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Li Y, Yang D, Kang J, Cao Y, Cui L, Liu F. COVID-19 and the risk of acute cardiovascular diseases: a two-sample Mendelian randomization study. BMC Cardiovasc Disord 2024; 24:389. [PMID: 39068390 PMCID: PMC11282648 DOI: 10.1186/s12872-024-04066-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Evidence suggests that coronavirus disease 2019 (COVID-19) is associated with the risk of cardiovascular diseases (CVDs). However, the results are inconsistent, and the causality remains to be established. We aimed to investigate the potential causal relationship between COVID-19 and CVDs by using two-sample Mendelian randomization (MR) analysis. METHODS Summary-level data for COVID-19 and CVDs including myocarditis, heart failure (HF), acute myocardial infarction (AMI), arrhythmia and venous thromboembolism (VTE) were obtained from the IEU OpenGWAS project, a public genome-wide association study (GWAS). Single nucleotide polymorphisms (SNPs) were used as instrumental variables. Five complementary MR methods were performed, including inverse variance weighted (IVW), MR-Egger, weighted median, weighted mode and simple mode methods. IVW method was considered as the primary approach. Besides, sensitivity analyses, including Cochran's Q test, MR-Egger intercept test, and leave-one-out analysis, were performed to evaluate the robustness of the results. RESULTS According to the IVW results, our MR study indicated that genetically predicted COVID-19 was not causally connected with the risk of CVDs [myocarditis: odds ratio (OR) = 1.407, 95% confidence interval (CI) = 0.761-2.602, p-value = 0.277; HF: OR = 1.180, 95% CI = 0.980-1.420, p-value = 0.080; AMI: OR = 1.002, 95% CI = 0.998-1.005, p-value = 0.241; arrhythmia: OR = 0.865, 95% CI = 0.717-1.044, p-value = 0.132; VTE: OR = 1.013, 95% CI = 0.997-1.028, p-value = 0.115]. The supplementary MR methods showed similar results. Sensitivity analyses suggested that the causal estimates were robust. CONCLUSION This two-sample MR analysis did not provide sufficient evidence for a causal relationship between COVID-19 and the risk of acute CVDs, which may provide new insights into the prevention of acute CVDs in COVID-19 patients.
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Affiliation(s)
- Yuling Li
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang, 110001, China
- Emergency Department, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | | | - Jian Kang
- Emergency Department, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Yaming Cao
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Funan Liu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang, 110001, China.
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, China Medical University, Ministry of Education, 155 North Nanjing Street, Heping District, Shenyang, 110001, China.
- Phase I Clinical Trials Center, The First Hospital, China Medical University, 518 North Chuangxin Road, Baita Street, Hunnan District, Shenyang, Liaoning, 110102, China.
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2
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Romero Starke K, Kaboth P, Rath N, Reissig D, Kaempf D, Nienhaus A, Seidler A. Cardiovascular disease risk after a SARS-CoV-2 infection: A systematic review and meta-analysis. J Infect 2024; 89:106215. [PMID: 38971381 DOI: 10.1016/j.jinf.2024.106215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVES To our knowledge, there is no systematic review examining CVD risks after a SARS-CoV-2 infection over time, while also taking into account disease severity. All evidence on the risk for pulmonary embolism (PE), myocardial infarction (MI), ischaemic stroke (IS), haemorrhagic stroke (HS), and arterial thrombosis following infection was evaluated. METHODS The protocol was registered with PROSPERO. We searched Pubmed, Embase, MedRxiv and screened the titles/abstracts and full texts. We extracted the included studies, assessed their quality, and estimated pooled risks by time after infection and according to disease severity. RESULTS Risks were highest in the acute phase [PE: 27.1 (17.8-41.10); MI: 4.4 (1.6-12.4); stroke: 3.3 (2.1-5.2); IS: 5.6 (2.1-14.8); HS: 4.0 (0.1-326.2)] compared to the post-acute phase [PE: 2.9 (2.6-3.3); MI: 1.4 (1.1-1.9); stroke: 1.4 (1.0-2.0); IS: 1.6 (0.9-2.7)]. Highest risks were observed after infection confirmation, dropping during the first month post-infection (e.g. PE: RR(7 days) = 31; RR(1 month) = 8.1). A doubled risk was still observed until 4.5 months for PE, one month for MI and two months for IS. Risks decreased with decreasing disease severity. CONCLUSIONS Because of increased risk of CVD outcomes, management of persons who survived a severe SARS-CoV-2 infection is required, especially during the first nine months post-infection.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Pauline Kaboth
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Natalie Rath
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - David Reissig
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Daniel Kaempf
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Albert Nienhaus
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre, Hamburg-Eppendorf, 20246 Hamburg, Germany; Department of Occupational Medicine, Hazardous Substances and Public Health, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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3
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Nechita LC, Ignat MD, Balta AAS, Barbu RE, Baroiu L, Voinescu DC, Nechita A, Debita M, Busila C, Stefanopol IA. The Impact of Cardiovascular Antecedents on the Prognosis of COVID-19 Critically Ill Patients. J Clin Med 2024; 13:3518. [PMID: 38930047 PMCID: PMC11205074 DOI: 10.3390/jcm13123518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/17/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: The objective of the study is to analyze the impact of cardiovascular history on mortality in COVID-19 patients, hospitalized in the intensive care unit with indications for continuous positive airway pressure (CPAP) and subsequently mechanical ventilation, without oncological disease. Methods: A retrospective observational study was carried out on a group of 108 critical COVID-19 patients. We compared demographic data, paraclinical and clinical parameters, days of hospitalization, and mortality rate between two groups of patients, one group with a history of cardiovascular disease (81 patients) and a group without a history of cardiovascular disease (27 patients). Results: Patients with cardiovascular antecedents had a higher mortality rate than those without cardiovascular antecedents, presenting severe forms with shorter survival time in the intensive care unit and increased inflammatory evidence. Compared to patients without a history of cardiovascular illness, those with cardiovascular disease had a lower average age, and developed a severe form of COVID-19. Conclusions: Cardiovascular antecedents can worsen the prognosis of patients with COVID-19, requiring a careful screening and multidisciplinary approach.
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Affiliation(s)
- Luiza Camelia Nechita
- Doctoral School of Biomedical Sciences, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.C.N.); (A.A.S.B.); (R.E.B.)
| | - Mariana Daniela Ignat
- Doctoral School of Biomedical Sciences, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.C.N.); (A.A.S.B.); (R.E.B.)
| | | | - Raisa Eloise Barbu
- Doctoral School of Biomedical Sciences, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.C.N.); (A.A.S.B.); (R.E.B.)
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.B.); (D.C.V.); (A.N.); (C.B.)
- ‘Sf. Cuv. Parascheva’ Clinical Hospital of Infectious Diseases, 800179 Galati, Romania;
| | - Doina Carina Voinescu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.B.); (D.C.V.); (A.N.); (C.B.)
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania
| | - Aurel Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.B.); (D.C.V.); (A.N.); (C.B.)
- ‘Sf. Ioan’ Clinical Hospital for Children, 800487 Galati, Romania;
| | - Mihaela Debita
- ‘Sf. Cuv. Parascheva’ Clinical Hospital of Infectious Diseases, 800179 Galati, Romania;
- Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania
| | - Camelia Busila
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (L.B.); (D.C.V.); (A.N.); (C.B.)
- ‘Sf. Ioan’ Clinical Hospital for Children, 800487 Galati, Romania;
| | - Ioana Anca Stefanopol
- ‘Sf. Ioan’ Clinical Hospital for Children, 800487 Galati, Romania;
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania
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Zhou Z, Zeng X, Liao J, Dong X, Deng Y, Wang Y, Zhou M. Immune Characteristic Genes and Neutrophil Immune Transformation Studies in Severe COVID-19. Microorganisms 2024; 12:737. [PMID: 38674681 PMCID: PMC11052247 DOI: 10.3390/microorganisms12040737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/26/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024] Open
Abstract
As a disease causing a global pandemic, the progression of symptoms to severe disease in patients with COVID-19 often has adverse outcomes, but research on the immunopathology of COVID-19 severe disease remains limited. In this study, we used mRNA-seq data from the peripheral blood of COVID-19 patients to identify six COVID-19 severe immune characteristic genes (FPR1, FCGR2A, TLR4, S100A12, CXCL1, and L TF), and found neutrophils to be the critical immune cells in COVID-19 severe disease. Subsequently, using scRNA-seq data from bronchoalveolar lavage fluid from COVID-19 patients, neutrophil subtypes highly expressing the S100A family were found to be located at the end of cellular differentiation and tended to release neutrophil extracellular traps. Finally, it was also found that alveolar macrophages, macrophages, and monocytes with a high expression of COVID-19 severe disease immune characteristic genes may influence neutrophils through intercellular ligand-receptor pairs to promote neutrophil extracellular trap release. This study provides immune characteristic genes, critical immune pathways, and immune cells in COVID-19 severe disease, explores intracellular immune transitions of critical immune cells and pit-induced intercellular communication of immune transitions, and provides new biomarkers and potential drug targets for the treatment of patients with COVID-19 severe disease.
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Affiliation(s)
| | | | | | | | | | - Yinghui Wang
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, China; (Z.Z.); (X.Z.); (J.L.); (X.D.); (Y.D.)
| | - Meijuan Zhou
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, China; (Z.Z.); (X.Z.); (J.L.); (X.D.); (Y.D.)
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5
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Gawaz A, Schindler M, Hagelauer E, Blanchard G, Riel S, Vollert A, Gilliet M, Unterluggauer L, Stary G, Pospischil I, Hoetzenecker W, Fehrenbacher B, Schaller M, Guenova E, Forchhammer S. SARS-CoV-2-Induced Vasculitic Skin Lesions Are Associated with Massive Spike Protein Depositions in Autophagosomes. J Invest Dermatol 2024; 144:369-377.e4. [PMID: 37580012 DOI: 10.1016/j.jid.2023.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/16/2023]
Abstract
In patients infected with severe acute respiratory syndrome coronavirus 2, vasculopathic changes of the skin are associated with a severe prognosis. However, the pathogenesis of this vasculopathy is not conclusively clarified. In this study, 25 prospectively collected skin samples from patients with COVID-19-related skin lesions were examined for vasculopathic changes and, in case of vasculitis, were further analyzed with electron microscopy and immunohistochemistry. Vasculopathy was observed in 76% of all COVID-19-related inflammatory skin lesions. Visual endothelial changes without manifest leukocytoclastic vasculitis were found in 60% of the COVID-19-related skin lesions, whereas leukocytoclastic vasculitis was diagnosed in 16%. In the cases of vasculitis, there were extensive spike protein depositions in microvascular endothelial cells that colocalized with the autophagosome proteins LC3B and LC3C. The autophagy protein complex LC3-associated endocytosis in microvascular endothelial cells seems to be an important pathogenic factor for severe acute respiratory syndrome coronavirus 2-related vasculitis in the skin. On ultrastructural morphology, the vasculitic process was dominated by intracellular vesicle formation and endothelial cell disruption. Direct presence of severe acute respiratory syndrome coronavirus 2 particles in the skin was not observed. Therefore, our results suggest that instead of direct viral infection, dermal vasculitic lesions in COVID-19 are caused by severe acute respiratory syndrome coronavirus 2 spike protein deposition followed by endothelial damage with activation of autophagy.
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Affiliation(s)
- Andrea Gawaz
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Michael Schindler
- Institute for Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Elena Hagelauer
- Institute for Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Gabriela Blanchard
- Department of Dermatology, Lausanne University Hospital (CHUV), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Simon Riel
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Anneli Vollert
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Michel Gilliet
- Department of Dermatology, Lausanne University Hospital (CHUV), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Georg Stary
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Isabella Pospischil
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Wolfram Hoetzenecker
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | | | - Martin Schaller
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Emmanuella Guenova
- Department of Dermatology, Lausanne University Hospital (CHUV), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland; Department of Dermatology, Hospital 12 de Octubre, Medical school, University Complutense, Madrid, Spain.
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6
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Shu H, Wen Z, Li N, Zhang Z, Ceesay BM, Peng Y, Zhou N, Wang DW. COVID-19 and Cardiovascular Diseases: From Cellular Mechanisms to Clinical Manifestations. Aging Dis 2023; 14:2071-2088. [PMID: 37199573 PMCID: PMC10676802 DOI: 10.14336/ad.2023.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/14/2023] [Indexed: 05/19/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), quickly spread worldwide and led to over 581 million confirmed cases and over 6 million deaths as 1 August 2022. The binding of the viral surface spike protein to the human angiotensin-converting enzyme 2 (ACE2) receptor is the primary mechanism of SARS-CoV-2 infection. Not only highly expressed in the lung, ACE2 is also widely distributed in the heart, mainly in cardiomyocytes and pericytes. The strong association between COVID-19 and cardiovascular disease (CVD) has been demonstrated by increased clinical evidence. Preexisting CVD risk factors, including obesity, hypertension, and diabetes etc., increase susceptibility to COVID-19. In turn, COVID-19 exacerbates the progression of CVD, including myocardial damage, arrhythmia, acute myocarditis, heart failure, and thromboembolism. Moreover, cardiovascular risks post recovery and the vaccination-associated cardiovascular problems have become increasingly evident. To demonstrate the association between COVID-19 and CVD, this review detailly illustrated the impact of COVID-19 on different cells (cardiomyocytes, pericytes, endothelial cells, and fibroblasts) in myocardial tissue and provides an overview of the clinical manifestations of cardiovascular involvements in the pandemic. Finally, the issues related to myocardial injury post recovery, as well as vaccination-induced CVD, has also been emphasized.
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Affiliation(s)
- Hongyang Shu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Zheng Wen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Na Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Zixuan Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Bala Musa Ceesay
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Yizhong Peng
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Ning Zhou
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
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Montes P, Ortíz-Islas E, Rodríguez-Pérez CE, Ruiz-Sánchez E, Silva-Adaya D, Pichardo-Rojas P, Campos-Peña V. Neuroprotective-Neurorestorative Effects Induced by Progesterone on Global Cerebral Ischemia: A Narrative Review. Pharmaceutics 2023; 15:2697. [PMID: 38140038 PMCID: PMC10747486 DOI: 10.3390/pharmaceutics15122697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/24/2023] Open
Abstract
Progesterone (P4) is a neuroactive hormone having pleiotropic effects, supporting its pharmacological potential to treat global (cardiac-arrest-related) cerebral ischemia, a condition associated with an elevated risk of dementia. This review examines the current biochemical, morphological, and functional evidence showing the neuroprotective/neurorestorative effects of P4 against global cerebral ischemia (GCI). Experimental findings show that P4 may counteract pathophysiological mechanisms and/or regulate endogenous mechanisms of plasticity induced by GCI. According to this, P4 treatment consistently improves the performance of cognitive functions, such as learning and memory, impaired by GCI. This functional recovery is related to the significant morphological preservation of brain structures vulnerable to ischemia when the hormone is administered before and/or after a moderate ischemic episode; and with long-term adaptive plastic restoration processes of altered brain morphology when treatment is given after an episode of severe ischemia. The insights presented here may be a guide for future basic research, including the study of P4 administration schemes that focus on promoting its post-ischemia neurorestorative effect. Furthermore, considering that functional recovery is a desired endpoint of pharmacological strategies in the clinic, they could support the study of P4 treatment for decreasing dementia in patients who have suffered an episode of GCI.
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Affiliation(s)
- Pedro Montes
- Laboratorio de Neuroinmunoendocrinología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico
| | - Emma Ortíz-Islas
- Laboratorio de Neurofarmacología Molecular y Nanotecnología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico; (E.O.-I.); (C.E.R.-P.)
| | - Citlali Ekaterina Rodríguez-Pérez
- Laboratorio de Neurofarmacología Molecular y Nanotecnología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico; (E.O.-I.); (C.E.R.-P.)
| | - Elizabeth Ruiz-Sánchez
- Laboratorio de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico;
| | - Daniela Silva-Adaya
- Laboratorio Experimental de Enfermedades Neurodegenerativas, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico;
| | - Pavel Pichardo-Rojas
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX 77030, USA;
| | - Victoria Campos-Peña
- Laboratorio Experimental de Enfermedades Neurodegenerativas, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico;
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Sivasubramanian BP, Ravikumar DB, Vyas B, Panchal V, Puli S, Kiernan G, Venkata VS. Role of POCUS in the Management of New-onset Tachyarrhythmia in the Setting of SARS-CoV-2: A Case Report. J Community Hosp Intern Med Perspect 2023; 13:50-53. [PMID: 38596561 PMCID: PMC11000831 DOI: 10.55729/2000-9666.1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction SARS-CoV-2 infection is associated with myocardial inflammation, new onset cardiomyopathy, and arrhythmias. Here, we describe the utilization of POCUS and management of concurrent new onset atrial tachycardia and heart failure with reduced ejection fraction (HfrEF) in a patient with SARS-CoV-2 infection. Presentation An 80-year-old female with multiple medical problems presented with sudden onset of shortness of breath and cough. She tested positive for SARS-CoV-2. Initially, she was hypoxic on room air and her heart rhythm was sinus tachycardia. CT angiogram of the chest showed consolidation, pleural effusion, and absence of pulmonary embolism. Because of persistent tachycardia, repeat EKGs and POCUS were performed. Subsequent EKGs showed intermittent atrial tachycardia and sinus tachycardia. Initially, home beta blockers were continued on admission, and additional dosages were considered for rate control, but Cardiac POCUS revealed HfrEF and was subsequently confirmed by comprehensive cardiac echocardiogram, consistent with SARS-CoV-2 infection-related cardiomyopathy. Beta blockers were discontinued, and treatment with amiodarone and furosemide showed improvement in symptoms. The patient was discharged with oral amiodarone and supplemental oxygen. Additionally, once the patient's hemodynamics improved, oral carvedilol was also started as part of GDMT for HfrEF. Follow-up echocardiogram 4 months later showed recovery of systolic EF to 60%. Conclusion It is essential to consider new onset HFrEF in the evaluation and management of new onset tachyarrhythmias since IV fluids and AV nodal blocking agents can be harmful in decompensated HFrEF. With the advent of POCUS, HFrEF can be quickly identified, and therapy can be tailored to that diagnosis.
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Affiliation(s)
- Barath P. Sivasubramanian
- Department of Infectious Diseases, University of Texas Health Science Centre, San Antonio, TX, 78229,
USA
| | - Diviya B. Ravikumar
- Department of Internal Medicine, ESIC Medical College and PGIMSR, Chennai, Tamil Nadu,
India
| | - Bhavya Vyas
- Department of Medicine, Smt. N.H.L. Municipal Medical College and SVPISMR, Ahmedabad, Gujarat,
India
| | - Viraj Panchal
- Department of Medicine, Smt. N.H.L. Municipal Medical College and SVPISMR, Ahmedabad, Gujarat,
India
| | - Srikanth Puli
- Hospital Medicine Division, Cheshire Medical Center,
USA
| | - Gerard Kiernan
- Hospital Medicine Division, Cheshire Medical Center,
USA
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9
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Liu Y, Si D, Bai P, Zhu L, Zhang L, Chen Q, Qi Y. CXCL10 May Be Responsible for Susceptibility to Pulmonary Embolism in COVID-19 Patients. J Inflamm Res 2023; 16:4913-4924. [PMID: 37927958 PMCID: PMC10625331 DOI: 10.2147/jir.s431212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
Background Although the potential of coronavirus disease 2019 (COVID-19) patients to develop pulmonary embolism (PE) is widely recognized, the underlying mechanism has not been completely elucidated. This study aimed to identify genes common to COVID-19 and PE to reveal the underlying pathogenesis of susceptibility to PE in COVID-19 patients. Methods COVID-19 genes were obtained from the GEO database and the OMIM, CTD, GeneCards, and DisGeNET databases; PE genes were obtained from the OMIM, CTD, GeneCards, and DisGeNET databases. We overlapped the genes of COVID-19 and PE to obtain common genes for additional analysis, including functional enrichment, protein-protein interaction, and immune infiltration analysis. Hub genes were identified using cytoHubba, a plugin of Cytoscape, and validated using the independent datasets GSE167000 and GSE13535. The genes validated by the above datasets were further validated in clinical samples. Results We obtained 36 genes shared by PE and COVID-19. Functional enrichment and immune infiltration analyses revealed the involvement of cytokines and immune activation. Five genes (CCL2, CXCL10, ALB, EGF, and MKI67) were identified as hub genes common to COVID-19 and PE. CXCL10 was validated in both independent datasets (GSE167000 and GSE13535). Serum levels of CXCL10 in the COVID-19 group and the COVID-19 combined with PE group were significantly higher than those in the healthy control group (P<0.001). In addition, there were significant differences between the COVID-19 group and the COVID-19 combined with PE group (P<0.01). Conclusion Our study reveals common genes shared by PE and COVID-19 and identifies CXCL10 as a possible cause of susceptibility to PE in COVID-19 patients.
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Affiliation(s)
- Yingli Liu
- Department of Pulmonary and Critical Care Medicine, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
| | - Dan Si
- Department of Pulmonary and Critical Care Medicine, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, 451464, People’s Republic of China
| | - Pingping Bai
- Department of Health Management, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
| | - Li Zhu
- Department of Pulmonary and Critical Care Medicine, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan, 450003, People’s Republic of China
| | - Lili Zhang
- Department of Pulmonary and Critical Care Medicine, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
| | - Qi Chen
- Department of Pulmonary and Critical Care Medicine, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
| | - Yong Qi
- Department of Pulmonary and Critical Care Medicine, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
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10
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Wang Y, Chen J, Jin L, Wu L, Zhang M, Sun J, Shen C, Du L, Wang B, Li Z. Sequence and directivity in cardiac muscle injury of COVID-19 patients: an observational study. Front Cardiovasc Med 2023; 10:1260971. [PMID: 37908504 PMCID: PMC10613984 DOI: 10.3389/fcvm.2023.1260971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023] Open
Abstract
Objective To compare cardiac function indicators between mild and moderate to severe COVID-19 patients and to try to identify the sequence and directivity in cardiac muscle injury of COVID-19 patients. Methods From December 2022 to January 2023, all patients with laboratory-confirmed SARS-CoV-2 infection in Shanghai General Hospital Jiading Branch were enrolled. The clinical classification was stratified into mild, moderate, or severe groups. We collected the clinical and laboratory information, transthoracic echocardiographic and speckle-tracking echocardiographic parameters of patients and compared the differences among different groups. Results The values of echocardiographic parameters in mild group were lower than that in moderate or severe group (P < 0.05) except LVEF. The values of LVEF of mild and moderate group were higher than severe group (P < 0.05). There were no significant differences between moderate and severe group. Positive correlations were observed between left ventricular global longitudinal strain (LVGLS) and myoglobin (r = 0.72), E/e' and age (r = 0.79), E/e' and BNP (r = 0.67). The multivariate analysis shows that SpO2 (OR = 0.360, P = 0.02), LVGLS (OR = 3.196, P = 0.003) and E/e' (OR = 1.307, P = 0.036) were the independent risk factors for mild cases progressing to moderate or severe. According to the receiver operating characteristic (ROC) curves, when all the COVID-19 patients was taken as the sample size, the area under the curve (AUC) of the LVGLS was the highest (AUC = 0.861). The AUC of the LVGLS was higher than LVGCS (AUC = 0.565, P < 0.001). Conclusion When mild COVID-19 progresses to moderate or severe, both systolic and diastolic functions of the heart are impaired. LVGLS was the independent risk factor for mild cases progressing to moderate or severe cases. Longitudinal changes may manifest earlier than circumferential changes as myocardial disease progresses in COVID-19.
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Affiliation(s)
- Yixuan Wang
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jianxiong Chen
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Lin Jin
- Department of Ultrasound, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lingheng Wu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Mengjiao Zhang
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiali Sun
- Department of Ultrasound, Jiading Branch of Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Cuiqin Shen
- Department of Ultrasound, Jiading Branch of Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bei Wang
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Zhaojun Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Ultrasound, Jiading Branch of Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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11
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Gao Y, Zhang Y, Mou K, Liu Y, Chen Q, Man S, Xu H, Zhou J, Wang T, Li Y, Chen Y, Zhang M. Assessment of alterations in the retina and vitreous in pre- and post-COVID-19 patients using swept-source optical coherence tomography and angiography: A comparative study. J Med Virol 2023; 95:e29168. [PMID: 37815403 DOI: 10.1002/jmv.29168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/06/2023] [Accepted: 09/30/2023] [Indexed: 10/11/2023]
Abstract
Ocular manifestations have been well recognized in coronavirus disease 2019 (COVID-19) outbreak. Several studies have detected ocular manifestations in patients after COVID-19. However, little is known about the retinal and vitreal alterations in patients before and after COVID-19 infection. This study aimed to investigate the retinal and vitreal alterations in patients before and after contracting COVID-19 infection using swept-source optical coherence tomography (SS-OCT) and angiography (SS-OCTA). A total of 38 participants (76 eyes) were enrolled and followed-up 1 month after COVID-19 infection. Then, 26 patients (52 eyes) were evaluated 3 months after COVID-19 infection. Compared with the pre-COVID-19 status, patients with 1- and 3-month post-COVID-19 statuses had significant thinning of ganglion cell and inner plexiform layer, thickening of inner nuclear layer, a decrease in the vessel density (VD) of superficial vascular complex, and an increase in the VD of deep vascular complex. Meanwhile, alteration in parameters of foveal avascular zone (all p < 0.05) and hyper-reflective dots in the vitreous of 27 patients (54 eyes) (71.1% vs. pre-COVID-19, 34.2%, p = 0.006) were observed. These findings suggest significantly retinal and vitreal alterations occurred in patients after COVID-19 infection, possibly due to direct or indirect virus-induced injuries. Further longitudinal studies are required to investigate the long-term effects of COVID-19 infection on the human eyes.
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Affiliation(s)
- Yuzhu Gao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology and Research Laboratory of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yifan Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Kefan Mou
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yilin Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Qing Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Shulei Man
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Hanyue Xu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Jiaming Zhou
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Ting Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yating Li
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yi Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
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12
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Shoura SJ, Teaima T, Sana MK, Abbasi A, Atluri R, Yilmaz M, Hammo H, Ali L, Kanitsoraphan C, Park DY, Alyousef T. Outcomes in patients with COVID-19 and new onset heart blocks: Insight from the National Inpatient Sample database. World J Cardiol 2023; 15:448-461. [PMID: 37900263 PMCID: PMC10600784 DOI: 10.4330/wjc.v15.i9.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/16/2023] [Accepted: 07/17/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a worldwide health crisis since it first appeared. Numerous studies demonstrated the virus's predilection to cardiomyocytes; however, the effects that COVID-19 has on the cardiac conduction system still need to be fully understood. AIM To analyze the impact that COVID-19 has on the odds of major cardiovascular complications in patients with new onset heart blocks or bundle branch blocks (BBB). METHODS The 2020 National Inpatient Sample (NIS) database was used to identify patients admitted for COVID-19 pneumonia with and without high-degree atrioventricular blocks (HDAVB) and right or left BBB utilizing ICD-10 codes. The patients with pre-existing pacemakers, suggestive of a prior diagnosis of HDAVB or BBB, were excluded from the study. The primary outcome was inpatient mortality. Secondary outcomes included total hospital charges (THC), the length of hospital stay (LOS), and other major cardiac outcomes detailed in the Results section. Univariate and multivariate regression analyses were used to adjust for confounders with Stata version 17. RESULTS A total of 1058815 COVID-19 hospitalizations were identified within the 2020 NIS database, of which 3210 (0.4%) and 17365 (1.6%) patients were newly diagnosed with HDAVB and BBB, respectively. We observed a significantly higher odds of in-hospital mortality, cardiac arrest, cardiogenic shock, sepsis, arrythmias, and acute kidney injury in the COVID-19 and HDAVB group. There was no statistically significant difference in the odds of cerebral infarction or pulmonary embolism. Encounters with COVID-19 pneumonia and newly diagnosed BBB had a higher odds of arrythmias, acute kidney injury, sepsis, need for mechanical ventilation, and cardiogenic shock than those without BBB. However, unlike HDAVB, COVID-19 pneumonia and BBB had no significant impact on mortality compared to patients without BBB. CONCLUSION In conclusion, there is a significantly higher odds of inpatient mortality, cardiac arrest, cardiogenic shock, sepsis, acute kidney injury, supraventricular tachycardia, ventricular tachycardia, THC, and LOS in patients with COVID-19 pneumonia and HDAVB as compared to patients without HDAVB. Likewise, patients with COVID-19 pneumonia in the BBB group similarly have a higher odds of supraventricular tachycardia, atrial fibrillation, atrial flutter, ventricular tachycardia, acute kidney injury, sepsis, need for mechanical ventilation, and cardiogenic shock as compared to those without BBB. Therefore, it is essential for healthcare providers to be aware of the possible worse predicted outcomes that patients with new-onset HDAVB or BBB may experience following SARS-CoV-2 infection.
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Affiliation(s)
- Sami J Shoura
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Taha Teaima
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Muhammad Khawar Sana
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Ayesha Abbasi
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Ramtej Atluri
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Mahir Yilmaz
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Hasan Hammo
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Laith Ali
- Department of Cardiology, John H. Stroger Jr Hospital of Cook County, Chicago, IL 60612, United States
| | - Chanavuth Kanitsoraphan
- Department of Cardiology, John H. Stroger Jr Hospital of Cook County, Chicago, IL 60612, United States
| | - Dae Yong Park
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Tareq Alyousef
- Department of Cardiology, John H. Stroger Jr Hospital of Cook County, Chicago, IL 60612, United States.
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13
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Zhao J, Xie Y, Meng Z, Liu C, Wu Y, Zhao F, Ma X, Christopher TA, Lopez BJ, Wang Y. COVID-19 and cardiovascular complications: updates of emergency medicine. EMERGENCY AND CRITICAL CARE MEDICINE 2023; 3:104-114. [PMID: 38314258 PMCID: PMC10836842 DOI: 10.1097/ec9.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV-2 variants, has become a global pandemic resulting in significant morbidity and mortality. Severe cases of COVID-19 are characterized by hypoxemia, hyper-inflammation, cytokine storm in lung. Clinical studies have reported an association between COVID-19 and cardiovascular disease (CVD). Patients with CVD tend to develop severe symptoms and mortality if contracted COVID-19 with further elevations of cardiac injury biomarkers. Furthermore, COVID-19 itself can induce and promoted CVD development, including myocarditis, arrhythmia, acute coronary syndrome, cardiogenic shock, and venous thromboembolism. Although the direct etiology of SARS-CoV-2 induced cardiac injury remains unknown and under-investigated, it is suspected that it is related to myocarditis, cytokine-mediated injury, microvascular injury, and stress-related cardiomyopathy. Despite vaccinations having provided the most effective approach to reducing mortality overall, an adapted treatment paradigm and regular monitoring of cardiac injury biomarkers is critical for improving outcomes in vulnerable populations at risk for severe COVID-19. In this review, we focus on the latest progress in clinic and research on the cardiovascular complications of COVID-19 and provide a perspective of treating cardiac complications deriving from COVID-19 in Emergency Medicine.
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Affiliation(s)
- Jianli Zhao
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, AL, USA
| | - Yaoli Xie
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
| | - Zhijun Meng
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
| | - Caihong Liu
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yalin Wu
- Department of Biomedical Engineering, University of Alabama at Birmingham, AL, USA
| | - Fujie Zhao
- Department of Biomedical Engineering, University of Alabama at Birmingham, AL, USA
| | - Xinliang Ma
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Bernard J. Lopez
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yajing Wang
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, AL, USA
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14
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Yan J, Hong J. COVID-19 Associated Myocarditis: Prevalence, Pathophysiology, Diagnosis, and Management. Cardiol Rev 2023:00045415-990000000-00141. [PMID: 37607078 DOI: 10.1097/crd.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been a pandemic and affected public health greatly. While COVID-19 primarily damages the lungs, leading to cough, sore throat, pneumonia, or acute respiratory distress syndrome, it also infects other organs and tissues, including the cardiovascular system. In particular, myocarditis is a well-recognized severe complication of COVID-19 infection and could result in adverse outcomes. Angiotensin-Converting Enzyme2 is thought to play a pivotal role in SARS-CoV-2 infection, and immune overresponse causes overwhelming damage to the host's myocardium. Direct viral infection and injury do take a part as well, but more evidence is needed to strengthen this proposal. The clinical abnormalities include elevated cardiac biomarkers and electrocardiogram changes and impaired cardiac function that might be presented in echocardiography and cardiovascular magnetic resonance imaging. If necessary, the endomyocardial biopsy would give more forceful information to diagnosis and aid in treatment. Comparisons between COVID-19 myocarditis and other viral myocarditis are also discussed briefly.
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Affiliation(s)
- Ji Yan
- From the Department of Internal and Emergency Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Hong
- From the Department of Internal and Emergency Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Chen Y, Cao B, Zhou Q, Liu Y, He Q, Zhao M. Bibliometric evaluation of 2020-2022 publications on COVID-19-related cardiovascular disease. Front Cardiovasc Med 2023; 9:1070336. [PMID: 36712251 PMCID: PMC9880207 DOI: 10.3389/fcvm.2022.1070336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
Objective This study aimed to investigate the international scientific output regarding the relationship between COVID-19 and cardiovascular diseases (CVDs) through a bibliometric analysis and explore research hotspots in this field. Methods We searched the Web of Science Core Collection for publications and used different types of software, such as R, CiteSpace, and VOSviewer, to analyze and visualize the data. Results A total of 10,055 publications were retrieved as of the 13 December 2022, based on the inclusion criteria after screening. The USA and China lead in the quantity and quality of publications in this field. Based on Bradford's law, 63 journals were considered core journals in the field. Co-cited references and keywords analysis indicated that researchers paid particular attention to cardiovascular comorbidities, outcomes, and COVID-19 regenerative medicine. In summary, with increasing COVID-19 research related to CVD, more attention might be drawn to the relationship between these two diseases. Conclusion The hotspots in this field may continue to revolve around cardiovascular comorbidities, outcomes, and COVID-19 regenerative medicine. Owing to the different situations faced by different groups with COVID-19, further exploration of the related factors specific to each of these groups, e.g., history or no history of heart failure, is needed, with a view to providing a reference for intervention measures in COVID-19 research.
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Affiliation(s)
- Yiru Chen
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China,Xiangya School of Medicine, Central South University, Changsha, China
| | - Buzi Cao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China,Medical School, Hunan Normal University, Changsha, China
| | - Quan Zhou
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China,Xiangya School of Medicine, Central South University, Changsha, China
| | - Yantong Liu
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China,Xiangya School of Medicine, Central South University, Changsha, China
| | - Qingnan He
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China,*Correspondence: Qingnan He ✉
| | - Mingyi Zhao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China,Mingyi Zhao ✉
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16
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Izzo C, Visco V, Gambardella J, Ferruzzi GJ, Rispoli A, Rusciano MR, Toni AL, Virtuoso N, Carrizzo A, Di Pietro P, Iaccarino G, Vecchione C, Ciccarelli M. Cardiovascular Implications of microRNAs in Coronavirus Disease 2019. J Pharmacol Exp Ther 2023; 384:102-108. [PMID: 35779946 DOI: 10.1124/jpet.122.001210] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/11/2022] [Accepted: 06/15/2022] [Indexed: 01/13/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic continues to be a global challenge due to resulting morbidity and mortality. Cardiovascular (CV) involvement is a crucial complication in coronavirus disease 2019 (COVID-19), and no strategies are available to prevent or specifically address CV events in COVID-19 patients. The identification of molecular partners contributing to CV manifestations in COVID-19 patients is crucial for providing early biomarkers, prognostic predictors, and new therapeutic targets. The current report will focus on the role of microRNAs (miRNAs) in CV complications associated with COVID-19. Indeed, miRNAs have been proposed as valuable biomarkers and predictors of both cardiac and vascular damage occurring in SARS-CoV-2 infection. SIGNIFICANCE STATEMENT: It is essential to identify the molecular mediators of coronavirus disease 2019 (COVID-19) cardiovascular (CV) complications. This report focused on the role of microRNAs in CV complications associated with COVID-19, discussing their potential use as biomarkers, prognostic predictors, and therapeutic targets.
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Affiliation(s)
- Carmine Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy (C.I., V.V., G.J.F., A.R., M.R.R., A.L.T., A.C., P.D.P., C.V., M.C.); Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (J.G., G.I.); Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (J.G.); Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy (N.V.); and Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy (A.C., C.V.)
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy (C.I., V.V., G.J.F., A.R., M.R.R., A.L.T., A.C., P.D.P., C.V., M.C.); Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (J.G., G.I.); Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (J.G.); Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy (N.V.); and Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy (A.C., C.V.)
| | - Jessica Gambardella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy (C.I., V.V., G.J.F., A.R., M.R.R., A.L.T., A.C., P.D.P., C.V., M.C.); Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (J.G., G.I.); Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (J.G.); Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy (N.V.); and Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy (A.C., C.V.)
| | - Germano Junior Ferruzzi
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy (C.I., V.V., G.J.F., A.R., M.R.R., A.L.T., A.C., P.D.P., C.V., M.C.); Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (J.G., G.I.); Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (J.G.); Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy (N.V.); and Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy (A.C., C.V.)
| | - Antonella Rispoli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy (C.I., V.V., G.J.F., A.R., M.R.R., A.L.T., A.C., P.D.P., C.V., M.C.); Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (J.G., G.I.); Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (J.G.); Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy (N.V.); and Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy (A.C., C.V.)
| | - Maria Rosaria Rusciano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy (C.I., V.V., G.J.F., A.R., M.R.R., A.L.T., A.C., P.D.P., C.V., M.C.); Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (J.G., G.I.); Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (J.G.); Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy (N.V.); and Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy (A.C., C.V.)
| | - Anna Laura Toni
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy (C.I., V.V., G.J.F., A.R., M.R.R., A.L.T., A.C., P.D.P., C.V., M.C.); Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (J.G., G.I.); Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (J.G.); Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy (N.V.); and Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy (A.C., C.V.)
| | - Nicola Virtuoso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy (C.I., V.V., G.J.F., A.R., M.R.R., A.L.T., A.C., P.D.P., C.V., M.C.); Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (J.G., G.I.); Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (J.G.); Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy (N.V.); and Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy (A.C., C.V.)
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy (C.I., V.V., G.J.F., A.R., M.R.R., A.L.T., A.C., P.D.P., C.V., M.C.); Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (J.G., G.I.); Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (J.G.); Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy (N.V.); and Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy (A.C., C.V.)
| | - Paola Di Pietro
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy (C.I., V.V., G.J.F., A.R., M.R.R., A.L.T., A.C., P.D.P., C.V., M.C.); Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (J.G., G.I.); Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (J.G.); Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy (N.V.); and Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy (A.C., C.V.)
| | - Guido Iaccarino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy (C.I., V.V., G.J.F., A.R., M.R.R., A.L.T., A.C., P.D.P., C.V., M.C.); Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (J.G., G.I.); Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (J.G.); Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy (N.V.); and Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy (A.C., C.V.)
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy (C.I., V.V., G.J.F., A.R., M.R.R., A.L.T., A.C., P.D.P., C.V., M.C.); Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (J.G., G.I.); Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (J.G.); Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy (N.V.); and Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy (A.C., C.V.)
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy (C.I., V.V., G.J.F., A.R., M.R.R., A.L.T., A.C., P.D.P., C.V., M.C.); Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy (J.G., G.I.); Department of Medicine, Einstein-Sinai Diabetes Research Center, The Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (J.G.); Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy (N.V.); and Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy (A.C., C.V.)
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Developing a Novel Immune-Related Seven-Gene Signature and Immune Infiltration Pattern in Patients with COVID-19 and Cardiovascular Disease. J Cardiovasc Dev Dis 2022; 9:jcdd9120450. [PMID: 36547446 PMCID: PMC9781048 DOI: 10.3390/jcdd9120450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND patients with pre-existence of cardiovascular disease (CVD) are vulnerable to coronavirus disease 2019 (COVID-19), and COVID-19 will cause long-term burden of CVD. However, the common pathogenic mechanisms are not fully elucidated. More detailed knowledge of linking biological molecules and the role of immune signature would allow more valuable and specific clinical management. METHODS the gene expression profiles of CVD and COVID-19 were retrieved from the GEO database. Common differentially expressed genes (DEGs) were screened with the Limma R package and the WGCNA algorithm, and then functional enrichment analysis, protein-protein interaction network, hub genes, and small therapeutic molecules analyses were performed. The hub immune-related genes (HIRGs) were intersected, and their associations with immune cells, expressional correlation, evaluated performance, and potential signal pathways were further investigated. RESULTS In total, 57 common DEGs were identified as a shared transcriptional signature between CVD and COVID-19, and 12 hub genes were screened using five topological algorithms. There are common altered immune responses in the response of these two diseases, and seven HIRGs, including C5AR1, MMP9, CYBB, FPR2, CSF1R, TLR2, and TLR4, were identified, with positive correlation to altered macrophages and neutrophils. Nine small molecular agents (SMAs) were detected as promising therapeutic drugs. These seven HIRGs mainly participated in the inflammatory immune response through activation of Il2 stat5 signaling and Tnfa signaling via nfκb pathways, and ROC curves confirmed their good discriminatory capacity in the two diseases. CONCLUSIONS this study established the co-expression network and identified a new immune-related seven-gene signature as therapeutic targets, which may provide new insights into pathogenic mechanisms and novel clinical management strategies.
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Priya SP, Sunil PM, Varma S, Brigi C, Isnadi MFAR, Jayalal JA, Shadamarshan RA, Kumar SS, Kumari NV, Kumar RPR. Direct, indirect, post-infection damages induced by coronavirus in the human body: an overview. Virusdisease 2022; 33:429-444. [PMID: 36311173 PMCID: PMC9593972 DOI: 10.1007/s13337-022-00793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Severe acute respiratory syndrome Coronavirus-2 invades the cells via ACE2 receptor and damages multiple organs of the human body. Understanding the pathological manifestation is mandatory to endure the rising post-infection sequel reported in patients with or without comorbidities. Materials and methods Our descriptive review emphasises the direct, indirect and post-infection damages due to COVID-19. We have performed an electronic database search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with selective inclusion and exclusion criteria. Results The included studies substantiated the extensive damages in the multiple organs due to direct and indirect consequences of COVID-19. After an apparent recovery, the prolonged presentation of the symptoms manifests as post-COVID that can be related with persisting viral antigens and dysregulated immune response. Conclusion A few of the symptoms of respiratory, cardiovascular, and neuropsychiatric systems that persist or reappear as post-COVID manifestations. Vaccination and preventive programs will effectively reduce the prevalence but, the post-COVID, a multisystem manifestation, will be a significant tribulation to the medical profession. However, the issue can be managed by implementing public health programs, rehabilitation services, and telemedicine virtual supports to raise awareness and reduce panic.
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Affiliation(s)
- Sivan Padma Priya
- Department of Basic Medical Sciences, RAK College of Dental Sciences, RAK Medical and Health Sciences, Ras Al Khaimah, UAE
| | - P. M. Sunil
- Department of Oral Pathology and Microbiology, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala India
- Centre for Stem Cells and Regenerate Medicine, Malabar Medical College, Calicut, Kerala India
| | - Sudhir Varma
- Department of Clinical Sciences, College of Dentistry, Center for Medical and Bio-Allied Health Science Research, Ajman University, Ajman, UAE
- Saveetha Dental College and Hospitals, Chennai, India
| | - Carel Brigi
- Molecular Medicine and Translational Research, University of Sharjah, Sharjah, UAE
| | - Mohammad Faruq Abd Rachman Isnadi
- Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - J. A. Jayalal
- Department of Surgery, Kanyakumari Medical College and Hospital, Asaripallam, India
| | - R. Arunkumar Shadamarshan
- Dental Officer and Graded Specialist (Oral and Maxillofacial Surgery), Indo Bhutan Friendship Hospital, IMTRAT, Thimpu Bhutan, 11001 Bhutan
| | - S. Suresh Kumar
- Centre for Materials Engineering and Regenerative Medicine,, Bharath Institute of Higher Eduction and Research, Chennai, 600073 Tamil Nadu India
| | - Neela Vasantha Kumari
- Department of Medical Microbiology and Parasitology, Universiti Putra Malaysia (UPM), Serdang, Selangor 43400 Malaysia
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Huang D, Yang H, Yu H, Wang T, Chen Z, Yao R, Liang Z. A prediction model for major adverse cardiovascular events (MACE) in patients with coronavirus disease 2019 (COVID-19). BMC Pulm Med 2022; 22:343. [PMID: 36096832 PMCID: PMC9466355 DOI: 10.1186/s12890-022-02143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Emerging evidence shows that cardiovascular injuries and events in coronavirus disease 2019 (COVID-19) should be considered. The current study was conducted to develop an early prediction model for major adverse cardiovascular events (MACE) during hospitalizations of COVID-19 patients. Methods This was a retrospective, multicenter, observational study. Hospitalized COVID-19 patients from Wuhan city, Hubei Province and Sichuan Province, China, between January 14 and March 9, 2020, were randomly divided into a training set (70% of patients) and a testing set (30%). All baseline data were recorded at admission or within 24 h after admission to hospitals. The primary outcome was MACE during hospitalization, including nonfatal myocardial infarction, nonfatal stroke and cardiovascular death. The risk factors were selected by LASSO regression and multivariate logistic regression analysis. The nomogram was assessed by calibration curve and decision curve analysis (DCA). Results Ultimately, 1206 adult COVID-19 patients were included. In the training set, 48 (5.7%) patients eventually developed MACE. Six factors associated with MACE were included in the nomogram: age, PaO2/FiO2 under 300, unconsciousness, lymphocyte counts, neutrophil counts and blood urea nitrogen. The C indices were 0.93 (95% CI 0.90, 0.97) in the training set and 0.81 (95% CI 0.70, 0.93) in the testing set. The calibration curve and DCA demonstrated the good performance of the nomogram. Conclusions We developed and validated a nomogram to predict the development of MACE in hospitalized COVID-19 patients. More prospective multicenter studies are needed to confirm our results. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02143-3.
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Affiliation(s)
- Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Huan Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - He Yu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Ting Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zhu Chen
- Department of Infectional Inpatient Ward Two, Chengdu Public Health Clinical Medical Center, Chengdu, Sichuan, China
| | - Rong Yao
- Department of Emergency Medicine, Emergency Medical Laboratory, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China. .,Disaster Medical Center, Sichuan University, Chengdu, Sichuan, China.
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
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20
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Yang H, Yang G, Xu M, Zhao Y, He S, Wang Q, Wen Y, Huang C, Wu J, Ren C, Yang Y, He S. Impact of high altitude on the incidence of postoperative venous thromboembolism and its genetic susceptibility: A meta-analysis and systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156632. [PMID: 35691358 DOI: 10.1016/j.scitotenv.2022.156632] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The effect of high-altitude (HA) on venous thromboembolism (VTE) and its mechanism remains ambiguous. To clarify this, we aimed to conduct a meta-analysis and systematic review to evaluate the incidence of VTE at HA and comparatively low altitude (LA) and figure out the intrinsic risk factors such as susceptibility genes of patients with VTE at HA. METHODS We selected studies that explored the risk factors for HA and VTE by searching PubMed, Embase, and Web of Science to analyze the impact of HA on VTE. All relevant studies before August 2021 were screened using the terms ([high altitude] OR [plateau] OR [mountain]) AND ([venous thromboembolism] OR [deep vein thrombosis] OR [pulmonary embolism]). Latest studies on the gene of HA-VTE patients were also summarized and analyzed. RESULTS Fifteen studies were eventually assessed, and the overall numbers of subjects with and without VTE were 1475 and 286,926 respectively. The overall incidence of VTE, deep vein thrombosis (DVT) and pulmonary embolism (PE) in the HA group was significantly higher than that in the LA group (P < 0.01). The overall incidence of VTE, DVT and PE in the HA group was significantly higher than that in the LA group at 30 days post operation (P < 0.05, P < 0.05 and P < 0.01, respectively). At 90 days post operation, incidence of VTE and PE in the HA group was higher than that in the LA group (P < 0.01and P < 0.01, respectively), but there was no difference in the incidence of DVT (P = 0.07). Regarding endogenous factors, the analysis of genes in patients with HA-VTE revealed numerous targeted genes such as ANG, ACE, lncRNA-LINC00 659/UXT-AS1 and GP4. CONCLUSIONS We observed a significant association between HA and the overall incidence of VTE and that at 30/90 days post operation, indicating that HA may be a risk factor for VTE.
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Affiliation(s)
- Haihong Yang
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Guan Yang
- Department of Pain, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Meiling Xu
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Yuanyuan Zhao
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Shengdong He
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Qiwu Wang
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Yi Wen
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Chen Huang
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Jianping Wu
- Department of Neurosurgery, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Chao Ren
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Yongxiang Yang
- Department of Neurosurgery, The General Hospital of Western Theater Command, Chengdu 610083, China.
| | - Siyi He
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, Chengdu 610083, China.
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ALGhasab NS, Altamimi LA, Alharbi MS, ALMesned SS, Khetan AK. Venous thromboembolism in COVID-19: A meta-summary of cases. Saudi Med J 2022; 43:979-990. [PMID: 36104055 PMCID: PMC9987652 DOI: 10.15537/smj.2022.43.9.20220316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To summarize cases of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT) among coronavirus disease (COVID-19) patients and discuss their symptoms, diagnostic method, clinical features, and prognosis. METHODS All major databases were searched for relevant studies published between December 1, 2019 and May 5, 2021. RESULTS A total of 233 articles were identified, 22 describing 48 patients were included. A total of 79.1% had PE and 20.9% had DVT. Most patients were men, with a mean age of 56 years. Comorbidities were present in 70.8%, and 85.4% had at least one risk factor of VTE. 56.3% had received anticoagulation therapy. Most patients were treated in the general ward. Complications occurred in 27.1% of the patients, and recovery was achieved in 80.4%. CONCLUSION Venous thromboembolism must be suspected even in patients who had received prior anticoagulant regimens or in stable cases, especially in males, the elderly, and patients with comorbidities and high D-dimer levels.
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Affiliation(s)
- Naif Saad ALGhasab
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
| | - Leen A. Altamimi
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
- Address correspondence and reprint request to: Dr. Leen A. Altamimi, from the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0003-3718-5291
| | - Mohammed Salem Alharbi
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
| | - Sulaman S. ALMesned
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
| | - Aditya K. Khetan
- From the Department of Internal Medicine (ALGhasab), Medical Collage, Ha’il University; from the Department of Medicine (Alharbi), College of Medicine, University of Ha’il, Ha’il; from the College of Medicine (Altamimi), King Saud University, Riyadh; from the Department of Surgery (ALMesned), Medical College, Qassim University, Buraydah, Kingdom of Saudi Arabia; and from the Department of Medicine (ALGhasab, Khetan), McMaster University, Canada.
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22
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Vidusa L, Kalejs O, Maca-Kaleja A, Strumfa I. Role of Endomyocardial Biopsy in Diagnostics of Myocarditis. Diagnostics (Basel) 2022; 12:diagnostics12092104. [PMID: 36140505 PMCID: PMC9497694 DOI: 10.3390/diagnostics12092104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/19/2022] Open
Abstract
Endomyocardial biopsy as the cornerstone of diagnostics has been re-evaluated throughout the years, leaving unanswered questions on the precedence of it. The reported incidence of myocarditis has increased during the pandemic of coronavirus disease 2019 (COVID-19), reinforcing discussions on appropriate diagnostics of myocarditis. By analysis of evidence-based literature published within the last demi-decade, we aimed to summarize the most recent information in order to evaluate the current role of endomyocardial biopsy in diagnostics and management of myocarditis. For the most part, research published over the last five years showed ongoing uncertainty regarding the use, informativeness, safety and necessity of performing a biopsy. Special circumstances, such as fulminant clinical course or failure to respond to empirical treatment, were reconfirmed as justified indications, with a growing applicability of non-invasive diagnostic approaches for most other cases. We concluded that endomyocardial biopsy, if performed properly and with adjunct diagnostic methods, holds a critical role for treatment correction in specific histological subtypes of myocarditis and for differential diagnosis between immune-mediated myocarditis and secondary infections due to immunosuppressive treatment. A high level of possible misdiagnosing was detected, indicating the need to review terminology used to describe findings of myocardial inflammation that did not meet Dallas criteria.
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Affiliation(s)
- Liga Vidusa
- Department of Pathology, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
| | - Oskars Kalejs
- Department of Internal Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
| | - Aija Maca-Kaleja
- Department of Internal Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
| | - Ilze Strumfa
- Department of Pathology, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Correspondence:
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23
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Gong L, He D, Huang D, Wu Z, Shi Y, Liang Z. Clinical profile analysis and nomogram for predicting in-hospital mortality among elderly severe community-acquired pneumonia patients with comorbid cardiovascular disease: a retrospective cohort study. BMC Pulm Med 2022; 22:312. [PMID: 35964040 PMCID: PMC9375910 DOI: 10.1186/s12890-022-02113-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Researchers have linked cardiovascular disease (CVD) with advancing age; however, how it drives disease progression in elderly severe community acquired pneumonia (SCAP) patients is still unclear. This study aims to identify leading risk predictors of in-hospital mortality in elderly SCAP patients with CVD, and construct a comprehensive nomogram for providing personalized prediction. Patients and methods The study retrospectively enrolled 2365 elderly patients identified SCAP. Among them, 413 patients were found to have CVD. The LASSO regression and multivariate logistic regression analysis were utilized to select potential predictors of in-hospital mortality in elderly SCAP patients with CVD. By incorporating these features, a nomogram was then developed and subjected to internal validations. Discrimination, calibration, and clinical use of the nomogram were assessed via C-index, calibration curve analysis, and decision plot. Results Compared with patients without CVD, elderly SCAP patients with CVD had a significant poor outcome. Further analysis of the CVD population identified 7 independent risk factors for in-hospital mortality in elderly SCAP patients, including age, the use of vasopressor, numbers of primary symptoms, body temperature, monocyte, CRP and NLR. The nomogram model incorporated these 7 predictors showed sufficient predictive accuracy, with the C-index of 0.800 (95% CI 0.758–0.842). High C-index value of 0.781 was obtained in the internal validation via bootstrapping validation. Moreover, the calibration curve indicative a good consistency of risk prediction, and the decision curve manifested that the nomogram had good overall net benefits. Conclusion An integrated nomogram was developed to facilitate the personalized prediction of in-hospital mortality in elderly SCAP patients with CVD.
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Affiliation(s)
- Linjing Gong
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.,Laboratory of Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Dingxiu He
- Department of Emergency Medicine, The People's Hospital of Deyang, Deyang, Sichuan, China
| | - Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.,Laboratory of Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zhenru Wu
- Laboratory of Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Yujun Shi
- Laboratory of Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
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Characteristics and mortality of 561,379 hospitalized COVID-19 patients in Germany until December 2021 based on real-life data. Sci Rep 2022; 12:11116. [PMID: 35778464 PMCID: PMC9247915 DOI: 10.1038/s41598-022-15287-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/22/2022] [Indexed: 01/08/2023] Open
Abstract
The ongoing SARS-CoV-2 pandemic is characterized by poor outcome and a high mortality especially in the older patient cohort. Up to this point there is a lack of data characterising COVID-19 patients in Germany admitted to intensive care (ICU) vs. non-ICU patients. German Reimbursement inpatient data covering the period in Germany from January 1st, 2020 to December 31th, 2021 were analyzed. 561,379 patients were hospitalized with COVID-19. 24.54% (n = 137,750) were admitted to ICU. Overall hospital mortality was 16.69% (n = 93,668) and 33.36% (n = 45,947) in the ICU group. 28.66% (n = 160,881) of all patients suffer from Cardiac arrhythmia and 17.98% (n = 100,926) developed renal failure. Obesity showed an odds-ratio ranging from 0.83 (0.79-0.87) for WHO grade I to 1.13 (1.08-1.19) for grade III. Mortality-rates peaked in April 2020 and January 2021 being 21.23% (n = 4539) and 22.99% (n = 15,724). A third peak was observed November and December 2021 (16.82%, n = 7173 and 16.54%, n = 9416). Hospitalized COVID-19 patient mortality in Germany is lower than previously shown in other studies. 24.54% of all patients had to be treated in the ICU with a mortality rate of 33.36%. Congestive heart failure was associated with a higher risk of death whereas low grade obesity might have a protective effect on patient survival. High admission numbers are accompanied by a higher mortality rate.
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25
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Histopathological and molecular links of COVID-19 with novel clinical manifestations for the management of coronavirus-like complications. Inflammopharmacology 2022; 30:1219-1257. [PMID: 35637319 PMCID: PMC9150634 DOI: 10.1007/s10787-022-00999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/12/2022] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) causes transmissible viral illness of the respiratory tract prompted by the SARS-CoV-2 virus. COVID-19 is one of the worst global pandemics affecting a large population worldwide and causing catastrophic loss of life. Patients having pre-existing chronic disorders are more susceptible to contracting this viral infection. This pandemic virus is known to cause notable respiratory pathology. Besides, it can also cause extra-pulmonary manifestations. Multiple extra-pulmonary tissues express the SARS-CoV-2 entry receptor, hence causing direct viral tissue damage. This insightful review gives a brief description of the impact of coronavirus on the pulmonary system, extra-pulmonary systems, histopathology, multiorgan consequences, the possible mechanisms associated with the disease, and various potential therapeutic approaches to tackle the manifestations.
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26
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Ambrosino P, Calcaterra IL, Mosella M, Formisano R, D’Anna SE, Bachetti T, Marcuccio G, Galloway B, Mancini FP, Papa A, Motta A, Di Minno MND, Maniscalco M. Endothelial Dysfunction in COVID-19: A Unifying Mechanism and a Potential Therapeutic Target. Biomedicines 2022; 10:biomedicines10040812. [PMID: 35453563 PMCID: PMC9029464 DOI: 10.3390/biomedicines10040812] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 02/07/2023] Open
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) generated a worldwide emergency, until the declaration of the pandemic in March 2020. SARS-CoV-2 could be responsible for coronavirus disease 2019 (COVID-19), which goes from a flu-like illness to a potentially fatal condition that needs intensive care. Furthermore, the persistence of functional disability and long-term cardiovascular sequelae in COVID-19 survivors suggests that convalescent patients may suffer from post-acute COVID-19 syndrome, requiring long-term care and personalized rehabilitation. However, the pathophysiology of acute and post-acute manifestations of COVID-19 is still under study, as a better comprehension of these mechanisms would ensure more effective personalized therapies. To date, mounting evidence suggests a crucial endothelial contribution to the clinical manifestations of COVID-19, as endothelial cells appear to be a direct or indirect preferential target of the virus. Thus, the dysregulation of many of the homeostatic pathways of the endothelium has emerged as a hallmark of severity in COVID-19. The aim of this review is to summarize the pathophysiology of endothelial dysfunction in COVID-19, with a focus on personalized pharmacological and rehabilitation strategies targeting endothelial dysfunction as an attractive therapeutic option in this clinical setting.
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Affiliation(s)
- Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (R.F.); (F.P.M.); (A.P.)
- Correspondence: (P.A.); (M.M.)
| | | | - Marco Mosella
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (M.M.); (S.E.D.)
| | - Roberto Formisano
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (R.F.); (F.P.M.); (A.P.)
| | - Silvestro Ennio D’Anna
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (M.M.); (S.E.D.)
| | - Tiziana Bachetti
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction, 27100 Pavia, Italy;
| | - Giuseppina Marcuccio
- Università della Campania Luigi Vanvitelli, 81100 Caserta, Italy; (G.M.); (B.G.)
| | - Brurya Galloway
- Università della Campania Luigi Vanvitelli, 81100 Caserta, Italy; (G.M.); (B.G.)
| | - Francesco Paolo Mancini
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (R.F.); (F.P.M.); (A.P.)
- Department of Science and Technology, University of Sannio, 82100 Benevento, Italy
| | - Antimo Papa
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (R.F.); (F.P.M.); (A.P.)
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli, Italy;
| | | | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (M.M.); (S.E.D.)
- Correspondence: (P.A.); (M.M.)
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Abrignani MG, Murrone A, De Luca L, Roncon L, Di Lenarda A, Valente S, Caldarola P, Riccio C, Oliva F, Gulizia MM, Gabrielli D, Colivicchi F. COVID-19, Vaccines, and Thrombotic Events: A Narrative Review. J Clin Med 2022; 11:948. [PMID: 35207220 PMCID: PMC8880092 DOI: 10.3390/jcm11040948] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 02/05/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), a deadly pandemic that has affected millions of people worldwide, is associated with cardiovascular complications, including venous and arterial thromboembolic events. Viral spike proteins, in fact, may promote the release of prothrombotic and inflammatory mediators. Vaccines, coding for the spike protein, are the primary means for preventing COVID-19. However, some unexpected thrombotic events at unusual sites, most frequently located in the cerebral venous sinus but also splanchnic, with associated thrombocytopenia, have emerged in subjects who received adenovirus-based vaccines, especially in fertile women. This clinical entity was soon recognized as a new syndrome, named vaccine-induced immune thrombotic thrombocytopenia, probably caused by cross-reacting anti-platelet factor-4 antibodies activating platelets. For this reason, the regulatory agencies of various countries restricted the use of adenovirus-based vaccines to some age groups. The prevailing opinion of most experts, however, is that the risk of developing COVID-19, including thrombotic complications, clearly outweighs this potential risk. This point-of-view aims at providing a narrative review of epidemiological issues, clinical data, and pathogenetic hypotheses of thrombosis linked to both COVID-19 and its vaccines, helping medical practitioners to offer up-to-date and evidence-based counseling to their often-alarmed patients with acute or chronic cardiovascular thrombotic events.
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Affiliation(s)
| | - Adriano Murrone
- Cardiology-UTIC, Hospitals of Città di Castello and Gubbio-Gualdo Tadino, AUSL Umbria 1, 06100 Perugia, Italy;
| | - Leonardo De Luca
- Cardiology, Cardio-Thoraco-Vascular Department, San Camillo Forlanini Hospital, 00100 Rome, Italy; (L.D.L.); (D.G.)
| | - Loris Roncon
- Cardiology Department, Santa Maria della Misericordia Hospital, 45100 Rovigo, Italy;
| | - Andrea Di Lenarda
- Cardiovascular and Sports Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, 34100 Trieste, Italy;
| | - Serafina Valente
- Clinical Surgical Cardiology (UTIC), A.O.U. Senese, Santa Maria alle Scotte Hospital, 53100 Siena, Italy;
| | | | - Carmine Riccio
- Follow-Up of the Post-Acute Patient Unit, Cardio-Vascular Department, A.O.R.N. Sant’Anna and San Sebastiano, 81000 Caserta, Italy;
| | - Fabrizio Oliva
- Cardiology 1-Hemodynamics, Cardiological Intensive Care Unit, Cardiothoracovascular Department “A. De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, 20100 Milan, Italy;
| | - Michele M. Gulizia
- Cardiology Department, Garibaldi-Nesima Hospital, Company of National Importance and High Specialization “Garibaldi”, 95100 Catania, Italy;
- Heart Care Foundation, 50121 Florence, Italy
| | - Domenico Gabrielli
- Cardiology, Cardio-Thoraco-Vascular Department, San Camillo Forlanini Hospital, 00100 Rome, Italy; (L.D.L.); (D.G.)
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri—ASL Roma 1, 00100 Rome, Italy;
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28
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Bautista-Becerril B, Pérez-Dimas G, Sommerhalder-Nava PC, Hanono A, Martínez-Cisneros JA, Zarate-Maldonado B, Muñoz-Soria E, Aquino-Gálvez A, Castillejos-López M, Juárez-Cisneros A, Lopez-Gonzalez JS, Camarena A. miRNAs, from Evolutionary Junk to Possible Prognostic Markers and Therapeutic Targets in COVID-19. Viruses 2021; 14:41. [PMID: 35062245 PMCID: PMC8781105 DOI: 10.3390/v14010041] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 12/21/2021] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has been a public health issue around the world in the last few years. Currently, there is no specific antiviral treatment to fight the disease. Thus, it is essential to highlight possible prognostic predictors that could identify patients with a high risk of developing complications. Within this framework, miRNA biomolecules play a vital role in the genetic regulation of various genes, principally, those related to the pathophysiology of the disease. Here, we review the interaction of host and viral microRNAs with molecular and cellular elements that could potentiate the main pulmonary, cardiac, renal, circulatory, and neuronal complications in COVID-19 patients. miR-26a, miR-29b, miR-21, miR-372, and miR-2392, among others, have been associated with exacerbation of the inflammatory process, increasing the risk of a cytokine storm. In addition, increased expression of miR-15b, -199a, and -491 are related to the prognosis of the disease, and miR-192 and miR-323a were identified as clinical predictors of mortality in patients admitted to the intensive care unit. Finally, we address miR-29, miR-122, miR-155, and miR-200, among others, as possible therapeutic targets. However, more studies are required to confirm these findings.
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Affiliation(s)
- Brandon Bautista-Becerril
- Laboratorio HLA, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico; (B.B.-B.); (A.J.-C.)
- Escuela Superior de Medicina, Departamento de Posgrado, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (G.P.-D.); (E.M.-S.)
| | - Guillermo Pérez-Dimas
- Escuela Superior de Medicina, Departamento de Posgrado, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (G.P.-D.); (E.M.-S.)
| | - Paola C. Sommerhalder-Nava
- Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Mexico City 52786, Mexico; (P.C.S.-N.); (A.H.); (B.Z.-M.)
| | - Alejandro Hanono
- Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Mexico City 52786, Mexico; (P.C.S.-N.); (A.H.); (B.Z.-M.)
| | | | - Bárbara Zarate-Maldonado
- Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, Mexico City 52786, Mexico; (P.C.S.-N.); (A.H.); (B.Z.-M.)
| | - Evangelina Muñoz-Soria
- Escuela Superior de Medicina, Departamento de Posgrado, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (G.P.-D.); (E.M.-S.)
| | - Arnoldo Aquino-Gálvez
- Laboratorio de Biología Molecular, Departamento de Fibrosis Pulmonar, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico;
| | - Manuel Castillejos-López
- Departamento de Epidemiología Hospitalaria e Infectología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico;
| | - Armida Juárez-Cisneros
- Laboratorio HLA, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico; (B.B.-B.); (A.J.-C.)
| | - Jose S. Lopez-Gonzalez
- Laboratorio de Cáncer Pulmonar, Departamento de Enfermedades Crónico-Degenerativas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico;
| | - Angel Camarena
- Laboratorio HLA, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico; (B.B.-B.); (A.J.-C.)
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Ma C, Tu D, Gu J, Xu Q, Hou P, Wu H, Guo Z, Bai Y, Zhao X, Li P. The Predictive Value of Myoglobin for COVID-19-Related Adverse Outcomes: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:757799. [PMID: 34869669 PMCID: PMC8636904 DOI: 10.3389/fcvm.2021.757799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022] Open
Abstract
Objective: Cardiac injury is detected in numerous patients with coronavirus disease 2019 (COVID-19) and has been demonstrated to be closely related to poor outcomes. However, an optimal cardiac biomarker for predicting COVID-19 prognosis has not been identified. Methods: The PubMed, Web of Science, and Embase databases were searched for published articles between December 1, 2019 and September 8, 2021. Eligible studies that examined the anomalies of different cardiac biomarkers in patients with COVID-19 were included. The prevalence and odds ratios (ORs) were extracted. Summary estimates and the corresponding 95% confidence intervals (95% CIs) were obtained through meta-analyses. Results: A total of 63 studies, with 64,319 patients with COVID-19, were enrolled in this meta-analysis. The prevalence of elevated cardiac troponin I (cTnI) and myoglobin (Mb) in the general population with COVID-19 was 22.9 (19–27%) and 13.5% (10.6–16.4%), respectively. However, the presence of elevated Mb was more common than elevated cTnI in patients with severe COVID-19 [37.7 (23.3–52.1%) vs.30.7% (24.7–37.1%)]. Moreover, compared with cTnI, the elevation of Mb also demonstrated tendency of higher correlation with case-severity rate (Mb, r = 13.9 vs. cTnI, r = 3.93) and case-fatality rate (Mb, r = 15.42 vs. cTnI, r = 3.04). Notably, elevated Mb level was also associated with higher odds of severe illness [Mb, OR = 13.75 (10.2–18.54) vs. cTnI, OR = 7.06 (3.94–12.65)] and mortality [Mb, OR = 13.49 (9.3–19.58) vs. cTnI, OR = 7.75 (4.4–13.66)] than cTnI. Conclusions: Patients with COVID-19 and elevated Mb levels are at significantly higher risk of severe disease and mortality. Elevation of Mb may serve as a marker for predicting COVID-19-related adverse outcomes. Prospero Registration Number:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175133, CRD42020175133.
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Affiliation(s)
- Chaoqun Ma
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Dingyuan Tu
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jiawei Gu
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Qiang Xu
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Pan Hou
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hong Wu
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhifu Guo
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yuan Bai
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xianxian Zhao
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Pan Li
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
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30
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Yin Y, Rohli KE, Shen P, Lu H, Liu Y, Dou Q, Zhang L, Kong X, Yang S, Jia P. The epidemiology, pathophysiological mechanisms, and management toward COVID-19 patients with Type 2 diabetes: A systematic review. Prim Care Diabetes 2021; 15:899-909. [PMID: 34600859 PMCID: PMC8418914 DOI: 10.1016/j.pcd.2021.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 08/09/2021] [Accepted: 08/31/2021] [Indexed: 02/05/2023]
Abstract
This review comprehensively summarizes epidemiologic evidence of COVID-19 in patients with Type 2 diabetes, explores pathophysiological mechanisms, and integrates recommendations and guidelines for patient management. We found that diabetes was a risk factor for diagnosed infection and poor prognosis of COVID-19. Patients with diabetes may be more susceptible to adverse outcomes associated with SARS-CoV-2 infection due to impaired immune function and possible upregulation of enzymes that mediate viral invasion. The chronic inflammation caused by diabetes, coupled with the acute inflammatory reaction caused by SARS-CoV-2, results in a propensity for inflammatory storm. Patients with diabetes should be aware of their increased risk for COVID-19.
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Affiliation(s)
- Yun Yin
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Kristen E Rohli
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Pengyue Shen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Haonan Lu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yuenan Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qingyu Dou
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China; National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China.
| | - Peng Jia
- School of Resources and Environmental Science, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China.
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31
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Águila-Gordo D, Martínez-Del Rio J, Negreira-Caamaño M, Mateo Gómez C, Soto Pérez M, Piqueras-Flores J. [Cardiovascular disease after COVID-19 infection in elderly patients. Results of annual follow-up of a cohort of survivors]. Rev Esp Geriatr Gerontol 2021; 57:100-104. [PMID: 34930633 PMCID: PMC8585603 DOI: 10.1016/j.regg.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/28/2021] [Accepted: 10/14/2021] [Indexed: 11/12/2022]
Abstract
Introducción Si bien el impacto de la infección por SARS-CoV-2 sobre el sistema cardiovascular es conocido en fase aguda, la repercusión cardiovascular de la población anciana superviviente a la infección respiratoria por la COVID-19 a largo plazo no ha sido suficientemente estudiada. Métodos Registro observacional de 240 pacientes ancianos (75 o más años), ingresados de forma consecutiva por infección respiratoria por la COVID-19 y supervivientes a la misma, entre el 1 de marzo y el 30 abril de 2020, en el Hospital General Universitario de Ciudad Real. Se analizó de forma prospectiva la incidencia de eventos cardiovasculares mayores (MACE) (mortalidad cardiovascular, síndrome coronario agudo, accidente cerebrovascular, enfermedad tromboembólica e insuficiencia cardiaca). Resultados La edad media fue de 83,75 ± 5,75 años. Tras un seguimiento medio de 352,2 ± 70,4 días el 13,8% de los pacientes falleció y el 9,6% presentó MACE, siendo el más frecuente la insuficiencia cardiaca, sin diferencias en la gravedad ni evolución general de la enfermedad aguda. En el modelo de regresión de Cox multivariante el riesgo de desarrollar MACE fue mayor en los pacientes con enfermedad pulmonar obstructiva crónica (HR 4,29; IC 95% 1,62-11,39; p = 0,003) y diurético de asa (HR 2,99; IC 95% 1,27-7,07; p = 0,01). Conclusiones En población anciana superviviente a la COVID-19 la incidencia de MACE tras un año de seguimiento es elevada, siendo la principal manifestación la insuficiencia cardiaca.
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Affiliation(s)
- Daniel Águila-Gordo
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
| | - Jorge Martínez-Del Rio
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | | | - Cristina Mateo Gómez
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Maeve Soto Pérez
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Jesús Piqueras-Flores
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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32
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Jud P, Gressenberger P, Muster V, Avian A, Meinitzer A, Strohmaier H, Sourij H, Raggam RB, Stradner MH, Demel U, Kessler HH, Eller K, Brodmann M. Evaluation of Endothelial Dysfunction and Inflammatory Vasculopathy After SARS-CoV-2 Infection-A Cross-Sectional Study. Front Cardiovasc Med 2021; 8:750887. [PMID: 34722682 PMCID: PMC8549830 DOI: 10.3389/fcvm.2021.750887] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/15/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Rising data suggest that COVID-19 affects vascular endothelium while the underlying mechanisms promoting COVID-19-associated endothelial dysfunction and inflammatory vasculopathy are largely unknown. The aim was to evaluate the contribution of COVID-19 to persisting vascular injury and to identify parameters linked to COVID-19-associated endothelial dysfunction and inflammatory vasculopathy. Methods: In a cross-sectional design, flow-mediated dilation (FMD), nitroglycerine-related dilation (NMD), pulse-wave velocity (PWV), augmentation index, intima-media thickness (IMT), compounds of the arginine and kynurenine metabolism, homocysteine, von Willebrand factor (vWF), endothelial microparticles (EMP), antiendothelial cell antibodies, inflammatory, and immunological parameters, as well as nailfold capillary morphology were measured in post-COVID-19 patients, patients with atherosclerotic cardiovascular diseases (ASCVD) and healthy controls without prior or recent SARS-CoV-2 infection. Results: Post-COVID-19 patients had higher values of PWV, augmentation index, IMT, asymmetric and symmetric dimethylarginine, vWF, homocysteine, CD31+/CD42b- EMP, C-reactive protein, erythrocyte sedimentation rate, interleukin-6, and β-2-glycoprotein antibodies as well as lower levels of homoarginine and tryptophan compared to healthy controls (all with p < 0.05). A higher total number of pathologically altered inflammatory conditions and higher rates of capillary ramifications, loss, caliber variability, elongations and bushy capillaries with an overall higher microangiopathy evolution score were also observed in post-COVID-19 patients (all with p < 0.05). Most parameters of endothelial dysfunction and inflammation were comparably altered in post-COVID-19 patients and patients with ASCVD, including FMD and NMD. Conclusion: COVID-19 may affect arterial stiffness, capillary morphology, EMP and selected parameters of arginine, kynurenine and homocysteine metabolism as well as of inflammation contributing to COVID-19-associated endothelial dysfunction and inflammatory vasculopathy.
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Affiliation(s)
- Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Paul Gressenberger
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Viktoria Muster
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Heimo Strohmaier
- Department Center of Medical Research, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Reinhard B Raggam
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martin Helmut Stradner
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ulrike Demel
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald H Kessler
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental, Medical University of Graz, Graz, Austria
| | - Kathrin Eller
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Rochette L, Zeller M, Cottin Y, Vergely C. GDF15: an emerging modulator of immunity and a strategy in COVID-19 in association with iron metabolism. Trends Endocrinol Metab 2021; 32:875-889. [PMID: 34593305 PMCID: PMC8423996 DOI: 10.1016/j.tem.2021.08.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/06/2021] [Accepted: 08/30/2021] [Indexed: 02/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic of respiratory and cardiovascular diseases, known as coronavirus disease 2019 (COVID-19). SARS-CoV-2 encodes the structural proteins spike (S), envelope (E), membrane (M), and nucleocapsid (N). The receptor-binding domain on the surface subunit S1 is responsible for attachment of the virus to angiotensin (Ang)-converting enzyme 2 (ACE2), which is highly expressed in host cells. The cytokine storm observed in patients with COVID-19 contributes to the endothelial vascular dysfunction, which can lead to acute respiratory distress syndrome, multiorgan failure, alteration in iron homeostasis, and death. Growth and differentiation factor 15 (GDF15), which belongs to the transforming growth factor-β (TGF-β) superfamily of proteins, has a pivotal role in the development and progression of diseases because of its role as a metabolic regulator. In COVID-19, GDF15 activity increases in response to tissue damage. GDF15 appears to be a strong predictor of poor outcomes in patients critically ill with COVID-19 and acts as an 'inflammation-induced central mediator of tissue tolerance' via its metabolic properties. In this review, we examine the potential properties of GDF15 as an emerging modulator of immunity in COVID-19 in association with iron metabolism. The virus life cycle in host cell provides potential targets for drug therapy.
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Affiliation(s)
- Luc Rochette
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases Research Unit (PEC2, EA 7460), University of Burgundy and Franche-Comté, UFR des Sciences de Santé, 21079 Dijon, France.
| | - Marianne Zeller
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases Research Unit (PEC2, EA 7460), University of Burgundy and Franche-Comté, UFR des Sciences de Santé, 21079 Dijon, France
| | - Yves Cottin
- Cardiology Unit, Dijon Bourgogne University Hospital, 21000 Dijon, France
| | - Catherine Vergely
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases Research Unit (PEC2, EA 7460), University of Burgundy and Franche-Comté, UFR des Sciences de Santé, 21079 Dijon, France
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Abstract
Since the coronavirus disease (COVID-19) pandemic spread unrelentingly all over the world, millions of cases have been reported. Despite a high number of asymptomatic cases, the course of the disease can be serious or even fatal. The affection of the myocardium, called myocardial injury, is caused by multiple triggers. The occurrence of cardiac arrhythmias in COVID-19 patients with myocardial involvement and a critical course is common. In this review, potential mechanisms, incidence, and treatment options for cardiac arrhythmias in COVID-19 patients will be provided by performing a literature research in MESH database and the National Library of Medicine. Common cardiac arrhythmias in COVID-19 patients were sinus tachycardia, atrial fibrillation (AF), ventricular tachycardia (VT), ventricular fibrillation (VF), atrioventricular block, sinusoidal block or QTc prolongation. AF was the most common heart rhythm disorder. About 10% of COVID-19 patients develop new-onset AF and 23 to 33% showed recurrence of AF in patients with known AF. One retrospective trial revealed the incidence of VT or VF to be 5.9% in hospitalized patients. Both AF and VT are clearly associated with worse outcome. Several mechanisms such as hypoxia, myocarditis, myocardial ischemia, or abnormal host immune response, which induce cardiac arrhythmias, have been described. The effect of QT-prolonging drugs in inducing cardiac arrhythmias has become mitigated as these medications are no longer recommended. Acute management of cardiac arrhythmias in COVID-19 patients is affected by the reduction of exposure of health care personnel. More prospective data are desirable to better understand pathophysiology and consecutively adapt management.
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Affiliation(s)
- Martin Duckheim
- Innere Medizin III, Department of Cardiology and Angiology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Jürgen Schreieck
- Innere Medizin III, Department of Cardiology and Angiology, Eberhard Karls Universität Tübingen, Tübingen, Germany
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Bae HJ, Cho HJ, Lee CH, Bae MH, Park HS, Jung BC, Shin DG, Cho Y, Hwang J, Han S, Park KH, Jang SY, Lee YS. Electrocardiographic Manifestations in Patients with COVID-19: Daegu in South Korea. Korean Circ J 2021; 51:851-862. [PMID: 34595853 PMCID: PMC8484995 DOI: 10.4070/kcj.2021.0116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/15/2021] [Accepted: 07/14/2021] [Indexed: 12/12/2022] Open
Abstract
As COVID-19 spreads worldwide, cardiac injury in patients infected with COVID-19 becomes a significant concern. Thus, this study investigates the impact of several electrocardiogram parameters and disease severity in COVID-19 patients. The deceased patients showed increased dispersion of QTc and Tpe-c compared with surviving patients (78.2±41.1 vs. 40.8±24.6 ms and 60.2±37.3 vs 40.8±24.5 ms, both p<0.05). The QTc dispersion of more than 56.1 ms could predict the mortality in multivariate analysis (Odd ratio 8.06, 95% Confidence Interval 2.843–25.750). A prolonged QTc dispersion could be an independent predictable factor of mortality. Background and Objectives As the coronavirus disease 2019 (COVID-19) spreads worldwide, cardiac injury in patients infected with COVID-19 becomes a significant concern. Thus, this study investigates the impact of several electrocardiogram (ECG) parameters and disease severity in COVID-19 patients. Methods Seven medical centers in Daegu admitted 822 patients with COVID-19 between February and April 2020. This study examined 267 patients among them who underwent an ECG test and evaluated their biochemical parameters like C-reactive protein (CRP), log N-terminal pro-B-type Natriuretic Peptide (NT-proBNP), cardiac enzyme, and ECG parameters (heart rate, PR interval, QRS interval, T inversion, QT interval, and Tpe [the interval between peak to end in a T wave]). Results Those patients were divided into 3 groups of mild (100 patients), moderate (89 patients), and severe (78 patients) according to clinical severity score. The level of CRP, log NT-proBNP, and creatinine kinase-myocardial band were significantly increased in severe patients. Meanwhile, severe patients exhibited prolonged QT intervals (QTc) and Tpe (Tpe-c) compared to mild or moderate patients. Moreover, deceased patients (58; 21.7%) showed increased dispersion of QTc and Tpe-c compared with surviving patients (78.2±41.1 vs. 40.8±24.6 ms and 60.2±37.3 vs. 40.8±24.5 ms, both p<0.05, respectively). The QTc dispersion of more than 56.1 ms could predict the mortality in multivariate analysis (odd ratio, 11.55; 95% confidence interval, 3.746–42.306). Conclusions COVID-19 infections could involve cardiac injuries, especially cardiac repolarization abnormalities. A prolonged QTc dispersion could be an independent predictable factor of mortality.
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Affiliation(s)
- Han-Joon Bae
- Division of Cardiology, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Hyun Jun Cho
- Division of Cardiology, Daegu Fatima General Hospital, Daegu, Korea
| | - Chan-Hee Lee
- Division of Cardiology, Yeungnam University College of Medicine, Daegu, Korea
| | - Myung Hwan Bae
- Division of Cardiology, Kyungpook National University, Daegu, Korea
| | - Hyoung-Seob Park
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Byung Chun Jung
- Division of Cardiology, Daegu Fatima General Hospital, Daegu, Korea
| | - Dong-Gu Shin
- Division of Cardiology, Yeungnam University College of Medicine, Daegu, Korea
| | - Yongkeun Cho
- Division of Cardiology, Kyungpook National University, Daegu, Korea
| | - Jongmin Hwang
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seongwook Han
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Kyu-Hwan Park
- Division of Cardiology, Daegu Veterans Hospital, Daegu, Korea
| | - Se Yong Jang
- Division of Cardiology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Young Soo Lee
- Division of Cardiology, Daegu Catholic University College of Medicine, Daegu, Korea.
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Muhammad M, Emin M, Bhutta A, Gul EH, Voorhees E, Afzal MR. Cardiac arrhythmias associated with COVID-19 infection: state of the art review. Expert Rev Cardiovasc Ther 2021; 19:881-889. [PMID: 34702128 PMCID: PMC8607535 DOI: 10.1080/14779072.2021.1997589] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/22/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION COVID-19 infection is associated with many different systemic complications. Among these, cardiovascular system complications are particularly important as these are associated with significant mortality. There are many different subgroups of cardiovascular complications, with Arrhythmias being one of them. Arrhythmias are especially important as there are a substantial percentage of patients who have arrhythmia after a COVID-19 infection, and these patients are seen with an increased mortality rate. The main interest of this review is understanding some of the specific post-COVID-19 arrhythmic complications and their predisposing factors. AREAS COVERED This paper will highlight the findings of studies on cardiovascular system disease after COVID-19 infection, different specific arrhythmic complications of COVID-19, and changes in electrophysiologic interventions post-COVID-19 outbreak in different centers around the world. An extensive literature search was made to find pertinent articles. EXPERT OPINION Studies show us that a significant percentage of COVID-19 patients have arrhythmia. Many distinct types of arrhythmias are associated with COVID-19 infection, and specific risk factors of these arrhythmias are important as this information can be used to detect and prioritize certain at-risk patients for early treatment, which can mean life or death in some cases.
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Affiliation(s)
- Marwan Muhammad
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Mustafa Emin
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Ayat Bhutta
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Essa H. Gul
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Elijah Voorhees
- Department of Internal Medicine, Kent State University, Kent, Ohio, USA
| | - Muhammad R. Afzal
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
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Myocardial Damage by SARS-CoV-2: Emerging Mechanisms and Therapies. Viruses 2021; 13:v13091880. [PMID: 34578462 PMCID: PMC8473126 DOI: 10.3390/v13091880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/06/2021] [Accepted: 09/18/2021] [Indexed: 01/01/2023] Open
Abstract
Evidence is emerging that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect various organs of the body, including cardiomyocytes and cardiac endothelial cells in the heart. This review focuses on the effects of SARS-CoV-2 in the heart after direct infection that can lead to myocarditis and an outline of potential treatment options. The main points are: (1) Viral entry: SARS-CoV-2 uses specific receptors and proteases for docking and priming in cardiac cells. Thus, different receptors or protease inhibitors might be effective in SARS-CoV-2-infected cardiac cells. (2) Viral replication: SARS-CoV-2 uses RNA-dependent RNA polymerase for replication. Drugs acting against ssRNA(+) viral replication for cardiac cells can be effective. (3) Autophagy and double-membrane vesicles: SARS-CoV-2 manipulates autophagy to inhibit viral clearance and promote SARS-CoV-2 replication by creating double-membrane vesicles as replication sites. (4) Immune response: Host immune response is manipulated to evade host cell attacks against SARS-CoV-2 and increased inflammation by dysregulating immune cells. Efficiency of immunosuppressive therapy must be elucidated. (5) Programmed cell death: SARS-CoV-2 inhibits programmed cell death in early stages and induces apoptosis, necroptosis, and pyroptosis in later stages. (6) Energy metabolism: SARS-CoV-2 infection leads to disturbed energy metabolism that in turn leads to a decrease in ATP production and ROS production. (7) Viroporins: SARS-CoV-2 creates viroporins that lead to an imbalance of ion homeostasis. This causes apoptosis, altered action potential, and arrhythmia.
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Gorini F, Del Turco S, Sabatino L, Gaggini M, Vassalle C. H 2S as a Bridge Linking Inflammation, Oxidative Stress and Endothelial Biology: A Possible Defense in the Fight against SARS-CoV-2 Infection? Biomedicines 2021; 9:biomedicines9091107. [PMID: 34572292 PMCID: PMC8472626 DOI: 10.3390/biomedicines9091107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/12/2021] [Accepted: 08/26/2021] [Indexed: 12/17/2022] Open
Abstract
The endothelium controls vascular homeostasis through a delicate balance between secretion of vasodilators and vasoconstrictors. The loss of physiological homeostasis leads to endothelial dysfunction, for which inflammatory events represent critical determinants. In this context, therapeutic approaches targeting inflammation-related vascular injury may help for the treatment of cardiovascular disease and a multitude of other conditions related to endothelium dysfunction, including COVID-19. In recent years, within the complexity of the inflammatory scenario related to loss of vessel integrity, hydrogen sulfide (H2S) has aroused great interest due to its importance in different signaling pathways at the endothelial level. In this review, we discuss the effects of H2S, a molecule which has been reported to demonstrate anti-inflammatory activity, in addition to many other biological functions related to endothelium and sulfur-drugs as new possible therapeutic options in diseases involving vascular pathobiology, such as in SARS-CoV-2 infection.
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Affiliation(s)
- Francesca Gorini
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.S.); (M.G.)
- Correspondence: (F.G.); (S.D.T.); (C.V.)
| | - Serena Del Turco
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.S.); (M.G.)
- Correspondence: (F.G.); (S.D.T.); (C.V.)
| | - Laura Sabatino
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.S.); (M.G.)
| | - Melania Gaggini
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.S.); (M.G.)
| | - Cristina Vassalle
- Fondazione CNR-Regione Toscana G. Monasterio, 56124 Pisa, Italy
- Correspondence: (F.G.); (S.D.T.); (C.V.)
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Cicco S, Vacca A, Cariddi C, Carella R, Altamura G, Solimando AG, Lauletta G, Pappagallo F, Cirulli A, Stragapede A, Susca N, Grasso S, Ria R. Imaging Evaluation of Pulmonary and Non-Ischaemic Cardiovascular Manifestations of COVID-19. Diagnostics (Basel) 2021; 11:1271. [PMID: 34359355 PMCID: PMC8304239 DOI: 10.3390/diagnostics11071271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19) has been a pandemic challenge for the last year. Cardiovascular disease is the most described comorbidity in COVID-19 patients, and it is related to the disease severity and progression. COVID-19 induces direct damage on cardiovascular system, leading to arrhythmias and myocarditis, and indirect damage due to endothelial dysfunction and systemic inflammation with a high inflammatory burden. Indirect damage leads to myocarditis, coagulation abnormalities and venous thromboembolism, Takotsubo cardiomyopathy, Kawasaki-like disease and multisystem inflammatory syndrome in children. Imaging can support the management, assessment and prognostic evaluation of these patients. Ultrasound is the most reliable and easy to use in emergency setting and in the ICU as a first approach. The focused approach is useful in management of these patients due its ability to obtain quick and focused results. This tool is useful to evaluate cardiovascular disease and its interplay with lungs. However, a detailed echocardiography evaluation is necessary in a complete assessment of cardiovascular involvement. Computerized tomography is highly sensitive, but it might not always be available. Cardiovascular magnetic resonance and nuclear imaging may be helpful to evaluate COVID-19-related myocardial injury, but further studies are needed. This review deals with different modalities of imaging evaluation in the management of cardiovascular non-ischaemic manifestations of COVID-19, comparing their use in emergency and in intensive care.
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Affiliation(s)
- Sebastiano Cicco
- Internal Medicine Unit “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Piazza G. Cesare 11, I-70124 Bari, Italy; (R.C.); (A.G.S.); (G.L.); (F.P.); (A.C.); (A.S.); (N.S.); (R.R.)
| | - Antonio Vacca
- Division of Internal Medicine, Department of Medicine, Building 8, University of Udine, I-33100 Udine, Italy;
| | - Christel Cariddi
- Anesthesiology and Intensive Care Unit, Department of Emergency and Organ Transplantation (DETO) Ospedale Policlinico, University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Piazza G. Cesare 11, I-70124 Bari, Italy; (C.C.); (G.A.); (S.G.)
| | - Rossella Carella
- Internal Medicine Unit “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Piazza G. Cesare 11, I-70124 Bari, Italy; (R.C.); (A.G.S.); (G.L.); (F.P.); (A.C.); (A.S.); (N.S.); (R.R.)
| | - Gianluca Altamura
- Anesthesiology and Intensive Care Unit, Department of Emergency and Organ Transplantation (DETO) Ospedale Policlinico, University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Piazza G. Cesare 11, I-70124 Bari, Italy; (C.C.); (G.A.); (S.G.)
| | - Antonio Giovanni Solimando
- Internal Medicine Unit “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Piazza G. Cesare 11, I-70124 Bari, Italy; (R.C.); (A.G.S.); (G.L.); (F.P.); (A.C.); (A.S.); (N.S.); (R.R.)
| | - Gianfranco Lauletta
- Internal Medicine Unit “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Piazza G. Cesare 11, I-70124 Bari, Italy; (R.C.); (A.G.S.); (G.L.); (F.P.); (A.C.); (A.S.); (N.S.); (R.R.)
| | - Fabrizio Pappagallo
- Internal Medicine Unit “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Piazza G. Cesare 11, I-70124 Bari, Italy; (R.C.); (A.G.S.); (G.L.); (F.P.); (A.C.); (A.S.); (N.S.); (R.R.)
| | - Anna Cirulli
- Internal Medicine Unit “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Piazza G. Cesare 11, I-70124 Bari, Italy; (R.C.); (A.G.S.); (G.L.); (F.P.); (A.C.); (A.S.); (N.S.); (R.R.)
| | - Assunta Stragapede
- Internal Medicine Unit “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Piazza G. Cesare 11, I-70124 Bari, Italy; (R.C.); (A.G.S.); (G.L.); (F.P.); (A.C.); (A.S.); (N.S.); (R.R.)
| | - Nicola Susca
- Internal Medicine Unit “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Piazza G. Cesare 11, I-70124 Bari, Italy; (R.C.); (A.G.S.); (G.L.); (F.P.); (A.C.); (A.S.); (N.S.); (R.R.)
| | - Salvatore Grasso
- Anesthesiology and Intensive Care Unit, Department of Emergency and Organ Transplantation (DETO) Ospedale Policlinico, University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Piazza G. Cesare 11, I-70124 Bari, Italy; (C.C.); (G.A.); (S.G.)
| | - Roberto Ria
- Internal Medicine Unit “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Piazza G. Cesare 11, I-70124 Bari, Italy; (R.C.); (A.G.S.); (G.L.); (F.P.); (A.C.); (A.S.); (N.S.); (R.R.)
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Telemonitoring and Care Program for Left Ventricular Assist Device Patients During COVID-19 Outbreak: A European Experience. ASAIO J 2021; 67:973-981. [PMID: 34403376 DOI: 10.1097/mat.0000000000001526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) radically modified the organization of healthcare systems with shutdown of routine activities and outpatient clinics. Herein, we report our institutional experience with a Telemonitoring and Care Program (TC-Program) to monitor and support left ventricular assist device (LVAD) patients during COVID-19 outbreak. This single-arm cohort study analyzed 156 patients who entered the TC-Program at our institution between April and August 2020. The TC-Program was based on routine phone calls to patients and a 24/7 emergency line. In November 2020, patients were asked for feedback on the TC-Program and checked for survival, transplant, or explant. The primary endpoint was the rate of TC-Program-driven interventions. Patients (males: 82.8%) were 61 years old (interquartile range [IQR]: 53.0-67.5) and on LVAD support for 1,266 days (IQR: 475-2,211). Patients were included in the TC-Program for a median time of 99 days (min:15, max:120) and received a median number of six phone calls (min:1, max:14). Twenty-three patients (14.7%) were referred for clinical evaluation after phone contact. Two patients (1.27%) were diagnosed with COVID-19: one of them died after intensive care, and one remained paucisymptomatic and recovered. Three patients asked to exit the program considering it not useful while the others gave high rates in terms of usefulness (median: 9, IQR: 8-10), information (median: 9, IQR: 8-10), good medical care (median: 9, IQR: 8-10), and psychologic support (median: 8, IQR: 7-10). A TC-Program based on the four ICSA principles (Inform, Care, Support, and Adapt) is feasible in LVAD patients and can be rapidly implemented during the COVID-19 pandemic.
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Raghavan S, Kenchappa DB, Leo MD. SARS-CoV-2 Spike Protein Induces Degradation of Junctional Proteins That Maintain Endothelial Barrier Integrity. Front Cardiovasc Med 2021; 8:687783. [PMID: 34179146 PMCID: PMC8225996 DOI: 10.3389/fcvm.2021.687783] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/19/2021] [Indexed: 01/01/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses the Angiotensin converting enzyme 2 (ACE2) receptor present on the cell surface to enter cells. Angiotensin converting enzyme 2 is present in many cell types including endothelial cells, where it functions to protect against oxidative damage. There is growing evidence to suggest that coronavirus disease (COVID-19) patients exhibit a wide range of post-recovery symptoms and shows signs related to cardiovascular and specifically, endothelial damage. We hypothesized that these vascular symptoms might be associated with disrupted endothelial barrier integrity. This was investigated in vitro using endothelial cell culture and recombinant SARS-CoV-2 spike protein S1 Receptor-Binding Domain (Spike). Mouse brain microvascular endothelial cells from normal (C57BL/6 mice) and diabetic (db/db) mice were used. An endothelial transwell permeability assay revealed increased permeability in diabetic cells as well as after Spike treatment. The expression of VE-Cadherin, an endothelial adherens junction protein, JAM-A, a tight junctional protein, Connexin-43, a gap junctional protein, and PECAM-1, were all decreased significantly after Spike treatment in control and to a greater extent, in diabetic cells. In control cells, Spike treatment increased association of endothelial junctional proteins with Rab5a, a mediator of the endocytic trafficking compartment. In cerebral arteries isolated from control and diabetic animals, Spike protein had a greater effect in downregulating expression of endothelial junctional proteins in arteries from diabetic animals than from control animals. In conclusion, these experiments reveal that Spike-induced degradation of endothelial junctional proteins affects endothelial barrier function and is the likely cause of vascular damage observed in COVID-19 affected individuals.
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Affiliation(s)
| | | | - M. Dennis Leo
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN, United States
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Wu X, Deng KQ, Li C, Yang Z, Hu H, Cai H, Zhang C, He T, Zheng F, Wang H, Zhang XA, Caillon A, Yuan Y, Wang X, Xu H, Lu Z. Cardiac Involvement in Recovered Patients From COVID-19: A Preliminary 6-Month Follow-Up Study. Front Cardiovasc Med 2021; 8:654405. [PMID: 34055936 PMCID: PMC8155269 DOI: 10.3389/fcvm.2021.654405] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Accumulating evidence has revealed that coronavirus disease 2019 (COVID-19) patients may be complicated with myocardial injury during hospitalization. However, data regarding persistent cardiac involvement in patients who recovered from COVID-19 are limited. Our goal is to further explore the sustained impact of COVID-19 during follow-up, focusing on the cardiac involvement in the recovered patients. Methods: In this prospective observational follow-up study, we enrolled a total of 40 COVID-19 patients (20 with and 20 without cardiac injury during hospitalization) who were discharged from Zhongnan Hospital of Wuhan University for more than 6 months, and 27 patients (13 with and 14 without cardiac injury during hospitalization) were finally included in the analysis. Clinical information including self-reported symptoms, medications, laboratory findings, Short Form 36-item scores, 6-min walk test, clinical events, electrocardiogram assessment, echocardiography measurement, and cardiac magnetic resonance imaging was collected and analyzed. Results: Among 27 patients finally included, none of patients reported any obvious cardiopulmonary symptoms at the 6-month follow-up. There were no statistically significant differences in terms of the quality of life and exercise capacity between the patients with and without cardiac injury. No significant abnormalities were detected in electrocardiogram manifestations in both groups, except for nonspecific ST-T changes, premature beats, sinus tachycardia/bradycardia, PR interval prolongation, and bundle-branch block. All patients showed normal cardiac structure and function, without any statistical differences between patients with and without cardiac injury by echocardiography. Compared with patients without cardiac injury, patients with cardiac injury exhibited a significantly higher positive proportion in late gadolinium enhancement sequences [7/13 (53.8%) vs. 1/14 (7.1%), p = 0.013], accompanied by the elevation of circulating ST2 level [median (interquartile range) = 16.6 (12.1, 22.5) vs. 12.5 (9.5, 16.7); p = 0.044]. Patients with cardiac injury presented higher levels of aspartate aminotransferase, creatinine, high-sensitivity troponin I, lactate dehydrogenase, and N-terminal pro-B-type natriuretic peptide than those without cardiac injury, although these indexes were within the normal range for all recovered patients at the 6-month follow-up. Among patients with cardiac injury, patients with positive late gadolinium enhancement presented higher cardiac biomarker (high-sensitivity troponin I) and inflammatory factor (high-sensitivity C-reactive protein) on admission than the late gadolinium enhancement-negative subgroup. Conclusions: Our preliminary 6-month follow-up study with a limited number of patients revealed persistent cardiac involvement in 29.6% (8/27) of recovered patients from COVID-19 after discharge. Patients with cardiac injury during hospitalization were more prone to develop cardiac fibrosis during their recovery. Among patients with cardiac injury, those with relatively higher cardiac biomarkers and inflammatory factors on admission appeared more likely to have cardiac involvement in the convalescence phase.
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Affiliation(s)
- Xiaoyan Wu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ke-Qiong Deng
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chenze Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhaoxia Yang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huijuan Hu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huanhuan Cai
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chao Zhang
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tao He
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fang Zheng
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hairong Wang
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xin A Zhang
- University of Oklahoma Health Science Center, Oklahoma City, OK, United States
| | - Antoine Caillon
- Hypertension and Vascular Research Unit, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Yufeng Yuan
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinghuan Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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43
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Jud P, Kessler HH, Brodmann M. Case Report: Changes of Vascular Reactivity and Arterial Stiffness in a Patient With Covid-19 Infection. Front Cardiovasc Med 2021; 8:671669. [PMID: 34055940 PMCID: PMC8149731 DOI: 10.3389/fcvm.2021.671669] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/13/2021] [Indexed: 01/12/2023] Open
Abstract
Covid-19 infection may be associated with a higher incidence developing cardiovascular complications, however, the underlying mechanisms contributing to cardiovascular complications are largely unknown, while endothelial cell damage may be present. We want to report a 24-year-old woman with Covid-19 infection who had undergone measurements of vascular reactivity and arterial stiffness, including flow-mediated dilation (FMD), nitroglycerin-mediated dilation (NMD), aortic pulse wave velocity (PWV), augmentation index and carotid intima-media-thickness (cIMT) at the time when Covid-19 was diagnosed. Reduced FMD of 0.0% and NMD of 15.5% were observed, while PWV (5.9 m/s), Aix (27%) and cIMT with 0.4 mm of both common carotid arteries were unremarkable. Repeated measurements of FMD, NMD, PWV, Aix, and cIMT 6 weeks after Covid-19 infection revealed persistently reduced FMD (0.0%), while NMD (17.24%), PWV (5.6 m/s) and augmentation index (13%) ameliorated. This case suggests potential impact of Covid-19 infection on endothelial function, also in young Covid-19 patients without any co-morbidity.
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Affiliation(s)
- Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald H Kessler
- Diagnostic and Research Institute of Hygiene, Microbiology, and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Xu Q, Samanapally H, Nathala P, Salunkhe V, Furmanek S, Cahill MN, McGuffin T, Mohammad T, Marsili B, Petrey J, Carrico R, Ramirez J, Akca O, Clifford SP, Pahwa S, Roser L, Kong M, Huang J. Outcomes and Risk Factors for Cardiovascular Events in Hospitalized COVID-19 Patients. J Cardiothorac Vasc Anesth 2021; 35:3581-3593. [PMID: 33867235 PMCID: PMC7997853 DOI: 10.1053/j.jvca.2021.03.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 12/25/2022]
Abstract
Objective To analyze outcomes and risk factors of cardiovascular events in a metropolitan coronavirus disease 2019 (COVID-19) database, and to perform a subgroup analysis in African American populations to determine whether outcomes and risk factors are influenced by race. Design Retrospective cohort analysis from March 9, 2020 to June 20, 2020. Setting Population-based study in Louisville, KY, USA. Participants Seven hundred adult inpatients hospitalized with COVID-19. Interventions N/A. Measurements and Main Results This cohort consisted of 126 patients (18%) with cardiovascular events and 574 patients without cardiovascular events. Patients with cardiovascular events had a much higher mortality rate than those without cardiovascular events (45.2% v 8.7%, p < 0.001). There was no difference between African American and white patients regarding mortality (43.9% v 46.3%, p = 1) and length of stay for survivors (11 days v 9.5 days, p = 0.301). Multiple logistics regression analysis suggested that male, race, lower SaO2/FIO2, higher serum potassium, lower serum albumin, and number of cardiovascular comorbidities were highly associated with the occurrence of cardiovascular events in COVID-19 patients. Lower serum albumin and neoplastic and/or immune-compromised diseases were highly associated with cardiovascular events for African American COVID-19 patients. SaO2/FIO2 ratio and cardiovascular comorbidity count were significantly associated with cardiovascular events in white patients. Conclusions Cardiovascular events were prevalent and associated with worse outcomes in hospitalized patients with COVID-19. Outcomes of cardiovascular events in African American and white COVID-19 patients were similar after propensity score matching analysis. There were common and unique risk factors for cardiovascular events in African American COVID-19 patients when compared with white patients.
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Affiliation(s)
- Qian Xu
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY
| | - Harideep Samanapally
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Pavani Nathala
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Vidyulata Salunkhe
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Stephen Furmanek
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Meredith N Cahill
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY; School of Medicine, University of Louisville, Louisville, KY
| | | | - Tahboub Mohammad
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Bradford Marsili
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY
| | - Jessica Petrey
- Kornhauser Health Sciences Library, University of Louisville, Louisville, KY
| | - Ruth Carrico
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Julio Ramirez
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Ozan Akca
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY
| | - Sean P Clifford
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY
| | - Siddharth Pahwa
- Department of Cardiovascular & Thoracic Surgery, University of Louisville, Louisville, KY
| | - Lynn Roser
- School of Nursing, University of Louisville, Louisville, KY
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY
| | - Jiapeng Huang
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY; Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY; Department of Cardiovascular & Thoracic Surgery, University of Louisville, Louisville, KY; Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY.
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