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Papageorgiou ST, Damdoumis S, Goulis D, Tzikas S, Giannakoulas G. The Effect of Pulmonary Hypertension on Mortality and Intensive Care Unit Admission in Patients With SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis. Heart Lung Circ 2024; 33:1136-1146. [PMID: 38600017 DOI: 10.1016/j.hlc.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/05/2023] [Accepted: 01/29/2024] [Indexed: 04/12/2024]
Abstract
AIM Severe COVID-19 can cause acute respiratory distress syndrome, hypoxia, systemic complications, and increased mortality. Pulmonary hypertension (PH) is a major global health issue associated with worsening symptoms and increased mortality. This systematic review aimed to assess the influence of PH onset among COVID-19 patients on all-cause mortality and intensive care unit (ICU) admission. METHOD An unrestricted search of five databases up to June 2022 was undertaken. Pulmonary hypertension was assessed using transthoracic echocardiogram, computed tomography, or right heart catheterisation. After duplicate screening, data extraction, and risk of bias assessment, random effects meta-analyses of odds ratios (OR) and their 95% confidence intervals (CI) were performed for all-cause mortality and ICU admission. RESULTS From the 26 studies that were included (3,373 patients, 76% males, median age 62.6 years), PH in COVID-19 patients was significantly associated with higher odds for all-cause mortality (26 studies; OR 3.89; 95% CI 2.85-5.31; p<0.001) and higher odds for ICU admission (six studies; OR 2.50; 95% CI 1.69-3.70; p<0.001). Meta-regression/subgroup analyses by patient demographics, comorbidities, or therapeutic regimens, and sensitivity analyses did not find any differences. CONCLUSION Evidence from observational studies indicates that PH in COVID-19 patients is associated with increased odds of mortality and ICU admission.
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Affiliation(s)
- Stefanos T Papageorgiou
- Department of Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany.
| | - Savvas Damdoumis
- Aristotle University of Thessaloniki, Faculty of Sciences, School of Biology, Department of Genetics, Development and Molecular Biology, Thessaloniki, Greece
| | - Dimitrios Goulis
- Unit of Reproductive Endocrinology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stergios Tzikas
- Third Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Giannakoulas
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Sartini S, Ferrari L, Cutuli O, Castellani L, Cristina ML, Arboscello E, Sartini M. The Role of POCUS to Face COVID-19: A Narrative Review. J Clin Med 2024; 13:2756. [PMID: 38792298 PMCID: PMC11121862 DOI: 10.3390/jcm13102756] [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: 04/02/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
COVID-19 has been a challenging outbreak to face, with millions of deaths among the globe. Acute respiratory failure due to interstitial pneumonia was the leading cause of death other than prothrombotic activation and complications. Lung ultrasound (LUS) and point-of-care ultrasound (POCUS) are widely used not only to triage, to identify, and to monitor lungs involvement but also to assess hemodynamic status and thrombotic and hemorrhagic complications, mainly in critically ill patients. POCUS has gained growing consideration due to its bedside utilization, reliability, and reproducibility even in emergency settings especially in unstable patients. In this narrative review, we aim to describe LUS and POCUS utilization in COVID-19 infection based on the literature found on this topic. We reported the LUS patterns of COVID-19 pulmonary infection, the diagnostic accuracy with respect to CT lung scan, its prognostic value, the variety of scores and protocols proposed, and the utilization of POCUS to investigate the extra-lung complications.
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Affiliation(s)
- Stefano Sartini
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (E.A.)
| | - Lorenzo Ferrari
- Emergency Medicine Post-Graduate School, University of Genoa, Via Balbi 5, 16126 Genoa, Italy;
| | - Ombretta Cutuli
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (E.A.)
| | - Luca Castellani
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (E.A.)
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy;
- Hospital Hygiene, E.O. Ospedali Galliera, Via Alessandro Volta 8, 16128 Genoa, Italy
| | - Eleonora Arboscello
- Emergency Medicine Department, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (O.C.); (L.C.); (E.A.)
| | - Marina Sartini
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy;
- Hospital Hygiene, E.O. Ospedali Galliera, Via Alessandro Volta 8, 16128 Genoa, Italy
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van Blydenstein SA, Omar S, Jacobson B, Menezes CN, Meel R. Right heart echocardiography findings in hypoxic pneumonia patients during the COVID-19 pandemic in a South African population. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad030. [PMID: 39045060 PMCID: PMC11195700 DOI: 10.1093/ehjimp/qyad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/03/2023] [Indexed: 07/25/2024]
Abstract
Aims The right ventricle is affected by Coronavirus disease 19 (COVID-19) via multiple mechanisms, which can result in right ventricular dysfunction (RVD). This study aimed to provide an assessment of right heart function using conventional echocardiography and advanced strain imaging, in patients with hypoxic pneumonia during the COVID-19 pandemic. Methods and results This study was an observational, prospective, single-centre study, including adults with hypoxic pneumonia, in two groups: COVID-19 pneumonia; and non-COVID-19 pneumonia. Bedside echocardiography was performed according to a pre-specified protocol and all right heart measurements were done as per standard guidelines. Right ventricular free wall strain (RVFWS) was measured using Philips® QLAB 11.0 speckle tracking software. Descriptive and comparative statistics were used to analyse data. Spearman Rank Order Correlations were used to determine the correlation between right ventricular (RV) parameters and clinical parameters. Univariate and multivariate logistic regression analyses were performed to characterize the predictors of in-hospital mortality. We enrolled 48 patients with COVID-19 pneumonia and 24 with non-COVID-19 pneumonia. COVID-19 patients were significantly older with a higher frequency of hypertension and diabetes and a trend towards a lower severity of illness score. Mean RVFWS yielded the highest estimates for the prevalence of RVD (81%), with no difference between the two pneumonia groups. Median Tricuspid Annular Plane Systolic Excursion (TAPSE) and right ventricular systolic excursion velocity (RVS') were not significantly different between COVID-19 (TAPSE 17.2 and RVS' 12), and non-COVID-19 pneumonia (TAPSE 17.8 and RVS' 12.1) with P values of 0.29 and 0.86, respectively. Non-COVID-19 pneumonia patients with moderate to severe hypoxaemia (PF < 150) were at greater risk of an elevated RV Systolic Pressure >30 mmHg respiratory rate = 3.25 (CI 1.35-7.82) on admission. Troponin levels discriminated between COVID-19 survivors (6 ng/L) and non-survivors (13 ng/L), P = 0.04. The mortality rate for COVID-19 was high (27%) compared to non-COVID-19 pneumonia (12%). Conclusion Patients with COVID-19 pneumonia had a similar admission prevalence of RVD when compared to patients with non-COVID-19 pneumonia. Despite preserved traditional parameters of RV systolic function, RVFWS was diminished in both groups, and we propose that RVFWS serves as an important marker of the subclinical disease of RV.
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Affiliation(s)
- S A van Blydenstein
- Division of Pulmonology, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Chris Hani Road, Johannesburg, 1864, South Africa
| | - S Omar
- Division of Critical Care, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Chris Hani Road, Johannesburg, 1864, South Africa
| | - B Jacobson
- Division of Haematology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa
| | - C N Menezes
- Division of Infectious Diseases, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Chris Hani Road, Johannesburg, 1864, South Africa
| | - R Meel
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa
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Javaid DM, Masood DF, Nadeem DA. Letter to the Editor: Influence of right ventricular structure and function on hospital outcomes in COVID-19 patients. Heart Lung 2023; 58:258-259. [PMID: 36163208 PMCID: PMC9448695 DOI: 10.1016/j.hrtlng.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Dr Mustafa Javaid
- Department of Medicine, Peshawar Medical College & Kuwait Teaching Hospital, Peshawar, Pakistan
| | - Dr Faizan Masood
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Dr Arsalan Nadeem
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
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Jordan-Rios A, Nuzzi V, Bromage DI, McDonagh T, Sinagra G, Cannata A. Reshaping care in the aftermath of the pandemic. Implications for cardiology health systems. Eur J Intern Med 2023; 109:4-11. [PMID: 36462964 PMCID: PMC9709614 DOI: 10.1016/j.ejim.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/12/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022]
Abstract
In the last two years, the COVID-19 pandemic has undeniably changed everyday life and significantly reshaped the healthcare systems. Besides the direct effect on daily care leading to significant excess mortality, several collateral damages have been observed during the pandemic. The impact of the pandemic led to staff shortages, disrupted education, worse healthcare professional well-being, and a lack of proper clinical training and research. In this review we highlight the results of these important changes and how can the healthcare systems can adapt to prevent unprecedented events in case of future catastrophes.
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Affiliation(s)
- Antonio Jordan-Rios
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK
| | - Vincenzo Nuzzi
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Daniel I Bromage
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK
| | - Theresa McDonagh
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Antonio Cannata
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.
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Kurnik M, Božič H, Vindišar A, Kolar P, Podbregar M. Pulmonary hypertension at admission predicts ICU mortality in elderly critically ill with severe COVID-19 pneumonia: retrospective cohort study. Cardiovasc Ultrasound 2023; 21:1. [PMID: 36653844 PMCID: PMC9847083 DOI: 10.1186/s12947-023-00300-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a useful diagnostic tool for non-invasive assessment of critically ill patients. Mortality of elderly patients with COVID-19 pneumonia is high and there is still scarcity of definitive predictors. Aim of our study was to assess the prediction value of combined lung and heart POCUS data on mortality of elderly critically ill patients with severe COVID-19 pneumonia. METHODS This was a retrospective observational study. Data of patients older than 70 years, with severe COVID-19 pneumonia admitted to mixed 25-bed, level 3, intensive care unit (ICU) was analyzed retrospectively. POCUS was performed at admission; our parameters of interest were pulmonary artery systolic pressure (PASP) and presence of diffuse B-line pattern (B-pattern) on lung ultrasound. RESULTS Between October 2020 and March 2021, 117 patients aged 70 years or more (average age 77 ± 5 years) were included. Average length of ICU stay was 10.7 ± 8.9 days. High-flow oxygenation, non-invasive ventilation and invasive mechanical ventilation were at some point used to support 36/117 (31%), 39/117 (33%) and 75/117 (64%) patients respectively. ICU mortality was 50.9%. ICU stay was shorter in survivors (8.8 ± 8.3 vs 12.6 ± 9.3 days, p = 0.02). PASP was lower in ICU survivors (32.5 ± 9.8 vs. 40.4 ± 14.3 mmHg, p = 0.024). B-pattern was more often detected in non-survivors (35/59 (59%) vs. 19/58 (33%), p = 0.005). PASP and B-pattern at admission, and also mechanical ventilation and development of VAP, were univariate predictors of mortality. PASP at admission was an independent predictor of ICU (OR 1.061, 95%CI 1.003-1.124, p = 0.039) and hospital (OR 1.073, 95%CI 1.003-1.146, p = 0.039) mortality. CONCLUSIONS Pulmonary artery systolic pressure at admission is an independent predictor of ICU and hospital mortality of elderly patients with severe COVID-19 pneumonia.
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Affiliation(s)
- Marko Kurnik
- grid.415428.e0000 0004 0621 9740Department of Internal Intensive Medicine, General Hospital Celje, Oblakova ulica 5, 3000 Celje, Slovenia
| | - Helena Božič
- grid.415428.e0000 0004 0621 9740Department of Internal Intensive Medicine, General Hospital Celje, Oblakova ulica 5, 3000 Celje, Slovenia
| | - Anže Vindišar
- grid.415428.e0000 0004 0621 9740Department of Internal Intensive Medicine, General Hospital Celje, Oblakova ulica 5, 3000 Celje, Slovenia
| | - Petra Kolar
- grid.415428.e0000 0004 0621 9740Department of Internal Intensive Medicine, General Hospital Celje, Oblakova ulica 5, 3000 Celje, Slovenia
| | - Matej Podbregar
- grid.415428.e0000 0004 0621 9740Department of Internal Intensive Medicine, General Hospital Celje, Oblakova ulica 5, 3000 Celje, Slovenia ,grid.8954.00000 0001 0721 6013Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Oweis J, Leamon A, Al-Tarbsheh AH, Goodspeed K, Khorolsky C, Feustel P, Naseer U, Albaba I, Parimi SA, Shkolnik B, Tiwari A, Chopra A, Torosoff M. Influence of right ventricular structure and function on hospital outcomes in COVID-19 patients. Heart Lung 2023; 57:19-24. [PMID: 35987113 PMCID: PMC9365873 DOI: 10.1016/j.hrtlng.2022.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The impact of the right ventricular (RV) structure and function on the in-hospital outcomes in patients with COVID-19 infection has not been rigorously investigated. OBJECTIVES The main aim of our study was to investigate in-hospital outcomes including mortality, ICU admission, mechanical ventilation, pressor support, associated with RV dilatation, and RV systolic dysfunction in COVID-19 patients without a history of pulmonary hypertension. METHODS It was a single academic tertiary center, retrospective cohort study of 997 PCR-confirmed COVID-19 patients. One hundred ninty-four of those patients did not have a history of pulmonary hypertension and underwent transthoracic echocardiography at the request of the treating physicians for clinical indications. Clinical endpoints which included mortality, ICU admission, need for mechanical ventilation or pressor support were abstracted from the electronic charts. RESULTS Patients' mean age was 68+/-16 years old and 42% of the study population were females. COPD was reported in 13% of the study population, whereas asthma was 10%, and CAD was 25%. The mean BMI was 29.8+/-9.5 kg/m2. Overall mortality was 27%, 46% in ICU patients, and 9% in the rest of the cohort. There were no significant differences in co-morbidities between expired patients and the survivors. A total of 19% of patients had evidence of RV dilatation and 17% manifested decreased RV systolic function. RV dilatation or decreased RV systolic function were noted in 24% of the total study population. RV dilatation was significantly more common in expired patients (15% vs 29%, p = 0.026) and was associated with increased mortality in patients treated in the ICU (HR 2.966, 95%CI 1.067-8.243, p = 0.037), who did not need require positive pressure ventilation, IV pressor support or acute hemodialysis. CONCLUSIONS In hospitalized COVID-19 patients without a history of pulmonary hypertension, RV dilatation is associated with a 2-fold increase in inpatient mortality and a 3-fold increase in ICU mortality.
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Affiliation(s)
- Jozef Oweis
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America.
| | - Annie Leamon
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Ali H Al-Tarbsheh
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Katharine Goodspeed
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Ciril Khorolsky
- Department of Cardiology, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Usman Naseer
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Isam Albaba
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Sai Anoosh Parimi
- Department of Internal Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Boris Shkolnik
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Anupama Tiwari
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Amit Chopra
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
| | - Mikhail Torosoff
- Department of Cardiology, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, United States of America
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Point-of-Care Echocardiographic Characteristics of COVID-19 Patients with Pulmonary Embolism. Diagnostics (Basel) 2022; 12:diagnostics12102380. [PMID: 36292069 PMCID: PMC9600333 DOI: 10.3390/diagnostics12102380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: Thrombotic complications, such as pulmonary embolism, are common in COVID-19 patients. Point-of-care ultrasound is a highly recommended tool for orientation in critically ill patients with suspected or confirmed complications. Methods: An observational study was conducted on 32 consecutive patients with confirmed pulmonary embolism and COVID-19 infection treated in the Intensive Care Unit of the University Hospital Medical Center “Bežanijska kosa”, Belgrade, Serbia, between April 2021 and March 2022. Predictors of the need for oxygen support were determined, while point-of-care echocardiographic parameters and various anamnestic, laboratory, and clinically significant parameters were correlated with the Pulmonary Embolism Severity Index (PESI) score. Results: More than two-thirds of patients in our study had PE symptoms present at hospital admission (68.8%). The majority of patients had segmental pulmonary embolism (48.4%), with high to very high PESI score values in 31.3% of patients. Pneumonia was present in 68.8% of the study population. The PESI score was negatively correlated with diastolic blood pressure and SaO2 at the time of PE diagnosis, LV ejection fraction, and PVAT. A positive correlation was found between the PESI score, maximum CRP, and D-dimer at the time of PTE diagnosis. A larger right ventricular diameter was associated with a greater need for oxygen support. Conclusion: Point-of-care echocardiography is a valuable tool for the risk assessment of COVID-19 patients with pulmonary embolism. Right ventricular size stood out as a significant marker of disease severity.
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Kamal AM, Dumitrescu F, Mită A, Săbiescu DM, Alexandru DO, Gheorghe CE, Filip MM, Ionescu-Ciocâlteu A, Maria DT, Kamal D, Kamal CK. Liver Function Tests and FIB-4 Score as Predictors of Severity in COVID-19 Patients from the South-West of Romania. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070934. [PMID: 35888026 PMCID: PMC9318778 DOI: 10.3390/life12070934] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 01/08/2023]
Abstract
Background: The coronavirus disease 2019 pandemic (COVID-19) is the most important global health crisis to date. In this study, we performed an analysis to find the association between liver damage, FIB-4 score and the severity of COVID-19 disease. Methods: We included a total of 580 patients that tested positive for SARS-CoV-2 infection and were hospitalized. No patient included had any known history of liver disease. Liver function tests were performed, and FIB-4 score was calculated in order to assess their involvement in the disease progression. Results: More than half of the patients had elevated liver function tests. Age, high body mass index, associated heart disease and diabetes were associated with poor outcome. Corticosteroids, antibiotics, and anticoagulants strongly correlated with liver injuries. Liver impairment and injury, as well as a FIB-4 score higher than 3.5, also correlated with higher degrees of disease severity. Conclusion: Liver injury and elevated FIB-4 score were associated with poor clinical outcome and disease severity, as well as being a valuable tool to predict COVID-19-related mortality.
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Affiliation(s)
- Adina M. Kamal
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: ; Tel.: +40-742-030-978
| | - Florentina Dumitrescu
- Department of Infectious Disease, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (F.D.); (D.M.S.)
| | - Adrian Mită
- Department of Clinical Semiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Denisa M. Săbiescu
- Department of Infectious Disease, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (F.D.); (D.M.S.)
| | - Dragoș O. Alexandru
- Department of Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Codruța E. Gheorghe
- Department of Family Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.E.G.); (C.K.K.)
| | - Monalisa M. Filip
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.M.F.); (A.I.-C.)
| | - Adriana Ionescu-Ciocâlteu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.M.F.); (A.I.-C.)
| | - Daniela T. Maria
- Department of Nephrology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Diana Kamal
- Department of Physical and Rehabilitation Medicine, Filantropia Municipal Hospital Craiova, 200516 Craiova, Romania;
| | - Constantin K. Kamal
- Department of Family Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.E.G.); (C.K.K.)
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Hong GH, Hays AG, Gilotra NA. The Evolving Role of Echocardiography During the Coronavirus Disease 2019 Pandemic. Heart Int 2022; 16:28-36. [PMID: 36275350 PMCID: PMC9524667 DOI: 10.17925/hi.2022.16.1.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/19/2022] [Indexed: 04/12/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) has been associated with a wide spectrum of cardiovascular manifestations. Since the beginning of the pandemic, echocardiography has served as a valuable tool for triaging, diagnosing and managing patients with COVID-19. More recently, speckle-tracking echocardiography has been shown to be effective in demonstrating subclinical myocardial dysfunction that is often not detected in standard echocardiography. Echocardiographic findings in COVID-19 patients include left or right ventricular dysfunction, including abnormal longitudinal strain and focal wall motion abnormalities, valvular dysfunction and pericardial effusion. Additionally, some of these echocardiographic abnormalities have been shown to correlate with biomarkers and adverse clinical outcomes, suggesting an additional prognostic value of echocardiography. With increasing evidence of cardiac sequelae of COVID-19, the use of echocardiography has expanded to patients with cardiopulmonary symptoms after recovery from initial infection. This article aims to highlight the available echocardiographic tools and to summarize the echocardiographic findings across the full spectrum of COVID-19 disease and their correlations with biomarkers and mortality.
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Affiliation(s)
- Gloria H Hong
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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A man with severe SARS-CoV-2 pneumonia and oliguria. VISUAL JOURNAL OF EMERGENCY MEDICINE 2022; 27:101273. [PMID: 35136845 PMCID: PMC8813567 DOI: 10.1016/j.visj.2022.101273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/26/2021] [Accepted: 02/02/2022] [Indexed: 12/30/2022]
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12
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Lau YH, See KC. Point-of-care ultrasound for critically-ill patients: A mini-review of key diagnostic features and protocols. World J Crit Care Med 2022; 11:70-84. [PMID: 35433316 PMCID: PMC8968483 DOI: 10.5492/wjccm.v11.i2.70] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/08/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
Point-of-care ultrasonography (POCUS) for managing critically ill patients is increasingly performed by intensivists or emergency physicians. Results of needs surveys among intensivists reveal emphasis on basic cardiac, lung and abdominal ultrasound, which are the commonest POCUS modalities in the intensive care unit. We therefore aim to describe the key diagnostic features of basic cardiac, lung and abdominal ultrasound as practised by intensivists or emergency physicians in terms of accuracy (sensitivity, specificity), clinical utility and limitations. We also aim to explore POCUS protocols that integrate basic cardiac, lung and abdominal ultrasound, and highlight areas for future research.
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Affiliation(s)
- Yie Hui Lau
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Kay Choong See
- Division of Respiratory & Critical Care Medicine, National University Hospital, Singapore 119074, Singapore
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13
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Hernandez-Montfort J, Miranda D, Randhawa VK, Sleiman J, de Armas YS, Lewis A, Taimeh Z, Alvarez P, Cremer P, Perez-Villa B, Navas V, Hakemi E, Velez M, Hernandez-Mejia L, Sheffield C, Brozzi N, Cubeddu R, Navia J, Estep JD. Hemodynamic-based Assessment and Management of Cardiogenic Shock. US CARDIOLOGY REVIEW 2022. [DOI: 10.15420/usc.2021.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cardiogenic shock (CS) remains a deadly disease entity challenging patients, caregivers, and communities across the globe. CS can rapidly lead to the development of hypoperfusion and end-organ dysfunction, transforming a predictable hemodynamic event into a potential high-resource, intense, hemometabolic clinical catastrophe. Based on the scalable heterogeneity from a cellular level to healthcare systems in the hemodynamic-based management of patients experiencing CS, we present considerations towards systematic hemodynamic-based transitions in which distinct clinical entities share the common path of early identification and rapid transitions through an adaptive longitudinal situational awareness model of care that influences specific management considerations. Future studies are needed to best understand optimal management of drugs and devices along with engagement of health systems of care for patients with CS.
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Affiliation(s)
| | - Diana Miranda
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Varinder Kaur Randhawa
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Jose Sleiman
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Yelenis Seijo de Armas
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Antonio Lewis
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Ziad Taimeh
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Paulino Alvarez
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Paul Cremer
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Bernardo Perez-Villa
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Viviana Navas
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Emad Hakemi
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Mauricio Velez
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Luis Hernandez-Mejia
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Cedric Sheffield
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Nicolas Brozzi
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Robert Cubeddu
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Jose Navia
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston Hospital, Weston, FL
| | - Jerry D Estep
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
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14
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Gao X, Zou X, Li R, Shu H, Yu Y, Yang X, Shang Y. Application of POCUS in patients with COVID-19 for acute respiratory distress syndrome management: a narrative review. BMC Pulm Med 2022; 22:52. [PMID: 35123448 PMCID: PMC8817642 DOI: 10.1186/s12890-022-01841-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/24/2022] [Indexed: 01/08/2023] Open
Abstract
COVID-19 has inflicted the world for over two years. The recent mutant virus strains pose greater challenges to disease prevention and treatment. COVID-19 can cause acute respiratory distress syndrome (ARDS) and extrapulmonary injury. Dynamic monitoring of each patient's condition is necessary to timely tailor treatments, improve prognosis and reduce mortality. Point-of-care ultrasound (POCUS) is broadly used in patients with ARDS. POCUS is recommended to be performed regularly in COVID-19 patients for respiratory failure management. In this review, we summarized the ultrasound characteristics of COVID-19 patients, mainly focusing on lung ultrasound and echocardiography. Furthermore, we also provided the experience of using POCUS to manage COVID-19-related ARDS.
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15
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Scudiero F, Silverio A, Muraca I, Russo V, Di Maio M, Silvestro A, Personeni D, Citro R, Canonico ME, Galasso G, Porto I, Parodi G. Long-Term Prognostic Impact of Right Ventricular Dysfunction in Patients with COVID-19. J Pers Med 2022; 12:162. [PMID: 35207651 PMCID: PMC8876743 DOI: 10.3390/jpm12020162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 01/10/2023] Open
Abstract
The characteristics and clinical course of hospitalized patients with coronavirus disease 2019 (COVID-19) have been widely described, while long-term data are still poor. The aim of this study was to evaluate the long-term clinical outcome and its association with right ventricular (RV) dysfunction in hospitalized patients with COVID-19. This was a prospective multicenter study of consecutive COVID-19 patients hospitalized at seven Italian Hospitals from 28 February to 20 April 2020. The study population was divided into two groups according to echocardiographic evidence of RV dysfunction. The primary study outcome was 1-year mortality. The propensity score matching was performed to balance for potential baseline confounders. The study population consisted of 224 patients (mean age 69 ± 14, male sex 62%); RV dysfunction was diagnosed in 63 cases (28%). Patients with RV dysfunction were older (75 vs. 67 years, p < 0.001), had higher prevenance of coronary artery disease (27% vs. 11%, p = 0.003), and lower left ventricular ejection fraction (50% vs. 55%, p < 0.001). The rate of 1-year mortality (67% vs. 28%; p ≤ 0.001) was significantly higher in patients with RV dysfunction compared with patients without. After propensity score matching, patients with RV dysfunction showed a worse long-term survival (62% vs. 29%, p < 0.001). The multivariable Cox regression model showed an independent association of RV dysfunction with 1-year mortality. RV dysfunction is a relatively common finding in hospitalized COVID-19 patients, and it is independently associated with an increased risk of 1-year mortality.
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Affiliation(s)
- Fernando Scudiero
- Division of Cardiology, “Bolognini” Hospital, ASST Bergamo est, 24068 Seriate, Italy; (F.S.); (A.S.); (D.P.)
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (M.D.M.); (R.C.); (G.G.)
| | - Iacopo Muraca
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, 50141 Florence, Italy;
| | - Vincenzo Russo
- Division of Cardiology Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”—Monaldi and Cotugno Hospital, 81100 Naples, Italy;
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (M.D.M.); (R.C.); (G.G.)
| | - Antonio Silvestro
- Division of Cardiology, “Bolognini” Hospital, ASST Bergamo est, 24068 Seriate, Italy; (F.S.); (A.S.); (D.P.)
| | - Davide Personeni
- Division of Cardiology, “Bolognini” Hospital, ASST Bergamo est, 24068 Seriate, Italy; (F.S.); (A.S.); (D.P.)
| | - Rodolfo Citro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (M.D.M.); (R.C.); (G.G.)
| | - Mario Enrico Canonico
- Cardiology Clinic, Sassari University Hospital, 07100 Sassari, Italy; (M.E.C.); (G.P.)
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (M.D.M.); (R.C.); (G.G.)
| | - Italo Porto
- Department of Internal Medicine and Medical Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, 16132 Genoa, Italy;
| | - Guido Parodi
- Cardiology Clinic, Sassari University Hospital, 07100 Sassari, Italy; (M.E.C.); (G.P.)
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16
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Pilot study on the value of echocardiography combined with lung ultrasound to evaluate COVID-19 pneumonia. Cardiovasc Ultrasound 2022; 20:2. [PMID: 35045881 PMCID: PMC8767359 DOI: 10.1186/s12947-021-00271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aimed to investigate the relationship between echocardiography results and lung ultrasound score (LUS) in coronavirus disease 2019 (COVID-19) pneumonia patients and evaluate the impact of the combined application of these techniques in the evaluation of COVID-19 pneumonia.
Methods
Hospitalized COVID-19 pneumonia patients who underwent daily lung ultrasound and echocardiography were included in this study. Patients with tricuspid regurgitation within three days of admission were enrolled. Moreover, the correlation and differences between their pulmonary artery pressure (PAP) and LUS on days 3, 8, and 13 were analyzed. The inner diameter of the pulmonary artery root as well as the size of the atria and ventricles were also considered.
Results
The PAP on days 3, 8, and 13 of hospitalization was positively correlated with the LUS (r = 0.448, p = 0.003; r = 0.738, p < 0.001; r = 0.325, p = 0.036, respectively). On day 8, the values of both PAP and LUS were higher than on days 3 and 13 (p < 0.01). Similarly, PAP and LUS were significantly increased in 92.9% (39/42) and 90.5% (38/42) of patients, respectively, and at least one of these two values was positive in 97.6% (41/42) of cases. The inner diameters of the right atrium, right ventricle, and pulmonary artery also differed significantly from their corresponding values on days 3 and 13 (p < 0.05).
Conclusions
PAP is positively correlated with LUS in COVID-19 pneumonia. The two values could be combined for a more precise assessment of disease progression and recovery status.
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17
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Ghidini S, Gasperetti A, Winterton D, Vicenzi M, Busana M, Pedrazzini G, Biasco L, Tersalvi G. Echocardiographic assessment of the right ventricle in COVID-19: a systematic review. Int J Cardiovasc Imaging 2021; 37:3499-3512. [PMID: 34292433 PMCID: PMC8295549 DOI: 10.1007/s10554-021-02353-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022]
Abstract
Cardiac involvement has been frequently reported in COVID-19 as responsible of increased morbidity and mortality. Given the importance of right heart function in acute and chronic respiratory diseases, its assessment in SARS-CoV-2 infected patients may add prognostic accuracy. Transthoracic echocardiography has been proposed to early predict myocardial injury and risk of death in hospitalized patients. This systematic review presents the up-to-date sum of literature regarding right ventricle ultrasound assessment. We evaluated commonly used echocardiographic parameters to assess RV function and discussed their relationship with pathophysiological mechanisms involved in COVID-19. We searched Medline and Embase for studies that used transthoracic echocardiography for right ventricle assessment in patients with COVID-19.
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Affiliation(s)
- Simone Ghidini
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dario Winterton
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Marco Vicenzi
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mattia Busana
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Giovanni Pedrazzini
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Luigi Biasco
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, Ciriè, Italy
| | - Gregorio Tersalvi
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland.
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Sankt-Anna-Strasse 32, 6006, Lucerne, Switzerland.
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18
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Arévalos V, Ortega-Paz L, Rodríguez-Arias JJ, Calvo López M, Castrillo-Golvano L, Salazar-Rodríguez A, Sabaté-Tormos M, Spione F, Sabaté M, Brugaletta S. Acute and Chronic Effects of COVID-19 on the Cardiovascular System. J Cardiovasc Dev Dis 2021; 8:128. [PMID: 34677197 PMCID: PMC8541609 DOI: 10.3390/jcdd8100128] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 has shown significant morbidity with the involvement of multiple systems, including the cardiovascular system. Cardiovascular manifestations in the acute phase can include myocardial injury itself, myocardial infarction, venous thromboembolic events, myocarditis, Takotsubo syndrome, and different arrhythmic events. Myocardial injury defined by the rise of cardiac biomarkers in blood has been found in multiple studies with a prevalence of about 20%. Its presence is related to worse clinical outcomes and in-hospital mortality. The mechanisms of myocardial injury have been the subject of intense research but still need to be clarified. The characterization of the cardiac affectation with echocardiography and cardiac magnetic resonance has found mixed results in different studies, with a striking incidence of imaging criteria for myocarditis. Regarding post-acute and chronic follow-up results, the persistence of symptoms and imaging changes in recovered COVID-19 patients has raised concerns about the duration and the possible significance of these findings. Even though the knowledge about this disease has increased incredibly in the last year, many aspects are still unclear and warrant further research.
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Affiliation(s)
- Victor Arévalos
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Luis Ortega-Paz
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Juan José Rodríguez-Arias
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Margarita Calvo López
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Leticia Castrillo-Golvano
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Anthony Salazar-Rodríguez
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Marta Sabaté-Tormos
- Department of Medicine, Medical School, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Francesco Spione
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Manel Sabaté
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Salvatore Brugaletta
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
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19
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Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis. Sci Rep 2021; 11:17774. [PMID: 34493763 PMCID: PMC8423751 DOI: 10.1038/s41598-021-96955-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023] Open
Abstract
The Coronavirus Disease (COVID-19) pandemic imposed a high burden of morbidity and mortality. In COVID-19, direct lung parenchymal involvement and pulmonary microcirculation dysfunction may entail pulmonary hypertension (PH). PH and direct cardiac injury beget right ventricular dysfunction (RVD) occurrence, which has been frequently reported in COVID-19 patients; however, the prevalence of RVD and its impact on outcomes during COVID-19 are still unclear. This study aims to evaluate the prevalence of RVD and associated outcomes in patients with COVID-19, through a Systematic Review and Meta-Analysis. MEDLINE and EMBASE were systematically searched from inception to 15th July 2021. All studies reporting either the prevalence of RVD in COVID-19 patients or all-cause death according to RVD status were included. The pooled prevalence of RVD and Odds Ratio (OR) for all-cause death according to RVD status were computed and reported. Subgroup analysis and meta-regression were also performed. Among 29 studies (3813 patients) included, pooled prevalence of RVD was 20.4% (95% CI 17.1-24.3%; 95% PI 7.8-43.9%), with a high grade of heterogeneity. No significant differences were found across geographical locations, or according to the risk of bias. Severity of COVID-19 was associated with increased prevalence of RVD at meta-regression. The presence of RVD was found associated with an increased likelihood of all-cause death (OR 3.32, 95% CI 1.94-5.70). RVD was found in 1 out of 5 COVID-19 patients, and was associated with all-cause mortality. RVD may represent one crucial marker for prognostic stratification in COVID-19; further prospective and larger are needed to investigate specific management and therapeutic approach for these patients.
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20
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Pimentel SLG, Nascimento BR, Franco J, Oliveira KKB, Fraga CL, de Macedo FVB, Raso LADM, de Ávila RE, dos Santos LPA, Rocha RTL, Oliveira RM, Barbosa MDM, Sable C, Ribeiro ALP, Beaton AZ, Nunes MCP. Bedside echocardiography to predict mortality of COVID-19 patients beyond clinical data: Data from the PROVAR-COVID study. Rev Soc Bras Med Trop 2021; 54:e03822021. [PMID: 34495258 PMCID: PMC8437446 DOI: 10.1590/0037-8682-0382-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/11/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Cardiac involvement seems to impact prognosis of COVID-19, being more frequent in critically ill patients. We aimed to assess the prognostic value of right ventricular (RV) and left ventricular (LV) dysfunction, evaluated by bedside echocardiography (echo), in patients hospitalized with COVID-19. METHODS Patients admitted in 2 reference hospitals in Brazil from Jul to Sept/2020 with confirmed COVID-19 and moderate/severe presentations underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid-IQ), at the earliest convenience, with remote interpretation. The association between demographics, clinical comorbidities and echo variables with all-cause hospital mortality was assessed, and factors significant at p<0.10 were put into multivariable models. RESULTS Total 163 patients were enrolled, 59% were men, mean age 64±16 years, and 107 (66%) were admitted to intensive care. Comorbidities were present in 144 (88%) patients: hypertension 115 (71%), diabetes 61 (37%) and heart failure 22 (14%). In-hospital mortality was 34% (N=56). In univariate analysis, echo variables significantly associated with death were: LV ejection fraction (LVEF, OR=0.94), RV fractional area change (OR=0.96), tricuspid annular plane systolic excursion (TAPSE, OR=0.83) and RV dysfunction (OR=5.3). In multivariate analysis, after adjustment for clinical and demographic variables, independent predictors of mortality were age≥63 years (OR=5.53, 95%CI 1.52-20.17), LVEF<64% (OR=7.37, 95%CI 2.10-25.94) and TAPSE<18.5 mm (OR=9.43, 95% CI 2.57-35.03), and the final model had good discrimination, with C-statistic=0.83 (95%CI 0.75-0.91). CONCLUSION Markers of RV and LV dysfunction assessed by bedside echo are independent predictors of mortality in hospitalized COVID-19 patients, after adjustment for clinical variables.
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Affiliation(s)
- Sander Luis Gomes Pimentel
- Universidade Federal de Minas Gerais, Centro de Telessaúde do Hospital das Clínicas, Serviço de Cardiologia e Cirurgia Cardiovascular, Belo Horizonte, MG, Brasil
| | - Bruno Ramos Nascimento
- Universidade Federal de Minas Gerais, Centro de Telessaúde do Hospital das Clínicas, Serviço de Cardiologia e Cirurgia Cardiovascular, Belo Horizonte, MG, Brasil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte, MG, Brasil
| | - Juliane Franco
- Universidade Federal de Minas Gerais, Centro de Telessaúde do Hospital das Clínicas, Serviço de Cardiologia e Cirurgia Cardiovascular, Belo Horizonte, MG, Brasil
| | - Kaciane Krauss Bruno Oliveira
- Universidade Federal de Minas Gerais, Centro de Telessaúde do Hospital das Clínicas, Serviço de Cardiologia e Cirurgia Cardiovascular, Belo Horizonte, MG, Brasil
| | - Clara Leal Fraga
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte, MG, Brasil
| | | | - Leonardo Arruda de Moraes Raso
- Universidade Federal de Minas Gerais, Centro de Telessaúde do Hospital das Clínicas, Serviço de Cardiologia e Cirurgia Cardiovascular, Belo Horizonte, MG, Brasil
| | | | | | - Rodrigo Tavares Lanna Rocha
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte, MG, Brasil
| | - Renan Mello Oliveira
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte, MG, Brasil
| | - Márcia de Melo Barbosa
- Universidade Federal de Minas Gerais, Centro de Telessaúde do Hospital das Clínicas, Serviço de Cardiologia e Cirurgia Cardiovascular, Belo Horizonte, MG, Brasil
| | - Craig Sable
- Cardiology, Children’s National Health System, Washington, DC, United States of America
| | - Antonio Luiz Pinho Ribeiro
- Universidade Federal de Minas Gerais, Centro de Telessaúde do Hospital das Clínicas, Serviço de Cardiologia e Cirurgia Cardiovascular, Belo Horizonte, MG, Brasil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte, MG, Brasil
| | - Andrea Zawacki Beaton
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
| | - Maria Carmo Pereira Nunes
- Universidade Federal de Minas Gerais, Centro de Telessaúde do Hospital das Clínicas, Serviço de Cardiologia e Cirurgia Cardiovascular, Belo Horizonte, MG, Brasil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte, MG, Brasil
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21
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Barssoum K, Victor V, Salem A, Kumar A, Mubasher M, Hassib M, Magdi M, Renjithlal S, Abdelazeem M, Shariff M, Idemudia O, Ibrahim M, Mohamed A, Thakkar S, Patel H, Diab M, Szeles A, Ibrahim F, Jha R, Chowdhury M, Akula N, Kalra A, Nanda NC. Echocardiography, lung ultrasound, and cardiac magnetic resonance findings in COVID-19: A systematic review. Echocardiography 2021; 38:1365-1404. [PMID: 34236091 PMCID: PMC8444724 DOI: 10.1111/echo.15152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/25/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The manifestations of COVID-19 as outlined by imaging modalities such as echocardiography, lung ultrasound (LUS), and cardiac magnetic resonance (CMR) imaging are not fully described. METHODS We conducted a systematic review of the current literature and included studies that described cardiovascular manifestations of COVID-19 using echocardiography, CMR, and pulmonary manifestations using LUS. We queried PubMed, EMBASE, and Web of Science for relevant articles. Original studies and case series were included. RESULTS This review describes the most common abnormalities encountered on echocardiography, LUS, and CMR in patients infected with COVID-19.
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Affiliation(s)
- Kirolos Barssoum
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Varun Victor
- Department of Internal MedicineCanton Medical Education FoundationCantonOhioUSA
| | - Ahmad Salem
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Ashish Kumar
- Section of Cardiovascular ResearchHeartVascular and Thoracic DepartmentCleveland Clinic Akron GeneralAkronOhioUSA
- Department of Internal MedicineCleveland Clinic Akron GeneralAkronOhioUSA
| | - Mahmood Mubasher
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | | | - Mohamed Magdi
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Sarathlal Renjithlal
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Mohamed Abdelazeem
- Department of Internal MedicineSt. Elizabeth Medical CenterBrightonMassachusettsUSA
| | | | - Osarenren Idemudia
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Mounir Ibrahim
- Department of Internal MedicineHackensack Meridian Health Palisades Medical CenterNorth BergenNew JerseyUSA
| | - Amr Mohamed
- Department of Internal MedicineRochester General HospitalRochesterNew YorkUSA
| | | | - Harsh Patel
- Department of Internal MedicineLouis A Weiss Memorial HospitalChicagoIllinoisUSA
| | - Mohamed Diab
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Andras Szeles
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Fadi Ibrahim
- American University of AntiguaAntigua and Barbuda
| | - Roshan Jha
- Department of Internal MedicineHackensack Meridian Health Palisades Medical CenterNorth BergenNew JerseyUSA
| | - Medhat Chowdhury
- Department of Internal MedicineRochester General HospitalRochesterNew YorkUSA
| | - Navya Akula
- Department of Internal MedicineRochester Regional HealthUnity HospitalRochesterNew YorkUSA
| | - Ankur Kalra
- Section of Cardiovascular ResearchHeartVascular and Thoracic DepartmentCleveland Clinic Akron GeneralAkronOhioUSA
- Department of Cardiovascular MedicineHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOhioUSA
| | - Navin C. Nanda
- Division of Cardiovascular DiseaseDepartment of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Manzur-Sandoval D, García-Cruz E, Gopar-Nieto R, Arteaga-Cárdenas G, Rascón-Sabido R, Mendoza-Copa G, Lazcano-Díaz E, Barajas-Campos RL, Jordán-Ríos A, Rodríguez-Jiménez GM, Martínez DSL, Murillo-Ochoa AL, Díaz-Méndez A, Bucio-Reta E, Rojas-Velasco G, Baranda-Tovar F. Right ventricular dysfunction and right ventricular-arterial uncoupling at admission increase the in-hospital mortality in patients with COVID-19 disease. Echocardiography 2021; 38:1345-1351. [PMID: 34286870 PMCID: PMC8444818 DOI: 10.1111/echo.15164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/15/2021] [Accepted: 07/10/2021] [Indexed: 12/28/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID‐19) frequently involves cardiovascular manifestations such as right ventricular (RV) dysfunction and alterations in pulmonary hemodynamics. We evaluated the application of the critical care ultrasonography ORACLE protocol to identify the most frequent alterations and their influence on adverse outcomes, especially those involving the RV (dilatation and dysfunction). Methods This cross‐sectional study included 204 adult patients with confirmed COVID‐19 admitted at three centers. Echocardiography and lung ultrasound images were acquired on admission using the ORACLE ultrasonography algorithm. Results Two‐hundred and four consecutive patients were evaluated: 22 (11.9%) demonstrated a fractional shortening of < 35%; 33 (17.1%) a tricuspid annular plane systolic excursion (TAPSE) of < 17 mm; 26 (13.5%) a tricuspid peak systolic S wave tissue Doppler velocity of < 9.5 cm/sec; 69 (37.5%) a RV basal diameter of > 41 mm; 119 (58.3%) a pulmonary artery systolic pressure (PASP) of > 35 mm Hg; and 14 (11%) a TAPSE/PASP ratio of < .31. The in‐hospital mortality rate was 37.6% (n = 71). Multiple logistic regression modeling showed that PASP > 35 mm Hg, RV FS of < 35%, TAPSE < 17 mm, RV S wave < 9.5, and TAPSE/PASP ratio < .31 mm/mm Hg were associated with this outcome. PASP and the TAPSE/PASP ratio had the lowest feasibility of being obtained among the investigators (62.2%). Conclusion The presence of RV dysfunction, pulmonary hypertension, and alteration of the RV–arterial coupling conveys an increased risk of in‐hospital mortality in patients presenting with COVID‐19 upon admission; therefore, searching for these alterations should be routine. These parameters can be obtained quickly and safely with the ORACLE protocol.
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Affiliation(s)
- Daniel Manzur-Sandoval
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Edgar García-Cruz
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Rodrigo Gopar-Nieto
- Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Gerardo Arteaga-Cárdenas
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Rafael Rascón-Sabido
- Heart Failure Service, Hospital Naval de Especialidades Veracruz, Veracruz, Mexico
| | | | - Emmanuel Lazcano-Díaz
- Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Antonio Jordán-Ríos
- Outpatient Clinic, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | | | | | - Arturo Díaz-Méndez
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Eduardo Bucio-Reta
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Gustavo Rojas-Velasco
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Francisco Baranda-Tovar
- Surgical and Medical Specialties Direction, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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Cruz EG, Broca Garcia BE, Sandoval DM, Gopar-Nieto R, Gonzalez Ruiz FJ, Gallardo LD, Ronco C, Madero M, Vasquez Jimenez E. Renal Resistive Index as a Predictor of Acute Kidney Injury and Mortality in COVID-19 Critically Ill Patients. Blood Purif 2021; 51:309-316. [PMID: 34280921 PMCID: PMC8339011 DOI: 10.1159/000517469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) in patients with COVID-19 can be caused by multiple mechanisms. Renal resistive index (RRI) is a noninvasive instrument to evaluate kidney hemodynamics, and it is obtained by analysis of intrarenal arterial waves using Doppler ultrasound. This study aimed to determine the role of RRI in predicting AKI and adverse outcomes in critically ill patients with COVID-19. METHODS This cross-sectional study included 65 patients with confirmed SARS-CoV-2 pneumonia admitted to the critical care unit from April 1, 2020, to June 20, 2020. Informed consent was obtained from all individual participants included in the study. Cardiac, pulmonary, and kidney ultrasonographic evaluations were performed in a protocolized way. RESULTS In this cohort, 65 patients were included, mean age was 53.4 years, 79% were male, and 35% were diabetic. Thirty-four percent of patients developed AKI, 12% required RRT, and 35% died. Of the patients who developed AKI, 68% had RRI ≥ 0.7. Also, 75% of the patients who required RRT had RRI ≥ 0.7. In the adjusted Cox model, the RRI ≥ 0.7 was associated with higher mortality (HR 2.86, 95% CI: 1.19-6.82, p = 0.01). CONCLUSIONS Critical care ultrasonography is a noninvasive, reproducible, and accurate bedside method that has proven its usefulness. An elevated RRI may have a role in predicting AKI, RRT initiation, and mortality in patients with severe SARS-CoV-2 pneumonia.
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Affiliation(s)
- Edgar Garcia Cruz
- Department of Cardiovascular Critical Care, Nacional Institute of Cardiology “Ignacio Chavez”, Mexico City, Mexico
| | | | - Daniel Manzur Sandoval
- Department of Cardiovascular Critical Care, Nacional Institute of Cardiology “Ignacio Chavez”, Mexico City, Mexico
| | - Rodrigo Gopar-Nieto
- Department of Cardiology, Nacional Institute of Cardiology “Ignacio Chavez”, Mexico City, Mexico
| | | | | | - Claudio Ronco
- Department of Nephrology, San Bortolo Hospital and International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Magdalena Madero
- Department of Nephrology, Nacional Institute of Cardiology “Ignacio Chavez”, Mexico City, Mexico
| | - Enzo Vasquez Jimenez
- Department of Nephrology, Nacional Institute of Cardiology “Ignacio Chavez”, Mexico City, Mexico
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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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García-Cruz E, Manzur-Sandoval D, Baeza-Herrera LA, Díaz-Méndez A, López-Zamora A, González-Ruiz F, Ramos-Enríquez Á, Melano-Carranza E, Rojas-Velasco G, Álvarez-Álvarez RJ, Baranda-Tovar FM. Acute right ventricular failure in COVID-19 infection: A case series. J Cardiol Cases 2021; 24:45-48. [PMID: 33520022 PMCID: PMC7832825 DOI: 10.1016/j.jccase.2021.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/28/2022] Open
Abstract
Severe forms of COVID-19 infection are associated with the need for invasive mechanical ventilation and thromboembolic complications; those can affect the cardiac function especially the right ventricle performance. Critical care echocardiography has rapidly evolved as the election technique in the evaluation of the critically ill patients. This technique has the advantage that it can be done at patient´s bedside and helps to provide the appropriate treatment and to monitoring maneuver's response. We present 4 patients with a confirmed COVID-19 infection who presented with sudden hemodynamic and / or respiratory deterioration, in which transthoracic echocardiogram showed acute right ventricular failure as the trigger for the event and helped to guide an early therapeutic intervention. .
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Affiliation(s)
- Edgar García-Cruz
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, PO. 14080, Tlalpan, Mexico City, Mexico
| | - Daniel Manzur-Sandoval
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, PO. 14080, Tlalpan, Mexico City, Mexico
| | - Luis Augusto Baeza-Herrera
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, PO. 14080, Tlalpan, Mexico City, Mexico
| | - Arturo Díaz-Méndez
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, PO. 14080, Tlalpan, Mexico City, Mexico
| | - Adán López-Zamora
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, PO. 14080, Tlalpan, Mexico City, Mexico
| | - Francisco González-Ruiz
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, PO. 14080, Tlalpan, Mexico City, Mexico
| | - Ángel Ramos-Enríquez
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, PO. 14080, Tlalpan, Mexico City, Mexico
| | - Efrén Melano-Carranza
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, PO. 14080, Tlalpan, Mexico City, Mexico
| | - Gustavo Rojas-Velasco
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, PO. 14080, Tlalpan, Mexico City, Mexico
| | - Rolando Joel Álvarez-Álvarez
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, PO. 14080, Tlalpan, Mexico City, Mexico
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COVID-19-related echocardiographic patterns of cardiovascular dysfunction in critically ill patients: A systematic review of the current literature. J Crit Care 2021; 65:26-35. [PMID: 34082252 PMCID: PMC8146405 DOI: 10.1016/j.jcrc.2021.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/21/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022]
Abstract
Purpose Coronavirus disease 2019 (COVID-19) infection may trigger a multi-systemic disease involving different organs. There has been growing interest regarding the harmful effects of COVID-19 on the cardiovascular system. This systematic review aims to systematically analyze papers reporting echocardiographic findings in hospitalized COVID-19 subjects. Materials and methods We included prospective and retrospective studies reporting echocardiography data in >10 hospitalized adult subjects with COVID-19; from 1st February 2020 to 15th January 2021. Results The primary electronic search identified 1120 articles. Twenty-nine studies were finally included, enrolling 3944 subjects. Overall the studies included a median of 68.0% (45.5–100.0) of patients admitted to ICU. Ten studies (34.4%) were retrospective, and 20 (68.9%) single-centred. Overall enrolling 1367 subjects, three studies reported normal echocardiographic findings in 49 ± 18% of cases. Seven studies (24.1%) analyzed the association between echocardiographic findings and mortality, mostly related to right ventricular (RV) dysfunction. Conclusions Data regarding the use of echocardiography on hospitalized, predominantly ICU, COVID-19 patients were retrieved from studies with heterogeneous designs, variable sample sizes, and severity scores. Normal echocardiographic findings were reported in about 50% of subjects, with LVEF usually not affected. Overall, RV dysfunction seems more likely associated with increased mortality. Trial Registration CRD42020218439.
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28
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Heart-lung interactions in COVID-19: prognostic impact and usefulness of bedside echocardiography for monitoring of the right ventricle involvement. Heart Fail Rev 2021; 27:1325-1339. [PMID: 33864580 PMCID: PMC8052527 DOI: 10.1007/s10741-021-10108-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 12/22/2022]
Abstract
Due to the SARS-CoV-2 infection–related severe pulmonary tissue damages associated with a relative specific widespread thrombotic microangiopathy, the pathophysiologic role of heart–lung interactions becomes crucial for the development and progression of right ventricular (RV) dysfunction. The high resistance in the pulmonary circulation, as a result of small vessel thrombosis and hypoxemia, is the major cause of right heart failure associated with a particularly high mortality in severe COVID-19. Timely identification of patients at high risk for RV failure, optimization of mechanical ventilation to limit its adverse effects on RV preload and afterload, avoidance of medication-related increase in the pulmonary vascular resistance, and the use of extracorporeal membrane oxygenation in refractory respiratory failure with hemodynamic instability, before RV failure develops, can improve patient survival. Since it was confirmed that the right-sided heart is particularly involved in the clinical deterioration of patients with COVID-19 and pressure overload-induced RV dysfunction plays a key role for patient outcome, transthoracic echocardiography (TTE) received increasing attention. Limited TTE focused on the right heart appears highly useful in hospitalized COVID-19 patients and particularly beneficial for monitoring of critically ill patients. In addition to detection of right-sided heart dilation and RV dysfunction, it enables assessment of RV-pulmonary arterial coupling and evaluation of RV adaptability to pressure loading which facilitate useful prognostic statements to be made. The increased use of bedside TTE focused on the right heart could facilitate more personalized management and treatment of hospitalized patients and can contribute towards reducing the high mortality associated with SARS-CoV-2 infection.
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Paternoster G, Bertini P, Innelli P, Trambaiolo P, Landoni G, Franchi F, Scolletta S, Guarracino F. Right Ventricular Dysfunction in Patients With COVID-19: A Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth 2021; 35:3319-3324. [PMID: 33980426 PMCID: PMC8038863 DOI: 10.1053/j.jvca.2021.04.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to describe the features of right ventricular impairment and pulmonary hypertension in coronavirus disease (COVID-19) and assess their effect on mortality. DESIGN The authors carried out a systematic review and meta-analysis of observational studies. SETTING The authors performed a search through PubMed, the International Clinical Trials Registry Platform, and the Cochrane Library for studies reporting right ventricular dysfunction in patients with COVID-19 and outcomes. PARTICIPANTS The search yielded nine studies in which the appropriate data were available. INTERVENTIONS Pooled odds ratios were calculated according to the random-effects model. MEASUREMENTS AND MAIN RESULTS Overall, 1,450 patients were analyzed, and half of them were invasively ventilated. Primary outcome was mortality at the longest follow-up available. Mortality was 48.5% versus 24.7% in patients with or without right ventricular impairment (n = 7; OR = 3.10; 95% confidence interval [CI] 1.72-5.58; p = 0.0002), 56.3% versus 30.6% in patients with or without right ventricular dilatation (n = 6; OR = 2.43; 95% CI 1.41-4.18; p = 0.001), and 52.9% versus 14.8% in patients with or without pulmonary hypertension (n = 3; OR = 5.75; 95% CI 2.67-12.38; p < 0.001). CONCLUSION Mortality in patients with COVID-19 requiring respiratory support and with a diagnosis of right ventricular dysfunction, dilatation, or pulmonary hypertension is high. Future studies should highlight the mechanisms of right ventricular derangement in COVID-19, and early detection of right ventricular impairment using ultrasound might be important to individualize therapies and improve outcomes.
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Affiliation(s)
- Gianluca Paternoster
- Division of Cardiac Resuscitation, Cardiovascular Anesthesia and Intensive Care, San Carlo Hospital, Potenza, Italy
| | - Pietro Bertini
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Pasquale Innelli
- Intensive Coronary Care Unit, Division of Cardiology, San Carlo Hospital, Potenza, Italy
| | - Paolo Trambaiolo
- Intensive Coronary Care Unit, Sandro Pertini Hospital, Roma, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, Istituto di Ricerca a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Federico Franchi
- Department of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of Siena, Siena, Italy
| | - Sabino Scolletta
- Department of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of Siena, Siena, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Li Y, Regan J, Fajnzylber J, Coxen K, Corry H, Wong C, Rosenthal A, Atyeo C, Fischinger S, Gillespie E, Chishti R, Baden L, Yu XG, Alter G, Kim A, Li JZ. Liver Fibrosis Index FIB-4 Is Associated With Mortality in COVID-19. Hepatol Commun 2021; 5:434-445. [PMID: 34553511 PMCID: PMC7753559 DOI: 10.1002/hep4.1650] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/27/2020] [Accepted: 11/01/2020] [Indexed: 12/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is associated with adverse outcomes, including need for invasive mechanical ventilation and death in people with risk factors. Liver enzyme elevation is commonly seen in this group, but its clinical significance remains elusive. In this study, we calculated the Fibrosis-4 (FIB-4) score for a cohort of hospitalized patients with COVID-19 and assessed its association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, inflammatory cytokine levels, and clinical outcome. A total of 202 hospitalized participants who tested positive for SARS-CoV-2 by nasopharyngeal sampling were included in this analysis. FIB-4 was calculated for each participant using the alanine aminotransferase, aspartate aminotransferase, age, and platelet count. We evaluated the association between FIB-4 and mortality using both multivariate logistic regression and Cox proportional hazards model. Correlations between FIB-4 and SARS-CoV-2 RNA and cytokine levels were evaluated using the Spearman test. Among the 202 participants, 22 died. The median FIB-4 in participants who survived and died were 1.91 and 3.98 (P < 0.001 by Mann-Whitney U test), respectively. Each one-unit increment in FIB-4 was associated with an increased odds of death (odds ratio, 1.79; 95% confidence interval, 1.36, 2.35; P < 0.001) after adjusting for baseline characteristics including sex, body mass index, hypertension, diabetes, and history of liver diseases. During hospitalization, FIB-4 peaked and then normalized in the survival group but failed to normalize in the death group. FIB-4 was positively correlated with the level of SARS-CoV-2 viral load and monocyte-associated cytokines, especially interleukin-6 and interferon gamma-induced protein 10. Conclusion: FIB-4 is associated with mortality in COVID-19, independent of underlying conditions including liver diseases. FIB-4 may be a simple and inexpensive approach to risk-stratify individuals with COVID-19.
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Affiliation(s)
- Yijia Li
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - James Regan
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Jesse Fajnzylber
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Kendyll Coxen
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Heather Corry
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Colline Wong
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Alexandra Rosenthal
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Caroline Atyeo
- Ragon Institute of MGHMIT and HarvardHarvard Medical SchoolCambridgeMAUSA
| | | | - Elizabeth Gillespie
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Rida Chishti
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Lindsey Baden
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Xu G Yu
- Ragon Institute of MGHMIT and HarvardHarvard Medical SchoolCambridgeMAUSA
| | - Galit Alter
- Ragon Institute of MGHMIT and HarvardHarvard Medical SchoolCambridgeMAUSA
- Division of Infectious DiseasesMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Arthur Kim
- Division of Infectious DiseasesMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Jonathan Z Li
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
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31
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Suri JS, Agarwal S, Gupta SK, Puvvula A, Biswas M, Saba L, Bit A, Tandel GS, Agarwal M, Patrick A, Faa G, Singh IM, Oberleitner R, Turk M, Chadha PS, Johri AM, Miguel Sanches J, Khanna NN, Viskovic K, Mavrogeni S, Laird JR, Pareek G, Miner M, Sobel DW, Balestrieri A, Sfikakis PP, Tsoulfas G, Protogerou A, Misra DP, Agarwal V, Kitas GD, Ahluwalia P, Teji J, Al-Maini M, Dhanjil SK, Sockalingam M, Saxena A, Nicolaides A, Sharma A, Rathore V, Ajuluchukwu JNA, Fatemi M, Alizad A, Viswanathan V, Krishnan PK, Naidu S. A narrative review on characterization of acute respiratory distress syndrome in COVID-19-infected lungs using artificial intelligence. Comput Biol Med 2021; 130:104210. [PMID: 33550068 PMCID: PMC7813499 DOI: 10.1016/j.compbiomed.2021.104210] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/03/2021] [Accepted: 01/03/2021] [Indexed: 02/06/2023]
Abstract
COVID-19 has infected 77.4 million people worldwide and has caused 1.7 million fatalities as of December 21, 2020. The primary cause of death due to COVID-19 is Acute Respiratory Distress Syndrome (ARDS). According to the World Health Organization (WHO), people who are at least 60 years old or have comorbidities that have primarily been targeted are at the highest risk from SARS-CoV-2. Medical imaging provides a non-invasive, touch-free, and relatively safer alternative tool for diagnosis during the current ongoing pandemic. Artificial intelligence (AI) scientists are developing several intelligent computer-aided diagnosis (CAD) tools in multiple imaging modalities, i.e., lung computed tomography (CT), chest X-rays, and lung ultrasounds. These AI tools assist the pulmonary and critical care clinicians through (a) faster detection of the presence of a virus, (b) classifying pneumonia types, and (c) measuring the severity of viral damage in COVID-19-infected patients. Thus, it is of the utmost importance to fully understand the requirements of for a fast and successful, and timely lung scans analysis. This narrative review first presents the pathological layout of the lungs in the COVID-19 scenario, followed by understanding and then explains the comorbid statistical distributions in the ARDS framework. The novelty of this review is the approach to classifying the AI models as per the by school of thought (SoTs), exhibiting based on segregation of techniques and their characteristics. The study also discusses the identification of AI models and its extension from non-ARDS lungs (pre-COVID-19) to ARDS lungs (post-COVID-19). Furthermore, it also presents AI workflow considerations of for medical imaging modalities in the COVID-19 framework. Finally, clinical AI design considerations will be discussed. We conclude that the design of the current existing AI models can be improved by considering comorbidity as an independent factor. Furthermore, ARDS post-processing clinical systems must involve include (i) the clinical validation and verification of AI-models, (ii) reliability and stability criteria, and (iii) easily adaptable, and (iv) generalization assessments of AI systems for their use in pulmonary, critical care, and radiological settings.
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Affiliation(s)
- Jasjit S Suri
- Stroke Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA, USA.
| | - Sushant Agarwal
- Advanced Knowledge Engineering Centre, GBTI, Roseville, CA, USA; Department of Computer Science Engineering, PSIT, Kanpur, India
| | - Suneet K Gupta
- Department of Computer Science Engineering, Bennett University, India
| | - Anudeep Puvvula
- Stroke Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA, USA; Annu's Hospitals for Skin and Diabetes, Nellore, AP, India
| | - Mainak Biswas
- Department of Computer Science Engineering, JIS University, Kolkata, India
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy
| | - Arindam Bit
- Department of Biomedical Engineering, NIT, Raipur, India
| | - Gopal S Tandel
- Department of Computer Science Engineering, VNIT, Nagpur, India
| | - Mohit Agarwal
- Department of Computer Science Engineering, Bennett University, India
| | | | - Gavino Faa
- Department of Pathology - AOU of Cagliari, Italy
| | - Inder M Singh
- Stroke Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA, USA
| | | | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, Delmenhorst, Germany
| | - Paramjit S Chadha
- Stroke Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA, USA
| | - Amer M Johri
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - J Miguel Sanches
- Institute of Systems and Robotics, Instituto Superior Tecnico, Lisboa, Portugal
| | - Narendra N Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
| | | | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, USA
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, RI, USA
| | - Martin Miner
- Men's Health Center, Miriam Hospital Providence, Rhode Island, USA
| | - David W Sobel
- Minimally Invasive Urology Institute, Brown University, Providence, RI, USA
| | | | - Petros P Sfikakis
- Rheumatology Unit, National Kapodistrian University of Athens, Greece
| | - George Tsoulfas
- Aristoteleion University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Vikas Agarwal
- Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK
| | - George D Kitas
- Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK; Arthritis Research UK Epidemiology Unit, Manchester University, Manchester, UK
| | - Puneet Ahluwalia
- Max Institute of Cancer Care, Max Superspeciality Hospital, New Delhi, India
| | - Jagjit Teji
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Mustafa Al-Maini
- Allergy, Clinical Immunology and Rheumatology Institute, Toronto, Canada
| | | | | | - Ajit Saxena
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, Cyprus
| | - Aditya Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Vijay Rathore
- Stroke Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA, USA
| | | | - Mostafa Fatemi
- Dept. of Physiology & Biomedical Engg., Mayo Clinic College of Medicine and Science, MN, USA
| | - Azra Alizad
- Dept. of Radiology, Mayo Clinic College of Medicine and Science, MN, USA
| | - Vijay Viswanathan
- MV Hospital for Diabetes and Professor M Viswanathan Diabetes Research Centre, Chennai, India
| | - P K Krishnan
- Neurology Department, Fortis Hospital, Bangalore, India
| | - Subbaram Naidu
- Electrical Engineering Department, University of Minnesota, Duluth, MN, USA
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32
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Carmona‐Levario P, Manzur‐Sandoval D. Man with dyspnea, dry cough and fever. J Am Coll Emerg Physicians Open 2021; 2:e12376. [PMID: 33554210 PMCID: PMC7846068 DOI: 10.1002/emp2.12376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Daniel Manzur‐Sandoval
- Cardiovascular Critical Care UnitInstituto Nacional de Cardiología Ignacio ChávezMexico CityTlalpanMexico
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33
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Lazzeri C, Bonizzoli M, Peris A. The clinical role of echocardiography in severe COVID-related ARDS: Not just a technical tool. Int J Cardiol 2021; 330:274. [PMID: 33515610 PMCID: PMC7973390 DOI: 10.1016/j.ijcard.2021.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/11/2021] [Accepted: 01/22/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Chiara Lazzeri
- Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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34
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Moody WE, Mahmoud-Elsayed HM, Senior J, Gul U, Khan-Kheil AM, Horne S, Banerjee A, Bradlow WM, Huggett R, Hothi SS, Shahid M, Steeds RP. Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race. CJC Open 2021; 3:91-100. [PMID: 32984798 PMCID: PMC7502228 DOI: 10.1016/j.cjco.2020.09.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Epidemiologic studies suggest that Black, Asian, and minority ethnic (BAME) patients may be at risk of worse outcomes from coronavirus disease-2019 (COVID-19), but the pathophysiological drivers for this association are unknown. This study sought to investigate the relationship between findings on echocardiography, mortality, and race in COVID-19 pneumonia. METHODS This was a multicentre, retrospective, observational study including 164 adults (aged 61 ± 13 years; 78% male; 36% BAME) hospitalized with COVID-19 undergoing echocardiography between March 16 and May 9, 2020 at 3 days (interquartile range 2-5) from admission. The primary outcome was all-cause mortality. RESULTS After a median follow-up of 31 days (interquartile range 14-42 days), 66 (40%) patients had died. The right ventricle was dilated in 62 (38%) patients, and 58 (35%) patients had right ventricular (RV) systolic dysfunction. Only 2 (1%) patients had left ventricular (LV) dilatation, and 133 (81%) had normal or hyperdynamic LV systolic function. Reduced tricuspid annulus planar systolic excursion was associated with elevated D-dimer (ρ = -0.18, P = 0.025) and high-sensitivity cardiac Troponin (ρ = -0.30, P < 0.0001). Reduced RV systolic function (hazard ratio 1.80; 95% confidence interval, 1.05-3.09; P = 0.032) was an independent predictor of all-cause mortality after adjustment for demographic and clinical risk factors. Comparing white and BAME individuals, there were no differences in echocardiography findings, biomarkers, or mortality. CONCLUSIONS In patients hospitalized with COVID-19 pneumonia, reduced RV systolic function is prevalent and associated with all-cause mortality. There is, however, no racial variation in the early findings on echocardiography, biomarkers, or mortality.
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Affiliation(s)
- William E. Moody
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Hani M. Mahmoud-Elsayed
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Jonathan Senior
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Uzma Gul
- Department of Cardiology, Russells Hall Hospital, Dudley, United Kingdom
| | - Ayisha M. Khan-Kheil
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Sebastian Horne
- Department of Cardiology, Russells Hall Hospital, Dudley, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
| | - William M. Bradlow
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Robert Huggett
- Department of Cardiology, Russells Hall Hospital, Dudley, United Kingdom
| | - Sandeep S. Hothi
- Heart & Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Muhammad Shahid
- Department of Cardiology, Russells Hall Hospital, Dudley, United Kingdom
| | - Richard P. Steeds
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
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35
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Dandel M. Pathophysiology of COVID-19-associated acute respiratory distress syndrome. THE LANCET RESPIRATORY MEDICINE 2020; 9:e4. [PMID: 33197385 PMCID: PMC7837097 DOI: 10.1016/s2213-2600(20)30507-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/14/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Michael Dandel
- German Centre for Heart and Circulatory Research (DZHK) Partner Site Berlin, Berlin 107085, Germany.
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36
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Price LC, Garfield B, Bleakley C, Keeling AG, Mcfadyen C, McCabe C, Ridge CA, Wort SJ, Price S, Arachchillage DJ. Rescue therapy with thrombolysis in patients with severe COVID-19-associated acute respiratory distress syndrome. Pulm Circ 2020; 10:2045894020973906. [PMID: 33403100 PMCID: PMC7745572 DOI: 10.1177/2045894020973906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/24/2020] [Indexed: 12/14/2022] Open
Abstract
Acute respiratory distress syndrome in patients with Coronavirus disease 19 is associated with an unusually high incidence of pulmonary embolism and microthrombotic disease, with evidence for reduced fibrinolysis. We describe seven patients requiring invasive ventilation for COVID-19-associated acute respiratory distress syndrome with pulmonary thromboembolic disease, pulmonary hypertension ± severe right ventricular dysfunction on echocardiography, who were treated with alteplase as fibrinolytic therapy. All patients were non-smokers, six (86%) were male and median age was 56.7 (50-64) years. They had failed approaches including therapeutic anticoagulation, prone ventilation (n = 4), inhaled nitric oxide (n = 5) and nebulised epoprostenol (n = 2). The median duration of mechanical ventilation prior to thrombolysis was seven (5-11) days. Systemic alteplase was administered to six patients (50 mg or 90 mg bolus over 120 min) at 16 (10-22) days after symptom onset. All received therapeutic heparin pre- and post-thrombolysis, without intracranial haemorrhage or other major bleeding. Alteplase improved PaO2/FiO2 ratio (from 97.0 (86.3-118.6) to 135.6 (100.7-171.4), p = 0.03) and ventilatory ratio (from 2.76 (2.09-3.49) to 2.36 (1.82-3.05), p = 0.011) at 24 h. Echocardiographic parameters at two (1-3) days (n = 6) showed right ventricular systolic pressure (RVSP) was 63 (50.3-75) then 57 (49-66) mmHg post-thrombolysis (p = 0.26), tricuspid annular planar systolic excursion (TAPSE) was unchanged (from 18.3 (11.9-24.5) to 20.5 (15.4-24.2) mm, p = 0.56) and right ventricular fractional area change (from 15.4 (11.1-35.6) to 31.2 (16.4-33.1)%, p = 0.09). At seven (1-13) days after thrombolysis, using dual energy computed tomography imaging (n = 3), average relative peripheral lung enhancement increased from 12.6 to 21.6% (p = 0.06). In conclusion, thrombolysis improved PaO2/FiO2 ratio and ventilatory ratio at 24 h as rescue therapy in patients with right ventricular dysfunction due to COVID-19-associated ARDS despite maximum therapy, as part of a multimodal approach, and warrants further study.
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Affiliation(s)
- Laura C. Price
- National Pulmonary Hypertension Service, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Benjamin Garfield
- National Pulmonary Hypertension Service, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Intensive Care Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Caroline Bleakley
- Department of Intensive Care Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | | | - Charles Mcfadyen
- Department of Intensive Care Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Colm McCabe
- National Pulmonary Hypertension Service, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Carole A. Ridge
- Department of Radiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Stephen J. Wort
- National Pulmonary Hypertension Service, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Susanna Price
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Intensive Care Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Deepa J. Arachchillage
- Department of Haematology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Department of Immunology and Inflammation, Imperial College London, London, UK
- Department of Haematology, Imperial College Healthcare NHS Trust, London, UK
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