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Rademacher J, Therre M, Hinze CA, Buder F, Böhm M, Welte T. Association of respiratory infections and the impact of vaccinations on cardiovascular diseases. Eur J Prev Cardiol 2024; 31:877-888. [PMID: 38205961 DOI: 10.1093/eurjpc/zwae016] [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: 11/29/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024]
Abstract
Influenza, pneumococcal, severe acute respiratory syndrome coronavirus 2, and respiratory syncytial virus infections are important causes of high morbidity and mortality in the elderly. Beyond the burden of infectious diseases, they are also associated with several non-infectious complications like cardiovascular events. A growing body of evidence in prospective studies and meta-analyses has shown the impact of influenza and pneumococcal vaccines on types of cardiovascular outcomes in the general population. Influenza vaccination showed a potential benefit for primary and secondary prevention of cardiovascular diseases across all ages. A reduced risk of cardiovascular events for individuals aged 65 years and older was associated with pneumococcal vaccination. Despite scientific evidence on the effectiveness, safety, and benefits of the vaccines and recommendations to vaccinate elderly patients and those with risk factors, vaccination rates remain sub-optimal in this population. Doubts about vaccine necessity or efficacy and concerns about possible adverse events in patients and physicians refer to delayed acceptance. Vaccination campaigns targeting increasing professional recommendations and public perceptions should be implemented in the coming years. The aim of this review paper is to summarize the effect of vaccination in the field of cardiovascular disease to achieve a higher vaccination rate in this patient population.
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Affiliation(s)
- Jessica Rademacher
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease, Hannover, Germany
| | - Markus Therre
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg 66421, Germany
| | - Christopher Alexander Hinze
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Felix Buder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg 66421, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg 66421, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease, Hannover, Germany
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2
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Johansen ND, Vaduganathan M, Bhatt AS, Lee SG, Modin D, Claggett BL, Dueger EL, Samson S, Loiacono MM, Harris RC, Køber L, Solomon SD, Sivapalan P, Jensen JUS, Martel CJM, Valentiner-Branth P, Krause TG, Biering-Sørensen T. Electronic nudges to increase influenza vaccination uptake among patients with heart failure: A pre-specified analysis of the NUDGE-FLU trial. Eur J Heart Fail 2023; 25:1450-1458. [PMID: 37211967 DOI: 10.1002/ejhf.2913] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023] Open
Abstract
AIMS Seasonal influenza vaccination is strongly recommended in patients with heart failure (HF). The NUDGE-FLU trial recently found two electronic behavioural nudging letter strategies - a letter highlighting potential cardiovascular benefits of vaccination and a repeated letter at day 14 -effective in increasing influenza vaccination in Denmark. The aims of this pre-specified analysis was to further examine vaccination patterns and effects of these behavioural nudges in patients with HF including potential off-target effects on guideline-directed medical therapy (GDMT) use. METHODS AND RESULTS The nationwide NUDGE-FLU trial randomized 964 870 Danish citizens ≥65 years to usual care or nine different electronic nudging letter strategies. Letters were delivered through the official Danish electronic letter system. The primary endpoint was the receipt of an influenza vaccine; additional outcomes for this analysis included GDMT use. In this analysis, we also assessed influenza vaccination rates in the overall Danish HF population including those <65 years (n = 65 075). During the 2022-2023 season, influenza vaccination uptake was 71.6% in the overall Danish HF population but this varied considerably with only 44.6% uptake in those <65 years. A total of 33 109 NUDGE-FLU participants had HF at baseline. Vaccination uptake was higher among those on higher levels of baseline GDMT (≥3 classes: 85.3% vs. ≤2 classes: 81.9%; p < 0.001). HF status did not modify the effects of the two overall successful nudging strategies on influenza vaccination uptake (cardiovascular gain-framed letter: pinteraction = 0.37; repeated letter: pinteraction = 0.55). No effect modification was observed across GDMT use levels for the repeated letter (pinteraction = 0.88), whereas a trend towards attenuated effect among those on low levels of GDMT was observed for the cardiovascular gain-framed letter (pinteraction = 0.07). The letters had no impact on longitudinal GDMT use. CONCLUSIONS Approximately one in four patients with HF did not receive influenza vaccination with a pronounced implementation gap in those <65 years where less than half were vaccinated. HF status did not modify the effectiveness of cardiovascular gain-framed and repeated electronic nudging letters in increasing influenza vaccination rates. No unintended negative effects on longitudinal GDMT use were observed. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT05542004.
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Affiliation(s)
- Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA, USA
| | - Ankeet S Bhatt
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA, USA
- Kaiser Permanente San Francisco Medical Center & Division of Research, San Francisco, CA, USA
| | - Simin Gharib Lee
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Cardiometabolic Implementation Science, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Modin
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Lars Køber
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pradeesh Sivapalan
- Respiratory Medicine Section, Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Jens Ulrik Staehr Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Respiratory Medicine Section, Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Cyril Jean-Marie Martel
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Palle Valentiner-Branth
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Tyra Grove Krause
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sun K, Cedarbaum E, Hill CA, Win S, Parikh NI, Hsue PY, Durstenfeld MS. Association of Right Ventricular Dilation on Echocardiogram With In-Hospital Mortality Among Patients Hospitalized With COVID-19 Compared With Bacterial Pneumonia. J Am Soc Echocardiogr 2023; 36:558-562. [PMID: 36592874 PMCID: PMC9803370 DOI: 10.1016/j.echo.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Kaiwen Sun
- Department of Medicine, University of California, San Francisco, California.
| | - Emily Cedarbaum
- Department of Medicine, University of California, San Francisco, California; Division of Cardiology, Zuckerberg San Francisco General, San Francisco, California
| | - Christopher A Hill
- University of California San Francisco School of Medicine, San Francisco, California
| | - Sithu Win
- Department of Medicine, University of California, San Francisco, California; Division of Cardiology, Zuckerberg San Francisco General, San Francisco, California
| | - Nisha I Parikh
- Department of Medicine, University of California, San Francisco, California; Division of Cardiology, UCSF Health, San Francisco, California
| | - Priscilla Y Hsue
- Department of Medicine, University of California, San Francisco, California; Division of Cardiology, Zuckerberg San Francisco General, San Francisco, California
| | - Matthew S Durstenfeld
- Department of Medicine, University of California, San Francisco, California; Division of Cardiology, Zuckerberg San Francisco General, San Francisco, California
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Volpe M, Battistoni A. What if flu vaccination is the most responsible thing to do for cardiovascular health in the upcoming season? Eur Heart J Suppl 2023; 25:A1-A4. [PMID: 36937368 PMCID: PMC10021493 DOI: 10.1093/eurheartjsupp/suac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Zhilinskaya IN, Marchenko VA, Kharchenko EP. Comparison of Fragments in Human Hemostatic Proteins That Mimics Fragments in Proteins of A/H1N1 Viruses and Coronaviruses. MOLECULAR GENETICS, MICROBIOLOGY AND VIROLOGY 2022; 37:209-225. [PMID: 36968805 PMCID: PMC10026243 DOI: 10.3103/s0891416822040103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/05/2022] [Accepted: 05/20/2022] [Indexed: 03/22/2023]
Abstract
Objective: To compare the repertoire of proteins of the human hemostatic system and fragments mimicking these proteins in the proteins of influenza A/H1N1 viruses and coronaviruses. Material and methods. Influenza viruses A/H1N1 (A/Brevig Mission/1/18), A/St. Petersburg /RII04/2016 (H1N1)pdm09, coronaviruses SARS-CoV and SARS-CoV-2 (strain Wuhan-Hu-1) were used for comparative computer analysis. The sources of the primary structures of proteins of the analyzed viruses and 41 proteins of the human hemostatic system were publicly available Internet databases, respectively, www.ncbi.nlm.nih.gov and www.nextprot.org. The search for homologous sequences in the structure of viral proteins and hemostatic proteins was carried out by comparing fragments of 12 amino acids in length, taking as related those that showed identity at ≥8 positions. Results. Comparative analysis of the repertoire of cellular proteins of the hemostatic system and fragments mimicking these proteins in the structure of proteins of viruses A/H1N1 1918, A(H1N1)pdm09 isolated in 2016, SARS-CoV and SARS-CoV-2, showed a significant difference between SARS-CoV-2 and analyzed viruses. In the protein structure of the SARS-CoV-2 virus, mimicry was revealed for almost all analyzed hemostasis proteins. As for the comparison of viruses A/H1N1 1918, A(H1N1)pdm09 2016 and SARS-CoV, the influenza virus A/H1N1 1918 and SARS-CoV are the closest in the repertoire of hemostatic proteins. Conclusion. Obtained bioinformatic analysis data can serve as a basis for further study of the role of homologous fragments in the regulation of hemostasis of the host organism.
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Nordenskjöld AM, Johansson N, Sunnefeldt E, Athlin S, Fröbert O. Prevalence and prognostic implications of myocardial injury in patients with influenza. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac051. [PMID: 36105869 PMCID: PMC9464904 DOI: 10.1093/ehjopen/oeac051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 11/12/2022]
Abstract
Aims Influenza may cause myocardial injury and trigger acute cardiovascular events. The aim of this study was to investigate the prevalence and prognostic implications of elevated high-sensitivity cardiac troponin I (hs-cTnI) in patients with influenza. Methods and results In this prospective cohort study, we consecutively enrolled patients with influenza-like illness from two emergency departments in Sweden during three seasons of influenza, 2017–20. Ongoing Influenza infection was diagnosed by polymerase chain reaction and blood samples were collected for later analysis of hs-cTnI. All patients were followed-up for a composite endpoint of major adverse cardiovascular events (MACE) including death, myocardial infarction, unstable angina, heart failure, atrial fibrillation, and stroke within 1 year. Of the 466 patients with influenza-like symptoms, 181 (39%) were positive for influenza. Fifty (28%) patients were hospitalized. High-sensitivity cTnI was elevated in 11 (6%) patients and 8 (4%) experienced MACE. In univariate analyses, MACE was associated with age [hazard ratio (HR): 1.14, 95% confidence interval (CI): 1.05–1.23], hypertension (HR 5.56, 95%CI: 1.12–27.53), estimated glomerular filtration rate (HR: 0.94, 95%CI: 0.91–0.97), and elevated hs-cTnI (HR: 18.29, 95%CI: 4.57–73.24), N-terminal prohormone of brain natriuretic peptide (HR: 14.21, 95%CI: 1.75–115.5), hs-CRP (HR: 1.01, 95%CI: 1.00–1.02), and white blood cell count (HR: 1.12, 95%CI: 1.01–1.25). In multivariate analysis, elevated hs-cTnI was independently associated with MACE (HR: 4.96, 95%CI: 1.10–22.41). Conclusion The prevalence of elevated hs-cTnI is low in unselected patients with influenza. Elevated hs-cTnI was associated with poor prognosis. A limitation is that the estimated associations are uncertain due to few events.
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Affiliation(s)
- Anna M Nordenskjöld
- Department of Cardiology, Faculty of Medicine and Health, Örebro University , 70281 Örebro , Sweden
| | - Niklas Johansson
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University , 70281 Örebro , Sweden
| | - Erik Sunnefeldt
- Department of Cardiology, Faculty of Medicine and Health, Örebro University , 70281 Örebro , Sweden
| | - Simon Athlin
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University , 70281 Örebro , Sweden
| | - Ole Fröbert
- Department of Cardiology, Faculty of Medicine and Health, Örebro University , 70281 Örebro , Sweden
- Steno Diabetes Center Aarhus, Aarhus University Hospital , 8200 Aarhus N , Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University , 8000 Aarhus , Denmark
- Department of Clinical Pharmacology, Aarhus University Hospital , 8200 Aarhus N , Denmark
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7
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Flu Vaccination as a Key Prevention Recommendation for Patients at High Cardiovascular Risk: The Next Season's Scenario. High Blood Press Cardiovasc Prev 2022; 29:405-407. [PMID: 36053448 PMCID: PMC9437400 DOI: 10.1007/s40292-022-00540-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 11/08/2022] Open
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Influenza Vaccination for Cardiovascular Prevention: Further Insights from the IAMI Trial and an Updated Meta-analysis. Curr Cardiol Rep 2022; 24:1327-1335. [PMID: 35876953 PMCID: PMC9310360 DOI: 10.1007/s11886-022-01748-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review Influenza infection is a significant, well-established cause of cardiovascular disease (CVD) and CV mortality. Influenza vaccination has been shown to reduce major adverse cardiovascular events (MACE) and CV mortality. Therefore, major society guidelines have given a strong recommendation for its use in patients with established CVD or high risk for CVD. Nevertheless, influenza vaccination remains underutilized. Historically, influenza vaccination is administered to stable outpatients. Until recently, the safety and efficacy of influenza vaccination among patients with acute myocardial infarction (MI) had not been established. Recent Findings The recently published Influenza Vaccination after Myocardial Infarction (IAMI) trial showed that influenza vaccination within 72 h of hospitalization for MI led to a significant 28% reduction in MACE and a 41% reduction in CV mortality, without any excess in serious adverse events. Additionally, we newly performed an updated meta-analysis of randomized clinical trials (RCTs) including IAMI and the recent Influenza Vaccine to Prevent Adverse Vascular Events (IVVE) trial. In pooled analysis of 8 RCTs with a total of 14,420 patients, influenza vaccine, as compared with control/placebo, was associated with significantly lower risk of MACE at follow-up [RR 0.75 (95%CI 0.57–0.97), I2 56%]. Summary The recent IAMI trial showed that influenza vaccination in patients with recent MI is safe and efficacious at reducing CV morbidity and mortality. Our updated meta-analysis confirms a 25% reduction in MACE. The influenza vaccine should be strongly encouraged in all patients with CVD and incorporated as an essential facet of post-MI care and secondary CVD prevention.
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Sun K, Cedarbaum E, Hill C, Win S, Parikh NI, Hsue PY, Durstenfeld MS. Association of Right Ventricular Dilation and Dysfunction on Echocardiogram with In-Hospital Mortality Among Patients Hospitalized with COVID-19 Compared with Other Acute Respiratory Illness. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.06.29.22277073. [PMID: 35794892 PMCID: PMC9258295 DOI: 10.1101/2022.06.29.22277073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although right ventricular (RV) dysfunction is associated with mortality in acute COVID-19, the role of RV dilation is uncertain. The prognostic significance of RV dilation and dysfunction among hospitalized patients with acute COVID-19 compared to other respiratory illnesses. METHODS We conducted a retrospective cohort study to examine 225 consecutive adults admitted for acute COVID-19 and 6,150 control adults admitted for influenza, pneumonia or ARDS who had a clinical echocardiogram performed. We used logistic regression models to assess associations between RV parameters and in-hospital mortality adjusted for confounders. RESULTS Among those with COVID-19, 48/225 (21.3%) died during the index hospitalization compared to 727/6150 (11.8%) with other respiratory illness (p=0.001). Independent of COVID-19, mild and moderate to severe RV dilation were associated with 1.4 and 2.0 times higher risk of inpatient mortality, respectively (95%CI 1.17 to 1.69; p=0.0003; 95%CI 1.62 to 2.47; p<0.0001, respectively). Similarly, mild and moderate RV dysfunction were associated with 1.4 and 1.7 times higher risk of inpatient mortality (95%CI 1.10 to 1.77; p=0.007; 95%CI 1.17 to 2.42; p=0.005, respectively). Relative to normal RV size and non-COVID-19 acute respiratory illness, mild and moderate RV dilation were associated with 1.4 times and 2.0 times higher risk among those without COVID-19 and 1.9 times higher and 3.0 times higher risk among those with COVID-19, with similar findings for RV dysfunction. Having both RV dilation and dysfunction or RV dilation alone were associated with 1.7 times higher risk while RV dysfunction alone was associated with 1.4 times higher risk compared to normal RV size and function. CONCLUSIONS RV dilation and dysfunction are associated with increased risk of inpatient mortality among those with COVID-19 and other respiratory illnesses. Abnormal RV findings may identify those at higher risk of short-term mortality from acute respiratory illness including COVID-19 beyond other risk markers.
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10
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Gupta C, Sachdeva A, Khamar J, Bu C, Bartoszko J, Loeb M. Effectiveness of the influenza vaccine at reducing adverse events in patients with heart failure: A systematic review and meta-analysis. Vaccine 2022; 40:3433-3443. [PMID: 35562195 DOI: 10.1016/j.vaccine.2022.04.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/25/2022] [Accepted: 04/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The association between influenza and adverse vascular events in patients with heart failure is well documented. The effect of the influenza vaccine on preventing such adverse events is uncertain. This systematic review and meta-analysis addressed whether vaccination against influenza reduces adverse vascular events and mortality in heart failure patients. METHODS MEDLINE and EMBASE databases were comprehensively searched, study screening and quality assessment were completed, and data was synthesized. Eligible studies investigated heart failure patients who received the influenza vaccine, and reported outcomes within 12 months, compared to heart failure patients who did not receive the influenza vaccine. The following 6 outcomes were assessed: all-cause mortality, cardiovascular-related mortality, all-cause hospitalization, cardiovascular-related hospitalization, non-fatal myocardial infarction, and non-fatal stroke. Risk of bias was assessed using the Newcastle-Ottawa Scale and a GRADE assessment was completed. A random-effects meta-analysis was performed to estimate the pooled risk ratio (RR), 95% confidence intervals (CIs), and heterogeneity using I2 statistics. RESULTS After synthesizing data from 7 non-randomized studies (247,842 patients), the results demonstrate the risk of all-cause mortality is significantly reduced within 12 months of a heart failure patient receiving the influenza vaccine (RR = 0.75, 95% CI 0.71-0.79; P<0.0001); very low certainty of evidence. The risk of cardiovascular-related mortality was significantly reduced (RR = 0.77, 95% CI 0.73-0.81; P<0.0001); low certainty of evidence. The pooled risk of all-cause hospitalization was higher among vaccinated heart failure patients (RR = 1.24, 95% CI 1.13-1.35; P<0.0001), based on two studies; very low certainty of evidence and considerable heterogeneity (I2 = 90%). No eligible studies assessed cardiovascular-related hospitalization, non-fatal myocardial infarction, or non-fatal stroke. CONCLUSIONS Influenza vaccination appears to reduce adverse cardiovascular events, although the certainty of the evidence is low or very low. Rigorous randomized controlled trial evidence is needed to further examine the protective effect of the influenza vaccine in heart failure patients.
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Affiliation(s)
- Christopher Gupta
- Department of Global Health, McMaster University, Hamilton, Ontario L8S 4L8, Canada.
| | - Anjali Sachdeva
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Jigish Khamar
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Cecilia Bu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Jessica Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Mark Loeb
- Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario L8S 4L8, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
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11
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Goyal P, Reshetnyak E, Khan S, Musse M, Navi BB, Kim J, Allen LA, Banerjee S, Elkind MSV, Shah SJ, Yancy C, Michos ED, Devereux RB, Okin PM, Weinsaft JW, Safford MM. Clinical Characteristics and Outcomes of Adults With a History of Heart Failure Hospitalized for COVID-19. Circ Heart Fail 2021; 14:e008354. [PMID: 34517720 DOI: 10.1161/circheartfailure.121.008354] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is important to understand the risk for in-hospital mortality of adults hospitalized with acute coronavirus disease 2019 (COVID-19) infection with a history of heart failure (HF). METHODS We examined patients hospitalized with COVID-19 infection from January 1, 2020 to July 22, 2020, from 88 centers across the US participating in the American Heart Association's COVID-19 Cardiovascular Disease registry. The primary exposure was history of HF and the primary outcome was in-hospital mortality. To examine the association between history of HF and in-hospital mortality, we conducted multivariable modified Poisson regression models that included sociodemographics and comorbid conditions. We also examined HF subtypes based on left ventricular ejection fraction in the prior year, when available. RESULTS Among 8920 patients hospitalized with COVID-19, mean age was 61.4±17.5 years and 55.5% were men. History of HF was present in 979 (11%) patients. In-hospital mortality occurred in 31.6% of patients with history of HF, and 16.9% in patients without a history of HF. In a fully adjusted model, history of HF was associated with increased risk for in-hospital mortality (relative risk: 1.16 [95% CI, 1.03-1.30]). Among 335 patients with left ventricular ejection fraction, heart failure with reduced ejection fraction was significantly associated with in-hospital mortality in a fully adjusted model (heart failure with reduced ejection fraction relative risk: 1.40 [95% CI, 1.10-1.79]; heart failure with mid-range ejection fraction relative risk: 1.06 [95% CI, 0.65-1.73]; heart failure with preserved ejection fraction relative risk, 1.06 [95% CI, 0.84-1.33]). CONCLUSIONS Risk for in-hospital mortality was substantial among adults with history of HF, in large part due to age and comorbid conditions. History of heart failure with reduced ejection fraction may confer especially elevated risk. This population thus merits prioritization for the COVID-19 vaccine.
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Affiliation(s)
- Parag Goyal
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Evgeniya Reshetnyak
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Sadiya Khan
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (S.K., S.J.S., C.Y.)
| | - Mahad Musse
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Babak B Navi
- Department of Neurology, Feil Family Brain and Mind Research Institute (B.B.N.), Weill Cornell Medicine, New York, NY
| | - Jiwon Kim
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Larry A Allen
- Division of Cardiology, University of Colorado, Denver (L.A.A.)
| | - Samprit Banerjee
- Department of Population Science (S.B.), Weill Cornell Medicine, New York, NY
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (S.K., S.J.S., C.Y.)
| | - Clyde Yancy
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (S.K., S.J.S., C.Y.)
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (E.D.M.)
| | - Richard B Devereux
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Peter M Okin
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Jonathan W Weinsaft
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Monika M Safford
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
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12
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Marchenko VA, Barashkova SV, Zelinskaya IA, Toropova YG, Ramsay ES, Zhilinskaya IN. [Modulation of endothelial factors activity in human endothelial cells in influenza A(H1N1)pdm09 virus infection]. Vopr Virusol 2021; 66:198-210. [PMID: 34251157 DOI: 10.36233/0507-4088-48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Influenza A virus infection can lead to endothelial dysfunction (ED), including apoptosis of endothelial cells and modulation of endothelial factor activities. Affected biochemical factors may include those playing important roles in vascular homeostasis. However, the effect of this pathogen on the expression pattern of key endothelial factors is still unknown.The aim of this work was to study the expression of endothelial nitric oxide synthase (eNOS) and plasminogen activator inhibitor-1 (PAI-1, serpin E1) in the EA.hy926 endothelial cells. RESEARCH OBJECTIVES to assess expression of eNOS and PAI-1 in endothelial cells infected with influenza virus A(H1N1)pdm09, and to identify homologous fragments in structure of viral proteins and endothelial factors. MATERIAL AND METHODS Cells were infected with influenza virus A/St. Petersburg/48/16 (H1N1)pdm09 and analyzed in dynamics in 6, 12, 18, 24, 48, and 72 hrs post infection (hpi). Detection of endothelial factors expression levels was performed by immunocytochemical method (ICC) using antibodies for eNOS and PAI-1 while quantitative assessment of expression levels was carried out by program Nis-Elements F3.2 («Nikon», Japan). The search for homologous sequences between viral proteins and eNOS and PAI-1 was performed by computer comparison. Sequences were analyzed as fragments 12 amino acid residues (aar) in length. RESULTS AND DISCUSSION eNOS expression in infected cells had decreased to 7.9% by 6 hpi (control was taken as 100%) to 3.3% at 72 hpi. PAI-1 expression varied significantly over the course of the experiment: by 6 hpi it had decreased to 49.6%, and to 43.2% by 12 hpi. Later PAI-1 levels were: 116.3% (18 hpi); 18.9% (24 hpi); 23.5% (48 hpi), and 35% (72 hpi). CONCLUSION These results indicate that influenza A infection of endothelial cells causes a significant decrease in eNOS expression, while modulating PAI-1 one. The described phenomenon can be used in the further development of directions of pathogenetic therapy of vascular complications of infection caused by this pathogen.
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Affiliation(s)
- V A Marchenko
- FSBI «A.A. Smorodintsev Research Institute of Influenza» of the Ministry of Health of Russia
| | - S V Barashkova
- SPB SBIH «K.A. Rauhfus Children's Municipal Multi-Specialty Clinical Center of High Medical Technologies»
| | - I A Zelinskaya
- FSBI «Almazov National Medical Research Centre» of the Ministry of Health of Russia
| | - Ya G Toropova
- FSBI «Almazov National Medical Research Centre» of the Ministry of Health of Russia
| | - E S Ramsay
- FSBI «A.A. Smorodintsev Research Institute of Influenza» of the Ministry of Health of Russia
| | - I N Zhilinskaya
- FSBI «A.A. Smorodintsev Research Institute of Influenza» of the Ministry of Health of Russia
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13
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Acute Cardiac Injury in Coronavirus Disease 2019 and Other Viral Infections-A Systematic Review and Meta-Analysis. Crit Care Med 2021; 49:1558-1566. [PMID: 33870918 DOI: 10.1097/ccm.0000000000005026] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Severe acute respiratory syndrome-related coronavirus-2 binds and inhibits angiotensin-converting enzyme-2. The frequency of acute cardiac injury in patients with coronavirus disease 2019 is unknown. The objective was to compare the rates of cardiac injury by angiotensin-converting enzyme-2-binding viruses from viruses that do not bind to angiotensin-converting enzyme-2. DATA SOURCES We performed a systematic review of coronavirus disease 2019 literature on PubMed and EMBASE. STUDY SELECTION We included studies with ten or more hospitalized adults with confirmed coronavirus disease 2019 or other viral pathogens that described the occurrence of acute cardiac injury. This was defined by the original publication authors or by: 1) myocardial ischemia, 2) new cardiac arrhythmia on echocardiogram, or 3) new or worsening heart failure on echocardiogram. DATA EXTRACTION We compared the rates of cardiac injury among patients with respiratory infections with viruses that down-regulate angiotensin-converting enzyme-2, including H1N1, H5N1, H7N9, and severe acute respiratory syndrome-related coronavirus-1, to those with respiratory infections from other influenza viruses that do not bind angiotensin-converting enzyme-2, including Influenza H3N2 and influenza B. DATA SYNTHESIS Of 57 studies including 34,072 patients, acute cardiac injury occurred in 50% (95% CI, 44-57%) of critically ill patients with coronavirus disease 2019. The overall risk of acute cardiac injury was 21% (95% CI, 18-26%) among hospitalized patients with coronavirus disease 2019. In comparison, 37% (95% CI, 26-49%) of critically ill patients with other respiratory viruses that bind angiotensin-converting enzyme-2 (p = 0.061) and 12% (95% CI, 7-22%) of critically ill patients with other respiratory viruses that do not bind angiotensin-converting enzyme-2 (p < 0.001) experienced a cardiac injury. CONCLUSIONS Acute cardiac injury may be associated with whether the virus binds angiotensin-converting enzyme-2. Acute cardiac injury occurs in half of critically ill coronavirus disease 2019 patients, but only 12% of patients infected by viruses that do not bind to angiotensin-converting enzyme-2.
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14
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Lippi G, Sanchis-Gomar F. Cardiac troponin elevation in patients with influenza virus infections. Biomed J 2021; 44:183-189. [PMID: 33097442 PMCID: PMC8178554 DOI: 10.1016/j.bj.2020.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 01/05/2023] Open
Abstract
The association between acute infections and cardiac injury, including myocarditis and acute myocardial infarction, is now well established. We have performed a systematic literature review for analyzing the results of epidemiological studies that measured cardiac troponins (cTn) in patients with Influenza virus infections. Overall, 14 articles were finally identified and analyzed. Taken together, the results of the scientific literature suggest that cTn elevation is a relatively rare phenomenon in patients with Influenza virus infection, with frequency generally comprised between 0 and 33%, more likely in elderly patients with significant comorbidities. In patients with modest cTn elevations, this phenomenon is apparently self-limited, transient and reversible, and especially involves patients with Influenza A (especially H1N1). In the minority of patients exhibiting an abrupt appearance of cardiovascular symptoms and concomitant elevation of cTn values, the relative increase of this biomarker reflects the presence of an underlying cardiac injury, that can be either myocarditis or an acute ischemic episode. Enhanced cTn values can also be more frequently observed in Influenza patients with complicated disease, in those developing acute respiratory distress syndrome and cardiac dysfunction, as well as in those at higher risk of death. cTn measurement shall be considered a valuable option in all patients developing acute cardiovascular symptoms during Influenza virus infections, as well as in those bearing cardiac or extra-cardiac comorbidities who bear a higher risk of complications.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain.
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15
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Bocchi EA, Lima IGCV, Biselli B, Salemi VMC, Ferreira SMA, Chizzola PR, Munhoz RT, Pessoa RS, Cardoso FAM, Bello MVDO, Hajjar LA, Gomes BR. Worsening of heart failure by coronavirus disease 2019 is associated with high mortality. ESC Heart Fail 2021; 8:943-952. [PMID: 33498096 PMCID: PMC8006661 DOI: 10.1002/ehf2.13199] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/25/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS Patients with advanced heart failure (HF) with reduced left ventricular ejection fraction (HFrEF) and concurrent coronavirus disease 2019 (COVID-19) might have a higher risk of severe events. METHODS AND RESULTS We retrospectively studied 16 patients with advanced HFrEF who developed COVID-19 between 1 March and 29 May 2020. Follow-up lasted until 30 September. Ten patients previously hospitalized with decompensated HFrEF were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during hospitalization. Six patients undergoing ambulatory care at initiation of COVID-19 symptoms were hospitalized because of advanced HFrEF. All patients who experienced worsening of HFrEF due to COVID-19 required higher doses or introduction of additional inotropic drugs or intra-aortic balloon pump in the intensive care unit. The mean intravenous dobutamine dose before SARS-CoV-2 infection in previously hospitalized patients (n = 10) and the median (inter-quartile range) peak intravenous dobutamine dose during SARS-CoV-2 infection in all patients (n = 16) were 2 (0-7) μg/kg/min and 20 (14-20) (P < 0.001), respectively. During follow-up, 56% underwent heart transplantation (n = 2) or died (n = 7). Four patients died during hospitalization from mixed shock consequent to severe acute respiratory syndrome with inflammatory storm syndrome associated with septic and cardiogenic shock during COVID-19. After COVID-19 recovery, two patients died from mixed septic and cardiogenic shock and one from sustained ventricular tachycardia and cardiogenic shock. Five patients were discharged from hospital to ambulatory care. Four were awaiting heart transplantation. CONCLUSION Worsening of advanced HF by COVID-19 is associated with high mortality. This report highlights the importance of preventing COVID-19 in patients with advanced HF.
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Affiliation(s)
- Edimar Alcides Bocchi
- Heart Failure Clinics of the Heart Institute (InCor) of São Paulo University Medical SchoolSão PauloBrazil
| | | | - Bruno Biselli
- Heart Failure Clinics of the Heart Institute (InCor) of São Paulo University Medical SchoolSão PauloBrazil
| | - Vera Maria Cury Salemi
- Heart Failure Clinics of the Heart Institute (InCor) of São Paulo University Medical SchoolSão PauloBrazil
| | | | - Paulo Roberto Chizzola
- Heart Failure Clinics of the Heart Institute (InCor) of São Paulo University Medical SchoolSão PauloBrazil
| | - Robinson Tadeu Munhoz
- Heart Failure Clinics of the Heart Institute (InCor) of São Paulo University Medical SchoolSão PauloBrazil
| | - Ranna Santos Pessoa
- Heart Institute (Incor) of São Paulo University Medical SchoolSão PauloBrazil
| | | | | | | | - Brenno Rizerio Gomes
- Heart Failure Clinics of the Heart Institute (InCor) of São Paulo University Medical SchoolSão PauloBrazil
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Grimaldi-Bensouda L, Begaud B, Benichou J, Nordon C, Dialla O, Morisot N, Hamon Y, Cottin Y, Serrano E, Abenhaim L, Touzé E. Decongestant use and the risk of myocardial infarction and stroke: a case-crossover study. Sci Rep 2021; 11:4160. [PMID: 33603081 PMCID: PMC7893034 DOI: 10.1038/s41598-021-83718-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
Pharmacovigilance reports of cerebral and cardiovascular events in those who use decongestants have triggered alerts related to their use. We aimed to assess the risk of stroke and myocardial infarction (MI) associated with the use of decongestants. We conducted a nested case-crossover study of patients with incident stroke and MI identified in France between 2013 and 2016 in two systematic disease registries. Decongestant use in the three weeks preceding the event was assessed using a structured telephone interview. Conditional logistic multivariable models were used to estimate the odds of incident MI and stroke, also accounting for transient risk factors and comparing week 1 (index at-risk time window, immediately preceding the event) to week 3 (reference). Time-invariant risk factors were controlled by design. In total, 1394 patients with MI and 1403 patients with stroke, mainly 70 years old or younger, were interviewed, including 3.2% who used decongestants during the three weeks prior to the event (1.0% definite exposure in the index at-risk time window, 1.1% in the referent time window; adjusted odds ratio (aOR), 0.78; 95%CI, 0.43-1.42). Secondary analysis yielded similar results for individual events (MI/stroke). We observed no increased risk of MI or stroke for patients 70 years of age and younger without previous MI or stroke who used decongestants.
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Affiliation(s)
- Lamiae Grimaldi-Bensouda
- The PGRx Study Group, Paris, France.
- Service de Pharmacologie, Hôpital Raymond Poincaré, Groupe Hospitalier Paris-Ile de France Ouest, Assistance Publique- Hôpitaux de Paris, Paris, France.
- UFR des Sciences de La Santé, Université Paris-Saclay, Paris, France.
| | - Bernard Begaud
- Département de Pharmacologie Médicale, Equipe "Pharmaco-Epidémiologie et Impact des Médicaments sur Les Populations", Bordeaux Population Health Research Center INSERM U1219, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Jacques Benichou
- Hôpital Universitaire de Rouen, Rouen, France
- INSERM U1219, Bordeaux, France
| | - Clementine Nordon
- The PGRx Study Group, Paris, France
- GHU Paris Psychiatrie Et Neurosciences, Paris, France
- Laser Core Paris, Paris, France
| | | | | | | | - Yves Cottin
- Departement de Cardiologie, Centre Hospitalo-Universitaire de Dijon, Dijon, France
| | - Elie Serrano
- ORL Et Chirurgie Cervico-Faciale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Lucien Abenhaim
- The PGRx Study Group, London, UK
- London School of Hygiene and Tropical Medicine and Laser Core UK, London, UK
| | - Emmanuel Touzé
- Normandie Université, Université Caen Normandie, CHU Caen Normandie, Inserm U1237, Caen, France
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17
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Shafiabadi Hassani N, Shojaee A, Khodaprast Z, Sepahvandi R, Shahrestanaki E, Rastad H. Echocardiographic Features of Cardiac Injury Related to COVID-19 and Their Prognostic Value: A Systematic Review. J Intensive Care Med 2020; 36:500-508. [PMID: 33349095 DOI: 10.1177/0885066620981015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The available information on the echocardiographic features of cardiac injury related to the novel coronavirus disease 2019 (COVID-19) and their prognostic value are scattered in the different literature. Therefore, the aim of this study was to investigate the echocardiographic features of cardiac injury related to COVID-19 and their prognostic value. METHODS Published studies were identified through searching PubMed, Embase (Elsevier), and Google scholar databases. The search was performed using the different combinations of the keywords "echocard*," "cardiac ultrasound," "TTE," "TEE," "transtho*," or "transeso*" with "COVID-19," "sars-COV-2," "novel corona, or "2019-nCOV." Two researchers independently screened the titles and abstracts and full texts of articles to identify studies that evaluated the echocardiographic features of cardiac injury related to COVID-19 and/or their prognostic values. RESULTS Of 783 articles retrieved from the initial search, 11 (8 cohort and 3 cross-sectional studies) met our eligibility criteria. Rates of echocardiographic abnormalities in COVID-19 patients varied across different studies as follow: RV dilatation from 15.0% to 48.9%; RV dysfunction from 3.6% to 40%; and LV dysfunction 5.4% to 40.0%. Overall, the RV abnormalities were more common than LV abnormalities. The majority of the studies showed that there was a significant association between RV abnormalities and the severe forms and death of COVID-19. CONCLUSION The available evidence suggests that RV dilatation and dysfunction may be the most prominent echocardiographic abnormality in symptomatic patients with COVID-19, especially in those with more severe or deteriorating forms of the disease. Also, RV dysfunction should be considered as a poor prognostic factor in COVID-19 patients.
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Affiliation(s)
| | - Abbas Shojaee
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Zeynab Khodaprast
- Social Determinants of Health Research Center, 391934Alborz University of Medical Sciences, Karaj, Iran
| | - Roya Sepahvandi
- Cardiovascular Research Center, 391934Alborz University of Medical Sciences, Karaj, Iran
| | - Ehsan Shahrestanaki
- Non-Communicable Diseases Research Center, 391934Alborz University of Medical Sciences, Karaj, Iran
| | - Hadith Rastad
- Cardiovascular Research Center, 391934Alborz University of Medical Sciences, Karaj, Iran
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18
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Khan MS, Shahid I, Anker SD, Solomon SD, Vardeny O, Michos ED, Fonarow GC, Butler J. Cardiovascular implications of COVID-19 versus influenza infection: a review. BMC Med 2020; 18:403. [PMID: 33334360 PMCID: PMC7746485 DOI: 10.1186/s12916-020-01816-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Due to the overlapping clinical features of coronavirus disease 2019 (COVID-19) and influenza, parallels are often drawn between the two diseases. Patients with pre-existing cardiovascular diseases (CVD) are at a higher risk for severe manifestations of both illnesses. Considering the high transmission rate of COVID-19 and with the seasonal influenza approaching in late 2020, the dual epidemics of COVID-19 and influenza pose serious cardiovascular implications. This review highlights the similarities and differences between influenza and COVID-19 and the potential risks associated with coincident pandemics. MAIN BODY COVID-19 has a higher mortality compared to influenza with case fatality rate almost 15 times more than that of influenza. Additionally, a significantly increased risk of adverse outcomes has been noted in patients with CVD, with ~ 15 to 70% of COVID-19 related deaths having an underlying CVD. The critical care need have ranged from 5 to 79% of patients hospitalized due to COVID-19, a proportion substantially higher than with influenza. Similarly, the frequency of vascular thrombosis including deep venous thrombosis and pulmonary embolism is markedly higher in COVID-19 patients compared with influenza in which vascular complications are rarely seen. Unexpectedly, while peak influenza season is associated with increased cardiovascular hospitalizations, a decrease of ~ 50% in cardiovascular hospitalizations has been observed since the first diagnosed case of COVID-19, owing in part to deferred care. CONCLUSION In the coming months, increasing efforts towards evaluating new interventions will be vital to curb COVID-19, especially as peak influenza season approaches. Currently, not enough data exist regarding co-infection of COVID-19 with influenza or how it would progress clinically, though it may cause a significant burden on an already struggling health care system. Until an effective COVID-19 vaccination is available, high coverage of influenza vaccination should be of utmost priority.
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Affiliation(s)
| | - Izza Shahid
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Stefan D Anker
- Department of Cardiology (CVK), and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Scott D Solomon
- Brigham and Women's Hospital, Heart & Vascular Center, Boston, MA, USA
| | | | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gregg C Fonarow
- Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA.
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19
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Gopal R, Marinelli MA, Alcorn JF. Immune Mechanisms in Cardiovascular Diseases Associated With Viral Infection. Front Immunol 2020; 11:570681. [PMID: 33193350 PMCID: PMC7642610 DOI: 10.3389/fimmu.2020.570681] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
Influenza virus infection causes 3-5 million cases of severe illness and 250,000-500,000 deaths worldwide annually. Although pneumonia is the most common complication associated with influenza, there are several reports demonstrating increased risk for cardiovascular diseases. Several clinical case reports, as well as both prospective and retrospective studies, have shown that influenza can trigger cardiovascular events including myocardial infarction (MI), myocarditis, ventricular arrhythmia, and heart failure. A recent study has demonstrated that influenza-infected patients are at highest risk of having MI during the first seven days of diagnosis. Influenza virus infection induces a variety of pro-inflammatory cytokines and chemokines and recruitment of immune cells as part of the host immune response. Understanding the cellular and molecular mechanisms involved in influenza-associated cardiovascular diseases will help to improve treatment plans. This review discusses the direct and indirect effects of influenza virus infection on triggering cardiovascular events. Further, we discussed the similarities and differences in epidemiological and pathogenic mechanisms involved in cardiovascular events associated with coronavirus disease 2019 (COVID-19) compared to influenza infection.
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Affiliation(s)
- Radha Gopal
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
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20
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Behrouzi B, Araujo Campoverde MV, Liang K, Talbot HK, Bogoch II, McGeer A, Fröbert O, Loeb M, Vardeny O, Solomon SD, Udell JA. Influenza Vaccination to Reduce Cardiovascular Morbidity and Mortality in Patients With COVID-19: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 76:1777-1794. [PMID: 33032740 PMCID: PMC7535809 DOI: 10.1016/j.jacc.2020.08.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/24/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023]
Abstract
Viral respiratory infections are risk factors for cardiovascular disease (CVD). Underlying CVD is also associated with an increased risk of complications following viral respiratory infections, including increased morbidity, mortality, and health care utilization. Globally, these phenomena are observed with seasonal influenza and with the current coronavirus disease 2019 (COVID-19) pandemic. Persons with CVD represent an important target population for respiratory virus vaccines, with capacity developed within 3 large ongoing influenza vaccine cardiovascular outcomes trials to determine the potential cardioprotective effects of influenza vaccines. In the context of COVID-19, these international trial networks may be uniquely positioned to redeploy infrastructure to study therapies for primary and secondary prevention of COVID-19. Here, we describe mechanistic links between influenza and COVID-19 infection and the risk of acute cardiovascular events, summarize the data to date on the potential cardioprotective effects of influenza vaccines, and describe the ongoing influenza vaccine cardiovascular outcomes trials, highlighting important lessons learned that are applicable to COVID-19.
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Affiliation(s)
- Bahar Behrouzi
- Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Maria Viviana Araujo Campoverde
- Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kyle Liang
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, Ontario, Canada
| | - H Keipp Talbot
- Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Isaac I Bogoch
- Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Allison McGeer
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Orly Vardeny
- Center for Care Delivery and Outcomes Research, Minneapolis Veteran Affairs Health Care System, Minneapolis, Minnesota
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Jacob A Udell
- Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada.
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21
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Walker TA, Waite B, Thompson MG, McArthur C, Wong C, Baker MG, Wood T, Haubrock J, Roberts S, Gross DK, Huang QS, Newbern EC. Risk of Severe Influenza Among Adults With Chronic Medical Conditions. J Infect Dis 2020; 221:183-190. [PMID: 31678990 DOI: 10.1093/infdis/jiz570] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/01/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Severe influenza illness is presumed more common in adults with chronic medical conditions (CMCs), but evidence is sparse and often combined into broad CMC categories. METHODS Residents (aged 18-80 years) of Central and South Auckland hospitalized for World Health Organization-defined severe acute respiratory illness (SARI) (2012-2015) underwent influenza virus polymerase chain reaction testing. The CMC statuses for Auckland residents were modeled using hospitalization International Classification of Diseases, Tenth Revision codes, pharmaceutical claims, and laboratory results. Population-level influenza rates in adults with congestive heart failure (CHF), coronary artery disease (CAD), cerebrovascular accidents (CVA), chronic obstructive pulmonary disease (COPD), asthma, diabetes mellitus (DM), and end-stage renal disease (ESRD) were calculated by Poisson regression stratified by age and adjusted for ethnicity. RESULTS Among 891 276 adults, 2435 influenza-associated SARI hospitalizations occurred. Rates were significantly higher in those with CMCs compared with those without the respective CMC, except for older adults with DM or those aged <65 years with CVA. The largest effects occurred with CHF (incidence rate ratio [IRR] range, 4.84-13.4 across age strata), ESRD (IRR range, 3.30-9.02), CAD (IRR range, 2.77-10.7), and COPD (IRR range, 5.89-8.78) and tapered with age. CONCLUSIONS Our findings support the increased risk of severe, laboratory-confirmed influenza disease among adults with specific CMCs compared with those without these conditions.
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Affiliation(s)
- Tiffany A Walker
- WHO National Influenza Centre, Institute of Environmental Science and Research, Porirua, New Zealand
| | - Ben Waite
- WHO National Influenza Centre, Institute of Environmental Science and Research, Porirua, New Zealand
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Colin McArthur
- Department of Critical Care Medicine, Auckland District Health Board, Greenlane, Auckland, New Zealand
| | - Conroy Wong
- Department of Respiratory Medicine, Counties Manukau District Health Board, Papatoetoe, Auckland, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, School of Medicine, Newtown, Wellington, New Zealand
| | - Tim Wood
- Health Intelligence Team, Institute of Environmental Science and Research, Porirua, New Zealand
| | - Jennifer Haubrock
- WHO National Influenza Centre, Institute of Environmental Science and Research, Porirua, New Zealand
| | - Sally Roberts
- Department of Microbiology, Auckland District Health Board, Greenlane, Auckland, New Zealand
| | - Diane K Gross
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Q Sue Huang
- WHO National Influenza Centre, Institute of Environmental Science and Research, Porirua, New Zealand
| | - E Claire Newbern
- Health Intelligence Team, Institute of Environmental Science and Research, Porirua, New Zealand
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22
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Ghimire LV, Chou FS, Moon-Grady AJ. Impact of congenital heart disease on outcomes among pediatric patients hospitalized for influenza infection. BMC Pediatr 2020; 20:450. [PMID: 32988364 PMCID: PMC7520971 DOI: 10.1186/s12887-020-02344-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/13/2020] [Indexed: 01/25/2023] Open
Abstract
Background Young children and those with chronic medical conditions are at risk for complications of influenza including cardiopulmonary compromise. Here we aim to examine risks of mortality, clinical complications in children with congenital heart disease (CHD) hospitalized for influenza. Methods We analyzed data from in-hospital pediatric patients from 2003, 2006, 2009, 2012 and 2016 using the nationally representative Kids Inpatient Database (KID). We included children 1 year and older and used weighted data to compare the incidence of in-hospital mortality and rates of complications such as respiratory failure, acute kidney injury, need for mechanical ventilation, arrhythmias and myocarditis. Results Data from the KID estimated 125,470 children who were admitted with a diagnosis of influenza infection. Out of those, 2174(1.73%) patients had discharge diagnosis of CHD. Children with CHD who required hospitalization for influenza had higher in-hospital mortality (2.0% vs 0.5%), with an adjusted OR (aOR) of 2.8 (95% CI: 1.7–4.5). Additionally, acute respiratory failure and acute kidney failure were more likely among patients with CHD, with aOR of 1.8 (95% CI: 1.5–2.2) and aOR of 2.2 (95% CI: 1.5–3.1), respectively. Similarly, the rate of mechanical ventilatory support was higher in patients with CHD compared to those without, 14.1% vs 5.6%, aOR of 1.9 (95% CI: 1.6–2.3). Median length of hospital stay in children with CHD was longer than those without CHD [4 (IQR: 2–8) days vs. 2 (IQR: 2–4) days]. Outcomes were similar between those with severe vs non-severe CHD. Conclusions Children with CHD who require hospital admission for influenza are at significantly increased risk for in-hospital mortality, morbidities, emphasizing the need to reinforce preventative measures (e.g. vaccination, personal hygiene) in this particularly vulnerable population.
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Affiliation(s)
- Laxmi V Ghimire
- Section of Pediatrics and Section of Cardiology, Department of Medicine, Lakes Region General Hospital, Laconia, NH, USA
| | - Fu-Sheng Chou
- Department of Pediatrics, Loma Linda University, Loma Linda, CA, USA
| | - Anita J Moon-Grady
- Clinical Pediatrics, Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco, 550 16th Street 5th Floor, San Francisco, CA, 94158, USA.
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Chen J, Kelley WJ, Goldstein DR. Role of Aging and the Immune Response to Respiratory Viral Infections: Potential Implications for COVID-19. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2020; 205:313-320. [PMID: 32493812 PMCID: PMC7343582 DOI: 10.4049/jimmunol.2000380] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023]
Abstract
Aging impairs immunity to promote diseases, especially respiratory viral infections. The current COVID-19 pandemic, resulting from SARS-CoV-2, induces acute pneumonia, a phenotype that is alarmingly increased with aging. In this article, we review findings of how aging alters immunity to respiratory viral infections to identify age-impacted pathways common to several viral pathogens, permitting us to speculate about potential mechanisms of age-enhanced mortality to COVID-19. Aging generally leads to exaggerated innate immunity, particularly in the form of elevated neutrophil accumulation across murine and large animal studies of influenza infection. COVID-19 patients who succumb exhibit a 2-fold increase in neutrophilia, suggesting that exaggerated innate immunity contributes to age-enhanced mortality to SARS-CoV-2 infection. Further investigation in relevant experimental models will elucidate the mechanisms by which aging impacts respiratory viral infections, including SARS-CoV-2. Such investigation could identify therapies to reduce the suffering of the population at large, but especially among older people, infected with respiratory viruses.
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Affiliation(s)
- Judy Chen
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109
- Program in Immunology, University of Michigan, Ann Arbor, MI 48109; and
| | - William J Kelley
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109
| | - Daniel R Goldstein
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109;
- Program in Immunology, University of Michigan, Ann Arbor, MI 48109; and
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI 48109
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Gutiérrez-Spillari L, Palma M G, Aceituno-Melgar J. Obesity, Cardiovascular Disease, and Influenza: How Are They Connected? CURRENT TROPICAL MEDICINE REPORTS 2020; 7:92-97. [PMID: 32837829 PMCID: PMC7335730 DOI: 10.1007/s40475-020-00207-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose of Review To better understand the impact of obesity and cardiovascular diseases on influenza A infection. Recent Findings This infection could have detrimental outcomes in obese patients with cardiovascular diseases, such as an increased risk, length of hospitalization, disease severity, morbidity, and mortality. Nevertheless, there also might be some cardioprotective benefits associated with influenza vaccination, such as a reduced mortality, hospitalization, and acute coronary syndromes, in patients with coronary heart disease and/or heart failure. Summary Obesity negatively impacts immune function and host defense. Recent studies report obesity to be an independent risk factor for increased morbidity and mortality following infection. Obese patients might need special considerations in the treatment; however, there is not enough evidence to fully comprehend the mechanisms behind the reduced immunocompetence when influenza A infection occurs. Future studies should focus on special consideration treatments when the patients have not been vaccinated and have cardiovascular diseases.
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Affiliation(s)
- Lucia Gutiérrez-Spillari
- School of Clinical Nutrition, Universidad Francisco Marroquín, 6 Calle final, zona 10, Guatemala City, Guatemala
| | - Geovani Palma M
- Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Jorge Aceituno-Melgar
- Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
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Kytömaa S, Hegde S, Claggett B, Udell JA, Rosamond W, Temte J, Nichol K, Wright JD, Solomon SD, Vardeny O. Association of Influenza-like Illness Activity With Hospitalizations for Heart Failure: The Atherosclerosis Risk in Communities Study. JAMA Cardiol 2020; 4:363-369. [PMID: 30916717 DOI: 10.1001/jamacardio.2019.0549] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Influenza is associated with an increased risk of cardiovascular events, but to our knowledge, few studies have explored the temporal association between influenza activity and hospitalizations, especially those caused by heart failure (HF). Objective To explore the temporal association between influenza activity and hospitalizations due to HF and myocardial infarction (MI). We hypothesized that increased influenza activity would be associated with an increase in hospitalizations for HF and MI among adults in the community. Design, Setting, and Participants As part of the community surveillance component of the Atherosclerosis Risk in Communities (ARIC) study, a population-based study with hospitalizations sampled from 4 US communities, data were collected from 451 588 adults aged 35 to 84 years residing in the ARIC communities from annual cross-sectional stratified random samples of hospitalizations during October 2010 to September 2014. Exposures Monthly influenza activity, defined as the percentage of patient visits to sentinel clinicians for influenza-like illness by state, as reported by the Centers for Disease Control and Prevention Surveillance Network. Main Outcomes and Measures The monthly frequency of MI hospitalizations (n = 3541) and HF hospitalizations (n = 4321), collected through community surveillance and adjudicated as part of the ARIC Study. Results Between October 2010 and September 2014, 2042 (47.3%) and 1599 (45.1%) of the sampled patients who were hospitalized for HF and MI, respectively, were women and 2391 (53.3%) and 2013 (57.4%) were white, respectively. A 5% monthly absolute increase in influenza activity was associated with a 24% increase in HF hospitalization rates, standardized to the total population in each community, within the same month after adjusting for region, season, race/ethnicity, sex, age, and number of MI/HF hospitalizations from the month before (incidence rate ratio, 1.24; 95% CI, 1.11-1.38; P < .001), while overall influenza activity was not significantly associated with MI hospitalizations (incidence rate ratio, 1.02; 95% CI, 0.90-1.17; P = .72). Influenza activity in the months before hospitalization was not associated with either outcome. Our model suggests that in a month with high influenza activity, approximately 19% of HF hospitalizations (95% CI, 10%-28%) could be attributable to influenza. Conclusions and Relevance Influenza activity was temporally associated with an increase in HF hospitalizations across 4 influenza seasons. These data suggest that influenza may contribute to the risk of HF hospitalization in the general population.
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Affiliation(s)
- Sonja Kytömaa
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sheila Hegde
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jacob A Udell
- Peter Munk Cardiac Centre, Toronto General Hospital and Cardiovascular Division, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Wayne Rosamond
- University of North Carolina at Chapel Hill, Chapel Hill
| | - Jonathan Temte
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Kristin Nichol
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,University of Minnesota, Minneapolis
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Orly Vardeny
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,University of Minnesota, Minneapolis
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Modin D, Jørgensen ME, Gislason G, Jensen JS, Køber L, Claggett B, Hegde SM, Solomon SD, Torp-Pedersen C, Biering-Sørensen T. Influenza Vaccine in Heart Failure. Circulation 2019; 139:575-586. [PMID: 30586760 DOI: 10.1161/circulationaha.118.036788] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Influenza infection is a serious event for patients with heart failure (HF). Little knowledge exists about the association between influenza vaccination and outcome in patients with HF. This study sought to determine whether influenza vaccination is associated with improved long-term survival in patients with newly diagnosed HF. METHODS We performed a nationwide cohort study including all patients who were >18 years of age and diagnosed with HF in Denmark in the period of January 1, 2003, to June 1, 2015 (n=134 048). We collected linked data using nationwide registries. Vaccination status, number, and frequency during follow-up were treated as time-varying covariates in time-dependent Cox regression. RESULTS Follow-up was 99.8% with a median follow-up time of 3.7 years (interquartile range, 1.7-6.8 years). The vaccination coverage of the study cohort ranged from 16% to 54% during the study period. In unadjusted analysis, receiving ≥1 vaccinations during follow-up was associated with a higher risk of death. After adjustment for inclusion date, comorbidities, medications, household income, and education level, receiving ≥1 vaccinations was associated with an 18% reduced risk of death (all-cause: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001; cardiovascular causes: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001). Annual vaccination, vaccination early in the year (September to October), and greater cumulative number of vaccinations were associated with larger reductions in the risk of death compared with intermittent vaccination. CONCLUSIONS In patients with HF, influenza vaccination was associated with a reduced risk of both all-cause and cardiovascular death after extensive adjustment for confounders. Frequent vaccination and vaccination earlier in the year were associated with larger reductions in the risk of death compared with intermittent and late vaccination.
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Affiliation(s)
- Daniel Modin
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark
| | - Mads Emil Jørgensen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences (G.G., J.S.J., L.K., C.T.-P.), University of Copenhagen, Denmark
| | - Jan Skov Jensen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences (G.G., J.S.J., L.K., C.T.-P.), University of Copenhagen, Denmark
| | - Lars Køber
- Institute of Clinical Medicine, Faculty of Health Sciences (G.G., J.S.J., L.K., C.T.-P.), University of Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet (L.K.), University of Copenhagen, Denmark
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.M.H., S.D.S.)
| | - Sheila M Hegde
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.M.H., S.D.S.)
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.M.H., S.D.S.)
| | - Christian Torp-Pedersen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences (G.G., J.S.J., L.K., C.T.-P.), University of Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark
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Kytömaa S, Hegde S, Vardeny O. Interactions Between Influenza and Heart Failure Hospitalizations—Diagnostic and Pathogenetic Issues—Reply. JAMA Cardiol 2019; 4:950. [DOI: 10.1001/jamacardio.2019.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sonja Kytömaa
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sheila Hegde
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Orly Vardeny
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
- University of Minnesota, Minneapolis
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Lazzeri C, Bonizzoli M, Cianchi G, Batacchi S, Chiostri M, Fulceri G, Peris A. Right Ventricular Hypertrophy in Refractory Acute Respiratory Distress Syndrome Treated With Venovenous Extracorporeal Membrane Oxygenation Support. J Cardiothorac Vasc Anesth 2019; 34:1441-1445. [PMID: 31540754 DOI: 10.1053/j.jvca.2019.08.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In severe acute respiratory distress syndrome (ARDS) treated with extracorporeal membrane oxygenation (ECMO), right ventricular (RV failure) and dilation have been investigated with the use of echocardiography, whereas RV hypertrophy has not been addressed in the literature. The present study assessed the incidence of RV hypertrophy using echocardiography before ECMO treatment and at intensive care unit (ICU) discharge in severe ARDS patients. DESIGN Observational, retrospective, single-center study. SETTING A single ECMO center. PARTICIPANTS The study comprised 46 consecutive patients with severe ARDS. INTERVENTION Echocardiographic evaluation and ECMO support. MEASUREMENTS AND MAIN RESULTS A dual-lumen cannula was implanted in most patients (38/46 [82.6%]). Before the start of ECMO, RV hypertrophy was present in 28 patients (60.8%) with no significant differences in baseline characteristics between the 2 subgroups. The ICU mortality rate was 30.4% (14/46), with no difference between patients with RV hypertrophy and those without. At ICU discharge, all patients showed RV hypertrophy. CONCLUSIONS In severe ARDS treated with ECMO support, RV hypertrophy is a common finding and patients with normal RV wall thickness developed RV hypertrophy after ECMO support. The latter finding may suggest that during ECMO support, the right ventricle still may be subjected to increased afterload. However, additional research should be performed to elucidate the spectrum of mechanism(s) involved in the genesis of RV hypertrophy.
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Affiliation(s)
- Chiara Lazzeri
- Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giovanni Cianchi
- Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Batacchi
- Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco Chiostri
- Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giorgio Fulceri
- Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Panhwar MS, Kalra A, Gupta T, Kolte D, Khera S, Bhatt DL, Ginwalla M. Effect of Influenza on Outcomes in Patients With Heart Failure. JACC-HEART FAILURE 2019; 7:112-117. [DOI: 10.1016/j.jchf.2018.10.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 12/29/2022]
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Extreme influenza epidemics and out-of-hospital cardiac arrest. Int J Cardiol 2018; 263:158-162. [PMID: 29754914 DOI: 10.1016/j.ijcard.2018.02.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/11/2018] [Accepted: 02/08/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION There is compelling evidence for an association between influenza epidemics and major adverse cardiovascular events. However, the role of extreme influenza epidemics as a trigger of out-of-hospital cardiac arrest (OHCA) is unclear. Thus, we evaluated the potential association between extreme influenza epidemics and incidence of OHCA. METHODS We used a quasi-experimental design with time-series analysis of national registry data for cases of OHCA from all 47 prefectures of Japan during influenza seasons between 2005 and 2014. A Poisson regression time-series model with a distributed lag non-linear model was used to estimate prefecture-specific effects of influenza epidemics on OHCA. A multivariate meta-analysis was conducted for nationally pooled estimates. RESULTS In total, 481,516 OHCAs of presumed cardiac origin were reported during the study period. The minimum morbidity percentile (MMP) was estimated as the 0th percentile for influenza incidence. The overall cumulative relative risk versus the MMP was 1.25 (95% confidence interval, 1.16-1.34) for extreme influenza epidemics (at the 99th percentile of influenza incidence). The effect of extreme influenza epidemics was significant for lag periods of 1.5-7.1 and 17.9-21 days. Multivariate random-effects meta-analysis indicated significant spatial heterogeneity among prefectures (Cochran Q test, p = 0.011; I2 = 23.2%). CONCLUSION Extreme influenza epidemics are associated with higher risk of OHCA. Our findings suggest that several weeks' prevention for extreme influenza infections should be implemented to reduce the risk of OHCA.
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Lazzeri C, Bonizzoli M, Cianchi G, Batacchi S, Guetti C, Cozzolino M, Bernardo P, Peris A. Right ventricular dysfunction and Pre Implantation Vasopressors in Refractory ARDS Supported by VV-ECMO. Heart Lung Circ 2018; 27:1483-1488. [DOI: 10.1016/j.hlc.2017.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 09/26/2017] [Accepted: 10/14/2017] [Indexed: 01/28/2023]
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Bhatt AS, Liang L, DeVore AD, Fonarow GC, Solomon SD, Vardeny O, Yancy CW, Mentz RJ, Khariton Y, Chan PS, Matsouaka R, Lytle BL, Piña IL, Hernandez AF. Vaccination Trends in Patients With Heart Failure: Insights From Get With The Guidelines-Heart Failure. JACC-HEART FAILURE 2018; 6:844-855. [PMID: 30098960 DOI: 10.1016/j.jchf.2018.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/04/2018] [Accepted: 04/04/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study sought to evaluate and contribute to the limited data on U.S. hospital practice patterns with respect to respiratory vaccination in patients hospitalized with heart failure (HF). BACKGROUND Respiratory infection is a major driver of morbidity in patients with HF, and many influenza and pneumococcal infections may be prevented by vaccination. METHODS This study evaluated patients hospitalized at centers participating in the Get With The Guidelines-HF (GWTG-HF) registry from October 2012 to March 2017. The proportion of patients receiving vaccination was described for influenza and pneumococcal vaccination, respectively. The association of hospital-level vaccination rates with individual GWTG-HF performance measures and defect-free care was evaluated using multivariable modeling. RESULTS This study evaluated 313,761 patients discharged from 392 hospitals during the study period. The proportion of patients receiving influenza vaccination was 68% overall and declined from 70% in 2012 to 2013 to 66% in 2016 to 2017 (p < 0.001), although this was not statistically significant after adjustment (odds ratio: 1.05 per flu season; 95% confidence interval [CI]: 0.94 to 1.18). The proportion of patients receiving pneumococcal vaccination was 66% overall and decreased over the study period from 71% in 2013 to 60% in 2016 (p < 0.001), remaining significant after adjustment (odds ratio: 0.75 per calendar year; 95% CI: 0.67 to 0.84). Hospitals with higher vaccination rates were more likely to discharge patients with higher performance on defect-free care and individual GWTG-HF performance measures (p < 0.001). In a subset of patients with linked Medicare claims, vaccinated patients had similar rates of 1-year all-cause mortality (adjusted hazard ratio: 0.96 [95% CI: 0.89 to 1.03] for influenza vaccination; adjusted hazard ratio: 0.95 [95% CI: 0.89 to 1.01] for pneumococcal vaccination) compared with those not vaccinated. CONCLUSIONS Nearly 1 in 3 patients hospitalized with HF at participating hospitals were not vaccinated for influenza or pneumococcal pneumonia, and vaccination rates did not improve from 2012 to 2017. Hospitals that exhibited higher vaccination rates performed well with respect to other HF quality of care measures. Vaccination status was not associated with differences in clinical outcomes. Further randomized controlled data are needed to assess the relationship between vaccination and outcomes.
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Affiliation(s)
- Ankeet S Bhatt
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Li Liang
- Duke Clinical Research Institute, Durham, North Carolina
| | - Adam D DeVore
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, California
| | - Scott D Solomon
- Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Orly Vardeny
- University of Wisconsin, School of Pharmacy, Madison, Wisconsin
| | - Clyde W Yancy
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Robert J Mentz
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Yevgeniy Khariton
- Department of Cardiovascular Outcomes Research, University of Missouri-Kansas City, St. Luke's Mid-America Heart Institute, Kansas City, Missouri
| | - Paul S Chan
- Department of Cardiovascular Outcomes Research, University of Missouri-Kansas City, St. Luke's Mid-America Heart Institute, Kansas City, Missouri
| | | | | | - Ileana L Piña
- Division of Cardiology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Adrian F Hernandez
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
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Vardeny O, Udell JA, Joseph J, Farkouh ME, Hernandez AF, McGeer AJ, Talbot HK, Bhatt DL, Cannon CP, Goodman SG, Anand I, DeMets DL, Temte J, Wittes J, Nichol K, Yancy CW, Gaziano JM, Cooper LS, Kim K, Solomon SD. High-dose influenza vaccine to reduce clinical outcomes in high-risk cardiovascular patients: Rationale and design of the INVESTED trial. Am Heart J 2018; 202:97-103. [PMID: 29909156 DOI: 10.1016/j.ahj.2018.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/18/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Influenza leads to significant cardiopulmonary morbidity and mortality-particularly in patients with cardiovascular disease-that may be prevented with a standard influenza vaccine. However, patients with cardiovascular conditions have a reduced immune response to influenza vaccine, potentially resulting in reduced effectiveness for preventing clinical events. High-dose vaccine augments immune response in cardiac patients, suggesting that a high-dose influenza vaccination strategy may further reduce morbidity and mortality. Alternatively, broader coverage with an influenza vaccine containing an increased number of viral strains is an alternative strategy without direct evaluation. RESEARCH DESIGN AND METHODS INfluenza Vaccine to Effectively Stop Cardio Thoracic Events and Decompensated heart failure (INVESTED) is a pragmatic, randomized, double-blind, parallel-group, active-controlled trial comparing the effectiveness of an annual vaccination strategy of high-dose trivalent versus standard-dose quadrivalent influenza vaccine in patients with a history of recent heart failure or myocardial infarction hospitalization. The trial will enroll approximately 9,300 patients over 4 influenza seasons. The primary hypothesis is that high-dose influenza vaccine will reduce the composite outcome of all-cause mortality and hospitalization from a cardiovascular or pulmonary cause compared with standard-dose influenza vaccine within each enrolling season. Approximately 1,300 primary outcome events will provide >90% power to detect an 18% relative risk reduction at a 2-sided α level of .05. CONCLUSION INVESTED is the largest and longest study to assess whether high-dose influenza vaccine is superior to standard-dose influenza vaccine in reducing cardiopulmonary events in a high-risk cardiovascular population (ClinicalTrials.gov Identifier: NCT02787044).
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Nguyen JL, Yang W, Ito K, Matte TD, Shaman J, Kinney PL. Seasonal Influenza Infections and Cardiovascular Disease Mortality. JAMA Cardiol 2018; 1:274-81. [PMID: 27438105 DOI: 10.1001/jamacardio.2016.0433] [Citation(s) in RCA: 239] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE Cardiovascular deaths and influenza epidemics peak during winter in temperate regions. OBJECTIVES To quantify the temporal association between population increases in seasonal influenza infections and mortality due to cardiovascular causes and to test if influenza incidence indicators are predictive of cardiovascular mortality during the influenza season. DESIGN, SETTING, AND PARTICIPANTS Time-series analysis of vital statistics records and emergency department visits in New York City, among cardiovascular deaths that occurred during influenza seasons between January 1, 2006, and December 31, 2012. The 2009 novel influenza A(H1N1) pandemic period was excluded from temporal analyses. EXPOSURES Emergency department visits for influenza-like illness, grouped by age (≥0 years and ≥65 years) and scaled by laboratory surveillance data for viral types and subtypes, in the previous 28 days. MAIN OUTCOMES AND MEASURES Mortality due to cardiovascular disease, ischemic heart disease, and myocardial infarction. RESULTS Among adults 65 years and older, who accounted for 83.0% (73 363 deaths) of nonpandemic cardiovascular mortality during influenza seasons, seasonal average influenza incidence was correlated year to year with excess cardiovascular mortality (Pearson correlation coefficients ≥0.75, P ≤ .05 for 4 different influenza indicators). In daily time-series analyses using 4 different influenza metrics, interquartile range increases in influenza incidence during the previous 21 days were associated with an increase between 2.3% (95% CI, 0.7%-3.9%) and 6.3% (95% CI, 3.7%-8.9%) for cardiovascular disease mortality and between 2.4% (95% CI, 1.1%-3.6%) and 6.9% (95% CI, 4.0%-9.9%) for ischemic heart disease mortality among adults 65 years and older. The associations were most acute and strongest for myocardial infarction mortality, with each interquartile range increase in influenza incidence during the previous 14 days associated with mortality increases between 5.8% (95% CI, 2.5%-9.1%) and 13.1% (95% CI, 5.3%-20.9%). Out-of-sample prediction of cardiovascular mortality among adults 65 years and older during the 2009-2010 influenza season yielded average estimates with 94.0% accuracy using 4 different influenza metrics. CONCLUSIONS AND RELEVANCE Emergency department visits for influenza-like illness were associated with and predictive of cardiovascular disease mortality. Retrospective estimation of influenza-attributable cardiovascular mortality burden combined with accurate and reliable influenza forecasts could predict the timing and burden of seasonal increases in cardiovascular mortality.
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Affiliation(s)
- Jennifer L Nguyen
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Wan Yang
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Kazuhiko Ito
- Bureau of Environmental Surveillance and Policy, New York City Department of Health and Mental Hygiene, New York
| | - Thomas D Matte
- Bureau of Environmental Surveillance and Policy, New York City Department of Health and Mental Hygiene, New York
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Patrick L Kinney
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
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Huang SJ, Nalos M, Smith L, Rajamani A, McLean AS. The use of echocardiographic indices in defining and assessing right ventricular systolic function in critical care research. Intensive Care Med 2018; 44:868-883. [PMID: 29789861 DOI: 10.1007/s00134-018-5211-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/05/2018] [Indexed: 01/25/2023]
Abstract
PURPOSE Many echocardiographic indices (or methods) for assessing right ventricular (RV) function are available, but each has its strengths and limitations. In some cases, there might be discordance between the indices. We conducted a systematic review to audit the echocardiographic RV assessments in critical care research to see if a consistent pattern existed. We specifically looked into the kind and number of RV indices used, and how RV dysfunction was defined in each study. METHODS Studies conducted in critical care settings and reported echocardiographic RV function indices from 1997 to 2017 were searched systematically from three databases. Non-adult studies, case reports, reviews and secondary studies were excluded. These studies' characteristics and RV indices reported were summarized. RESULTS Out of 495 non-duplicated publications found, 81 studies were included in our systematic review. There has been an increasing trend of studying RV function by echocardiography since 2001, and most were conducted in ICU. Thirty-one studies use a single index, mostly TAPSE, to define RV dysfunction; 33 used composite indices and the combinations varied between studies. Seventeen studies did not define RV dysfunction. For those using composite indices, many did not explain their choices. CONCLUSIONS TAPSE seemed to be the most popular index in the last 2-3 years. Many studies used combinations of indices but, apart from cor pulmonale, we could not find a consistent pattern of RV assessment and definition of RV dysfunction amongst these studies.
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Affiliation(s)
- Stephen J Huang
- Department of Intensive Care Medicine, Nepean Hospital, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | - Marek Nalos
- Department of Intensive Care Medicine, Nepean Hospital, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Louise Smith
- Cardiovascular Ultrasound Laboratory, Intensive Care Unit, Nepean Hospital, Sydney, NSW, Australia
| | - Arvind Rajamani
- Department of Intensive Care Medicine, Nepean Hospital, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Anthony S McLean
- Department of Intensive Care Medicine, Nepean Hospital, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Abstract
The interaction of influenza infection with the pathogenesis of acute heart failure (AHF) and the worsening of chronic heart failure (CHF) is rather complex. The deleterious effects of influenza infection on AHF/CHF can be attenuated by specific immunization. Our review aimed to summarize the efficacy, effectiveness, safety, and dosage of anti-influenza vaccination in HF. In this literature review, we searched MEDLINE and EMBASE from January 1st 1966 to December 31st, 2016, for studies examining the association between AHF/CHF, influenza infections, and anti-influenza immunizations. We used broad criteria to increase the sensitivity of the search. HF was a prerequisite for our search. The search fields used included “heart failure,” “vaccination,” “influenza,” “immunization” along with variants of these terms. No restrictions on the type of study design were applied. The most common clinical scenario is exacerbation of pre-existing CHF by influenza infection. Scarce evidence supports a potential positive association of influenza infection with AHF. Vaccinated patients with pre-existing CHF have reduced all-cause morbidity and mortality, but effects are not consistently documented. Immunization with higher antigen quantity may confer additional protection, but such aggressive approach has not been generally advocated. Further studies are needed to delineate the role of influenza infection on AHF/CHF pathogenesis and maintenance. Annual anti-influenza vaccination appears to be an effective measure for secondary prevention in HF. Better immunization strategies and more efficacious vaccines are urgently necessary.
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Vardeny O, Solomon SD. Influenza vaccination: a one-shot deal to reduce cardiovascular events. Eur Heart J 2018; 38:334-337. [PMID: 27856498 DOI: 10.1093/eurheartj/ehw560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Orly Vardeny
- University of Wisconsin, School of Pharmacy, Madison, WI, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Perioperative Management of the Adult Patient on Venovenous Extracorporeal Membrane Oxygenation Requiring Noncardiac Surgery. Anesthesiology 2018; 128:181-201. [DOI: 10.1097/aln.0000000000001887] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abstract
The use of venovenous extracorporeal membrane oxygenation is increasing worldwide. These patients often require noncardiac surgery. In the perioperative period, preoperative assessment, patient transport, choice of anesthetic type, drug dosing, patient monitoring, and intraoperative and postoperative management of common patient problems will be impacted. Furthermore, common monitoring techniques will have unique limitations. Importantly, patients on venovenous extracorporeal membrane oxygenation remain subject to hypoxemia, hypercarbia, and acidemia in the perioperative setting despite extracorporeal support. Treatments of these conditions often require both manipulation of extracorporeal membrane oxygenation settings and physiologic interventions. Perioperative management of anticoagulation, as well as thresholds to transfuse blood products, remain highly controversial and must take into account the specific procedure, extracorporeal membrane oxygenation circuit function, and patient comorbidities. We will review the physiologic management of the patient requiring surgery while on venovenous extracorporeal membrane oxygenation.
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Lazzeri C, Cianchi G, Mauri T, Pesenti A, Bonizzoli M, Batacchi S, Chiostri M, Socci F, Peris A. A novel risk score for severe ARDS patients undergoing ECMO after retrieval from peripheral hospitals. Acta Anaesthesiol Scand 2018; 62:38-48. [PMID: 29058310 DOI: 10.1111/aas.13022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/10/2017] [Accepted: 10/04/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Extracorporeal Membrane Oxygenation in severe ARDS unresponsive to conventional protective ventilation is associated with elevated costs, resource and complications, and appropriate risk stratification of candidate patients could be useful to recognize those more likely to benefit from ECMO. We aimed to derive a new outcome prediction score for patients retrieved by our ECMO team from peripheral centers, including systematic echocardiographic evaluation before ECMO start. METHODS Sixty-nine consecutive patients with refractory ARDS requiring ECMO transferred from peripheral centers to our ICU (a tertiary ECMO referral center), from 1 October 2009 to 31 December 2015, were assessed. RESULTS All patients were transported on ECMO (distance, median 77, range 4-456 km) The mortality rate was 41% (28/69). Our new risk score included age ≥ 42 years, BMI < 31 kg/m2 , RV dilatation, and pH < 7.35. The proposed cut off (Youden's index method) of nine had a sensitivity of 96% and a specificity of 30% (AUC-ROC: 0.85, 95% CI: 0.76-0.94, P < 0.001). When assessing the discriminatory ability of our risk score in the population of local patients, survivors had a mean value of 15.4 ± 8.6, whereas non-survivors showed a mean value of 20.1 ± 7.4 (P < 0.001). CONCLUSIONS Our new risk score shows good discriminatory ability both in patients retrieved from peripheral centers and in those implanted at our center. This score includes variables easily available at bedside, and, for the first time, a pathophysiologic element, RV dilatation.
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Affiliation(s)
- C. Lazzeri
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - G. Cianchi
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - T. Mauri
- Department of Anesthesia, Critical Care and Emergency; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - A. Pesenti
- Department of Anesthesia, Critical Care and Emergency; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - M. Bonizzoli
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - S. Batacchi
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - M. Chiostri
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - F. Socci
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - A. Peris
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
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Cárdenes León A, Gallardo Santos E, Prada Osorio R, López Pérez M, Martín Lorenzo PL. Shock cardiogénico y taponamiento cardiaco en el contexto de la miopericarditis por influenza A. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2017.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Mongodi S, Orlando A, Tavazzi G, Pozzi M, Maggio G, Braschi A, Iotti GA, Mojoli F. Veno-Venous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in a Patient With Acute Right Heart Failure. J Cardiothorac Vasc Anesth 2017; 31:1374-1377. [DOI: 10.1053/j.jvca.2016.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Indexed: 01/06/2023]
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Cárdenes León A, Gallardo Santos E, Prada Osorio R, López Pérez M, Martín Lorenzo PL. Cardiogenic Shock and Cardiac Tamponade in the Context of Influenza A Myopericarditis. ACTA ACUST UNITED AC 2017; 70:1149-1151. [PMID: 28454888 DOI: 10.1016/j.rec.2017.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/20/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Aridane Cárdenes León
- Servicio de Cardiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
| | - Elena Gallardo Santos
- Servicio de Medicina Intensiva, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Roland Prada Osorio
- Servicio de Medicina Intensiva, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Marta López Pérez
- Servicio de Cardiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Pedro Luis Martín Lorenzo
- Servicio de Cardiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
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Lazzeri C, Bonizzoli M, Cianchi G, Batacchi S, Terenzi P, Cozzolino M, Bernardo P, Peris A. Lactate and Echocardiography Before Veno-Venous Extracorporeal Membrane Oxygenation Support. Heart Lung Circ 2017; 27:99-103. [PMID: 28343949 DOI: 10.1016/j.hlc.2017.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 02/01/2017] [Accepted: 02/06/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lactate has been recognised as a prognostic factor in several critical conditions. Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is a well-established therapy in patients with Acute Respiratory Disease Syndrome (ARDS) unresponsive to conventional therapy and echocardiography pre ECMO initiation has been recently reported to help in risk stratifying these patients. METHODS We assessed whether the detection of hyperlactataemia could be associated with the presence of left ventricle (LV) or right ventricle (RV) dysfunction in 121 consecutive patients with refractory ARDS. RESULTS The mortality rate was 42.9% (52/121). Higher dosages of norepinephrine and dobutamine were administered to non survivors (p=0.023 and p=0.047, respectively) who showed significantly higher levels of lactate (p=0.002). At echocardiography, non survivors showed higher values of systolic pulmonary artery pressure (sPAP) (p=0.05) and a higher incidence of RV dysfunction (as indicated by lower Tricuspid Annular Plane Excursion (TAPSE)) and RV dilatation (p=0.001). At multivariate logistic regression analysis, the following variables were independent predictors of death: body mass index (BMI) (OR: 0.914, 95%CI 0.857-0.975, p=0.006), RV dilatation (OR: 0.239, 95%CI 0.101-0.561, p=0.001) and lactate (OR: 1.292, 95%CI 1.015-1.645, p=0.038). Lactate values were directly correlated with the simplified acute physiology score (SAPS) II (r=0.38, p<0.001), while they showed an indirect correlation with left ventricular ejection fraction (LVEF) (r=-0.24, p=0.009) and TAPSE (r=-0.21, p=0.024). CONCLUSIONS In refractory ARDS, hyperlactataemia before VVV-ECMO identified a subset of patients at higher risk of death, being an independent predictor of in-Intensive Care Unit (ICU) mortality. Lactate values are mainly related to disease severity (as indicated by SAPS II) and haemodynamic impairment (as inferred by LVEF) and RV failure, as (indicated by TAPSE).
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Affiliation(s)
- Chiara Lazzeri
- Intensive Care Unit of Heart and Vessels Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giovanni Cianchi
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Batacchi
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Paolo Terenzi
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Morena Cozzolino
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pasquale Bernardo
- Intensive Care Unit of Heart and Vessels Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Body mass index and echocardiography in refractory ARDS treated with veno-venous extracorporeal membrane oxygenation. J Artif Organs 2016; 20:50-56. [DOI: 10.1007/s10047-016-0931-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 10/16/2016] [Indexed: 12/12/2022]
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Sidhu RS, Sharma A, Paterson ID, Bainey KR. Influenza H1N1 Infection Leading To Cardiac Tamponade in a Previously Healthy Patient: A Case Report. Res Cardiovasc Med 2016; 5:e31546. [PMID: 27800452 PMCID: PMC5075430 DOI: 10.5812/cardiovascmed.31546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/03/2015] [Accepted: 08/13/2015] [Indexed: 12/16/2022] Open
Abstract
Introduction The cardiac manifestations of influenza A are broad, ranging from self-limited pericarditis to fatal cardiomyopathy. The 2009 H1N1 influenza A (H1N1) strain is a rare cause of pericarditis, and its role in developing a pericardial effusion leading to tamponade has infrequently been reported. Case Presentation We describe a case of a young female with no prior cardiovascular history who presents with a pericardial effusion and shock secondary to cardiac tamponade from pericarditis due to H1N1 influenza A. Conclusions This case highlights the potential severity of H1N1 infections and the utility of considering cardiac tamponade in patients presenting with influenza symptoms and circulatory collapse.
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Affiliation(s)
- Robinder S. Sidhu
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Abhinav Sharma
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Ian D. Paterson
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Kevin R. Bainey
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
- Corresponding author: Kevin R. Bainey, MD, MSc, FRCPC, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada., E-mail:
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Lazzeri C, Cianchi G, Bonizzoli M, Batacchi S, Terenzi P, Bernardo P, Valente S, Gensini GF, Peris A. Pulmonary vascular dysfunction in refractory acute respiratory distress syndrome before veno-venous extracorporeal membrane oxygenation. Acta Anaesthesiol Scand 2016; 60:485-91. [PMID: 26482659 DOI: 10.1111/aas.12643] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/16/2015] [Accepted: 09/09/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Pulmonary vascular dysfunction has been described in patients with acute respiratory distress syndrome (ARDS). Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a well-established treatment for these patients. We hypothesized that severe pulmonary vascular dysfunction and cor pulmonale identified by echocardiography before cannulation in these patients were associated with worse survival. METHODS Echocardiography was used to identify pulmonary hypertension in 21 patients with refractory ARDS just before ECMO implantation. Survival was compared for those with and without cor pulmonale. RESULTS In our series, the overall mortality rate was 57.1% (12/21). Echocardiographic exams were transthoracic in 5 patients (23.8%), transesophageal in 4 patients (19%), and both (transthoracic and transesophageal) in the remaining 12 patients (57.1%). In our series, six patients (28.5%) showed LV dysfunction. Acute cor pulmonale was detectable in 2 patients (9.5%), while the remaining 19 patients showed moderate pulmonary dysfunction. Survivors had a higher pre-cannulation LV ejection fraction (EF) (P = 0.02) and tricuspid annular plane excursion (P = 0.04), and lower peak systolic pulmonary artery pressures (P = 0.02). CONCLUSIONS In patients with refractory ARDS immediately before ECMO implantation, the prevalence of acute cor pulmonale is low (9.5%). Survival is associated with higher LVEF and lower systolic pulmonary arterial pressure. These findings support the idea that echocardiographic assessment of pulmonary artery pressure in patients with refractory ARDS before VV-ECMO implantation may have value for risk-stratification.
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Affiliation(s)
- C. Lazzeri
- Intensive Care Unit of Heart and Vessels Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - G. Cianchi
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - M. Bonizzoli
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - S. Batacchi
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - P. Terenzi
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - P. Bernardo
- Intensive Care Unit of Heart and Vessels Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - S. Valente
- Intensive Care Unit of Heart and Vessels Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - G. F. Gensini
- Intensive Care Unit of Heart and Vessels Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; AOU Careggi; Fondazione Don Carlo Gnocchi IRCCS; Florence Italy
| | - A. Peris
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
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Lazzeri C, Bonizzoli M, Cozzolino M, Verdi C, Cianchi G, Batacchi S, Franci A, Gensini GF, Peris A. Serial measurements of troponin and echocardiography in patients with moderate-to-severe acute respiratory distress syndrome. J Crit Care 2016; 33:132-6. [PMID: 26851140 DOI: 10.1016/j.jcrc.2016.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/24/2015] [Accepted: 01/05/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the clinical significance of serial troponin I levels (measured in the first 72 hours from admission) in 42 consecutive patients with moderate-to-severe acute respiratory distress syndrome (ARDS). Echocardiography and electrocardiogram testings were serially performed in the time window. MATERIALS AND METHODS Troponin I was measured every 12 hours in the first 72 hours from intensive care unit (ICU) admission. Echocardiography and electrocardiogram testings were serially performed in the same time window to clinically interpret Tn I levels. RESULTS Patients with admission positive Tn I (38.1%) showed higher values of systolic pulmonary hypertension (P = .013) associated with significantly lower values of tricuspid annular plane excursion (P = .011). Twenty-five patients (25/42, 59.5%) exhibited positive peak Tn I and at second echocardiographic assessment exhibited significant lower tricuspid annular plane excursion values (P = .005). At stepwise regression analysis the following variables were an independent predictor for in-ICU mortality: Pco2 (OR 1.08, 95% CI 1.011-1.161, P = .023), systolic pulmonary arterial hypertension (OR 0.83, 95% CI 0.701-0.977, P = .002), log peak Tn I (OR 3.56, 95% CI 1.045-12.132, P = .042). CONCLUSIONS In moderate-to-severe ARDS, serial troponin I assessment together with echocardiography evaluation helped to identify a subgroup at higher risk for in-ICU death. Moreover, troponin release can be related to right ventricular dysfunction, thus highlighting the clinical role of echocardiography in ARDS patients.
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Affiliation(s)
- Chiara Lazzeri
- Intensive Care Unit of Heart and Vessels Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Morena Cozzolino
- Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Camilla Verdi
- Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giovanni Cianchi
- Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Batacchi
- Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea Franci
- Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gian Franco Gensini
- Intensive Care Unit of Heart and Vessels Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, Fondazione Don Carlo Gnocchi IRCCS, Florence, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Ludwig A, Lucero-Obusan C, Schirmer P, Winston C, Holodniy M. Acute cardiac injury events ≤30 days after laboratory-confirmed influenza virus infection among U.S. veterans, 2010-2012. BMC Cardiovasc Disord 2015; 15:109. [PMID: 26423142 PMCID: PMC4589211 DOI: 10.1186/s12872-015-0095-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 09/14/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Cardiac injury is a known potential complication of influenza infection. Because U.S. veterans cared for at the U.S. Department of Veterans Affairs are older and have more cardiovascular disease (CVD) risk factors than the general U.S. population, veterans are at risk for cardiac complications of influenza infection. We investigated biomarkers of cardiac injury characteristics and associated cardiac events among veterans who received cardiac biomarker testing ≤30 days after laboratory-confirmed influenza virus infection. METHODS Laboratory-confirmed influenza cases among veterans cared for at U.S. Department of Veterans Affairs' facilities for October 2010-December 2012 were identified using electronic medical records (EMRs). Influenza confirmation was based on respiratory specimen viral culture or antigen or nucleic acid detection. Acute cardiac injury (ACI) was defined as an elevated cardiac biomarker (troponin I or creatinine kinase isoenzyme MB) >99 % of the upper reference limit occurring ≤30 days after influenza specimen collection. EMRs were reviewed for demographics, CVD history and risk factors, and ACI-associated cardiac events. RESULTS Among 38,197 patients with influenza testing results, 4,469 (12 %) had a positive result; 600 of those patients had cardiac biomarker testing performed ≤30 days after influenza testing, and 143 (24 %) had one or more elevated cardiac biomarkers. Among these 143, median age was 73 years (range 44-98 years), and 98 (69 %) were non-Hispanic white. All patients had one or more CVD risk factors, and 98 (69 %) had a history of CVD. Eighty-six percent of ACI-associated events occurred within 3 days of influenza specimen collection date. Seventy patients (49 %) had documented or probable acute myocardial infarction, 8 (6 %) acute congestive heart failure, 6 (4 %) myocarditis, and 4 (3 %) atrial fibrillation. Eleven (8 %) had non-cardiac explanations for elevated cardiac biomarkers, and 44 (31 %) had no documented explanation. Sixty-eight (48 %) patients had received influenza vaccination during the related influenza season. CONCLUSION Among veterans with laboratory-confirmed influenza infection and cardiac biomarker testing ≤30 days after influenza testing, approximately 25 % had evidence of ACI, the majority within 3 days. Approximately half were myocardial infarctions. Our findings emphasize the importance of considering ACI associated with influenza infection among patients at high risk, including this older population with prevalent CVD risk factors.
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Affiliation(s)
- Alison Ludwig
- Centers for Disease Control and Prevention, assigned to Veterans Affairs Office of Public Health Surveillance and Research, 3801 Miranda Avenue (132), Palo Alto, CA, 94304, USA. .,Veterans Affairs Office of Public Health Surveillance and Research, 3801 Miranda Avenue (132), Palo Alto, CA, 94304, USA.
| | - Cynthia Lucero-Obusan
- Veterans Affairs Office of Public Health Surveillance and Research, 3801 Miranda Avenue (132), Palo Alto, CA, 94304, USA.
| | - Patricia Schirmer
- Veterans Affairs Office of Public Health Surveillance and Research, 3801 Miranda Avenue (132), Palo Alto, CA, 94304, USA.
| | - Carla Winston
- Veterans Affairs Office of Public Health Surveillance and Research, 3801 Miranda Avenue (132), Palo Alto, CA, 94304, USA.
| | - Mark Holodniy
- Veterans Affairs Office of Public Health Surveillance and Research, 3801 Miranda Avenue (132), Palo Alto, CA, 94304, USA. .,Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, CA, 94303, USA.
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Udell JA, Farkouh ME, Solomon SD, Vardeny O. Does influenza vaccination influence cardiovascular complications? Expert Rev Cardiovasc Ther 2015; 13:593-6. [DOI: 10.1586/14779072.2015.1044439] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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