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Sha'ari NI, Ismail A, Abdul Aziz AF, Suddin LS, Azzeri A, Sk Abd Razak R, Mad Tahir NS. Cardiovascular diseases as risk factors of post-COVID syndrome: a systematic review. BMC Public Health 2024; 24:1846. [PMID: 38987743 PMCID: PMC11238467 DOI: 10.1186/s12889-024-19300-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/28/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND A growing proportion of people experience incomplete recovery months after contracting coronavirus disease 2019 (COVID-19). These COVID-19 survivors develop a condition known as post-COVID syndrome (PCS), where COVID-19 symptoms persist for > 12 weeks after acute infection. Limited studies have investigated PCS risk factors that notably include pre-existing cardiovascular diseases (CVD), which should be examined considering the most recent PCS data. This review aims to identify CVD as a risk factor for PCS development in COVID-19 survivors. METHODS Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) checklist, systematic literature searches were performed in the PubMed, Scopus, and Web of Science databases from the earliest date available to June 2023. Data from observational studies in English that described the association between CVD and PCS in adults (≥ 18 years old) were included. A minimum of two authors independently performed the screening, study selection, data extraction, data synthesis, and quality assessment (Newcastle-Ottawa Scale). The protocol of this review was registered under PROSPERO (ID: CRD42023440834). RESULTS In total, 594 studies were screened after duplicates and non-original articles had been removed. Of the 11 included studies, CVD including hypertension (six studies), heart failure (three studies), and others (two studies) were significantly associated with PCS development with different factors considered. The included studies were of moderate to high methodological quality. CONCLUSION Our review highlighted that COVID-19 survivors with pre-existing CVD have a significantly greater risk of developing PCS symptomology than survivors without pre-existing CVD. As heart failure, hypertension and other CVD are associated with a higher risk of developing PCS, comprehensive screening and thorough examinations are essential to minimise the impact of PCS and improve patients' disease progression.
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Affiliation(s)
- Nur Insyirah Sha'ari
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras Campus, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Aniza Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras Campus, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia.
- Faculty of Public Health, Universitas Sumatera Utara, North Sumatra, Jalan Universitas No. 21 Kampus USU, Medan, 20155, Indonesia.
| | - Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras Campus, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Leny Suzana Suddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh, 47000, Selangor, Malaysia
| | - Amirah Azzeri
- Department of Primary Care, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Putra Nilai, Negeri Sembilan, Nilai, 71800, Malaysia
| | - Ruhana Sk Abd Razak
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras Campus, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Nur Syazana Mad Tahir
- Federal Government Administrative Centre, Ministry of Health Malaysia, Pusat Pentadbiran Kerajaan Persekutuan, Wilayah Persekutuan Putrajaya, Putrajaya, 62000, Malaysia
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Matthaiou AM, Bizymi N, Pagonidis K, Manousaki E, Fragkoulakis M, Lambiri I, Mitrouska I, Vasarmidi E, Tzanakis N, Antoniou KM. Reversibility of the Enlargement of the Pulmonary Artery in COVID-19 Pneumonia as a Marker of Remission of the Disease. J Pers Med 2024; 14:161. [PMID: 38392595 PMCID: PMC10890114 DOI: 10.3390/jpm14020161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) pneumonia is associated with extensive pulmonary microangiopathy and the enlargement of the pulmonary artery (PA), while its progression after the remission of the disease has not been investigated yet. The aim was to assess the diametral increase in the PA in COVID-19 pneumonia, as revealed on chest computed tomography (CT), and further investigate its progression. This was a retrospective cohort study of patients with COVID-19 pneumonia, without prior history of pulmonary hypertension, who underwent CT pulmonary angiography before, during, and after the infection. Pulmonary embolism was excluded in all cases. The main PA diameter (MPAD) was assessed in consecutive chest imaging. Statistical analysis was performed with the non-parametric Wilcoxon and Kruskal-Wallis tests, while correlations were performed with the non-parametric Spearman test. A mean ± SD MPAD of 3.1 ± 0.3 cm in COVID-19 pneumonia was significantly decreased to 2.8 ± 0.3 cm in the post-infectious state after 2-18 months in 31 patients (p-value: <0.0001). In a subgroup of six patients with more than one post-COVID-19 CT, a significant further decline in the diameter was observed (p-value: 0.0313). On the other hand, in accordance with the literature, a significant increase in the MPAD during COVID-19 pneumonia was noted in a group of 10 patients with a pre-COVID-19 CT (p-value: 0.0371). The enlargement of the PA is a common finding in COVID-19 pneumonia that regresses after the remission of the disease, indicating that this reversible cardiovascular event is a potential marker of disease activity, while its course in long COVID is yet to be determined.
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Affiliation(s)
- Andreas M Matthaiou
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71500 Heraklion, Greece
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Nikoleta Bizymi
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71500 Heraklion, Greece
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Konstantinos Pagonidis
- Department of Medical Imaging, Knossos Medical Diagnosis Centre, 71409 Heraklion, Greece
| | - Eirini Manousaki
- Department of Medical Imaging, Knossos Medical Diagnosis Centre, 71409 Heraklion, Greece
| | - Michail Fragkoulakis
- Department of Medical Imaging, Knossos Medical Diagnosis Centre, 71409 Heraklion, Greece
| | - Irini Lambiri
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Ioanna Mitrouska
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Eirini Vasarmidi
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71500 Heraklion, Greece
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Nikolaos Tzanakis
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71500 Heraklion, Greece
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71500 Heraklion, Greece
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
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Mwangi VI, Netto RLA, de Morais CEP, Silva AS, Silva BM, Lima AB, Neves JCF, Borba MGS, Val FFDAE, de Almeida ACG, Costa AG, Sampaio VDS, Gardinassi LG, de Lacerda MVG, Monteiro WM, de Melo GC. Temporal patterns of cytokine and injury biomarkers in hospitalized COVID-19 patients treated with methylprednisolone. Front Immunol 2023; 14:1229611. [PMID: 37662953 PMCID: PMC10468998 DOI: 10.3389/fimmu.2023.1229611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background The novel coronavirus disease 2019 (COVID-19) presents with complex pathophysiological effects in various organ systems. Following the COVID-19, there are shifts in biomarker and cytokine equilibrium associated with altered physiological processes arising from viral damage or aggressive immunological response. We hypothesized that high daily dose methylprednisolone improved the injury biomarkers and serum cytokine profiles in COVID-19 patients. Methods Injury biomarker and cytokine analysis was performed on 50 SARS-Cov-2 negative controls and 101 hospitalized severe COVID-19 patients: 49 methylprednisolone-treated (MP group) and 52 placebo-treated serum samples. Samples from the treated groups collected on days D1 (pre-treatment) all the groups, D7 (2 days after ending therapy) and D14 were analyzed. Luminex assay quantified the biomarkers HMGB1, FABP3, myoglobin, troponin I and NTproBNP. Immune mediators (CXCL8, CCL2, CXCL9, CXCL10, TNF, IFN-γ, IL-17A, IL-12p70, IL-10, IL-6, IL-4, IL-2, and IL-1β) were quantified using cytometric bead array. Results At pretreatment, the two treatment groups were comparable demographically. At pre-treatment (D1), injury biomarkers (HMGB1, TnI, myoglobin and FABP3) were distinctly elevated. At D7, HMGB1 was significantly higher in the MP group (p=0.0448) compared to the placebo group, while HMGB1 in the placebo group diminished significantly by D14 (p=0.0115). Compared to healthy control samples, several immune mediators (IL-17A, IL-6, IL-10, MIG, MCP-1, and IP-10) were considerably elevated at baseline (all p≤0.05). At D7, MIG and IP-10 of the MP-group were significantly lower than in the placebo-group (p=0.0431, p=0.0069, respectively). Longitudinally, IL-2 (MP-group) and IL-17A (placebo-group) had increased significantly by D14. In placebo group, IL-2 and IL-17A continuously increased, as IL-12p70, IL-10 and IP-10 steadily decreased during follow-up. The MP treated group had IL-2, IFN-γ, IL-17A and IL-12p70 progressively increase while IL-1β and IL-10 gradually decreased towards D14. Moderate to strong positive correlations between chemokines and cytokines were observed on D7 and D14. Conclusion These findings suggest MP treatment could ameliorate levels of myoglobin and FABP3, but appeared to have no impact on HMGB1, TnI and NTproBNP. In addition, methylprednisolone relieves the COVID-19 induced inflammatory response by diminishing MIG and IP-10 levels. Overall, corticosteroid (methylprednisolone) use in COVID-19 management influences the immunological molecule and injury biomarker profile in COVID-19 patients.
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Affiliation(s)
- Victor Irungu Mwangi
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | | | - Carlos Eduardo Padron de Morais
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Arineia Soares Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | - Bernardo Maia Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Amanda Barros Lima
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, Brazil
| | | | - Mayla Gabriela Silva Borba
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Fernando Fonseca de Almeida e Val
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Anne Cristine Gomes de Almeida
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás (UFG), Goiânia, Brazil
| | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, Brazil
- Escola de Enfermagem de Manaus, Universidade Federal do Amazonas (UFAM), Manaus, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM) Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | - Vanderson de Souza Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Instituto Todos pela Saúde, São Paulo, São Paulo, Brazil
| | - Luiz Gustavo Gardinassi
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás (UFG), Goiânia, Brazil
| | - Marcus Vinicius Guimarães de Lacerda
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Instituto Leônidas & Maria Deane/Fundação Oswaldo Cruz (ILMD/Fiocruz Amazônia), Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Gisely Cardoso de Melo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM) Universidade do Estado do Amazonas (UEA), Manaus, Brazil
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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: 0] [Impact Index Per Article: 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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5
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Cheng A, Ren H, Ma Z, Alam N, Jia L, Liu E. Trends and characteristics of COVID-19 and cardiovascular disease related studies. Front Pharmacol 2023; 14:1105459. [PMID: 37180704 PMCID: PMC10166808 DOI: 10.3389/fphar.2023.1105459] [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] [Received: 12/05/2022] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction: The new coronavirus has caused a pandemic that has infected hundreds of millions of people around the world since its outbreak. But the cardiovascular damage caused by the new coronavirus is unknown. We have analyzed the current global scenario and the general pattern of growth. After summarizing the known relationship between cardiovascular diseases and new coronary pneumonia, relevant articles are analyzed through bibliometrics and visualization. Methods: Following our pre-designed search strategy, we selected publications on COVID-19 and cardiovascular disease in the Web of Science database. In our relevant bibliometric visualization analysis, a total of 7,028 related articles in the WOS core database up to 20th October 2022 were summarized, and the most prolific authors, the most prolific countries, and the journals and institutions that published the most articles were summarized and quantitatively analyzed. Results: SARS-CoV-2 is more infectious than SARS-CoV-1 and has significant involvement in the cardiovascular system in addition to pulmonary manifestations, with a difference of 10.16% (20.26%/10.10%) in the incidence of cardiovascular diseases. The number of cases increases in winter and decreases slightly in summer with temperature changes, but the increase in cases tends to break out of seasonality across the region as mutant strains emerge. The co-occurrence analysis found that with the progress of the epidemic, the research keywords gradually shifted from ACE2 and inflammation to the treatment of myocarditis and complications, indicating that the research on the new crown epidemic has entered the stage of prevention and treatment of complications. Conclusion: When combined with the current global pandemic trend, how to improve prognosis and reduce human body damage could become a research focus. At the same time, timely detection, prevention, and discovery of new mutant strains have also become key tasks in the fight against the epidemic, and full preparations have been made to prevent the spread of the next wave of mutant strains, and still need to continue to pay attention to the differential performance of the variant "omicron."
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Affiliation(s)
| | | | | | | | - Linying Jia
- Laboratory Animal Centre, Xi’an Jiaotong University Health Science Centre, Xi’an, Shaanxi, China
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Singh I, Swisher J, Gidda H, Nashed B, Rodriguez D. Acute Viral Pericarditis Complicated by Cardiac Tamponade as a Result of COVID-19. Cureus 2023; 15:e36695. [PMID: 37113373 PMCID: PMC10127944 DOI: 10.7759/cureus.36695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/28/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) and coronavirus disease 2019 (COVID-19) predominantly cause respiratory symptoms but cardiovascular complications from COVID-19 have been documented in the literature. Acute pericarditis has been known to be caused by COVID-19 but severe cardiac complications, such as cardiac tamponade, have rarely been reported. Early diagnosis and treatment with pericardiocentesis are imperative, as this can improve patient outcomes. A 56-year-old female presented with chest pain and recurrent episodes of presyncope. The patient tested positive for SARS-Cov-2 through a polymerase chain reaction (PCR) test. The patient was hypotensive on arrival and the initial workup with electrocardiogram was significant for sinus tachycardia with low voltage QRS complexes in the precordial and limb leads. A transthoracic echocardiogram was also done and showed a large circumferential pericardial effusion with chamber collapse of the right atrium and right ventricle during diastole indicative of tamponade physiology. The patient's clinical course was complicated by pulseless electrical activity cardiac arrest during which a pericardiocentesis was done. One hundred (100) mL of serous pericardial fluid was drained and a return of spontaneous circulation was obtained after roughly 10 minutes of cardiopulmonary resuscitation. Further infectious and noninfectious workups, including malignant and rheumatologic etiologies for acute pericarditis, were negative. The patient was subsequently treated with high-dose non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine for viral pericarditis. The patient's clinical course improved, and the patient was subsequently discharged after a prolonged hospital course to a subacute rehabilitation facility to undergo physical therapy.
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Ghantous E, Shetrit A, Hochstadt A, Banai A, Lupu L, Levi E, Szekely Y, Schellekes N, Jacoby T, Zahler D, Itach T, Taieb P, Gefen S, Viskin D, Shidlansik L, Adler A, Levitsky E, Havakuk O, Ingbir M, Banai S, Topilsky Y. Cardiologic Manifestations in Omicron-Type Versus Wild-Type COVID-19: A Systematic Echocardiographic Study. J Am Heart Assoc 2023; 12:e027188. [PMID: 36695308 PMCID: PMC9973649 DOI: 10.1161/jaha.122.027188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Information about the cardiac manifestations of the Omicron variant of COVID-19 is limited. We performed a systematic prospective echocardiographic evaluation of consecutive patients hospitalized with the Omicron variant of COVID-19 infection and compared them with similarly recruited patients were propensity matched with the wild-type variant. Methods and Results A total of 162 consecutive patients hospitalized with Omicron COVID-19 underwent complete echocardiographic evaluation within 24 hours of admission and were compared with propensity-matched patients with the wild-type variant (148 pairs). Echocardiography included left ventricular (LV) systolic and diastolic, right ventricular (RV), strain, and hemodynamic assessment. Echocardiographic parameters during acute infection were compared with historic exams in 62 patients with the Omicron variant and 19 patients with the wild-type variant who had a previous exam within 1 year. Of the patients, 85 (53%) had a normal echocardiogram. The most common cardiac pathology was RV dilatation and dysfunction (33%), followed by elevated LV filling pressure (E/e' ≥14, 29%) and LV systolic dysfunction (ejection fraction <50%, 10%). Compared with the matched wild-type cohort, patients with Omicron had smaller RV end-systolic areas (9.3±4 versus 12.3±4 cm2; P=0.0003), improved RV function (RV fractional-area change, 53.2%±10% versus 39.7%±13% [P<0.0001]; RV S', 12.0±3 versus 10.7±3 cm/s [P=0.001]), and higher stroke volume index (35.6 versus 32.5 mL/m2; P=0.004), all possibly related to lower mean pulmonary pressure (34.6±12 versus 41.1±14 mm Hg; P=0.0001) and the pulmonary vascular resistance index (P=0.0003). LV systolic or diastolic parameters were mostly similar to the wild-type variant-matched cohort apart from larger LV size. However, in patients who had a previous echocardiographic exam, these LV abnormalities were recorded before acute Omicron infection, but not in the wild-type cohort. Numerous echocardiographic parameters were associated with higher in-hospital mortality (LV ejection fraction, stroke volume index, E/e', RV S'). Conclusions In patients with Omicron, RV function is impaired to a lower extent compared with the wild-type variant, possibly related to the attenuated pulmonary parenchymal and/or vascular disease. LV systolic and diastolic abnormalities are as common as in the wild-type variant but were usually recorded before acute infection and probably reflect background cardiac morbidity. Numerous LV and RV abnormalities are associated with adverse outcome in patients with Omicron.
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Affiliation(s)
- Eihab Ghantous
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Aviel Shetrit
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Ariel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Lior Lupu
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Erez Levi
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Yishay Szekely
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Nadav Schellekes
- Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Tammy Jacoby
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - David Zahler
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Tamar Itach
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Philippe Taieb
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Sheizaf Gefen
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Dana Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Lia Shidlansik
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Amos Adler
- Clinical Microbiology Laboratory, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Ekaterina Levitsky
- Clinical Microbiology Laboratory, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Ofer Havakuk
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Merav Ingbir
- Department of Internal Medicine J, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
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A comprehensive mini-review on amyloidogenesis of different SARS-CoV-2 proteins and its effect on amyloid formation in various host proteins. 3 Biotech 2022; 12:322. [PMID: 36254263 PMCID: PMC9558030 DOI: 10.1007/s13205-022-03390-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/30/2022] [Indexed: 11/21/2022] Open
Abstract
Amyloidogenesis is the inherent ability of proteins to change their conformation from native state to cross β-sheet rich fibrillar structures called amyloids which result in a wide range of diseases like Parkinson's disease, Alzheimer’s disease, Finnish familial amyloidosis, ATTR amyloidosis, British and Danish dementia, etc. COVID-19, on the other hand is seen to have many similarities in symptoms with other amyloidogenic diseases and the overlap of these morbidities and symptoms led to the proposition whether SARS-CoV-2 proteins are undergoing amyloidogenesis and whether it is resulting in or aggravating amyloidogenesis of any human host protein. Thus the SARS-CoV-2 proteins in infected cells, i.e., Spike (S) protein, Nucleocapsid (N) protein, and Envelope (E) protein were tested via different machinery and amyloidogenesis in them were proven. In this review, we will analyze the pathway of amyloid formation in S-protein, N-protein, E-protein along with the effect that SARS-CoV-2 is creating on various host proteins leading to the unexpected onset of many morbidities like COVID-induced Acute Respiratory Distress Syndrome (ARDS), Parkinsonism in young COVID patients, formation of fibrin microthrombi in heart, etc., and their future implications.
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Priya SP, Sunil PM, Varma S, Brigi C, Isnadi MFAR, Jayalal JA, Shadamarshan RA, Kumar SS, Kumari NV, Kumar RPR. Direct, indirect, post-infection damages induced by coronavirus in the human body: an overview. Virusdisease 2022; 33:429-444. [PMID: 36311173 PMCID: PMC9593972 DOI: 10.1007/s13337-022-00793-9] [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: 08/19/2021] [Accepted: 09/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Severe acute respiratory syndrome Coronavirus-2 invades the cells via ACE2 receptor and damages multiple organs of the human body. Understanding the pathological manifestation is mandatory to endure the rising post-infection sequel reported in patients with or without comorbidities. Materials and methods Our descriptive review emphasises the direct, indirect and post-infection damages due to COVID-19. We have performed an electronic database search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with selective inclusion and exclusion criteria. Results The included studies substantiated the extensive damages in the multiple organs due to direct and indirect consequences of COVID-19. After an apparent recovery, the prolonged presentation of the symptoms manifests as post-COVID that can be related with persisting viral antigens and dysregulated immune response. Conclusion A few of the symptoms of respiratory, cardiovascular, and neuropsychiatric systems that persist or reappear as post-COVID manifestations. Vaccination and preventive programs will effectively reduce the prevalence but, the post-COVID, a multisystem manifestation, will be a significant tribulation to the medical profession. However, the issue can be managed by implementing public health programs, rehabilitation services, and telemedicine virtual supports to raise awareness and reduce panic.
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Affiliation(s)
- Sivan Padma Priya
- Department of Basic Medical Sciences, RAK College of Dental Sciences, RAK Medical and Health Sciences, Ras Al Khaimah, UAE
| | - P. M. Sunil
- Department of Oral Pathology and Microbiology, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala India ,Centre for Stem Cells and Regenerate Medicine, Malabar Medical College, Calicut, Kerala India
| | - Sudhir Varma
- Department of Clinical Sciences, College of Dentistry, Center for Medical and Bio-Allied Health Science Research, Ajman University, Ajman, UAE ,Saveetha Dental College and Hospitals, Chennai, India
| | - Carel Brigi
- Molecular Medicine and Translational Research, University of Sharjah, Sharjah, UAE
| | - Mohammad Faruq Abd Rachman Isnadi
- Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - J. A. Jayalal
- Department of Surgery, Kanyakumari Medical College and Hospital, Asaripallam, India
| | - R. Arunkumar Shadamarshan
- Dental Officer and Graded Specialist (Oral and Maxillofacial Surgery), Indo Bhutan Friendship Hospital, IMTRAT, Thimpu Bhutan, 11001 Bhutan
| | - S. Suresh Kumar
- Centre for Materials Engineering and Regenerative Medicine,, Bharath Institute of Higher Eduction and Research, Chennai, 600073 Tamil Nadu India
| | - Neela Vasantha Kumari
- Department of Medical Microbiology and Parasitology, Universiti Putra Malaysia (UPM), Serdang, Selangor 43400 Malaysia
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10
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Johnson JN, Loriaux DB, Jenista E, Kim HW, Baritussio A, De Garate Iparraguirre E, Bucciarelli-Ducci C, Denny V, O'Connor B, Siddiqui S, Fujikura K, Benton CW, Weinsaft JW, Kochav J, Kim J, Madamanchi C, Steigner M, Kwong R, Chango-Azanza D, Chapa M, Rosales-Uvera S, Sitwala P, Filev P, Sahu A, Craft J, Punnakudiyil GJ, Jayam V, Shams F, Hughes SG, Lee JCY, Hulten EA, Steel KE, Chen SSM. Society for Cardiovascular Magnetic Resonance 2021 cases of SCMR and COVID-19 case collection series. J Cardiovasc Magn Reson 2022; 24:42. [PMID: 35787291 PMCID: PMC9251594 DOI: 10.1186/s12968-022-00872-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). "Cases of SCMR" is a case series hosted on the SCMR website ( https://www.scmr.org ) that demonstrates the utility and importance of CMR in the clinical diagnosis and management of cardiovascular disease. The COVID-19 Case Collection highlights the impact of coronavirus disease 2019 (COVID-19) on the heart as demonstrated on CMR. Each case in series consists of the clinical presentation and the role of CMR in diagnosis and guiding clinical management. The cases are all instructive and helpful in the approach to patient management. We present a digital archive of the 2021 Cases of SCMR and the 2020 and 2021 COVID-19 Case Collection series of nine cases as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar literature search engine.
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Affiliation(s)
- Jason N Johnson
- Division of Pediatric Cardiology and Pediatric Radiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Daniel B Loriaux
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth Jenista
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Han W Kim
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Anna Baritussio
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
- Bristol Heart Institute, NIHR Bristol Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Estefania De Garate Iparraguirre
- Bristol Heart Institute, NIHR Bristol Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, NIHR Bristol Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Vanessa Denny
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Brian O'Connor
- Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Saira Siddiqui
- Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Kana Fujikura
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Charles W Benton
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Jiwon Kim
- Weill Cornell Medicine, New York, NY, USA
| | | | | | | | - Diego Chango-Azanza
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Mónica Chapa
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Sandra Rosales-Uvera
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Jason Craft
- Dematteis Research Center, Greenvale, NY, USA
| | | | - Viraj Jayam
- Dematteis Research Center, Greenvale, NY, USA
| | - Farah Shams
- Infectious Diseases, St Francis Hospital, Roslyn, NY, USA
| | - Sean G Hughes
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonan C Y Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, China
| | | | | | - Sylvia S M Chen
- Department of Adult Congenital Heart Disease and Cardiology, The Prince Charles Hospital, Brisbane, Australia.
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11
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Srinivasan A, Wong F, Couch LS, Wang BX. Cardiac Complications of COVID-19 in Low-Risk Patients. Viruses 2022; 14:v14061322. [PMID: 35746793 PMCID: PMC9228093 DOI: 10.3390/v14061322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has resulted in over 6 million deaths and significant morbidity across the globe. Alongside common respiratory symptoms, COVID-19 is associated with a variety of cardiovascular complications in the acute and post-acute phases of infection. The suggested pathophysiological mechanisms that underlie these complications include direct viral infection of the myocardium via the angiotensin-converting enzyme 2 (ACE2) protein and a cytokine release syndrome that results in indirect inflammatory damage to the heart. Patients with pre-existing cardiovascular disease and co-morbidities are generally more susceptible to the cardiac manifestations of COVID-19. However, studies have identified a variety of complications in low-risk individuals, including young adults and children. Myocarditis and paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS) are among the adverse events reported in the acute phase of infection. Furthermore, patients have reported cardiac symptoms persisting beyond the acute phase in post-COVID syndrome. This review summarises the acute and chronic cardiac consequences of COVID-19 in low-risk patients, explores the pathophysiology behind them, and discusses new predictive factors for poor outcomes.
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Affiliation(s)
- Akash Srinivasan
- Department of Medicine, Faculty of Medicine, Imperial College London, London SW7 2AD, UK; (A.S.); (F.W.)
| | - Felyx Wong
- Department of Medicine, Faculty of Medicine, Imperial College London, London SW7 2AD, UK; (A.S.); (F.W.)
| | - Liam S. Couch
- King’s College London BHF Centre, The Rayne Institute, St Thomas’ Hospital, London SE1 7EH, UK;
| | - Brian X. Wang
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
- Correspondence:
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12
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Epidemiology of COVID-19 and Its Cardiac and Neurologic Complications Among Chinese and South Asians in Ontario: Waves 1, 2, and 3. CJC Open 2022; 4:894-904. [PMID: 36254328 PMCID: PMC9568686 DOI: 10.1016/j.cjco.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background Although we had previously reported the cardiac and neurologic outcomes of Chinese and South Asian Ontarians in wave 1 of COVID-19, data on subsequent waves of COVID-19 remain unexamined. This is an extension study of this cohort in waves 2 and 3. Methods We identified adult Ontarians with a positive COVID-19 polymerase chain reaction test from January 1, 2020 to June 30, 2021, and they were classified as being Chinese or South Asian using a validated surname algorithm; we compared their outcomes of mortality, and cardiac and neurologic complications with those of the general population using multivariable logistic regression models. Results Compared to the general population (n = 439,977), the Chinese population (n = 15,208) was older (mean age 44.2 vs 40.6 years, P < 0.001) and the South Asian population (n = 46,333) was younger (39.2 years, P < 0.001). The Chinese population had a higher 30-day mortality (odds ratio [OR] 1.44; 95% confidence interval [CI] 1.28-1.61) and more hospitalization or emergency department visits (OR, 1.14; 95% CI, 1.09-1.28), with a trend toward a higher incidence of cardiac complications (OR, 1.03; 95% CI, 0.87-1.12) and neurologic complications (OR, 1.23; 95% CI, 0.96-1.58). South Asians had a lower 30-day mortality (OR, 0.88; 95% CI, 0.78-0.98) but a higher incidence of hospitalization or emergency department visits (OR, 1.17; 95% CI, 1.14-1.20) with a trend toward a lower incidence of cardiac complications (OR, 0.76; 95% CI, 0.67-0.87) and neurologic complications (OR, 0.89; 95% CI, 0.73-1.09). There was also a significant difference in these outcomes between wave 1, 2 and 3, with a greater mortality in all groups in waves 2 and 3. Conclusions Ethnicity continues to be an important determinant of mortality, cardiac and neurologic outcomes, and healthcare use among patients with COVID-19, requiring further studies to understand factors driving these differences.
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13
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Durstenfeld MS, Peluso MJ, Kelly JD, Win S, Swaminathan S, Li D, Arechiga VM, Zepeda VA, Sun K, Shao SJ, Hill C, Arreguin MI, Lu S, Hoh R, Tai VW, Chenna A, Yee BC, Winslow JW, Petropoulos CJ, Kornak J, Henrich TJ, Martin JN, Deeks SG, Hsue PY. Role of antibodies, inflammatory markers, and echocardiographic findings in post-acute cardiopulmonary symptoms after SARS-CoV-2 infection. JCI Insight 2022; 7:157053. [PMID: 35389890 PMCID: PMC9220849 DOI: 10.1172/jci.insight.157053] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/06/2022] [Indexed: 12/15/2022] Open
Abstract
Shortness of breath, chest pain, and palpitations occur as postacute sequelae of COVID-19, but whether symptoms are associated with echocardiographic abnormalities, cardiac biomarkers, or markers of systemic inflammation remains unknown. In a cross-sectional analysis, we assessed symptoms, performed echocardiograms, and measured biomarkers among adults more than 8 weeks after confirmed SARS-CoV-2 infection. We modeled associations between symptoms and baseline characteristics, echocardiographic findings, and biomarkers using logistic regression. We enrolled 102 participants at a median of 7.2 months following COVID-19 onset; 47 individuals reported dyspnea, chest pain, or palpitations. Median age was 52 years, and 41% of participants were women. Female sex, hospitalization, IgG antibody against SARS-CoV-2 receptor binding domain, and C-reactive protein were associated with symptoms. Regarding echocardiographic findings, 4 of 47 participants (9%) with symptoms had pericardial effusions compared with 0 of 55 participants without symptoms; those with effusions had a median of 4 symptoms compared with a median of 1 symptom in those without effusions. There was no strong evidence for a relationship between symptoms and echocardiographic functional parameters or other biomarkers. Among adults more than 8 weeks after SARS-CoV-2 infection, SARS-CoV-2 RBD antibodies, markers of inflammation, and, possibly, pericardial effusions are associated with cardiopulmonary symptoms. Investigation into inflammation as a mechanism underlying postacute sequelae of COVID-19 is warranted.
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Affiliation(s)
- Matthew S Durstenfeld
- Division of Cardiology, University of California, San Francisco, San Francisco, United States of America
| | - Michael J Peluso
- University of California, San Francisco, San Francisco, United States of America
| | - J Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, United States of America
| | - Sithu Win
- Division of Cardiology, University of California, San Francisco, San Francisco, United States of America
| | - Shreya Swaminathan
- Division of Cardiology, University of California, San Francisco, San Francisco, United States of America
| | - Danny Li
- Division of Cardiology, University of California, San Francisco, San Francisco, United States of America
| | - Victor M Arechiga
- Division of Cardiology, University of California, San Francisco, San Francisco, United States of America
| | - Victor Antonio Zepeda
- Division of Cardiology, University of California, San Francisco, San Francisco, United States of America
| | - Kaiwen Sun
- Department of Medicine, University of California, San Francisco, San Francisco, United States of America
| | - Shirley J Shao
- School of Medicine, University of California, San Francisco, San Francisco, United States of America
| | - Christopher Hill
- School of Medicine, University of California, San Francisco, San Francisco, United States of America
| | - Mireya I Arreguin
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, United States of America
| | - Scott Lu
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, United States of America
| | - Rebecca Hoh
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, United States of America
| | - Viva W Tai
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, United States of America
| | - Ahmed Chenna
- Oncology Group, Monogram Biosciences, South San Francisco, United States of America
| | - Brandon C Yee
- Monogram Biosciences, South San Francisco, United States of America
| | - John W Winslow
- Oncology Group, Monogram Biosciences, South San Francisco, United States of America
| | | | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, United States of America
| | - Timothy J Henrich
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, United States of America
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, United States of America
| | - Steven G Deeks
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, United States of America
| | - Priscilla Y Hsue
- Division of Cardiology, University of California, San Francisco, San Francisco, United States of America
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14
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Ling RR, Ramanathan K, Tan FL, Tai BC, Somani J, Fisher D, MacLaren G. Myopericarditis following COVID-19 vaccination and non-COVID-19 vaccination: a systematic review and meta-analysis. THE LANCET RESPIRATORY MEDICINE 2022; 10:679-688. [PMID: 35421376 PMCID: PMC9000914 DOI: 10.1016/s2213-2600(22)00059-5] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 12/17/2022]
Abstract
Background Myopericarditis is a rare complication of vaccination. However, there have been increasing reports of myopericarditis following COVID-19 vaccination, especially among adolescents and young adults. We aimed to characterise the incidence of myopericarditis following COVID-19 vaccination, and compare this with non-COVID-19 vaccination. Methods We did a systematic review and meta-analysis, searching four international databases from Jan 1, 1947, to Dec 31, 2021, for studies in English reporting on the incidence of myopericarditis following vaccination (the primary outcome). We included studies reporting on people in the general population who had myopericarditis in temporal relation to receiving vaccines, and excluded studies on a specific subpopulation of patients, non-human studies, and studies in which the number of doses was not reported. Random-effects meta-analyses (DerSimonian and Laird) were conducted, and the intra-study risk of bias (Joanna Briggs Institute checklist) and certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluations approach) were assessed. We analysed the difference in incidence of myopericarditis among subpopulations, stratifying by the type of vaccine (COVID-19 vs non-COVID-19) and age group (adult vs paediatric). Among COVID-19 vaccinations, we examined the effect of the type of vaccine (mRNA or non-mRNA), sex, age, and dose on the incidence of myopericarditis. This study was registered with PROSPERO (CRD42021275477). Findings The overall incidence of myopericarditis from 22 studies (405 272 721 vaccine doses) was 33·3 cases (95% CI 15·3–72·6) per million vaccine doses, and did not differ significantly between people who received COVID-19 vaccines (18·2 [10·9–30·3], 11 studies [395 361 933 doses], high certainty) and those who received non-COVID-19 vaccines (56·0 [10·7–293·7], 11 studies [9 910 788 doses], moderate certainty, p=0·20). Compared with COVID-19 vaccination, the incidence of myopericarditis was significantly higher following smallpox vaccinations (132·1 [81·3–214·6], p<0·0001) but was not significantly different after influenza vaccinations (1·3 [0·0–884·1], p=0·43) or in studies reporting on various other non-smallpox vaccinations (57·0 [1·1–3036·6], p=0·58). Among people who received COVID-19 vaccines, the incidence of myopericarditis was significantly higher in males (vs females), in people younger than 30 years (vs 30 years or older), after receiving an mRNA vaccine (vs non-mRNA vaccine), and after a second dose of vaccine (vs a first or third dose). Interpretation The overall risk of myopericarditis after receiving a COVID-19 vaccine is low. However, younger males have an increased incidence of myopericarditis, particularly after receiving mRNA vaccines. Nevertheless, the risks of such rare adverse events should be balanced against the risks of COVID-19 infection (including myopericarditis). Funding None.
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Affiliation(s)
- Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore.
| | - Felicia Liying Tan
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Bee Choo Tai
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Jyoti Somani
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Dale Fisher
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Graeme MacLaren
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore
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15
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Al-Tarbsheh AH, Leamon A, Chong WH, Chung JK, Oweis J, Vamshek S, Dawani O, Chopra A. Pericardial Effusion in COVID-19 Patients. Am J Med Sci 2022; 364:129-130. [PMID: 35276074 PMCID: PMC9110270 DOI: 10.1016/j.amjms.2022.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/19/2021] [Accepted: 01/31/2022] [Indexed: 12/20/2022]
Affiliation(s)
| | - Annie Leamon
- Department of Medicine, Albany Medical Center, Albany, NY, USA
| | - Woon H Chong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical Center, Albany, NY, USA
| | - Jae Keun Chung
- Department of Medicine, Albany Medical Center, Albany, NY, USA
| | - Jozef Oweis
- Department of Medicine, Albany Medical Center, Albany, NY, USA
| | | | - Om Dawani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical Center, Albany, NY, USA
| | - Amit Chopra
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical Center, Albany, NY, USA
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16
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Ito GNW, Rodrigues VAC, Hümmelgen J, Meschino GSPG, Abou‐Rejaile GM, Brenny ID, de Castro Júnior CR, Artigas RC, Munhoz JPS, Cardoso GC, Picheth GF. COVID-19 pathophysiology and ultrasound imaging: A multiorgan review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:326-338. [PMID: 35218034 PMCID: PMC9088355 DOI: 10.1002/jcu.23160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 05/09/2023]
Abstract
COVID-19 is a dynamic disease and may affect different tissues and organs as it progresses. Therefore, the impact generated by the disease in all its stages and organs requires a functional and versatile imaging technique able to detect particularities or artifacts dynamically. Ultrasonography fulfills all these requirements and exhibit several advantages relative to other imaging modalities, including portability, lower cost and biosafety. Throughout the COVID-19 pandemic, ultrasonography displayed a crucial role in the triage, monitoring, indicating organ damages and enabling individualized therapeutical decisions in COVID-19 patients. This review is dedicated to highlight the main pathological effects correlated with ultrasound changes caused by COVID-19 in the lungs, heart and liver.
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Affiliation(s)
- Giovana N. W. Ito
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
| | | | - Juliana Hümmelgen
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
| | | | | | - Isadora D. Brenny
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
| | | | - Rafaela C. Artigas
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
| | | | | | - Guilherme F. Picheth
- School of MedicinePontifical Catholic University of ParanáCuritibaBrazil
- Department of Basic PathologyFederal University of ParanáCuritibaBrazil
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17
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Al-Kindi S, Zidar DA. COVID-lateral damage: cardiovascular manifestations of SARS-CoV-2 infection. Transl Res 2022; 241:25-40. [PMID: 34780967 PMCID: PMC8588575 DOI: 10.1016/j.trsl.2021.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 02/07/2023]
Abstract
Early in the pandemic, concern that cardiovascular effects would accompany COVID-19 was fueled by lessons from the first SARS epidemic, knowledge that the SARS-COV2 entry receptor (Angiotensin-converting enzyme 2, ACE2) is highly expressed in the heart, early reports of myocarditis, and first-hand accounts by physicians caring for those with severe COVID-19. Over 18 months, our understanding of the cardiovascular manifestations has expanded greatly, leaving more new questions than those conclusively answered. Cardiac involvement is common (∼20%) but not uniformly observed in those who require treatment in a hospitalized setting. Cardiac MRI studies raise the possibility of manifestations in those with minimal symptoms. Some appear to experience protracted cardiovascular symptoms as part of a larger syndrome of post-acute sequelae of COVID-19. Instances of vaccine induced thrombosis and myocarditis are exceedingly rare but illustrate the need to monitor the cardiovascular safety of interventions that induce inflammation. Here, we will summarize the current understanding of potential cardiovascular manifestations of SARS-COV2. To provide proper context, paradigms of cardiovascular injury due to other inflammatory processes will also be discussed. Ongoing research and a deeper understanding COVID-19 may ultimately reveal new insight into the mechanistic underpinnings of cardiovascular disease. Thus, in this time of unprecedented suffering and risk to global health, there exists the opportunity that well conducted translational research of SARS-COV2 may provide health dividends that outlast the current pandemic.
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Key Words
- ace2, angiotensin-converting enzyme 2
- pasc, post-acute sequelae of covid-19
- cvd, cardiovascular disease
- tnf, tumor necrosis factor
- pamp, pathogen associated molecular patterns
- damps, damage associated molecular patterns
- car-t, chimeric antigen receptor therapy
- dvt, deep venous thrombosis
- tf, tissue factor
- psgl, p-selectin glycoprotein ligand
- nets, neutrophil extracellular traps
- lv, left ventricular
- crp, c-reactive protein
- lge, late gadolinium enhancement
- cbv, coxsackie virus b
- b19v, parvovirus b12
- car, coxsackievirus and adenovirus receptor
- ns1, nonstructural protein 1
- ec, endothelial cells
- scrnaseq, single cell rna sequencing
- embx, endomyocardial biopsy
- tte, transthoracic echocardiograms
- rv, right ventricular
- gls, global longitudinal strain
- hscrp, high sensitivity c-reative protein
- vitt, vaccine-induced immune thrombotic thrombocytopenia
- dtap, diphtheria, tetanus, and polio
- vaers, vaccine adverse event reporting system
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Affiliation(s)
- Sadeer Al-Kindi
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - David A Zidar
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio; Louis Stokes VA Medical Center, Cleveland, Ohio.
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18
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John KJ, Mishra AK, Ramasamy C, George AA, Selvaraj V, Lal A. Heart failure in COVID-19 patients: Critical care experience. World J Virol 2022; 11:1-19. [PMID: 35117968 PMCID: PMC8788216 DOI: 10.5501/wjv.v11.i1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/09/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with heart failure (HF) may be at a higher risk of coronavirus disease 2019 (COVID-19) infection and may have a worse outcome due to their comorbid conditions and advanced age. In this narrative review, we aim to study the interaction between COVID-19 and HF from a critical care perspective. We performed a systematic search for studies that reported HF and critical care-related outcomes in COVID-19 patients in the PubMed and Medline databases. From a total of 1050 papers, we identified 26 that satisfied the eligibility criteria for our review. Data such as patient demographics, HF, intensive care unit (ICU) admission, management, and outcome were extracted from these studies and analyzed. We reported outcomes in heart-transplant patients with COVID-19 separately. In hospitalized patients with COVID-19, the prevalence of HF varied between 4% and 21%. The requirement for ICU admission was between 8% and 33%. HF patients with COVID-19 had an overall mortality rate between 20% and 40%. We identified that HF is an independent predictor of mortality in hospitalized COVID-19 patients, and patients with HF were more likely to require ventilation, ICU admission and develop complications. Patients with HF with reduced ejection fraction did worse than those with HF with midrange ejection fraction, and HF with preserved ejection fraction. COVID-19 patients with HF should be identified early and managed aggressively in an attempt to improve outcomes in this cohort of patients.
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Affiliation(s)
- Kevin John John
- Department of Critical Care, Believers Church Medical College Hospital, Thiruvalla 689103, India
| | - Ajay K Mishra
- Department of Internal Medicine, Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Chidambaram Ramasamy
- Department of Internal Medicine, Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Anu A George
- Department of Internal Medicine, Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Vijairam Selvaraj
- Division of Medicine, The Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care medicine, Mayo Clinic, Rochester, MN 55902, United States
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19
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Batta Y, King C, Johnson J, Haddad N, Boueri M, Haddad G. Sequelae and Comorbidities of COVID-19 Manifestations on the Cardiac and the Vascular Systems. Front Physiol 2022; 12:748972. [PMID: 35095546 PMCID: PMC8795698 DOI: 10.3389/fphys.2021.748972] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/28/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 patients with pre-existing cardiovascular conditions are at greater risk of severe illness due to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus. This review evaluates the highest risk factors for these patients, not limited to pre-existing hypertension, cardiac arrhythmias, hypercoagulation, ischemic heart disease, and a history of underlying heart conditions. SARS-CoV-2 may also precipitate de novo cardiac complications. The interplay between existing cardiac conditions and de novo cardiac complications is the focus of this review. In particular, SARS-CoV-2 patients present with hypercoagulation conditions, cardiac arrhythmias, as significant complications. Also, cardiac arrhythmias are another well-known cardiovascular-related complication seen in COVID-19 infections and merit discussion in this review. Amid the pandemic, myocardial infarction (MI) has been reported to a high degree in SARS-CoV-2 patients. Currently, the specific causative mechanism of the increased incidence of MI is unclear. However, studies suggest several links to high angiotensin-converting enzyme 2 (ACE2) expression in myocardial and endothelial cells, systemic hyper-inflammation, an imbalance between myocardial oxygen supply and demand, and loss of ACE2-mediated cardio-protection. Furthermore, hypertension and SARS-CoV-2 infection patients’ prognosis has shown mixed results across current studies. For this reason, an in-depth analysis of the interactions between SARS-CoV2 and the ACE2 cardio-protective mechanism is warranted. Similarly, ACE2 receptors are also expressed in the cerebral cortex tissue, both in neurons and glia. Therefore, it seems very possible for both cardiovascular and cerebrovascular systems to be damaged leading to further dysregulation and increased risk of mortality risk. This review aims to discuss the current literature related to potential complications of COVID-19 infection with hypertension and the vasculature, including the cervical one. Finally, age is a significant prognostic indicator among COVID-19 patients. For a mean age group of 70 years, the main presenting symptoms include fever, shortness of breath, and a persistent cough. Elderly patients with cardiovascular comorbidities, particularly hypertension and diabetes, represent a significant group of critical cases with increased case fatality rates. With the current understanding of COVID-19, it is essential to explore the mechanisms by which SARS-CoV-2 operates to improve clinical outcomes for patients suffering from underlying cardiovascular diseases and reduce the risk of such conditions de novo.
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Affiliation(s)
- Yashvardhan Batta
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Cody King
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - John Johnson
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Natasha Haddad
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | | | - Georges Haddad
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
- *Correspondence: Georges Haddad,
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20
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Ogungbe O, Kumbe B, Fadodun O, Latha T, Meyer D, Asala A, Davidson PM, Dennison Himmelfarb CR, Post WS, Commodore-Mensah Y. Subclinical myocardial injury, coagulopathy, and inflammation in COVID-19: A meta-analysis of 41,013 hospitalized patients. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2022; 40:100950. [PMID: 35005211 PMCID: PMC8723832 DOI: 10.1016/j.ijcha.2021.100950] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/08/2021] [Accepted: 12/29/2021] [Indexed: 12/24/2022]
Abstract
Background Infection with the SARS-CoV-2 virus can lead to myocardial injury, evidenced by increases in specific biomarkers and imaging. Objective To quantify the association between biomarkers of myocardial injury, coagulation, and severe COVID-19 and death in hospitalized patients. Methods Studies were identified through a systematic search of indexed articles in PubMed, Embase, CINAHL, Cochrane, Web of Science, and Scopus, published between December 2019 to August 2021. Effect estimates from individual studies for association between markers of myocardial injury (Troponin), myocardial stretch (N-terminal-pro hormone BNP, NT-proBNP), and coagulopathy (D-Dimer) and death or severe/critical COVID-19 were pooled using inverse variance weighted random-effects model. Odds Ratios (OR), Hazard Ratios (HR), and 95% Confidence Intervals (CI) were pooled separately and reported by outcomes of critical/severe COVID-19 and death. A meta-analysis of proportions was also performed to summarize the pooled prevalence of co-morbidities in patients hospitalized with COVID-19. Results We included 62 articles, with a total of 41,013 patients. The pooled proportion of patients with history of hypertension was 39% (95% CI: 34-44%); diabetes, 21% (95% CI: 18%-24%); coronary artery disease, 13% (95% CI: 10-16%); chronic obstructive pulmonary disease, 7% (95% CI: 5-8%), and history of cancer, 5% (95% CI: 4-7%). Elevated troponin was associated with higher pooled odds of critical/severe COVID-19 and death [Odds Ratio (OR: 1.76, 95% CI: 1.42-2.16)]; and also separately for death (OR: 1.72, 95% CI: 1.32-2.25), and critical/severe COVID-1919 (OR: 1.93, 95% CI: 1.45-2.40). Elevations in NT-proBNP were also associated with higher severe COVID-19 and death (OR: 3.00, 95% CI: 1.58-5.70). Increases in D-dimer levels was also significantly associated with critical/severe COVID-19 and death (pooled OR: 1.38, 95% CI: 1.07-1.79). Conclusions This meta-analysis synthesizes existing evidence showing that myocardial injury, and coagulopathy are complications of COVID-19. The durability of these complications and their contributions to long-term cardiac implications of the disease is still being investigated. Patients who have recovered from COVID-19 may benefit from minimally invasive assessment for markers of myocardial injury, stretch and coagulopathy for early risk stratification purposes.
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Affiliation(s)
| | - Baridosia Kumbe
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - T Latha
- Manipal Academy of Higher Education, Manipal, India
| | - Diane Meyer
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Patricia M Davidson
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,University of Wollongong, Wollongong, Australia
| | - Cheryl R Dennison Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wendy S Post
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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21
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Oktaviono YH, Mulia EPB, Luke K, Nugraha D, Maghfirah I, Subagjo A. Right ventricular dysfunction and pulmonary hypertension in COVID-19: a meta-analysis of prevalence and its association with clinical outcome. Arch Med Sci 2022; 18:1169-1180. [PMID: 36160328 PMCID: PMC9479723 DOI: 10.5114/aoms/136342] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Rapid spread of COVID-19 has caused detrimental effects globally. Involvement of the ACE2 receptor has identified COVID-19 as a multi-organ disease. Preliminary studies have provided evidence that cardiac involvement, including right ventricular dysfunction (RVD) and pulmonary hypertension (PH), were found in COVID-19 cases, even in the non-advanced stage. This meta-analysis aims to analyze the prevalence of RVD and PH, and their association with COVID-19 clinical outcome. MATERIAL AND METHODS A systematic data search was conducted through PubMed, medRxiv, ProQuest, Science Direct, and Scopus databases using constructed keywords based on MeSH terms. Any outcomes regarding mortality, severity, ICU admission, and mechanical ventilation usage were analyzed using RevMan v.5.4 and Stata v.16. RESULTS A total of 16 eligible studies (1,728 patients) were included. Pooled prevalence of RVD in COVID-19 was 19% (95% CI: 13-25%), and PH was 22% (95% CI: 14-31%). RVD was associated with increased mortality (OR = 2.98 (95% CI: 1.50-5.89), p = 0.002), severity (OR = 3.61 (95% CI: 2.05-6.35), p < 0.001), ICU admission (OR = 1.70 (95% CI: 1.12-2.56), p = 0.01), and mechanical ventilation (MV) usage (OR = 1.60 (95% CI: 1.14-2.25), p = 0.007). PH was also associated with increased mortality (OR = 5.42 (95% CI: 2.66-11.060, p < 0.001), severity (OR = 5.74 (95% CI: 2.28-14.49), p < 0.001), and ICU admission (OR = 12.83 (95% CI: 3.55-46.41), p < 0.001). CONCLUSIONS RVD and PH were prevalent in COVID-19 and associated with mortality, severity, ICU admission, and MV usage in COVID-19 patients. Bedside echocardiography examination could be considered as a novel risk stratification tool in COVID-19.
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Affiliation(s)
- Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Eka Prasetya Budi Mulia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Kevin Luke
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - David Nugraha
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Irma Maghfirah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Agus Subagjo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
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22
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Long-COVID Syndrome and the Cardiovascular System: A Review of Neurocardiologic Effects on Multiple Systems. Curr Cardiol Rep 2022; 24:1711-1726. [PMID: 36178611 PMCID: PMC9524329 DOI: 10.1007/s11886-022-01786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Long-COVID syndrome is a multi-organ disorder that persists beyond 12 weeks post-acute SARS-CoV-2 infection (COVID-19). Here, we provide a definition for this syndrome and discuss neuro-cardiology involvement due to the effects of (1) angiotensin-converting enzyme 2 receptors (the entry points for the virus), (2) inflammation, and (3) oxidative stress (the resultant effects of the virus). RECENT FINDINGS These effects may produce a spectrum of cardio-neuro effects (e.g., myocardial injury, primary arrhythmia, and cardiac symptoms due to autonomic dysfunction) which may affect all systems of the body. We discuss the symptoms and suggest therapies that target the underlying autonomic dysfunction to relieve the symptoms rather than merely treating symptoms. In addition to treating the autonomic dysfunction, the therapy also treats chronic inflammation and oxidative stress. Together with a full noninvasive cardiac workup, a full assessment of the autonomic nervous system, specifying parasympathetic and sympathetic (P&S) activity, both at rest and in response to challenges, is recommended. Cardiac symptoms must be treated directly. Cardiac treatment is often facilitated by treating the P&S dysfunction. Cardiac symptoms of dyspnea, chest pain, and palpitations, for example, need to be assessed objectively to differentiate cardiac from neural (autonomic) etiology. Long-term myocardial injury commonly involves P&S dysfunction. P&S assessment usually connects symptoms of Long-COVID to the documented autonomic dysfunction(s).
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23
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Risk Factors Associated with Severe Disease in COVID-19. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1010651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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24
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Ma C, Tu D, Gu J, Xu Q, Hou P, Wu H, Guo Z, Bai Y, Zhao X, Li P. The Predictive Value of Myoglobin for COVID-19-Related Adverse Outcomes: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:757799. [PMID: 34869669 PMCID: PMC8636904 DOI: 10.3389/fcvm.2021.757799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022] Open
Abstract
Objective: Cardiac injury is detected in numerous patients with coronavirus disease 2019 (COVID-19) and has been demonstrated to be closely related to poor outcomes. However, an optimal cardiac biomarker for predicting COVID-19 prognosis has not been identified. Methods: The PubMed, Web of Science, and Embase databases were searched for published articles between December 1, 2019 and September 8, 2021. Eligible studies that examined the anomalies of different cardiac biomarkers in patients with COVID-19 were included. The prevalence and odds ratios (ORs) were extracted. Summary estimates and the corresponding 95% confidence intervals (95% CIs) were obtained through meta-analyses. Results: A total of 63 studies, with 64,319 patients with COVID-19, were enrolled in this meta-analysis. The prevalence of elevated cardiac troponin I (cTnI) and myoglobin (Mb) in the general population with COVID-19 was 22.9 (19–27%) and 13.5% (10.6–16.4%), respectively. However, the presence of elevated Mb was more common than elevated cTnI in patients with severe COVID-19 [37.7 (23.3–52.1%) vs.30.7% (24.7–37.1%)]. Moreover, compared with cTnI, the elevation of Mb also demonstrated tendency of higher correlation with case-severity rate (Mb, r = 13.9 vs. cTnI, r = 3.93) and case-fatality rate (Mb, r = 15.42 vs. cTnI, r = 3.04). Notably, elevated Mb level was also associated with higher odds of severe illness [Mb, OR = 13.75 (10.2–18.54) vs. cTnI, OR = 7.06 (3.94–12.65)] and mortality [Mb, OR = 13.49 (9.3–19.58) vs. cTnI, OR = 7.75 (4.4–13.66)] than cTnI. Conclusions: Patients with COVID-19 and elevated Mb levels are at significantly higher risk of severe disease and mortality. Elevation of Mb may serve as a marker for predicting COVID-19-related adverse outcomes. Prospero Registration Number:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175133, CRD42020175133.
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Affiliation(s)
- Chaoqun Ma
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Dingyuan Tu
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jiawei Gu
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Qiang Xu
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Pan Hou
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hong Wu
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhifu Guo
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yuan Bai
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xianxian Zhao
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Pan Li
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
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25
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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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26
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Funakoshi K, Morita T, Kumanogoh A. Longer Prehospitalization and Preintubation Periods in Intubated Non-survivors and ECMO Patients With COVID-19: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:727101. [PMID: 34722567 PMCID: PMC8554002 DOI: 10.3389/fmed.2021.727101] [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: 06/18/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose: There is no clear consensus on the clinical course of critical COVID-19 patients. We examined the clinical course among intubated survivors, non-survivors, and extracorporeal membrane oxygenation (ECMO) patients to reveal the standard clinical course and the difference among critical COVID-19 patients. Methods: In this systematic review and meta-analysis, we searched PubMed, Web of Science, and Scopus for original studies published until December 11, 2020, including case accumulation and clinical course reporting. Pregnant patients and children were excluded. We followed PRISMA guidelines and registered them with PROSPERO (CRD42021235534). Results: Of the 11,716 studies identified, 94 met the selection criteria, and 2,549 cases were included in this meta-analysis. The times from intubation to extubation and death were 12.07 days (95% confidence interval 9.80–14.33 days) and 10.14 days (8.18–12.10 days), respectively, and the ECMO duration was 14.72 days (10.57–18.87 days). The time from symptom onset to hospitalization (prehospitalization period) of intubated survivors, non-survivors, and ECMO patients was 6.15 (4.61–7.69 days), 6.45 (4.55–8.34 days), and 7.15 days (6.48–7.81 days), and that from symptom onset to intubation (preintubation period) was 8.58 (7.36–9.80 days), 9.14 (7.26–11.01 days), and 10.54 days (9.18–11.90 days), respectively. Sensitivity analysis showed that the time from intubation to extubation and death was longer in the US and Europe than in East Asia. Conclusion: For COVID-19, we hypothesize that prehospitalization and preintubation periods are longer in intubated non-survivors and ECMO patients than in intubated survivors. These periods may serve as a predictor of disease severity or death and support therapeutic strategy determination.
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Affiliation(s)
- Kenji Funakoshi
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takayoshi Morita
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan.,Department of Immunopathology, WPI, Immunology Frontier Research Center (iFReC), Osaka University, Suita, Japan.,Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Japan.,Center for Infectious Diseases for Education and Research (CiDER), Osaka University, Suita, Japan
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27
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Wang Y, Xu J, Wang Y, Hou H, Shi L, Yang H. Prevalence of comorbid tuberculosis amongst COVID-19 patients: A rapid review and meta-analysis. Int J Clin Pract 2021; 75:e14867. [PMID: 34670351 PMCID: PMC8646527 DOI: 10.1111/ijcp.14867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yadong Wang
- Department of ToxicologyHenan Center for Disease Control and PreventionZhengzhouChina
| | - Jie Xu
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
| | - Ying Wang
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
| | - Hongjie Hou
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
| | - Li Shi
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
| | - Haiyan Yang
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
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28
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Aggarwal AN, Agarwal R, Dhooria S, Prasad KT, Sehgal IS, Muthu V. Active pulmonary tuberculosis and coronavirus disease 2019: A systematic review and meta-analysis. PLoS One 2021; 16:e0259006. [PMID: 34673822 PMCID: PMC8530351 DOI: 10.1371/journal.pone.0259006] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/08/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The proportion of COVID-19 patients having active pulmonary tuberculosis, and its impact on COVID-19 related patient outcomes, is not clear. We conducted this systematic review to evaluate the proportion of patients with active pulmonary tuberculosis among COVID-19 patients, and to assess if comorbid pulmonary tuberculosis worsens clinical outcomes in these patients. METHODS We queried the PubMed and Embase databases for studies providing data on (a) proportion of COVID-19 patients with active pulmonary tuberculosis or (b) severe disease, hospitalization, or mortality among COVID-19 patients with and without active pulmonary tuberculosis. We calculated the proportion of tuberculosis patients, and the relative risk (RR) for each reported outcome of interest. We used random-effects models to summarize our data. RESULTS We retrieved 3,375 citations, and included 43 studies, in our review. The pooled estimate for proportion of active pulmonary tuberculosis was 1.07% (95% CI 0.81%-1.36%). COVID-19 patients with tuberculosis had a higher risk of mortality (summary RR 1.93, 95% CI 1.56-2.39, from 17 studies) and for severe COVID-19 disease (summary RR 1.46, 95% CI 1.05-2.02, from 20 studies), but not for hospitalization (summary RR 1.86, 95% CI 0.91-3.81, from four studies), as compared to COVID-19 patients without tuberculosis. CONCLUSION Active pulmonary tuberculosis is relatively common among COVID-19 patients and increases the risk of severe COVID-19 and COVID-19-related mortality.
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Affiliation(s)
- Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Geng J, Yu X, Bao H, Feng Z, Yuan X, Zhang J, Chen X, Chen Y, Li C, Yu H. Chronic Diseases as a Predictor for Severity and Mortality of COVID-19: A Systematic Review With Cumulative Meta-Analysis. Front Med (Lausanne) 2021; 8:588013. [PMID: 34540855 PMCID: PMC8440884 DOI: 10.3389/fmed.2021.588013] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/05/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Given the ongoing coronavirus disease 2019 (COVID-19) pandemic and the consequent global healthcare crisis, there is an urgent need to better understand risk factors for symptom deterioration and mortality among patients with COVID-19. This systematic review aimed to meet the need by determining the predictive value of chronic diseases for COVID-19 severity and mortality. Methods: We searched PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Complete to identify studies published between December 1, 2019, and December 31, 2020. Two hundred and seventeen observational studies from 26 countries involving 624,986 patients were included. We assessed the risk of bias of the included studies and performed a cumulative meta-analysis. Results: We found that among COVID-19 patients, hypertension was a very common condition and was associated with higher severity, intensive care unit (ICU) admission, acute respiratory distress syndrome, and mortality. Chronic obstructive pulmonary disease was the strongest predictor for COVID-19 severity, admission to ICU, and mortality, while asthma was associated with a reduced risk of COVID-19 mortality. Patients with obesity were at a higher risk of experiencing severe symptoms of COVID-19 rather than mortality. Patients with cerebrovascular disease, chronic liver disease, chronic renal disease, or cancer were more likely to become severe COVID-19 cases and had a greater probability of mortality. Conclusions: COVID-19 patients with chronic diseases were more likely to experience severe symptoms and ICU admission and faced a higher risk of mortality. Aggressive strategies to combat the COVID-19 pandemic should target patients with chronic diseases as a priority.
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Affiliation(s)
- JinSong Geng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoLan Yu
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - HaiNi Bao
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Zhe Feng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoYu Yuan
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - JiaYing Zhang
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoWei Chen
- Library and Reference Department, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - YaLan Chen
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - ChengLong Li
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
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An W, Kang JS, Wang Q, Kim TE. Cardiac biomarkers and COVID-19: A systematic review and meta-analysis. J Infect Public Health 2021; 14:1191-1197. [PMID: 34416596 PMCID: PMC8320426 DOI: 10.1016/j.jiph.2021.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 07/08/2021] [Accepted: 07/26/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To systematically investigate the relationship between cardiac biomarkers and COVID-19 severity and mortality. METHODS We performed a literature search using PubMed, Web of Science, and Google Scholar. The standardized mean difference (SMD) and 95% confidence interval (CI) were applied to estimate the combined results of 67 studies. A meta-analysis of cardiac biomarkers was used to evaluate disease mortality and severity in COVID-19 patients. RESULTS A meta-analysis of 7812 patients revealed that patients with high levels of cardiac troponin I (SMD = 0.81 U/L, 95% CI = 0.14-1.48, P = 0.017), cardiac troponin T (SMD = 0.78 U/L, 95% CI = 0.07-1.49, P = 0.032), high-sensitive cardiac troponin I (SMD = 0.66 pg/mL, 95% CI = 0.51-0.81, P < 0.001), high-sensitive cardiac troponin T (SMD = 0.93 U/L, 95% CI = 0.21-1.65, P = 0.012), creatine kinase-MB (SMD = 0.54 U/L, 95% CI = 0.39-0.69, P < 0.001), and myoglobin (SMD = 0.80 U/L, 95% CI = 0.57-1.03, P < 0.001) were associated with prominent disease severity in COVID-19 infection. Moreover, 9532 patients with a higher serum level of cardiac troponin I (SMD = 0.51 U/L, 95% CI = 0.37-0.64, P < 0.001), high-sensitive cardiac troponin (SMD = 0.51 ng/L, 95% CI = 0.29-0.73, P < 0.001), high-sensitive cardiac troponin I (SMD = 0.51 pg/mL, 95% CI = 0.38-0.63, P < 0.001), high-sensitive cardiac troponin T (SMD = 0.85 U/L, 95% CI = 0.63-1.07, P < 0.001), creatine kinase-MB (SMD = 0.48 U/L, 95% CI = 0.32-0.65, P < 0.001), and myoglobin (SMD = 0.55 U/L, 95% CI = 0.45-0.65, P < 0.001) exhibited a prominent level of mortality from COVID-19 infection. CONCLUSION Cardiac biomarkers (cardiac troponin I, cardiac troponin T, high-sensitive cardiac troponin, high-sensitive cardiac troponin I, high-sensitive cardiac troponin T, creatine kinase-MB, and myoglobin) should be more frequently applied in identifying high-risk COVID-19 patients so that timely treatment can be implemented to reduce severity and mortality in COVID-19 patients.
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Affiliation(s)
- Wen An
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
| | - Ju-Seop Kang
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
| | - Qiuyang Wang
- Department of Central China Research Institute of Health, Xinxiang Medical University, Xinxiang, China.
| | - Tae-Eun Kim
- Department of Clinical Pharmacology, Konkuk University Hospital, Seoul, Republic of Korea.
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Martinot M, Eyriey M, Gravier S, Bonijoly T, Kayser D, Ion C, Mohseni-Zadeh M, Camara S, Dubois J, Haerrel E, Drouaine J, Kaiser J, Ongagna JC, Schieber-Pachart A, Kempf C. Predictors of mortality, ICU hospitalization, and extrapulmonary complications in COVID-19 patients. Infect Dis Now 2021; 51:518-525. [PMID: 34242842 PMCID: PMC8260549 DOI: 10.1016/j.idnow.2021.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/08/2021] [Accepted: 07/01/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE A major coronavirus disease 2019 (COVID-19) outbreak occurred in Northeastern France in spring 2020. This single-center retrospective observational cohort study aimed to compare patients with severe COVID-19 and those with non-severe COVID-19 (survivors vs. non-survivors, ICU patients vs. non-ICU patients) and to describe extrapulmonary complications. PATIENTS AND METHODS We included all patients with a confirmed diagnosis of COVID-19 admitted to Colmar Hospital in March 2020. RESULTS We examined 600 patients (median age 71.09 years; median body mass index: 26.9 kg/m2); 57.7% were males, 86.3% had at least one comorbidity, 153 (25.5%) required ICU hospitalization, and 115 (19.1%) died. Baseline independent factors associated with death were older age (>75 vs. ≤75 years), male sex, oxygen supply, chronic neurological, renal, and pulmonary diseases, diabetes, cancer, low platelet and hemoglobin counts, and high levels of C-reactive protein (CRP) and serum creatinine. Factors associated with ICU hospitalization were age <75 years, oxygen supply, chronic pulmonary disease, absence of dementia, and high levels of CRP, hemoglobin, and serum creatinine. Among the 600 patients, 80 (13.3%) had an acute renal injury, 33 (5.5%) had a cardiovascular event, 27 (4.5%) had an acute liver injury, 24 (4%) had venous thromboembolism, eight (1.3%) had a neurological event, five (0.8%) had rhabdomyolysis, and one had acute pancreatitis. Most extrapulmonary complications occurred in ICU patients. CONCLUSION This study highlighted the main risk factors for ICU hospitalization and death caused by severe COVID-19 and the frequency of numerous extrapulmonary complications in France.
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Affiliation(s)
- M Martinot
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France.
| | - M Eyriey
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - S Gravier
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - T Bonijoly
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - D Kayser
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - C Ion
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - M Mohseni-Zadeh
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - S Camara
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - J Dubois
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - E Haerrel
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - J Drouaine
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - J Kaiser
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France; Pharmacy Department, Hôpitaux Civils de Colmar, Colmar, France
| | - J C Ongagna
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | | | - C Kempf
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
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Bonnemain J, Ltaief Z, Liaudet L. The Right Ventricle in COVID-19. J Clin Med 2021; 10:jcm10122535. [PMID: 34200990 PMCID: PMC8230058 DOI: 10.3390/jcm10122535] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022] Open
Abstract
Infection with the novel severe acute respiratory coronavirus-2 (SARS-CoV2) results in COVID-19, a disease primarily affecting the respiratory system to provoke a spectrum of clinical manifestations, the most severe being acute respiratory distress syndrome (ARDS). A significant proportion of COVID-19 patients also develop various cardiac complications, among which dysfunction of the right ventricle (RV) appears particularly common, especially in severe forms of the disease, and which is associated with a dismal prognosis. Echocardiographic studies indeed reveal right ventricular dysfunction in up to 40% of patients, a proportion even greater when the RV is explored with strain imaging echocardiography. The pathophysiological mechanisms of RV dysfunction in COVID-19 include processes increasing the pulmonary vascular hydraulic load and others reducing RV contractility, which precipitate the acute uncoupling of the RV with the pulmonary circulation. Understanding these mechanisms provides the fundamental basis for the adequate therapeutic management of RV dysfunction, which incorporates protective mechanical ventilation, the prevention and treatment of pulmonary vasoconstriction and thrombotic complications, as well as the appropriate management of RV preload and contractility. This comprehensive review provides a detailed update of the evidence of RV dysfunction in COVID-19, its pathophysiological mechanisms, and its therapy.
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Affiliation(s)
- Jean Bonnemain
- Department of Adult Intensive Care Medicine, Lausanne University Hospital, 1011 Lausanne, Switzerland; (J.B.); (Z.L.)
| | - Zied Ltaief
- Department of Adult Intensive Care Medicine, Lausanne University Hospital, 1011 Lausanne, Switzerland; (J.B.); (Z.L.)
| | - Lucas Liaudet
- Department of Adult Intensive Care Medicine, Lausanne University Hospital, 1011 Lausanne, Switzerland; (J.B.); (Z.L.)
- Division of Pathophysiology, Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-79-556-4278
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COVID-19-related echocardiographic patterns of cardiovascular dysfunction in critically ill patients: A systematic review of the current literature. J Crit Care 2021; 65:26-35. [PMID: 34082252 PMCID: PMC8146405 DOI: 10.1016/j.jcrc.2021.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/21/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022]
Abstract
Purpose Coronavirus disease 2019 (COVID-19) infection may trigger a multi-systemic disease involving different organs. There has been growing interest regarding the harmful effects of COVID-19 on the cardiovascular system. This systematic review aims to systematically analyze papers reporting echocardiographic findings in hospitalized COVID-19 subjects. Materials and methods We included prospective and retrospective studies reporting echocardiography data in >10 hospitalized adult subjects with COVID-19; from 1st February 2020 to 15th January 2021. Results The primary electronic search identified 1120 articles. Twenty-nine studies were finally included, enrolling 3944 subjects. Overall the studies included a median of 68.0% (45.5–100.0) of patients admitted to ICU. Ten studies (34.4%) were retrospective, and 20 (68.9%) single-centred. Overall enrolling 1367 subjects, three studies reported normal echocardiographic findings in 49 ± 18% of cases. Seven studies (24.1%) analyzed the association between echocardiographic findings and mortality, mostly related to right ventricular (RV) dysfunction. Conclusions Data regarding the use of echocardiography on hospitalized, predominantly ICU, COVID-19 patients were retrieved from studies with heterogeneous designs, variable sample sizes, and severity scores. Normal echocardiographic findings were reported in about 50% of subjects, with LVEF usually not affected. Overall, RV dysfunction seems more likely associated with increased mortality. Trial Registration CRD42020218439.
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Hothi SS, Jiang J, Steeds RP, Moody WE. Utility of Non-invasive Cardiac Imaging Assessment in Coronavirus Disease 2019. Front Cardiovasc Med 2021; 8:663864. [PMID: 34095253 PMCID: PMC8175983 DOI: 10.3389/fcvm.2021.663864] [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: 02/03/2021] [Accepted: 03/29/2021] [Indexed: 12/20/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) was initially regarded as a disease of the lungs, which manifests as an acute respiratory illness and pneumonia, although more recently cardiac complications have been well-characterised. Serological cardiac biomarkers have been used to define acute myocardial injury, with significant elevation of high-sensitivity cardiac troponin (hs-cTn) associated with poor prognosis. Accordingly, 20-25% patients with acute myocardial injury (as defined by an elevated hs-cTn greater than the 99th percentile) have clinical signs of heart failure and increased mortality. An important outstanding clinical question is how best to determine the extent and nature of cardiac involvement in COVID-19. Non-invasive cardiac imaging has a well-established role in assessing cardiac structure and function in a wide range of cardiac diseases. It offers the potential to differentiate between direct and indirect COVID-19 effects upon the heart, providing incremental diagnostic and prognostic utility beyond the information yielded by elevated cardiac biomarkers in isolation. This review will focus on the non-invasive imaging assessment of cardiac involvement in COVID-19.
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Affiliation(s)
- Sandeep S. Hothi
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jin Jiang
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Richard P. Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University of Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - William E. Moody
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University of Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Garcia-Zamora S, Lee S, Haseeb S, Bazoukis G, Tse G, Alvarez-Garcia J, Gul EE, Çinier G, Alexander B, Martins Pinto-Filho M, Liu T, Baranchuk A. Arrhythmias and electrocardiographic findings in Coronavirus disease 2019: A systematic review and meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1062-1074. [PMID: 33890684 PMCID: PMC8250376 DOI: 10.1111/pace.14247] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/15/2021] [Accepted: 04/11/2021] [Indexed: 12/15/2022]
Abstract
Background Coronavirus disease 2019 (COVID‐19) primarily causes lung infection, but recent studies have shown that cardiac involvement is associated with a worse prognosis. Objectives We conducted a systematic review and meta‐analysis to examine the prevalence of cardiac arrhythmias detected by the electrocardiogram and their relationships with adverse outcomes in patients with COVID‐19. Methods PubMed and Google were searched for studies that reported on cardiac arrhythmias and/or examined the relationship between arrhythmias and adverse outcomes. Results Thirty studies with 12,713 participants were included in the systematic review, and 28 studies (n = 12,499) in the meta‐analysis. The mean age was 61.3 ± 16.8 years; 39.3% were female. In 25 studies with 7578 patients, the overall prevalence of cardiac arrhythmias was 10.3% (95% confidence interval [CI]: 8.4%–12.3%). The most common arrhythmias documented during hospitalization were supraventricular arrhythmias (6.2%, 95% CI: 4.4%–8.1%) followed by ventricular arrhythmias (2.5%, 95% CI: 1.8%–3.1%). The incidence of cardiac arrhythmias was higher among critically ill patients (relative risk [RR]: 12.1, 95% CI: 8.5–17.3) and among non‐survivors (RR: 3.8, 95%, CI: 1.7–8.7). Eight studies reported changes in the QT interval. The prevalence of QTc > 500 ms was 12.3% (95% CI: 6.9%–17.8%). ST‐segment deviation was reported in eight studies, with a pooled estimate of 8.7% (95% CI: 7.3% to 10.0%). Conclusion Our meta‐analysis showed that QTc prolongation, ST‐segment deviation, and various other cardiac arrhythmias were observed in patients hospitalized with COVID‐19. The presence of cardiac arrhythmias was associated with a worse prognosis.
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Affiliation(s)
| | - Sharen Lee
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Sohaib Haseeb
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - George Bazoukis
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jesus Alvarez-Garcia
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, Bronx, New York, USA.,Cardiology Department, Hospital de la Santa Creui Sant Pau, CIBERCV, Barcelona, Spain
| | - Enes Elvin Gul
- Division of Cardiac Electrophysiology, Madinah Cardiac Centre, Madinah, Saudi Arabia
| | - Göksel Çinier
- Department of Cardiology, Dr.SiyamiErsek Hospital Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Bryce Alexander
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Marcelo Martins Pinto-Filho
- Cardiology Department at Hospital das Clinicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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Brannagan TH, Auer-Grumbach M, Berk JL, Briani C, Bril V, Coelho T, Damy T, Dispenzieri A, Drachman BM, Fine N, Gaggin HK, Gertz M, Gillmore JD, Gonzalez E, Hanna M, Hurwitz DR, Khella SL, Maurer MS, Nativi-Nicolau J, Olugemo K, Quintana LF, Rosen AM, Schmidt HH, Shehata J, Waddington-Cruz M, Whelan C, Ruberg FL. ATTR amyloidosis during the COVID-19 pandemic: insights from a global medical roundtable. Orphanet J Rare Dis 2021; 16:204. [PMID: 33957949 PMCID: PMC8100737 DOI: 10.1186/s13023-021-01834-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 04/20/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing the ongoing coronavirus disease 2019 (COVID-19) pandemic has raised serious concern for patients with chronic disease. A correlation has been identified between the severity of COVID-19 and a patient's preexisting comorbidities. Although COVID-19 primarily involves the respiratory system, dysfunction in multiple organ systems is common, particularly in the cardiovascular, gastrointestinal, immune, renal, and nervous systems. Patients with amyloid transthyretin (ATTR) amyloidosis represent a population particularly vulnerable to COVID-19 morbidity due to the multisystem nature of ATTR amyloidosis. MAIN BODY ATTR amyloidosis is a clinically heterogeneous progressive disease, resulting from the accumulation of amyloid fibrils in various organs and tissues. Amyloid deposition causes multisystem clinical manifestations, including cardiomyopathy and polyneuropathy, along with gastrointestinal symptoms and renal dysfunction. Given the potential for exacerbation of organ dysfunction, physicians note possible unique challenges in the management of patients with ATTR amyloidosis who develop multiorgan complications from COVID-19. While the interplay between COVID-19 and ATTR amyloidosis is still being evaluated, physicians should consider that the heightened susceptibility of patients with ATTR amyloidosis to multiorgan complications might increase their risk for poor outcomes with COVID-19. CONCLUSION Patients with ATTR amyloidosis are suspected to have a higher risk of morbidity and mortality due to age and underlying ATTR amyloidosis-related organ dysfunction. While further research is needed to characterize this risk and management implications, ATTR amyloidosis patients might require specialized management if they develop COVID-19. The risks of delaying diagnosis or interrupting treatment for patients with ATTR amyloidosis should be balanced with the risk of exposure in the health care setting. Both physicians and patients must adapt to a new construct for care during and possibly after the pandemic to ensure optimal health for patients with ATTR amyloidosis, minimizing treatment interruptions.
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Affiliation(s)
| | | | | | | | - Vera Bril
- University Health Network, Toronto, ON Canada
| | - Teresa Coelho
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Thibaud Damy
- Referral Center for Cardiac Amyloidosis, Cardiology Department, APHP-Henri Mondor Hospital, Creteil, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carol Whelan
- National Amyloidosis Centre, Royal Free Hospital, London, UK
| | - Frederick L. Ruberg
- Section of Cardiovascular Medicine, Department of Medicine and Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA USA
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Panchal A, Kyvernitakis A, Mikolich JR, Biederman RWW. Contemporary use of cardiac imaging for COVID-19 patients: a three center experience defining a potential role for cardiac MRI. Int J Cardiovasc Imaging 2021; 37:1721-1733. [PMID: 33559800 PMCID: PMC7871025 DOI: 10.1007/s10554-020-02139-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/17/2020] [Indexed: 01/08/2023]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) secondary to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has bestowed an unprecedented challenge upon us, resulting in an international public health emergency. COVID-19 has already resulted in > 1,600,000 deaths worldwide and the fear of a global economic collapse. SARS-CoV-2 is notorious for causing acute respiratory distress syndrome, however emerging literature suggests various dreaded cardiac manifestations associated with high mortality. The mechanism of myocardial damage in COVID-19 is unclear but thought to be multifactorial and mainly driven by the host's immune response (cytokine storm), hypoxemia and direct myocardial injury by the virus. Cardiac manifestations from COVID-19 include but are not limited to, acute myocardial injury, cardiac arrhythmias, congestive heart failure and acute coronary syndrome. Cardiac imaging is paramount to appropriately diagnose and manage the cardiac manifestations of COVID-19. Herein, we present cardiac imaging findings of COVID-19 patients with biomarker and imaging confirmed myocarditis to provide insight regarding the variable manifestations of COVID-19 myocarditis via Cardiac MRI (CMR) coupled with CMR-edema education along with recommendations on how to incorporate advanced CMR into the clinicians' COVID-19 armamentarium.
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Affiliation(s)
- Ankur Panchal
- Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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The Usefulness of Chest CT Imaging in Patients With Suspected or Diagnosed COVID-19: A Review of Literature. Chest 2021; 160:652-670. [PMID: 33861993 PMCID: PMC8056836 DOI: 10.1016/j.chest.2021.04.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has had devastating medical and economic consequences globally. The severity of COVID-19 is related, in a large measure, to the extent of pulmonary involvement. The role of chest CT imaging in the management of patients with COVID-19 has evolved since the onset of the pandemic. Specifically, the description of CT scan findings, use of chest CT imaging in various acute and subacute settings, and its usefulness in predicting chronic disease have been defined better. We performed a review of published data on CT scans in patients with COVID-19. A summary of the range of imaging findings, from typical to less common abnormalities, is provided. Familiarity with these findings may facilitate the diagnosis and management of this disease. A comparison of sensitivity and specificity of chest CT imaging with reverse-transcriptase polymerase chain reaction testing highlights the potential role of CT imaging in difficult-to-diagnose cases of COVID-19. The usefulness of CT imaging to assess prognosis, to guide management, and to identify acute pulmonary complications associated with SARS-CoV-2 infection is highlighted. Beyond the acute stage, it is important for clinicians to recognize pulmonary parenchymal abnormalities, progressive fibrotic lung disease, and vascular changes that may be responsible for persistent respiratory symptoms. A large collection of multi-institutional images were included to elucidate the CT scan findings described.
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Heart-lung interactions in COVID-19: prognostic impact and usefulness of bedside echocardiography for monitoring of the right ventricle involvement. Heart Fail Rev 2021; 27:1325-1339. [PMID: 33864580 PMCID: PMC8052527 DOI: 10.1007/s10741-021-10108-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 12/22/2022]
Abstract
Due to the SARS-CoV-2 infection–related severe pulmonary tissue damages associated with a relative specific widespread thrombotic microangiopathy, the pathophysiologic role of heart–lung interactions becomes crucial for the development and progression of right ventricular (RV) dysfunction. The high resistance in the pulmonary circulation, as a result of small vessel thrombosis and hypoxemia, is the major cause of right heart failure associated with a particularly high mortality in severe COVID-19. Timely identification of patients at high risk for RV failure, optimization of mechanical ventilation to limit its adverse effects on RV preload and afterload, avoidance of medication-related increase in the pulmonary vascular resistance, and the use of extracorporeal membrane oxygenation in refractory respiratory failure with hemodynamic instability, before RV failure develops, can improve patient survival. Since it was confirmed that the right-sided heart is particularly involved in the clinical deterioration of patients with COVID-19 and pressure overload-induced RV dysfunction plays a key role for patient outcome, transthoracic echocardiography (TTE) received increasing attention. Limited TTE focused on the right heart appears highly useful in hospitalized COVID-19 patients and particularly beneficial for monitoring of critically ill patients. In addition to detection of right-sided heart dilation and RV dysfunction, it enables assessment of RV-pulmonary arterial coupling and evaluation of RV adaptability to pressure loading which facilitate useful prognostic statements to be made. The increased use of bedside TTE focused on the right heart could facilitate more personalized management and treatment of hospitalized patients and can contribute towards reducing the high mortality associated with SARS-CoV-2 infection.
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Chung MK, Zidar DA, Bristow MR, Cameron SJ, Chan T, Harding CV, Kwon DH, Singh T, Tilton JC, Tsai EJ, Tucker NR, Barnard J, Loscalzo J. COVID-19 and Cardiovascular Disease: From Bench to Bedside. Circ Res 2021; 128:1214-1236. [PMID: 33856918 PMCID: PMC8048382 DOI: 10.1161/circresaha.121.317997] [Citation(s) in RCA: 200] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A pandemic of historic impact, coronavirus disease 2019 (COVID-19) has potential consequences on the cardiovascular health of millions of people who survive infection worldwide. Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), the etiologic agent of COVID-19, can infect the heart, vascular tissues, and circulating cells through ACE2 (angiotensin-converting enzyme 2), the host cell receptor for the viral spike protein. Acute cardiac injury is a common extrapulmonary manifestation of COVID-19 with potential chronic consequences. This update provides a review of the clinical manifestations of cardiovascular involvement, potential direct SARS-CoV-2 and indirect immune response mechanisms impacting the cardiovascular system, and implications for the management of patients after recovery from acute COVID-19 infection.
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Affiliation(s)
- Mina K. Chung
- Cleveland Clinic (M.K.C., S.J.C., T.C., D.H.K., T.S., J.B.), OH
- Cleveland Clinic Lerner College of Medicine (M.K.C., S.J.C., T.C., D.H.K., T.S., J.B.), OH
- Case Western Reserve University School of Medicine (M.K.C., D.A.Z., S.J.C., T.C., C.V.H., D.H.K., T.S., J.C.T.), OH
| | - David A. Zidar
- Case Western Reserve University School of Medicine (M.K.C., D.A.Z., S.J.C., T.C., C.V.H., D.H.K., T.S., J.C.T.), OH
- Louis Stokes Cleveland Veterans Affairs Medical Center, OH (D.A.Z.)
| | | | - Scott J. Cameron
- Cleveland Clinic (M.K.C., S.J.C., T.C., D.H.K., T.S., J.B.), OH
- Cleveland Clinic Lerner College of Medicine (M.K.C., S.J.C., T.C., D.H.K., T.S., J.B.), OH
- Case Western Reserve University School of Medicine (M.K.C., D.A.Z., S.J.C., T.C., C.V.H., D.H.K., T.S., J.C.T.), OH
| | - Timothy Chan
- Cleveland Clinic (M.K.C., S.J.C., T.C., D.H.K., T.S., J.B.), OH
- Cleveland Clinic Lerner College of Medicine (M.K.C., S.J.C., T.C., D.H.K., T.S., J.B.), OH
- Case Western Reserve University School of Medicine (M.K.C., D.A.Z., S.J.C., T.C., C.V.H., D.H.K., T.S., J.C.T.), OH
| | - Clifford V. Harding
- Case Western Reserve University School of Medicine (M.K.C., D.A.Z., S.J.C., T.C., C.V.H., D.H.K., T.S., J.C.T.), OH
| | - Deborah H. Kwon
- Cleveland Clinic (M.K.C., S.J.C., T.C., D.H.K., T.S., J.B.), OH
- Cleveland Clinic Lerner College of Medicine (M.K.C., S.J.C., T.C., D.H.K., T.S., J.B.), OH
- Case Western Reserve University School of Medicine (M.K.C., D.A.Z., S.J.C., T.C., C.V.H., D.H.K., T.S., J.C.T.), OH
| | - Tamanna Singh
- Cleveland Clinic (M.K.C., S.J.C., T.C., D.H.K., T.S., J.B.), OH
- Cleveland Clinic Lerner College of Medicine (M.K.C., S.J.C., T.C., D.H.K., T.S., J.B.), OH
- Case Western Reserve University School of Medicine (M.K.C., D.A.Z., S.J.C., T.C., C.V.H., D.H.K., T.S., J.C.T.), OH
| | - John C. Tilton
- Case Western Reserve University School of Medicine (M.K.C., D.A.Z., S.J.C., T.C., C.V.H., D.H.K., T.S., J.C.T.), OH
| | - Emily J. Tsai
- Columbia University Vagelos College of Physicians and Surgeons, New York (E.J.T.)
| | - Nathan R. Tucker
- Masonic Medical Research Institute, Utica, NY (N.R.T.)
- Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Boston, MA (N.R.T.)
| | - John Barnard
- Cleveland Clinic (M.K.C., S.J.C., T.C., D.H.K., T.S., J.B.), OH
- Cleveland Clinic Lerner College of Medicine (M.K.C., S.J.C., T.C., D.H.K., T.S., J.B.), OH
| | - Joseph Loscalzo
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (J.L.)
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Lan Y, Liu W, Zhou Y. Right Ventricular Damage in COVID-19: Association Between Myocardial Injury and COVID-19. Front Cardiovasc Med 2021; 8:606318. [PMID: 33665210 PMCID: PMC7920943 DOI: 10.3389/fcvm.2021.606318] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/26/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, is a global pandemic. It has resulted in considerable morbidity and mortality around the world. The respiratory system is the main system invaded by the virus involved in COVID-19. In addition to typical respiratory manifestations, a certain proportion of severe COVID-19 cases present with evidence of myocardial injury, which is associated with excessive mortality. With availability of an increasing amount of imaging data, right ventricular (RV) damage is prevalent in patients with COVID-19 and myocardial injury, while left ventricular damage is relatively rare and lacks specificity. The mechanisms of RV damage may be due to increased RV afterload and decreased RV contractility caused by various factors, such as acute respiratory distress syndrome, pulmonary thrombosis, direct viral injury, hypoxia, inflammatory response and autoimmune injury. RV dysfunction usually indicates a poor clinical outcome in patients with COVID-19. Timely and effective treatment is of vital importance to save patients' lives as well as improve prognosis. By use of echocardiography or cardiovascular magnetic resonance, doctors can find RV dilatation and dysfunction early. By illustrating the phenomenon of RV damage and its potential pathophysiological mechanisms, we will guide doctors to give timely medical treatments (e.g., anticoagulants, diuretics, cardiotonic), and device-assisted therapy (e.g., mechanical ventilation, extracorporeal membrane oxygenation) when necessary for these patients. In the paper, we examined the latest relevant studies to investigate the imaging features, potential mechanisms, and treatments of myocardial damage caused by COVID-19. RV damage may be an association between myocardial damage and lung injury in COVID-19. Early assessment of RV geometry and function will be helpful in aetiological determination and adjustment of treatment options.
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Affiliation(s)
- Yonghao Lan
- Department of Cardiology, Beijing Jishuitan Hospital, Peking University Fourth Hospital, Beijing, China.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
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Gao Y, Ding M, Dong X, Zhang J, Kursat Azkur A, Azkur D, Gan H, Sun Y, Fu W, Li W, Liang H, Cao Y, Yan Q, Cao C, Gao H, Brüggen M, Veen W, Sokolowska M, Akdis M, Akdis CA. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy 2021; 76:428-455. [PMID: 33185910 DOI: 10.1111/all.14657] [Citation(s) in RCA: 743] [Impact Index Per Article: 247.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused an unprecedented global social and economic impact, and high numbers of deaths. Many risk factors have been identified in the progression of COVID-19 into a severe and critical stage, including old age, male gender, underlying comorbidities such as hypertension, diabetes, obesity, chronic lung diseases, heart, liver and kidney diseases, tumors, clinically apparent immunodeficiencies, local immunodeficiencies, such as early type I interferon secretion capacity, and pregnancy. Possible complications include acute kidney injury, coagulation disorders, thoromboembolism. The development of lymphopenia and eosinopenia are laboratory indicators of COVID-19. Laboratory parameters to monitor disease progression include lactate dehydrogenase, procalcitonin, high-sensitivity C-reactive protein, proinflammatory cytokines such as interleukin (IL)-6, IL-1β, Krebs von den Lungen-6 (KL-6), and ferritin. The development of a cytokine storm and extensive chest computed tomography imaging patterns are indicators of a severe disease. In addition, socioeconomic status, diet, lifestyle, geographical differences, ethnicity, exposed viral load, day of initiation of treatment, and quality of health care have been reported to influence individual outcomes. In this review, we highlight the scientific evidence on the risk factors of severity of COVID-19.
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Affiliation(s)
- Ya‐dong Gao
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Mei Ding
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Zurich Switzerland
| | - Xiang Dong
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Jin‐jin Zhang
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Ahmet Kursat Azkur
- Department of Virology Faculty of Veterinary Medicine University of Kirikkale Kirikkale Turkey
| | - Dilek Azkur
- Division of Pediatric Allergy and Immunology Department of Pediatrics Faculty of Medicine University of Kirikkale Kirikkale Turkey
| | - Hui Gan
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Yuan‐li Sun
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Wei Fu
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Wei Li
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Hui‐ling Liang
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Yi‐yuan Cao
- Department of Radiology Zhongnan Hospital of Wuhan University Wuhan China
| | - Qi Yan
- Department of Geriatrics Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Huazhong China
| | - Can Cao
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Hong‐yu Gao
- Department of Geriatrics Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Huazhong China
| | - Marie‐Charlotte Brüggen
- Department of Dermatology University Hospital Zurich Zurich Switzerland
- Faculty of Medicine University of Zurich Zurich Switzerland
- Hochgebirgsklinik Davos Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Willem Veen
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Zurich Switzerland
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Zurich Switzerland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Zurich Switzerland
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Zurich Switzerland
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Li G, Yang Y, Gao D, Xu Y, Gu J, Liu P. Is liver involvement overestimated in COVID-19 patients? A meta-analysis. Int J Med Sci 2021; 18:1285-1296. [PMID: 33526990 PMCID: PMC7847626 DOI: 10.7150/ijms.51174] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Considering transaminase more than the upper limit of normal value as liver injury might overestimate the prevalence of liver involvement in COVID-19 patients. No meta-analysis has explored the impact of varied definitions of liver injury on the reported prevalence of liver injury. Moreover, few studies reported the extent of hypertransaminasemia stratified by COVID-19 disease severity. Methods: A literature search was conducted using PubMed and Embase. The pooled prevalence of liver injury and hypertransaminasemia was estimated. Results: In total, 60 studies were included. The overall prevalence of liver injury was 25%. Compared to subgroups with the non-strict definition of liver injury (33%) and subgroups without giving detailed definition (26%), the subgroup with a strict definition had a much lower prevalence of liver injury (9%). The overall prevalence of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) elevation was 19% and 22%. The prevalence of elevated ALT and AST were significantly higher in severe COVID-19 cases compare to non-severe cases (31% vs 16% and 44% vs 11%). In critically ill and fatal cases, no difference was found in the prevalence of elevated ALT (24% vs 30%) or AST (54% vs 49%). Sensitivity analyses indicated that the adjusted prevalence of ALT elevation, AST elevation, and liver injury decreased to 14%, 7%, and 12%. Conclusion: The overall prevalence of liver injury and hypertransaminasemia in COVID-19 patients might be overestimated. Only a small fraction of COVID-19 patients have clinically significant liver injury. The prevalence of hypertransaminasemia was significantly higher in severe COVID-19 cases compare to non-severe cases. Hence, in severe COVID-19 patients, more attention should be paid to liver function tests.
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Affiliation(s)
- Gang Li
- Department of General Surgery, Peking University Third Hospital, Haidian District, Beijing 100191, China
| | - Yitian Yang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Danyang Gao
- Department of Anesthesiology, Capital Medical University affiliated Beijing Shijitan Hospital, Beijing 100038, China
| | - Yongxing Xu
- Department of Nephrology, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Jianwen Gu
- The Leading Group on COVID-19 Prevention and Control, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Pengfei Liu
- Department of Anesthesiology, Capital Medical University affiliated Beijing Shijitan Hospital, Beijing 100038, China
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Zylla MM, Merle U, Vey JA, Korosoglou G, Hofmann E, Müller M, Herth F, Schmidt W, Blessing E, Göggelmann C, Weidner N, Fiedler MO, Weigand MA, Kälble F, Morath C, Leiner J, Kieser M, Katus HA, Thomas D. Predictors and Prognostic Implications of Cardiac Arrhythmias in Patients Hospitalized for COVID-19. J Clin Med 2021; 10:jcm10010133. [PMID: 33401735 PMCID: PMC7796041 DOI: 10.3390/jcm10010133] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cardiac manifestation of COVID-19 has been reported during the COVID pandemic. The role of cardiac arrhythmias in COVID-19 is insufficiently understood. This study assesses the incidence of cardiac arrhythmias and their prognostic implications in hospitalized COVID-19-patients. METHODS A total of 166 patients from eight centers who were hospitalized for COVID-19 from 03/2020-06/2020 were included. Medical records were systematically analyzed for baseline characteristics, biomarkers, cardiac arrhythmias and clinical outcome parameters related to the index hospitalization. Predisposing risk factors for arrhythmias were identified. Furthermore, the influence of arrhythmia on the course of disease and related outcomes was assessed using univariate and multiple regression analyses. RESULTS Arrhythmias were detected in 20.5% of patients. Atrial fibrillation was the most common arrhythmia. Age and cardiovascular disease were predictors for new-onset arrhythmia. Arrhythmia was associated with a pronounced increase in cardiac biomarkers, prolonged hospitalization, and admission to intensive- or intermediate-care-units, mechanical ventilation and in-hospital mortality. In multiple regression analyses, incident arrhythmia was strongly associated with duration of hospitalization and mechanical ventilation. Cardiovascular disease was associated with increased mortality. CONCLUSIONS Arrhythmia was the most common cardiac event in association with hospitalization for COVID-19. Older age and cardiovascular disease predisposed for arrhythmia during hospitalization. Whereas in-hospital mortality is affected by underlying cardiovascular conditions, arrhythmia during hospitalization for COVID-19 is independently associated with prolonged hospitalization and mechanical ventilation. Thus, incident arrhythmia may indicate a patient subgroup at risk for a severe course of disease.
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Affiliation(s)
- Maura M. Zylla
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (E.H.); (C.G.); (J.L.); (H.A.K.); (D.T.)
- German Center for Cardiovascular Research (DZHK), Partner site Heidelberg/Mannheim, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Heidelberg Center for Heart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-56-35183
| | - Uta Merle
- Department of Gastroenterology, Hepatology and Infectious Disease, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany;
| | - Johannes A. Vey
- Institute of Medical Biometry and Informatics, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.A.V.); (M.K.)
| | - Grigorios Korosoglou
- GRN Klinikum Weinheim, Klinik für Kardiologie, Angiologie und Pneumologie, Röntgenstraße 1, 69469 Weinheim, Germany;
| | - Eva Hofmann
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (E.H.); (C.G.); (J.L.); (H.A.K.); (D.T.)
- Department of Pulmonary and Respiratory Critical Care Medicine, Thoraxklinik, Heidelberg University Hospital, Röntgenstr. 1, 69126 Heidelberg, Germany; (M.M.); (F.H.)
| | - Michael Müller
- Department of Pulmonary and Respiratory Critical Care Medicine, Thoraxklinik, Heidelberg University Hospital, Röntgenstr. 1, 69126 Heidelberg, Germany; (M.M.); (F.H.)
- German Center for Lung Research (DZL)Translational Lung Resarch Center (TLRCH), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
| | - Felix Herth
- Department of Pulmonary and Respiratory Critical Care Medicine, Thoraxklinik, Heidelberg University Hospital, Röntgenstr. 1, 69126 Heidelberg, Germany; (M.M.); (F.H.)
- German Center for Lung Research (DZL)Translational Lung Resarch Center (TLRCH), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
| | - Werner Schmidt
- Department of Anaesthesiology, Intensive Care, Pain Therapy, Thoraxklinik, Heidelberg University Hospital, Röntgenstr. 1, 69126 Heidelberg, Germany;
| | - Erwin Blessing
- SRH Klinikum Karlsbad-Langensteinbach, Abteilung für Innere Medizin, Guttmannstraße 1, 76307 Karlsbad, Germany;
| | - Christoph Göggelmann
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (E.H.); (C.G.); (J.L.); (H.A.K.); (D.T.)
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany;
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany;
| | - Mascha O. Fiedler
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; (M.O.F.); (M.A.W.)
| | - Markus A. Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; (M.O.F.); (M.A.W.)
| | - Florian Kälble
- Nierenzentrum Heidelberg, Department of Nephrology, Heidelberg University Hospital, Im Neuenheimer Feld 162, 69120 Heidelberg, Germany; (F.K.); (C.M.)
| | - Christian Morath
- Nierenzentrum Heidelberg, Department of Nephrology, Heidelberg University Hospital, Im Neuenheimer Feld 162, 69120 Heidelberg, Germany; (F.K.); (C.M.)
| | - Johannes Leiner
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (E.H.); (C.G.); (J.L.); (H.A.K.); (D.T.)
- Heidelberg Center for Heart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.A.V.); (M.K.)
| | - Hugo A. Katus
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (E.H.); (C.G.); (J.L.); (H.A.K.); (D.T.)
- German Center for Cardiovascular Research (DZHK), Partner site Heidelberg/Mannheim, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Heidelberg Center for Heart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (E.H.); (C.G.); (J.L.); (H.A.K.); (D.T.)
- German Center for Cardiovascular Research (DZHK), Partner site Heidelberg/Mannheim, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Heidelberg Center for Heart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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Maisch B. [The ESC recommendations for COVID-19-no guideline, but a learning guidance]. Herz 2020; 46:46-55. [PMID: 33315146 PMCID: PMC7735183 DOI: 10.1007/s00059-020-05006-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023]
Abstract
„No guideline but guidance“ ist das Motto dieses Leitfadens der European Society of Cardiology (ESC), der als lernende Orientierungshilfe für Ärzte in der Coronapandemie konzipiert ist. 62 europäische Kardiologen haben als Autoren und 29 weitere Experten als Reviewer zu dem 119 Seiten starken Dokument beigetragen. Der Leitfaden ist geprägt von einer vorsichtigen Strategie im Umgang mit einer Pandemie, von der vieles noch nicht bekannt ist. Er beschränkt sich bewusst auf kardiovaskuläre Erkrankungen. In seiner letzten Fassung vom 10. Juni 2020 gibt er zahlreiche praktische Anleitungen zur kardiovaskulären Diagnostik und Therapie unter Pandemiebedingungen. Die Empfehlungen sind oft redundante Rückgriffe auf die bekannten Leitlinien der ESC. Informativ, aber in Teilen ergänzungsbedürftig sind die Abschnitte zur Pathophysiologie und zu den Pathomechanismen, über die SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“) spezifisch auf das Herz-Kreislauf-System wirken dürfte. Kontraproduktiv ist die Empfehlung, auf pathohistologische und molekulare Untersuchungen von Gewebe betroffener oder verstorbener Patienten zu verzichten. Den hohen Ansprüchen an einen sich immer wieder ergänzenden Leitfaden genügt die letzte verfügbare Fassung dennoch in weiten Teilen. Sie benötigt aber eine baldige Aktualisierung, wenn sie ihren Ambitionen gerecht werden will.
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Affiliation(s)
- Bernhard Maisch
- Philipps-Universität, Marburg, Deutschland. .,Herz- und Gefäßzentrum Marburg, Marburg, Deutschland. .,, Feldbergstr. 45, 35043, Marburg, Deutschland.
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Böhm M, Frey N, Giannitsis E, Sliwa K, Zeiher AM. Coronavirus Disease 2019 (COVID-19) and its implications for cardiovascular care: expert document from the German Cardiac Society and the World Heart Federation. Clin Res Cardiol 2020; 109:1446-1459. [PMID: 32462267 PMCID: PMC7252421 DOI: 10.1007/s00392-020-01656-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus diseases 2019 (COVID-19) has become a worldwide pandemic affecting people at high risk and particularly at advanced age, cardiovascular and pulmonary disease. As cardiovascular patients are at high risk but also have dyspnea and fatigue as leading symptoms, prevention, diagnostics and treatment in these patients are important to provide adequate care for those with or without COVID-19 but most importantly when comorbid cardiovascular conditions are present. Severe COVID-19 with acute respiratory distress (ARDS) is challenging as patients with elevated myocardial markers such as troponin are at enhanced high risk for fatal outcomes. As angiotensin-converting enzyme 2 (ACE2) is regarded as the viral receptor for cell entry and as the Coronavirus is downregulating this enzyme, which provides cardiovascular and pulmonary protection, there is ongoing discussions on whether treatment with cardiovascular drugs, which upregulate the viral receptor ACE2 should be modified. As most of the COVID-19 patients have cardiovascular comorbidities like hypertension, diabetes, coronary artery disease and heart failure, which imposes a high risk on these patients, cardiovascular therapy should not be modified or even withdrawn. As cardiac injury is a common feature of COVID-19 associated ARDS and is linked with poor outcomes, swift diagnostic management and specialist care of cardiovascular patients in the area of COVID-19 is of particular importance and deserves special attention.
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Affiliation(s)
- Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, 66421, Homburg, Saar, Germany.
| | - Norbert Frey
- Klinik für Innere Medizin III, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Evangelos Giannitsis
- Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Karen Sliwa
- Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Andreas M Zeiher
- Department of Medicine-Cardiology,, J.W. Goethe University, Frankfurt, Germany
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48
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Jin L, Tang W, Song L, Luo L, Zhou Z, Fan X, Zhang J, Wu N, Liu K, Chen J. Acute cardiac injury in adult hospitalized COVID-19 patients in Zhuhai, China. Cardiovasc Diagn Ther 2020; 10:1303-1312. [PMID: 33224754 DOI: 10.21037/cdt-20-607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) has already became a public health emergency of international concern. COVID-19 related cardiac injury remains largely unclear. Methods We retrospectively analyzed demographic, clinical, laboratory and cardiovascular imaging data of all consecutively admitted adult COVID-19 patients in Zhuhai, China from January 17th, 2020 to February 18th, 2020. Results A total of 93 patients were included in the study. Acute cardiac injury was found in 9 (9.7%) COVID-19 patients with median level of hypersensitive cardiac troponin I (hs-cTnI) to be 0.085 µg/L (IQR 0.027-0.560 µg/L). Compared with patients without cardiac injury, the median age of patients with cardiac injury was significantly older (65.0 vs. 44.0, P<0.05), hypertension was significantly more common (44.4% vs. 14.3%, P<0.05), and the proportion of severe-critical cases were greater (77.8% vs. 17.9%, P<0.05). Patients with cardiac injury were more likely have elevation of N-terminal proBNP (NT-proBNP) in comparison (66.7% vs. 10.0%, P<0.05). There was no significant difference in echocardiographic parameters between patients with and without cardiac injury. Multivariable logistic regression analysis indicated that older age (OR: 1.093, 95% CI: 1.011-1.182) and increased NT-proBNP (OR: 10.979, 95% CI: 2.024-59.555) were independent risk factors for cardiac injury. Cardiac magnetic resonance (CMR) imaging performed on three patients at around one month after they underwent significant hs-cTnI elevation showed that they had underlying cardiovascular comorbidities. Conclusions Acute cardiac injury was seen in the minority of hospitalized COVID-19 patients in Zhuhai, China. Older age and increased NT-proBNP were associated with acute cardiac injury. Registration number ChiCTR2000030952.
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Affiliation(s)
- Lizi Jin
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Wenyi Tang
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Lizheng Song
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Liyun Luo
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zhijuan Zhou
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiuwu Fan
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jinyou Zhang
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Niujian Wu
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Kan Liu
- Division of Cardiology, University of Iowa, Iowa City, IA 52240, USA
| | - Jian Chen
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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49
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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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50
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Mondal R, Lahiri D, Deb S, Bandyopadhyay D, Shome G, Sarkar S, Paria SR, Thakurta TG, Singla P, Biswas SC. COVID-19: Are we dealing with a multisystem vasculopathy in disguise of a viral infection? J Thromb Thrombolysis 2020; 50:567-579. [PMID: 32627126 PMCID: PMC7335630 DOI: 10.1007/s11239-020-02210-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
After the emergence of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in the last two decades, the world is facing its new challenge in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic with unprecedented global response. With the expanding domain of presentations in COVID-19 patients, the full range of manifestations is yet to unfold. The classical clinical symptoms for SARS-CoV-2 affected patients are dry cough, high fever, dyspnoea, lethal pneumonia whereas many patients have also been found to be associated with a few additional signs and clinical manifestations of isolated vasculopathy. Albeit a deep and profound knowledge has been gained on the clinical features and management of COVID-19, less clear association has been provided on SARS-CoV-2 mediated direct or indirect vasculopathy and its possible correlation with disease prognosis. The accumulative evidences suggest that novel coronavirus, apart from its primary respiratory confinement, may also invade vascular endothelial cells of several systems including cerebral, cardio-pulmonary as well as renal microvasculature, modulating multiple visceral perfusion indices. Here we analyse the phylogenetic perspective of SARS-CoV-2 along with other strains of β-coronaviridae from a standpoint of vasculopathic derangements. Based on the existing case reports, literature and open data bases, we also analyse the differential pattern of vasculopathy related changes in COVID-19 positive patients. Besides, we debate the need of modulation in clinical approach from a hemodynamical point of view, as a measure towards reducing disease transmission, morbidity and mortality in SARS-CoV-2 affected patients.
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Affiliation(s)
- Ritwick Mondal
- Institute of Post Graduate Medical Education and Research, SSKM Hospital, 52/1A, S.N. Pandit Street, Kolkata, 700025, India
| | - Durjoy Lahiri
- Institute of Post Graduate Medical Education and Research, SSKM Hospital, 52/1A, S.N. Pandit Street, Kolkata, 700025, India.
| | - Shramana Deb
- S.N. Pradhan Centre for Neuroscience, University of Calcutta, Kolkata, India
| | - Deebya Bandyopadhyay
- Institute of Post Graduate Medical Education and Research, SSKM Hospital, 52/1A, S.N. Pandit Street, Kolkata, 700025, India
| | - Gourav Shome
- Department of Microbiology, University of Calcutta, Kolkata, India
| | - Sukanya Sarkar
- CSIR-Indian Institute of Chemical Biology, Kolkata, India
| | - Sudeb R Paria
- Institute of Post Graduate Medical Education and Research, SSKM Hospital, 52/1A, S.N. Pandit Street, Kolkata, 700025, India
| | | | - Pratibha Singla
- Gian Sagar Medical College and Hospital, Patiala, Punjab, India
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