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Furmanek S, Salunkhe V, Pahwa S, Samanapally H, Nathala P, Xu Q, Han Y, Huang EC, Ali T, Deepti F, Glynn A, McGuffin T, Huang JJ, Farah I, Jones CM, Ramirez JA, Clifford SP, Arnold FW, Kong M, Roser L, Huang J. Association between echocardiographic features, troponin levels, and survival time in hospitalized COVID-19 patients with cardiovascular events. JOURNAL OF ANESTHESIA AND TRANSLATIONAL MEDICINE 2024; 3:36-44. [PMID: 38993392 PMCID: PMC11238549 DOI: 10.1016/j.jatmed.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Introduction This study aims to explore the predictive roles of echocardiographic parameters and biomarkers in determining outcomes among hospitalized COVID-19 patients experiencing cardiovascular events. Methods A retrospective cohort study was conducted involving 49 COVID-19 patients who encountered cardiovascular events during hospitalization and underwent echocardiography. Our findings revealed notable associations between echocardiographic parameters and survival time. Results A decrease in left ventricular ejection fraction (LVEF) of 10% was linked to a 20% reduction in survival time (TR: 0.80, 95% CI: 0.67 - 0.96, p = .017). Similarly, an increase in left ventricular (LV) volume by 10 mL was associated with a 9% decrease in survival time (TR: 0.91, 95% CI: 0.84 - 0.98, p = .011). Moreover, an increase in left atrial (LA) volume by 10 mL corresponded to an 8% decrease in survival time (TR: 0.92, 95% CI: 0.86 - 0.99, p = .026). Additionally, each 1 cm increase in right ventricular (RV) diameter was linked to a 22% reduction in survival time (TR: 0.78, 95% CI: 0.61 - 0.99, p = .043). Furthermore, a 10 mL increase in right atrial (RA) volume was associated with a 12% decrease in survival time (TR: 0.88, 95% CI: 0.78 - 0.98, p = .017). Notably, a tenfold rise in troponin levels was linked to a 33% decrease in survival time (TR: 0.67, 95% CI: 0.48 - 0.93, p = .014). Conclusions Our study emphasizes the significant associations between various echocardiographic parameters and troponin levels with reduced survival time among COVID-19 patients experiencing cardiovascular events. These findings highlight the potential utility of echocardiography and troponin assessment in predicting outcomes and guiding management strategies in this patient population.
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Affiliation(s)
- Stephen Furmanek
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
- Norton Infectious Diseases Institute, Norton Healthcare, 234 E Gray St, Louisville, KY 40202, USA
| | - Vidyulata Salunkhe
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Siddharth Pahwa
- Department of Cardiovascular & Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Louisville, KY 40202, USA
| | - Harideep Samanapally
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Pavani Nathala
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Qian Xu
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY 40202, USA
- Biometrics and Data Science, Fosun Pharma, Beijing 100026, China
| | - Yuchen Han
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY 40202, USA
| | - Emma C Huang
- Department of Anesthesiology, Duke University, Durham, NC 27710, USA
| | - T'shura Ali
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Fnu Deepti
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Alex Glynn
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Trevor McGuffin
- School of Nursing, University of Louisville, 555 S Floyd St, Louisville, KY 40202, USA
| | - Justin J Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, 530 S Jackson St, Louisville, KY 40202, USA
| | - Ian Farah
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, 530 S Jackson St, Louisville, KY 40202, USA
| | - Christopher M Jones
- Division of Transplantation, Department of Surgery, University of Louisville, 323 E Chestnut St, Louisville, KY 40202, USA
| | - Julio A Ramirez
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
- Norton Infectious Diseases Institute, Norton Healthcare, 234 E Gray St, Louisville, KY 40202, USA
| | - Sean P Clifford
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, 530 S Jackson St, Louisville, KY 40202, USA
| | - Forest W Arnold
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY 40202, USA
| | - Lynn Roser
- School of Nursing, University of Louisville, 555 S Floyd St, Louisville, KY 40202, USA
| | - Jiapeng Huang
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, 530 S Jackson St, Louisville, KY 40202, USA
- Department of Pharmacology & Toxicology, University of Louisville, 505 S Hancock St, Louisville, KY 40202, USA
- Department of Cardiovascular & Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Louisville, KY 40202, USA
- Center for Integrative Environmental Health Sciences, University of Louisville, 500 S Preston St, Louisville, KY 40202, USA
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Siddique YA, Chaudhry R, Ahmad M, Sebai A, Sharma L, Hassouba M, Virk GS. The Trend of Arrhythmias in Patients With COVID-19: A Complication or Late Manifestation? Cureus 2023; 15:e50746. [PMID: 38239526 PMCID: PMC10794791 DOI: 10.7759/cureus.50746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/22/2024] Open
Abstract
Patients diagnosed with coronavirus disease (CVD) who experience cardiovascular complications or have pre-existing cardiovascular disease are at an increased risk of death. The primary heart-related consequences associated with COVID-19 encompass venous thromboembolism, shock, heart failure, arrhythmias, myocarditis, acute myocardial infarction, and acute cardiac damage. The coronavirus has the potential to induce cardiovascular complications or exacerbate pre-existing CVD through various mechanisms. These mechanisms include dysregulation of the renin-angiotensin-aldosterone system; direct viral toxicity; damage to endothelial cells; formation of blood clots and subsequent inflammation, a phenomenon known as thromboinflammation; an excessive immune response known as cytokine storm; and an imbalance between the demand and supply of oxygen in the body. In this study, we comprehensively analyze the cardiovascular symptoms, histology, and underlying mechanisms associated with COVID-19. Our aim is to contribute to the identification of future research objectives and aid in the advancement of therapeutic management approaches.
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Affiliation(s)
- Yusuf A Siddique
- Basic Sciences, St. George's University School of Medicine, True Blue, GRD
| | | | | | - Ahmad Sebai
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Lubhani Sharma
- Family Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Mohamed Hassouba
- Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, USA
| | - Ghazala S Virk
- Internal Medicine, Avalon University School of Medicine, Ohio, USA
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José SG, Carrizales-Sepúlveda EF, Vera-Pineda R, Morales-Rendón EJ, de Jesús Ortiz-Corona J, Flores-Ramírez R. Takotsubo Cardiomyopathy and COVID-19: A Case Report and Literature Review. Curr Cardiol Rev 2023; 19:e180822207660. [PMID: 35984028 PMCID: PMC10201897 DOI: 10.2174/1573403x18666220818155039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/03/2022] [Accepted: 06/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy is characterized by transient regional ventricular abnormalities in the absence of coronary artery disease and is reported as a complication of COVID-19. CASE PRESENTATION It can have a diverse clinical presentation, occasionally resembling an acute coronary syndrome, and progress to acute heart failure and cardiogenic shock, adversely affecting patients' prognosis. A high index of suspicion and a thorough diagnostic approach supported by ancillary studies like echocardiography and coronary angiography is key for an accurate diagnosis and correct medical treatment. Herein, we report a patient with severe COVID-19 who developed Takotsubo cardiomyopathy. CONCLUSION We also present a detailed literature review regarding the relationship between COVID-19 and Takotsubo cardiomyopathy.
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Affiliation(s)
- Solís Gabriel José
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | | | - Raymundo Vera-Pineda
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Eliu Jefte Morales-Rendón
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
- Division of Interventional Cardiology, Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - José de Jesús Ortiz-Corona
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
- Division of Interventional Cardiology, Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Ramiro Flores-Ramírez
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
- Echocardiography Laboratory, Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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Ghasemi H, Kazemian S, Nejadghaderi SA, Shafie M. Takotsubo syndrome and COVID‐19: A systematic review. Health Sci Rep 2023; 6:e972. [PMID: 36479387 PMCID: PMC9718950 DOI: 10.1002/hsr2.972] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/30/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Aims Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is characterized by acute and transient left ventricular dysfunction and has increased during the COVID-19 pandemic. Herein, we aim to review studies on TTS that were associated with COVID-19 infection, vaccine, and other COVID-19-related etiologies including psychosocial stressors. Methods We systematically searched PubMed, EMBASE, and Scopus up to May 12, 2022. We included case reports, case series, and original articles that reported at least one TTS case associated with COVID-19, or TTS cases after receiving COVID-19 vaccines, or TTS cases secondary to psychological stress due to the COVID-19 pandemic. The quality assessment was conducted using the Joanna Briggs Institute checklist. Results Sixty-seven articles including 102 cases were included. Hypertension was the most frequently accompanying comorbidity (N = 67 [65.6%]) and the mean left ventricular ejection fraction was 36.5%. Among COVID-19 patients, the in-hospital mortality rate was 33.3%. On the other hand, only one COVID-19-negative individual expired (2.3%). The most common presenting clinical symptom was dyspnea in 42 (73.6%) patients. the mean time interval from the first symptom to admission was 7.2 days. The most common chest imaging finding was ground-glass opacity which was reported in 14 (31.1%) participants. The most common abnormalities were T-wave inversion in 35 (43.2%) and ST-segment elevation in 30 (37%). Brain natriuretic peptide and troponin were elevated in 94.7% and 95.9% of participants, respectively. Conclusion The TTS in patients with COVID-19 is almost rare, whereas it could lead to a great mortality and morbidity. An individual with COVID-19, especially an elderly woman, presented with dyspnea in addition to a rise in brain natriuretic peptide and troponin should be evaluated for TTS.
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Affiliation(s)
- Hoomaan Ghasemi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran
| | - Sina Kazemian
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Seyed Aria Nejadghaderi
- Research Center for Integrative Medicine in Aging, Aging Research Institute Tabriz University of Medical Sciences Tabriz Iran
- Systematic Review and Meta‐Analysis Expert Group (SRMEG) Universal Scientific Education and Research Network (USERN) Tehran Iran
| | - Mahan Shafie
- School of Medicine Tehran University of Medical Sciences Tehran Iran
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5
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Li M, Nguyen CN, Toleva O, Mehta PK. Takotsubo syndrome: A current review of presentation, diagnosis, and management. Maturitas 2022; 166:96-103. [PMID: 36108540 DOI: 10.1016/j.maturitas.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 12/25/2022]
Abstract
Takotsubo syndrome is a syndrome of acute heart failure due to left ventricular systolic dysfunction that is associated with increased cardiovascular morbidity and mortality. It occurs in both sexes and at all ages, but predominates in post-menopausal women for reasons that are unclear. In a patient who presents with cardiac symptoms, electrocardiographic changes, and/or biomarker elevation indicating myocardial stress (i.e. troponin elevation), this condition should be considered in the differential diagnosis. Cardiac imaging is critical for a timely diagnosis of this condition and has management implications. This syndrome can occur with or without underlying coronary artery disease, and while there are various characteristic myocardial patterns described on imaging, the most common one is left ventricular dysfunction due to apical stunning with basal hyperkinesis. In the acute phase, Takotsubo syndrome can lead to life-threatening sequelae, including cardiogenic shock, pulmonary edema, thromboembolism, and arrhythmias. Multiple pathophysiologic mechanisms are implicated, including an acute increase in left ventricular afterload in the setting of sympathetic activation with a catecholamine storm, multi-vessel coronary vasospasm, coronary endothelial microvascular dysfunction, and inflammation. In this review, we discuss the current knowledge surrounding presentation, diagnosis, and treatment of this under-diagnosed condition.
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Affiliation(s)
- Monica Li
- J. Willis Hurst Internal Medicine Residency Training Program, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Christopher N Nguyen
- Northside Hospital Gwinnett Internal Medicine Residency Program, Lawrenceville, GA, United States of America
| | - Olga Toleva
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, United States of America; Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Puja K Mehta
- Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America.
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6
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Guglin M, Ballut K, Ilonze O, Jones M, Rao R. Clinical variants of myocardial involvement in COVID-19-positive patients: a cumulative experience of 2020. Heart Fail Rev 2022; 27:1341-1353. [PMID: 34215924 PMCID: PMC8252982 DOI: 10.1007/s10741-021-10129-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/11/2022]
Abstract
Myocardial injury, diagnosed by troponin elevation, is common in COVID-19 patients, but cardiac involvement with clinical manifestations occurs less frequently. We analyzed the literature on COVID-19 (2020) and systematically reviewed the cases where individual patient data were presented. We searched PubMed and Google Scholar for "COVID," "COVID-19," and "coronavirus" in combination with "myocarditis," "heart failure," "takotsubo," "cardiomyopathy," and "cardiogenic shock." We identified 90 cases of COVID-19 with myocardial involvement, mean age 52.9 ± 18.3 years, 54.5% males. Of them, 55 survived (61.1%), 20 died (22.2%), and in 15 (16.7%) the outcome was unknown at the time of publication. Among patients with known outcome, mortality was 26%. The nadir LVEF was 31.7 ± 13.1% and recovered to 50.1 ± 16.0%. Pericardial effusion was a common finding, reported in 21 (23.3%) of patients, including moderate size effusion in 8.9% and large in 7.8%. The effusion caused tamponade in 11 (12.2%) of patients. Out of 83 patients who experienced a decrease in LVEF, 30 could be classified as takotsubo syndrome. The takotsubo patients were older than those with myocarditis, and with relatively high proportion of males. About one third of the cases was complicated by cardiogenic shock. Myocardial involvement in COVID-19 patients most often presents as a new, rapid decrease in LVEF, although normal LVEF or takotsubo-like wall motion pattern does not rule out myocarditis. Moderate and large pericardial effusion is common, and cardiac tamponade occurs in 12.2% of patients. Cardiogenic shock develops in one third of the patients. Mortality appears to be high at 26%.
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Affiliation(s)
- Maya Guglin
- Krannert Institute of Cardiology, Indiana University, 1801 Senate Blvd Suite 2000, IN, 46202, Indianapolis, USA.
| | - Kareem Ballut
- Krannert Institute of Cardiology, Indiana University, 1801 Senate Blvd Suite 2000, IN, 46202, Indianapolis, USA
| | - Onyedika Ilonze
- Krannert Institute of Cardiology, Indiana University, 1801 Senate Blvd Suite 2000, IN, 46202, Indianapolis, USA
| | - Mark Jones
- Krannert Institute of Cardiology, Indiana University, 1801 Senate Blvd Suite 2000, IN, 46202, Indianapolis, USA
| | - Roopa Rao
- Krannert Institute of Cardiology, Indiana University, 1801 Senate Blvd Suite 2000, IN, 46202, Indianapolis, USA
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7
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Bairashevskaia AV, Belogubova SY, Kondratiuk MR, Rudnova DS, Sologova SS, Tereshkina OI, Avakyan EI. Update of Takotsubo cardiomyopathy: Present experience and outlook for the future. IJC HEART & VASCULATURE 2022; 39:100990. [PMID: 35281752 PMCID: PMC8913320 DOI: 10.1016/j.ijcha.2022.100990] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/21/2022]
Abstract
Takotsubo cardiomyopathy (TTS) has become a recognised clinical entity since the Japanese scientist Sato first described it in 1990. Despite an increasing number of confirmed cases, especially during the COVID-19 pandemic, its pathophysiology remains incompletely understood, and decision-making differs in the diagnosis and treatment. In addition, it is not evident whether a significant increase in TTS is due to better understanding among practitioners and widespread access to coronary angiography, or if it is a reflection of an actual increase in incidence. We analysed a series of international research studies from 1990 to 2021. Beyond epidemiology and clinical presentation, we evaluated and summarised fundamental knowledge about various predisposing factors, with particular attention to the iatrogenic impact of certain drugs, namely antidepressants, chemotherapy, and antiarrhythmics. Furthermore, we highlighted the main pathophysiological theories to date. In addition, based on published studies and clinical cases, we investigated the role of numerous diagnostic approaches in the differential diagnosis of TTS and identified predictors of TTS complications, such as cardiogenic shock, ventricular fibrillation, and left ventricular thrombi. Accordingly, we sought to propose a diagnostic algorithm and further treatment management of TTS under the presence of possible complications to help practitioners make more informed decisions, as the initial presentation continues to pose a challenge due to its close similarity to acute coronary syndrome with ST-elevation. In conclusion, this article examines Takotsubo cardiomyopathy from different perspectives and, along with future systematic reviews and meta-analyses, can be of particular interest to practising cardiologists and researchers in developing clinical guidelines.
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Affiliation(s)
- Anastasiia V. Bairashevskaia
- Department of Paediatrics, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Sofiya Y. Belogubova
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- AMEE International Networking Centre, Sechenov First Moscow State Medical University (Sechenov University), 123242 Moscow, Russia
| | - Mikhail R. Kondratiuk
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Daria S. Rudnova
- International School “Medicine of the Future”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Susanna S. Sologova
- Department of Pharmacology, Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), 119571 Moscow, Russia
| | - Olga I. Tereshkina
- Department of Pharmacology, Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), 119571 Moscow, Russia
| | - Esma I. Avakyan
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- AMEE International Networking Centre, Sechenov First Moscow State Medical University (Sechenov University), 123242 Moscow, Russia
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Saed Aldien A, Ganesan GS, Wahbeh F, Al-Nassr N, Altarawneh H, Al Theyab L, Saed Aldien S, Tomerak S, Naveed H, Elshazly MB, Zakaria D. Systemic Inflammation May Induce Cardiac Injury in COVID-19 Patients Including Children and Adolescents Without Underlying Cardiovascular Diseases: A Systematic Review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 35:169-178. [PMID: 33952432 PMCID: PMC8046745 DOI: 10.1016/j.carrev.2021.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019(COVID-19) is an ongoing global pandemic with a daily increasing number of affected individuals and a relatively high mortality rate. COVID-19 patients that develop cardiac injury are at increased risk of a worse clinical course with higher rates of mortality. Increasing amounts of evidence suggest that a system-wide inflammatory response and a cytokine storm mediated type syndrome plays a crucial role in disease progression. This systematic review investigates the possible role of hyperinflammation in inducing cardiac injury as one of the severe complications of COVID-19. A systematic literature search was performed using PubMed, Embase and Scopus databases to identify relevant clinical studies that investigated cardiovascular injury manifestations and reported inflammatory and cardiac biomarkers in COVID-19 patients. Only 29 studies met our inclusion criteria and the majority of these studies demonstrated significantly elevated inflammatory and cardiac blood markers. It was evident that underlying cardiovascular diseases may increase the risk of developing cardiac injury. However, many COVID-19 patients included in this review, developed different types of cardiac injury without having any underlying cardiovascular diseases. Furthermore, many of these patients were either children or adolescents. Therefore, age and comorbidities may not always be the two main risk factors that dictate the severity and outcome of COVID-19. Further investigations are required to understand the underlying mechanisms of pathogenicity as an urgent requirement to develop the appropriate treatment and prevention strategies. These strategies may specifically target hyperinflammation as a suspected driving factor for some of the severe complications of COVID-19.
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Affiliation(s)
- Arwa Saed Aldien
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al, Luqta St. Ar-Rayyan, P.O. Box 24144, Doha, Qatar
| | - Gowrii S. Ganesan
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al, Luqta St. Ar-Rayyan, P.O. Box 24144, Doha, Qatar
| | - Farah Wahbeh
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al, Luqta St. Ar-Rayyan, P.O. Box 24144, Doha, Qatar
| | - Noor Al-Nassr
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al, Luqta St. Ar-Rayyan, P.O. Box 24144, Doha, Qatar
| | - Heba Altarawneh
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al, Luqta St. Ar-Rayyan, P.O. Box 24144, Doha, Qatar
| | - Lolwa Al Theyab
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al, Luqta St. Ar-Rayyan, P.O. Box 24144, Doha, Qatar
| | | | - Sara Tomerak
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al, Luqta St. Ar-Rayyan, P.O. Box 24144, Doha, Qatar
| | - Hiba Naveed
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al, Luqta St. Ar-Rayyan, P.O. Box 24144, Doha, Qatar
| | - Mohamed B. Elshazly
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al, Luqta St. Ar-Rayyan, P.O. Box 24144, Doha, Qatar
| | - Dalia Zakaria
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al, Luqta St. Ar-Rayyan, P.O. Box 24144, Doha, Qatar.
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Moady G, Atar S. Stress-Induced Cardiomyopathy—Considerations for Diagnosis and Management during the COVID-19 Pandemic. Medicina (B Aires) 2022; 58:medicina58020192. [PMID: 35208516 PMCID: PMC8875249 DOI: 10.3390/medicina58020192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) is associated with several cardiovascular manifestations including myocardial injury, myocarditis, arrhythmia, and pulmonary embolism. Rare cases of stress-induced cardiomyopathy, or takotsubo syndrome have also been reported during the acute infection, and secondary to stress following lockdown and self-isolation. Diagnosis in the setting of the acute infection is challenging since conventional imaging modalities such as transthoracic echocardiography and coronary angiography should be restricted to minimize physician-patient contact until the patients is tested negative for COVID-19. The use of point of care hand-held ultrasound is appropriate for this purpose. The overall course of the disease seems to be similar to takotsubo in the general population. Physicians should be familiar with the clinical presentation, possible complications, and management of takotsubo during COVID-19 outbreak. Here, we review the special considerations in the diagnosis and management of takotsubo syndrome during the current pandemic.
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Affiliation(s)
- Gassan Moady
- Department of Cardiology, Galilee Medical Center, Nahariya 2221006, Israel;
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 5290002, Israel
- Correspondence: ; Tel.: +972-4-9107273
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya 2221006, Israel;
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 5290002, Israel
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Techasatian W, Nishimura Y, Nagamine T, Ha G, Huang R, Shah P, Yeo J, Kanitsoraphan C. Characteristics of Takotsubo cardiomyopathy in patients with COVID-19: Systematic scoping review. AMERICAN HEART JOURNAL PLUS: CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100092. [PMID: 35128499 PMCID: PMC8802667 DOI: 10.1016/j.ahjo.2022.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/01/2022] [Indexed: 12/01/2022]
Abstract
Background COVID-19 has recently been associated with the development of Takotsubo cardiomyopathy (TCM). This scoping review aims to summarize the existing evidence regarding TCM in COVID-19 and offer future direction for study. Methods Following the PRISMA Extension for Scoping Reviews, MEDLINE and EMBASE were searched for all peer-reviewed articles with relevant keywords including “Takotsubo”, “Stress-induced cardiomyopathy” and “COVID-19” from their inception to September 25, 2021. Results A total of 40 articles with 52 cases were included. Patients with TCM and COVID-19 showed only slight female predominance (59.6%), median age of 68.5 years, and were mostly of the apical subtype (88.6%). All-cause mortality was 36.5%. The median LVEF was 30%. Compared to those without TCM, those with TCM in COVID-19 had more critical illness, higher mortality, lower LVEF, and higher cardiac and inflammatory biomarkers. Notably, the diagnostic criteria of TCM were considerably different between case reports and observational studies. Conclusion This scoping review identifies that TCM in COVID-19 may have distinct features that distinguish this condition from TCM without COVID-19. Future studies are warranted to help describe risk factors, determine the utility of inflammatory biomarkers and serum catecholamine levels, and establish disease-specific diagnostic criteria.
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11
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Takamizawa K, Shindo T, Ono H, Kato H. Infantile takotsubo cardiomyopathy following human metapneumovirus infection. Pediatr Int 2022; 64:e15125. [PMID: 35396781 DOI: 10.1111/ped.15125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/29/2021] [Accepted: 01/11/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Koichi Takamizawa
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | - Takahiro Shindo
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | - Hitoshi Kato
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
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12
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Ribeiro Queirós P, Caeiro D, Ponte M, Guerreiro C, Silva M, Pipa S, Rios AL, Adrião D, Neto R, Teixeira P, Silva G, Silva M, Ferreira ND, Castelões P, Braga P. Fighting the pandemic with collaboration at heart: Report from cardiologists in a COVID-19-dedicated Portuguese intensive care unit. Rev Port Cardiol 2021; 40:923-928. [PMID: 34922698 PMCID: PMC8673477 DOI: 10.1016/j.repce.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 01/10/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The coronavirus disease 2019 (COVID-19) spread quickly around the world. Although mainly a respiratory illness, there is growing interest in non-respiratory manifestations, particularly cardiovascular ones. At our center, mobilization of cardiologists with intensive care training was needed. Our aim is to describe patients with severe COVID-19 admitted to a Portuguese intensive care unit (ICU), the cardiovascular impact of the disease and the experience of cardiologists working in a COVID-19 ICU. METHODS Data from adult patients with COVID-19 admitted to the ICU of Centro Hospitalar de Vila Nova de Gaia/Espinho between 16 March 2020 and 21 April 2020 were analyzed retrospectively. RESULTS Thirty-five patients were admitted. Mean age was 62.6±6.0 years and 23 (65.7%) were male. Dyslipidemia was the most common cardiovascular risk factor (65.7%, n=23), followed by hypertension (57.1%, n=20). Mean ICU stay time was 15.9±10.0 days. Patients had high rates of mechanical ventilation (88.6%, n=31) and vasopressor support (88.6%, n=31). Low rates of new onset left systolic dysfunction were detected (8.5%, n=2). One patient required venoarterial extra-corporeal membrane oxygenation. Mortality was 25% (n=9). Acute myocardial injury and N-terminal pro-B-type natriuretic peptide (NT-proBNP) elevation was detected in 62.9% (n=22). Patients that died had higher NT-proBNP compared to those discharged alive (p<0.05). Care by cardiologists frequently changed decision making. CONCLUSIONS The cardiovascular impact of COVID-19 seems relevant but is still widely unknown. Studies are needed to clarify the role of cardiac markers in COVID-19 prognosis. Multidisciplinary care most likely results in improved patient care.
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Affiliation(s)
- Pedro Ribeiro Queirós
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal.
| | - Daniel Caeiro
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Marta Ponte
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Cláudio Guerreiro
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Marisa Silva
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Sara Pipa
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Intensive Care Department, Vila Nova de Gaia, Portugal
| | - Ana Lúcia Rios
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Intensive Care Department, Vila Nova de Gaia, Portugal
| | - Diana Adrião
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Intensive Care Department, Vila Nova de Gaia, Portugal
| | - Raul Neto
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Intensive Care Department, Vila Nova de Gaia, Portugal
| | - Pedro Teixeira
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Gualter Silva
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Mariana Silva
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Nuno Dias Ferreira
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Paula Castelões
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Intensive Care Department, Vila Nova de Gaia, Portugal
| | - Pedro Braga
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
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13
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Ribeiro Queirós P, Caeiro D, Ponte M, Guerreiro C, Silva M, Pipa S, Rios AL, Adrião D, Neto R, Teixeira P, Silva G, Silva M, Ferreira ND, Castelões P, Braga P. Fighting the pandemic with collaboration at heart: Report from cardiologists in a COVID-19-dedicated Portuguese intensive care unit. Rev Port Cardiol 2021; 40:923-928. [PMID: 34429566 PMCID: PMC8376649 DOI: 10.1016/j.repc.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 01/10/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The coronavirus disease 2019 (COVID-19) spread quickly around the world. Although mainly a respiratory illness, there is growing interest in non-respiratory manifestations, particularly cardiovascular ones. At our center, mobilization of cardiologists with intensive care training was needed. Our aim is to describe patients with severe COVID-19 admitted to a Portuguese intensive care unit (ICU), the cardiovascular impact of the disease and the experience of cardiologists working in a COVID-19 ICU. METHODS Data from adult patients with COVID-19 admitted to the ICU of Centro Hospitalar de Vila Nova de Gaia/Espinho between 16 March 2020 and 21 April 2020 were analyzed retrospectively. RESULTS Thirty-five patients were admitted. Mean age was 62.6±6.0 years and 23 (65.7%) were male. Dyslipidemia was the most common cardiovascular risk factor (65.7%, n=23), followed by hypertension (57.1%, n=20). Mean ICU stay time was 15.9±10.0 days. Patients had high rates of mechanical ventilation (88.6%, n=31) and vasopressor support (88.6%, n=31). Low rates of new onset left systolic dysfunction were detected (8.5%, n=2). One patient required venoarterial extra-corporeal membrane oxygenation. Mortality was 25% (n=9). Acute myocardial injury and N-terminal pro-B-type natriuretic peptide (NT-proBNP) elevation was detected in 62.9% (n=22). Patients that died had higher NT-proBNP compared to those discharged alive (p<0.05). Care by cardiologists frequently changed decision making. CONCLUSIONS The cardiovascular impact of COVID-19 seems relevant but is still widely unknown. Studies are needed to clarify the role of cardiac markers in COVID-19 prognosis. Multidisciplinary care most likely results in improved patient care.
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Affiliation(s)
- Pedro Ribeiro Queirós
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Daniel Caeiro
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Marta Ponte
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Cláudio Guerreiro
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Marisa Silva
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Sara Pipa
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Intensive Care Department, Vila Nova de Gaia, Portugal
| | - Ana Lúcia Rios
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Intensive Care Department, Vila Nova de Gaia, Portugal
| | - Diana Adrião
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Intensive Care Department, Vila Nova de Gaia, Portugal
| | - Raul Neto
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Intensive Care Department, Vila Nova de Gaia, Portugal
| | - Pedro Teixeira
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Gualter Silva
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Mariana Silva
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Nuno Dias Ferreira
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
| | - Paula Castelões
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Intensive Care Department, Vila Nova de Gaia, Portugal
| | - Pedro Braga
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Cardiology Department, Vila Nova de Gaia, Portugal
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14
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Haussner W, DeRosa AP, Haussner D, Tran J, Torres-Lavoro J, Kamler J, Shah K. COVID-19 associated myocarditis: A systematic review. Am J Emerg Med 2021; 51:150-155. [PMID: 34739868 PMCID: PMC8531234 DOI: 10.1016/j.ajem.2021.10.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/28/2021] [Accepted: 10/02/2021] [Indexed: 12/15/2022] Open
Abstract
Background Most COVID-19 infections result in a viral syndrome characterized by fever, cough, shortness of breath, and myalgias. A small but significant proportion of patients develop severe COVID-19 resulting in respiratory failure. Many of these patients also develop multi-organ dysfunction as a byproduct of their critical illness. Although heart failure can be a part of this, there also appears to be a subset of patients who have primary cardiac collapse from COVID-19. Objective Conduct a systematic review of COVID-19-associated myocarditis, including clinical presentation, risk factors, and prognosis. Discussion Our review demonstrates two distinct etiologies of primary acute heart failure in surprisingly equal incidence in patients with COVID-19: viral myocarditis and Takotsubo cardiomyopathy. COVID myocarditis, Takotsubo cardiomyopathy, and severe COVID-19 can be clinically indistinguishable. All can present with dyspnea and evidence of cardiac injury, although in myocarditis and Takotsubo this is due to primary cardiac dysfunction as compared to respiratory failure in severe COVID-19. Conclusion COVID-19-associated myocarditis differs from COVID-19 respiratory failure by an early shock state. However, not all heart failure from COVID-19 is from direct viral infection; some patient's develop takotsubo cardiomyopathy. Regardless of etiology, steroids may be a beneficial treatment, similar to other critically ill COVID-19 patients. Evidence of cardiac injury in the form of ECG changes or elevated troponin in patients with COVID-19 should prompt providers to consider concurrent myocarditis.
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Affiliation(s)
- William Haussner
- New York Presbyterian-Weill Cornell Medicine, 525 East 68(th) Street, New York, NY 10065, USA.
| | - Antonio P DeRosa
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, 1305 York Ave., New York, NY 10065, USA.
| | - Danielle Haussner
- New York Presbyterian-Weill Cornell Medicine, 525 East 68(th) Street, New York, NY 10065, USA.
| | - Jacqueline Tran
- Weill Cornell Medicine, Weill Cornell Medical College, 1300 York Ave., New York, NY 10065, USA.
| | - Jane Torres-Lavoro
- Weill Cornell Medicine, Emergency Medicine, 525 East 68(th) Street, Box 179, New York, NY 10065, USA.
| | - Jonathan Kamler
- New York Presbyterian-Weill Cornell Medicine, 525 East 68(th) Street, New York, NY 10065, USA.
| | - Kaushal Shah
- New York Presbyterian-Weill Cornell Medicine, 525 East 68(th) Street, New York, NY 10065, USA.
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15
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Fan S, Gao L, Bell AC, Azure JA, Wang Y. Spontaneous myogenic fasciculation associated with the lengthening of cardiac muscle in response to static preloading. Sci Rep 2021; 11:14794. [PMID: 34285326 PMCID: PMC8292328 DOI: 10.1038/s41598-021-94335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
Force enhancement is one kind of myogenic spontaneous fasciculation in lengthening preload striated muscles. In cardiac muscle, the role of this biomechanical event is not well established. The physiological passive property is an essential part for maintaining normal diastole in the heart. In excessive preload heart, force enhancement relative erratic passive properties may cause muscle decompensating, implicate in the development of diastolic dysfunction. In this study, the force enhancement occurrence in mouse cardiac papillary muscle was evaluated by a microstepping stretch method. The intracellular Ca2+ redistribution during occurrence of force enhancement was monitored in real-time by a Flou-3 (2 mM) indicator. The force enhancement amplitude, the enhancement of the prolongation time, and the tension-time integral were analyzed by myography. The results indicated that the force enhancement occurred immediately after active stretching and was rapidly enhanced during sustained static stretch. The presence of the force and the increase in the amplitude synchronized with the acquisition and immediate transfer of Ca2+ to adjacent fibres. In highly preloaded fibres, the enhancement exceeded the maximum passive tension (from 4.49 ± 0.43 N/mm2 to 6.20 ± 0.51 N/mm2). The occurrence of force enhancement were unstable in each static stretch. The increased enhancement amplitude combined with the reduced prolongation time to induce a reduction in the tension-time integral. We concluded that intracellular Ca2+-synchronized force enhancement is one kind of interruption event in excessive preload cardiac muscle. During the cardiac muscle in its passive relaxation period, the occurrence of this interruption affected the rhythmic stability of the cardiac relaxation cycle.
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Affiliation(s)
- Shouyan Fan
- grid.443397.e0000 0004 0368 7493Laboratory of Extreme Environment Sports Medicine, Hainan Medical University, No. 3 Chengxi Xueyuan Road, Haikou, Hainan PFTZ 571199 China
| | - Lingfeng Gao
- grid.443397.e0000 0004 0368 7493Laboratory of Extreme Environment Sports Medicine, Hainan Medical University, No. 3 Chengxi Xueyuan Road, Haikou, Hainan PFTZ 571199 China
| | - Annie Christel Bell
- grid.443397.e0000 0004 0368 7493Laboratory of Extreme Environment Sports Medicine, Hainan Medical University, No. 3 Chengxi Xueyuan Road, Haikou, Hainan PFTZ 571199 China ,grid.443397.e0000 0004 0368 7493School of Emergency Trauma, Hainan Medical University, Haikou, Hainan PFTZ 571199 China
| | - Joseph Akparibila Azure
- grid.443397.e0000 0004 0368 7493Laboratory of Extreme Environment Sports Medicine, Hainan Medical University, No. 3 Chengxi Xueyuan Road, Haikou, Hainan PFTZ 571199 China ,grid.443397.e0000 0004 0368 7493School of Emergency Trauma, Hainan Medical University, Haikou, Hainan PFTZ 571199 China
| | - Yang Wang
- grid.443397.e0000 0004 0368 7493Laboratory of Extreme Environment Sports Medicine, Hainan Medical University, No. 3 Chengxi Xueyuan Road, Haikou, Hainan PFTZ 571199 China
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16
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AKKUŞ O, BAL T, YAGOOBİ H, BEKLER Ö, AKKUŞ G, ÇABALAK M. Hastanede yatan COVID-19 hastalarında elektrokardiyografik bulgular ve hidroksiklorokin + azitromisin tedavisinin kardiyak güvenliği. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.856174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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17
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Omidi F, Hajikhani B, Kazemi SN, Tajbakhsh A, Riazi S, Mirsaeidi M, Ansari A, Ghanbari Boroujeni M, Khalili F, Hadadi S, Nasiri MJ. COVID-19 and Cardiomyopathy: A Systematic Review. Front Cardiovasc Med 2021; 8:695206. [PMID: 34222385 PMCID: PMC8248804 DOI: 10.3389/fcvm.2021.695206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/21/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Cardiomyopathies (CMPs) due to myocytes involvement are among the leading causes of sudden adolescent death and heart failure. During the COVID-19 pandemic, there are limited data available on cardiac complications in patients with COVID-19, leading to severe outcomes. Methods: We conducted a systematic search in Pubmed/Medline, Web of Science, and Embase databases up to August 2020, for all relevant studies about COVID-19 and CMPs. Results: A total of 29 articles with a total number of 1460 patients were included. Hypertension, diabetes, obesity, hyperlipidemia, and ischemic heart disease were the most reported comorbidities among patients with COVID-19 and cardiomyopathy. In the laboratory findings, 21.47% of patients had increased levels of troponin. Raised D-dimer levels were also reported in all of the patients. Echocardiographic results revealed mild, moderate, and severe Left Ventricular (LV) dysfunction present in 17.13, 11.87, and 10% of patients, respectively. Conclusions: Cardiac injury and CMPs were common conditions in patients with COVID-19. Therefore, it is suggested that cardiac damage be considered in managing patients with COVID-19.
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Affiliation(s)
- Fatemeh Omidi
- Department of Cardiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyedeh Neda Kazemi
- Preventative Gynecology Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ardeshir Tajbakhsh
- Anesthesiology Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sajedeh Riazi
- Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Mirsaeidi
- Department of Pulmonary and Critical Care, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ali Ansari
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Farima Khalili
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Hadadi
- Department of Pulmonary and Critical Care, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Moady G, Atar S. Takotsubo syndrome during the COVID-19 pandemic, state-of -the- art review. CJC Open 2021; 3:1249-1256. [PMID: 34056570 PMCID: PMC8149464 DOI: 10.1016/j.cjco.2021.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/16/2021] [Indexed: 12/02/2022] Open
Abstract
The current coronavirus disease 2019 (COVID-19) presents an ongoing medical challenge, as it involves multiple organs, including the cardiovascular system. Takotsubo syndrome (TTS) has been described in the context of COVID-19 in 2 different scenarios: as a direct complication of the infection, and as an indirect outcome secondary to the psychological burden of quarantine and social isolation (ie, stress-induced cardiomyopathy). Confirming the diagnosis of TTS in COVID-19 may be challenging due to the limited use of coronary angiography consistent with the recommended guidelines aimed at minimizing contact with infected individuals. The use of natriuretic peptide as a diagnostic and prognostic marker in this context may not be reliable as this peptide is already elevated in severe cases of COVID-19 regardless of TTS diagnosis. A relatively high incidence of complications has been reported in these cases, probably related to the severity of the underlying infectious disease. Although quarantine-induced stress cardiomyopathy is an unsurprising outcome of the powerful stress resulting from the current pandemic, conflicting results have been reported, and further studies are encouraged to determine the true incidence.
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Affiliation(s)
- Gassan Moady
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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19
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Manolis AS, Manolis AA, Manolis TA, Melita H. COVID-19 and Acute Myocardial Injury and Infarction: Related Mechanisms and Emerging Challenges. J Cardiovasc Pharmacol Ther 2021; 26:399-414. [PMID: 33949887 DOI: 10.1177/10742484211011026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the era of the coronavirus disease 2019 (COVID-19) pandemic, acute cardiac injury (ACI), as reflected by elevated cardiac troponin above the 99th percentile, has been observed in 8%-62% of patients with COVID-19 infection with highest incidence and mortality recorded in patients with severe infection. Apart from the clinically and electrocardiographically discernible causes of ACI, such as acute myocardial infarction (MI), other cardiac causes need to be considered such as myocarditis, Takotsubo syndrome, and direct injury from COVID-19, together with noncardiac conditions, such as pulmonary embolism, critical illness, and sepsis. Acute coronary syndromes (ACS) with normal or near-normal coronary arteries (ACS-NNOCA) appear to have a higher prevalence in both COVID-19 positive and negative patients in the pandemic compared to the pre-pandemic era. Echocardiography, coronary angiography, chest computed tomography and/or cardiac magnetic resonance imaging may render a correct diagnosis, obviating the need for endomyocardial biopsy. Importantly, a significant delay has been recorded in patients with ACS seeking advice for their symptoms, while their routine care has been sharply disrupted with fewer urgent coronary angiographies and/or primary percutaneous coronary interventions performed in the case of ST-elevation MI (STEMI) with an inappropriate shift toward thrombolysis, all contributing to a higher complication rate in these patients. Thus, new challenges have emerged in rendering a diagnosis and delivering treatment in patients with ACI/ACS in the pandemic era. These issues, the various mechanisms involved in the development of ACI/ACS, and relevant current guidelines are herein reviewed.
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Affiliation(s)
- Antonis S Manolis
- First Department of Cardiology, 68989Athens University School of Medicine, Athens, Greece
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20
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Almas T, Khedro T, Haadi A, Ahmed R, Alshaikh L, Al-Awaid AH, Panhwar MS, Hassan Virk HU. COVID-19-induced takotsubo cardiomyopathy: Venturing beyond the obvious. Ann Med Surg (Lond) 2021; 65:102291. [PMID: 33981423 PMCID: PMC8082200 DOI: 10.1016/j.amsu.2021.102291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/04/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tarek Khedro
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Abdul Haadi
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Reema Ahmed
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Lamees Alshaikh
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Muhammad Siyab Panhwar
- Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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21
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John K, Lal A, Mishra A. A review of the presentation and outcome of takotsubo cardiomyopathy in COVID-19. Monaldi Arch Chest Dis 2021; 91. [PMID: 33759445 DOI: 10.4081/monaldi.2021.1710] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/23/2021] [Indexed: 12/26/2022] Open
Abstract
Although the most frequent presentation of the novel Coronavirus disease-2019 (COVID-19) is a respiratory syndrome, cardiac involvement is being increasingly recognized. One such entity is takotsubo cardiomyopathy. We sought to review the various cases of takotsubo cardiomyopathy reported during the COVID-19 pandemic and consolidate the information available on its clinical features, evaluation and treatment. We performed a PubMed search using the MeSH terms "Takotsubo Cardiomyopathy" or "Stress Cardiomyopathy" and "COVID-19", and identified 16 case reports, two case series, and one retrospective cohort study. There was a total of 24 reported patients with COVID-19 infection, who developed takotsubo cardiomyopathy, and two patients without COVID-19 who developed takotsubo cardiomyopathy due to the emotional stress associated with the global pandemic. The mean age of the patients was 67.19 years (SD 15.83) and 16(59.3%) were women. Chest pain was reported in only ten patients (38.46 %) and ST-elevation was seen in 11 patients (42.3%). While most patients had typical takotsubo cardiomyopathy, four patients had inverted(reverse) takotsubo cardiomyopathy, two had bi-ventricular involvement, one had median takotsubo and another had global takotsubo with apical sparing variant. Most patients had a positive outcome with complete or near-complete reversal of cardiac dysfunction at the time of discharge. Five deaths (19.23%) were reported. Takotsubo cardiomyopathy is a rare, but increasingly reported reversible cardiomyopathy that can be seen in patients with COVID-19 infection and the diagnosis must be actively sought for in these patients.
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Affiliation(s)
- Kevin John
- Department of Critical Care, Bangalore Baptist Hospital, Bellary Road, Hebbal, Bengaluru, Karnataka.
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN.
| | - Ajay Mishra
- Department of Medicine, Saint Vincent Hospital, Worcester, MA.
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22
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Carrizales-Sepúlveda EF, Vera-Pineda R, Flores-Ramírez R, Hernández-Guajardo DA, Pérez-Contreras E, Lozano-Ibarra MM, Ordaz-Farías A. Echocardiographic Manifestations in COVID-19: A Review. Heart Lung Circ 2021; 30:1117-1129. [PMID: 33715970 PMCID: PMC7894123 DOI: 10.1016/j.hlc.2021.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/29/2020] [Accepted: 02/02/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 has rapidly spread around the world and threatened global health. Although this disease mainly affects the respiratory system, there is increasing evidence that SARS-CoV-2 also has effects on the cardiovascular system. Echocardiography is a valuable tool in the assessment of cardiovascular disease. It is cost-effective, widely available and provides information that can influence management. Given the risk of personnel infection and equipment contamination during echocardiography, leading world societies have recommended performing echocardiography only when a clinical benefit is likely, favouring focussed evaluations and using smaller portable equipment. In the past months, multiple reports have described a wide pattern of echocardiographic abnormalities in patients with COVID-19. This review summarises these findings and discusses the possible mechanisms involved.
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Affiliation(s)
| | - Raymundo Vera-Pineda
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Ramiro Flores-Ramírez
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México; Echocardiography Laboratory, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | | | - Eduardo Pérez-Contreras
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México; Echocardiography Laboratory, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Marcelo Mario Lozano-Ibarra
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México; Echocardiography Laboratory, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Alejandro Ordaz-Farías
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México; Echocardiography Laboratory, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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23
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Kong N, Singh N, Mazzone S, Burkhart R, Anchan R, Blair J. Takotsubo Syndrome Presenting as Cardiogenic Shock in Patients With COVID-19: A Case Series and Review of Current Literature. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:50-53. [PMID: 32893157 PMCID: PMC7825852 DOI: 10.1016/j.carrev.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 11/25/2022]
Abstract
Takotsubo's syndrome (TTS) is a form of stress cardiomyopathy with a relatively benign long-term course, but may lead to arrhythmias and cardiogenic shock in the acute setting. Despite a recent rise in suspected stress-induced cardiomyopathy, the relationship between the novel coronavirus disease 19 (COVID-19) and TTS is not fully understood. Early recognition of TTS in these patients is important to guide management and treatment. We present 2 cases of TTS arising in the setting of COVID-19 with rapid progression to biventricular heart failure and cardiogenic shock.
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Affiliation(s)
- Nathan Kong
- Department of Internal Medicine, University of Chicago, Chicago, IL, United States of America
| | - Nikhil Singh
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, IL, United States of America
| | - Steven Mazzone
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, IL, United States of America
| | - Ryan Burkhart
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, IL, United States of America
| | - Rajeev Anchan
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, IL, United States of America
| | - John Blair
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, IL, United States of America.
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24
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Sharma K, Desai HD, Patoliya JV, Jadeja DM, Gadhiya D. Takotsubo Syndrome a Rare Entity in COVID-19: a Systemic Review-Focus on Biomarkers, Imaging, Treatment, and Outcome. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:62-72. [PMID: 33458567 PMCID: PMC7799869 DOI: 10.1007/s42399-021-00743-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 02/06/2023]
Abstract
Takotsubo syndrome(TTS) is attributed to catecholamine surge, which is also observed in COVID-19 disease due to the cytokine storm. We performed a systematic literature search using PubMed, Embase, and the Cochrane Central Register of Controlled Trials retrospectively to identify COVID-19-associated TTS case reports and evaluated patient-level demographics, laboratory markers clinical attributes, treatment given, and outcomes. There are 27 cases reported of TTS associated with COVID-19 infection of which 44.5% were male. Reported median age was 57 years (IQR: 39-65) and 62.95 years (IQR: 50.5-73.5) in case series and individual patients' cases in database, respectively. The time interval from the symptom onset to TTS diagnosis was median 6.5 days (IQR: 1.0-8.0) in case series and 6.7 days (IQR: 4-10) in individual patients' database. The median LVEF was 36% (IQR: 35-37) and 38.15%(IQR: 30-42.5%-[male: 40.33% (IQR: 33-44.2)] and female [37.15% (IQR: 30-40)] in case series and individual-patients' database, respectively. Troponin was elevated in all patients except one patient. 77.2% patients of TTS with COVID-19 had an elevated C-reactive protein and/or D-dimer. Twelve out of 22 (54.5%) patients developed cardiac complication such as cardiogenic-shock, atrial fibrillation, acute heart failure, supraventricular tachycardia, and biventricular heart failure. Nineteen out of 26 (73.07%) patients were discharged, and three were hospitalized due to acute respiratory distress syndrome and needed extracorporeal membrane oxygenation or ongoing maternal age. There were 4 (14.8%) mortality. There was no major gender difference observed in development of TTS in COVID-19 unlike COVID-19 per se. Older median age group for TTS in COVID-19 patients irrespective of cardiovascular comorbidities and gender probably reflects age as an independent risk factor. Patients who developed TTS had higher mortality rate especially if they developed cardiogenic shock.
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Affiliation(s)
- Kamal Sharma
- Department of Cardiology, U.N. Mehta Institute of cardiology and research center, Affiliated to B.J Medical College, Ahmedabad, 380016 India
| | - Hardik D. Desai
- Graduate Medical Education, Gujarat Adani Institute of Medical Sciences, Affiliated to K.S.K.V University, Bhuj, 370001 Gujarat India
| | - Jaimini V. Patoliya
- Department of Biochemistry and Forensic sciences, Gujarat University, Ahmedabad, 380009 Gujarat India
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25
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Reply to “Takotsubo Syndrome in Patients with COVID-19: a Systematic Review of Published Cases”. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:73-74. [PMID: 33426472 PMCID: PMC7778717 DOI: 10.1007/s42399-020-00716-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/21/2022]
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26
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Gomez JMD, Nair G, Nanavaty P, Rao A, Marinescu K, Suboc T. COVID-19-associated takotsubo cardiomyopathy. BMJ Case Rep 2020; 13:13/12/e236811. [PMID: 33310830 PMCID: PMC7735089 DOI: 10.1136/bcr-2020-236811] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The novel COVID-19 has had an unprecedented and devastating spread internationally. COVID-19 infection can lead to a number of cardiovascular sequelae, including heart failure, which may portend worse clinical outcomes. Here, we report a rare case of a 57-year-old woman who developed acute left ventricular systolic dysfunction with apical ballooning consistent with takotsubo cardiomyopathy (TCM), and mixed cardiogenic and septic shock in the setting of COVID-19 disease. We briefly review the pathophysiology and diagnosis of TCM (also described as apical ballooning syndrome and stress-induced cardiomyopathy). Additionally, this case highlights the importance of a multidisciplinary approach to clinical decision-making and resource allocation in diagnosis and management of critical illness in the setting of the ongoing international COVID-19 pandemic.
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Affiliation(s)
| | - Gatha Nair
- Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Prema Nanavaty
- Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Anupama Rao
- Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Tisha Suboc
- Cardiology, Rush University Medical Center, Chicago, Illinois, USA
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27
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Shah RM, Shah M, Shah S, Li A, Jauhar S. Takotsubo Syndrome and COVID-19: Associations and Implications. Curr Probl Cardiol 2020; 46:100763. [PMID: 33360674 PMCID: PMC7732220 DOI: 10.1016/j.cpcardiol.2020.100763] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
Incidence of cardiovascular complications has increased during the COVID-19 (Coronavirus disease 2019) pandemic, both population-wide and in patients diagnosed with the disease. This increase has presented complications in patient care, leading to increased hospitalizations, adverse outcomes, and medical costs. A condition of interest is takotsubo syndrome, which may be associated with the novel coronavirus. To understand this connection, a narrative review was performed by analyzing primary studies and case reports available. The findings showed increased incidence of takotsubo cardiomyopathy in both the general population and COVID-19 patients. Proposed mechanisms for the linkage include generalized increases in psychological distress, the cytokine storm, increased sympathetic responses in COVID-19 patients, and microvascular dysfunction. Moreover, natural disasters are noted as likely being associated with increases of takotsubo syndrome. As the pandemic continues, treating COVID-19 as a systemic condition is imperative, with the increase in takotsubo syndrome marking a significant impact of the novel coronavirus.
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Affiliation(s)
| | - Morish Shah
- Nova Southeastern University, Fort Lauderdale, Florida
| | - Sareena Shah
- University of Missouri Kansas-City School of Medicine, Kansas-City, Missouri
| | - Angela Li
- Hofstra Northwell School of Medicine, New York City, New York
| | - Sandeep Jauhar
- Hofstra Northwell School of Medicine, New York City, New York; Heart Failure Program, Long Island Jewish Medical Center, New Hyde Park, New York
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28
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Dou Q, Wei X, Zhou K, Yang S, Jia P. Cardiovascular Manifestations and Mechanisms in Patients with COVID-19. Trends Endocrinol Metab 2020; 31:893-904. [PMID: 33172748 PMCID: PMC7566786 DOI: 10.1016/j.tem.2020.10.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/31/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) patients with pre-existing cardiovascular disease (CVD) or with cardiovascular complications have a higher risk of mortality. The main cardiovascular complications of COVID-19 include acute cardiac injury, acute myocardial infarction (AMI), myocarditis, arrhythmia, heart failure, shock, and venous thromboembolism (VTE)/pulmonary embolism (PE). COVID-19 can cause cardiovascular complications or deterioration of coexisting CVD through direct or indirect mechanisms, including viral toxicity, dysregulation of the renin-angiotensin-aldosterone system (RAAS), endothelial cell damage and thromboinflammation, cytokine storm, and oxygen supply-demand mismatch. We systematically review cardiovascular manifestations, histopathology, and mechanisms of COVID-19, to help to formulate future research goals and facilitate the development of therapeutic management strategies.
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Affiliation(s)
- Qingyu Dou
- National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kehua Zhou
- Department of Hospital Medicine, ThedaCare Regional Medical Center-Appleton, Appleton, WI, USA; International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.
| | - Peng Jia
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.
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29
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Titi L, Magnanimi E, Mancone M, Infusino F, Coppola G, Del Nonno F, Colombo D, Nardacci R, Falasca L, d'Amati G, Tarsitano MG, Merlino L, Fedele F, Pugliese F. Fatal Takotsubo syndrome in critical COVID-19 related pneumonia. Cardiovasc Pathol 2020; 51:107314. [PMID: 33259936 PMCID: PMC7699026 DOI: 10.1016/j.carpath.2020.107314] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 01/19/2023] Open
Abstract
COVID-19 can involve several organs and systems, often with indirect and poorly clarified mechanisms. Different presentations of myocardial injury have been reported, with variable degrees of severity, often impacting on the prognosis of COVID-19 patients. The pathogenic mechanisms underlying cardiac damage in SARS-CoV-2 infection are under active investigation. We report the clinical and autopsy findings of a fatal case of Takotsubo Syndrome occurring in an 83-year-old patient with COVID-19 pneumonia. The patient was admitted to Emergency Department with dyspnea, fever and diarrhea. A naso-pharyngeal swab test for SARS-CoV-2 was positive. In the following week his conditions worsened, requiring intubation and deep sedation. While in the ICU, the patient suddenly showed ST segment elevation. Left ventricular angiography showed decreased with hypercontractile ventricular bases and mid-apical ballooning, consistent with diagnosis of Takotsubo syndrome. Shortly after the patient was pulseless. After extensive resuscitation maneuvers, the patient was declared dead. Autopsy revealed a subepicardial hematoma, in absence of myocardial rupture. On histology, the myocardium showed diffuse edema, multiple foci of contraction band necrosis in both ventricles and occasional coagulative necrosis of single cardiac myocytes. Abundant macrophages CD68+ were detected in the myocardial interstitium. The finding of diffuse contraction band necrosis supports the pathogenic role of increased catecholamine levels; the presence of a significant interstitial inflammatory infiltrate, made up by macrophages, remains of uncertain significance.
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Affiliation(s)
- Luca Titi
- Department of Anesthesia and Intensive Care Medicine, Sapienza University of Rome, Rome, Italy.
| | - Eugenia Magnanimi
- Department of Anesthesia and Intensive Care Medicine, Sapienza University of Rome, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabio Infusino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Coppola
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Italy
| | - Franca Del Nonno
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Daniele Colombo
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Roberta Nardacci
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Laura Falasca
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Italy
| | | | - Lucia Merlino
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Pugliese
- Department of Anesthesia and Intensive Care Medicine, Sapienza University of Rome, Rome, Italy
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30
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Finsterer J, Stöllberger C. SARS-CoV-2 triggered Takotsubo in 38 patients. J Med Virol 2020; 93:1236-1238. [PMID: 33022810 PMCID: PMC7675589 DOI: 10.1002/jmv.26581] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 11/18/2022]
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31
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Abstract
Takotsubo cardiomyopathy or takotsubo syndrome (TTS) has become a well-known disease not only in Japan but also in the rest of the world. Early reports suggested that TTS is a self-limiting disease with better prognosis than acute coronary syndrome. However, recent data showed that TTS is not a benign disease as compared with acute coronary syndrome. In addition to the apical ballooning, several other types of wall motion abnormalities have been classified as variants of TTS. In particular, right ventricular involvement, or biventricular TTS, is not uncommon and is associated with poor in-hospital as well as long-term outcomes. With respect to the pathophysiology, modulation (desensitization) of the beta-adrenergic receptor is suspected as a possible mechanism for transiently depressed myocardial contraction. Although specific treatments to improve prognosis of TTS are still uncertain, observational data suggest favorable impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Finally, in the era of COVID-19, we should pay attention to a variety of cardiovascular conditions related to COVID-19. TTS is one of these conditions that can be triggered by both emotional and physical impact of the COVID-19 pandemic.
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Affiliation(s)
- Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
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32
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Singh S, Desai R, Gandhi Z, Fong HK, Doreswamy S, Desai V, Chockalingam A, Mehta PK, Sachdeva R, Kumar G. Takotsubo Syndrome in Patients with COVID-19: a Systematic Review of Published Cases. ACTA ACUST UNITED AC 2020; 2:2102-2108. [PMID: 33043251 PMCID: PMC7538054 DOI: 10.1007/s42399-020-00557-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/18/2022]
Abstract
Takotsubo syndrome (TTS) is caused by catecholamine surge, which is also observed in COVID-19 disease due to the cytokine storm. We performed a systematic literature search using PubMed/Medline, SCOPUS, Web of Science, and Google Scholar databases to identify COVID-19-associated TTS case reports and evaluated patient-level demographics, clinical attributes, and outcomes. There are 12 cases reported of TTS associated with COVID-19 infection with mean age of 70.8 ± 15.2 years (range 43–87 years) with elderly (66.6% > 60 years) female (66.6%) majority. The time interval from the first symptom to TTS was 8.3 ± 3.6 days (range 3–14 days). Out of 12 cases, 7 reported apical ballooning, 4 reported basal segment hypo/akinesia, and 1 reported median TTS. Out of 12 cases, during hospitalization, data on left ventricular ejection fraction (LVEF) was reported in only 9 of the cases. The mean LVEF was 40.6 ± 9.9% (male, 46.7 ± 5.7%, and female, 37.7 ± 10.6%). Troponin was measured in all 12 cases and was elevated in 11 (91.6%) without stenosis on coronary angiography except one. Out of 11 cases, 6 developed cardiac complications with 1 case each of cardiac tamponade, heart failure, myocarditis, hypertensive crisis, and cardiogenic shock in 2. Five patients required intubation, 1 patient required continuous positive airway pressure, and 1 patient required venovenous extracorporeal membrane oxygenation. The outcome was reported in terms of recovery in 11 (91.6%) out of 12 cases, and a successful recovery was noted in 10 (90.9%) cases. COVID-19-related TTS has a higher prevalence in older women. Despite a lower prevalence of cardiac comorbidities in COVID-19 patients, direct myocardial injury, inflammation, and stress may contribute to TTS with a high complication rate.
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Affiliation(s)
- Sandeep Singh
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Center, AMC, Amsterdam, Netherlands
| | - Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA USA
| | - Zainab Gandhi
- Department of Internal Medicine, Geisinger Community Medical Center, Scranton, PA USA
| | - Hee Kong Fong
- Division of Cardiology, UC Davis Medical Center, Sacramento, CA USA
| | - Shriya Doreswamy
- Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Virmitra Desai
- University of North Texas Health Science Center, Fort Worth, TX USA
| | - Anand Chockalingam
- Division of Cardiology, University of Missouri Health Care, Columbia, MO USA
| | - Puja K Mehta
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA USA
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA USA.,Division of Cardiology, Morehouse School of Medicine, Atlanta, GA USA.,Division of Cardiology, Medical College of Georgia, Augusta, GA USA
| | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA USA.,Division of Cardiology, Emory University School of Medicine, Atlanta, GA USA
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33
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Bugger H, Gollmer J, Pregartner G, Wünsch G, Berghold A, Zirlik A, von Lewinski D. Complications and mortality of cardiovascular emergency admissions during COVID-19 associated restrictive measures. PLoS One 2020; 15:e0239801. [PMID: 32970774 PMCID: PMC7514100 DOI: 10.1371/journal.pone.0239801] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
While hospital admissions for myocardial infarction (MI) and pulmonary embolism (PE) are decreased during the COVID-19 pandemic, controversy remains about respective complication and mortality rates. This study evaluated admission rates, complications, and intrahospital mortality for selected life-threatening cardiovascular emergencies (MI, PE, and acute aortic dissection (AAD)) during COVID-19-associated restrictive social measures (RM) in Styria, Austria. By screening a patient information system for International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis codes covering more than 85% of acute hospital admissions in the state of Styria (~1.24 million inhabitants), we retrospectively identified patients with admission diagnoses for MI (I21, I22), PE (I26), and AAD (I71). Rates of complications such as cardiogenic shock and cardiopulmonary resuscitation, treatment escalations (thrombolysis for PE), and mortality were analyzed by patient chart review during 6 weeks following onset of COVID-19 associated RM, and during respective time frames in the years 2016 to 2019. 1,668 patients were included. Cumulative admissions for MI, PE and AAD decreased (RR 0.77; p<0.001) during RM compared to previous years. In contrast, intrahospital mortality increased by 65% (RR 1.65; p = 0.041), mainly driven by mortality following MI (RR 1.80; p = 0.042). PE patients received more frequently thrombolysis treatment (RR 3.63; p = 0.006), while rates of cardiogenic shock and cardiopulmonary resuscitation remained unchanged. Of 226 patients hospitalized during RM, 81 patients with suspected COVID-19 disease were screened for SARS-CoV-2 infection with only 5 testing positive. Thus, cumulative hospital admissions for cardiovascular emergencies decreased during COVID-19 associated RM while intrahospital mortality increased.
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Affiliation(s)
- Heiko Bugger
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Johannes Gollmer
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Gerit Wünsch
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Andreas Zirlik
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Dirk von Lewinski
- Division of Cardiology, Medical University of Graz, Graz, Austria
- * E-mail:
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34
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Kuno T, Ueyama H, Takagi H, Fox J, Bangalore S. Optimal Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome: Insights From a Network Meta-Analysis of Randomized Trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28:50-56. [PMID: 32893157 DOI: 10.1016/j.carrev.2020.07.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND With newer generation drug eluting stents (DES), the minimal duration of dual antiplatelet therapy (DAPT) recommended by guidelines has been reduced to 6 months in patients with stable coronary artery disease. Whether shorter duration of DAPT is safe in patients presenting with acute coronary syndrome (ACS) remains controversial. Our aim of this study was to investigate the optimal DAPT duration (≤3 months vs. 6 months vs. 12 months vs. >12 months) among patients with ACS undergoing percutaneous coronary intervention (PCI). METHODS PUBMED and EMBASE were searched through January 2020 for randomized controlled trials of DAPT duration in patients with ACS. The ischemic outcomes were all-cause death, myocardial infarction, and stent thrombosis. The safety outcome was major and/or clinically relevant bleeding. RESULTS Our search identified 14 eligible trials enrolling a total of 31,837 patients comparing different DAPT duration in patients with ACS. Short-term DAPT (≤3 months or 6 months) did not increase ischemic outcomes compared to long-term DAPT (12 months and >12 months). For bleeding outcomes, ≤3 months DAPT was associated with significant reduction in bleeding compared to 6 months, 12 months or >12 months DAPT (OR [95% CI]: 0.60 [0.37-0.98]; 0.68 [0.54-0.85] and 0.43 [0.34-0.54], respectively). These findings were similar when limited to 2nd generation DES. CONCLUSIONS Data from this meta-analysis of randomized trials support short-term (≤3 months and 6 months) DAPT in patients with ACS undergoing PCI. Guidelines might need to consider short-term DAPT even in patients presenting with ACS, especially in this era of newer generation DES.
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Affiliation(s)
- Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA.
| | - Hiroki Ueyama
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - John Fox
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Sripal Bangalore
- Division of Cardiovascular Medicine, New York University School of Medicine, NY, USA
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Porzionato A, Emmi A, Barbon S, Boscolo-Berto R, Stecco C, Stocco E, Macchi V, De Caro R. Sympathetic activation: a potential link between comorbidities and COVID-19. FEBS J 2020; 287:3681-3688. [PMID: 32779891 PMCID: PMC7405290 DOI: 10.1111/febs.15481] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
In coronavirus disease 2019 (COVID-19), higher morbidity and mortality are associated with age, male gender, and comorbidities, such as chronic lung diseases, cardiovascular pathologies, hypertension, kidney diseases, diabetes mellitus, and obesity. All of the above conditions are characterized by increased sympathetic discharge, which may exert significant detrimental effects on COVID-19 patients, through actions on the lungs, heart, blood vessels, kidneys, metabolism, and/or immune system. Furthermore, COVID-19 may also increase sympathetic discharge, through changes in blood gases (chronic intermittent hypoxia, hyperpnea), angiotensin-converting enzyme (ACE)1/ACE2 imbalance, immune/inflammatory factors, or emotional distress. Nevertheless, the potential role of the sympathetic nervous system has not yet been considered in the pathophysiology of COVID-19. In our opinion, sympathetic overactivation could represent a so-far undervalued mechanism for a vicious circle between COVID-19 and comorbidities.
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Affiliation(s)
- Andrea Porzionato
- Section of Anatomy, Department of Neuroscience, University of Padova, Italy
| | - Aron Emmi
- Section of Anatomy, Department of Neuroscience, University of Padova, Italy
| | - Silvia Barbon
- Section of Anatomy, Department of Neuroscience, University of Padova, Italy
| | | | - Carla Stecco
- Section of Anatomy, Department of Neuroscience, University of Padova, Italy
| | - Elena Stocco
- Section of Anatomy, Department of Neuroscience, University of Padova, Italy
| | - Veronica Macchi
- Section of Anatomy, Department of Neuroscience, University of Padova, Italy
| | - Raffaele De Caro
- Section of Anatomy, Department of Neuroscience, University of Padova, Italy
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Desai HD. Takotsubo syndrome a rare entity in patients with COVID-19: An updated review of case-reports and case-series. IJC HEART & VASCULATURE 2020; 29:100604. [PMID: 32766416 PMCID: PMC7377718 DOI: 10.1016/j.ijcha.2020.100604] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
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