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Ioannou P, Akoumianakis I, Filippatos TD, Akoumianaki E, Chamilos G, Kofteridis DP. High-Flow Nasal Oxygen for Severe COVID-19 Pneumonia in Greek Patients: A Prospective Observational Study. Kurume Med J 2023; 69:53-63. [PMID: 37793892 DOI: 10.2739/kurumemedj.ms69120013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
INTRODUCTION High-flow nasal oxygen (HFNO) and prone positioning may improve outcomes of coronavirus disease 2019 (COVID-19) patients treated in the intensive care unit (ICU). The aim of this study was to describe outcomes following the timely application of HFNO and prone positioning in COVID-19 patients treated in a ward setting. METHODS The study included 89 prospectively recruited subjects at the COVID-19 ward unit of the University Hospital of Heraklion, Greece, between March and December 2020. RESULTS Seventy-four (83%) of the 89 subjects in the study had severe COVID-19. Of those, 33 (45%) required HFNO treatment and prone positioning and 15 (45%) were transferred to the ICU, with 4 of them being intubated. Severe COVID-19 and HFNO needs were associated with an increased pneumonia severity index (PSI) score on admission and a worse PaO2/FiO2 ratio. In multivariate analysis, PSI was the only independent predictor of subsequent HFNO needs (OR=1.022). Overall intubation and mortality rates were 5.6% and 3.4%, respectively. CONCLUSION This study shows that for patients with severe COVID-19 hospitalized in medical wards, standard COVID-19 treatment, along with the timely utilization of HFNO and prone positioning, resulted in excellent outcomes with fewer ICU admission rates.
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Affiliation(s)
- Petros Ioannou
- Internal Medicine & Infectious Diseases, University Hospital of Heraklion
| | | | | | | | - Georgios Chamilos
- Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion
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Koskinas KC, Twerenbold R, Carballo D, Matter CM, Cook S, Heg D, Frenk A, Windecker S, Osswald S, Lüscher TF, Mach F. Effects of SARS-COV-2 infection on outcomes in patients hospitalized for acute cardiac conditions. A prospective, multicenter cohort study (Swiss Cardiovascular SARS-CoV-2 Consortium). Front Cardiovasc Med 2023; 10:1203427. [PMID: 37900573 PMCID: PMC10613056 DOI: 10.3389/fcvm.2023.1203427] [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: 04/10/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Background Although the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) causing coronavirus disease 2019 (COVID-19) primarily affects the respiratory system, the disease entity has been associated with cardiovascular complications. This study sought to assess the effect of concomitant SARS-COV-2 infection on clinical outcomes of patients hospitalized primarily for acute cardiac conditions on cardiology wards in Switzerland. Methods In this prospective, observational study conducted in 5 Swiss cardiology centers during the COVID-19 pandemic, patients hospitalized due to acute cardiac conditions underwent a reverse-transcriptase polymerase chain reaction test at the time of admission and were categorized as SARS-COV-2 positive (cases) or negative (controls). Patients hospitalized on cardiology wards underwent treatment for the principal acute cardiac condition according to local practice. Clinical outcomes were recorded in-hospital, at 30 days, and after 1 year and compared between cases and controls. To adjust for imbalanced baseline characteristics, a subgroup of patients derived by propensity matching was analyzed. Results Between March 2020 and February 2022, 538 patients were enrolled including 122 cases and 416 controls. Mean age was 68.0 ± 14.7 years, and 75% were men. Compared with controls, SARS-COV-2-positive patients more commonly presented with acute heart failure (35% vs. 17%) or major arrhythmia (31% vs. 9%), but less commonly with acute coronary syndrome (26% vs. 53%) or severe aortic stenosis (4% vs. 18%). Mortality was significantly higher in cases vs. controls in-hospital (16% vs. 1%), at 30 days (19.0% vs. 2.2%), and at 1 year (28.7% vs. 7.6%: p < 0.001 for all); this was driven primarily (up to 30 days) and exclusively (at one-year follow-up) by higher non-cardiovascular mortality, and was accompanied by a greater incidence of worsening renal function in cases vs. controls. These findings were maintained in a propensity-matched subgroup of 186 patients (93 cases and 93 controls) with balanced clinical presentation and baseline characteristics. Conclusions In this observational study of patients hospitalized for acute cardiac conditions, SARS-COV-2 infection at index hospitalization was associated with markedly higher all-cause and non-cardiovascular mortality throughout one-year follow-up. These findings highlight the need for effective, multifaceted management of both cardiac and non-cardiac morbidities and prolonged surveillance in patients with acute cardiac conditions complicated by SARS-COV-2 infection.
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Affiliation(s)
| | - Raphael Twerenbold
- Department of Cardiology, Basel University Hospital, Basel, Switzerland
- University Center of Cardiovascular Science & Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg–Kiel–Lübeck, Hamburg, Germany
| | - David Carballo
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Stephane Cook
- Department of Cardiology, Fribourg Canton Hospital, Fribourg, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Andre Frenk
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
| | - Stefan Osswald
- Department of Cardiology, Basel University Hospital, Basel, Switzerland
| | - Thomas F. Lüscher
- Department of Cardiology, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, London, United Kingdom
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Francois Mach
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
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van Blydenstein SA, Omar S, Jacobson B, Menezes CN, Meel R. Right heart echocardiography findings in hypoxic pneumonia patients during the COVID-19 pandemic in a South African population. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad030. [PMID: 39045060 PMCID: PMC11195700 DOI: 10.1093/ehjimp/qyad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/03/2023] [Indexed: 07/25/2024]
Abstract
Aims The right ventricle is affected by Coronavirus disease 19 (COVID-19) via multiple mechanisms, which can result in right ventricular dysfunction (RVD). This study aimed to provide an assessment of right heart function using conventional echocardiography and advanced strain imaging, in patients with hypoxic pneumonia during the COVID-19 pandemic. Methods and results This study was an observational, prospective, single-centre study, including adults with hypoxic pneumonia, in two groups: COVID-19 pneumonia; and non-COVID-19 pneumonia. Bedside echocardiography was performed according to a pre-specified protocol and all right heart measurements were done as per standard guidelines. Right ventricular free wall strain (RVFWS) was measured using Philips® QLAB 11.0 speckle tracking software. Descriptive and comparative statistics were used to analyse data. Spearman Rank Order Correlations were used to determine the correlation between right ventricular (RV) parameters and clinical parameters. Univariate and multivariate logistic regression analyses were performed to characterize the predictors of in-hospital mortality. We enrolled 48 patients with COVID-19 pneumonia and 24 with non-COVID-19 pneumonia. COVID-19 patients were significantly older with a higher frequency of hypertension and diabetes and a trend towards a lower severity of illness score. Mean RVFWS yielded the highest estimates for the prevalence of RVD (81%), with no difference between the two pneumonia groups. Median Tricuspid Annular Plane Systolic Excursion (TAPSE) and right ventricular systolic excursion velocity (RVS') were not significantly different between COVID-19 (TAPSE 17.2 and RVS' 12), and non-COVID-19 pneumonia (TAPSE 17.8 and RVS' 12.1) with P values of 0.29 and 0.86, respectively. Non-COVID-19 pneumonia patients with moderate to severe hypoxaemia (PF < 150) were at greater risk of an elevated RV Systolic Pressure >30 mmHg respiratory rate = 3.25 (CI 1.35-7.82) on admission. Troponin levels discriminated between COVID-19 survivors (6 ng/L) and non-survivors (13 ng/L), P = 0.04. The mortality rate for COVID-19 was high (27%) compared to non-COVID-19 pneumonia (12%). Conclusion Patients with COVID-19 pneumonia had a similar admission prevalence of RVD when compared to patients with non-COVID-19 pneumonia. Despite preserved traditional parameters of RV systolic function, RVFWS was diminished in both groups, and we propose that RVFWS serves as an important marker of the subclinical disease of RV.
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Affiliation(s)
- S A van Blydenstein
- Division of Pulmonology, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Chris Hani Road, Johannesburg, 1864, South Africa
| | - S Omar
- Division of Critical Care, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Chris Hani Road, Johannesburg, 1864, South Africa
| | - B Jacobson
- Division of Haematology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa
| | - C N Menezes
- Division of Infectious Diseases, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Chris Hani Road, Johannesburg, 1864, South Africa
| | - R Meel
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa
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Nagai T, Horinouchi H, Yoshioka K, Ikari Y. Right ventricular free wall longitudinal strain assessment using offline speckle tracking in COVID-19 patients requiring intensive medical care. J Med Ultrason (2001) 2023; 50:417-425. [PMID: 37079160 PMCID: PMC10117272 DOI: 10.1007/s10396-023-01305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/14/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE The purpose of this study was to evaluate and confirm the prognostic utility of comprehensive transthoracic echocardiography (TTE) using offline myocardial strain analyses in a Japanese coronavirus disease (COVID-19) cohort hospitalized in intensive care units. METHODS We performed a retrospective analysis of 90 consecutive adult patients with COVID-19 who underwent clinically indicated standard two-dimensional TTE in intensive care wards. Patients on extracorporeal membrane oxygenation (ECMO) at the time of TTE were excluded. Biventricular strain assessments using vendor-independent offline speckle tracking analysis were performed. Patients with inadequate TTE image quality were also excluded. RESULTS Among the 90 COVID-19 patients, 15 (17%) patients required venovenous or venoarterial ECMO. There were 25 (28%) in-hospital deaths. A composite event, defined as the combination of in-hospital mortality and subsequent initiation of ECMO, occurred in 32 patients. Multivariate logistic regression for composite events indicated that right ventricular free wall longitudinal strain (RV-FWLS) and mechanical ventilation at the time of TTE were independent risk factors for composite events (p = 0.01, odds ratio [OR] 1.09, 95% confidence interval [CI] 1.01-1.18; p = 0.04, OR 3.24, 95% CI 1.03-10.20). Cumulative survival probability plots generated using the Kaplan-Meier method for composite events with log-rank tests revealed a significant difference between subgroups divided by the cutoff value of RV-FWLS (p < 0.001). CONCLUSION Offline measurement of RV-FWLS may be a potent predictor of worse outcomes in COVID-19 requiring intensive care. Larger multicenter prospective studies are needed.
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Affiliation(s)
- Tomoo Nagai
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan.
| | - Hitomi Horinouchi
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
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Javidi Dasht Bayaz R, Askari VR, Tayyebi M, Ahmadi M, Heidari-Bakavoli A, Baradaran Rahimi V. Increasing cardiac troponin-I level as a cardiac injury index correlates with in-hospital mortality and biofactors in severe hospitalised COVID-19 patients. J Infect Chemother 2023; 29:250-256. [PMID: 36414196 PMCID: PMC9674565 DOI: 10.1016/j.jiac.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2 raised in 2019 (COVID-19) affects the lung tissue and other organs, specifically the heart. METHODS The current study evaluated 120 hospitalised patients with severe COVID-19 between March 2021 and February 2022. Patients' demographics, vital signs, electrocardiogram abnormalities, clinical laboratory tests, including troponin I (TPI), mortality, and discharge type, were recorded. RESULTS Among the 120 hospitalised patients with severe COVID-19, 54 (45.0%) patients were male, with an average age of 63.2 ± 1.4. Many patients have chronic comorbidities, including hypertension (51.6%), diabetes mellitus (34.1%), and ischemic heart disease (17.5%). The in-hospital and six months after the discharge mortality were 45.8% and 21.5%, respectively. Cardiac injury was observed in 14 (11.7%) patients with a mean TPI level of 8.386 ± 17.89 μg/L, and patients with cardiac injury had higher mortality than those without cardiac injury (P < 0.001). Furthermore, the cardiac injury was meaningfully correlated with age (ρ = 0.182, P = 0.019), history of ischemic heart disease (ρ = 0.176, P = 0.05), hospitalisation result and mortality (ρ = 0.261, P = 0.004), inpatient in ICU (ρ = 0.219, P = 0.016), and serum levels of urea (ρ = 0.244, P = 0.008) and creatinine (ρ = 0.197, P = 0.033). Additionally, the discharge results were significantly correlated with oxygen saturation with (ρ = -0.23, P = 0.02) and without (ρ = -0.3, P = 0.001) oxygen therapy, D-dimer (ρ = 0.328, P = 0.019), LDH (ρ = 0.308, P = 0.003), urea (ρ = 0.2, P = 0.03), and creatinine (ρ = 0.17, P = 0.06) levels. CONCLUSION Elevated TPI levels are associated with increased mortality in severe COVID-19 patients. Therefore, TPI may be a beneficial biofactor for early diagnosis of cardiac injury and preventing a high mortality rate.
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Affiliation(s)
- Reza Javidi Dasht Bayaz
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Vahid Reza Askari
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mohammad Tayyebi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mostafa Ahmadi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Alireza Heidari-Bakavoli
- Vascular & Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Artico J, Shiwani H, Moon JC, Gorecka M, McCann GP, Roditi G, Morrow A, Mangion K, Lukaschuk E, Shanmuganathan M, Miller CA, Chiribiri A, Prasad SK, Adam RD, Singh T, Bucciarelli-Ducci C, Dawson D, Knight D, Fontana M, Manisty C, Treibel TA, Levelt E, Arnold R, Macfarlane PW, Young R, McConnachie A, Neubauer S, Piechnik SK, Davies RH, Ferreira VM, Dweck MR, Berry C, Greenwood JP. Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study. Circulation 2023; 147:364-374. [PMID: 36705028 PMCID: PMC9889203 DOI: 10.1161/circulationaha.122.060632] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/29/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Acute myocardial injury in hospitalized patients with coronavirus disease 2019 (COVID-19) has a poor prognosis. Its associations and pathogenesis are unclear. Our aim was to assess the presence, nature, and extent of myocardial damage in hospitalized patients with troponin elevation. METHODS Across 25 hospitals in the United Kingdom, 342 patients with COVID-19 and an elevated troponin level (COVID+/troponin+) were enrolled between June 2020 and March 2021 and had a magnetic resonance imaging scan within 28 days of discharge. Two prospective control groups were recruited, comprising 64 patients with COVID-19 and normal troponin levels (COVID+/troponin-) and 113 patients without COVID-19 or elevated troponin level matched by age and cardiovascular comorbidities (COVID-/comorbidity+). Regression modeling was performed to identify predictors of major adverse cardiovascular events at 12 months. RESULTS Of the 519 included patients, 356 (69%) were men, with a median (interquartile range) age of 61.0 years (53.8, 68.8). The frequency of any heart abnormality, defined as left or right ventricular impairment, scar, or pericardial disease, was 2-fold greater in cases (61% [207/342]) compared with controls (36% [COVID+/troponin-] versus 31% [COVID-/comorbidity+]; P<0.001 for both). More cases than controls had ventricular impairment (17.2% versus 3.1% and 7.1%) or scar (42% versus 7% and 23%; P<0.001 for both). The myocardial injury pattern was different, with cases more likely than controls to have infarction (13% versus 2% and 7%; P<0.01) or microinfarction (9% versus 0% and 1%; P<0.001), but there was no difference in nonischemic scar (13% versus 5% and 14%; P=0.10). Using the Lake Louise magnetic resonance imaging criteria, the prevalence of probable recent myocarditis was 6.7% (23/342) in cases compared with 1.7% (2/113) in controls without COVID-19 (P=0.045). During follow-up, 4 patients died and 34 experienced a subsequent major adverse cardiovascular event (10.2%), which was similar to controls (6.1%; P=0.70). Myocardial scar, but not previous COVID-19 infection or troponin, was an independent predictor of major adverse cardiovascular events (odds ratio, 2.25 [95% CI, 1.12-4.57]; P=0.02). CONCLUSIONS Compared with contemporary controls, patients with COVID-19 and elevated cardiac troponin level have more ventricular impairment and myocardial scar in early convalescence. However, the proportion with myocarditis was low and scar pathogenesis was diverse, including a newly described pattern of microinfarction. REGISTRATION URL: https://www.isrctn.com; Unique identifier: 58667920.
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Affiliation(s)
- Jessica Artico
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - Hunain Shiwani
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - James C. Moon
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - Miroslawa Gorecka
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, UK (M.G., E. Levelt, J.P.G.)
| | - Gerry P. McCann
- University of Leicester and the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, UK (G.P.M., R.A.)
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre (G.R., A. Morrow, K.M., C.B.), Institute of Health and Wellbeing, University of Glasgow, UK
| | - Andrew Morrow
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre (G.R., A. Morrow, K.M., C.B.), Institute of Health and Wellbeing, University of Glasgow, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre (G.R., A. Morrow, K.M., C.B.), Institute of Health and Wellbeing, University of Glasgow, UK
| | - Elena Lukaschuk
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, UK (E. Lukaschuk, M.S., S.N., S.K.P., V.M.F.)
| | - Mayooran Shanmuganathan
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, UK (E. Lukaschuk, M.S., S.N., S.K.P., V.M.F.)
| | - Christopher A. Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK (C.A.M.)
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, BHF Centre of Excellence and the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, The Rayne Institute, St Thomas’ Hospital, London, UK (A.C., C.B.-D.)
| | - Sanjay K. Prasad
- National Heart and Lung Institute, Imperial College, London, UK (S.K.P.)
| | - Robert D. Adam
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - Trisha Singh
- University of Edinburgh and British Heart Foundation Centre for Cardiovascular Science, UK (T.S., M.R.D.)
| | - Chiara Bucciarelli-Ducci
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre (G.R., A. Morrow, K.M., C.B.), Institute of Health and Wellbeing, University of Glasgow, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, BHF Centre of Excellence and the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, The Rayne Institute, St Thomas’ Hospital, London, UK (A.C., C.B.-D.)
- Royal Brompton and Harefield Hospitals and Guys’ and St Thomas NHS Trust, London, UK (C.B.-D.)
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Trust, Bristol, UK (C.B.-D.)
| | - Dana Dawson
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, UK (D.D.)
| | - Daniel Knight
- Division of Medicine, Royal Free Hospital (D.K., M.F.), University College London, UK
| | - Marianna Fontana
- Division of Medicine, Royal Free Hospital (D.K., M.F.), University College London, UK
| | - Charlotte Manisty
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - Thomas A. Treibel
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - Eylem Levelt
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, UK (M.G., E. Levelt, J.P.G.)
| | - Ranjit Arnold
- University of Leicester and the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, UK (G.P.M., R.A.)
| | - Peter W. Macfarlane
- Electrocardiology Core Laboratory (P.W.M.), Institute of Health and Wellbeing, University of Glasgow, UK
| | - Robin Young
- Robertson Centre for Biostatistics (R.Y., A. McConnachie), Institute of Health and Wellbeing, University of Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics (R.Y., A. McConnachie), Institute of Health and Wellbeing, University of Glasgow, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, UK (E. Lukaschuk, M.S., S.N., S.K.P., V.M.F.)
| | - Stefan K. Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, UK (E. Lukaschuk, M.S., S.N., S.K.P., V.M.F.)
| | - Rhodri H. Davies
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
| | - Vanessa M. Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, UK (E. Lukaschuk, M.S., S.N., S.K.P., V.M.F.)
| | - Marc R. Dweck
- University of Edinburgh and British Heart Foundation Centre for Cardiovascular Science, UK (T.S., M.R.D.)
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre (G.R., A. Morrow, K.M., C.B.), Institute of Health and Wellbeing, University of Glasgow, UK
| | - OxAMI (Oxford Acute Myocardial Infarction Study) Investigators; COVID-HEART Investigators†
- Institute of Cardiovascular Science (J.A., H.S., J.C.M., R.D.A., C.M., T.A.T., R.H.D.), University College London, UK
- Division of Medicine, Royal Free Hospital (D.K., M.F.), University College London, UK
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, UK (M.G., E. Levelt, J.P.G.)
- University of Leicester and the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, UK (G.P.M., R.A.)
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre (G.R., A. Morrow, K.M., C.B.), Institute of Health and Wellbeing, University of Glasgow, UK
- Electrocardiology Core Laboratory (P.W.M.), Institute of Health and Wellbeing, University of Glasgow, UK
- Robertson Centre for Biostatistics (R.Y., A. McConnachie), Institute of Health and Wellbeing, University of Glasgow, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, UK (E. Lukaschuk, M.S., S.N., S.K.P., V.M.F.)
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK (C.A.M.)
- School of Biomedical Engineering and Imaging Sciences, King’s College London, BHF Centre of Excellence and the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, The Rayne Institute, St Thomas’ Hospital, London, UK (A.C., C.B.-D.)
- National Heart and Lung Institute, Imperial College, London, UK (S.K.P.)
- University of Edinburgh and British Heart Foundation Centre for Cardiovascular Science, UK (T.S., M.R.D.)
- Royal Brompton and Harefield Hospitals and Guys’ and St Thomas NHS Trust, London, UK (C.B.-D.)
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Trust, Bristol, UK (C.B.-D.)
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, UK (D.D.)
| | - John P. Greenwood
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, UK (M.G., E. Levelt, J.P.G.)
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Liu A, Hammond R, Chan K, Chukwuenweniwe C, Johnson R, Khair D, Duck E, Olubodun O, Barwick K, Banya W, Stirrup J, Donnelly PD, Kaski JC, Coates ARM. Normal high-sensitivity cardiac troponin for ruling-out inpatient mortality in acute COVID-19. PLoS One 2023; 18:e0284523. [PMID: 37083886 PMCID: PMC10121001 DOI: 10.1371/journal.pone.0284523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/10/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Assessment of inpatient mortality risk in COVID-19 patients is important for guiding clinical decision-making. High sensitivity cardiac troponin T (hs-cTnT) is a biomarker of cardiac injury associated with a worse prognosis in COVID-19. We explored how hs-cTnT could potentially be used in clinical practice for ruling in and ruling out mortality in COVID-19. METHOD We tested the diagnostic value of hs-cTnT in laboratory-confirmed COVID-19 patients (≥18 years old) admitted to the Royal Berkshire Hospital (UK) between 1st March and 10th May 2020. A normal hs-cTnT was defined as a value within the 99th percentile of healthy individuals (≤14 ng/L), and an elevated hs-cTnT was defined as >14 ng/L. Adverse clinical outcome was defined as inpatient mortality related to COVID-19. RESULTS A total of 191 COVID-19 patients (62% male; age 66±16 years) had hs-cTnT measured on admission. Of these patients, 124 (65%) had elevated hs-cTnT and 67 (35%) had normal hs-cTnT. On a group level, patients with elevated hs-cTnT had worse inpatient survival (p = 0.0014; Kaplan-Meier analysis) and higher risk of inpatient mortality (HR 5.84 [95% CI 1.29-26.4]; p = 0.02; Cox multivariate regression) compared to patients with normal hs-cTnT. On a per-patient level, a normal hs-cTnT had a negative predictive value of 94% (95% CI: 85-98%) for ruling out mortality, whilst an elevated hs-cTnT had a low positive predictive value of 38% (95% CI: 39-47%) for ruling in mortality. CONCLUSIONS In this study cohort of COVID-19 patients, the potential clinical utility of hs-cTnT appears to rest in ruling out inpatient mortality. This finding, if prospectively validated in a larger study, may allow hs-cTnT to become an important biomarker to facilitate admission-avoidance and early safe discharge.
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Affiliation(s)
- Alexander Liu
- University of St Andrews School of Medicine, St Andrews, United Kingdom
| | - Robert Hammond
- University of St Andrews School of Medicine, St Andrews, United Kingdom
| | - Kenneth Chan
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | | | - Rebecca Johnson
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Duaa Khair
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Eleanor Duck
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | | | | | | | - James Stirrup
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Peter D Donnelly
- University of St Andrews School of Medicine, St Andrews, United Kingdom
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
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Özdemir E, Karagöz U, Emren SV, Altay S, Eren NK, Özdemir S, Tokaç M. Strain Echocardiographic Evaluation of Myocardial Involvement in Patients with Continuing Chest Pain after COVID-19 Infection. Arq Bras Cardiol 2022; 120:e20220287. [PMID: 36629604 PMCID: PMC9833213 DOI: 10.36660/abc.20220287] [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: 01/22/2022] [Accepted: 09/21/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A new clinical manifestation called post or long coronavirus disease (p/l COVID) has walked into our lives after the acute COVID-19 phase. P/l COVID may lead to myocardial injury with subsequent cardiac problems. Diagnosing these patients quickly and simply has become more important due to the increasing number of patients with p/l COVID. OBJECTIVES We compared strain echocardiography (SE) parameters of patients who suffered from atypical chest pain and had sequel myocarditis findings on cardiac magnetic resonance (CMR). We aimed to investigate the value of SE for detection of myocardial involvement in patients with p/l COVID. METHODS A total of 42 patients were enrolled. Our population was separated into two groups. The CMR(-) group (n = 21) had no myocardial sequelae on CMR, whereas the CMR(+) group had myocardial sequelae on CMR (n = 21). The predictive value of SE for myocarditis was also evaluated by age-adjusted multivariate analysis. P values < 0.05 were considered statistically significant. RESULTS When compared with left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS) had a stronger relationship (LVEF, p = 0.05; GLS, p < 0.001; GCS, p < 0.001) with p/l COVID associated myocardial involvement. GLS < 20.35 had 85.7% sensitivity and 81% specificity; GCS < 21.35 had 81% sensitivity and 81% specificity as diagnostic values for myocardial sequelae detected with CMR. While there was no difference between the groups in terms of inflammatory markers (C-reactive protein, p = 0.31), a difference was observed between biochemical markers, which are indicators of cardiac involvement (brain natriuretic peptide, p < 0.001). CONCLUSION SE is more useful than traditional echocardiography for making diagnosis quickly and accurately in order not to delay treatment in the presence of myocardial involvement.
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Affiliation(s)
- Emre Özdemir
- Faculdade de MedicinaAtatürk Research and Training HospitalKatip Çelebi UniversityIzmirTurquiaDepartamento da Cardiologia, Faculdade de Medicina, Atatürk Research and Training Hospital, Katip Çelebi University, Izmir – Turquia
| | - Uğur Karagöz
- Departamento da CardiologiaTorbalı Goverment HospitalIzmirTurquiaDepartamento da Cardiologia, Torbalı Goverment Hospital, Izmir – Turquia
| | - Sadık Volkan Emren
- Faculdade de MedicinaAtatürk Research and Training HospitalKatip Çelebi UniversityIzmirTurquiaDepartamento da Cardiologia, Faculdade de Medicina, Atatürk Research and Training Hospital, Katip Çelebi University, Izmir – Turquia
| | - Sedat Altay
- Departamento da RadiologiaAtatürk Research and Training HospitalIzmirTurquiaDepartamento da Radiologia, Atatürk Research and Training Hospital, Izmir – Turquia
| | - Nihan Kahya Eren
- Faculdade de MedicinaAtatürk Research and Training HospitalKatip Çelebi UniversityIzmirTurquiaDepartamento da Cardiologia, Faculdade de Medicina, Atatürk Research and Training Hospital, Katip Çelebi University, Izmir – Turquia
| | - Selin Özdemir
- Departamento de Doenças InfecciosasBozyaka Research and Training HospitalIzmirTurquiaDepartamento de Doenças Infecciosas, Bozyaka Research and Training Hospital, Izmir – Turquia
| | - Mehmet Tokaç
- Faculdade de MedicinaAtatürk Research and Training HospitalKatip Çelebi UniversityIzmirTurquiaDepartamento da Cardiologia, Faculdade de Medicina, Atatürk Research and Training Hospital, Katip Çelebi University, Izmir – Turquia
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9
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Mumtaz A, Rehman E, Rahaman MA, Rehman S. Inflammatory biomarkers and cardiac injury in COVID-19 patients. Front Public Health 2022; 10:1024535. [PMID: 36505005 PMCID: PMC9729944 DOI: 10.3389/fpubh.2022.1024535] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Cardiac injury has received considerable attention due to the higher risk of morbidity and mortality associated with coronavirus disease. However, in a developing country, there is a scarcity of data on cardiac injury in COVID-19 patients related to inflammatory biomarkers. Methods Therefore, the present research retrospectively analyzes data from three territorial hospitals in Pakistan's Punjab province to investigate the potential impact of the cardiac injury on the mortality and severity of COVID-19-infected patients. We evaluated 2,051 patients between January 16 and April 18, 2022, with confirmed COVID-19. The in-hospital mortality recorded for the selected sample size was about 16.28%. Results The majority of the participants were identified as male (64%) with a median age of 65 years. Also, fever, fatigue, and dyspnea were reported as common symptoms. An aggregate of 623 patients (30.38%) had a cardiac injury, and when these patients are compared to those without cardiac injury, the participants were significantly older and had more comorbidities with higher leukocyte counts, elevated levels of C-reactive protein, interleukin-6, procalcitonin, myohemoglobin, creatinine kinase-myocardial band, serum creatinine, high-sensitivity troponin-I, N-terminal pro-B-type natriuretic peptide had a significant amount of multiple ground-glass opacity and bilateral pulmonary infiltration in radiographic results. Participants with heart injury required more non-invasive or invasive mechanical respiration than those who did not have a cardiac injury. Individuals with cardiac injury had higher rates of sepsis, acute respiratory distress syndrome (ARDS), d-dimer concentration, and respiratory failure than those without cardiac injury. Patients who had had a cardiac injury died at a higher rate than those who had not suffered cardiac damage. In the multivariable logistic regression analysis, participants with cardiac injury showed greater odds of COVID-19 mortality and were found associated with older age (OR = 1.99, 95% CI = 0.04-3.19), elevated cardiac troponin I (OR = 18.64, 95% CI = 13.16-23.01), the complication of sepsis (OR = 10.39, 95% CI = 7.41-13.39) and ARDS (OR = 6.65, 95% CI = 4.04-8.91). Conclusion Cardiac injury is a frequent complication among patients with coronavirus-induced infection in Punjab, Pakistan, and it is significantly linked to a greater risk of in-hospital mortality.
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Affiliation(s)
- Ayesha Mumtaz
- School of Public Administration, Hangzhou Normal University, Hangzhou, China
| | - Erum Rehman
- Department of Mathematics, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Mohammad Anisur Rahaman
- College of Public Administration, Zhejiang University, Hangzhou, China
- Department of Sociology, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
| | - Shazia Rehman
- Department of Biomedical Sciences, Pak-Austria Fachhochschule, Institute of Applied Sciences and Technology, Haripur, Pakistan
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10
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Vezzoli M, Inciardi RM, Oriecuia C, Paris S, Murillo NH, Agostoni P, Ameri P, Bellasi A, Camporotondo R, Canale C, Carubelli V, Carugo S, Catagnano F, Danzi G, Dalla Vecchia L, Giovinazzo S, Gnecchi M, Guazzi M, Iorio A, La Rovere MT, Leonardi S, Maccagni G, Mapelli M, Margonato D, Merlo M, Monzo L, Mortara A, Nuzzi V, Pagnesi M, Piepoli M, Porto I, Pozzi A, Provenzale G, Sarullo F, Senni M, Sinagra G, Tomasoni D, Adamo M, Volterrani M, Maroldi R, Metra M, Lombardi CM, Specchia C. Machine learning for prediction of in-hospital mortality in coronavirus disease 2019 patients: results from an Italian multicenter study. J Cardiovasc Med (Hagerstown) 2022; 23:439-446. [PMID: 35763764 DOI: 10.2459/jcm.0000000000001329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several risk factors have been identified to predict worse outcomes in patients affected by SARS-CoV-2 infection. Machine learning algorithms represent a novel approach to identifying a prediction model with a good discriminatory capacity to be easily used in clinical practice. The aim of this study was to obtain a risk score for in-hospital mortality in patients with coronavirus disease infection (COVID-19) based on a limited number of features collected at hospital admission. METHODS AND RESULTS We studied an Italian cohort of consecutive adult Caucasian patients with laboratory-confirmed COVID-19 who were hospitalized in 13 cardiology units during Spring 2020. The Lasso procedure was used to select the most relevant covariates. The dataset was randomly divided into a training set containing 80% of the data, used for estimating the model, and a test set with the remaining 20%. A Random Forest modeled in-hospital mortality with the selected set of covariates: its accuracy was measured by means of the ROC curve, obtaining AUC, sensitivity, specificity and related 95% confidence interval (CI). This model was then compared with the one obtained by the Gradient Boosting Machine (GBM) and with logistic regression. Finally, to understand if each model has the same performance in the training and test set, the two AUCs were compared using the DeLong's test. Among 701 patients enrolled (mean age 67.2 ± 13.2 years, 69.5% male individuals), 165 (23.5%) died during a median hospitalization of 15 (IQR, 9-24) days. Variables selected by the Lasso procedure were: age, oxygen saturation, PaO2/FiO2, creatinine clearance and elevated troponin. Compared with those who survived, deceased patients were older, had a lower blood oxygenation, lower creatinine clearance levels and higher prevalence of elevated troponin (all P < 0.001). The best performance out of the samples was provided by Random Forest with an AUC of 0.78 (95% CI: 0.68-0.88) and a sensitivity of 0.88 (95% CI: 0.58-1.00). Moreover, Random Forest was the unique model that provided similar performance in sample and out of sample (DeLong test P = 0.78). CONCLUSION In a large COVID-19 population, we showed that a customizable machine learning-based score derived from clinical variables is feasible and effective for the prediction of in-hospital mortality.
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Affiliation(s)
- Marika Vezzoli
- Department of Molecular and Translational Medicine, University of Brescia, Italy
| | - Riccardo Maria Inciardi
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Chiara Oriecuia
- Department of Molecular and Translational Medicine, University of Brescia, Italy
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Sara Paris
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Natalia Herrera Murillo
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Department of Clinical Sciences and Community Health, University of Milano, Milan
- Department of Clinical Sciences and Community Health, University of Milano, Milan
| | - Pietro Ameri
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova
| | - Antonio Bellasi
- Innovation and Brand Reputation Unit, Papa Giovanni XXIII Hospital, Bergamo
| | - Rita Camporotondo
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia
| | - Claudia Canale
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova
| | - Valentina Carubelli
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Stefano Carugo
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo E Carlo, University of Milano, Milan
| | - Francesco Catagnano
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia
- Cardiology Department, Policlinico Di Monza, Monza
| | | | - Laura Dalla Vecchia
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico Di Milano, Milan
| | - Stefano Giovinazzo
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova
| | | | - Marco Guazzi
- Heart Failure Unit, Cardiology Department, IRCCS San Donato Hospital, University of Milan, Milan
| | - Anita Iorio
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo
| | - Maria Teresa La Rovere
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico Di Pavia, Pavia
| | - Sergio Leonardi
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia
| | - Gloria Maccagni
- Heart Failure Unit, Cardiology Department, IRCCS San Donato Hospital, University of Milan, Milan
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Department of Clinical Sciences and Community Health, University of Milano, Milan
- Department of Clinical Sciences and Community Health, University of Milano, Milan
| | - Davide Margonato
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia
- Cardiology Department, Policlinico Di Monza, Monza
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste
| | - Luca Monzo
- Istituto Clinico Casal Palocco, Rome
- Policlinico Casilino, Rome
| | | | - Vincenzo Nuzzi
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Massimo Piepoli
- Heart Failure Unit, G da Saliceto Hospital, AUSL Piacenza, Piacenza
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa
| | - Italo Porto
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova
| | - Andrea Pozzi
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo
| | - Giovanni Provenzale
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo E Carlo, University of Milano, Milan
| | - Filippo Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo
| | - Michele Senni
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Maurizio Volterrani
- Department of Medical Sciences, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana
| | - Roberto Maroldi
- Radiology ASST Spedali Civili di Brescia and Department of Medical and Surgical, Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Carlo Mario Lombardi
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Italy
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11
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Welty FK, Rajai N, Amangurbanova M. Comprehensive Review of Cardiovascular Complications of Coronavirus Disease 2019 and Beneficial Treatments. Cardiol Rev 2022; 30:145-157. [PMID: 35384908 PMCID: PMC8983616 DOI: 10.1097/crd.0000000000000422] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 and was first reported in December 2019 in Wuhan, China. Since then, it caused a global pandemic with 212,324,054 confirmed cases and 4,440,840 deaths worldwide as of August 22, 2021. The disease spectrum of COVID-19 ranges from asymptomatic subclinical infection to clinical manifestations predominantly affecting the respiratory system. However, it is now evident that COVID-19 is a multiorgan disease with a broad spectrum of manifestations leading to multiple organ injuries including the cardiovascular system. We review studies that have shown that the relationship between cardiovascular diseases and COVID-19 is indeed bidirectional, implicating that preexisting cardiovascular comorbidities increase the morbidity and mortality of COVID-19, and newly emerging cardiac injuries occur in the settings of acute COVID-19 in patients with no preexisting cardiovascular disease. We present the most up-to-date literature summary to explore the incidence of new-onset cardiac complications of coronavirus and their role in predicting the severity of COVID-19. We review the association of elevated troponin with the severity of COVID-19 disease, which includes mild compared to severe disease, in nonintensive care unit compared to intensive care unit patients and in those discharged from the hospital compared to those who die. The role of serum troponin levels in predicting prognosis are compared in survivors and non-survivors. The association between COVID-19 disease and myocarditis, heart failure and coagulopathy are reviewed. Finally, an update on beneficial treatments is discussed.
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Affiliation(s)
- Francine K. Welty
- From the Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Nazanin Rajai
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maral Amangurbanova
- From the Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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12
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Amin A, Chitsazan M, Chitsazan M, Haehling S, Naghashzadeh F, Khoshavi M, Hoseinalizadeh M, Amini S, Ziaie N, Ghaffari S, Asghari R, Amiri A, Garfias-Macedo T, Maleki M. Inpatient cardiology consultation for COVID-19: What are cardiologists' diagnostic approaches? Res Cardiovasc Med 2022. [DOI: 10.4103/rcm.rcm_45_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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13
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Singh V, Kamaleswaran R, Chalfin D, Buño-Soto A, San Roman J, Rojas-Kenney E, Molinaro R, von Sengbusch S, Hodjat P, Comaniciu D, Kamen A. A deep learning approach for predicting severity of COVID-19 patients using a parsimonious set of laboratory markers. iScience 2021; 24:103523. [PMID: 34870131 PMCID: PMC8626152 DOI: 10.1016/j.isci.2021.103523] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022] Open
Abstract
The SARS-CoV-2 virus has caused tremendous healthcare burden worldwide. Our focus was to develop a practical and easy-to-deploy system to predict the severe manifestation of disease in patients with COVID-19 with an aim to assist clinicians in triage and treatment decisions. Our proposed predictive algorithm is a trained artificial intelligence-based network using 8,427 COVID-19 patient records from four healthcare systems. The model provides a severity risk score along with likelihoods of various clinical outcomes, namely ventilator use and mortality. The trained model using patient age and nine laboratory markers has the prediction accuracy with an area under the curve (AUC) of 0.78, 95% CI: 0.77–0.82, and the negative predictive value NPV of 0.86, 95% CI: 0.84–0.88 for the need to use a ventilator and has an accuracy with AUC of 0.85, 95% CI: 0.84–0.86, and the NPV of 0.94, 95% CI: 0.92–0.96 for predicting in-hospital 30-day mortality. Algorithm using 9 laboratory markers & age may predict severity in patients with COVID-19 Model was trained and tested on a multicenter sample of 10,937 patients Algorithm can predict ventilator use (NPV, 0.86) and mortality (NPV, 0.94) High NPV suggests utility as an adjunct to aid in triaging of patients with COVID-19
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Affiliation(s)
- Vivek Singh
- Siemens Healthineers, Digital Technology and Innovation, 755 College Road East, Princeton, NJ 08540, USA
| | - Rishikesan Kamaleswaran
- Emory University School of Medicine WMB, 1010 Woodruff Circle, Suite 4127, Atlanta, GA 30322, USA
| | - Donald Chalfin
- Siemens Healthineers, Laboratory Diagnostics, 511 Benedict Avenue, Tarrytown, NY 10591, USA.,Jefferson College of Population Health of Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA 19107, USA
| | - Antonio Buño-Soto
- Department of Laboratory Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Janika San Roman
- Siemens Healthineers, Laboratory Diagnostics, 511 Benedict Avenue, Tarrytown, NY 10591, USA
| | - Edith Rojas-Kenney
- Siemens Healthineers, Laboratory Diagnostics, 511 Benedict Avenue, Tarrytown, NY 10591, USA
| | - Ross Molinaro
- Siemens Healthineers, Laboratory Diagnostics, 511 Benedict Avenue, Tarrytown, NY 10591, USA
| | - Sabine von Sengbusch
- Siemens Healthineers, Laboratory Diagnostics, 511 Benedict Avenue, Tarrytown, NY 10591, USA
| | - Parsa Hodjat
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA
| | - Dorin Comaniciu
- Siemens Healthineers, Digital Technology and Innovation, 755 College Road East, Princeton, NJ 08540, USA
| | - Ali Kamen
- Siemens Healthineers, Digital Technology and Innovation, 755 College Road East, Princeton, NJ 08540, USA
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14
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Abstract
2019 novel coronavirus disease (COVID-19) is caused by the infection of severe acute respiratory syndrome novel coronavirus (SARS-CoV-2). It is characterized by substantial respiratory symptoms and complicated with widespread other organ injuries. Cardiovascular impairment is one of the notable extrapulmonary manifestations, in terms of the deterioration of pre-existing cardiovascular diseases and newly onset acute events. We hereby review the high-quality reports about cardiovascular involvement in COVID-19 and summarize the main clinical characteristics of cardiac relevance for the all the first line clinical physicians. Additionally, the possible underlying mechanisms and the rationale for the application of specific medications, such as renin-angiotensin-aldosterone system inhibitors and hydroxychloroquine are also discussed.
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15
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Ma C, Tu D, Gu J, Xu Q, Hou P, Wu H, Guo Z, Bai Y, Zhao X, Li P. The Predictive Value of Myoglobin for COVID-19-Related Adverse Outcomes: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:757799. [PMID: 34869669 PMCID: PMC8636904 DOI: 10.3389/fcvm.2021.757799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022] Open
Abstract
Objective: Cardiac injury is detected in numerous patients with coronavirus disease 2019 (COVID-19) and has been demonstrated to be closely related to poor outcomes. However, an optimal cardiac biomarker for predicting COVID-19 prognosis has not been identified. Methods: The PubMed, Web of Science, and Embase databases were searched for published articles between December 1, 2019 and September 8, 2021. Eligible studies that examined the anomalies of different cardiac biomarkers in patients with COVID-19 were included. The prevalence and odds ratios (ORs) were extracted. Summary estimates and the corresponding 95% confidence intervals (95% CIs) were obtained through meta-analyses. Results: A total of 63 studies, with 64,319 patients with COVID-19, were enrolled in this meta-analysis. The prevalence of elevated cardiac troponin I (cTnI) and myoglobin (Mb) in the general population with COVID-19 was 22.9 (19–27%) and 13.5% (10.6–16.4%), respectively. However, the presence of elevated Mb was more common than elevated cTnI in patients with severe COVID-19 [37.7 (23.3–52.1%) vs.30.7% (24.7–37.1%)]. Moreover, compared with cTnI, the elevation of Mb also demonstrated tendency of higher correlation with case-severity rate (Mb, r = 13.9 vs. cTnI, r = 3.93) and case-fatality rate (Mb, r = 15.42 vs. cTnI, r = 3.04). Notably, elevated Mb level was also associated with higher odds of severe illness [Mb, OR = 13.75 (10.2–18.54) vs. cTnI, OR = 7.06 (3.94–12.65)] and mortality [Mb, OR = 13.49 (9.3–19.58) vs. cTnI, OR = 7.75 (4.4–13.66)] than cTnI. Conclusions: Patients with COVID-19 and elevated Mb levels are at significantly higher risk of severe disease and mortality. Elevation of Mb may serve as a marker for predicting COVID-19-related adverse outcomes. Prospero Registration Number:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175133, CRD42020175133.
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Affiliation(s)
- Chaoqun Ma
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Dingyuan Tu
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jiawei Gu
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Qiang Xu
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Pan Hou
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hong Wu
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhifu Guo
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yuan Bai
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xianxian Zhao
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Pan Li
- Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, China
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16
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Mahamat-Saleh Y, Fiolet T, Rebeaud ME, Mulot M, Guihur A, El Fatouhi D, Laouali N, Peiffer-Smadja N, Aune D, Severi G. Diabetes, hypertension, body mass index, smoking and COVID-19-related mortality: a systematic review and meta-analysis of observational studies. BMJ Open 2021; 11:e052777. [PMID: 34697120 PMCID: PMC8557249 DOI: 10.1136/bmjopen-2021-052777] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/07/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES We conducted a systematic literature review and meta-analysis of observational studies to investigate the association between diabetes, hypertension, body mass index (BMI) or smoking with the risk of death in patients with COVID-19 and to estimate the proportion of deaths attributable to these conditions. METHODS Relevant observational studies were identified by searches in the PubMed, Cochrane library and Embase databases through 14 November 2020. Random-effects models were used to estimate summary relative risks (SRRs) and 95% CIs. Certainty of evidence was assessed using the Cochrane methods and the Grading of Recommendations, Assessment, Development and Evaluations framework. RESULTS A total of 186 studies representing 210 447 deaths among 1 304 587 patients with COVID-19 were included in this analysis. The SRR for death in patients with COVID-19 was 1.54 (95% CI 1.44 to 1.64, I2=92%, n=145, low certainty) for diabetes and 1.42 (95% CI 1.30 to 1.54, I2=90%, n=127, low certainty) for hypertension compared with patients without each of these comorbidities. Regarding obesity, the SSR was 1.45 (95% CI 1.31 to 1.61, I2=91%, n=54, high certainty) for patients with BMI ≥30 kg/m2 compared with those with BMI <30 kg/m2 and 1.12 (95% CI 1.07 to 1.17, I2=68%, n=25) per 5 kg/m2 increase in BMI. There was evidence of a J-shaped non-linear dose-response relationship between BMI and mortality from COVID-19, with the nadir of the curve at a BMI of around 22-24, and a 1.5-2-fold increase in COVID-19 mortality with extreme obesity (BMI of 40-45). The SRR was 1.28 (95% CI 1.17 to 1.40, I2=74%, n=28, low certainty) for ever, 1.29 (95% CI 1.03 to 1.62, I2=84%, n=19) for current and 1.25 (95% CI 1.11 to 1.42, I2=75%, n=14) for former smokers compared with never smokers. The absolute risk of COVID-19 death was increased by 14%, 11%, 12% and 7% for diabetes, hypertension, obesity and smoking, respectively. The proportion of deaths attributable to diabetes, hypertension, obesity and smoking was 8%, 7%, 11% and 2%, respectively. CONCLUSION Our findings suggest that diabetes, hypertension, obesity and smoking were associated with higher COVID-19 mortality, contributing to nearly 30% of COVID-19 deaths. TRIAL REGISTRATION NUMBER CRD42020218115.
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Affiliation(s)
- Yahya Mahamat-Saleh
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Thibault Fiolet
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Mathieu Edouard Rebeaud
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Matthieu Mulot
- Laboratory of Soil Biodiversity, Faculty of Science, University of Neuchatel, Neuchâtel, Switzerland
| | - Anthony Guihur
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Douae El Fatouhi
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Nasser Laouali
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Nathan Peiffer-Smadja
- Universite de Paris, IAME, INSERM, Paris, France
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gianluca Severi
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
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17
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Arévalos V, Ortega-Paz L, Rodríguez-Arias JJ, Calvo López M, Castrillo-Golvano L, Salazar-Rodríguez A, Sabaté-Tormos M, Spione F, Sabaté M, Brugaletta S. Acute and Chronic Effects of COVID-19 on the Cardiovascular System. J Cardiovasc Dev Dis 2021; 8:jcdd8100128. [PMID: 34677197 PMCID: PMC8541609 DOI: 10.3390/jcdd8100128] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 has shown significant morbidity with the involvement of multiple systems, including the cardiovascular system. Cardiovascular manifestations in the acute phase can include myocardial injury itself, myocardial infarction, venous thromboembolic events, myocarditis, Takotsubo syndrome, and different arrhythmic events. Myocardial injury defined by the rise of cardiac biomarkers in blood has been found in multiple studies with a prevalence of about 20%. Its presence is related to worse clinical outcomes and in-hospital mortality. The mechanisms of myocardial injury have been the subject of intense research but still need to be clarified. The characterization of the cardiac affectation with echocardiography and cardiac magnetic resonance has found mixed results in different studies, with a striking incidence of imaging criteria for myocarditis. Regarding post-acute and chronic follow-up results, the persistence of symptoms and imaging changes in recovered COVID-19 patients has raised concerns about the duration and the possible significance of these findings. Even though the knowledge about this disease has increased incredibly in the last year, many aspects are still unclear and warrant further research.
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Affiliation(s)
- Victor Arévalos
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Luis Ortega-Paz
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Juan José Rodríguez-Arias
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Margarita Calvo López
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Leticia Castrillo-Golvano
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Anthony Salazar-Rodríguez
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Marta Sabaté-Tormos
- Department of Medicine, Medical School, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Francesco Spione
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Manel Sabaté
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Salvatore Brugaletta
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-227-9305
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18
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Nagai T, Horinouchi H, Yoshioka K, Nakagawa Y, Ikari Y. Value of standard echocardiography at the bedside for COVID-19 patients in intensive care units: a Japanese single-center analysis. J Med Ultrason (2001) 2021; 48:595-603. [PMID: 34403024 PMCID: PMC8368052 DOI: 10.1007/s10396-021-01122-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/09/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE In the era of COVID-19, those special settings or indications for which standard transthoracic echocardiography (TTE) can safely produce benefits or advantages over minimized ultrasound imaging procedures need to be identified. Thus, the purpose of this study was to conduct a retrospective analysis with offline comprehensive conventional measurement of bilateral heart function and develop an appropriate prognostic model for in-hospital death. METHODS We performed a retrospective analysis of 37 consecutive patients with COVID-19, confirmed by real-time reverse-transcriptase polymerase chain reaction assay, who had undergone clinically indicated standard two-dimensional echocardiographic studies in intensive care wards. Offline comprehensive measurement was also performed. We further integrated the echocardiographic findings as paired evidence of vital organ involvement (possible respiratory distress assessed using right ventricular functional parameters, possible myocardial injury assessed using increased wall thickness, effusion or asynergy) and circulatory failure (suspected low flow status assessed using stroke volume index, suspected congestion assessed using elevated right or left atrial pressure). We evaluated its value for in-hospital death along with other echocardiographic findings. RESULTS The most common features included a normal-sized left atrium and left ventricle with preserved left ventricular ejection fraction, despite deteriorated left ventricular flow volume. Less frequent findings, such as abnormalities in the right heart and left ventricular abnormalities suggesting myocarditis, were observed. Although the single echocardiographic parameters failed to show predictive values for in-hospital death, integration of the echocardiographic findings suggested predictive value (p = 0.04, odds ratio: 12.28). CONCLUSION Standard TTE at the bedside with offline comprehensive conventional measurement may provide prognostic information that is valuable for the management of patients with COVID-19.
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Affiliation(s)
- Tomoo Nagai
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 259-1193, Japan.
| | - Hitomi Horinouchi
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 259-1193, Japan
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 259-1193, Japan
| | - Yoshihide Nakagawa
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 259-1193, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 259-1193, Japan
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19
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Caro-Codón J, Rey JR, Buño A, Iniesta AM, Rosillo SO, Castrejon-Castrejon S, Merino C, Marco I, Martinez LA, Garcia-Veas JM, Martin-Polo L, Rodriguez-Sotelo L, Martinez-Cossiani M, Gonzalez-Valle L, Herrero A, López-de-Sá E, Merino JL. Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 infection. MEDICINA CLINICA (ENGLISH ED.) 2021; 157:274-280. [PMID: 34568576 PMCID: PMC8451250 DOI: 10.1016/j.medcle.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Myocardial injury has been identified as a common complication in patients with COVID-19. However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up. Using data from a large European cohort, we aimed to overcome these pitfalls and adequately characterize myocardial damage in COVID-19. METHODS Consecutive patients with confirmed SARS-CoV-2 infection and available high-sensitive troponin I (hs-TnI), from March 1st to April 20th, 2020 who completed at least 1-month follow-up or died, were studied. RESULTS A total of 918 patients (mean age 63.2 ± 15.5 years, 60.1% male) with a median follow-up of 57 (49-63) days were included. Of these, 190 (20.7%) fulfilled strict criteria for myocardial injury (21.1% chronic, 76.8% acute non-ischemic, 2.1% acute ischemic). Time from onset of symptoms to maximum hs-TnI was 11 (7-18) days. Thrombotic and bleeding events, arrhythmias, heart failure, need for mechanical ventilation and death were significantly more prevalent in patients with higher hs-TnI concentrations, even without fulfilling criteria for myocardial injury. hs-TnI was identified as an independent predictor of mortality [HR 2.52 (1.57-4.04) per 5-logarithmic units increment] after adjusting for multiple relevant covariates. CONCLUSION Elevated hs-TnI is highly prevalent among patients with SARS-CoV-2 infection. Even mild elevations well below the 99th URL were significantly associated with higher rates of cardiac and non-cardiac complications, and higher mortality. Future research should address the role of serial hs-TnI assessment to improve COVID-19 prognostic stratification and clinical outcomes.
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Affiliation(s)
- Juan Caro-Codón
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Juan R Rey
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Buño
- Clinical Analytics Department, Hospital Universitario La Paz, Madrid, Spain
| | - Angel M Iniesta
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Sandra O Rosillo
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Carlos Merino
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Irene Marco
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Luis A Martinez
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | - Alicia Herrero
- Pharmacy Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Jose L Merino
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
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20
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Caro-Codón J, Rey JR, Buño A, Iniesta AM, Rosillo SO, Castrejon-Castrejon S, Merino C, Marco I, Martinez LA, Garcia-Veas JM, Martin-Polo L, Rodriguez-Sotelo L, Martinez-Cossiani M, Gonzalez-Valle L, Herrero A, López-de-Sá E, Merino JL. Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 infection. Med Clin (Barc) 2021; 157:274-280. [PMID: 33846001 PMCID: PMC7988449 DOI: 10.1016/j.medcli.2021.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Myocardial injury has been identified as a common complication in patients with COVID-19. However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up. Using data from a large European cohort, we aimed to overcome these pitfalls and adequately characterize myocardial damage in COVID-19. METHODS Consecutive patients with confirmed SARS-CoV-2 infection and available high-sensitive troponin I (hs-TnI), from March 1st to April 20th, 2020 who completed at least 1-month follow-up or died, were studied. RESULTS A total of 918 patients (mean age 63.2±15.5 years, 60.1% male) with a median follow-up of 57 (49-63) days were included. Of these, 190 (20.7%) fulfilled strict criteria for myocardial injury (21.1% chronic, 76.8% acute non-ischemic, 2.1% acute ischemic). Time from onset of symptoms to maximum hs-TnI was 11 (7-18) days. Thrombotic and bleeding events, arrhythmias, heart failure, need for mechanical ventilation and death were significantly more prevalent in patients with higher hs-TnI concentrations, even without fulfilling criteria for myocardial injury. hs-TnI was identified as an independent predictor of mortality [HR 2.52 (1.57-4.04) per 5-logarithmic units increment] after adjusting for multiple relevant covariates. CONCLUSION Elevated hs-TnI is highly prevalent among patients with SARS-CoV-2 infection. Even mild elevations well below the 99th URL were significantly associated with higher rates of cardiac and non-cardiac complications, and higher mortality. Future research should address the role of serial hs-TnI assessment to improve COVID-19 prognostic stratification and clinical outcomes.
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Affiliation(s)
- Juan Caro-Codón
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain.
| | - Juan R Rey
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Buño
- Clinical Analytics Department, Hospital Universitario La Paz, Madrid, Spain
| | - Angel M Iniesta
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Sandra O Rosillo
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Carlos Merino
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Irene Marco
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Luis A Martinez
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | - Alicia Herrero
- Pharmacy Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Jose L Merino
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
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21
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Abstract
There has been strong evidence of myocardial injury in coronavirus disease 2019 (COVID-19) patients with significantly elevated serum cardiac troponin (cTn). While the exact mechanism of injury is unclear, possible suggested pathological mechanisms of injury are discussed. These include increased susceptibility of the myocardium and endothelium to viral invasion, underlying hyperinflammatory state and subsequent cytokine storm, a hypercoagulable and prothrombotic state, and indirect myocardial injury due to hypoxemia. As a result of these pathological mechanisms in COVID-19 patients, cTn may be elevated largely due to myocarditis, microangiopathy or myocardial infarction. The utility of cTn as a biomarker for measuring myocardial injury in these patients and assessing its ability as a prognostic factor for clinical outcome is also discussed.
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Affiliation(s)
- Chan W Kim
- Cardiology Department, & The Department of Medicine, Westchester Medical Center & New York Medical College, Valhalla, NY 10595, USA
| | - Wilbert S Aronow
- Cardiology Department, & The Department of Medicine, Westchester Medical Center & New York Medical College, Valhalla, NY 10595, USA
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22
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Ashraf H, Soleimani A, Kazemi saeid A, Sadat Naseri A, Majidi F, Peirovi N, Karbalai Saleh S. Troponin I biomarker as a strong prognostic factor for predicting COVID-19 mortality: A systematic review. World J Meta-Anal 2021; 9:342-352. [DOI: 10.13105/wjma.v9.i4.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/03/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The increase in circulating Troponin-I in the blood of patients suffering coronavirus disease 2019 (COVID-19) can be a strong prognostic factor for predicting disease poorer outcome.
AIM To review the literatures to approve this claim systematically.
METHODS Two blinded reviewers independently screened the titles and abstracts of the manuscripts using the keywords and deeply searching the databanks including PubMed, Scopus, Google Scholar, and Web of knowledge, followed by profoundly appraisement of the full texts to assess the inclusion appropriateness.
RESULTS The manuscripts entered into our final assessment were categorized as the two groups including 10 manuscripts describing and comparing death and disease-related complications between the subgroups of patients with raised serum troponin level and those with normal ranges of this biomarker and 7 manuscripts comparing the mean level of serum troponin concentration across the survived and non-survived groups. Comparing outcome of COVID-19 disease in the groups with raised troponin level and normal level of this markers showed increased the likelihood of death [hazard ratio (HR) = 4.967, P < 0.001], acute respiratory distress syndrome (HR = 5.914, P < 0.001), acute kidney injury (HR = 3.849, P < 0.001), and intensive care unit (ICU) admission (HR = 3.780, P < 0.001) following raise of troponin. The pooled analysis showed significantly higher concentration of this marker in the survived group compared to non-survived group (weighted mean differences of 22.278, 95%CI: 15.647 to 28.927, P < 0.001).
CONCLUSION Raising troponin-I on admission can be linked to the increase risk for in-hospital death, acute respiratory distress syndrome, kidney injury, and ICU admission by 4.9, 5.9, 3.8, and 3.7 times as compared to those with initial normal troponin-I concentration. Thus, raising baseline value of troponin-I can be used as a prognostic factor for poor outcome of COVID-19.
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Affiliation(s)
- Haleh Ashraf
- Department of Cardiology, Tehran University of Medical Sciences, Tehran 1136746911, Iran
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, zip code 1411713138
| | - Abbas Soleimani
- Department of Cardiology, Tehran University of Medical Sciences, Tehran 1136746911, Iran
| | - Ali Kazemi saeid
- Department of Cardiology, Tehran University of Medical Sciences, Tehran 1136746911, Iran
| | - Azadeh Sadat Naseri
- Department of Cardiology, Tehran University of Medical Sciences, Tehran 1136746911, Iran
| | - Fazeleh Majidi
- Reserch and Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran 1136746911, Iran
| | - Niloufar Peirovi
- Reserch and Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran 1136746911, Iran
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23
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Cardiovascular injuries and SARS-COV-2 infection: focus on elderly people. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:534-548. [PMID: 34404990 PMCID: PMC8352775 DOI: 10.11909/j.issn.1671-5411.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The novel coronavirus disease (COVID-19) has hit the healthcare system worldwide. The risk of severe infection and mortality increases with advancing age, especially in subjects with comorbidities such as cardiovascular disease, hypertension, diabetes, obesity and cancer. Moreover, cardiovascular complications such as myocardial injury, heart failure and thromboembolism are frequently observed in COVID-19 cases, and several biomarkers (troponin, NTproBNP and D-Dimer) have been identified as prognostic indicators of disease severity and worst outcome. Currently, there is no specific therapy against SARS-CoV-2, although many medications are under investigation. The aim of this review will be to explore the intertwined relationship between COVID-19 disease and the cardiovascular system, focusing on elderly population. The available supportive treatments along with the related concerns in elderly patients, due to their comorbidities and polypharmacotherapy, will be explored.
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24
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Gorecka M, McCann GP, Berry C, Ferreira VM, Moon JC, Miller CA, Chiribiri A, Prasad S, Dweck MR, Bucciarelli-Ducci C, Dawson D, Fontana M, Macfarlane PW, McConnachie A, Neubauer S, Greenwood JP. Demographic, multi-morbidity and genetic impact on myocardial involvement and its recovery from COVID-19: protocol design of COVID-HEART-a UK, multicentre, observational study. J Cardiovasc Magn Reson 2021; 23:77. [PMID: 34112195 PMCID: PMC8190746 DOI: 10.1186/s12968-021-00752-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although coronavirus disease 2019 (COVID-19) is primarily a respiratory illness, myocardial injury is increasingly reported and associated with adverse outcomes. However, the pathophysiology, extent of myocardial injury and clinical significance remains unclear. METHODS COVID-HEART is a UK, multicentre, prospective, observational, longitudinal cohort study of patients with confirmed COVID-19 and elevated troponin (sex-specific > 99th centile). Baseline assessment will be whilst recovering in-hospital or recently discharged, and include cardiovascular magnetic resonance (CMR) imaging, quality of life (QoL) assessments, electrocardiogram (ECG), serum biomarkers and genetics. Assessment at 6-months includes repeat CMR, QoL assessments and 6-min walk test (6MWT). The CMR protocol includes cine imaging, T1/T2 mapping, aortic distensibility, late gadolinium enhancement (LGE), and adenosine stress myocardial perfusion imaging in selected patients. The main objectives of the study are to: (1) characterise the extent and nature of myocardial involvement in COVID-19 patients with an elevated troponin, (2) assess how cardiac involvement and clinical outcome associate with recognised risk factors for mortality (age, sex, ethnicity and comorbidities) and genetic factors, (3) evaluate if differences in myocardial recovery at 6 months are dependent on demographics, genetics and comorbidities, (4) understand the impact of recovery status at 6 months on patient-reported QoL and functional capacity. DISCUSSION COVID-HEART will provide detailed characterisation of cardiac involvement, and its repair and recovery in relation to comorbidity, genetics, patient-reported QoL measures and functional capacity. CLINICAL TRIAL REGISTRATION ISRCTN 58667920. Registered 04 August 2020.
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Affiliation(s)
- Miroslawa Gorecka
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Gerry P. McCann
- University of Leicester and The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Vanessa M. Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - James C. Moon
- Institute of Cardiovascular Science, University College London, London, UK
| | - Christopher A. Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, BHF Centre of Excellence and the NIHR Biomedical Research Centre at Guy’s and St. Thomas’ NHS Foundation Trust, The Rayne Institute, St. Thomas’ Hospital, London, UK
| | - Sanjay Prasad
- National Heart and Lung Institute, Imperial College, London, UK
| | - Marc R. Dweck
- University of Edinburgh and British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Research Centre, University of Bristol and University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - Dana Dawson
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, UK
| | - Marianna Fontana
- Division of Medicine, Royal Free Hospital, University College London, London, UK
| | - Peter W. Macfarlane
- Electrocardiology Core Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - John P. Greenwood
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
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Wu X, Deng KQ, Li C, Yang Z, Hu H, Cai H, Zhang C, He T, Zheng F, Wang H, Zhang XA, Caillon A, Yuan Y, Wang X, Xu H, Lu Z. Cardiac Involvement in Recovered Patients From COVID-19: A Preliminary 6-Month Follow-Up Study. Front Cardiovasc Med 2021; 8:654405. [PMID: 34055936 PMCID: PMC8155269 DOI: 10.3389/fcvm.2021.654405] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Accumulating evidence has revealed that coronavirus disease 2019 (COVID-19) patients may be complicated with myocardial injury during hospitalization. However, data regarding persistent cardiac involvement in patients who recovered from COVID-19 are limited. Our goal is to further explore the sustained impact of COVID-19 during follow-up, focusing on the cardiac involvement in the recovered patients. Methods: In this prospective observational follow-up study, we enrolled a total of 40 COVID-19 patients (20 with and 20 without cardiac injury during hospitalization) who were discharged from Zhongnan Hospital of Wuhan University for more than 6 months, and 27 patients (13 with and 14 without cardiac injury during hospitalization) were finally included in the analysis. Clinical information including self-reported symptoms, medications, laboratory findings, Short Form 36-item scores, 6-min walk test, clinical events, electrocardiogram assessment, echocardiography measurement, and cardiac magnetic resonance imaging was collected and analyzed. Results: Among 27 patients finally included, none of patients reported any obvious cardiopulmonary symptoms at the 6-month follow-up. There were no statistically significant differences in terms of the quality of life and exercise capacity between the patients with and without cardiac injury. No significant abnormalities were detected in electrocardiogram manifestations in both groups, except for nonspecific ST-T changes, premature beats, sinus tachycardia/bradycardia, PR interval prolongation, and bundle-branch block. All patients showed normal cardiac structure and function, without any statistical differences between patients with and without cardiac injury by echocardiography. Compared with patients without cardiac injury, patients with cardiac injury exhibited a significantly higher positive proportion in late gadolinium enhancement sequences [7/13 (53.8%) vs. 1/14 (7.1%), p = 0.013], accompanied by the elevation of circulating ST2 level [median (interquartile range) = 16.6 (12.1, 22.5) vs. 12.5 (9.5, 16.7); p = 0.044]. Patients with cardiac injury presented higher levels of aspartate aminotransferase, creatinine, high-sensitivity troponin I, lactate dehydrogenase, and N-terminal pro-B-type natriuretic peptide than those without cardiac injury, although these indexes were within the normal range for all recovered patients at the 6-month follow-up. Among patients with cardiac injury, patients with positive late gadolinium enhancement presented higher cardiac biomarker (high-sensitivity troponin I) and inflammatory factor (high-sensitivity C-reactive protein) on admission than the late gadolinium enhancement-negative subgroup. Conclusions: Our preliminary 6-month follow-up study with a limited number of patients revealed persistent cardiac involvement in 29.6% (8/27) of recovered patients from COVID-19 after discharge. Patients with cardiac injury during hospitalization were more prone to develop cardiac fibrosis during their recovery. Among patients with cardiac injury, those with relatively higher cardiac biomarkers and inflammatory factors on admission appeared more likely to have cardiac involvement in the convalescence phase.
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Affiliation(s)
- Xiaoyan Wu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ke-Qiong Deng
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chenze Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhaoxia Yang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huijuan Hu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huanhuan Cai
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chao Zhang
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tao He
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fang Zheng
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hairong Wang
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xin A Zhang
- University of Oklahoma Health Science Center, Oklahoma City, OK, United States
| | - Antoine Caillon
- Hypertension and Vascular Research Unit, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Yufeng Yuan
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinghuan Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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26
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Arévalos V, Ortega-Paz L, Rodríguez-Arias JJ, Calvo M, Castrillo L, Salazar A, Roque M, Dantas AP, Sabaté M, Brugaletta S. Myocardial Injury in COVID-19 Patients: Association with Inflammation, Coagulopathy and In-Hospital Prognosis. J Clin Med 2021; 10:2096. [PMID: 34068127 PMCID: PMC8152726 DOI: 10.3390/jcm10102096] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022] Open
Abstract
The exact mechanisms leading to myocardial injury in the coronavirus disease 2019 (COVID-19) are still unknown. In this retrospective observational study, we include all consecutive COVID-19 patients admitted to our center. They were divided into two groups according to the presence of myocardial injury. Clinical variables, Charlson Comorbidity Index (CCI), C-reactive protein (CRP), CAC (COVID-19-associated coagulopathy), defined according to the ISTH score, treatment and in-hospital events were collected. Between March and April 2020, 331 COVID-19 patients were enrolled, 72 of them (21.8%) with myocardial injury. Patients with myocardial injury showed a higher CCI score (median (interquartile range), 5 (4-7) vs. 2 (1-4), p = 0.001), higher CRP values (18.3 (9.6-25.9) mg/dL vs. 12.0 (5.4-19.4) mg/dL, p ˂ 0.001) and CAC score (1 (0-2) vs. 0 (0-1), p = 0.001), and had lower use of any anticoagulant (57 patients (82.6%) vs. 229 patients (90.9%), p = 0.078), than those without. In the adjusted logistic regression, CRP, myocardial injury, CCI and CAC score were positive independent predictors of mortality, whereas anticoagulants resulted as a protective factor. Myocardial injury in COVID-19 patients is associated with inflammation and coagulopathy, resulting in a worse in-hospital prognosis. Treatment with anticoagulant agents may help to improve in-hospital outcomes.
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Affiliation(s)
- Victor Arévalos
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Luis Ortega-Paz
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Juan José Rodríguez-Arias
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Margarita Calvo
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
| | - Leticia Castrillo
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
| | - Anthony Salazar
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
| | - Merce Roque
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Ana Paula Dantas
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Manel Sabaté
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Salvatore Brugaletta
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.); (L.C.); (A.S.); (M.R.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
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Mardian Y, Kosasih H, Karyana M, Neal A, Lau CY. Review of Current COVID-19 Diagnostics and Opportunities for Further Development. Front Med (Lausanne) 2021; 8:615099. [PMID: 34026773 PMCID: PMC8138031 DOI: 10.3389/fmed.2021.615099] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/06/2021] [Indexed: 12/15/2022] Open
Abstract
Diagnostic testing plays a critical role in addressing the coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Rapid and accurate diagnostic tests are imperative for identifying and managing infected individuals, contact tracing, epidemiologic characterization, and public health decision making. Laboratory testing may be performed based on symptomatic presentation or for screening of asymptomatic people. Confirmation of SARS-CoV-2 infection is typically by nucleic acid amplification tests (NAAT), which requires specialized equipment and training and may be particularly challenging in resource-limited settings. NAAT may give false-negative results due to timing of sample collection relative to infection, improper sampling of respiratory specimens, inadequate preservation of samples, and technical limitations; false-positives may occur due to technical errors, particularly contamination during the manual real-time polymerase chain reaction (RT-PCR) process. Thus, clinical presentation, contact history and contemporary phyloepidemiology must be considered when interpreting results. Several sample-to-answer platforms, including high-throughput systems and Point of Care (PoC) assays, have been developed to increase testing capacity and decrease technical errors. Alternatives to RT-PCR assay, such as other RNA detection methods and antigen tests may be appropriate for certain situations, such as resource-limited settings. While sequencing is important to monitor on-going evolution of the SARS-CoV-2 genome, antibody assays are useful for epidemiologic purposes. The ever-expanding assortment of tests, with varying clinical utility, performance requirements, and limitations, merits comparative evaluation. We herein provide a comprehensive review of currently available COVID-19 diagnostics, exploring their pros and cons as well as appropriate indications. Strategies to further optimize safety, speed, and ease of SARS-CoV-2 testing without compromising accuracy are suggested. Access to scalable diagnostic tools and continued technologic advances, including machine learning and smartphone integration, will facilitate control of the current pandemic as well as preparedness for the next one.
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Affiliation(s)
- Yan Mardian
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Muhammad Karyana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Aaron Neal
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Chuen-Yen Lau
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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28
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Ferrero P, Piazza I. Cardio-thoracic imaging and COVID-19 in the pediatric population: A narrative review. World J Radiol 2021; 13:94-101. [PMID: 33968312 PMCID: PMC8069348 DOI: 10.4329/wjr.v13.i4.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/19/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
Abstract
Worldwide experience about coronavirus disease 2019 (COVID-19) pandemics suggests that symptomatic disease is significantly less frequent in the pediatric age range. Nevertheless, multi-system inflammatory syndrome has been consistently reported in children and has been associated with severe acute respiratory syndrome coronavirus 2 exposure. In this paper we give an overview of the multimodality chest imaging of pediatric patients with suspected COVID-19, focusing on relevant differences with adults.
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Affiliation(s)
- Paolo Ferrero
- ACHD Unit–Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, San Donato Milanese 20097, Milan, Italy
| | - Isabelle Piazza
- Department of Emergency Medicine, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
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29
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Ali J, Khan FR, Ullah R, Hassan Z, Khattak S, Lakhta G, Zad Gul N, Ullah R. Cardiac Troponin I Levels in Hospitalized COVID-19 Patients as a Predictor of Severity and Outcome: A Retrospective Cohort Study. Cureus 2021; 13:e14061. [PMID: 33898144 PMCID: PMC8061753 DOI: 10.7759/cureus.14061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction The COVID-19 (coronavirus disease) has affected millions of people, wreaking havoc worldwide. World Health Organization (WHO) labelled this disease as a serious threat to public health since its rapid spread from Wuhan, China. The respiratory manifestations of COVID-19 are common, but myocardium involvement causing myocardial injury and rise in cardiac markers is much less discussed. Materials and methods We conducted this retrospective cohort study from 1st April 2020 to 1st October 2020. Data was collected from the Hospital Management and Information System (HMIS) based on inclusion criteria. We used the Cox proportional hazard regression model for survival analysis, estimated the probability curves of survival using the Kaplan-Meier method, and contrasted it with the log-rank test. Results Among the 466 patients, 280 (69%) were male; the rest were female. The majority were both hypertensive and diabetic, and one-third had a myocardial injury on arrival. The most frequent symptoms in more than half of the patients (51.90%) included a combination of fever, dry cough, and shortness of breath. Out of 466 patients, 266 patients were discharged, and 200 did not survive. In our study, 168 (36.05%) patients had a cardiac injury; among them, 38 (22.61%) were in the discharge group, and the remaining 130 (77.39%) patients were in the nonsurvivor group. Our study results showed that the mortality rate was higher in patients with high cardiac troponin I (cTnI) levels (hazard ratio [HR] 3.61) on admission. Conclusion Our result concluded that measuring cTnI levels on presentation could help predict the severity and outcome in COVID-19 patients. It will allow physicians to triage patients and decrease mortality.
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Affiliation(s)
- Jabar Ali
- Cardiology/Interventional Cardiology, Lady Reading Hospital, Peshawar, PAK
| | - Fahad R Khan
- Cardiology, Lady Reading Hospital, Peshawar, PAK
| | - Rizwan Ullah
- Cardiology, Lady Reading Hospital, Peshawar, PAK
| | - Zair Hassan
- Cardiology, Lady Reading Hospital, Peshawar, PAK
| | | | - Gul Lakhta
- Gynecology and Obstetrics, Lady Reading Hospital, Peshawar, PAK
| | - Nooh Zad Gul
- Cardiology, Lady Reading Hospital, Peshawar, PAK
| | - Rahman Ullah
- Cardiology, Lady Reading Hospital, Peshawar, PAK
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Mengozzi A, Georgiopoulos G, Falcone M, Tiseo G, Pugliese NR, Dimopoulos MA, Ghiadoni L, Barbieri G, Forfori F, Carrozzi L, Santini M, Monzani F, De Marco S, Menichetti F, Virdis A, Masi S. The relationship between cardiac injury, inflammation and coagulation in predicting COVID-19 outcome. Sci Rep 2021; 11:6515. [PMID: 33753759 PMCID: PMC7985490 DOI: 10.1038/s41598-021-85646-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/19/2021] [Indexed: 01/07/2023] Open
Abstract
High sensitivity troponin T (hsTnT) is a strong predictor of adverse outcome during SARS-CoV-2 infection. However, its determinants remain partially unknown. We aimed to assess the relationship between severity of inflammatory response/coagulation abnormalities and hsTnT in Coronavirus Disease 2019 (COVID-19). We then explored the relevance of these pathways in defining mortality and complications risk and the potential effects of the treatments to attenuate such risk. In this single-center, prospective, observational study we enrolled 266 consecutive patients hospitalized for SARS-CoV-2 pneumonia. Primary endpoint was in-hospital COVID-19 mortality. hsTnT, even after adjustment for confounders, was associated with mortality. D-dimer and CRP presented stronger associations with hsTnT than PaO2. Changes of hsTnT, D-dimer and CRP were related; but only D-dimer was associated with mortality. Moreover, low molecular weight heparin showed attenuation of the mortality in the whole population, particularly in subjects with higher hsTnT. D-dimer possessed a strong relationship with hsTnT and mortality. Anticoagulation treatment showed greater benefits with regard to mortality. These findings suggest a major role of SARS-CoV-2 coagulopathy in hsTnT elevation and its related mortality in COVID-19. A better understanding of the mechanisms related to COVID-19 might pave the way to therapy tailoring in these high-risk individuals.
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Affiliation(s)
- Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marco Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giusy Tiseo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Greta Barbieri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Forfori
- Department of Anaesthesia and Intensive Care, University Hospital of Pisa, Pisa, Italy
| | - Laura Carrozzi
- Department of Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Massimo Santini
- Department of Emergency Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Fabio Monzani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Salvatore De Marco
- Fifth Medical Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Cardiovascular Science, University College London, London, UK
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31
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Fu L, Liu X, Su Y, Ma J, Hong K. Prevalence and impact of cardiac injury on COVID-19: A systematic review and meta-analysis. Clin Cardiol 2020; 44:276-283. [PMID: 33382482 PMCID: PMC7852167 DOI: 10.1002/clc.23540] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The exact prevalence and impact of cardiac injury in hospitalized patients with coronavirus disease 2019 (COVID-19) is still controversial. Hence, we aim to investigate prevalence of cardiac injury and its impact on the outcomes in patients with COVID-19. HYPOTHESIS Cardiac injury is common and associated with higher risk of death. METHODS We searched the Cochrane Library, PubMed, MedRxiv, and EMBASE databases from December 2019 to July 15, 2020 for studies that evaluated the prevalence and impact of cardiac injury on COVID-19. This study has been registered with PROSPERO (International prospective register of systematic reviews)-registration number-CRD-42020186120. RESULTS Twenty-one studies including 6297 participants were identified. The proportions of cardiac injury were 22%, 28% among hospitalized patients with COVID-19 or severe COVID-19 patients, respectively. The incidences of cardiac injury in advance age (>60 years) (30%) was about two-fold than young patients (<60 years) (15%) with COVID-19. Severe cases (42%) have seven-fold prevalence cardiac injury than in their non- severe counterparts (6%). Furthermore, cardiac injury is associated with an increased risk of all-cause mortality in patients with COVID-19 (OR 10.11, 95% CI 4.49-22.77). In patients with severe COVID-19, cardiac injury is associated with an increased risk of all-cause mortality (OR: 16.79, 95% CI: 5.52-51.02). CONCLUSIONS This was the first meta-analysis exploring the prevalence and impact of cardiac injury on COVID-19. Cardiac injury is common in hospitalized patients and advanced age and severe COVID-19 patients prone to experience more risk of cardiac injury. Furthermore, cardiac injury is associated with increased risk of all-cause mortality.
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Affiliation(s)
- Linghua Fu
- Cardiology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiao Liu
- Cardiology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuhao Su
- Cardiology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianyong Ma
- Cardiology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Kui Hong
- Cardiology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Jiangxi Key Laboratory of Molecular Medicine, Nanchang, Jiangxi, China
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Mascia G, Pescetelli F, Baldari A, Gatto P, Seitun S, Sartori P, Pieroni M, Calò L, Della Bona R, Porto I. Interpretation of elevated high-sensitivity cardiac troponin I in elite soccer players previously infected by severe acute respiratory syndrome coronavirus 2. Int J Cardiol 2020; 326:248-251. [PMID: 33242510 PMCID: PMC7682525 DOI: 10.1016/j.ijcard.2020.11.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/06/2020] [Accepted: 11/17/2020] [Indexed: 01/01/2023]
Abstract
Objectives To clarify the meaning of elevated cardiac troponin in elite soccer athletes previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and screened for cardiovascular involvement in the wake of competitive sport resumption. Methods We designed a retrospective cohort study with the collaboration of two Italian Serie A teams. Soccer players from both rosters (58 athletes) were systematically analysed. For every SARS-CoV-2 positive athlete, the Italian Soccer Federation protocol requested full blood tests including high-sensitivity cardiac troponin I (hs-cTnI), along with a complete cardiovascular examination. We extended the analysis to SARS-CoV-2 negative athletes. Results A total of 13/58 players (22.4%) suffered from SARS-CoV-2infection: all had a negative cardiovascular examination and 2/13 (15%) showed increased hs-cTnI values (120.8 pg/ml and 72,6 pg/ml, respectively; upper reference level 39.2 pg/ml), which did not track with inflammatory biomarkers. Regarding the 45/58 (77.6%) non infected athletes, a slight increase in hs-cTnI was observed in 2 (4.5%) subjects (values: 61 pg/ml and 75 pg/ml respectively). All hs-cTnI positive athletes (4/58, 7%) underwent cardiac magnetic resonance (CMR), that excluded any cardiac injury. Conclusions In our retrospective study, SARS-CoV-2 infection in elite soccer athletes was not associated to clinical or biomarkers abnormalities. Increased hs-cTnI was rare and not significantly associated with previous SARS-COV2 infection nor with pathological findings at CMR, albeit elevated hs-cTnI was numerically more prevalent in the infected group.
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Affiliation(s)
- Giuseppe Mascia
- Cardiovascular and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italia - Italian IRCCS Cardiovascular Network
| | - Fabio Pescetelli
- Università di Genova, Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Genova, Italy
| | - Amedeo Baldari
- U.C. Sampdoria, Torre B, Piazza Borgo Pila, 39/Piano 5, 16129 Genova, Italy
| | - Piero Gatto
- Genoa Cricket and Soccer Club, Centro Sportivo PIO XII - G. Signorini, via Ronchi 67, Genova, Italy
| | - Sara Seitun
- Department of Radiology and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genova, Italia - Italian IRCCS Cardiovascular Network, Italy
| | - Paolo Sartori
- Cardiovascular and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italia - Italian IRCCS Cardiovascular Network
| | | | - Leonardo Calò
- Department of Cardiology, Policlinico Casillino Hospital, Rome, Italy
| | - Roberta Della Bona
- Cardiovascular and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italia - Italian IRCCS Cardiovascular Network
| | - Italo Porto
- Cardiovascular and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italia - Italian IRCCS Cardiovascular Network; Università di Genova, Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Genova, Italy.
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Zhao BC, Liu WF, Lei SH, Zhou BW, Yang X, Huang TY, Deng QW, Xu M, Li C, Liu KX. Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis. J Intensive Care 2020; 8:88. [PMID: 33292649 PMCID: PMC7682759 DOI: 10.1186/s40560-020-00508-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The clinical significance of cardiac troponin measurement in patients hospitalised for coronavirus disease 2019 (covid-19) is uncertain. We investigated the prevalence of elevated troponins in these patients and its prognostic value for predicting mortality. METHODS Studies were identified by searching electronic databases and preprint servers. We included studies of hospitalised covid-19 patients that reported the frequency of troponin elevations above the upper reference limit and/or the association between troponins and mortality. Meta-analyses were performed using random-effects models. RESULTS Fifty-one studies were included. Elevated troponins were found in 20.8% (95% confidence interval [CI] 16.8-25.0 %) of patients who received troponin test on hospital admission. Elevated troponins on admission were associated with a higher risk of subsequent death (risk ratio 2.68, 95% CI 2.08-3.46) after adjusting for confounders in multivariable analysis. The pooled sensitivity of elevated admission troponins for predicting death was 0.60 (95% CI 0.54-0.65), and the specificity was 0.83 (0.77-0.88). The post-test probability of death was about 42% for patients with elevated admission troponins and was about 9% for those with non-elevated troponins on admission. There was significant heterogeneity in the analyses, and many included studies were at risk of bias due to the lack of systematic troponin measurement and inadequate follow-up. CONCLUSION Elevated troponins were relatively common in patients hospitalised for covid-19. Troponin measurement on admission might help in risk stratification, especially in identifying patients at high risk of death when troponin levels are elevated. High-quality prospective studies are needed to validate these findings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020176747.
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Affiliation(s)
- Bing-Cheng Zhao
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Wei-Feng Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Shao-Hui Lei
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Bo-Wei Zhou
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Xiao Yang
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Tong-Yi Huang
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Qi-Wen Deng
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Miao Xu
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Cai Li
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Ke-Xuan Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China.
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Yu M, Cheng X. Cardiac injury is independently associated with mortality irrespective of comorbidity in hospitalized patients with coronavirus disease 2019. Cardiol J 2020; 27:472-473. [PMID: 33165894 DOI: 10.5603/cj.2020.0150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 12/25/2022] Open
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Shah P, Doshi R, Chenna A, Owens R, Cobb A, Ivey H, Newton S, Mccarley K. Prognostic Value of Elevated Cardiac Troponin I in Hospitalized Covid-19 Patients. Am J Cardiol 2020; 135:150-153. [PMID: 32861733 PMCID: PMC7452835 DOI: 10.1016/j.amjcard.2020.08.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 12/29/2022]
Abstract
Myocardial injury is common in hospitalized Covid-19 patients. Myocardial injury as assessed by elevated cardiac troponin I is an independent predictor of mortality in Covid-19 patients. Higher troponin I is associated with further increase in mortality and other adverse clinical outcomes. Levels of cardiac troponin I have prognostic value in hospitalized Covid-19 patients.
This study aimed to determine if cardiac troponin I (cTnI) is an independent predictor of clinical outcomes and whether higher values are associated with worse clinical outcomes in Covid-19 patients. This case-series study was conducted at Phoebe Putney Health System. Participants were confirmed Covid-19 patients admitted to our health system between March 2, 2020 and June 7, 2020. Data were collected from electronic medical records. Patients were divided into 2 groups: with and without elevated cTnI. The cTnI were further divided in 4 tertiles. Multivariable logistic regression analysis was performed to adjust for demographics, baseline comorbidities, and laboratory parameters including D-dimer, ferritin, lactate dehydrogenase, procalcitonin and C-reactive protein. Out of 309 patients, 116 (37.5%) had elevated cTnI. Those with elevated cTnI were older (59.9 vs. 68.2 years, p <0.001), and more likely to be males (53.5% vs. 36.3%, p = 0.003). Elevated cTnI group had higher baseline comorbidities. After multivariable adjustment, overall mortality was significantly higher in elevated cTnI group (37.9% vs. 11.4%, odds ratio:4.45; confidence interval:1.78 to 11.14, p <0.001). Need for intubation, dialysis, and intensive care unit (ICU) transfer was higher in elevated cTnI group. Among those with elevated cTnI, mortality was 23.2% for 50th percentile, 48.4% for 75th percentile, and 55.2% for 100th percentile. Similarly, further increase in cTnI was associated with a higher need for intubation, dialysis, and ICU transfer. In conclusion, myocardial injury occurs in significant proportion of hospitalized Covid-19 patients and is an independent predictor of clinical outcomes, with higher values associated with worse outcomes.
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Affiliation(s)
- Priyank Shah
- Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, Georgia; Department of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia.
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada
| | - Avantika Chenna
- Department of Nephrology, Phoebe Putney Memorial Hospital, Albany, Georgia
| | - Robin Owens
- Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, Georgia
| | - Abigail Cobb
- Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, Georgia
| | - Holley Ivey
- Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, Georgia
| | - Sarah Newton
- Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, Georgia
| | - Kelly Mccarley
- Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, Georgia
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Electrocardiographic Findings and Clinical Outcome in Patients with COVID-19 or Other Acute Infectious Respiratory Diseases. J Clin Med 2020; 9:jcm9113647. [PMID: 33198406 PMCID: PMC7697612 DOI: 10.3390/jcm9113647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023] Open
Abstract
Background. Cardiac involvement in coronavirus SARS-CoV-2 infection (COVID-19) has been reported in a sizeable proportion of patients and associated with a negative outcome; furthermore, a pre-existing heart disease is associated with increased mortality in these patients. In this prospective single-center case-control study we investigated whether COVID-19 patients present different rates and clinical implications of an abnormal electrocardiogram (ECG) compared to patients with an acute infectious respiratory disease (AIRD) caused by other pathogens. Methods. We studied 556 consecutive patients admitted to the emergency department of our hospital with symptoms of AIRD; 324 were diagnosed to have COVID-19 and 232 other causes of AIRD (no-COVID-19 group). Standard 12-lead ECG performed on admission was assessed for various kinds of abnormalities, including ST segment/T wave changes, atrial fibrillation, ventricular arrhythmias, and intraventricular conduction disorders. Results. ECG abnormalities were found in 120 (37.0%) and 101 (43.5%) COVID-19 and no-COVID-19 groups, respectively (p = 0.13). No differences in ECG abnormalities were found between the 2 groups after adjustment for clinical and laboratory variables. During a follow-up of 45 ± 16 days, 51 deaths (15.7%) occurred in the COVID-19 and 30 (12.9%) in the no-COVID-19 groups (p = 0.39). ST segment depression ≥ 0.5 mm (p = 0.016), QRS duration (p = 0.016) and presence of any ECG abnormality (p = 0.027) were independently associated with mortality at multivariable Cox regression analysis. Conclusion. Among patients hospitalized because of AIRD, we found no significant differences in abnormal ECG findings between COVID-19 vs. no-COVID-19 patients. The ECG on admission was helpful to identify patients with increased risk of death in both groups of patients.
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Myhre PL, Prebensen C, Strand H, Røysland R, Jonassen CM, Rangberg A, Sørensen V, Søvik S, Røsjø H, Svensson M, Berdal JE, Omland T. Growth Differentiation Factor 15 Provides Prognostic Information Superior to Established Cardiovascular and Inflammatory Biomarkers in Unselected Patients Hospitalized With COVID-19. Circulation 2020; 142:2128-2137. [PMID: 33058695 PMCID: PMC7688084 DOI: 10.1161/circulationaha.120.050360] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Growth differentiation factor 15 (GDF-15) is a strong prognostic marker in sepsis and cardiovascular disease (CVD). The prognostic value of GDF-15 in coronavirus disease 2019 (COVID-19) is unknown. Methods: Consecutive, hospitalized patients with laboratory-confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and symptoms of COVID-19 were enrolled in the prospective, observational COVID Mechanisms Study. Biobank samples were collected at baseline, day 3 and day 9. The primary end point was admission to the intensive care unit or death during hospitalization, and the prognostic performance of baseline and serial GDF-15 concentrations were compared with that of established infectious disease and cardiovascular biomarkers. Results: Of the 123 patients enrolled, 35 (28%) reached the primary end point; these patients were older, more often had diabetes, and had lower oxygen saturations and higher National Early Warning Scores on baseline. Baseline GDF-15 concentrations were elevated (>95th percentile in age-stratified healthy individuals) in 97 (79%), and higher concentrations were associated with detectable SARS-CoV-2 viremia and hypoxemia (both P<0.001). Patients reaching the primary end point had higher concentrations of GDF-15 (median, 4225 [IQR, 3197–5972] pg/mL versus median, 2187 [IQR, 1344–3620] pg/mL, P<0.001). The area under the receiver operating curve was 0.78 (95% CI, 0.70–0.86). The association between GDF-15 and the primary end point persisted after adjusting for age, sex, race, body mass index, estimated glomerular filtration rate, previous myocardial infarction, heart failure, and atrial fibrillation (P<0.001) and was superior and incremental to interleukin-6, C-reactive protein, procalcitonin, ferritin, D-dimer, cardiac troponin T, and N-terminal pro-B-type natriuretic peptide. Increase in GDF-15 from baseline to day 3 was also greater in patients reaching the primary end point (median, 1208 [IQR, 0–4305] pg/mL versus median, –86 [IQR, –322 to 491] pg/mL, P<0.001). Conclusions: GDF-15 is elevated in the majority of patients hospitalized with COVID-19, and higher concentrations are associated with SARS-CoV-2 viremia, hypoxemia, and worse outcome. The prognostic value of GDF-15 was additional and superior to established cardiovascular and inflammatory biomarkers. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04314232.
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Affiliation(s)
- Peder L Myhre
- Department of Cardiology (P.L.M., T.O.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - Christian Prebensen
- Department of Infectious Diseases (C.P., J.E.B.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - Heidi Strand
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Division of Diagnostics and Technology (H.S., R.R.), Akershus University Hospital, Lørenskog, Norway
| | - Ragnhild Røysland
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Division of Diagnostics and Technology (H.S., R.R.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - Christine M Jonassen
- Center for Laboratory Medicine, Østfold Hospital Trust, Grålum, Norway (C.M.J., A.R.)
| | - Anbjørg Rangberg
- Center for Laboratory Medicine, Østfold Hospital Trust, Grålum, Norway (C.M.J., A.R.)
| | - Vibecke Sørensen
- Department of Anaesthesia and Intensive Care, Division of Surgery (V.S., S.S.), Akershus University Hospital, Lørenskog, Norway
| | - Signe Søvik
- Department of Anaesthesia and Intensive Care, Division of Surgery (V.S., S.S.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - Helge Røsjø
- Division of Research and Innovation (H.R.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - My Svensson
- Department of Research (M.S.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - Jan Erik Berdal
- Department of Infectious Diseases (C.P., J.E.B.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - Torbjørn Omland
- Department of Cardiology (P.L.M., T.O.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
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