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Lawson CA, Moss AJ, Arnold JR, Bagot C, Banerjee A, Berry C, Greenwood J, Hughes AD, Khunti K, Mills NL, Neubauer S, Raman B, Sattar N, Leavy OC, Richardson M, Elneima O, McAuley HJ, Shikotra A, Singapuri A, Sereno M, Saunders R, Harris V, Houchen-Wolloff L, Greening NJ, Harrison E, Docherty AB, Lone NI, Quint JK, Chalmers J, Ho LP, Horsley A, Marks M, Poinasamy K, Evans R, Wain LV, Brightling C, McCann GP. Long COVID and cardiovascular disease: a prospective cohort study. Open Heart 2024; 11:e002662. [PMID: 38802280 PMCID: PMC11131117 DOI: 10.1136/openhrt-2024-002662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Pre-existing cardiovascular disease (CVD) or cardiovascular risk factors have been associated with an increased risk of complications following hospitalisation with COVID-19, but their impact on the rate of recovery following discharge is not known. OBJECTIVES To determine whether the rate of patient-perceived recovery following hospitalisation with COVID-19 was affected by the presence of CVD or cardiovascular risk factors. METHODS In a multicentre prospective cohort study, patients were recruited following discharge from the hospital with COVID-19 undertaking two comprehensive assessments at 5 months and 12 months. Patients were stratified by the presence of either CVD or cardiovascular risk factors prior to hospitalisation with COVID-19 and compared with controls with neither. Full recovery was determined by the response to a patient-perceived evaluation of full recovery from COVID-19 in the context of physical, physiological and cognitive determinants of health. RESULTS From a total population of 2545 patients (38.8% women), 472 (18.5%) and 1355 (53.2%) had CVD or cardiovascular risk factors, respectively. Compared with controls (n=718), patients with CVD and cardiovascular risk factors were older and more likely to have had severe COVID-19. Full recovery was significantly lower at 12 months in patients with CVD (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.89) and cardiovascular risk factors (aOR 0.66, 95% CI 0.50 to 0.86). CONCLUSION Patients with CVD or cardiovascular risk factors had a delayed recovery at 12 months following hospitalisation with COVID-19. Targeted interventions to reduce the impact of COVID-19 in patients with cardiovascular disease remain an unmet need. TRAIL REGISTRATION NUMBER ISRCTN10980107.
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Affiliation(s)
| | - Alastair James Moss
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, Glasgow, Glasgow, UK
| | - Amitava Banerjee
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Cardiology, Golden Jubilee National Hospital, Clydebank, UK
| | - John Greenwood
- Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Stefan Neubauer
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Olivia C Leavy
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Rachael Evans
- The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Louise V Wain
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Chris Brightling
- The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, UK
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Khokhlov RA, Lipovka SN, Dubrovina MV, Lobas IA, Tribuntseva LV, Prozorova GG, Arzamasсeva GI, Khokhlov LR, Yarmonova MV, Zarechnova SV, Kuleshova NA, Shaley AA. Combined Heart Injuries on the Data of Contrast-Enhanced Cardiac Magnetic Resonance Imaging in Patients With Post-Covid Syndrome. KARDIOLOGIIA 2023; 63:46-53. [PMID: 38156489 DOI: 10.18087/cardio.2023.12.n2268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/18/2023] [Indexed: 12/30/2023]
Abstract
Aim Prospective assessment of the nature of cardiac injury in patients with post-COVID syndrome according to contrast-enhanced MRI in routine clinical practice.Material and methods 106 previously unvaccinated patients were evaluated. 62 (58.5%) of them were women with complaints that persisted after COVID-19 (median age, 57.5 [49; 64] years). In addition to standard indexes, markers of inflammation and myocardial injury were determined, and cardiac contrast-enhanced MRI was performed in each patient.Results The median time from the onset of COVID-19 to cardiac MRI was 112.5 [75; 151] days. The nature of cardiac injury according to MRI in patients with post-COVID syndrome was complex and included a decrease in left ventricular (LV) and right ventricular ejection fraction, pericardial effusion, and pathological foci of late and early contrast enhancement at various locations. In 29 (27.4%) cases, there was a combination of any two signs of heart injury. In 28 (26.4%) patients with focal myocardial injury during the acute phase of COVID-19, hydroxychloroquine and tocilizumab were administered significantly more frequently, but antiviral drugs were administered less frequently. The presence of focal myocardial injury was associated with pathological LV remodeling.Conclusion According to contrast-enhanced cardiac MRI, at least 27.4% of patients with post-COVID syndrome may have signs of cardiac injury in various combinations, and in 26.4% of cases, foci of myocardial injury accompanied by LV remodeling are detected. The nature of heart injury after COVID-19 depends on the premorbid background, characteristics of the course of the infectious process, and the type of prescribed therapy. An algorithm for evaluating patients with post-COVID syndrome is proposed.
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Affiliation(s)
- R A Khokhlov
- Burdenko Voronezh State Medical University, Voronezh; Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | - S N Lipovka
- Burdenko Voronezh State Medical University, Voronezh; Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | - M V Dubrovina
- Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | - I A Lobas
- Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | | | - G G Prozorova
- Burdenko Voronezh State Medical University, Voronezh
| | - G I Arzamasсeva
- Burdenko Voronezh State Medical University, Voronezh; Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | | | - M V Yarmonova
- Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | - S V Zarechnova
- Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | - N A Kuleshova
- Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
| | - A A Shaley
- Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh
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Shu H, Wen Z, Li N, Zhang Z, Ceesay BM, Peng Y, Zhou N, Wang DW. COVID-19 and Cardiovascular Diseases: From Cellular Mechanisms to Clinical Manifestations. Aging Dis 2023; 14:2071-2088. [PMID: 37199573 PMCID: PMC10676802 DOI: 10.14336/ad.2023.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/14/2023] [Indexed: 05/19/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), quickly spread worldwide and led to over 581 million confirmed cases and over 6 million deaths as 1 August 2022. The binding of the viral surface spike protein to the human angiotensin-converting enzyme 2 (ACE2) receptor is the primary mechanism of SARS-CoV-2 infection. Not only highly expressed in the lung, ACE2 is also widely distributed in the heart, mainly in cardiomyocytes and pericytes. The strong association between COVID-19 and cardiovascular disease (CVD) has been demonstrated by increased clinical evidence. Preexisting CVD risk factors, including obesity, hypertension, and diabetes etc., increase susceptibility to COVID-19. In turn, COVID-19 exacerbates the progression of CVD, including myocardial damage, arrhythmia, acute myocarditis, heart failure, and thromboembolism. Moreover, cardiovascular risks post recovery and the vaccination-associated cardiovascular problems have become increasingly evident. To demonstrate the association between COVID-19 and CVD, this review detailly illustrated the impact of COVID-19 on different cells (cardiomyocytes, pericytes, endothelial cells, and fibroblasts) in myocardial tissue and provides an overview of the clinical manifestations of cardiovascular involvements in the pandemic. Finally, the issues related to myocardial injury post recovery, as well as vaccination-induced CVD, has also been emphasized.
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Affiliation(s)
- Hongyang Shu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Zheng Wen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Na Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Zixuan Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Bala Musa Ceesay
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Yizhong Peng
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Ning Zhou
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan 430000, China.
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LaRocca G, Skorton DJ. Cardiovascular Complications and Imaging in the Era of the COVID-19 Pandemic 2020 to Present. Curr Probl Cardiol 2023; 48:101937. [PMID: 37422041 DOI: 10.1016/j.cpcardiol.2023.101937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/10/2023]
Abstract
The COVID-19 pandemic has impacted the world that was not previously conceivable. In early 2020, hospitals on all continents were overwhelmed with patients afflicted with this novel virus, with unanticipated mortality worldwide. The virus has had a deleterious effect, particularly the respiratory and cardiovascular systems. Cardiovascular biomarkers demonstrated an array of cardiovascular insults from hypoxia to inflammatory and perfusion abnormalities of the myocardium to life-threatening arrhythmias and heart failure. Patients were at increased risk of a pro-thrombotic state early in the course of the disease. Cardiovascular imaging became a primary tool in diagnosing, prognosing and risk-stratifying patients. Transthoracic echocardiography became the initial imaging modality in management of cardiovascular implications. In addition to cardiac function, LV longitudinal strain (LVLS) and right ventricular free wall strain (RVFWS) were indicators of increased morbidly and mortality. Cardiac MRI has become the diagnostic cardiovascular imaging for myocardial injury and tissue evaluation in the age of COVID-19.
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Affiliation(s)
- Gina LaRocca
- Mount Sinai / Icahn School of Medicine, New York, NY.
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Joshi SS, Singh T, Kershaw LE, Gibb FW, Dweck MR, Williams M, Idris I, Semple S, Forbes S, Newby DE, Reynolds RM. Non-invasive imaging of functional pancreatic islet beta-cell mass in people with type 1 diabetes mellitus. Diabet Med 2023; 40:e15111. [PMID: 37035965 PMCID: PMC10946460 DOI: 10.1111/dme.15111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 03/07/2023] [Accepted: 04/06/2023] [Indexed: 04/11/2023]
Abstract
AIMS To investigate whether manganese-enhanced magnetic resonance imaging can assess functional pancreatic beta-cell mass in people with type 1 diabetes mellitus. METHODS In a prospective case-control study, 20 people with type 1 diabetes mellitus (10 with low (≥50 pmol/L) and 10 with very low (<50 pmol/L) C-peptide concentrations) and 15 healthy volunteers underwent manganese-enhanced magnetic resonance imaging of the pancreas following an oral glucose load. Scan-rescan reproducibility was performed in 10 participants. RESULTS Mean pancreatic manganese uptake was 31 ± 6 mL/100 g of tissue/min in healthy volunteers (median 32 [interquartile range 23-36] years, 6 women), falling to 23 ± 4 and 13 ± 5 mL/100 g of tissue/min (p ≤ 0.002 for both) in people with type1 diabetes mellitus (52 [44-61] years, 6 women) and low or very low plasma C-peptide concentrations respectively. Pancreatic manganese uptake correlated strongly with plasma C-peptide concentrations in people with type1 diabetes mellitus (r = 0.73, p < 0.001) but not in healthy volunteers (r = -0.054, p = 0.880). There were no statistically significant correlations between manganese uptake and age, body-mass index, or glycated haemoglobin. There was strong intra-observer (mean difference: 0.31 (limits of agreement -1.42 to 2.05) mL/100 g of tissue/min; intra-class correlation, ICC = 0.99), inter-observer (-1.23 (-5.74 to 3.27) mL/100 g of tissue/min; ICC = 0.85) and scan-rescan (-0.72 (-2.9 to 1.6) mL/100 g of tissue/min; ICC = 0.96) agreement for pancreatic manganese uptake. CONCLUSIONS Manganese-enhanced magnetic resonance imaging provides a potential reproducible non-invasive measure of functional beta-cell mass in people with type 1 diabetes mellitus. This holds major promise for investigating type 1 diabetes, monitoring disease progression and assessing novel immunomodulatory interventions.
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Affiliation(s)
- Shruti S. Joshi
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Trisha Singh
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Lucy E. Kershaw
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh ImagingUniversity of EdinburghEdinburghUK
| | - Fraser W. Gibb
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh Centre for EndocrinologyNHS LothianEdinburghUK
| | - Marc R. Dweck
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Michelle Williams
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh ImagingUniversity of EdinburghEdinburghUK
- Department of RadiologyNHS LothianEdinburghUK
| | - Iskandar Idris
- Department of EndocrinologyUniversity of NottinghamNottinghamUK
| | - Scott Semple
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh ImagingUniversity of EdinburghEdinburghUK
| | - Shareen Forbes
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh Centre for EndocrinologyNHS LothianEdinburghUK
| | - David E. Newby
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh ImagingUniversity of EdinburghEdinburghUK
| | - Rebecca M. Reynolds
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
- Edinburgh Centre for EndocrinologyNHS LothianEdinburghUK
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6
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Olszanecka A, Wojciechowska W, Bednarek A, Kusak P, Wizner B, Terlecki M, Stolarz-Skrzypek K, Klocek M, Drożdż T, Sładek K, Bociąga-Jasik M, Garlicki A, Rewiuk K, Matyja A, Małecki M, Sydor W, Krzanowski M, Grodzicki T, Rajzer M. Serial echocardiographic evaluation of COVID-19 patients without prior history of structural heart disease: a 1-year follow-up CRACoV-HHS study. Front Cardiovasc Med 2023; 10:1230669. [PMID: 37781311 PMCID: PMC10533911 DOI: 10.3389/fcvm.2023.1230669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background It is a well-known fact that COVID-19 affects the cardiovascular system by exacerbating heart failure in patients with preexisting conditions. However, there is a poor insight into the cardiovascular involvement and sequelae in patients without preexisting conditions. The aim of the study is to analyse the influence of COVID-19 on cardiac performance in patients without prior history of structural heart disease. The study is part of the CRACoV project, which includes a prospective design and a 12-month follow-up period. Material and methods The study included 229 patients hospitalised with a diagnosis of COVID-19 (median age of 59 years, 81 were women). A standard clinical assessment and laboratory tests were performed in all participants. An extended echocardiographic image acquisition was performed at baseline and at a 3-, 6-, and 12-month follow-up. All analyses were performed off-line. A series of echocardiographic parameters was compared using repeated measures or Friedman analysis of variance. Results In all subjects, the left ventricular (LV) ejection fraction at baseline was preserved [63.0%; Q1:Q3 (60.0-66.0)]. Elevated levels of high-sensitivity cardiac troponin T were detected in 21.3% of the patients, and elevated NT-proBNP levels were detected in 55.8%. At the 1-year follow-up, no significant changes were observed in the LV diameter and volume (LV 48.0 ± 5.2 vs. 47.8 ± 4.8 mm, p = 0.08), while a significant improvement of the parameters in the biventricular strain was observed (LV -19.1 ± 3.3% vs. -19.7 ± 2.5%, p = 0.01, and right ventricular -19.9 ± 4.5% vs. -23.2 ± 4.9%, p = 0.002). In addition, a decrease in the LV wall thickness was also observed (interventricular septum 10.4 ± 1.6 vs. 9.7 ± 2.0 mm, p < 0.001; LV posterior wall 9.8 ± 1.4 vs. 9.1 ± 1.5 mm, p < 0.001). Conclusions In an acute phase of COVID-19, the elevation of cardiac biomarkers in patients with normal left ventricular ejection fraction is a frequent occurrence; however, it does not translate into clinically significant cardiac dysfunction after 1 year. The serial echocardiographic evaluations conducted in patients without preexisting structural heart disease demonstrate an overall trend towards an improved cardiac function and a reduced myocardial thickening at 1-year follow-up. This suggests that the acute cardiac consequences of COVID-19 are associated with systemic inflammation and haemodynamic stress in patients without preexisting conditions.
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Affiliation(s)
- Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
| | - Wiktoria Wojciechowska
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
| | | | - Piotr Kusak
- University Hospital in Kraków, Kraków, Poland
| | - Barbara Wizner
- University Hospital in Kraków, Kraków, Poland
- Department of Internal Diseases and Geriatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Terlecki
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
| | - Katarzyna Stolarz-Skrzypek
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
| | - Marek Klocek
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
| | - Tomasz Drożdż
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
| | - Krzysztof Sładek
- University Hospital in Kraków, Kraków, Poland
- Department of Pulmonology and Allergology, Jagiellonian University Medical College, Kraków, Poland
| | - Monika Bociąga-Jasik
- University Hospital in Kraków, Kraków, Poland
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksander Garlicki
- University Hospital in Kraków, Kraków, Poland
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Rewiuk
- University Hospital in Kraków, Kraków, Poland
- Department of Internal Diseases and Geriatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Matyja
- University Hospital in Kraków, Kraków, Poland
- Department of General, Oncological, Metabolic, and Emergency Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Małecki
- University Hospital in Kraków, Kraków, Poland
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech Sydor
- University Hospital in Kraków, Kraków, Poland
- Center for InnovativeTherapies, Clinical Research Coordination Center, University Hospital in Kraków, Kraków, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Krzanowski
- University Hospital in Kraków, Kraków, Poland
- Department of Nephrology and Dialysis, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Grodzicki
- University Hospital in Kraków, Kraków, Poland
- Department of Internal Diseases and Geriatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
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7
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Sewanan LR, Di Tullio MR, Laine AF, D’Souza B, Leb J, Mironov A, Khan A, Stanger DE, Konofagou EE, Goldsmith RL, Jambawalikar SR, Hirschfeld CB, Castillo M, Durkin KJ, Dashnaw S, Thomas Vaughan J, Einstein AJ. Absence of long-term structural and functional cardiac abnormalities on multimodality imaging in a multi-ethnic group of COVID-19 survivors from the early stage of the pandemic. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad034. [PMID: 39045071 PMCID: PMC11195772 DOI: 10.1093/ehjimp/qyad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/17/2023] [Indexed: 07/25/2024]
Abstract
Aims Many patients with coronavirus disease-2019 (COVID-19), particularly from the pandemic's early phase, have been reported to have evidence of cardiac injury such as cardiac symptoms, troponinaemia, or imaging or ECG abnormalities during their acute course. Cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE) have been widely used to assess cardiac function and structure and characterize myocardial tissue during COVID-19 with report of numerous abnormalities. Overall, findings have varied, and long-term impact of COVID-19 on the heart needs further elucidation. Methods and results We performed TTE and 3 T CMR in survivors of the initial stage of the pandemic without pre-existing cardiac disease and matched controls at long-term follow-up a median of 308 days after initial infection. Study population consisted of 40 COVID-19 survivors (50% female, 28% Black, and 48% Hispanic) and 12 controls of similar age, sex, and race-ethnicity distribution; 35% had been hospitalized with 28% intubated. We found no difference in echocardiographic characteristics including measures of left and right ventricular structure and systolic function, valvular abnormalities, or diastolic function. Using CMR, we also found no differences in measures of left and right ventricular structure and function and additionally found no significant differences in parameters of tissue structure including T1, T2, extracellular volume mapping, and late gadolinium enhancement. With analysis stratified by patient hospitalization status as an indicator of COVID-19 severity, no differences were uncovered. Conclusion Multimodal imaging of a diverse cohort of COVID-19 survivors indicated no long-lasting damage or inflammation of the myocardium.
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Affiliation(s)
- Lorenzo R Sewanan
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Marco R Di Tullio
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Andrew F Laine
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Belinda D’Souza
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Jay Leb
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Alexander Mironov
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Ahsan Khan
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Dylan E Stanger
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Elisa E Konofagou
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Rochelle L Goldsmith
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Sachin R Jambawalikar
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Cole B Hirschfeld
- Maurice R. and Corinne P. Greenberg Division of Cardiology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Michelle Castillo
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Kathleen J Durkin
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, USA
| | - Stephen Dashnaw
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - J Thomas Vaughan
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
| | - Andrew J Einstein
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
- Department of Radiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH 10-203E, New York 10032, NY, USA
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8
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Holby SN, Richardson TL, Laws JL, McLaren TA, Soslow JH, Baker MT, Dendy JM, Clark DE, Hughes SG. Multimodality Cardiac Imaging in COVID. Circ Res 2023; 132:1387-1404. [PMID: 37167354 PMCID: PMC10171309 DOI: 10.1161/circresaha.122.321882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Infection with SARS-CoV-2, the virus that causes COVID, is associated with numerous potential secondary complications. Global efforts have been dedicated to understanding the myriad potential cardiovascular sequelae which may occur during acute infection, convalescence, or recovery. Because patients often present with nonspecific symptoms and laboratory findings, cardiac imaging has emerged as an important tool for the discrimination of pulmonary and cardiovascular complications of this disease. The clinician investigating a potential COVID-related complication must account not only for the relative utility of various cardiac imaging modalities but also for the risk of infectious exposure to staff and other patients. Extraordinary clinical and scholarly efforts have brought the international medical community closer to a consensus on the appropriate indications for diagnostic cardiac imaging during this protracted pandemic. In this review, we summarize the existing literature and reference major societal guidelines to provide an overview of the indications and utility of echocardiography, nuclear imaging, cardiac computed tomography, and cardiac magnetic resonance imaging for the diagnosis of cardiovascular complications of COVID.
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Affiliation(s)
- S Neil Holby
- Cardiovascular Medicine Fellowship, Division of Cardiology, Department of Internal Medicine (S.N.H., T.L.R., J.L.L.), Vanderbilt University Medical Center
| | - Tadarro Lee Richardson
- Cardiovascular Medicine Fellowship, Division of Cardiology, Department of Internal Medicine (S.N.H., T.L.R., J.L.L.), Vanderbilt University Medical Center
| | - J Lukas Laws
- Cardiovascular Medicine Fellowship, Division of Cardiology, Department of Internal Medicine (S.N.H., T.L.R., J.L.L.), Vanderbilt University Medical Center
| | - Thomas A McLaren
- Division of Cardiology, Department of Internal Medicine, Department of Radiology & Radiological Sciences (T.A.M., S.G.H.), Vanderbilt University Medical Center
| | - Jonathan H Soslow
- Thomas P. Graham Jr Division of Pediatric Cardiology, Department of Pediatrics (J.H.S.), Vanderbilt University Medical Center
| | - Michael T Baker
- Division of Cardiology, Department of Internal Medicine (M.T.B., J.M.D.), Vanderbilt University Medical Center
| | - Jeffrey M Dendy
- Division of Cardiology, Department of Internal Medicine (M.T.B., J.M.D.), Vanderbilt University Medical Center
| | - Daniel E Clark
- Division of Cardiology, Department of Internal Medicine, Stanford University School of Medicine (D.E.C.)
| | - Sean G Hughes
- Division of Cardiology, Department of Internal Medicine, Department of Radiology & Radiological Sciences (T.A.M., S.G.H.), Vanderbilt University Medical Center
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9
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Shu H, Zhao C, Wang DW. Understanding COVID-19-related myocarditis: pathophysiology, diagnosis, and treatment strategies. CARDIOLOGY PLUS 2023; 8:72-81. [PMID: 37539019 PMCID: PMC10364646 DOI: 10.1097/cp9.0000000000000046] [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: 01/30/2023] [Accepted: 03/27/2023] [Indexed: 08/05/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) disease has infected nearly 600 million people, resulting in > 6 million deaths, with many of them dying from cardiovascular diseases. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is caused by a combination of the virus surface spike protein and the human angiotensin-converting enzyme 2 (ACE2) receptor. In addition to being highly expressed in the lungs, ACE2 is widely distributed in the heart, mainly in myocardial cells and pericytes. Like other types of viruses, SARS-CoV-2 can cause myocarditis after infecting the myocardial tissue, which is attributed to the direct damage of the virus and uncontrolled inflammatory reactions. Patients with chest tightness, palpitation, abnormal electrocardiogram, and cardiac troponin elevation, should be suspected of myocarditis within 1-3 weeks of COVID-19 infection. When the hemodynamics change rapidly, fulminant myocarditis should be suspected. Cardiac ultrasound, myocardial biopsy, cytokine detection, cardiac magnetic resonance imaging, 18F-fluorodeoxyglucose positron emission tomography, and other examination methods can assist in the diagnosis. Although scientists and clinicians have made concerted efforts to seek treatment and prevention measures, there are no clear recommendations for the treatment of COVID-19-related myocarditis. For most cases of common myocarditis, general symptomatic and supportive treatments are used. For COVID-19-related fulminant myocarditis, it is emphasized to achieve "early identification, early diagnosis, early prediction, and early treatment" based on the "life support-based comprehensive treatment regimen." Mechanical circulatory support therapy can rest the heart, which is a cure for symptoms, and immune regulation therapy can control the inflammatory storms which is a cure for the disease. Furthermore, complications of COVID-19-related myocarditis, such as arrhythmia, thrombosis, and infection, should be actively treated. Herein, we summarized the incidence rate, manifestations, and diagnosis of COVID-19-related myocarditis and discussed in detail the treatment of COVID-19-related myocarditis, especially the treatment strategy of fulminant myocarditis.
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Affiliation(s)
- Hongyang Shu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
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10
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Singh T, Joshi S, Kershaw LE, Dweck MR, Semple SI, Newby DE. Manganese-Enhanced Magnetic Resonance Imaging of the Heart. J Magn Reson Imaging 2023; 57:1011-1028. [PMID: 36314991 PMCID: PMC10947173 DOI: 10.1002/jmri.28499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 02/23/2023] Open
Abstract
Manganese-based contrast media were the first in vivo paramagnetic agents to be used in magnetic resonance imaging (MRI). The uniqueness of manganese lies in its biological function as a calcium channel analog, thus behaving as an intracellular contrast agent. Manganese ions are taken up by voltage-gated calcium channels in viable tissues, such as the liver, pancreas, kidneys, and heart, in response to active calcium-dependent cellular processes. Manganese-enhanced magnetic resonance imaging (MEMRI) has therefore been used as a surrogate marker for cellular calcium handling and interest in its potential clinical applications has recently re-emerged, especially in relation to assessing cellular viability and myocardial function. Calcium homeostasis is central to myocardial contraction and dysfunction of myocardial calcium handling is present in various cardiac pathologies. Recent studies have demonstrated that MEMRI can detect the presence of abnormal myocardial calcium handling in patients with myocardial infarction, providing clear demarcation between the infarcted and viable myocardium. Furthermore, it can provide more subtle assessments of abnormal myocardial calcium handling in patients with cardiomyopathies and being excluded from areas of nonviable cardiomyocytes and severe fibrosis. As such, MEMRI offers exciting potential to improve cardiac diagnoses and provide a noninvasive measure of myocardial function and contractility. This could be an invaluable tool for the assessment of both ischemic and nonischemic cardiomyopathies as well as providing a measure of functional myocardial recovery, an accurate prediction of disease progression and a method of monitoring treatment response. EVIDENCE LEVEL: 5: TECHNICAL EFFICACY: STAGE 5.
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Affiliation(s)
- Trisha Singh
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh Heart CentreRoyal Infirmary of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - Shruti Joshi
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh Heart CentreRoyal Infirmary of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - Lucy E Kershaw
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - Marc R Dweck
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh Heart CentreRoyal Infirmary of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - Scott I Semple
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - David E Newby
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh Heart CentreRoyal Infirmary of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
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11
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Abstract
PURPOSE OF REVIEW Cardiac consequences occur in both acute COVID-19 and post-acute sequelae of COVID-19 (PASC). Here, we highlight the current understanding about COVID-19 cardiac effects, based upon clinical, imaging, autopsy, and molecular studies. RECENT FINDINGS COVID-19 cardiac effects are heterogeneous. Multiple, concurrent cardiac histopathologic findings have been detected on autopsies of COVID-19 non-survivors. Microthrombi and cardiomyocyte necrosis are commonly detected. Macrophages often infiltrate the heart at high density but without fulfilling histologic criteria for myocarditis. The high prevalences of microthrombi and inflammatory infiltrates in fatal COVID-19 raise the concern that recovered COVID-19 patients may have similar but subclinical cardiac pathology. Molecular studies suggest that SARS-CoV-2 infection of cardiac pericytes, dysregulated immunothrombosis, and pro-inflammatory and anti-fibrinolytic responses underlie COVID-19 cardiac pathology. The extent and nature by which mild COVID-19 affects the heart is unknown. Imaging and epidemiologic studies of recovered COVID-19 patients suggest that even mild illness confers increased risks of cardiac inflammation, cardiovascular disorders, and cardiovascular death. The mechanistic details of COVID-19 cardiac pathophysiology remain under active investigation. The ongoing evolution of SARS-CoV-2 variants and vast numbers of recovered COVID-19 patients portend a burgeoning global cardiovascular disease burden. Our ability to prevent and treat cardiovascular disease in the future will likely depend on comprehensive understanding of COVID-19 cardiac pathophysiologic phenotypes.
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Affiliation(s)
- Lorenzo R. Sewanan
- Department of Medicine, Columbia University Irving Medical Center, New York, NY USA
| | - Kevin J. Clerkin
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Irving Medical Center, New York, NY USA
| | | | - Emily J. Tsai
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Irving Medical Center, New York, NY USA
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12
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Repeatability and reproducibility of cardiac manganese-enhanced magnetic resonance imaging. Sci Rep 2023; 13:3366. [PMID: 36849509 PMCID: PMC9971197 DOI: 10.1038/s41598-023-29591-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023] Open
Abstract
Manganese-enhanced magnetic resonance imaging can provide a surrogate measure of myocardial calcium handling. Its repeatability and reproducibility are currently unknown. Sixty-eight participants: 20 healthy volunteers, 20 with acute myocardial infarction, 18 with hypertrophic and 10 with non-ischemic dilated cardiomyopathy underwent manganese-enhanced magnetic resonance imaging. Ten healthy volunteers were re-scanned at 3 months. Native T1 values and myocardial manganese uptake were assessed for intra and inter-observer repeatability. Scan-rescan reproducibility was assessed in ten healthy volunteers. Intra-observer and inter-observer correlation was excellent in healthy volunteers for mean native T1 mapping [Lin's correlation coefficient (LCC) 0.97 and 0.97 respectively] and myocardial manganese uptake (LCC: 0.99 and 0.96 respectively). Scan-rescan correlation for native T1 and myocardial manganese uptake was also excellent. Similarly, intra-observer correlations for native T1 and myocardial manganese uptake in patients with acute myocardial infarction (LCC: 0.97 and 0.97 respectively), hypertrophic (LCC: 0.98 and 0.97 respectively) and dilated cardiomyopathy (LCC: 0.99 and 0.95 respectively) were excellent. Limits of agreement were broader in patients with dilated cardiomyopathy. Manganese-enhanced magnetic resonance imaging has high repeatability and reproducibility in healthy myocardium and high repeatability in diseased myocardium. However, further study is needed to establish robustness in pathologies with diffuse myocardial fibrosis.
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13
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Saeedi-Boroujeni A, Purrahman D, Shojaeian A, Poniatowski ŁA, Rafiee F, Mahmoudian-Sani MR. Progranulin (PGRN) as a regulator of inflammation and a critical factor in the immunopathogenesis of cardiovascular diseases. J Inflamm (Lond) 2023; 20:1. [PMID: 36658641 PMCID: PMC9851114 DOI: 10.1186/s12950-023-00327-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/15/2023] [Indexed: 01/20/2023] Open
Abstract
Immune dysregulation has been identified as a critical cause of the most common types of cardiovascular diseases (CVDs). Notably, the innate and adaptive immune responses under physiological conditions are typically regulated with high sensitivity to avoid the exacerbation of inflammation, but any dysregulation can probably be associated with CVDs. In this respect, progranulin (PGRN) serves as one of the main components of the regulation of inflammatory processes, which significantly contributes to the immunopathogenesis of such disorders. PGRN has been introduced among the secreted growth factors as one related to wound healing, inflammation, and human embryonic development, as well as a wide variety of autoimmune diseases. The relationship between the serum PGRN and TNF-α ratio with the spontaneous bacterial peritonitis constitute one of the independent predictors of these conditions. The full-length PGRN can thus effectively reduce the calcification of valve interstitial cells, and the granulin precursor (GRN), among the degradation products of PGRN, can be beneficial. Moreover, it was observed that, PGRN protects the heart against ischemia-reperfusion injury. Above all, PGRN also provides protection in the initial phase following myocardial ischemia-reperfusion injury. The protective impact of PGRN on this may be associated with the early activation of the PI3K/Akt signaling pathway. PGRN also acts as a protective factor in hyperhomocysteinemia, probably by down-regulating the wingless-related integration site Wnt/β-catenin signaling pathway. Many studies have further demonstrated that SARS-CoV-2 (COVID-19) has dramatically increased the risks of CVDs due to inflammation, so PGRN has drawn much more attention among scholars. Lysosomes play a pivotal role in the inflammation process, and PGRN is one of the key regulators in their functioning, which contributes to the immunomodulatory mechanism in the pathogenesis of CVDs. Therefore, investigation of PGRN actions can help find new prospects in the treatment of CVDs. This review aims to summarize the role of PGRN in the immunopathogenesis of CVD, with an emphasis on its treatment.
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Affiliation(s)
- Ali Saeedi-Boroujeni
- Department of Microbiology, School of Medicine, Abadan University of Medical Sciences, Abadan, Iran
| | - Daryush Purrahman
- grid.411230.50000 0000 9296 6873Thalassemia and Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Shojaeian
- grid.411950.80000 0004 0611 9280Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Łukasz A. Poniatowski
- grid.491786.50000 0001 0211 9062Department of Neurosurgery, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - Fatemeh Rafiee
- grid.469309.10000 0004 0612 8427Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Science, Zanjan, Iran
| | - Mohammad-Reza Mahmoudian-Sani
- grid.411230.50000 0000 9296 6873Thalassemia and Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran ,grid.411230.50000 0000 9296 6873Clinical Research Development Unit, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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14
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Varona JF, Landete P, Paredes R, Vates R, Torralba M, Guisado-Vasco P, Porras L, Muñoz P, Gijon P, Ancochea J, Saiz E, Meira F, Jimeno J, Lopez-Martin J, Estrada V. Plitidepsin in adult patients with COVID-19 requiring hospital admission: A long-term follow-up analysis. Front Cell Infect Microbiol 2023; 13:1097809. [PMID: 36909731 PMCID: PMC9992643 DOI: 10.3389/fcimb.2023.1097809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction The APLICOV-PC study assessed the safety and preliminary efficacy of plitidepsin in hospitalized adult patients with COVID-19. In this follow-up study (E-APLICOV), the incidence of post-COVID-19 morbidity was evaluated and any long-term complications were characterized. Methods Between January 18 and March 16, 2022, 34 of the 45 adult patients who received therapy with plitidepsin in the APLICOV-PC study were enrolled in E-APLICOV (median time from plitidepsin first dose to E-APLICOV enrollment, 16.8 months [range, 15.2-19.5 months]). All patients were functionally autonomous with regard to daily living (Barthel index: 100) and had normal physical examinations. Results From the APLICOV-PC date of discharge to the date of the extension visit, neither Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5) grade 3-4 complications nor QT prolongation or significant electrocardiogram (EKG) abnormalities were reported. Five (14.7%) patients had another COVID-19 episode after initial discharge from APLICOV-PC, and in 2 patients (5.9%), previously unreported chest X-ray findings were documented. Spirometry and lung-diffusion tests were normal in 29 (85.3%) and 27 (79.4%) patients, respectively, and 3 patients needed additional oxygen supplementation after initial hospital discharge. None of these patients required subsequent hospital readmission for disease-related complications. Discussion In conclusion, plitidepsin has demonstrated a favorable long-term safety profile in adult patients hospitalized for COVID-19. With the constraints of a low sample size and a lack of control, the rate of post-COVID-19 complications after treatment with plitidepsin is in the low range of published reports. (ClinicalTrials.gov Identifier: NCT05121740; https://clinicaltrials.gov/ct2/show/NCT05121740).
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Affiliation(s)
- Jose F. Varona
- Departamento de Medicina Interna, Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain
- Facultad de Medicina, Universidad San Pablo-Centro de Estudios Universitarios (CEU), Madrid, Spain
- *Correspondence: Jose F. Varona,
| | - Pedro Landete
- Departamento de Neumología, Hospital Universitario La Princesa, Madrid, Spain
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Roger Paredes
- Infectious Diseases Department, IrsiCaixa Acquired Immunodeficiency Syndrome (AIDS) Research Institute, Barcelona, Spain
- Servicio de Enfermedades Infecciosas Hospital Germans Trias I Pujol, Barcelona, Spain
| | - Roberto Vates
- Internal Medicine Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Miguel Torralba
- Medicine Department, Health Sciences Faculty, University of Alcalá, Madrid, Spain
- Internal Medicine Department, Guadalajara University Hospital, Guadalajara, Spain
| | - Pablo Guisado-Vasco
- Internal Medicine Department, Hospital Universitario Quironsalud Madrid, Madrid, Spain
- Departamento de Medicina, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain
| | - Lourdes Porras
- Internal Medicine, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Paloma Gijon
- Clinical Microbiology and Infectious Diseases Department, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Julio Ancochea
- Departamento de Neumología, Hospital Universitario La Princesa, Madrid, Spain
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Saiz
- Virology Unit, PharmaMar, SA, Madrid, Spain
| | | | | | | | - Vicente Estrada
- Departamento de Medicina Interna Hospital Clínico San Carlos, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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15
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Bularga A, Newby DE, Chapman AR. Not to be sneezed at: cardiovascular disease after COVID-19 infection. Heart 2022; 109:84-85. [PMID: 36280345 DOI: 10.1136/heartjnl-2022-321748] [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] [Indexed: 11/04/2022] Open
Affiliation(s)
- Anda Bularga
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Andrew R Chapman
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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16
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Singh T, Joshi S, Kershaw LE, Baker AH, McCann GP, Dawson DK, Dweck MR, Semple SI, Newby DE. Manganese-Enhanced Magnetic Resonance Imaging in Takotsubo Syndrome. Circulation 2022; 146:1823-1835. [PMID: 36317524 PMCID: PMC7613919 DOI: 10.1161/circulationaha.122.060375] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Takotsubo syndrome is an acute cardiac emergency characterized by transient left ventricular systolic dysfunction typically following a stressful event. Despite its rapidly rising incidence, its pathophysiology remains poorly understood. Takotsubo syndrome may pass unrecognized, especially if timely diagnostic imaging is not performed. Defective myocardial calcium homeostasis is a central cause of contractile dysfunction and has not been explored in takotsubo syndrome. We aimed to investigate myocardial calcium handling using manganese-enhanced magnetic resonance imaging during the acute and recovery phases of takotsubo syndrome. METHODS Twenty patients with takotsubo syndrome (63±12 years of age; 90% female) and 20 volunteers matched on age, sex, and cardiovascular risk factors (59±11 years of age; 70% female) were recruited from the Edinburgh Heart Centre between March 2020 and October 2021. Patients underwent gadolinium and manganese-enhanced magnetic resonance imaging during index hospitalization with repeat manganese-enhanced magnetic resonance imaging performed after at least 3 months. RESULTS Compared with matched control volunteers, patients had a reduced left ventricular ejection fraction (51±11 versus 67±8%; P<0.001), increased left ventricular mass (86±11 versus 57±14 g/m2; P<0.001), and, in affected myocardial segments, elevated native T1 (1358±49 versus 1211±28 ms; P<0.001) and T2 (60±7 versus 38±3 ms; P<0.0001) values at their index presentation. During manganese-enhanced imaging, kinetic modeling demonstrated a substantial reduction in myocardial manganese uptake (5.1±0.5 versus 8.2±1.1 mL/[100 g of tissue ·min], respectively; P<0.0001), consistent with markedly abnormal myocardial calcium handling. After recovery, left ejection fraction, left ventricular mass, and T2 values were comparable with those of matched control volunteers. Despite this, native and postmanganese T1 and myocardial manganese uptake remained abnormal compared with matched control volunteers (6.6±0.5 versus 8.2±1.1 mL/[100 g of tissue ·min]; P<0.0001). CONCLUSIONS In patients with takotsubo syndrome, there is a profound perturbation of myocardial manganese uptake, which is most marked in the acute phase but persists for at least 3 months despite apparent restoration of normal left ventricular ejection fraction and resolution of myocardial edema, suggesting abnormal myocardial calcium handling may be implicated in the pathophysiology of takotsubo syndrome. Manganese-enhanced magnetic resonance imaging has major potential to assist in the diagnosis, characterization, and risk stratification of patients with takotsubo syndrome. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04623788.
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Affiliation(s)
- Trisha Singh
- BHF/University Centre for Cardiovascular Science (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
- Edinburgh Imaging (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (T.S., S.J., A.H.B., M.R.D., D.E.N.)
| | - Shruti Joshi
- BHF/University Centre for Cardiovascular Science (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
- Edinburgh Imaging (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (T.S., S.J., A.H.B., M.R.D., D.E.N.)
| | - Lucy E Kershaw
- BHF/University Centre for Cardiovascular Science (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
- Edinburgh Imaging (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
| | - Andy H Baker
- BHF/University Centre for Cardiovascular Science (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
- Edinburgh Imaging (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (T.S., S.J., A.H.B., M.R.D., D.E.N.)
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, United Kingdom (G.P.M.)
| | - Dana K Dawson
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, United Kingdom (D.K.D.)
| | - Marc R Dweck
- BHF/University Centre for Cardiovascular Science (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
- Edinburgh Imaging (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (T.S., S.J., A.H.B., M.R.D., D.E.N.)
| | - Scott I Semple
- BHF/University Centre for Cardiovascular Science (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
- Edinburgh Imaging (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
| | - David E Newby
- BHF/University Centre for Cardiovascular Science (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
- Edinburgh Imaging (T.S., S.J., L.E.K., A.H.B., M.R.D., S.I.S., D.E.N.), University of Edinburgh, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (T.S., S.J., A.H.B., M.R.D., D.E.N.)
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17
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Pushparaj TL, Irudaya Raj EF, Irudaya Rani EF. A detailed review of contrast-enhanced fluorescence magnetic resonance imaging techniques for earlier prediction and easy detection of COVID-19. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2022. [DOI: 10.1080/21681163.2022.2144762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - E. Fantin Irudaya Raj
- Department of Electrical and Electronics Engineering, Dr. Sivanthi Aditanar College of Engineering, India
| | - E. Francy Irudaya Rani
- Department of Electronics and Communication Engineering, Francis Xavier Engineering College, India
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18
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Qiao J, Zhao P, Lu J, Huang L, Ma X, Zhou X, Xia L. Cardiac involvement in patients 1 year after recovery from moderate and severe COVID-19 infections. Front Cardiovasc Med 2022; 9:1009637. [PMID: 36386376 PMCID: PMC9646443 DOI: 10.3389/fcvm.2022.1009637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background Some patients suffered persistent cardiac symptoms after hospital discharge following COVID-19 infection, including chest tightness, chest pain, and palpitation. However, the cardiac involvement in these patients remains unknown. The purpose of this study was to investigate the effect of COVID-19 infection on the cardiovascular system after 1 year of recovery in patients hospitalized with persistent cardiac symptoms. Materials and methods In this prospective observational study, a total of 32 patients who had COVID-19 (11 diagnosed as severe COVID-19 and 21 as moderate) with persistent cardiac symptoms after hospital discharge were enrolled. Contrast-enhanced cardiovascular magnetic resonance (CMR) imaging was performed on all patients. Comparisons were made with age- and sex-matched healthy controls (n = 13), and age-, sex- and risk factor-matched controls (n = 21). Further analysis was made between the severe and moderate COVID-19 cohorts. Results The mean time interval between acute COVID-19 infection and CMR was 462 ± 18 days. Patients recovered from COVID-19 had reduced left ventricular ejection fraction (LVEF) (p = 0.003) and increased extracellular volumes (ECVs) (p = 0.023) compared with healthy controls. Focal late gadolinium enhancement (LGE) was found in 22 (68.8%) patients, mainly distributed linearly in the septal mid-wall or patchily in RV insertion point. The LGE extent in patients with severe COVID-19 was higher than that in patients with moderate COVID-19 (p = 0.009). Conclusion This 1-year follow-up study revealed that patients with persistent cardiac symptoms, after recovering from COVID-19, had decreased cardiac function and increased ECV compared with healthy controls. Patients with COVID-19 predominately had a LGE pattern of septal mid-wall or RV insertion point. Patients with severe COVID-19 had greater LGE extent than patients with moderate COVID-19.
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Affiliation(s)
- Jinhan Qiao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peijun Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianyao Lu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoling Ma
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Liming Xia,
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19
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Gorecka M, Jex N, Thirunavukarasu S, Chowdhary A, Corrado J, Davison J, Tarrant R, Poenar AM, Sharrack N, Parkin A, Sivan M, Swoboda PP, Xue H, Vassiliou V, Kellman P, Plein S, Halpin SJ, Simms AD, Greenwood JP, Levelt E. Cardiovascular magnetic resonance imaging and spectroscopy in clinical long-COVID-19 syndrome: a prospective case-control study. J Cardiovasc Magn Reson 2022; 24:50. [PMID: 36089591 PMCID: PMC9464490 DOI: 10.1186/s12968-022-00887-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The underlying pathophysiology of post-coronavirus disease 2019 (long-COVID-19) syndrome remains unknown, but increased cardiometabolic demand and state of mitochondrial dysfunction have emerged as candidate mechanisms. Cardiovascular magnetic resonance (CMR) provides insight into pathophysiological mechanisms underlying cardiovascular disease and 31-phosphorus CMR spectroscopy (31P-CMRS) allows non-invasive assessment of the myocardial energetic state. The main aim of the study was to assess whether long COVID-19 syndrome is associated with abnormalities of myocardial structure, function, perfusion and energy metabolism. METHODS Prospective case-control study. A total of 20 patients with a clinical diagnosis of long COVID-19 syndrome (seropositive) and no prior underlying cardiovascular disease (CVD) and 10 matching healthy controls underwent 31P-CMRS and CMR at 3T at a single time point. All patients had been symptomatic with acute COVID-19, but none required hospital admission. RESULTS Between the long COVID-19 syndrome patients and matched contemporary healthy controls there were no differences in myocardial energetics (phosphocreatine to ATP ratio), in cardiac structure (biventricular volumes), function (biventricular ejection fractions, global longitudinal strain), tissue characterization (T1 mapping and late gadolinium enhancement) or perfusion (myocardial rest and stress blood flow, myocardial perfusion reserve). One patient with long COVID-19 syndrome showed subepicardial hyperenhancement on late gadolinium enhancement imaging compatible with prior myocarditis, but no accompanying abnormality in cardiac size, function, perfusion, extracellular volume fraction, native T1, T2 or cardiac energetics. CONCLUSIONS In this prospective case-control study, the overwhelming majority of patients with a clinical long COVID-19 syndrome with no prior CVD did not exhibit any abnormalities in myocardial energetics, structure, function, blood flow or tissue characteristics.
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Affiliation(s)
- Miroslawa Gorecka
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Nicholas Jex
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Sharmaine Thirunavukarasu
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Amrit Chowdhary
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Joanna Corrado
- Department of Rehabilitation Medicine, Leeds Teaching Hospitals Trust, Leeds, UK
| | | | | | - Ana-Maria Poenar
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Noor Sharrack
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Amy Parkin
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Manoj Sivan
- Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD, 20892, USA
| | - Vassilios Vassiliou
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD, 20892, USA
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Stephen J Halpin
- Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.
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21
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Singh J, Bhagaloo L, Sy E, Lavoie AJ, Dehghani P, Bardutz HA, Mang CS, Buttigieg J, Neary JP. Cardiac impairments in postacute COVID-19 with sustained symptoms: A review of the literature and proof of concept. Physiol Rep 2022; 10:e15430. [PMID: 35993433 PMCID: PMC9393908 DOI: 10.14814/phy2.15430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
Although acute COVID-19 is known to cause cardiac damage in some cases, there is still much to learn about the duration and relative permanence of the damage that may occur. Long COVID is a condition that can occur when COVID-19 symptoms remain in the postviral acute period. Varying accounts of long COVID have been described across the literature, however, cardiac impairments are sustained in many individuals and cardiovascular assessment is now considered to be an expected follow-up examination. The purpose of this review and proof of concept is to summarize the current research related to the assessment of cardiac function, including echocardiography and blood biomarker data, during the follow-up period in patients who recovered from COVID-19. Following a literature review, it was found that right ventricular dysfunction along with global longitudinal strain and diastolic dysfunction are common findings. Finally, more severe acute myocardial injury during the index hospitalization appears to exacerbate cardiac function. The available literature implies that cardiac function must be monitored in patients recovered from COVID-19 who remain symptomatic and that the impairments and severity vary from person-to-person. The proof-of-concept analysis of patients with cardiac disease and respiratory disease in comparison to those with sustained symptoms from COVID-19 suggests elevated systolic time interval in those with sustained symptoms from COVID-19, thus reducing heart performance indices. Future research must consider the details of cardiac complications during the acute infection period and relate this to the cardiac function in patients with long COVID during mid- and long-term follow-up.
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Affiliation(s)
- Jyotpal Singh
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
- Department of CardiologyPrairie Vascular Research Inc, Saskatchewan Health AuthorityReginaSaskatchewanCanada
| | - Lanishen Bhagaloo
- Gateway Alliance MedicalReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
- Department of Family MedicineSaskatchewan Health AuthorityReginaSaskatchewanCanada
| | - Eric Sy
- Department of Critical CareSaskatchewan Health AuthorityReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
- College of Graduate and Postdoctoral StudiesUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Andrea J. Lavoie
- Department of CardiologyPrairie Vascular Research Inc, Saskatchewan Health AuthorityReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
| | - Payam Dehghani
- Department of CardiologyPrairie Vascular Research Inc, Saskatchewan Health AuthorityReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
| | - Holly A. Bardutz
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
| | - Cameron S. Mang
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
| | - Josef Buttigieg
- Faculty of Science, Department of BiologyUniversity of ReginaReginaSaskatchewanCanada
| | - J. Patrick Neary
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
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22
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Morrow AJ, Sykes R, McIntosh A, Kamdar A, Bagot C, Bayes HK, Blyth KG, Briscoe M, Bulluck H, Carrick D, Church C, Corcoran D, Findlay I, Gibson VB, Gillespie L, Grieve D, Hall Barrientos P, Ho A, Lang NN, Lennie V, Lowe DJ, Macfarlane PW, Mark PB, Mayne KJ, McConnachie A, McGeoch R, McGinley C, McKee C, Nordin S, Payne A, Rankin AJ, Robertson KE, Roditi G, Ryan N, Sattar N, Allwood-Spiers S, Stobo D, Touyz RM, Veldtman G, Watkins S, Weeden S, Weir RA, Welsh P, Wereski R, Mangion K, Berry C. A multisystem, cardio-renal investigation of post-COVID-19 illness. Nat Med 2022; 28:1303-1313. [PMID: 35606551 PMCID: PMC9205780 DOI: 10.1038/s41591-022-01837-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/25/2022] [Indexed: 12/27/2022]
Abstract
The pathophysiology and trajectory of post-Coronavirus Disease 2019 (COVID-19) syndrome is uncertain. To clarify multisystem involvement, we undertook a prospective cohort study including patients who had been hospitalized with COVID-19 (ClinicalTrials.gov ID NCT04403607 ). Serial blood biomarkers, digital electrocardiography and patient-reported outcome measures were obtained in-hospital and at 28-60 days post-discharge when multisystem imaging using chest computed tomography with pulmonary and coronary angiography and cardio-renal magnetic resonance imaging was also obtained. Longer-term clinical outcomes were assessed using electronic health records. Compared to controls (n = 29), at 28-60 days post-discharge, people with COVID-19 (n = 159; mean age, 55 years; 43% female) had persisting evidence of cardio-renal involvement and hemostasis pathway activation. The adjudicated likelihood of myocarditis was 'very likely' in 21 (13%) patients, 'probable' in 65 (41%) patients, 'unlikely' in 56 (35%) patients and 'not present' in 17 (11%) patients. At 28-60 days post-discharge, COVID-19 was associated with worse health-related quality of life (EQ-5D-5L score 0.77 (0.23) versus 0.87 (0.20)), anxiety and depression (PHQ-4 total score 3.59 (3.71) versus 1.28 (2.67)) and aerobic exercise capacity reflected by predicted maximal oxygen utilization (20.0 (7.6) versus 29.5 (8.0) ml/kg/min) (all P < 0.01). During follow-up (mean, 450 days), 24 (15%) patients and two (7%) controls died or were rehospitalized, and 108 (68%) patients and seven (26%) controls received outpatient secondary care (P = 0.017). The illness trajectory of patients after hospitalization with COVID-19 includes persisting multisystem abnormalities and health impairments that could lead to substantial demand on healthcare services in the future.
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Affiliation(s)
- Andrew J Morrow
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Robert Sykes
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Anna Kamdar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Hannah K Bayes
- Department of Respiratory Medicine, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Michael Briscoe
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - David Carrick
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | - Colin Church
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Iain Findlay
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Vivienne B Gibson
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Douglas Grieve
- Department of Respiratory Medicine, Royal Alexandra Hospital, Glasgow, UK
| | | | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, Institute of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Ninian N Lang
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Vera Lennie
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - David J Lowe
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Peter W Macfarlane
- Electrocardiology Core Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Kaitlin J Mayne
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ross McGeoch
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | | | - Connor McKee
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sabrina Nordin
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alexander Payne
- Department of Cardiology, University Hospital Crosshouse, Kilmarnock, UK
| | - Alastair J Rankin
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Keith E Robertson
- West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Giles Roditi
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Nicola Ryan
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Sarah Allwood-Spiers
- Department of Respiratory Medicine, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - David Stobo
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Rhian M Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Gruschen Veldtman
- Scottish Adult Congenital Cardiac Services, NHS Golden Jubilee, Clydebank, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Sarah Weeden
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robin A Weir
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Ryan Wereski
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK.
- West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK.
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23
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Bularga A, Hung J, Daghem M, Stewart S, Taggart C, Wereski R, Singh T, Meah MN, Fujisawa T, Ferry AV, Chiong J, Jenkins WS, Strachan FE, Semple S, van Beek EJ, Williams M, Dey D, Tuck C, Baker AH, Newby DE, Dweck MR, Mills NL, Chapman AR. Coronary Artery and Cardiac Disease in Patients With Type 2 Myocardial Infarction: A Prospective Cohort Study. Circulation 2022; 145:1188-1200. [PMID: 35341327 PMCID: PMC9010024 DOI: 10.1161/circulationaha.121.058542] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/25/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Type 2 myocardial infarction is caused by myocardial oxygen supply-demand imbalance, and its diagnosis is increasingly common with the advent of high-sensitivity cardiac troponin assays. Although this diagnosis is associated with poor outcomes, widespread uncertainty and confusion remain among clinicians as to how to investigate and manage this heterogeneous group of patients with type 2 myocardial infarction. METHODS In a prospective cohort study, 8064 consecutive patients with increased cardiac troponin concentrations were screened to identify patients with type 2 myocardial infarction. We excluded patients with frailty or renal or hepatic failure. All study participants underwent coronary (invasive or computed tomography angiography) and cardiac (magnetic resonance or echocardiography) imaging, and the underlying causes of infarction were independently adjudicated. The primary outcome was the prevalence of coronary artery disease. RESULTS In 100 patients with a provisional diagnosis of type 2 myocardial infarction (median age, 65 years [interquartile range, 55-74 years]; 43% women), coronary and cardiac imaging reclassified the diagnosis in 7 patients: type 1 or 4b myocardial infarction in 5 and acute myocardial injury in 2 patients. In those with type 2 myocardial infarction, median cardiac troponin I concentrations were 195 ng/L (interquartile range, 62-760 ng/L) at presentation and 1165 ng/L (interquartile range, 277-3782 ng/L) on repeat testing. The prevalence of coronary artery disease was 68% (63 of 93), which was obstructive in 30% (28 of 93). Infarct-pattern late gadolinium enhancement or regional wall motion abnormalities were observed in 42% (39 of 93), and left ventricular systolic dysfunction was seen in 34% (32 of 93). Only 10 patients had both normal coronary and normal cardiac imaging. Coronary artery disease and left ventricular systolic dysfunction were previously unrecognized in 60% (38 of 63) and 84% (27 of 32), respectively, with only 33% (21 of 63) and 19% (6 of 32) on evidence-based treatments. CONCLUSIONS Systematic coronary and cardiac imaging of patients with type 2 myocardial infarction identified coronary artery disease in two-thirds and left ventricular systolic dysfunction in one-third of patients. Unrecognized and untreated coronary or cardiac disease is seen in most patients with type 2 myocardial infarction, presenting opportunities for initiation of evidence-based treatments with major potential to improve clinical outcomes. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03338504.
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Affiliation(s)
- Anda Bularga
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - John Hung
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Marwa Daghem
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Stacey Stewart
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
- Edinburgh Imaging (S.S., E.J.R.v.B., M.W.), University of Edinburgh, United Kingdom
| | - Caelan Taggart
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Ryan Wereski
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Trisha Singh
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Mohammed N. Meah
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Takeshi Fujisawa
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Amy V. Ferry
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Justin Chiong
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - William S. Jenkins
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Fiona E. Strachan
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Scott Semple
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Edwin J.R. van Beek
- Edinburgh Imaging (S.S., E.J.R.v.B., M.W.), University of Edinburgh, United Kingdom
| | - Michelle Williams
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
- Edinburgh Imaging (S.S., E.J.R.v.B., M.W.), University of Edinburgh, United Kingdom
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.D.)
| | - Chris Tuck
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Andrew H. Baker
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - David E. Newby
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Marc R. Dweck
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | | | - Andrew R. Chapman
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
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24
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Tudoran C, Tudoran M, Cut TG, Lazureanu VE, Oancea C, Marinescu AR, Pescariu SA, Pop GN, Bende F. Evolution of Echocardiographic Abnormalities Identified in Previously Healthy Individuals Recovering from COVID-19. J Pers Med 2022; 12:jpm12010046. [PMID: 35055360 PMCID: PMC8778114 DOI: 10.3390/jpm12010046] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Although the infection with the SARS-CoV-2 virus affects primarily the lungs, it is well known that associated cardiovascular (CV) complications are important contributors to the increased morbidity and mortality of COVID-19. Thus, in some situations, their diagnosis is overlooked, and during recovery, some patients continue to have symptoms enclosed now in the post-acute COVID-19 syndrome. (2) Methods: In 102 patients, under 55 years old, and without a history of CV diseases, all diagnosed with post-acute COVID-19 syndrome, we assessed by transthoracic echocardiography (TTE) four patterns of abnormalities frequently overlapping each other. Their evolution was followed at 3 and 6 months. (3) Results: In 35 subjects, we assessed impaired left ventricular function (LVF), in 51 increased systolic pulmonary artery pressure, in 66 diastolic dysfunction (DD) with normal LVF, and in 23 pericardial effusion/thickening. All TTE alterations alleviated during the follow-up, the best evolution being observed in patients with pericarditis, and a considerably worse one in those with DD, thus with a reduction in severity (4) Conclusions: In patients with post-acute COVID-19 syndrome, several cardiac abnormalities may be assessed by TTE, most of them alleviating in time. Some of them, especially DD, may persist, raising the presumption of chronic alterations.
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Affiliation(s)
- Cristina Tudoran
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (C.T.); (M.T.); (F.B.)
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- County Emergency Hospital, Liviu Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
| | - Mariana Tudoran
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (C.T.); (M.T.); (F.B.)
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- County Emergency Hospital, Liviu Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
- Correspondence: (M.T.); (T.G.C.); Tel.: +40-722310302 (M.T.)
| | - Talida Georgiana Cut
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (C.O.); (A.R.M.)
- Doctoral School, Victor Baes university of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Correspondence: (M.T.); (T.G.C.); Tel.: +40-722310302 (M.T.)
| | - Voichita Elena Lazureanu
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (C.O.); (A.R.M.)
| | - Cristian Oancea
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (C.O.); (A.R.M.)
| | - Adelina Raluca Marinescu
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (C.O.); (A.R.M.)
- Doctoral School, Victor Baes university of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Silvius Alexandru Pescariu
- Doctoral School, Victor Baes university of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department VI, Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
| | - Gheorghe Nicusor Pop
- Department VI, Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
| | - Felix Bende
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (C.T.); (M.T.); (F.B.)
- County Emergency Hospital, Liviu Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
- Center of Advanced Research in Gastroenterology and Hepatology, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania
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25
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Affiliation(s)
- Bruno Ramos Nascimento
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil .,Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Craig Sable
- Department of Pediatric Cardiology, Children's National Health System, Washington, District of Columbia, USA
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