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Núñez-Gil IJ, Feltes G, Viana-Llamas MC, Raposeiras-Roubin S, Romero R, Alfonso-Rodríguez E, Uribarri A, Santoro F, Becerra-Muñoz V, Pepe M, Castro-Mejía AF, Signes-Costa J, Gonzalez A, Marín F, Lopez-País J, Cerrato E, Vázquez-Cancela O, Espejo-Paeres C, López Masjuan Á, Velicki L, El-Battrawy I, Ramakrishna H, Fernandez-Ortiz A, Perez-Villacastín J. Post-COVID-19 Symptoms and Heart Disease: Incidence, Prognostic Factors, Outcomes and Vaccination: Results from a Multi-Center International Prospective Registry (HOPE 2). J Clin Med 2023; 12:706. [PMID: 36675633 PMCID: PMC9863454 DOI: 10.3390/jcm12020706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Heart disease is linked to worse acute outcomes after coronavirus disease 2019 (COVID-19), although long-term outcomes and prognostic factor data are lacking. We aim to characterize the outcomes and the impact of underlying heart diseases after surviving COVID-19 hospitalization. METHODS We conducted an analysis of the prospective registry HOPE-2 (Health Outcome Predictive Evaluation for COVID-19-2, NCT04778020). We selected patients discharged alive and considered the primary end-point all-cause mortality during follow-up. As secondary main end-points, we included any readmission or any post-COVID-19 symptom. Clinical features and follow-up events are compared between those with and without cardiovascular disease. Factors with p < 0.05 in the univariate analysis were entered into the multivariate analysis to determine independent prognostic factors. RESULTS HOPE-2 closed on 31 December 2021, with 9299 patients hospitalized with COVID-19, and 1805 died during this acute phase. Finally, 7014 patients with heart disease data were included in the present analysis, from 56 centers in 8 countries. Heart disease (+) patients were older (73 vs. 58 years old), more frequently male (63 vs. 56%), had more comorbidities than their counterparts, and suffered more frequently from post-COVID-19 complications and higher mortality (OR heart disease: 2.63, 95% CI: 1.81-3.84). Vaccination was found to be an independent protector factor (HR all-cause death: 0.09; 95% CI: 0.04-0.19). CONCLUSIONS After surviving the acute phase, patients with underlying heart disease continue to present a more complex clinical profile and worse outcomes including increased mortality. The COVID-19 vaccine could benefit survival in patients with heart disease during follow-up.
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Affiliation(s)
- Ivan J. Núñez-Gil
- Cardiology Department, Hospital Clínico San Carlos, 28040 Madrid, Spain
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Gisela Feltes
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Cardiology Department, Hospital Vithas Arturo Soria, 28043 Madrid, Spain
| | - María C. Viana-Llamas
- Cardiology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
| | | | - Rodolfo Romero
- Emergency Department, Hospital Isabel Zendal and Hospital Universitario de Getafe, 28905 Madrid, Spain
| | - Emilio Alfonso-Rodríguez
- Cardiology Department, Institute of Cardiology and Cardiovascular Surgery, Havana C.P. 10400, Cuba
| | - Aitor Uribarri
- Cardiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
| | | | - Víctor Becerra-Muñoz
- Cardiology Department, Hospital Clínico Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - Martino Pepe
- Department of Emergency and Organ Transplantation, Cardiology Unit, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Alex F. Castro-Mejía
- Cardiology Department, Hospital General del Norte de Guayaquil IESS Los Ceibos, Guayaquil 090615, Ecuador
| | - Jaime Signes-Costa
- Pneumology Department, Hospital Clínico de Valencia, 46010 Valencia, Spain
| | - Adelina Gonzalez
- Anesthesiology Department, Hospital Universitario Infanta Sofia, 28703 San Sebastian de los Reyes, Spain
| | - Francisco Marín
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, 30003 Murcia, Spain
| | - Javier Lopez-País
- Cardiology Department, Complejo Hospitalario Universitario de Ourense, 32005 Orense, Spain
| | - Enrico Cerrato
- Cardiology Department, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, 10043 Rivoli, Italy
| | - Olalla Vázquez-Cancela
- Preventive Department, Hospital Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Carolina Espejo-Paeres
- Cardiology and Emergency Department, Hospital Universitario Príncipe de Asturias, 28034 Madrid, Spain
| | - Álvaro López Masjuan
- Cardiology Department, Hospital Universitario Juan Ramón Jimenez, 21002 Huelva, Spain
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia
- Institute of Cardiovascular Diseases Vojvodina, 21204 Novi Sad, Serbia
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Bergmannsheil Bochum, Medical Clinic II, Ruhr University, 44801 Bochum, Germany
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
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Semiz S. COVID19 biomarkers: What did we learn from systematic reviews? Front Cell Infect Microbiol 2022; 12:1038908. [PMID: 36583110 PMCID: PMC9792992 DOI: 10.3389/fcimb.2022.1038908] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID19) pandemic continues to represent a substantial public health concern. It can rapidly progress to severe disease, with poor prognosis and a high mortality risk. An early diagnosis and specific prognostic tools can help healthcare providers to start interventions promptly, understand the likely prognosis and to identify and treat timely individuals likely to develop severe disease with enhanced mortality risk. Here we focused on an impressive set of systematic reviews and meta-analyses that were performed since the start of the COVID19 pandemic and summarized their results related to the levels of hematologic, inflammatory, immunologic biomarkers as well as markers of cardiac, respiratory, hepatic, gastrointestinal and renal systems and their association with the disease progression, severity and mortality. The evidence outlines the significance of specific biomarkers, including inflammatory and immunological parameters (C-reactive protein, procalcitonin, interleukin-6), hematological (lymphocytes count, neutrophil-to-lymphocyte ratio, D-dimer, ferritin, red blood cell distribution width), cardiac (troponin, CK-MB, myoglobin), liver (AST, ALT, total bilirubin, albumin) and lung injury (Krebs von den Lungen-6) that can be used as prognostic biomarkers to aid the identification of high-risk patients and the prediction of serious outcomes, including mortality, in COVID19. Thus, these parameters should be used as essential tools for an early risk stratification and adequate intervention in improving disease outcomes in COVID19 patients.
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Villacorta H, Ávila DXD, Souza TPD, Souza ALCD, Meyas GA, Santos MCV, Mendonça JDC, Costa LMMD, Sousa BDP, Oliveira MVBD, Guimarães JCC, Melo U. The Impact of Cardiovascular Risk Factors and Renal Disease on Outcomes in Patients Hospitalized with COVID-19: An Observational Study from Two Public Hospitals in Brazil. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20220041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Gimeno JR, Olivotto I, Rodríguez AI, Ho CY, Fernández A, Quiroga A, Espinosa MA, Gómez‐González C, Robledo M, Tojal‐Sierra L, Day SM, Owens A, Barriales‐Villa R, Larrañaga JM, Rodríguez‐Palomares J, González‐del‐Hoyo M, Piqueras‐Flores J, Reza N, Chumakova O, Ashley EA, Parikh V, Wheeler M, Jacoby D, Pereira AC, Saberi S, Helms AS, Villacorta E, Gallego‐Delgado M, de Castro D, Domínguez F, Ripoll‐Vera T, Zorio‐Grima E, Sánchez‐Martínez JC, García‐Álvarez A, Arbelo E, Mogollón MV, Fuentes‐Cañamero ME, Grande E, Peña C, Monserrat L, Lakdawala NK. Impact of SARS-Cov-2 infection in patients with hypertrophic cardiomyopathy: results of an international multicentre registry. ESC Heart Fail 2022; 9:2189-2198. [PMID: 36255281 PMCID: PMC9288745 DOI: 10.1002/ehf2.13964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 01/08/2023] Open
Abstract
AIMS To describe the natural history of SARS-CoV-2 infection in patients with hypertrophic cardiomyopathy (HCM) compared with a control group and to identify predictors of adverse events. METHODS AND RESULTS Three hundred and five patients [age 56.6 ± 16.9 years old, 191 (62.6%) male patients] with HCM and SARS-Cov-2 infection were enrolled. The control group consisted of 91 131 infected individuals. Endpoints were (i) SARS-CoV-2 related mortality and (ii) severe clinical course [death or intensive care unit (ICU) admission]. New onset of atrial fibrillation, ventricular arrhythmias, shock, stroke, and cardiac arrest were also recorded. Sixty-nine (22.9%) HCM patients were hospitalized for non-ICU level care, and 21 (7.0%) required ICU care. Seventeen (5.6%) died: eight (2.6%) of respiratory failure, four (1.3%) of heart failure, two (0.7%) suddenly, and three (1.0%) due to other SARS-CoV-2-related complications. Covariates associated with mortality in the multivariable were age {odds ratio (OR) per 10 year increase 2.25 [95% confidence interval (CI): 1.12-4.51], P = 0.0229}, baseline New York Heart Association class [OR per one-unit increase 4.01 (95%CI: 1.75-9.20), P = 0.0011], presence of left ventricular outflow tract obstruction [OR 5.59 (95%CI: 1.16-26.92), P = 0.0317], and left ventricular systolic impairment [OR 7.72 (95%CI: 1.20-49.79), P = 0.0316]. Controlling for age and sex and comparing HCM patients with a community-based SARS-CoV-2 cohort, the presence of HCM was associated with a borderline significant increased risk of mortality OR 1.70 (95%CI: 0.98-2.91, P = 0.0600). CONCLUSIONS Over one-fourth of HCM patients infected with SARS-Cov-2 required hospitalization, including 6% in an ICU setting. Age and cardiac features related to HCM, including baseline functional class, left ventricular outflow tract obstruction, and systolic impairment, conveyed increased risk of mortality.
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Affiliation(s)
- Juan R. Gimeno
- Departamento de Medicina InternaUniversidad de MurciaCtra. Finca Buenavista s/n, Campus Ciencias de la Salud, El PalmarMurcia30120Spain
- European Reference Networks for rare, low prevalence and complex diseases of the heart (ERN GUARD‐Heart)AmsterdamThe Netherlands
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
| | | | - Ana Isabel Rodríguez
- Departamento de Medicina InternaUniversidad de MurciaCtra. Finca Buenavista s/n, Campus Ciencias de la Salud, El PalmarMurcia30120Spain
- European Reference Networks for rare, low prevalence and complex diseases of the heart (ERN GUARD‐Heart)AmsterdamThe Netherlands
| | - Carolyn Y. Ho
- Cardiovascular DivisionBrigham and Women's HospitalBostonMAUSA
| | - Adrián Fernández
- Unidad de Cardiopatías FamiliaresFavaloro Foundation University HospitalBuenos AiresArgentina
| | - Alejandro Quiroga
- Unidad de Cardiopatías FamiliaresFavaloro Foundation University HospitalBuenos AiresArgentina
| | - Mari Angeles Espinosa
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad de Cardiopatías FamiliaresHospital General Universitario Gregorio MarañónMadridSpain
| | - Cristina Gómez‐González
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad de Cardiopatías FamiliaresHospital General Universitario Gregorio MarañónMadridSpain
| | - María Robledo
- Hospital Universitario Araba (Txagorritxu)AlavaSpain
| | | | - Sharlene M. Day
- Department of MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | - Anjali Owens
- Department of MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | - Roberto Barriales‐Villa
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad CSUR Cardiopatías FamiliaresComplexo Hospitalario Universitario de A CoruñaA CoruñaSpain
| | - Jose María Larrañaga
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad CSUR Cardiopatías FamiliaresComplexo Hospitalario Universitario de A CoruñaA CoruñaSpain
| | - Jose Rodríguez‐Palomares
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Department of CardiologyHospital Universitari Vall d'HebronBarcelonaSpain
- Vall d'Hebron Institut de Recerca (VHIR)Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Maribel González‐del‐Hoyo
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Department of CardiologyHospital Universitari Vall d'HebronBarcelonaSpain
- Vall d'Hebron Institut de Recerca (VHIR)Universitat Autònoma de BarcelonaBarcelonaSpain
| | | | - Nosheen Reza
- Department of MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | | | - Euan A. Ashley
- Center for Inherited Heart DiseaseStanford University Medical CenterStanfordCAUSA
| | - Victoria Parikh
- Center for Inherited Heart DiseaseStanford University Medical CenterStanfordCAUSA
| | - Matthew Wheeler
- Center for Inherited Heart DiseaseStanford University Medical CenterStanfordCAUSA
| | | | | | - Sara Saberi
- Department of Internal MedicineUniversity of Michigan HospitalAnn ArborMIUSA
| | - Adam S. Helms
- Department of Internal MedicineUniversity of Michigan HospitalAnn ArborMIUSA
| | - Eduardo Villacorta
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad de Cardiopatías Familiares, Servicio de CardiologíaComplejo Asistencial Universitario de SalamancaSalamancaSpain
- Gerencia Regional de Salud de Castilla y León (SACYL)Instituto de Investigación Biomédica de Salamanca (IBSAL)SalamancaSpain
- Departamento de MedicinaUniversidad de SalamancaSalamancaSpain
| | - María Gallego‐Delgado
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad de Cardiopatías Familiares, Servicio de CardiologíaComplejo Asistencial Universitario de SalamancaSalamancaSpain
- Gerencia Regional de Salud de Castilla y León (SACYL)Instituto de Investigación Biomédica de Salamanca (IBSAL)SalamancaSpain
- Departamento de MedicinaUniversidad de SalamancaSalamancaSpain
| | - Daniel de Castro
- European Reference Networks for rare, low prevalence and complex diseases of the heart (ERN GUARD‐Heart)AmsterdamThe Netherlands
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad CSUR/ERN Cardiopatias FamiliaresHospital Universitario Puerta Hierro MajadahondaMadridSpain
| | - Fernando Domínguez
- European Reference Networks for rare, low prevalence and complex diseases of the heart (ERN GUARD‐Heart)AmsterdamThe Netherlands
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad CSUR/ERN Cardiopatias FamiliaresHospital Universitario Puerta Hierro MajadahondaMadridSpain
| | - Tomás Ripoll‐Vera
- Unidad Cardiopatias FamiliaresHospital Universitario Son LlàtzerMallorcaSpain
| | - Esther Zorio‐Grima
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad Cardiopatias FamiliaresHospital Universitario y Politécnico La FeValenciaSpain
| | - José Carlos Sánchez‐Martínez
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Unidad Cardiopatias FamiliaresHospital Universitario y Politécnico La FeValenciaSpain
| | - Ana García‐Álvarez
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Arrhythmia Section, Cardiology Department, Hospital ClínicUniversity of BarcelonaBarcelonaSpain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Elena Arbelo
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV)MadridSpain
- Arrhythmia Section, Cardiology Department, Hospital ClínicUniversity of BarcelonaBarcelonaSpain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS)BarcelonaSpain
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Maitz T, Parfianowicz D, Vojtek A, Rajeswaran Y, Vyas AV, Gupta R. COVID-19 Cardiovascular Connection: A Review of Cardiac Manifestations in COVID-19 Infection and Treatment Modalities. Curr Probl Cardiol 2022:101186. [PMID: 35351486 PMCID: PMC8957382 DOI: 10.1016/j.cpcardiol.2022.101186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 01/08/2023]
Abstract
The coronavirus pandemic has crippled healthcare system since its outbreak in 2020, and has led to over 2.6 million deaths worldwide. Clinical manifestations of COVID-19 range from asymptomatic carrier to severe pneumonia, to life-threatening acute respiratory distress syndrome (ARDS). The early efforts of the pandemic surrounded treating the pulmonary component of COVID-19, however, there has been robust data surrounding the cardiac complications associated with the virus. This is suspected to be from a marked inflammatory response as well as direct viral injury. Arrhythmias, acute myocardial injury, myocarditis, cardiomyopathy, thrombosis, and myocardial fibrosis are some of the observed cardiac complications. There have been high morbidity and mortality rates in those affected by cardiac conditions associated with COVID-19. Additionally, there have been documented cases of patients presenting with typical cardiac symptoms who are subsequently discovered to have COVID-19 infection. In those who test positive for COVID-19, clinical awareness of the significant cardiac components of the virus is pertinent to prevent morbidity and mortality. Unfortunately, treatment and preventative measures developed for COVID-19 have been shown to be also be associated with cardiac complications. This is a comprehensive review of the cardiac complications and manifestations of COVID-19 infection in addition to those associated with both treatment and vaccination.
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Affiliation(s)
- Theresa Maitz
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA
| | | | - Ashley Vojtek
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA
| | | | - Apurva V Vyas
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - Rahul Gupta
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA.
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An W, Kang JS, Wang Q, Kim TE. Cardiac biomarkers and COVID-19: A systematic review and meta-analysis. J Infect Public Health 2021; 14:1191-1197. [PMID: 34416596 PMCID: PMC8320426 DOI: 10.1016/j.jiph.2021.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 07/08/2021] [Accepted: 07/26/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To systematically investigate the relationship between cardiac biomarkers and COVID-19 severity and mortality. METHODS We performed a literature search using PubMed, Web of Science, and Google Scholar. The standardized mean difference (SMD) and 95% confidence interval (CI) were applied to estimate the combined results of 67 studies. A meta-analysis of cardiac biomarkers was used to evaluate disease mortality and severity in COVID-19 patients. RESULTS A meta-analysis of 7812 patients revealed that patients with high levels of cardiac troponin I (SMD = 0.81 U/L, 95% CI = 0.14-1.48, P = 0.017), cardiac troponin T (SMD = 0.78 U/L, 95% CI = 0.07-1.49, P = 0.032), high-sensitive cardiac troponin I (SMD = 0.66 pg/mL, 95% CI = 0.51-0.81, P < 0.001), high-sensitive cardiac troponin T (SMD = 0.93 U/L, 95% CI = 0.21-1.65, P = 0.012), creatine kinase-MB (SMD = 0.54 U/L, 95% CI = 0.39-0.69, P < 0.001), and myoglobin (SMD = 0.80 U/L, 95% CI = 0.57-1.03, P < 0.001) were associated with prominent disease severity in COVID-19 infection. Moreover, 9532 patients with a higher serum level of cardiac troponin I (SMD = 0.51 U/L, 95% CI = 0.37-0.64, P < 0.001), high-sensitive cardiac troponin (SMD = 0.51 ng/L, 95% CI = 0.29-0.73, P < 0.001), high-sensitive cardiac troponin I (SMD = 0.51 pg/mL, 95% CI = 0.38-0.63, P < 0.001), high-sensitive cardiac troponin T (SMD = 0.85 U/L, 95% CI = 0.63-1.07, P < 0.001), creatine kinase-MB (SMD = 0.48 U/L, 95% CI = 0.32-0.65, P < 0.001), and myoglobin (SMD = 0.55 U/L, 95% CI = 0.45-0.65, P < 0.001) exhibited a prominent level of mortality from COVID-19 infection. CONCLUSION Cardiac biomarkers (cardiac troponin I, cardiac troponin T, high-sensitive cardiac troponin, high-sensitive cardiac troponin I, high-sensitive cardiac troponin T, creatine kinase-MB, and myoglobin) should be more frequently applied in identifying high-risk COVID-19 patients so that timely treatment can be implemented to reduce severity and mortality in COVID-19 patients.
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Affiliation(s)
- Wen An
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
| | - Ju-Seop Kang
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
| | - Qiuyang Wang
- Department of Central China Research Institute of Health, Xinxiang Medical University, Xinxiang, China.
| | - Tae-Eun Kim
- Department of Clinical Pharmacology, Konkuk University Hospital, Seoul, Republic of Korea.
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