol can indirectly increase the susceptibility of patients to SARS-CoV-2 and increase the risk of death from COVID-19, which are mediated by NLRP3 and atherosclerotic plaques, respectively. Cholesterol present in the host cell membrane, virus, and blood may also directly participate in the virus cell entry process, but the specific mechanism still needs further study. Patients with COVID-19 are recommended to continue lipid-lowering therapy.
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Affiliation(s)
- Yan Tang
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, 235 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
- Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, No. 6, Chenggui Road, East District, Zhongshan, 528403, Guangdong, People's Republic of China
| | - Longtai Hu
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, 235 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
- School of Traditional Chinese Medicine, Southern Medical University, No. 6, Chenggui Road, East District, Zhongshan, 528403, Guangdong, People's Republic of China
| | - Yi Liu
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, 235 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
- Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, No. 6, Chenggui Road, East District, Zhongshan, 528403, Guangdong, People's Republic of China
| | - Bangyi Zhou
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, 235 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
- Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, No. 6, Chenggui Road, East District, Zhongshan, 528403, Guangdong, People's Republic of China
| | - Xiaohuan Qin
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, 235 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
- Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, No. 6, Chenggui Road, East District, Zhongshan, 528403, Guangdong, People's Republic of China
| | - Jujian Ye
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, 235 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
- Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, No. 6, Chenggui Road, East District, Zhongshan, 528403, Guangdong, People's Republic of China
| | - Maoze Shen
- Department of Cardiology, Raoping County People's Hospital, 161 Caichang Street, Huanggang Town, Chaozhou, 515700, Guangdong, People's Republic of China
| | - Zhijian Wu
- Department of Cardiology, Affiliated Boai Hospital of Zhongshan, Southern Medical University, No. 6, Chenggui Road, East District, Zhongshan, 528403, Guangdong, People's Republic of China
| | - Peidong Zhang
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, 235 Industrial Avenue, Guangzhou, 510282, Guangdong, People's Republic of China
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Colombo C, Garatti L, Ferrante G, Casadei F, Montalto C, Crimi G, Cogliati C, Ammirati E, Savonitto S, Morici N. Cardiovascular injuries and SARS-COV-2 infection: focus on elderly people. J Geriatr Cardiol 2021; 18:534-548. [PMID: 34404990 PMCID: PMC8352775 DOI: 10.11909/j.issn.1671-5411.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The novel coronavirus disease (COVID-19) has hit the healthcare system worldwide. The risk of severe infection and mortality increases with advancing age, especially in subjects with comorbidities such as cardiovascular disease, hypertension, diabetes, obesity and cancer. Moreover, cardiovascular complications such as myocardial injury, heart failure and thromboembolism are frequently observed in COVID-19 cases, and several biomarkers (troponin, NTproBNP and D-Dimer) have been identified as prognostic indicators of disease severity and worst outcome. Currently, there is no specific therapy against SARS-CoV-2, although many medications are under investigation. The aim of this review will be to explore the intertwined relationship between COVID-19 disease and the cardiovascular system, focusing on elderly population. The available supportive treatments along with the related concerns in elderly patients, due to their comorbidities and polypharmacotherapy, will be explored.
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Affiliation(s)
- Claudia Colombo
- Department of Cardiology De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Garatti
- Department of Cardiology De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, University of Milano Bicocca, Italy
| | - Giulia Ferrante
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Italy
| | - Francesca Casadei
- Department of Cardiology De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Claudio Montalto
- Division of Cardiology, University of Pavia, Pavia, Lombardia, Italy
| | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio Thoraco Vascular Department (DICATOV), IRCCS Policlinico San Martino, Genova, Italy
| | - Chiara Cogliati
- Internal Medicine, Department of Medicine and Riabilitation, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | | | - Nuccia Morici
- Department of Cardiology De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Rubattu S, Gallo G, Volpe M. A Contemporary View of Natriuretic Peptides in the SARS-CoV-2 Era. Front Physiol 2021; 12:643721. [PMID: 34335287 PMCID: PMC8322647 DOI: 10.3389/fphys.2021.643721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/16/2021] [Indexed: 12/11/2022] Open
Abstract
The heart releases natriuretic peptides (NPs) which represent an important hormonal axis with cardiorenal protective effects. In view of their properties, NPs have pathophysiologic, diagnostic and prognostic implications in several cardiovascular diseases (CVDs). Severe pulmonary inflammation, as induced by the SARS-COV2, may increase pulmonary pressure with potential influence on NPs release, whereby normal cardiovascular integrity becomes impaired. Moreover, pre-existing CVDs are strong negative prognostic factors since they exacerbate the effects of the viral infection and lead to worse outcomes. In this context, it may be expected that NPs exert a key protective role toward the virus infection whereas an impairment of NPs release contributes to the virus deleterious effects. In this review article we explore the potential involvement of NPs in the COVID-19 disease. To this aim, we will first focus on the interactions between NPs and the Ang II/ATIR arm of the renin-angiotensin-aldosterone system (RAAS) as well as with the protective ACE2/Ang (1-7) arm of the RAAS. Subsequently, we will review evidence that strongly supports the role of increased NT-proBNP level as a marker of cardiac damage and of worse prognosis in the COVID-19 affected patients. Finally, we will discuss the potential therapeutic benefits of these protective hormones toward the viral infection through their endothelial protective function, anti-inflammatory and anti-thrombotic effects. In conclusion, the potential implications of NPs in the SARS-CoV-2 infection, as discussed in our article, represent an important issue that deserves to be fully investigated.
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Affiliation(s)
- Speranza Rubattu
- Cardiology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Giovanna Gallo
- Cardiology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Volpe
- Cardiology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
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Cini Oliveira M, de Araujo Eleuterio T, de Andrade Corrêa AB, da Silva LDR, Rodrigues RC, de Oliveira BA, Martins MM, Raymundo CE, de Andrade Medronho R. Fatores associados ao óbito em casos confirmados de COVID-19 no estado do Rio de Janeiro. BMC Infect Dis 2021; 21:687. [PMID: 34271868 PMCID: PMC8283387 DOI: 10.1186/s12879-021-06384-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 can occur asymptomatically, as influenza-like illness, or as more severe forms, which characterize severe acute respiratory syndrome (SARS). Its mortality rate is higher in individuals over 80 years of age and in people with comorbidities, so these constitute the risk group for severe forms of the disease. We analyzed the factors associated with death in confirmed cases of COVID-19 in the state of Rio de Janeiro. This cross-sectional study evaluated the association between individual demographic, clinical, and epidemiological variables and the outcome (death) using data from the Unified Health System information systems. METHODS We used the extreme boosting gradient (XGBoost) model to analyze the data, which uses decision trees weighted by the estimation difficulty. To evaluate the relevance of each independent variable, we used the SHapley Additive exPlanations (SHAP) metric. From the probabilities generated by the XGBoost model, we transformed the data to the logarithm of odds to estimate the odds ratio for each independent variable. RESULTS This study showed that older individuals of black race/skin color with heart disease or diabetes who had dyspnea or fever were more likely to die. CONCLUSIONS The early identification of patients who may progress to a more severe form of the disease can help improve the clinical management of patients with COVID-19 and is thus essential to reduce the lethality of the disease.
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Affiliation(s)
| | - Tatiana de Araujo Eleuterio
- Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
- Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Lucas Dalsenter Romano da Silva
- Departamento de Medicina Preventiva, Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | - Marlos Melo Martins
- Department of Child Neurology, Martagão Gesteira Institute of Childcare and Pediatrics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Eduardo Raymundo
- Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Roberto de Andrade Medronho
- Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Portale G, Ciolina F, Arcari L, Giraldi GDL, Danti M, Pietropaolo L, Camastra G, Cordischi C, Urbani L, Proietti L, Cacciotti L, Santini C, Melandri S, Ansalone G, Sbarbati S, Sighieri C. Lung Ultrasound in COVID-19: Clinical Correlates and Comparison with Chest Computed Tomography. ACTA ACUST UNITED AC 2021; 3:2075-2081. [PMID: 34179691 PMCID: PMC8211720 DOI: 10.1007/s42399-021-00986-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 12/14/2022]
Abstract
Lung ultrasound (LUS) and chest computed tomography (chest CT) are largely employed to evaluate coronavirus disease 2019 (COVID-19) pneumonia. We investigated semi-quantitative LUS and CT scoring in hospitalized COVID-19 patients. LUS and chest CT were performed within 24 h upon admission. Both were analyzed according to semi-quantitative scoring systems. Subgroups were identified according to median LUS score. Patients within higher LUS score group were older (79 vs 60 years, p<0.001), had higher C-reactive protein (CRP) (7.2 mg/dl vs 1.3 mg/dl, p<0.001) and chest CT score (10 vs 4, p=0.027) as well as lower PaO2/FiO2 (286 vs 356, p=0.029) as compared to patients within lower scores. We found a significant correlation between scores (r=0.390, p=0.023). Both LUS and CT scores correlated directly with patients age (r=0.586, p<0.001 and r=0.399, p=0.021 respectively) and CRP (r=0.472, p=0.002 and r=0.518, p=0.002 respectively), inversely with PaO2/FiO2 (r=-0.485, p=0.003 and r=-0.440, p=0.017 respectively). LUS score only showed significant correlation with hs-troponin T, NT-pro-BNP, and creatinine (r=0.433, p=0.019; r=0.411, p=0.027, and r=0.497, p=0.001, respectively). Semi-quantitative bedside LUS is related to the severity of COVID-19 pneumonia similarly to chest CT. Correlation of LUS score with markers of cardiac and renal injury suggests that LUS might contribute to a more comprehensive evaluation of this heterogeneous population.
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Affiliation(s)
- Grazia Portale
- Emergency Medicine Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Federica Ciolina
- Radiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Luca Arcari
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | | | - Massimiliano Danti
- Radiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Lorenzo Pietropaolo
- Emergency Medicine Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Giovanni Camastra
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Chiara Cordischi
- Emergency Medicine Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Laura Urbani
- Emergency Medicine Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Lidia Proietti
- Emergency Medicine Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Luca Cacciotti
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Claudio Santini
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Serena Melandri
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Gerardo Ansalone
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Stefano Sbarbati
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Cinzia Sighieri
- Emergency Medicine Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
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Schreiber A, Elango K, Hong K, Ahsan C. Cardiac transplant recipient with COVID-19 induced acute hypoxic respiratory failure: a case report. Eur Heart J Case Rep 2021; 5:ytab217. [PMID: 34189399 PMCID: PMC8233495 DOI: 10.1093/ehjcr/ytab217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/10/2020] [Accepted: 05/12/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Heart transplant recipients represent a particularly vulnerable patient population to the novel coronavirus disease 2019 (COVID-19) due to chronic immunosuppression and high rates of comorbidities. Currently, data are limited and evidence to guide management of heart transplant recipients with COVID-19 is sparse. In this case report, we provide a summary of the current literature as well as an in-depth analysis of our clinical decision-making. CASE SUMMARY A 67-year-old female who underwent cardiac transplantation 1 year prior was found to have acute hypoxic respiratory failure due to COVID-19. Her immunosuppressant medications were modulated with discontinuation of mycophenolate and titration of tacrolimus troughs with a goal of 6-10 ng/dL. She was administered supportive treatment including convalescent plasma, remdesivir, and dexamethasone, in addition to antibiotic treatment that resulted in resolution of her symptoms within a matter of days despite her precarious disposition. DISCUSSION This case demonstrates that it can be safe and efficacious to modulate immunosuppressant medications in cardiac transplant recipients in accordance with recommendations made by the International Society of Heart and Lung Transplantation. This case additionally demonstrates that aspects of the current literature regarding the management of COVID-19 can be safely extrapolated to cardiac transplant recipients. Providing supportive care with dexamethasone, remdesivir, and convalescent plasma as indicated can be beneficial in cardiac transplant recipients; although, the current literature regarding convalescent plasma and remdesivir is conflicting.
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Affiliation(s)
- Ariyon Schreiber
- Department of Cardiology, University of Nevada, Las Vegas, 1800 W Charleston Blvd, Las Vegas, NV 89102, USA
| | - Kalaimani Elango
- Department of Cardiology, University of Nevada, Las Vegas, 1800 W Charleston Blvd, Las Vegas, NV 89102, USA
| | - Kimberly Hong
- Department of Cardiology, University of California, San Diego Health, 200 West Arbor Drive, San Diego, CA 92103, USA
| | - Chowdhury Ahsan
- Department of Cardiology, University of Nevada, Las Vegas, 1800 W Charleston Blvd, Las Vegas, NV 89102, USA
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30
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Norden N, Lundin EO, Hagberg E, Gao SA, Hård af Segerstad M, Nellgård B, Dalla K. Cardiac involvement in critically ill and mechanically ventilated patients with COVID-19 - a prospective, observational echocardiographic study. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:253-261. [PMID: 34084661 PMCID: PMC8166586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/20/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION In this prospective, observational study, we have evaluated right (RV) and left (LV) ventricular function with echocardiography and correlated it to the levels of biomarkers, hs-TNT, NT-pro-BNP, D-dimer and fibrinogen. In a subgroup, we have evaluated the effect of inhaled milrinone on RV afterload and function. METHODS Thirty-one ICU patients with COVID-19 in need of mechanical ventilation and norepinephrine infusion were prospectively included. Hemodynamic and respiratory variables were measured at the time of the echocardiographic examination and biomarkers were obtained on arrival at the ICU and then followed up routinely. Eight patients received inhaled aerosolized milrinone at a dose of 2.5 mg/hour. RESULTS The most common echocardiographic pattern was RV dilation with or without systolic dysfunction, which was found in 62% of patients. Pulmonary acceleration time was abnormal in 55% and indices of RV systolic function, such as fractional area of change, RV strain, were abnormal in 30% and 31% of patients respectively. A cardiac index of < 2.5 l/min*m2 was seen in 58% of the patients. Left ventricular ejection fraction and global left ventricular strain were impaired in 10% and 16% respectively. The correlation between echocardiographic variables and cardiac biomarkers was poor. RV afterload correlated well to the levels of D-dimer. Milrinone inhalation did not improve RV function or afterload. CONCLUSION RV dysfunction was the most common finding. The poor correlation to cardiac biomarkers argues against extensive myocardial involvement. The lack of improvement in RV function after milrinone inhalation suggests that the most likely cause of RV dysfunction is increased RV afterload caused by pulmonary thrombosis/embolism.
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Affiliation(s)
- Nina Norden
- Department of Anaesthesia and Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
| | - Erik O Lundin
- Department of Anaesthesia and Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
| | - Eva Hagberg
- Department of Clinical Physiology, Institute of Medicine, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of GothenburgSweden
| | - Sinsia A Gao
- Department of Clinical Physiology, Institute of Medicine, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
| | - Mathias Hård af Segerstad
- Department of Anaesthesia and Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
| | - Bengt Nellgård
- Department of Anaesthesia and Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
| | - Keti Dalla
- Department of Anaesthesia and Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
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Wibowo A, Pranata R, Akbar MR, Purnomowati A, Martha JW. Prognostic performance of troponin in COVID-19: A diagnostic meta-analysis and meta-regression. Int J Infect Dis 2021; 105:312-318. [PMID: 33667694 PMCID: PMC7923942 DOI: 10.1016/j.ijid.2021.02.113] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cardiac injury is frequently encountered in patients with coronavirus disease 2019 (COVID-19) and is associated with increased risk of mortality. Elevated troponin may signify myocardial damage and is predictive of mortality. This study aimed to assess the prognostic value of troponin above the 99th percentile upper reference limit (URL) for mortality, and factors affecting the relationship. METHODS A comprehensive literature search of PubMed (MEDLINE), Scopus and Embase was undertaken, from inception of the databases until 16 December 2020. The key exposure was elevated serum troponin, defined as troponin (of any type) above the 99th percentile URL. The outcome was mortality due to any cause. RESULTS In total, 12,262 patients from 13 studies were included in this systematic review and meta-analysis. The mortality rate was 23% (20-26%). Elevated troponin was observed in 31% (23-38%) of patients. Elevated troponin was associated with increased mortality [odds ratio (OR) 4.75, 95% confidence interval (CI) 4.07-5.53; P < 0.001; I2 = 19.9%]. Meta-regression showed that the association did not vary with age (P = 0.218), male gender (P = 0.707), hypertension (P = 0.182), diabetes (P = 0.906) or coronary artery disease (P = 0864). The association between elevated troponin and mortality had sensitivity of 0.55 (0.44-0.66), specificity of 0.80 (0.71-0.86), positive likelihood ratio of 2.7 (2.2-3.3), negative likelihood ratio of 0.56 (0.49-0.65), diagnosis odds ratio of 5 (4-5) and area under the curve of 0.73 (0.69-0.77). The probability of mortality was 45% in patients with elevated troponin and 14% in patients with non-elevated troponin. CONCLUSION Elevated troponin was associated with mortality in patients with COVID-19 with 55% sensitivity and 80% specificity.
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Affiliation(s)
- Arief Wibowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia; Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
| | - Augustine Purnomowati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
| | - Januar Wibawa Martha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
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32
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Umbrajkar S, Stankowski RV, Rezkalla S, Kloner RA. Cardiovascular Health and Disease in the Context of COVID-19. Cardiol Res 2021; 12:67-79. [PMID: 33738009 PMCID: PMC7935632 DOI: 10.14740/cr1199] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
First documented in China in early December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly and continues to test the strength of healthcare systems and public health programs all over the world. Underlying cardiovascular disease has been recognized as a risk factor for coronavirus disease 2019 (COVID-19)-related morbidity and mortality since the early days of the pandemic. In addition, evidence demonstrates cardiac and endothelial damage in somewhere between one-third and three-quarters of individuals with COVID-19, regardless of symptom severity. This damage is thought to be mediated by direct viral infection, immunopathology and hypoxemia with the additional possibility of exacerbation via medication-induced cardiotoxicity. Clinically, the cardiovascular consequences of COVID-19 may present as myocarditis with or without arrhythmia, endothelial dysfunction and thrombosis, acute coronary syndromes and heart failure. Presentation can vary widely and may or may not be typical of the condition in an individual without COVID-19. There is evidence to support the prognostic utility of cardiac biomarkers (e.g., cardiac troponin) and imaging studies (e.g., echocardiography, cardiac magnetic resonance imaging) in the context of COVID-19 and building evidence suggests that cardiovascular screening may be warranted even among those with asymptomatic or mild infection and those without traditional cardiovascular risk factors. In addition, evidence suggests the potential for long-term cardiovascular consequences for those who recover from COVID-19 with implications for the field of cardiology long into the future. Even among those without COVID-19, disruption of infrastructure and changes in human behavior as a result of the pandemic also have an upstream role in cardiovascular outcomes, which have already been documented in multiple locations. This review summarizes what is currently known regarding the pathogenic mechanisms of COVID-19-related cardiovascular injury and describes clinical cardiovascular presentations, prognostic indicators, recommendations for screening and treatment, and long-term cardiovascular consequences of infection. Ultimately, medical personnel must be vigilant in their attention to possible cardiovascular symptoms, take appropriate steps for clinical diagnosis and be prepared for long-term ramifications of myocardial injury sustained as a result of COVID-19.
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Affiliation(s)
- Sidhant Umbrajkar
- University of California, Los Angeles (UCLA), 10833 Le Conte Ave., Los Angeles, CA 90095, USA.,Huntington Medical Research Institutes, 686 South Fair Oaks Ave., Pasadena, CA 91105, USA
| | - Rachel V Stankowski
- Family Health Center of Marshfield, Inc., Marshfield Clinic Health System, 1000 N Oak Ave., Marshfield, WI 54449, USA
| | - Shereif Rezkalla
- Department of Cardiology, Marshfield Medical Center, 1000 N Oak Ave., Marshfield, WI 54449, USA
| | - Robert A Kloner
- Huntington Medical Research Institutes, 686 South Fair Oaks Ave., Pasadena, CA 91105, USA.,Keck School of Medicine of the University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
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33
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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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34
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Hoepler W, Traugott MT, Christ G, Kitzberger R, Pawelka E, Karolyi M, Seitz T, Baumgartner S, Kelani H, Wenisch C, Laferl H, Zoufaly A, Weseslindtner L, Neuhold S. Clinical and Angiographic Features in Three COVID-19 Patients with Takotsubo Cardiomyopathy. Case Report. ACTA ACUST UNITED AC 2021; 3:263-268. [PMID: 33426474 PMCID: PMC7786154 DOI: 10.1007/s42399-020-00683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 10/31/2022]
Abstract
While coronavirus disease 2019 (COVID-19), caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), has often been perceived as a predominantly respiratory condition, it is characterized by complications in multiple organ systems. Especially the involvement of the cardiovascular system, along with the possibly severe pulmonary injury, is crucial for prognosis. We identified three COVID-19 patients with takotsubo (TT) cardiomyopathy at our infectious diseases treatment center and present their clinical, laboratory, echocardiographic, electrocardiographic, and angiographic features. All patients were female (median age, 67 years); disease severity regarding COVID-19 ranged from asymptomatic to ARDS (adult respiratory syndrome) necessitating mechanical ventilation for 22 days. Angiography revealed normal coronary arteries in patient 1, severe three-vessel coronary artery disease (CAD) in patient 2, and insignificant bystander CAD in patient 3. All patients showed classic apical hypokinesia with basal hyperkinesia. In patient 3, TT cardiomyopathy resulted in transient cardiogenic shock. Twenty-eight-day mortality was 0% in this case series. In conclusion, takotsubo cardiomyopathy may be yet another clinical entity associated with SARS-CoV-2 infection.
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Affiliation(s)
- Wolfgang Hoepler
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Marianna Theresia Traugott
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Guenter Christ
- Fifth Medical Department with Cardiology, Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Reinhard Kitzberger
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Erich Pawelka
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Mario Karolyi
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Tamara Seitz
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Sebastian Baumgartner
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Hasan Kelani
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Christoph Wenisch
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Hermann Laferl
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | - Alexander Zoufaly
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
| | | | - Stephanie Neuhold
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten/Kaiser-Franz-Josef Hospital, 1100 Vienna, Austria
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35
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Luciani M, Bentivegna E, Spuntarelli V, Lamberti PA, Cacioli G, Del Porto F, Sesti G, Martelletti P, De Biase L. Recurrent COVID-19 pneumonia in the course of chemotherapy: Consequence of a weakened immune system? J Med Virol 2020; 93:1882-1884. [PMID: 33247596 PMCID: PMC7753699 DOI: 10.1002/jmv.26701] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Michelangelo Luciani
- Internal Medicine Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Enrico Bentivegna
- Internal Medicine Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Valerio Spuntarelli
- Emergency Medicine COVID-19 Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Piera Amoriello Lamberti
- Internal Medicine Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Giulio Cacioli
- Cardiology Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Flavia Del Porto
- Internal Medicine Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Giorgio Sesti
- Internal Medicine Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Paolo Martelletti
- Emergency Medicine COVID-19 Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Luciano De Biase
- Emergency Medicine COVID-19 Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy.,Heart Failure Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
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36
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Martelletti P, Bentivegna E, Luciani M, Spuntarelli V. Headache as a Prognostic Factor for COVID-19. Time to Re-evaluate. ACTA ACUST UNITED AC 2020; 2:2509-2510. [PMID: 33263101 PMCID: PMC7690334 DOI: 10.1007/s42399-020-00657-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/17/2022]
Abstract
Headache occurs in only about 13% of patients within the cohort of presenting COVID-19 symptoms. The hypothesis that such a painful symptomatic picture could be considered a prognostic factor for COVID-19 positive evolution or its trend of severity, or the co-generation of hyposmia/anosmia and/or hypogeusia/ageusia, needs robust epidemiological data, punctual pathophysiological demonstrations, and a detailed comparative analysis on drug–drug interactions (DDIs).
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Affiliation(s)
- Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Emergency Medicine & COVID-19 Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Enrico Bentivegna
- Emergency Medicine & COVID-19 Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Michelangelo Luciani
- Emergency Medicine & COVID-19 Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Valerio Spuntarelli
- Emergency Medicine & COVID-19 Unit, Sant'Andrea University Hospital, Rome, Italy
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37
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Zhao BC, Liu WF, Lei SH, Zhou BW, Yang X, Huang TY, Deng QW, Xu M, Li C, Liu KX. Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis. J Intensive Care 2020; 8:88. [PMID: 33292649 PMCID: PMC7682759 DOI: 10.1186/s40560-020-00508-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The clinical significance of cardiac troponin measurement in patients hospitalised for coronavirus disease 2019 (covid-19) is uncertain. We investigated the prevalence of elevated troponins in these patients and its prognostic value for predicting mortality. METHODS Studies were identified by searching electronic databases and preprint servers. We included studies of hospitalised covid-19 patients that reported the frequency of troponin elevations above the upper reference limit and/or the association between troponins and mortality. Meta-analyses were performed using random-effects models. RESULTS Fifty-one studies were included. Elevated troponins were found in 20.8% (95% confidence interval [CI] 16.8-25.0 %) of patients who received troponin test on hospital admission. Elevated troponins on admission were associated with a higher risk of subsequent death (risk ratio 2.68, 95% CI 2.08-3.46) after adjusting for confounders in multivariable analysis. The pooled sensitivity of elevated admission troponins for predicting death was 0.60 (95% CI 0.54-0.65), and the specificity was 0.83 (0.77-0.88). The post-test probability of death was about 42% for patients with elevated admission troponins and was about 9% for those with non-elevated troponins on admission. There was significant heterogeneity in the analyses, and many included studies were at risk of bias due to the lack of systematic troponin measurement and inadequate follow-up. CONCLUSION Elevated troponins were relatively common in patients hospitalised for covid-19. Troponin measurement on admission might help in risk stratification, especially in identifying patients at high risk of death when troponin levels are elevated. High-quality prospective studies are needed to validate these findings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020176747.
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Affiliation(s)
- Bing-Cheng Zhao
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Wei-Feng Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Shao-Hui Lei
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Bo-Wei Zhou
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Xiao Yang
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Tong-Yi Huang
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Qi-Wen Deng
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Miao Xu
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Cai Li
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Ke-Xuan Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China.
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38
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Wagner J, Garcia-Rodriguez V, Yu A, Dutra B, DuPont A, Cash B, Farooq A. Elevated D-Dimer Is Associated with Multiple Clinical Outcomes in Hospitalized Covid-19 Patients: a Retrospective Cohort Study. ACTA ACUST UNITED AC 2020; 2:2561-2567. [PMID: 33195993 PMCID: PMC7648852 DOI: 10.1007/s42399-020-00627-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 01/08/2023]
Abstract
D-dimer is a prognostic marker for Covid-19 disease mortality and severity in hospitalized patients; however, little is known about the association between D-dimer and other clinical outcomes. The aim of this paper was to define a threshold of D-dimer to use in hospitalized patients with Covid-19 and to assess its utility in prognosticating in-hospital mortality, development of an acute kidney injury (AKI), and need for hemodialysis, vasopressors, or intubation. This is a single-center, retrospective, cohort review study of 100 predominantly minority patients (94%) hospitalized with Covid-19. The electronic medical record system was used to collect data. Receiver operating characteristics (ROC) and area under the curve (AUC) analysis were used to determine optimal thresholds of peak D-dimer, defined as the highest D-dimer obtained during admission that was clinically meaningful. Odds ratios were then used to assess the relationship between peak D-dimer thresholds and clinical outcomes. D-dimer > 2.1 μg/mL and > 2.48 μg/mL had > 90% sensitivity and > 50% specificity for predicting need for vasopressors (AUC 0.80) or intubation (AUC 0.83) and in-hospital mortality (AUC 0.89), respectively. Additionally, D-dimer > 4.86 μg/mL had a 100% sensitivity and 81% specificity for predicting the need for hemodialysis (AUC 0.92). Furthermore, peak D-dimer > 2.48 μg/mL was associated with in-hospital mortality (p < 0.001), development of an AKI (p = 0.002), and need for intubation (p < 0.001), hemodialysis (p < 0.001), and vasopressors (p < 0.001). Peak D-dimer > 2.48 μg/mL may be a useful threshold that is prognostic of multiple clinical outcomes in hospitalized patients with Covid-19.
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Affiliation(s)
- Jason Wagner
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA
| | - Victor Garcia-Rodriguez
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA
| | - Abraham Yu
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA
| | - Barbara Dutra
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA
| | - Andrew DuPont
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA
| | - Brooks Cash
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA
| | - Ahmad Farooq
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX USA.,Department of Medicine, Division of Gastroenterology and Hepatology, Duke University, Durham, NC USA
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