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Poyatos P, Luque N, Sabater G, Eizaguirre S, Bonnin M, Orriols R, Tura-Ceide O. Endothelial dysfunction and cardiovascular risk in post-COVID-19 patients after 6- and 12-months SARS-CoV-2 infection. Infection 2024; 52:1269-1285. [PMID: 38324145 PMCID: PMC11289012 DOI: 10.1007/s15010-024-02173-5] [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: 09/18/2023] [Accepted: 01/01/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION SARS-CoV-2 infection causes severe endothelial damage, an essential step for cardiovascular complications. Endothelial-colony forming cells (ECFCs) act as a biomarker of vascular damage but their role in SARS-CoV-2 remain unclear. The aim of this study was to assess whether the number of ECFCs and angiogenic biomarkers remained altered after 6 and 12-months post-infection and whether this imbalance correlated with the presence of long-COVID syndrome and other biological parameters measured. METHODS Seventy-two patients were recruited at different time-points after overcoming COVID-19 and thirty-one healthy controls. All subjects were matched for age, gender, BMI, and comorbidities. ECFCs were obtained from peripheral blood and cultured with specific conditions. RESULTS The results confirm the presence of a long-term sequela in post-COVID-19 patients, with an abnormal increase in ECFC production compared to controls (82.8% vs. 48.4%, P < 0.01) that is maintained up to 6-months (87.0% vs. 48.4%, P < 0.01) and 12-months post-infection (85.0% vs. 48.4%, P < 0.01). Interestingly, post-COVID-19 patients showed a significant downregulation of angiogenesis-related proteins compared to controls indicating a clear endothelial injury. Troponin, NT-proBNP and ferritin levels, markers of cardiovascular risk and inflammation, remained elevated up to 12-months post-infection. Patients with lower numbers of ECFC exhibited higher levels of inflammatory markers, such as ferritin, suggesting that ECFCs may play a protective role. Additionally, long-COVID syndrome was associated with higher ferritin levels and with female gender. CONCLUSIONS These findings highlight the presence of vascular sequela that last up to 6- and 12-months post-infection and point out the need for preventive measures and patient follow-up.
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Affiliation(s)
- Paula Poyatos
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Neus Luque
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain
| | - Gladis Sabater
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Saioa Eizaguirre
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Marc Bonnin
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Ramon Orriols
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain.
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain.
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Madrid, Spain.
| | - Olga Tura-Ceide
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain.
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain.
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Madrid, Spain.
- Department of Pulmonary Medicine, Servei de Pneumologia, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
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Rafiee MJ, Friedrich MG. MRI of cardiac involvement in COVID-19. Br J Radiol 2024; 97:1367-1377. [PMID: 38656976 PMCID: PMC11256941 DOI: 10.1093/bjr/tqae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/20/2024] [Accepted: 04/20/2024] [Indexed: 04/26/2024] Open
Abstract
The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has led to a diverse pattern of myocardial injuries, including myocarditis, which is linked to adverse outcomes in patients. Research indicates that myocardial injury is associated with higher mortality in hospitalized severe COVID-19 patients (75.8% vs 9.7%). Cardiovascular Magnetic Resonance (CMR) has emerged as a crucial tool in diagnosing both ischaemic and non-ischaemic myocardial injuries, providing detailed insights into the impact of COVID-19 on myocardial tissue and function. This review synthesizes existing studies on the histopathological findings and CMR imaging patterns of myocardial injuries in COVID-19 patients. CMR imaging has revealed a complex pattern of cardiac damage in these patients, including myocardial inflammation, oedema, fibrosis, and ischaemic injury, due to coronary microthrombi. This review also highlights the role of LLC criteria in diagnosis of COVID-related myocarditis and the importance of CMR in detecting cardiac complications of COVID-19 in specific groups, such as children, manifesting multisystem inflammatory syndrome in children (MIS-C) and athletes, as well as myocardial injuries post-COVID-19 infection or following COVID-19 vaccination. By summarizing existing studies on CMR in COVID-19 patients and highlighting ongoing research, this review contributes to a deeper understanding of the cardiac impacts of COVID-19. It emphasizes the effectiveness of CMR in assessing a broad spectrum of myocardial injuries, thereby enhancing the management and prognosis of patients with COVID-19 related cardiac complications.
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Affiliation(s)
- Moezedin Javad Rafiee
- Department of Medicine, McGill University Health Centre, Montreal, Quebec H4A3J1, Canada
- Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Quebec H4A3J1, Canada
| | - Matthias G Friedrich
- Department of Medicine, McGill University Health Centre, Montreal, Quebec H4A3J1, Canada
- Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Quebec H4A3J1, Canada
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Alvandi M, Shaghaghi Z, Fatehi Z, Naghshtabrizi B, Mohammadi T, Nikzad S. Exploring the impact of recent COVID-19 infection on perfusion and functional parameters derived from gated myocardial perfusion imaging in patients undergoing evaluation for coronary artery disease. Ann Nucl Med 2024:10.1007/s12149-024-01946-0. [PMID: 38806866 DOI: 10.1007/s12149-024-01946-0] [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: 02/19/2024] [Accepted: 05/19/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE This study seeks to evaluate how recent COVID-19 infection affects myocardial perfusion and functional parameters derived from gated myocardial perfusion imaging in patients undergoing evaluation for coronary artery disease. The goal is to enhance our understanding of COVID-19's influence on the cardiovascular system. METHOD Conducted at Farshchian Heart Hospital from 2022 to 2023, this case-control study enrolled patients suspected of coronary artery disease, stratified into two groups: those with confirmed COVID-19 infection within the past 6 months (study group) and those without prior COVID-19 infection (control group). Employing a 2-day protocol, stress testing and gated SPECT MPI were performed. Statistical analysis included descriptive statistics, Chi-square test, Student's t test, and Mann-Whitney U test. RESULT Among the 86 patients included, 43 were in each group. Significantly higher summed stress core and summed difference score values were observed in the study group compared to the control group (p < 0.05). In addition, the study group exhibited significantly altered global left ventricular ejection fraction, end-diastolic volume, and end-systolic volume (p < 0.05). Non-perfusion findings, including transient ischemic dilation and transient right ventricular visualization, were more prevalent in the study group. CONCLUSION Recent COVID-19 infection is associated with impaired myocardial perfusion and altered functional parameters as detected by MPI. These findings underscore the intricate interplay between COVID-19 and cardiovascular health, emphasizing the importance of comprehensive evaluation and management strategies to address cardiac complications in affected individuals. Further research is warranted to elucidate the underlying mechanisms and optimize patient care in the context of COVID-19-associated cardiovascular manifestations.
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Affiliation(s)
- Maryam Alvandi
- Cardiovascular Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Shaghaghi
- Cancer Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Zhino Fatehi
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Behshad Naghshtabrizi
- Clinical Research Development Unit of Farshchian Heart Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Tayeb Mohammadi
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Safoora Nikzad
- Department of Medical Physics, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Zhang Y, Chen S, Tian Y, Fu X. Host factors of SARS-CoV-2 in infection, pathogenesis, and long-term effects. Front Cell Infect Microbiol 2024; 14:1407261. [PMID: 38846354 PMCID: PMC11155306 DOI: 10.3389/fcimb.2024.1407261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
SARS-CoV-2 is the causative virus of the devastating COVID-19 pandemic that results in an unparalleled global health and economic crisis. Despite unprecedented scientific efforts and therapeutic interventions, the fight against COVID-19 continues as the rapid emergence of different SARS-CoV-2 variants of concern and the increasing challenge of long COVID-19, raising a vast demand to understand the pathomechanisms of COVID-19 and its long-term sequelae and develop therapeutic strategies beyond the virus per se. Notably, in addition to the virus itself, the replication cycle of SARS-CoV-2 and clinical severity of COVID-19 is also governed by host factors. In this review, we therefore comprehensively overview the replication cycle and pathogenesis of SARS-CoV-2 from the perspective of host factors and host-virus interactions. We sequentially outline the pathological implications of molecular interactions between host factors and SARS-CoV-2 in multi-organ and multi-system long COVID-19, and summarize current therapeutic strategies and agents targeting host factors for treating these diseases. This knowledge would be key for the identification of new pathophysiological aspects and mechanisms, and the development of actionable therapeutic targets and strategies for tackling COVID-19 and its sequelae.
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Affiliation(s)
| | | | - Yan Tian
- Department of Endocrinology and Metabolism, Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Medical School, West China Hospital and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, Sichuan, Chengdu, China
| | - Xianghui Fu
- Department of Endocrinology and Metabolism, Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Medical School, West China Hospital and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, Sichuan, Chengdu, China
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Golzardi M, Hromić-Jahjefendić A, Šutković J, Aydin O, Ünal-Aydın P, Bećirević T, Redwan EM, Rubio-Casillas A, Uversky VN. The Aftermath of COVID-19: Exploring the Long-Term Effects on Organ Systems. Biomedicines 2024; 12:913. [PMID: 38672267 PMCID: PMC11048001 DOI: 10.3390/biomedicines12040913] [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: 04/03/2024] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Post-acute sequelae of SARS-CoV-2 infection (PASC) is a complicated disease that affects millions of people all over the world. Previous studies have shown that PASC impacts 10% of SARS-CoV-2 infected patients of which 50-70% are hospitalised. It has also been shown that 10-12% of those vaccinated against COVID-19 were affected by PASC and its complications. The severity and the later development of PASC symptoms are positively associated with the early intensity of the infection. RESULTS The generated health complications caused by PASC involve a vast variety of organ systems. Patients affected by PASC have been diagnosed with neuropsychiatric and neurological symptoms. The cardiovascular system also has been involved and several diseases such as myocarditis, pericarditis, and coronary artery diseases were reported. Chronic hematological problems such as thrombotic endothelialitis and hypercoagulability were described as conditions that could increase the risk of clotting disorders and coagulopathy in PASC patients. Chest pain, breathlessness, and cough in PASC patients were associated with the respiratory system in long-COVID causing respiratory distress syndrome. The observed immune complications were notable, involving several diseases. The renal system also was impacted, which resulted in raising the risk of diseases such as thrombotic issues, fibrosis, and sepsis. Endocrine gland malfunction can lead to diabetes, thyroiditis, and male infertility. Symptoms such as diarrhea, nausea, loss of appetite, and taste were also among reported observations due to several gastrointestinal disorders. Skin abnormalities might be an indication of infection and long-term implications such as persistent cutaneous complaints linked to PASC. CONCLUSIONS Long-COVID is a multidimensional syndrome with considerable public health implications, affecting several physiological systems and demanding thorough medical therapy, and more study to address its underlying causes and long-term effects is needed.
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Affiliation(s)
- Maryam Golzardi
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (M.G.); (J.Š.)
| | - Altijana Hromić-Jahjefendić
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (M.G.); (J.Š.)
| | - Jasmin Šutković
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (M.G.); (J.Š.)
| | - Orkun Aydin
- Department of Psychology, Faculty of Arts and Social Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (O.A.); (P.Ü.-A.)
| | - Pinar Ünal-Aydın
- Department of Psychology, Faculty of Arts and Social Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina; (O.A.); (P.Ü.-A.)
| | - Tea Bećirević
- Atrijum Polyclinic, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Elrashdy M. Redwan
- Department of Biological Science, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Centre of Excellence in Bionanoscience Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Therapeutic and Protective Proteins Laboratory, Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City of Scientific Research and Technological Applications (SRTA-City), New Borg EL-Arab, Alexandria 21934, Egypt
| | - Alberto Rubio-Casillas
- Autlan Regional Hospital, Health Secretariat, Autlan 48900, Jalisco, Mexico;
- Biology Laboratory, Autlan Regional Preparatory School, University of Guadalajara, Autlan 48900, Jalisco, Mexico
| | - Vladimir N. Uversky
- Department of Molecular Medicine and USF Health Byrd Alzheimer’s Research Institute, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
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Nedeljkovic-Arsenovic O, Ristić A, Đorđević N, Tomić M, Krljanac G, Maksimović R. Cardiac Magnetic Resonance Imaging as a Risk Stratification Tool in COVID-19 Myocarditis. Diagnostics (Basel) 2024; 14:790. [PMID: 38667436 PMCID: PMC11049213 DOI: 10.3390/diagnostics14080790] [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: 01/28/2024] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 04/28/2024] Open
Abstract
The aim of this retrospective study was to identify myocardial injury after COVID-19 inflammation and explore whether myocardial damage could be a possible cause of the persistent symptoms following COVID-19 infection in previously healthy individuals. This study included 139 patients who were enrolled between January and June 2021, with a mean age of 46.7 ± 15.2 years, of whom 68 were men and 71 were women without known cardiac or pulmonary diseases. All patients underwent clinical work-up, laboratory analysis, cardiac ultrasound, and CMR on a 1.5 T scanner using a recommended protocol for morphological and functional assessment before and after contrast media application with multi-parametric sequences. In 39% of patients, late gadolinium enhancement (LGE) was found as a sign of myocarditis. Fibrinogen was statistically significantly higher in patients with LGE than in those without LGE (4.3 ± 0.23 vs. 3.2 ± 0.14 g/L, p < 0.05, respectively), as well as D-dimer (1.8 ± 0.3 vs. 0.8 ± 0.1 mg/L FEU). Also, troponin was statistically significantly higher in patients with myocardial LGE (13.1 ± 0.4 ng/L) compared to those with normal myocardium (4.9 ± 0.3 ng/L, p < 0.001). We demonstrated chest pain, fatigue, and elevated troponin to be independent predictors for LGE. Septal LGE was shown to be a predictor for arrhythmias. The use of CMR is a potential risk stratification tool in evaluating outcomes following COVID-19 myocarditis.
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Affiliation(s)
- Olga Nedeljkovic-Arsenovic
- Department of Magnetic Resonance Imaging, Centre for Radiology, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia;
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia;
| | - Arsen Ristić
- Clinic for Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (A.R.); (N.Đ.); (M.T.)
| | - Nemanja Đorđević
- Clinic for Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (A.R.); (N.Đ.); (M.T.)
| | - Milenko Tomić
- Clinic for Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (A.R.); (N.Đ.); (M.T.)
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia;
- Clinic for Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (A.R.); (N.Đ.); (M.T.)
| | - Ruzica Maksimović
- Department of Magnetic Resonance Imaging, Centre for Radiology, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia;
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia;
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Miljoen H, Favere K, Van De Heyning C, Corteville B, Dausin C, Herbots L, Teulingkx T, Bekhuis Y, Lyssens M, Bogaert J, Heidbuchel H, Claessen G. Low rates of myocardial fibrosis and ventricular arrhythmias in recreational athletes after SARS-CoV-2 infection. Front Cardiovasc Med 2024; 11:1372028. [PMID: 38628312 PMCID: PMC11018940 DOI: 10.3389/fcvm.2024.1372028] [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: 01/17/2024] [Accepted: 02/26/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction High rates of cardiac involvement were reported in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. This led to anxiety in the athletic population. The current study was set up to assess the prevalence of myocardial fibrosis and ventricular arrhythmias in recreational athletes with the recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Consecutive adult recreational athletes (≥18 years old, ≥4 h of mixed type or endurance sports/week) underwent systematic cardiac evaluation after a prior confirmed COVID-19 infection. Evaluation included clinical history, electrocardiogram (ECG), 5-day Holter monitoring, and cardiac magnetic resonance (CMR) imaging with simultaneous measurement of high-sensitive cardiac Troponin I. Data from asymptomatic or mildly symptomatic athletes (Group 1) were compared with those with moderate to severe symptoms (Groups 2-3). Furthermore, a comparison with a historical control group of athletes without COVID-19 (Master@Heart) was made. Results In total, 35 athletes (18 Group 1, 10 female, 36.9 ± 2.2 years, mean 143 ± 20 days following diagnosis) were evaluated. The baseline characteristics for the Group 1 and Groups 2-3 athletes were similar. None of the athletes showed overt myocarditis on CMR based on the updated Lake Louise criteria for diagnosis of myocarditis. The prevalence of non-ischemic late gadolinium enhancement [1 (6%) Group 1 vs. 2 (12%) Groups 2-3; p = 0.603] or ventricular arrhythmias [1 Group 1 athlete showed non-sustained ventricular tachycardia (vs. 0 in Groups 2-3: p = 1.000)] were not statistically different between the groups. When the male athletes were compared with the Master@Heart athletes, again no differences regarding these criteria were found. Conclusion In our series of recreational athletes with prior confirmed COVID-19, we found no evidence of ongoing myocarditis, and no more detection of fibrosis or ventricular arrhythmias than in a comparable athletic pre-COVID cohort. This points to a much lower cardiac involvement of COVID-19 in athletes than originally suggested.
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Affiliation(s)
- Hielko Miljoen
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
| | - Kasper Favere
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Caroline Van De Heyning
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
| | - Ben Corteville
- Department of Cardiology, Jan Palfijn Hospital, Ghent, Belgium
| | - Christophe Dausin
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Lieven Herbots
- Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Youri Bekhuis
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Leuven University Hospitals, Leuven, Belgium
- Department of Cardiovascular Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Malou Lyssens
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Guido Claessen
- Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Olumuyide E, Agwuegbo CC, Ahmed EN. Exploring the Heart Failure Connection in Long COVID Patients: A Narrative Review. Cureus 2024; 16:e58694. [PMID: 38774167 PMCID: PMC11108637 DOI: 10.7759/cureus.58694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/24/2024] Open
Abstract
In this narrative review, we explore the relationship between long COVID patients and their risk of developing heart failure (HF). Patients with long COVID face a heightened risk of HF, a critical cardiovascular complication linked to the prolonged effects of COVID-19. Clinical manifestations of long COVID-associated HF present diagnostic challenges, complicating patient management. Multidisciplinary care is essential to address these complexities effectively. We found that long COVID can result in various cardiovascular issues including HF. The current view is long COVID leads to HF by activating systemic inflammation by causing endothelial dysfunction, which leads to activation of the complement pathways, tissue factor pathways, and Von Willebrand factor; activation of all these factors leads to venous and arterial thrombosis, which could lead to clogging of blood vessel of the heart leading to cardiovascular complications. The association between long COVID and HF can be challenging despite being recognized as comorbidity because biomarkers are not dependable in determining whether a patient had HF before or after contracting COVID-19. Emerging therapeutic modalities offer hope for improving outcomes, but further research is needed to refine management strategies and mitigate long-term cardiovascular consequences of COVID-19.
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Affiliation(s)
- Emmanuel Olumuyide
- Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, USA
| | | | - Eman N Ahmed
- Internal Medicine, Alfaisal University College of Medicine, Riyadh, SAU
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Stave GM, Nabeel I, Durand-Moreau Q. Long COVID-ACOEM Guidance Statement. J Occup Environ Med 2024; 66:349-357. [PMID: 38588073 DOI: 10.1097/jom.0000000000003059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
ABSTRACT Persistent symptoms are common after acute COVID-19, often referred to as long COVID. Long COVID may affect the ability to perform activities of daily living, including work. Long COVID occurs more frequently in those with severe acute COVID-19. This guidance statement reviews the pathophysiology of severe acute COVID-19 and long COVID and provides pragmatic approaches to long COVID symptoms, syndromes, and conditions in the occupational setting. Disability laws and workers' compensation are also addressed.
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Affiliation(s)
- Gregg M Stave
- From the Division of Occupational and Environmental Medicine, Duke University, Durham, NC (G.M.S.); Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY (I.N.); and Division of Preventive Medicine, University of Alberta, Edmonton, Canada (Q.D.-M.)
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Howick JF, Saric P, Elwazir M, Newman DB, Pellikka PA, Howick AS, O'Horo JC, Cooper LT, Deshmukh AJ, Ganesh R, Hurt R, Gersh B, Bois JP. A Pragmatic Study of Cardiovascular Disease During Long-Term COVID-19. Am J Med 2024:S0002-9343(24)00162-1. [PMID: 38548213 DOI: 10.1016/j.amjmed.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Many patients diagnosed with COVID-19 have persistent cardiovascular symptoms, but whether this represents a true cardiac process is unclear. This study assessed whether symptoms associated with long COVID among patients referred for cardiovascular evaluation are associated with objective abnormalities on cardiac testing to explain their clinical presentation. METHODS A retrospective cohort study of 40,462 unique patients diagnosed with COVID-19 at our tertiary referral was conducted and identified 363 patients with persistent cardiovascular symptoms a minimum of 4 weeks after polymerase chain reaction confirmed COVID-19 infection. Patients had no cardiovascular symptoms prior to COVID-19 infection. Each patient was referred for cardiovascular evaluation at a tertiary referral center. The incidence and etiology of abnormalities on cardiovascular testing among patients with long COVID symptoms are reported here. The cohort was subsequently divided into 3 categories based on the dominant circulating severe acute respiratory syndrome coronavirus 2 variant at the time of initial infection for further analysis. RESULTS Among 40,462 unique patients diagnosed with COVID-19 at our tertiary referral center from April 2020 to March 2022, 363 (0.9%) patients with long COVID were evaluated by Cardiology for possible cardiac sequelae from COVID and formed the main study cohort. Of these, 229 (63%) were vaccinated and 47 (12.9%) had severe initial infection, receiving inpatient treatment for COVID prior to developing long COVID symptoms. Symptoms were associated with a cardiac cause in 85 (23.4%), of which 52 (14.3%) were attributed to COVID; 39 (10.7%) with new cardiac disease from COVID, and 13 (3.6%) to worsening of pre-existing cardiac disease after COVID infection. The median troponin change in 45 patients with troponin measurements within 4 weeks of acute infection was +4 ng/dL (9 to 13 ng/dL). Among the total cohort with long COVID, 83.7% were diagnosed during the pre-Delta phase, 13.2% during the Delta phase, and 3.1% during the Omicron phase of the pandemic. There were 6 cases of myocarditis, 11 rhythm disorders, 8 cases of pericarditis, 5 suspected cases of endothelial dysfunction, and 33 cases of autonomic dysfunction. CONCLUSION This pragmatic retrospective cohort study suggests that patients with long COVID referred for cardiovascular evaluation infrequently have new, objective cardiovascular disease to explain their clinical presentation. A multidisciplinary, patient-centered approach is warranted for symptom management along with conservative use of diagnostic testing.
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Affiliation(s)
| | | | | | | | | | | | - John C O'Horo
- Division of Public Health, Infectious Diseases and Occupational Medicine; Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minn
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Fla
| | | | | | - Ryan Hurt
- Division of General Internal Medicine
| | | | - John P Bois
- Department of Cardiovascular Medicine; Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minn
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11
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Karagodin I, Wang S, Wang H, Singh A, Gutbrod J, Landeras L, Patel H, Alvi N, Tang M, Benovoy M, Janich MA, Benjamin HJ, Chung JH, Patel AR. Myocardial Blood Flow Quantified Using Stress Cardiac Magnetic Resonance After Mild COVID-19 Infection. JACC. ADVANCES 2024; 3:100834. [PMID: 38433786 PMCID: PMC10906962 DOI: 10.1016/j.jacadv.2024.100834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Severe COVID-19 infection is known to alter myocardial perfusion through its effects on the endothelium and microvasculature. However, the majority of patients with COVID-19 infection experience only mild symptoms, and it is unknown if their myocardial perfusion is altered after infection. OBJECTIVES The authors aimed to determine if there are abnormalities in myocardial blood flow (MBF), as measured by stress cardiac magnetic resonance (CMR), in individuals after a mild COVID-19 infection. METHODS We conducted a prospective, comparative study of individuals who had a prior mild COVID-19 infection (n = 30) and matched controls (n = 26) using stress CMR. Stress and rest myocardial blood flow (sMBF, rMBF) were quantified using the dual sequence technique. Myocardial perfusion reserve was calculated as sMBF/rMBF. Unpaired t-tests were used to test differences between the groups. RESULTS The median time interval between COVID-19 infection and CMR was 5.6 (IQR: 4-8) months. No patients with the COVID-19 infection required hospitalization. Symptoms including chest pain, shortness of breath, syncope, and palpitations were more commonly present in the group with prior COVID-19 infection than in the control group (57% vs 7%, P < 0.001). No significant differences in rMBF (1.08 ± 0.27 mL/g/min vs 0.97 ± 0.29 mL/g/min, P = 0.16), sMBF (3.08 ± 0.79 mL/g/min vs 3.06 ± 0.89 mL/g/min, P = 0.91), or myocardial perfusion reserve (2.95 ± 0.90 vs 3.39 ± 1.25, P = 0.13) were observed between the groups. CONCLUSIONS This study suggests that there are no significant abnormalities in rest or stress myocardial perfusion, and thus microvascular function, in individuals after mild COVID-19 infection.
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Affiliation(s)
- Ilya Karagodin
- Department of Medicine, NorthShore University Health System in Evanston, Chicago, Illinois, USA
| | - Shuo Wang
- Division of Cardiovascular Medicine, The University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Amita Singh
- Department of Cardiology, Central Dupage Hospital, Winfield, Illinois, USA
| | - Joseph Gutbrod
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Luis Landeras
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Hena Patel
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Nazia Alvi
- Department of Cardiology, Advent Health Heart and Vascular Institute, Chicago, Illinois, USA
| | - Maxine Tang
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | | | | | - Holly J. Benjamin
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jonathan H. Chung
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Amit R. Patel
- Division of Cardiovascular Medicine, The University of Virginia Health System, Charlottesville, Virginia, USA
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12
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Zhang J, Luo S, Cai J, Kong X, Zhang L, Qi L, Zhang LJ. Multiparametric Cardiovascular Magnetic Resonance in Nonhospitalized COVID-19 Infection Subjects: An Intraindividual Comparison Study. J Thorac Imaging 2024; 39:86-92. [PMID: 38270475 DOI: 10.1097/rti.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
PURPOSE To investigate intraindividual cardiac structural and functional changes before and after COVID-19 infection in a previously healthy population with a 3T cardiac magnetic resonance (CMR). MATERIALS AND METHODS A total of 39 unhospitalized patients with COVID-19 were recruited. They participated in our previous study as non-COVID-19 healthy volunteers undergoing baseline CMR examination and were recruited to perform a repeated CMR examination after confirmed COVID-19 infection in December 2022. The CMR parameters were measured and compared between before and after COVID-19 infection with paired t tests. The laboratory measures including myocardial enzymes and inflammatory indicators were also collected when performing repeated CMR. RESULTS The median duration was 393 days from the first to second CMR and 26 days from clinical symptoms onset to the second CMR. Four patients (10.3%, 4/39) had the same late gadolinium enhancement pattern at baseline and repeated CMR and 5 female patients (12.8%, 5/39) had myocardial T2 ratio >2 (2.07 to 2.27) but with normal T2 value in post-COVID-19 CMR. All other CMR parameters were in normal ranges before and after COVID-19 infection. Between before and after the COVID-19 infection, there were no significant differences in cardiac structure, function, and tissue characterization, no matter with or without symptoms (fatigue, chest discomfort, palpitations, shortness of breath, and insomnia/sleep disorders) (all P >0.05). The laboratory measures at repeated CMR were in normal ranges in all participants. CONCLUSIONS These intraindividual CMR studies showed unhospitalized patients with COVID-19 with normal myocardial enzymes had no measurable CMR abnormalities, which can help alleviate wide social concerns about COVID-19-related myocarditis.
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Affiliation(s)
- Jun Zhang
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Song Luo
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
| | - Jun Cai
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
| | - Xiang Kong
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
| | - Lingyan Zhang
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
| | - Li Qi
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Long Jiang Zhang
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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13
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Ibrahim ESH, Rubenstein J, Sosa A, Stojanovska J, Pan A, North P, Rui H, Benjamin I. Myocardial Strain for the Differentiation of Myocardial Involvement in the Post-Acute Sequelae of COVID-19-A Multiparametric Cardiac MRI Study. Tomography 2024; 10:331-348. [PMID: 38535768 PMCID: PMC10974260 DOI: 10.3390/tomography10030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 04/01/2024] Open
Abstract
Myocardial involvement was shown to be associated with an unfavorable prognosis in patients with COVID-19, which could lead to fatal outcomes as in myocardial injury-induced arrhythmias and sudden cardiac death. We hypothesized that magnetic resonance imaging (MRI) myocardial strain parameters are sensitive markers for identifying subclinical cardiac dysfunction associated with myocardial involvement in the post-acute sequelae of COVID-19 (PASC). This study evaluated 115 subjects, including 65 consecutive COVID-19 patients, using MRI for the assessment of either post-COVID-19 myocarditis or other cardiomyopathies. Subjects were categorized, based on the results of the MRI exams, as having either 'suspected' or 'excluded' myocarditis. A control group of 50 matched individuals was studied. Along with parameters of global cardiac function, the MRI images were analyzed for measurements of the myocardial T1, T2, extracellular volume (ECV), strain, and strain rate. Based on the MRI late gadolinium enhancement and T1/T2/ECV mappings, myocarditis was suspected in 7 out of 22 patients referred due to concern of myocarditis and in 9 out of 43 patients referred due to concern of cardiomyopathies. The myocardial global longitudinal, circumferential, and radial strains and strain rates in the suspected myocarditis group were significantly smaller than those in the excluded myocarditis group, which in turn were significantly smaller than those in the control group. The results showed significant correlations between the strain, strain rate, and global cardiac function parameters. In conclusion, this study emphasizes the value of multiparametric MRI for differentiating patients with myocardial involvement in the PASC based on changes in the myocardial contractility pattern and tissue structure.
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Affiliation(s)
- El-Sayed H. Ibrahim
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Jason Rubenstein
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.R.); (I.B.)
| | - Antonio Sosa
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Jadranka Stojanovska
- Department of Radiology, New York University, 221 Lexington Ave, New York, NY 10016, USA;
| | - Amy Pan
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Paula North
- Department of Pathology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (P.N.); (H.R.)
| | - Hallgeir Rui
- Department of Pathology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (P.N.); (H.R.)
| | - Ivor Benjamin
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.R.); (I.B.)
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14
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Izquierdo-Condoy JS, Vásconez-Gonzáles J, Morales-Lapo E, Tello-De-la-Torre A, Naranjo-Lara P, Fernández R, Hidalgo MR, Escobar A, Yépez VH, Díaz AM, Oliva C, Ortiz-Prado E. Beyond the acute phase: a comprehensive literature review of long-term sequelae resulting from infectious diseases. Front Cell Infect Microbiol 2024; 14:1293782. [PMID: 38357446 PMCID: PMC10864624 DOI: 10.3389/fcimb.2024.1293782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Infectious diseases have consistently served as pivotal influences on numerous civilizations, inducing morbidity, mortality, and consequently redirecting the course of history. Their impact extends far beyond the acute phase, characterized by the majority of symptom presentations, to a multitude of adverse events and sequelae that follow viral, parasitic, fungal, or bacterial infections. In this context, myriad sequelae related to various infectious diseases have been identified, spanning short to long-term durations. Although these sequelae are known to affect thousands of individuals individually, a comprehensive evaluation of all potential long-term effects of infectious diseases has yet to be undertaken. We present a comprehensive literature review delineating the primary sequelae attributable to major infectious diseases, categorized by systems, symptoms, and duration. This compilation serves as a crucial resource, illuminating the long-term ramifications of infectious diseases for healthcare professionals worldwide. Moreover, this review highlights the substantial burden that these sequelae impose on global health and economies, a facet often overshadowed by the predominant focus on the acute phase. Patients are frequently discharged following the resolution of the acute phase, with minimal long-term follow-up to comprehend and address potential sequelae. This emphasizes the pressing need for sustained vigilance, thorough patient monitoring, strategic health management, and rigorous research to understand and mitigate the lasting economic and health impacts of infectious diseases more fully.
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15
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Del Vecchio L, Balafa O, Dounousi E, Ekart R, Fernandez BF, Mark PB, Sarafidis P, Valdivielso JM, Ferro CJ, Mallamaci F. COVID-19 and cardiovascular disease in patients with chronic kidney disease. Nephrol Dial Transplant 2024; 39:177-189. [PMID: 37771078 PMCID: PMC10828215 DOI: 10.1093/ndt/gfad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Indexed: 09/30/2023] Open
Abstract
Millions of people worldwide have chronic kidney disease (CKD). Affected patients are at high risk for cardiovascular (CV) disease for several reasons. Among various comorbidities, CKD is associated with the more severe forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This is particularly true for patients receiving dialysis or for kidney recipients. From the start of the SARS-CoV-2 pandemic, several CV complications have been observed in affected subjects, spanning acute inflammatory manifestations, CV events, thrombotic episodes and arrythmias. Several pathogenetic mechanisms have been hypothesized, including direct cytopathic viral effects on the myocardium, endothelial damage and hypercoagulability. This spectrum of disease can occur during the acute phase of the infection, but also months after recovery. This review is focussed on the CV complications of coronavirus disease 2019 (COVID-19) with particular interest in their implications for the CKD population.
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Affiliation(s)
- Lucia Del Vecchio
- Department of Nephrology and Dialysis, Sant'Anna Hospital, ASST Lariana, Como, Italy
| | - Olga Balafa
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece
| | - Evangelia Dounousi
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Robert Ekart
- Department of Dialysis, Clinic for Internal Medicine, University Medical Center Maribor, Maribor, Slovenia
| | | | - Patrick B Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Pantelis Sarafidis
- 1st Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jose M Valdivielso
- Vascular and Renal Translational Research Group, Institute for Biomedical Research on Lleida (IRBLleida), Lleida, Spain
| | - Charles J Ferro
- Department of Renal Medicine, University Hospitals Birmingham and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham,UK
| | - Francesca Mallamaci
- Francesca Mallamaci Department of Nephrology, Dialysis, and Transplantation Azienda Ospedaliera “Bianchi-Melacrino-Morelli” & CNR-IFC, Reggio Calabria, Italy
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16
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Kounis NG, Gogos C, de Gregorio C, Hung MY, Kounis SN, Tsounis EP, Assimakopoulos SF, Pourmasumi S, Mplani V, Servos G, Dousdampanis P, Plotas P, Michalaki MA, Tsigkas G, Grammatikopoulos G, Velissaris D, Koniar I. "When," "Where," and "How" of SARS-CoV-2 Infection Affects the Human Cardiovascular System: A Narrative Review. Balkan Med J 2024; 41:7-22. [PMID: 38173173 PMCID: PMC10767774 DOI: 10.4274/balkanmedj.galenos.2023.2023-10-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by the novel severe acute respiratory coronavirus-2 (SARS-CoV-2). Several explanations for the development of cardiovascular complications during and after acute COVID-19 infection have been hypothesized. The COVID-19 pandemic, caused by SARS-CoV-2, has emerged as one of the deadliest pandemics in modern history. The myocardial injury in COVID-19 patients has been associated with coronary spasm, microthrombi formation, plaque rupture, hypoxic injury, or cytokine storm, which have the same pathophysiology as the three clinical variants of Kounis syndrome. The angiotensin-converting enzyme 2 (ACE2), reninaldosterone system (RAAS), and kinin-kallikrein system are the main proposed mechanisms contributing to cardiovascular complications with the COVID-19 infection. ACE receptors can be found in the heart, blood vessels, endothelium, lungs, intestines, testes, neurons, and other human body parts. SARS-CoV-2 directly invades the endothelial cells with ACE2 receptors and constitutes the main pathway through which the virus enters the endothelial cells. This causes angiotensin II accumulation downregulation of the ACE2 receptors, resulting in prothrombotic effects, such as hemostatic imbalance via activation of the coagulation cascade, impaired fibrinolysis, thrombin generation, vasoconstriction, endothelial and platelet activation, and pro-inflammatory cytokine release. The KKS system typically causes vasodilation and regulates tissue repair, inflammation, cell proliferation, and platelet aggregation, but SARS-CoV-2 infection impairs such counterbalancing effects. This cascade results in cardiac arrhythmias, cardiac arrest, cardiomyopathy, cytokine storm, heart failure, ischemic myocardial injuries, microvascular disease, Kounis syndrome, prolonged COVID, myocardial fibrosis, myocarditis, new-onset hypertension, pericarditis, postural orthostatic tachycardia syndrome, pulmonary hypertension, stroke, Takotsubo syndrome, venous thromboembolism, and thrombocytopenia. In this narrative review, we describe and elucidate when, where, and how COVID-19 affects the human cardiovascular system in various parts of the human body that are vulnerable in every patient category, including children and athletes.
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Affiliation(s)
- Nicholas G. Kounis
- Department of Cardiology, University of Patras Medical School, Rio, Greece
| | - Christos Gogos
- Clinic of Cardiology, COVID-19 Unit, Papageorgiou General Hospital, Pavlos Melas, Greece
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina Medical School, Messina, Italy
| | - Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | | | - Efthymios P. Tsounis
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University Hospital of Patras, Rio, Greece
| | - Stelios F. Assimakopoulos
- Department of Internal Medicine, Division of Infectious Diseases, University of Patras Medical School, Rio, Greece
| | - Soheila Pourmasumi
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Virginia Mplani
- Intensive Care Unit, Patras University Hospital, Rio, Greece
| | - George Servos
- Pediatric Cardiology Unit, “P. & A. Kyriakou” Children’s Hospital, Athina, Greece
| | | | - Panagiotis Plotas
- Department of Cardiology, University of Patras Medical School, Rio, Greece
| | - Marina A. Michalaki
- Department of Internal Medicine, Division of Endocrinology, University of Patras, School of Health Sciences, Rio, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, Rio, Greece
| | | | - Dimitrios Velissaris
- Department of Internal Medicine, University of Patras Medical School, Rio, Greece
| | - Ioanna Koniar
- Electrophysiology and Device Department, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
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17
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Rhee E, Dobrila J, Kaur H, Patel MD, Uppu SC. Right and left ventricular cardiac magnetic resonance imaging derived peak systolic strain is abnormal in children with myocarditis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:139-147. [PMID: 37861812 DOI: 10.1007/s10554-023-02975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Cardiac Magnetic resonance (CMR) derived left ventricular longitudinal and circumferential strain is known to be abnormal in myocarditis. CMR strain is a useful additional tool that can identify subclinical myocardial involvement and may help with longitudinal follow-up. Right ventricular strain derived by CMR in children has not been studied. We sought to evaluate CMR derived biventricular strain in children with acute myocarditis. METHODS Children with acute myocarditis who underwent CMR between 2016-2022 at our center were reviewed, this group included subjects with COVID-19 myocarditis. Children with no evidence of myocarditis served as controls Those with congenital heart disease and technically limited images for CMR strain analysis were excluded from final analysis. Biventricular longitudinal, circumferential, and radial peak systolic strains were derived using circle cvi42®. Data between cases and controls were compared using an independent sample t-test. One-way ANOVA with post hoc analysis was used to compare COVID-19, non-COVID myocarditis and controls. RESULTS 38 myocarditis and 14 controls met inclusion criteria (mean age 14.4 ± 3 years). All CMR derived peak strain values except for RV longitudinal strain were abnormal in myocarditis group. One-way ANOVA revealed that there was a statistically significant difference with abnormal RV and LV strain in COVID-19 myocarditis when compared to non-COVID-19 myocarditis and controls. CONCLUSION CMR derived right and left ventricular peak systolic strain using traditionally acquired cine images were abnormal in children with acute myocarditis. All strain measurements were significantly abnormal in children with COVID-19 even when compared to non-COVID myocarditis.
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Affiliation(s)
- Elisa Rhee
- Children's Heart Institute, The University of Texas Health Science Center at Houston, 6410 Fannin St, Suite 425, Houston, TX, 77030, USA
- Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Heart Center, 1111 Marcus Ave, Suite M15, New Hyde Park, NY, 11042, USA
| | - Julija Dobrila
- Children's Heart Institute, The University of Texas Health Science Center at Houston, 6410 Fannin St, Suite 425, Houston, TX, 77030, USA
| | - Harmanpreet Kaur
- Children's Heart Institute, The University of Texas Health Science Center at Houston, 6410 Fannin St, Suite 425, Houston, TX, 77030, USA
| | - Mehul D Patel
- Children's Heart Institute, The University of Texas Health Science Center at Houston, 6410 Fannin St, Suite 425, Houston, TX, 77030, USA
| | - Santosh C Uppu
- Children's Heart Institute, The University of Texas Health Science Center at Houston, 6410 Fannin St, Suite 425, Houston, TX, 77030, USA.
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18
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Özlek B, Akın F, Altun İ. Long COVID and myocardial ischemia: how aware are we? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:207-208. [PMID: 37950097 DOI: 10.1007/s10554-023-03001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Bülent Özlek
- Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman University, Kötekli Mah. Marmaris Yolu, No:48, 48000, Mugla, Turkey.
| | - Fatih Akın
- Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman University, Kötekli Mah. Marmaris Yolu, No:48, 48000, Mugla, Turkey
| | - İbrahim Altun
- Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman University, Kötekli Mah. Marmaris Yolu, No:48, 48000, Mugla, Turkey
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19
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Eftekhar Z, Haybar H, Mohebbi A, Saki N. Cardiac Complications and COVID-19: A Review of Life-threatening Co-morbidities. Curr Cardiol Rev 2024; 20:1-12. [PMID: 38415433 DOI: 10.2174/011573403x279782240206091322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/23/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
The novel 2019 coronavirus disease (COVID-19) was first reported in the last days of December 2019 in Wuhan, China. The presence of certain co-morbidities, including cardiovascular diseases (CVDs), are the basis for worse outcomes in patients with COVID-19. Relevant English-language literature was searched and retrieved from the Google Scholar search engine and PubMed database up to 2023 using COVID-19, SARS-CoV-2, Heart failure, Myocardial infarction, and Arrhythmia and Cardiac complication as keywords. Increased hemodynamic load, ischemia-related dysfunction, ventricular remodeling, excessive neurohumoral stimulation, abnormal myocyte calcium cycling, and excessive or insufficient extracellular matrix proliferation are associated with heart failure (HF) in COVID-19 patients. Inflammatory reaction due to the excessive release of inflammatory cytokines, leads to myocardial infarction (MI) in these patients. The virus can induce heart arrhythmia through cardiac complications, hypoxia, decreased heart hemodynamics, and remarkable inflammatory markers. Moreover, studies have linked cardiac complications in COVID-19 with poor outcomes, extended hospitalization time, and increased mortality rate. Patients with COVID-19 and CVDs are at higher mortality risk and they should be given high priority when receiving the treatment and intensive care during hospitalization.
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Affiliation(s)
- Zeinab Eftekhar
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Habib Haybar
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Mohebbi
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmaldin Saki
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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20
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Khokhlov RA, Lipovka SN, Dubrovina MV, Lobas IA, Tribuntseva LV, Prozorova GG, Arzamasсeva GI, Khokhlov LR, Yarmonova MV, Zarechnova SV, Kuleshova NA, Shaley AA. Combined Heart Injuries on the Data of Contrast-Enhanced Cardiac Magnetic Resonance Imaging in Patients With Post-Covid Syndrome. KARDIOLOGIIA 2023; 63:46-53. [PMID: 38156489 DOI: 10.18087/cardio.2023.12.n2268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/18/2023] [Indexed: 12/30/2023]
Abstract
Aim Prospective assessment of the nature of cardiac injury in patients with post-COVID syndrome according to contrast-enhanced MRI in routine clinical practice.Material and methods 106 previously unvaccinated patients were evaluated. 62 (58.5%) of them were women with complaints that persisted after COVID-19 (median age, 57.5 [49; 64] years). In addition to standard indexes, markers of inflammation and myocardial injury were determined, and cardiac contrast-enhanced MRI was performed in each patient.Results The median time from the onset of COVID-19 to cardiac MRI was 112.5 [75; 151] days. The nature of cardiac injury according to MRI in patients with post-COVID syndrome was complex and included a decrease in left ventricular (LV) and right ventricular ejection fraction, pericardial effusion, and pathological foci of late and early contrast enhancement at various locations. In 29 (27.4%) cases, there was a combination of any two signs of heart injury. In 28 (26.4%) patients with focal myocardial injury during the acute phase of COVID-19, hydroxychloroquine and tocilizumab were administered significantly more frequently, but antiviral drugs were administered less frequently. The presence of focal myocardial injury was associated with pathological LV remodeling.Conclusion According to contrast-enhanced cardiac MRI, at least 27.4% of patients with post-COVID syndrome may have signs of cardiac injury in various combinations, and in 26.4% of cases, foci of myocardial injury accompanied by LV remodeling are detected. The nature of heart injury after COVID-19 depends on the premorbid background, characteristics of the course of the infectious process, and the type of prescribed therapy. An algorithm for evaluating patients with post-COVID syndrome is proposed.
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Affiliation(s)
- R A Khokhlov
- Burdenko Voronezh State Medical University, Voronezh; Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | - S N Lipovka
- Burdenko Voronezh State Medical University, Voronezh; Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | - M V Dubrovina
- Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | - I A Lobas
- Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | | | - G G Prozorova
- Burdenko Voronezh State Medical University, Voronezh
| | - G I Arzamasсeva
- Burdenko Voronezh State Medical University, Voronezh; Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | | | - M V Yarmonova
- Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | - S V Zarechnova
- Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | - N A Kuleshova
- Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | - A A Shaley
- Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
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21
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Johnson JN, Pouraliakbar H, Mahdavi M, Ranjbar A, Pfirman K, Mehra V, Ahmed S, Ba-Atiyah W, Galal MO, Zahr RA, Hussain N, Tadikamalla RR, Farah V, Dzelebdzic S, Muniz JC, Lee M, Williams J, Lee S, Aggarwal SK, Clark DE, Hughes SG, Ganigara M, Nagiub M, Hussain T, Kwok C, Lim HS, Nolan M, Kikuchi DS, Goulbourne CA, Sahu A, Sievers B, Sievers B, Sievers B, Garg R, Armas CR, Paleru V, Agarwal R, Rajagopal R, Bhagirath P, Kozor R, Aneja A, Tunks R, Chen SSM. Society for Cardiovascular Magnetic Resonance 2022 Cases of SCMR case series. J Cardiovasc Magn Reson 2023; 26:100007. [PMID: 38211509 PMCID: PMC11211240 DOI: 10.1016/j.jocmr.2023.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 01/13/2024] Open
Abstract
"Cases of SCMR" is a case series on the SCMR website (https://www.scmr.org) for the purpose of education. The cases reflect the clinical presentation, and the use of cardiovascular magnetic resonance (CMR) in the diagnosis and management of cardiovascular disease. The 2022 digital collection of cases are presented in this manuscript.
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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
| | - Hamidreza Pouraliakbar
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdavi
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolmohammad Ranjbar
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kristopher Pfirman
- Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Vishal Mehra
- Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Shahzad Ahmed
- Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Wejdan Ba-Atiyah
- Pediatric Cardiology Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammed Omar Galal
- Pediatric Cardiology Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Riad Abou Zahr
- Pediatric Cardiology Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Nasir Hussain
- Department of Advanced Cardiac Imaging, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Victor Farah
- Department of Advanced Cardiac Imaging, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | | | - Marc Lee
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jason Williams
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Simon Lee
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Daniel E Clark
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sean G Hughes
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madhusudan Ganigara
- Division of Pediatric Cardiology, The University of Chicago & Biological Sciences, Chicago, IL, USA
| | - Mohamed Nagiub
- Division of Pediatric Cardiology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Tarique Hussain
- Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Cecilia Kwok
- Cardiology Department, Western Health, St Albans, Victoria, Australia
| | - Han S Lim
- Cardiology Department, Austin and Northern Health, University of Melbourne, Victoria, Australia
| | - Mark Nolan
- Cardiology Department, Western Health, St Albans, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Daniel S Kikuchi
- Osler Medical Residency, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Clive A Goulbourne
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Anurag Sahu
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Berge Sievers
- International School Düsseldorf, Düsseldorf, Germany
| | - Berk Sievers
- International School Düsseldorf, Düsseldorf, Germany
| | - Burkhard Sievers
- Department of Internal Medicine, Divisions of Cardiology, Pulmonology, Vascular Medicine, Nephrology and Intensive Care Medicine, Sana Klinikum Remscheid, Germany
| | - Rimmy Garg
- University of Illinois College of Medicine Peoria, OSF St. Francis Medical Center, Peoria, IL, USA
| | - Carlos Requena Armas
- University of Illinois College of Medicine Peoria, OSF St. Francis Medical Center, Peoria, IL, USA
| | - Vijayasree Paleru
- University of Illinois College of Medicine Peoria, OSF St. Francis Medical Center, Peoria, IL, USA
| | - Ritu Agarwal
- Department of Radiology, Eternal Hospital, Jaipur, India
| | - Rengarajan Rajagopal
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pranav Bhagirath
- Department of Cardiology, St. Thomas Hospital, London, England, UK
| | - Rebecca Kozor
- Department of Cardiology, Royal North Shore Hospital, The University of Sydney, St Leonards, Australia
| | - Ashish Aneja
- Department of Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Robert Tunks
- Division of Pediatric Cardiology, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Sylvia S M Chen
- Adult Congenital Heart Disease, The Prince Charles Hospital, Australia.
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22
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Sideratou CM, Papaneophytou C. Persisting Shadows: Unraveling the Impact of Long COVID-19 on Respiratory, Cardiovascular, and Nervous Systems. Infect Dis Rep 2023; 15:806-830. [PMID: 38131885 PMCID: PMC10742861 DOI: 10.3390/idr15060072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), instigated by the zoonotic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), rapidly transformed from an outbreak in Wuhan, China, into a widespread global pandemic. A significant post-infection condition, known as 'long- COVID-19' (or simply 'long- COVID'), emerges in a substantial subset of patients, manifesting with a constellation of over 200 reported symptoms that span multiple organ systems. This condition, also known as 'post-acute sequelae of SARS-CoV-2 infection' (PASC), presents a perplexing clinical picture with far-reaching implications, often persisting long after the acute phase. While initial research focused on the immediate pulmonary impact of the virus, the recognition of COVID-19 as a multiorgan disruptor has unveiled a gamut of protracted and severe health issues. This review summarizes the primary effects of long COVID on the respiratory, cardiovascular, and nervous systems. It also delves into the mechanisms underlying these impacts and underscores the critical need for a comprehensive understanding of long COVID's pathogenesis.
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Affiliation(s)
| | - Christos Papaneophytou
- Department of Life Sciences, School of Life and Health Sciences, University of Nicosia, 2417 Nicosia, Cyprus;
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23
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Liu G, Chen T, Zhang X, Hu B, Shi H. Causal relationship between COVID-19 and myocarditis or pericarditis risk: a bidirectional Mendelian randomization study. Front Cardiovasc Med 2023; 10:1271959. [PMID: 38162133 PMCID: PMC10755931 DOI: 10.3389/fcvm.2023.1271959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Background & aims Coronavirus disease 2019 (COVID-19) is strongly associated with myocarditis or pericarditis risk in observational studies, however, there are still studies that do not support the above conclusion. Whether the observed association reflects causation needs to be confirmed. We performed a bidirectional Mendelian randomization (MR) study to assess the causal relationship of COVID-19, which was divided into three groups, namely severe COVID-19, hospitalized COVID-19, and COVID-19 infection, measured by myocarditis or pericarditis. Methods We extracted summary genome-wide association statistics for the severe COVID-19 (case: 13,769, control: 1,072,442), hospitalized COVID-19 (case: 32,519, control: 2,062,805), COVID-19 infection (case: 122,616, control: 2,475,240), myocarditis (case 1,521, control 191,924), and pericarditis (case 979, control 286,109) among individuals of European ancestry. Independent genetic variants that exhibited a significant association with each phenotype at the genome-wide level of significance were utilized as instrumental variables. Estimation of the causal effect was mainly performed using the random effects inverse-variance weighted method (IVW). Additionally, other tests such as MR-Egger intercept, MR-PRESSO, Cochran's Q-test, "Leave-one-out", and funnel plots were conducted to assess the extent of pleiotropy and heterogeneity. Results Non-associations in the IVW and sensitivity analyses were observed for COVID-19 with myocarditis or pericarditis. Severe COVID-19 was not associated with myocarditis [odds ratio (OR), 1.00; 95% confidence interval (CI), 0.89-1.12; P = 0.99], pericarditis (OR = 0.90, 95% CI, 0.78-1.04, P = 0.17). Similar results can be observed in hospitalized COVID-19, and COVID-19 infection. At the same time, null associations were observed for myocarditis or pericarditis with COVID-19 traits in the reverse direction. The main results are kept stable in the sensitivity analysis. Conclusion There is no evidence that COVID-19 is independently and causally associated with myocarditis or pericarditis.
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Affiliation(s)
- Guihong Liu
- Department of Biotherapy, State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Chen
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xin Zhang
- Department of Biotherapy, State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Binbin Hu
- Department of Biotherapy, State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Huashan Shi
- Department of Biotherapy, State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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24
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Hofbauer T, Humann K, Neidenbach RC, Scharhag J. Myocarditis Screening Methods in Athletes After SARS-CoV-2 Infection - a Systematic Review. Int J Sports Med 2023; 44:929-940. [PMID: 37225132 DOI: 10.1055/a-2099-6725] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This review aims to elucidate the myocarditis incidence in SARS-CoV-2-positive athletes and to evaluate different screening approaches to derive sports cardiological recommendations after SARS-CoV-2 infection. The overall incidence of athletes (age span 17-35 years, 70% male) with myocarditis after SARS-CoV-2 infection was 1.2%, with a high variation between studies (which contrasts an incidence of 4.2% in 40 studies within the general population). Studies that used conventional screening based on symptoms, electrocardiogram, echocardiography, and cardiac troponin - only followed by cardiac magnetic resonance imaging in case of abnormal findings - reported lower myocarditis incidences (0.5%, 20/3978). On the other hand, advanced screening that included cardiac magnetic resonance imaging within the primary screening reported higher incidences (2.4%, 52/2160). The sensitivity of advanced screening seems to be 4.8 times higher in comparison to conventional screening. However, we recommend prioritization of conventional screening, as the economical load of advanced screening for all athletes is high and the incidence of myocarditis in SARS-CoV-2-positive athletes and the risk of adverse outcomes seems low. Future research will be important to analyze the long-term effects of myocarditis after infection with SARS-CoV-2 in athletes for risk stratification to optimally guide a safe return to sport.
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Affiliation(s)
- Theresa Hofbauer
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Science, Vienna, Austria
| | - Kathrin Humann
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Science, Vienna, Austria
| | - Rhoia Clara Neidenbach
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Science, Vienna, Austria
| | - Jürgen Scharhag
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Science, Vienna, Austria
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25
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Zhang J, Xu S, Luo S, Kong X, Wang Q, Ma Y, Dou W, Qi L, Liu Z, Zhang LJ. Image Improved Intravoxel Incoherent Motion MRI With Optimized Trigger Delays Based on Strain Curve Analysis to Evaluate Myocardial Microvascular Dysfunction of Exertional Heat Illness. J Magn Reson Imaging 2023; 58:1785-1796. [PMID: 36943201 DOI: 10.1002/jmri.28684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Intravoxel incoherent motion (IVIM) MRI has not been widely used and its role in evaluating exertional heat illness (EHI)-related myocardial involvement remains unknown. PURPOSE To investigate the feasibility of strain curve-derived trigger delay (TD) IVIM-MRI and its role in assessing myocardial diffusion and microvascular perfusion of EHI patients. STUDY TYPE Prospective. SUBJECTS A total of 42 male EHI patients (median age: 21 years) and 22 age- and sex-matched healthy controls (HC). FIELD STRENGTH/SEQUENCE A 3-T, diffusion-weighted spin-echo echo-planar-imaging sequence. ASSESSMENT IVIM-MRI was acquired by conventional TD method (group A) or strain curve-based TD method (group B) in random order. IVIM image quality was evaluated on a 3-point Likert scale (1, nondiagnostic; 2, moderate; 3, good). Technical success was defined as image quality score = 3. IVIM-MRI-derived parameters (pseudo diffusion in the capillaries [D*], perfusion fraction [f], and slow apparent diffusion coefficient [D]) were compared between EHI and HC. STATISTICAL TESTS Student's t-tests, chi-square tests, one-way analysis of variance, receiver operating characteristic (ROC) curve analysis, Pearson's correlation coefficient (r). The statistical significance level was set at P < 0.05. RESULTS IVIM-MRI image quality score (median [interquartile range]: 3 [2, 3] vs. 2 [1-3]) and technical success rate (61.9%[13/21] vs. 28.6%[6/21]) were significantly improved in group B. EHI patients showed significantly decreased D* (118.1 ± 23.3 × 10-3 mm2 /sec vs. 142.7 ± 42.6 × 10-3 mm2 /sec) and f values (0.42 ± 0.12 vs. 0.51 ± 0.11) and significantly higher D values (3.0 ± 0.9 × 10-3 mm2 /sec vs. 2.5 ± 0.6 × 10-3 mm2 /sec) compared to HC. Relative to D and D*, f showed the most robust efficacy for detecting EHI-related myocardial injury with the highest area under the ROC curve (0.906: 95% confidence interval, 0.799, 0.967) and sensitivity of 88.5% and specificity of 85.6%. CONCLUSION The strain curve-based TD method significantly improved image quality and technical success rate of IVIM-MRI, and f value may be an effective biomarker to assess myocardial microcirculation abnormalities of EHI patients. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 3.
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Affiliation(s)
- Jun Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Shutian Xu
- National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Song Luo
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xiang Kong
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Qingqing Wang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Yan Ma
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | | | - Li Qi
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhihong Liu
- National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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26
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Morillas-Blasco P, Guedes-Ramallo P, Vicente-Ibarra N, Martínez-Moreno M, Romero-Valero A, García-Honrubia A, Castilla-Cabanes E, Viedma-Contreras JA, Masiá-Canuto M, Castillo-Castillo J, Santos-Martínez S. Subclinical Left Ventricular Systolic Dysfunction in Hospitalized Patients with COVID-19 by Strain: A 30-Day Echocardiographic Follow-Up. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2065. [PMID: 38138168 PMCID: PMC10744515 DOI: 10.3390/medicina59122065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Available studies confirm myocardial injury and its association with mortality in patients with COVID-19, but few data have been reported from echocardiographic studies. The aim of this study was to identify subclinical left ventricular dysfunction by global longitudinal strain (GLS) and its evolution in the short term in hospitalized patients with COVID-19. Materials and Methods: Thirty-one consecutive noncritical patients admitted for COVID-19 were included. Information on demographics, laboratory results, comorbidities, and medications was collected. Transthoracic echocardiograms were performed using a Philips Affinity 50, at the acute stage and at a 30-day follow-up. Automated left ventricular GLS was measured using a Philips Qlab 13.0. A GLS of <-15.9% was defined as abnormal. Results: The mean age was 65 ± 15.2 years, and 61.3% of patients were male. Nine patients (29%) had elevated levels of high-sensitivity troponin I. Left ventricular ejection fraction was preserved in all; however, 11 of them (35.5%) showed reduced GLS. These patients had higher troponin levels (median, 23.7 vs. 3.2 ng/L; p < 0.05) and NT-proBNP (median, 753 vs. 81 pg/mL; p < 0.05). The multivariate analysis revealed that myocardial injury, defined as increased troponin, was significantly associated with GLS values (coefficient B; p < 0.05). Follow-up at 30 days showed an improvement in GLS values in patients with subclinical left ventricular dysfunction (-16.4 ± 2.07% vs. -13.2 ± 2.40%; p < 0.01), without changes in the normal GLS group. Conclusions: Subclinical left ventricular dysfunction is common in noncritical hospitalized patients with COVID-19 (one in every three patients), even with preserved left ventricular ejection fraction. This impairment tends to be reversible on clinical recovery.
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Affiliation(s)
- Pedro Morillas-Blasco
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Paula Guedes-Ramallo
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Nuria Vicente-Ibarra
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Marina Martínez-Moreno
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Andrea Romero-Valero
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Antonio García-Honrubia
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Elena Castilla-Cabanes
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | | | - Mar Masiá-Canuto
- Infectious Disease Unit, Hospital General Universitario Elche, 03203 Elche, Spain
| | - Jesús Castillo-Castillo
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Sandra Santos-Martínez
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
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27
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Mojica-Pisciotti ML, Panovský R, Holeček T, Opatřil L, Feitová V. Lower ventricular and atrial strain in patients who recovered from COVID-19 assessed by cardiovascular magnetic resonance feature tracking. Front Cardiovasc Med 2023; 10:1293105. [PMID: 38028469 PMCID: PMC10679333 DOI: 10.3389/fcvm.2023.1293105] [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: 09/12/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction One of the most common complications of coronavirus disease 2019 (COVID-19) is myocardial injury, and although its cause is unclear, it can alter the heart's contractility. This study aimed to characterize the ventricular and atrial strain in patients who recovered from COVID-19 using cardiovascular magnetic resonance feature-tracking (CMR-FT). Methods In this single-center study, we assessed left ventricle (LV) and right ventricular (RV) global circumferential strain (GCS), global longitudinal strain (GLS), global radial strain (GRS), left atrial (LA) and right atrial (RA) longitudinal strain (LS) parameters by CMR-FT. The student's t-test and Wilcoxon rank-sum test were used to compare the variables. Results We compared seventy-two patients who recovered from COVID-19 (49 ± 16 years) to fifty-four controls (49 ± 12 years, p = 0.752). The patients received a CMR examination 48 (34 to 165) days after the COVID-19 diagnosis. 28% had LGE. Both groups had normal LV systolic function. Strain parameters were significantly lower in the COVID-19 survivors than in controls. Discussion Patients who recovered from COVID-19 exhibited significantly lower strain in the left ventricle (through LVGCS, LVGLS, LVGRS), right ventricle (through RVGLS and RVGRS), left atrium (through LALS), and right atrium (through RALS) than controls.
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Affiliation(s)
- Mary Luz Mojica-Pisciotti
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
- 1st Department of Internal Medicine/Cardioangiology, St. Anne's University Hospital, Brno, Czech Republic
| | - Roman Panovský
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
- 1st Department of Internal Medicine/Cardioangiology, St. Anne's University Hospital, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomáš Holeček
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
- Department of Medical Imaging, St. Anne’s University Hospital, Brno, Czech Republic
- Department of Biomedical Engineering, Brno University of Technology, Brno, Czech Republic
| | - Lukáš Opatřil
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
- 1st Department of Internal Medicine/Cardioangiology, St. Anne's University Hospital, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Věra Feitová
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
- Department of Medical Imaging, St. Anne’s University Hospital, Brno, Czech Republic
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28
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Luchian ML, Higny J, Benoit M, Robaye B, Berners Y, Henry JP, Colle B, Xhaët O, Blommaert D, Droogmans S, Motoc AI, Cosyns B, Gabriel L, Guedes A, Demeure F. Unmasking Pandemic Echoes: An In-Depth Review of Long COVID's Unabated Cardiovascular Consequences beyond 2020. Diagnostics (Basel) 2023; 13:3368. [PMID: 37958264 PMCID: PMC10647305 DOI: 10.3390/diagnostics13213368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
At the beginning of 2020, coronavirus disease 2019 (COVID-19) emerged as a new pandemic, leading to a worldwide health crisis and overwhelming healthcare systems due to high numbers of hospital admissions, insufficient resources, and a lack of standardized therapeutic protocols. Multiple genetic variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been detected since its first public declaration in 2020, some of them being considered variants of concern (VOCs) corresponding to several pandemic waves. Nevertheless, a growing number of COVID-19 patients are continuously discharged from hospitals, remaining symptomatic even months after their first episode of COVID-19 infection. Long COVID-19 or 'post-acute COVID-19 syndrome' emerged as the new pandemic, being characterized by a high variability of clinical manifestations ranging from cardiorespiratory and neurological symptoms such as chest pain, exertional dyspnoea or cognitive disturbance to psychological disturbances, e.g., depression, anxiety or sleep disturbance with a crucial impact on patients' quality of life. Moreover, Long COVID is viewed as a new cardiovascular risk factor capable of modifying the trajectory of current and future cardiovascular diseases, altering the patients' prognosis. Therefore, in this review we address the current definitions of Long COVID and its pathophysiology, with a focus on cardiovascular manifestations. Furthermore, we aim to review the mechanisms of acute and chronic cardiac injury and the variety of cardiovascular sequelae observed in recovered COVID-19 patients, in addition to the potential role of Long COVID clinics in the medical management of this new condition. We will further address the role of future research for a better understanding of the actual impact of Long COVID and future therapeutic directions.
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Affiliation(s)
- Maria-Luiza Luchian
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Julien Higny
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Martin Benoit
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Benoit Robaye
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Yannick Berners
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Jean-Philippe Henry
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Benjamin Colle
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Olivier Xhaët
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Dominique Blommaert
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Steven Droogmans
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Andreea Iulia Motoc
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Laurence Gabriel
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Antoine Guedes
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
| | - Fabian Demeure
- Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium (A.G.); (F.D.)
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Nour A, Fouad M, Salam ZA. Evaluation of cardiovascular autonomic dysfunction in symptomatic post-COVID-19 patients using the heart rate variability (HRV) and detection of subtle LV dysfunction using 2D global longitudinal strain (GLS). Int J Cardiovasc Imaging 2023; 39:2107-2118. [PMID: 37658987 PMCID: PMC10673727 DOI: 10.1007/s10554-023-02915-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 06/30/2023] [Indexed: 09/05/2023]
Abstract
AIM The COVID-19 disease primarily affects the respiratory system; however, cardiac involvement has been documented in the acute phase. We aimed to evaluate the cardiac autonomic function and subtle left ventricular dysfunction in those subjects recovered from mild to moderate acute COVID-19 patients but still symptomatic. METHODS AND RESULTS The study group was composed of 50 subjects with confirmed mild to moderate COVID-19. All subjects underwent routine 2D echocardiography assessment in addition to 2D speckle tracking and 24 h Holter monitoring for HRV analysis. The mean age of the study population was 42 ± 18 years; symptoms were reported as follows 27 (54%) had dyspnoea, 17 (34%) had palpitation, and 7 (14%) had dizziness. Time domain parameters Standard Deviation of NN intervals (SDNN), Standard Deviation of the Average NN intervals for each 5 min segment of a 24 h HRV recording (SDANN), and Root Mean Square of Successive RR interval Differences (rMSSD) were diminished with mean SDNN value being markedly impaired in 12 (24%) patients, while frequency domain parameters as assessed by the ratio of the Low-Frequency band power to the High-Frequency band power (LF/HF) with the mean of 1.837 with 8% of the patients being impaired. SDNN was significantly reduced in patients with impaired global longitudinal strain (p 0.000). The global longitudinal strain was diminished in 10 patients (20%); also, 80% of the patients with impaired GLS had decreased SDNN. CONCLUSION Our study targeted patients experiencing prolonged symptoms after COVID-19 illness. We detected a high incidence of GLS impairment using Speckle Tracking Echocardiography (STE) and a significant prevalence of diminished HRV. HRV (especially SDNN) and GLS were found to be significantly correlated.
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Affiliation(s)
- Amira Nour
- Cardiology department, Ain Shams University, Cairo, Egypt.
| | - Mirna Fouad
- Cardiology department, Ain Shams University, Cairo, Egypt
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Udeh R, Utrero-Rico A, Dolja-Gore X, Rahmati M, McEVoy M, Kenna T. Lactate dehydrogenase contribution to symptom persistence in long COVID: A pooled analysis. Rev Med Virol 2023; 33:e2477. [PMID: 37706263 DOI: 10.1002/rmv.2477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023]
Abstract
There's critical need for risk predictors in long COVID. This meta-analysis evaluates the evidence for an association between plasma lactate dehydrogenase (LDH) and long COVID and explores the contribution of LDH to symptoms persistent across the distinct post-acute sequelae of COVID-19 (PASC) domains. PubMed, EMBASE, Web of Science, and Google Scholar were searched for articles published up to 20 March 2023 for studies that reported data on LDH levels in COVID-19 survivors with and without PASC. Random-effect meta-analysis was employed to estimate the standardized mean difference (SMD) with corresponding 95% confidence interval of each outcome. There were a total of 8289 study participants (3338 PASC vs. 4951 controls) from 46 studies. Our meta-analysis compared to the controls showed a significant association between LDH elevation and Resp-PASC [SMD = 1.07, 95%CI = 0.72, 1.41, p = 0.01] but not Cardio-PASC [SMD = 1.79, 95%CI = -0.02, 3.61, p = 0.05], Neuro-PASC [SMD = 0.19, 95%CI = -0.24, 0.61, p = 0.40], and Gastrointestinal-PASC [SMD = 0.45, 95%CI = -1.08, 1.98, p = 0.56]. This meta-analysis suggests elevated LDH can be used for predicting Resp-PASC, but not Cardio-PASC, Neuro-PASC or gastrointestinal-PASC. Thus, elevated plasma LDH following COVID infection may be considered as a disease biomarker.
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Affiliation(s)
- Raphael Udeh
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, New South Wales, Australia
| | | | - Xenia Dolja-Gore
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Mark McEVoy
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, VIC, Australia
| | - Tony Kenna
- Centre for Immunology & Infection Control, Queensland University of Technology, Bendigo, Queensland, Australia
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Luo S, Xu ST, Zhang J, Schoepf UJ, Varga-Szemes A, Carpenter CRT, Zhang LY, Ma Y, Li Z, Wang Y, Huang WW, Zhi BB, Dou WQ, Qi L, Zhang LJ. Multiparametric cardiac magnetic resonance reveals persistent myocardial inflammation in patients with exertional heat illness. Eur Radiol 2023; 33:8165-8176. [PMID: 37145150 DOI: 10.1007/s00330-023-09706-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/26/2023] [Accepted: 03/12/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To explore the clinical potential of multiparametric cardiac magnetic resonance (CMR) in evaluating myocardial inflammation in patients with exertional heat illness (EHI). METHODS This prospective study enrolled 28 males with EHI (18 patients with exertional heat exhaustion (EHE) and 10 with exertional heat stroke (EHS)) and 18 age-matched male healthy controls (HC). All subjects underwent multiparametric CMR, and 9 patients had follow-up CMR measurements 3 months after recovery from EHI. CMR-derived left ventricular geometry, function, strain, native T1, extracellular volume (ECV), T2, T2*, and late gadolinium enhancement (LGE) were obtained and compared among different groups. RESULTS Compared with HC, EHI patients showed increased global ECV, T2, and T2* values (22.6% ± 4.1 vs. 19.7% ± 1.7; 46.8 ms ± 3.4 vs. 45.1 ms ± 1.2; 25.5 ms ± 2.2 vs. 23.8 ms ± 1.7; all p < 0.05). Subgroup analysis showed that ECV was higher in the EHS patients than those in EHE and HC groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05). Repeated CMR measurements at 3 months after baseline CMR showed persistently higher ECV than HC (p = 0.042). CONCLUSIONS With multiparametric CMR, EHI patients demonstrated increased global ECV, T2, and persistent myocardial inflammation at 3-month follow-up after EHI episode. Therefore, multiparametric CMR might be an effective method in evaluating myocardial inflammation in patients with EHI. CLINICAL RELEVANCE STATEMENT This study showed persistent myocardial inflammation after an exertional heat illness (EHI) episode demonstrated by multiparametric CMR, which is a potential promising method to evaluate the severity of myocardial inflammation and guide return to work, play, or duty in EHI patients. KEY POINTS • EHI patients showed an increased global extracellular volume (ECV), late gadolinium enhancement, and T2 value, indicating myocardial edema and fibrosis. • ECV was higher in the exertional heat stroke patients than exertional heat exhaustion and healthy control groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05). • EHI patients showed persistent myocardial inflammation with higher ECV than healthy controls 3 months after index CMR (22.3% ± 2.4 vs. 19.7% ± 1.7, p = 0.042).
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Affiliation(s)
- Song Luo
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - Shu Tian Xu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jun Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | | | - Ling Yan Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - Yan Ma
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - Zhe Li
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yang Wang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Wei Wei Huang
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - Bei Bei Zhi
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | | | - Li Qi
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China.
| | - Long Jiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China.
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Paglialonga L, Aurelio C, Principi N, Esposito S. Return to Play after SARS-CoV-2 Infection: Focus on the Pediatric Population with Potential Heart Involvement. J Clin Med 2023; 12:6823. [PMID: 37959288 PMCID: PMC10647408 DOI: 10.3390/jcm12216823] [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: 10/04/2023] [Revised: 10/22/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
The COVID-19 pandemic has entailed consequences on any type of physical activities, mainly due to the social restriction measures applied to reduce the spreading of SARS-CoV-2. When public health policies progressively reduced limitations and resuming a normal life was possible, the return to previous physical activity and sports was not only requested by people who had deeply suffered from limitations, but was also recommended by experts as a means of reducing the physical and psychological consequences induced by the pandemic. The aim of this narrative review is to summarize the available evidence on the return to play in children after SARS-CoV-2 infection, suggesting an algorithm for clinical practice and highlighting priorities for future studies. Criteria to identify subjects requiring laboratory and radiological tests before returning to physical activity are severity of COVID-19 and existence of underlying disease. Children of any age with asymptomatic infection or mild disease severity, i.e., the great majority of children with previous COVID-19, do not need a cardiologic test before resumption of previous physical activity. Only a visit or a telephonic contact with the primary care pediatricians should be established. On the contrary, children with moderate COVID-19 should not exercise until they are cleared by a physician and evaluated for resting electrocardiogram, exercise testing, and echocardiogram. Finally, in those with severe COVID-19, return to play should be delayed for several months, should be gradual and should be performed only after a cardiologist's clearance. Further studies are needed to assess the risks of returning to sports activity in pediatric age, including careful age-adjusted risk stratification, in order to improve the cost-benefit ratio of specific screenings.
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Affiliation(s)
- Letizia Paglialonga
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (L.P.); (C.A.)
| | - Camilla Aurelio
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (L.P.); (C.A.)
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (L.P.); (C.A.)
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Xiao W, Huang Q, Luo P, Tan X, Xia H, Wang S, Sun Y, Wang Z, Ma Y, Zhang J, Jin Y. Lipid metabolism of plasma-derived small extracellular vesicles in COVID-19 convalescent patients. Sci Rep 2023; 13:16642. [PMID: 37789017 PMCID: PMC10547714 DOI: 10.1038/s41598-023-43189-5] [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: 04/21/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), which affects multiple organs, is causing an unprecedented global public health crisis. Most COVID-19 patients recover gradually upon appropriate interventions. Viruses were reported to utilize the small extracellular vesicles (sEVs), containing a cell-specific cargo of proteins, lipids, and nucleic acids, to escape the attack from the host's immune system. This study aimed to examine the sEVs lipid profile of plasma of recovered COVID-19 patients (RCs). Plasma sEVs were separated from 83 RCs 3 months after discharge without underlying diseases, including 18 recovered asymptomatic patients (RAs), 32 recovered moderate patients (RMs), and 33 recovered severe and critical patients (RSs), and 19 healthy controls (HCs) by Total Exosome Isolation Kit. Lipids were extracted from sEVs and then subjected to targeted liquid chromatography-mass spectrometry. The size, concentration, and distribution of sEVs did not differ in RCs and HCs as validated by transmission electron microscopy, nanoparticle tracking analysis, and immunoblot analysis. Fifteen subclasses of 508 lipids were detected in plasma sEVs from HCs, RAs, RMs, and RSs, such as phosphatidylcholines (PCs) and diacylglycerols (DAGs), etc. Total lipid intensity displayed downregulation in RCs compared with HCs. The relative abundance of DAGs gradually dropped, whereas PCs, lysophosphatidylcholines, and sphingomyelins were higher in RCs relative to HCs, especially in RSs. 88 lipids out of 241 in sEVs of RCs were significantly different and a conspicuous increase was revealed with disease status. The sEVs lipids alternations were found to be significantly correlated with the clinical indices in RCs and HCs, suggesting that the impact of COVID-19 on lipid metabolism lingered for a long time. The lipid abnormalities bore an intimate link with glycerophospholipid metabolism and glycosylphosphatidylinositol anchor biosynthesis. Furthermore, the lipidomic analysis showed that RCs were at higher risk of developing diabetes and sustaining hepatic impairment. The abnormality of immunomodulation in RCs might still exist. The study may offer new insights into the mechanism of organ dysfunction and help identify novel therapeutic targets in the RCs.
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Affiliation(s)
- Wenjing Xiao
- Department of Respiratory and Critical Care Medicine, Hubei Province Clinical Research Center for Major Respiratory Diseases, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- MOE Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Qi Huang
- Department of Respiratory and Critical Care Medicine, Hubei Province Clinical Research Center for Major Respiratory Diseases, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- MOE Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Ping Luo
- Department of Translational Medicine Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Xueyun Tan
- Department of Respiratory and Critical Care Medicine, Hubei Province Clinical Research Center for Major Respiratory Diseases, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Hui Xia
- Department of Respiratory and Critical Care Medicine, Hubei Province Clinical Research Center for Major Respiratory Diseases, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Sufei Wang
- Department of Respiratory and Critical Care Medicine, Hubei Province Clinical Research Center for Major Respiratory Diseases, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Yice Sun
- Department of Respiratory and Critical Care Medicine, Hubei Province Clinical Research Center for Major Respiratory Diseases, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Zhihui Wang
- Department of Scientific Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Yanling Ma
- Department of Respiratory and Critical Care Medicine, Hubei Province Clinical Research Center for Major Respiratory Diseases, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Jianchu Zhang
- Department of Respiratory and Critical Care Medicine, Hubei Province Clinical Research Center for Major Respiratory Diseases, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- MOE Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, Hubei Province Clinical Research Center for Major Respiratory Diseases, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- MOE Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- Hubei Province Engineering Research Center for Tumor-Targeted Biochemotherapy, Wuhan, 430022, China.
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Sewanan LR, Di Tullio MR, Laine AF, D’Souza B, Leb J, Mironov A, Khan A, Stanger DE, Konofagou EE, Goldsmith RL, Jambawalikar SR, Hirschfeld CB, Castillo M, Durkin KJ, Dashnaw S, Thomas Vaughan J, Einstein AJ. Absence of long-term structural and functional cardiac abnormalities on multimodality imaging in a multi-ethnic group of COVID-19 survivors from the early stage of the pandemic. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad034. [PMID: 39045071 PMCID: PMC11195772 DOI: 10.1093/ehjimp/qyad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/17/2023] [Indexed: 07/25/2024]
Abstract
Aims Many patients with coronavirus disease-2019 (COVID-19), particularly from the pandemic's early phase, have been reported to have evidence of cardiac injury such as cardiac symptoms, troponinaemia, or imaging or ECG abnormalities during their acute course. Cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE) have been widely used to assess cardiac function and structure and characterize myocardial tissue during COVID-19 with report of numerous abnormalities. Overall, findings have varied, and long-term impact of COVID-19 on the heart needs further elucidation. Methods and results We performed TTE and 3 T CMR in survivors of the initial stage of the pandemic without pre-existing cardiac disease and matched controls at long-term follow-up a median of 308 days after initial infection. Study population consisted of 40 COVID-19 survivors (50% female, 28% Black, and 48% Hispanic) and 12 controls of similar age, sex, and race-ethnicity distribution; 35% had been hospitalized with 28% intubated. We found no difference in echocardiographic characteristics including measures of left and right ventricular structure and systolic function, valvular abnormalities, or diastolic function. Using CMR, we also found no differences in measures of left and right ventricular structure and function and additionally found no significant differences in parameters of tissue structure including T1, T2, extracellular volume mapping, and late gadolinium enhancement. With analysis stratified by patient hospitalization status as an indicator of COVID-19 severity, no differences were uncovered. Conclusion Multimodal imaging of a diverse cohort of COVID-19 survivors indicated no long-lasting damage or inflammation of the myocardium.
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Affiliation(s)
- Lorenzo R Sewanan
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Marco R Di Tullio
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Andrew F Laine
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Belinda D’Souza
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Jay Leb
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Alexander Mironov
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Ahsan Khan
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Dylan E Stanger
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Elisa E Konofagou
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Rochelle L Goldsmith
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Sachin R Jambawalikar
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Cole B Hirschfeld
- Maurice R. and Corinne P. Greenberg Division of Cardiology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Michelle Castillo
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Kathleen J Durkin
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, USA
| | - Stephen Dashnaw
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - J Thomas Vaughan
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Andrew J Einstein
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
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Sánchez Tijmes F, Marschner CA, de Matos JFRG, Urzua Fresno CM, Gutiérrez Chacoff JM, Thavendiranathan P, Fuss C, Hanneman K. Imaging Acute and Chronic Cardiac Complications of COVID-19 and after COVID-19 Vaccination. Radiographics 2023; 43:e230044. [PMID: 37616171 DOI: 10.1148/rg.230044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
COVID-19 is associated with acute and longer-term cardiovascular manifestations including myocardial injury, myopericarditis, stress-induced cardiomyopathy, myocardial infarction, and thromboembolic disease. Although the morbidity and mortality related to acute COVID-19 have decreased substantially, there is growing concern about the longer-term cardiovascular effects of the disease and postacute sequelae. Myocarditis has also been reported after messenger ribonucleic acid (mRNA)-based COVID-19 vaccination, with the highest risk among adolescent boys and young adult men. Noninvasive imaging including cardiac MRI has a key role in identifying the presence of cardiovascular disease, evaluating for potential mechanisms of injury, stratifying risk of future adverse cardiovascular events, and potentially guiding treatment in patients with suspected cardiovascular injury after COVID-19 and vaccination. Patterns of injury identified at cardiac MRI after COVID-19 include myocarditis and pericarditis, myocardial ischemia, and infarction. Myocardial edema and late gadolinium enhancement have been described months after the initial infection in a minority of patients with persistent cardiac symptoms after COVID-19. In patients with myocarditis after receiving a COVID-19 vaccination, the most common pattern of late gadolinium enhancement is subepicardial at the basal inferolateral wall, and patients tend to have milder imaging abnormalities compared with those from other causes of myocarditis. This article describes the role of multimodality cardiac imaging and imaging findings in patients with acute and longer-term cardiovascular manifestations of COVID-19 and in patients with myocarditis after receiving an mRNA-based COVID-19 vaccination. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Felipe Sánchez Tijmes
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Constantin A Marschner
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Joao Francisco Ribeiro Gavina de Matos
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Camila M Urzua Fresno
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Jose Miguel Gutiérrez Chacoff
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Cristina Fuss
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Kate Hanneman
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
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Taş S, Taş Ü. Effects of COVID-19 on the Autonomic Cardiovascular System: Heart Rate Variability and Turbulence in Recovered Patients. Tex Heart Inst J 2023; 50:e227952. [PMID: 37605870 PMCID: PMC10660136 DOI: 10.14503/thij-22-7952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND COVID-19 may be a risk factor for developing cardiovascular autonomic dysfunction. Data are limited, however, on the association between heart rate variability, heart rate turbulence, and COVID-19. The aims of this study were to evaluate the effect of COVID-19 on the cardiovascular autonomic system in patients with persistent symptoms after recovering from COVID-19 and to determine whether these patients showed changes in ambulatory electrocardiography monitoring. METHODS Fifty-one adults who had confirmed SARS-CoV-2 infection and presented with persistent symptoms to the cardiology outpatient clinic after clinical recovery between April and June 2021 were included. Patients were prospectively followed for 6 months. The patients were evaluated at the time of first application to the cardiology outpatient clinic and at 6 months after presentation. Ambulatory electrocardiography monitoring and echocardiographic findings were compared with a control group of 95 patients. RESULTS Patients in the post-COVID-19 group had significantly higher mean (SD) turbulence onset (0.39% [1.82%] vs -1.37% [2.93%]; P < .001) and lower heart rate variability than those in the control group at both initial and 6-month evaluations. The post-COVID-19 group had no significant differences in echocardiographic findings compared with the control group at 6 months, except for right ventricle late diastolic mitral annular velocity (P = .034). Furthermore, turbulence onset was significantly correlated with turbulence slope (r = -0.232; P = .004), heart rate variability, and the parameters of left (r = -0.194; P=.049) and right (r = 0.225; P = .02) ventricular diastolic function. CONCLUSIONS COVID-19 may cause cardiovascular autonomic dysfunction. Heart rate variability and turbulence parameters can be used to recognize cardiovascular autonomic dysfunction in patients who have recovered from COVID-19 but have persistent symptoms.
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Affiliation(s)
- Sedat Taş
- Department of Cardiology, Manisa City Hospital, Manisa, Turkey
| | - Ümmü Taş
- Department of Cardiology, Manisa Merkezefendi State Hospital, Manisa, Turkey
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Kanagaratnam P, Francis DP, Chamie D, Coyle C, Marynina A, Katritsis G, Paiva P, Szigeti M, Cole G, de Andrade Nunes D, Howard J, Esper R, Khan M, More R, Barreto G, Meneguz-Moreno R, Arnold A, Nowbar A, Kaura A, Mariveles M, March K, Shah J, Nijjer S, Lip GYH, Mills N, Camm AJ, Cooke GS, Corbett SJ, Llewelyn MJ, Ghanima W, Toshner M, Peters N, Petraco R, Al-Lamee R, Boshoff ASM, Durkina M, Malik I, Ruparelia N, Cornelius V, Shun-Shin M. A randomized controlled trial to investigate the use of acute coronary syndrome therapy in patients hospitalized with COVID-19: the COVID-19 Acute Coronary Syndrome trial. J Thromb Haemost 2023; 21:2213-2222. [PMID: 37230416 PMCID: PMC10204350 DOI: 10.1016/j.jtha.2023.04.045] [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: 11/14/2022] [Revised: 04/11/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Patients hospitalized with COVID-19 suffer thrombotic complications. Risk factors for poor outcomes are shared with coronary artery disease. OBJECTIVES To investigate the efficacy of an acute coronary syndrome regimen in patients hospitalized with COVID-19 and coronary disease risk factors. METHODS A randomized controlled, open-label trial across acute hospitals (United Kingdom and Brazil) added aspirin, clopidogrel, low-dose rivaroxaban, atorvastatin, and omeprazole to standard care for 28 days. Primary efficacy and safety outcomes were 30-day mortality and bleeding. The key secondary outcome was a daily clinical status (at home, in hospital, on intensive therapy unit admission, or death). RESULTS Three hundred twenty patients from 9 centers were randomized. The trial terminated early due to low recruitment. At 30 days, there was no significant difference in mortality (intervention vs control, 11.5% vs 15%; unadjusted odds ratio [OR], 0.73; 95% CI, 0.38-1.41; p = .355). Significant bleeds were infrequent and were not significantly different between the arms (intervention vs control, 1.9% vs 1.9%; p > .999). Using a Bayesian Markov longitudinal ordinal model, it was 93% probable that intervention arm participants were more likely to transition to a better clinical state each day (OR, 1.46; 95% credible interval [CrI], 0.88-2.37; Pr [beta > 0], 93%; adjusted OR, 1.50; 95% CrI, 0.91-2.45; Pr [beta > 0], 95%) and median time to discharge to home was 2 days shorter (95% CrI, -4 to 0; 2% probability that it was worse). CONCLUSION Acute coronary syndrome treatment regimen was associated with a reduction in the length of hospital stay without an excess in major bleeding. A larger trial is needed to evaluate mortality.
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Affiliation(s)
- Prapa Kanagaratnam
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK.
| | - Darrel P Francis
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | - Daniel Chamie
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Clare Coyle
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | | | - Patricia Paiva
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Matyas Szigeti
- Imperial College, London, UK; Physiological Controls Research Centre, Obuda University, Budapest, Hungary
| | - Graham Cole
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | - James Howard
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | - Masood Khan
- West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Ranjit More
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | - Rafael Meneguz-Moreno
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil; Centro de Ensino e Pesquisa da Rede Primavera, Aracaju, Brazil; Universidade Federal de Sergipe, Lagarto, Brazil
| | - Ahran Arnold
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | - Amit Kaura
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | | | - Jaymin Shah
- London North West University Healthcare NHS Trust, London, UK
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Nicholas Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
| | - A John Camm
- St George's University of London, London, UK
| | - Graham S Cooke
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | - Simon J Corbett
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Martin J Llewelyn
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Waleed Ghanima
- Østfold Hospital: Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mark Toshner
- Heart and Lung Research Institute, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Nicholas Peters
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | - Ricardo Petraco
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | - Rasha Al-Lamee
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | - Margarita Durkina
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Iqbal Malik
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | - Neil Ruparelia
- Imperial College Healthcare NHS Trust, London, UK; Royal Berkshire Hospital NHS Trust, Reading, UK
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Matthew Shun-Shin
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK. https://twitter.com/mshunshin
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Santangelo G, Toriello F, Faggiano A, Henein MY, Carugo S, Faggiano P. Role of cardiac and lung ultrasound in the COVID-19 era. Minerva Cardiol Angiol 2023; 71:387-401. [PMID: 35767237 DOI: 10.23736/s2724-5683.22.06074-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
INTRODUCTION The primary diagnostic method of Coronavirus disease 2019 is reverse transcription polymerase chain reaction of the nucleic acid of severe acute respiratory syndrome coronavirus 2 in nasopharyngeal swabs. There is growing evidence regarding the 2019 coronavirus disease imaging results on chest X-rays and computed tomography but the accessibility to standard diagnostic methods may be limited during the pandemic. EVIDENCE ACQUISITION Databases used for the search were MEDLINE (PubMed), Scopus Search, and Cochrane Library. The research took into consideration studies published in English until March 2022 and was conducted using the following research query: ((((sars cov [MeSH Terms])) OR (COVID-19)) OR (Sars-Cov2)) OR (Coronavirus)) AND (((((2d echocardiography [MeSH Terms]) OR (doppler ultrasound imaging [MeSH Terms]))) OR (echography [MeSH Terms])) OR (LUS)) OR ("LUNG ULTRASOUND")). EVIDENCE SYNTHESIS Pulmonary and cardiac ultrasound are cost-effective, widely available, and provide information that can influence management. CONCLUSIONS Point-of-care ultrasonography is a method that can provide relevant clinical and therapeutic information in patients with COVID-19 where other diagnostic methods may not be easily accessible.
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Affiliation(s)
- Gloria Santangelo
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Filippo Toriello
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Faggiano
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, University of Umea, Umea, Sweden
| | - Stefano Carugo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pompilio Faggiano
- Unit of Cardiovascular Disease, Cardiovascular Department, Poliambulanza Foundation, Brescia, Italy -
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Ghany R, Tamariz L, Chen G, Dawkins E, Forbes E, Tajiri T, Palacio A. Impact of Prediabetes on Cardiac Function Among Primary Care Patients. Metab Syndr Relat Disord 2023; 21:314-318. [PMID: 35930273 DOI: 10.1089/met.2021.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Prediabetes is a novel risk factor recently associated with changes in the left ventricle. Our aim is to determine if prediabetes is associated with heart failure (HF) and structural heart disease. Methods: We conducted a cross-sectional study and performed screening echocardiograms to consecutive primary care patients. We calculated the hemoglobin A1c (HbA1c) within 3 months of the echocardiogram and classified patients as having normal glucose, low-risk or high-risk prediabetes or diabetes. Our primary outcome was HF defined as an ejection fraction (EF) <50% and HF with preserved EF. Our secondary outcome was structural heart disease defined as having either a large atrium, left ventricular hypertrophy, or low EF. Results: We included 15,056 patients who underwent a screening echocardiogram and had a recorded HbA1c. Only 2794 patients had a normal blood glucose, 4201 had low-risk prediabetes, 2499 had high-risk prediabetes, and the remainder had diabetes. The adjusted odds ratio (ORs) of HF for low-risk prediabetes, high-risk prediabetes and diabetes were 1.38 [confidence interval (95% CI) 1.07-1.78] (P = 0.01), 1.47 (95% CI 1.05-2.01) (P = 0.01), and 1.60 (95% CI 1.16-2.01) (P < 0.01), respectively, when compared with normoglycemic patients. The adjusted OR of HF with preserved EF for low- and high-risk prediabetes and diabetes were 1.17 (95% CI 0.86-1.60) (P = 0.30), 1.60 (95% CI 1.15-2.21) (P < 0.01), and 1.63 (95% CI 1.24-2.13) (P < 0.01), respectively, when compared with normoglycemic patients. Conclusions: Prediabetes is a prevalent condition associated with structural heart disease and HF.
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Affiliation(s)
- Reyan Ghany
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Leonardo Tamariz
- Chen Neighborhood Medical Centers, Miller School of Medicine at the University of Miami, Miami, Florida, USA
- Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Miami, Florida, USA
| | - Gordon Chen
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Elissa Dawkins
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Emancia Forbes
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Thiago Tajiri
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Ana Palacio
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, Florida, USA
- Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Miami, Florida, USA
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Wanjari M, Late S, Sharma R, Munjewar P. Long-term pulmonary and extra-pulmonary consequences of COVID-19: A comprehensive review of current evidence and future perspectives. NARRA J 2023; 3:e156. [PMID: 38454970 PMCID: PMC10919748 DOI: 10.52225/narra.v3i2.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/26/2023] [Indexed: 03/09/2024]
Abstract
The global impact of the coronavirus disease 2019 (COVID-19) pandemic has been significant, affecting countless individuals worldwide. The existence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to considerable levels of illness and mortality. While considerable attention has been devoted to the immediate handling of COVID-19, there is a growing concern about the long-term effects of this disease. The recent studies have brought to light various complexities associated with COVID-19, encompassing both respiratory and non-respiratory problems such as lung scarring, heart diseases, neurological effects, and psychological consequences. The purpose of this review is to provide a comprehensive understanding of the persistent repercussions of COVID-19. It presents a summary of recent studies that have examined the frequency and severity of these complications, as well as an exploration of the potential mechanisms that contribute to their development. Specifically, it delves into the role of immune dysregulation, prolonged inflammation, and dysfunction of blood vessel linings in the origin of these complications. Moreover, the clinical significance of these long-term consequences is discussed, including their potential impact on healthcare systems and society as a whole. Our review highlights the necessity for continuous monitoring and management of patients diagnosed with COVID-19, along with the importance of conducting follow-up studies over an extended period to determine the most effective strategies for prevention and treatment of these complications.
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Affiliation(s)
- Mayur Wanjari
- Departement of Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, India
| | - Sampada Late
- Department of Nursing, Government Hospital Samudrapur, Wardha, India
| | - Ranjana Sharma
- Department of Medical Surgical Nursing, Srimati Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, India
| | - Pratiksha Munjewar
- Department of Medical Surgical Nursing, Srimati Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, India
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Tijmes FS, Marschner C, Thavendiranathan P, Hanneman K. Magnetic Resonance Imaging of Cardiovascular Manifestations Following COVID-19. J Magn Reson Imaging 2023; 58:26-43. [PMID: 36951477 DOI: 10.1002/jmri.28677] [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: 01/18/2023] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 03/24/2023] Open
Abstract
Globally, over 650 million people have had COVID-19 due to infection with the SARS-Cov-2 virus. Cardiac complications in the acute infectious and early recovery phase were recognized early in the pandemic, including myocardial injury and inflammation. With a decrease in the number of acute COVID-19 related deaths, there has been increased interest in postacute sequela of COVID-19 (PASC) and other longer-term cardiovascular complications. A proportion of patients recovered from COVID-19 have persistent cardiac symptoms and are at risk of cardiovascular disease. Cardiovascular imaging, including MRI, plays an important role in the detection of cardiovascular manifestations of COVID-19 in both the acute and longer-term phases after COVID-19. The purpose of this review is to highlight the role of cardiovascular imaging in the diagnosis and risk stratification of patients with acute and chronic cardiovascular manifestations of COVID-19 with a focus on cardiac MRI. EVIDENCE LEVEL: 4. TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Felipe Sanchez Tijmes
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile
| | - Constantin Marschner
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
| | - Kate Hanneman
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
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Shin SH. Beyond COVID-19 Infection: Long-Term Risks of Cardiovascular Sequelae. J Cardiovasc Imaging 2023; 31:133-134. [PMID: 37488917 PMCID: PMC10374391 DOI: 10.4250/jcvi.2023.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/11/2023] [Indexed: 07/26/2023] Open
Affiliation(s)
- Sung-Hee Shin
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.
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43
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Baig MMA, Adnan M, Baig MU, Ramzan Z. Late-onset pulmonary complications among survivors of coronavirus Disease 2019. Pak J Med Sci 2023; 39:1035-1039. [PMID: 37492317 PMCID: PMC10364300 DOI: 10.12669/pjms.39.4.6302] [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: 03/11/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 07/27/2023] Open
Abstract
Objectives To assess the late-onset pulmonary complications among survivors of coronavirus disease 2019. Methods The cross-sectional analytical study was conducted in the department of Pulmonology, Sir Ganga Ram Hospital Lahore between October 2020 and March 2021. Total 288 patients visiting the hospital 12-week after recovery from COVID-19 enrolled using convenience sampling. After excluding patients (n=61) with a history of previous respiratory symptoms before the development of COVID-19, data from 227 patients was subjected to final analysis. Chest X-ray (CXR) was used to evaluate lung condition. Results Participation of middle-aged adults (54.6%) was higher than older (38.3%) and young adults (7.0%). The percentage of males was 55.5% and smokers was 29.1%. Dyspnea was the most common complication as 80.0% patients had moderate to severe dyspnea while chronic cough was 78.0% and lung fibrosis (LF) was 13.2%. The chances of LF increased with the rise in age (p-value 0.033). However, the distribution of LF was similar between males and females. The frequency of lung fibrosis in smokers was 3-time higher than among non-smokers (24.2 vs. 8.7%; p-value 0.003). The patients with LF were more dependent on O2 as compared to the patients without LF (p-value < 0.001). The frequency of tachycardia was significantly different between patients with and without LF (all p-values < 0.05). Conclusion LF is a common late-onset pulmonary complication of COVID-19 and is associated with old age, smoking, O2 dependency, tachycardia, and severe dyspnea.
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Affiliation(s)
| | - Muhammad Adnan
- Muhammad Adnan, Health Research Institute, National Institute of Health, HRI NIH Research Center FJMU, Lahore, Pakistan
| | | | - Zohaib Ramzan
- Zohaib Ramzan Department of Pulmonology, Sir Ganga Ram Hospital, Lahore, Pakistan
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44
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Paruchuri SSH, Farwa UE, Jabeen S, Pamecha S, Shan Z, Parekh R, Lakkimsetti M, Alamin E, Sharma V, Haider S, Khan J, Razzaq W. Myocarditis and Myocardial Injury in Long COVID Syndrome: A Comprehensive Review of the Literature. Cureus 2023; 15:e42444. [PMID: 37637608 PMCID: PMC10449234 DOI: 10.7759/cureus.42444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
The repercussions of coronavirus disease 2019 (COVID-19) have been devastating on a global scale. Long COVID, which affects patients for weeks or even months after their initial infection, is not limited to individuals with severe symptoms and can affect people of all ages. The condition can impact various physiological systems, leading to chronic health conditions and long-term disabilities that present significant challenges for healthcare systems worldwide. This review explores the link between long COVID and cardiovascular complications such as myocardial injury and myocarditis. It also highlights the prevalence of these complications and identifies risk factors for their development in long COVID patients. Myocardial injury occurs due to direct cellular damage and T-cell-mediated cytotoxicity resulting in elevated cardiac biomarkers. Diagnostic techniques like electrocardiogram, troponin level testing, and magnetic resonance imaging can help identify myocarditis, but endomyocardial biopsy is considered the gold-standard diagnostic technique. Guideline-directed medical therapy is recommended for COVID-19 myocarditis patients for better prognosis while being monitored under comprehensive care management approaches. Therefore, it's critical to develop effective screening techniques specifically for vulnerable populations while conducting further research that addresses the effects of long COVID on society's physical health.
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Affiliation(s)
- Sai Sri Hari Paruchuri
- Internal Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, IND
| | - Umm E Farwa
- Emergency Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Shaista Jabeen
- Medicine, Pakistan Air Force (PAF) Hospital, Islamabad, PAK
| | - Shreyansh Pamecha
- Internal Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Zoofi Shan
- Cardiology, Hero DMC (Dayanand Medical College) Heart Institute, Ludhiana, IND
| | - Ritika Parekh
- Community Health, K. J. (Karamshibhai Jethabhai) Somaiya Medical College and Research Centre, Mumbai, Mumbai, IND
| | | | - Eman Alamin
- Community Health, University of Medical Sciences and Technology, Khartoum, SDN
| | - Vagisha Sharma
- College of Medicine, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Salar Haider
- Physiology, Shifa College of Medicine, Islamabad, PAK
| | - Javeria Khan
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Waleed Razzaq
- Internal Medicine, Services Hospital Lahore, Lahore, PAK
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45
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Fijalkowska J, Glinska A, Fijalkowski M, Sienkiewicz K, Kulawiak-Galaska D, Szurowska E, Pienkowska J, Dorniak K. Cardiac Magnetic Resonance Relaxometry Parameters, Late Gadolinium Enhancement, and Feature-Tracking Myocardial Longitudinal Strain in Patients Recovered from COVID-19. J Cardiovasc Dev Dis 2023; 10:278. [PMID: 37504534 PMCID: PMC10380498 DOI: 10.3390/jcdd10070278] [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: 05/26/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
COVID-19 infection is associated with myocarditis, and cardiovascular magnetic resonance (CMR) is the reference non-invasive imaging modality for myocardial tissue characterization. Quantitative CMR techniques, such as feature tracking (FT) and left ventricular global longitudinal strain (GLS) analysis, have been introduced as promising diagnostic tools to improve the diagnostic accuracy of suspected myocarditis. The aim of this study was to analyze the left ventricular global longitudinal strain (GLS) and the influence of T1 and T2 relaxation times, ECV, and LGE appearance on GLS parameters in a multiparametric imaging protocol in patients who recovered from COVID-19. The 86 consecutive patients enrolled in the study had all recovered from mild or moderate COVID-19 infections; none required hospitalization. Their persistent symptoms and suspected myocarditis led to cardiac magnetic resonance imaging within 3 months of the diagnosis of the SARS-CoV-2 infection. Results: Patients with GLS less negative than -15% had significantly lower LVEF (53.6% ± 8.9 vs. 61.6% ± 4.8; <0.001) and were significantly more likely to have prolonged T1 (28.6% vs. 7.5%; p = 0.019). Left ventricular GLS correlated significantly with T1 (r = 0.303; p = 0.006) and LVEF (r = -0.732; p < 0.001). Left ventricular GLS less negative than -15% was 7.5 times more likely in patients with prolonged T1 (HR 7.62; 95% CI 1.25-46.64). The reduced basal inferolateral longitudinal strain had a significant impact on the global left ventricular longitudinal strain. ROC results suggested that a GLS of 14.5% predicted prolonged T1 relaxation time with the best sensitivity and specificity. Conclusions: CMR abnormalities, including a myocarditis pattern, are common in patients who have recovered from COVID-19. The CMR feature-tracking left ventricular GLS is related to T1 relaxation time and may serve as a novel parameter to detect global and regional myocardial injury and dysfunction in patients with suspected myocardial involvement after recovery from COVID-19.
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Affiliation(s)
- Jadwiga Fijalkowska
- Second Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Anna Glinska
- Second Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Marcin Fijalkowski
- First Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | | | | | - Edyta Szurowska
- Second Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Joanna Pienkowska
- Second Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Karolina Dorniak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, 80-211 Gdansk, Poland
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46
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Garg R, Hussain M, Friedrich MG. Phenotyping myocardial injury related to COVID and SARS-CoV-2 vaccination: insights from cardiovascular magnetic resonance. Front Cardiovasc Med 2023; 10:1186556. [PMID: 37396575 PMCID: PMC10308023 DOI: 10.3389/fcvm.2023.1186556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- Ria Garg
- Department of Internal Medicine, Geisinger Wyoming Valley Hospital, Wilkes Barre, PA, United States
- Department of CV Imaging, Courtois CMR Research Group at the Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Muzna Hussain
- Department of Internal Medicine, Geisinger Wyoming Valley Hospital, Wilkes Barre, PA, United States
| | - Matthias G. Friedrich
- Department of CV Imaging, Courtois CMR Research Group at the Research Institute of the McGill University Health Centre, Montreal, Canada
- Division of Experimental Medicine, Departments of Medicine and Diagnostic Radiology, Universitaire de Santé McGill Site Glen, Montreal, QC, Canada
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Parhizgar P, Yazdankhah N, Rzepka AM, Chung KYC, Ali I, Lai Fat Fur R, Russell V, Cheung AM. Beyond Acute COVID-19: A Review of Long-term Cardiovascular Outcomes. Can J Cardiol 2023; 39:726-740. [PMID: 36754119 PMCID: PMC9901229 DOI: 10.1016/j.cjca.2023.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/03/2023] [Accepted: 01/21/2023] [Indexed: 02/08/2023] Open
Abstract
Statistics Canada estimated that approximately 1.4 million Canadians suffer from long COVID. Although cardiovascular changes during acute SARS-CoV-2 infection are well documented, long-term cardiovascular sequelae are less understood. In this review, we sought to characterize adult cardiovascular outcomes in the months after acute COVID-19 illness. In our search we identified reports of outcomes including cardiac dysautonomia, myocarditis, ischemic injuries, and ventricular dysfunction. Even in patients without overt cardiac outcomes, subclinical changes have been observed. Cardiovascular sequelae after SARS-CoV-2 infection can stem from exacerbation of preexisting conditions, ongoing inflammation, or as a result of damage that occurred during acute infection. For example, myocardial fibrosis has been reported months after hospital admission for COVID-19 illness, and might be a consequence of myocarditis and myocardial injury during acute disease. In turn, myocardial fibrosis can contribute to further outcomes including dysrhythmias and heart failure. Severity of acute infection might be a risk factor for long-term cardiovascular consequences, however, cardiovascular changes have also been reported in young, healthy individuals who had asymptomatic or mild acute disease. Although evolving evidence suggests that previous SARS-CoV-2 infection might be a risk factor for cardiovascular disease, there is heterogeneity in existing evidence, and some studies are marred by measured and unmeasured confounders. Many investigations have also been limited by relatively short follow-up. Future studies should focus on longer term outcomes (beyond 1 year) and identifying the prevalence of outcomes in different populations on the basis of acute and long COVID disease severity.
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Affiliation(s)
- Parinaz Parhizgar
- Department of Medicine and Joint Department of Medical Imaging, Toronto Hospital Research Institute and Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nima Yazdankhah
- Department of Medicine and Joint Department of Medical Imaging, Toronto Hospital Research Institute and Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anna M Rzepka
- Department of Medicine and Joint Department of Medical Imaging, Toronto Hospital Research Institute and Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kit Yan Christie Chung
- Department of Medicine and Joint Department of Medical Imaging, Toronto Hospital Research Institute and Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Irfan Ali
- Department of Medicine and Joint Department of Medical Imaging, Toronto Hospital Research Institute and Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Lai Fat Fur
- Department of Medicine and Joint Department of Medical Imaging, Toronto Hospital Research Institute and Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Russell
- Department of Medicine and Joint Department of Medical Imaging, Toronto Hospital Research Institute and Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Angela M Cheung
- Department of Medicine and Joint Department of Medical Imaging, Toronto Hospital Research Institute and Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Aprile I, Bramante L, La Russa C, Germanotta M, Barletta VT, Falchini F, Brambilla L, Guglielmelli E, Rossi P. A Multiaxial Rehabilitation Programme for Workers with COVID-19 Sequelae Using a Conventional and Technological-Robotic Approach: The Proposal of INAIL and Fondazione Don Carlo Gnocchi. Healthcare (Basel) 2023; 11:1593. [PMID: 37297733 PMCID: PMC10252900 DOI: 10.3390/healthcare11111593] [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: 03/07/2023] [Revised: 05/11/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
The COVID-19 sequelae have been shown to affect respiratory and cardiological functions as well as neuro-psychological functions, and, in some cases, metabolic/nutritional aspects. The Italian National Institute for Insurance against Accidents at Work (Istituto Nazionale Assicurazione Infortuni sul Lavoro, INAIL) recorded that, until December 2022, 315,055 workers were affected by COVID-19; therefore, there is a need to identify an effective approach to treat such patients. Robotic and technological devices could be integrated into the rehabilitation programme of people with long COVID conditions. A review of the literature showed that telerehabilitation may improve functional capacity, dyspnoea, performance, and quality of life in these patients, but no studies were found evaluating the effects of robot-mediated therapy or virtual reality systems. Considering the above, Fondazione Don Carlo Gnocchi and INAIL propose a multi-axial rehabilitation for workers with COVID-19 sequelae. To accomplish this goal, the two institutions merged the epidemiological information gathered by INAIL, the expertise in robotic and technological rehabilitation of Fondazione Don Carlo Gnocchi, and the literature review. Our proposal aims to facilitate a multi-axial rehabilitation approach customized to meet the unique needs of each individual, with a particular emphasis on utilizing advanced technologies to address the current and future challenges of patient care.
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Affiliation(s)
- Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (I.A.); (V.T.B.); (F.F.); (L.B.)
| | - Lucia Bramante
- Central Medical Department, National Institute for Insurance against Accidents at Work (INAIL), 00144 Rome, Italy; (L.B.); (C.L.R.); (P.R.)
| | - Chiara La Russa
- Central Medical Department, National Institute for Insurance against Accidents at Work (INAIL), 00144 Rome, Italy; (L.B.); (C.L.R.); (P.R.)
| | - Marco Germanotta
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (I.A.); (V.T.B.); (F.F.); (L.B.)
| | | | - Francesca Falchini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (I.A.); (V.T.B.); (F.F.); (L.B.)
| | - Lorenzo Brambilla
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (I.A.); (V.T.B.); (F.F.); (L.B.)
| | - Eugenio Guglielmelli
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy;
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Roma, Italy
| | - Patrizio Rossi
- Central Medical Department, National Institute for Insurance against Accidents at Work (INAIL), 00144 Rome, Italy; (L.B.); (C.L.R.); (P.R.)
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49
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Holby SN, Richardson TL, Laws JL, McLaren TA, Soslow JH, Baker MT, Dendy JM, Clark DE, Hughes SG. Multimodality Cardiac Imaging in COVID. Circ Res 2023; 132:1387-1404. [PMID: 37167354 PMCID: PMC10171309 DOI: 10.1161/circresaha.122.321882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Infection with SARS-CoV-2, the virus that causes COVID, is associated with numerous potential secondary complications. Global efforts have been dedicated to understanding the myriad potential cardiovascular sequelae which may occur during acute infection, convalescence, or recovery. Because patients often present with nonspecific symptoms and laboratory findings, cardiac imaging has emerged as an important tool for the discrimination of pulmonary and cardiovascular complications of this disease. The clinician investigating a potential COVID-related complication must account not only for the relative utility of various cardiac imaging modalities but also for the risk of infectious exposure to staff and other patients. Extraordinary clinical and scholarly efforts have brought the international medical community closer to a consensus on the appropriate indications for diagnostic cardiac imaging during this protracted pandemic. In this review, we summarize the existing literature and reference major societal guidelines to provide an overview of the indications and utility of echocardiography, nuclear imaging, cardiac computed tomography, and cardiac magnetic resonance imaging for the diagnosis of cardiovascular complications of COVID.
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Affiliation(s)
- S Neil Holby
- Cardiovascular Medicine Fellowship, Division of Cardiology, Department of Internal Medicine (S.N.H., T.L.R., J.L.L.), Vanderbilt University Medical Center
| | - Tadarro Lee Richardson
- Cardiovascular Medicine Fellowship, Division of Cardiology, Department of Internal Medicine (S.N.H., T.L.R., J.L.L.), Vanderbilt University Medical Center
| | - J Lukas Laws
- Cardiovascular Medicine Fellowship, Division of Cardiology, Department of Internal Medicine (S.N.H., T.L.R., J.L.L.), Vanderbilt University Medical Center
| | - Thomas A McLaren
- Division of Cardiology, Department of Internal Medicine, Department of Radiology & Radiological Sciences (T.A.M., S.G.H.), Vanderbilt University Medical Center
| | - Jonathan H Soslow
- Thomas P. Graham Jr Division of Pediatric Cardiology, Department of Pediatrics (J.H.S.), Vanderbilt University Medical Center
| | - Michael T Baker
- Division of Cardiology, Department of Internal Medicine (M.T.B., J.M.D.), Vanderbilt University Medical Center
| | - Jeffrey M Dendy
- Division of Cardiology, Department of Internal Medicine (M.T.B., J.M.D.), Vanderbilt University Medical Center
| | - Daniel E Clark
- Division of Cardiology, Department of Internal Medicine, Stanford University School of Medicine (D.E.C.)
| | - Sean G Hughes
- Division of Cardiology, Department of Internal Medicine, Department of Radiology & Radiological Sciences (T.A.M., S.G.H.), Vanderbilt University Medical Center
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50
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Sayegh MN, Goins AE, Hall MAK, Shin YM. Presentations, Diagnosis, and Treatment of Post-COVID Viral Myocarditis in the Inpatient Setting: A Narrative Review. Cureus 2023; 15:e39338. [PMID: 37378093 PMCID: PMC10292156 DOI: 10.7759/cureus.39338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/29/2023] Open
Abstract
While coronavirus disease 2019 (COVID-19) infection rates have declined, and mortality outcomes have improved with vaccines, targeted antiviral therapies, and improved care practices over the course of the pandemic, post-acute sequelae of SARS CoV-2 infection (PASC, also referred to as "long COVID") has emerged as a significant concern, even among individuals who appear to have fully recovered from their initial infection. Acute COVID-19 infection is associated with myocarditis and cardiomyopathies, but the prevalence and presentation of post-infectious myocarditis are unclear. We provide a narrative review of post-COVID myocarditis, including symptoms and signs, physical exam findings, diagnosis, and treatment strategies. Post-COVID myocarditis has a wide range of presentations, from very mild symptoms to severe ones that can include sudden cardiac death. Several studies have noted what appears to be a bimodal distribution of affected patients, with individuals under age 16 (particularly males) most affected, followed by those over age 50. The gold standard of diagnosis for myocarditis is endomyocardial biopsy and cardiac magnetic resonance imaging with a confirmed diagnosis of COVID-19. However, if these are not available, other studies such as electrocardiogram, echocardiography, and inflammatory markers can guide clinicians to diagnose post-COVID myocarditis when appropriate. Treatment is largely supportive and may include oxygen therapy, intravenous hydration, diuretics, steroids, and antivirals. Post-COVID myocarditis is rare but important to recognize as more patients present with this condition in the inpatient setting.
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Affiliation(s)
- Michael N Sayegh
- Department of Medicine, Emory University School of Medicine, Atlanta, USA
| | - Allie E Goins
- Department of Medicine, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, USA
- Hospital Medicine, Emory University Hospital Midtown, Atlanta, USA
| | - Mary Ann Kirkconnell Hall
- Department of Medicine, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, USA
| | - Yoo Mee Shin
- Department of Medicine, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, USA
- Hospital Medicine, Emory University Hospital Midtown, Atlanta, USA
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