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Eligulashvili A, Gordon M, Lee JS, Lee J, Mehrotra-Varma S, Mehrotra-Varma J, Hsu K, Hilliard I, Lee K, Li A, Essibayi MA, Yee J, Altschul DJ, Eskandar E, Mehler MF, Duong TQ. Long-term outcomes of hospitalized patients with SARS-CoV-2/COVID-19 with and without neurological involvement: 3-year follow-up assessment. PLoS Med 2024; 21:e1004263. [PMID: 38573873 PMCID: PMC10994395 DOI: 10.1371/journal.pmed.1004263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Acute neurological manifestation is a common complication of acute Coronavirus Disease 2019 (COVID-19) disease. This retrospective cohort study investigated the 3-year outcomes of patients with and without significant neurological manifestations during initial COVID-19 hospitalization. METHODS AND FINDINGS Patients hospitalized for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection between 03/01/2020 and 4/16/2020 in the Montefiore Health System in the Bronx, an epicenter of the early pandemic, were included. Follow-up data was captured up to 01/23/2023 (3 years post-COVID-19). This cohort consisted of 414 patients with COVID-19 with significant neurological manifestations and 1,199 propensity-matched patients (for age and COVID-19 severity score) with COVID-19 without neurological manifestations. Neurological involvement during the acute phase included acute stroke, new or recrudescent seizures, anatomic brain lesions, presence of altered mentation with evidence for impaired cognition or arousal, and neuro-COVID-19 complex (headache, anosmia, ageusia, chemesthesis, vertigo, presyncope, paresthesias, cranial nerve abnormalities, ataxia, dysautonomia, and skeletal muscle injury with normal orientation and arousal signs). There were no significant group differences in female sex composition (44.93% versus 48.21%, p = 0.249), ICU and IMV status, white, not Hispanic (6.52% versus 7.84%, p = 0.380), and Hispanic (33.57% versus 38.20%, p = 0.093), except black non-Hispanic (42.51% versus 36.03%, p = 0.019). Primary outcomes were mortality, stroke, heart attack, major adverse cardiovascular events (MACE), reinfection, and hospital readmission post-discharge. Secondary outcomes were neuroimaging findings (hemorrhage, active and prior stroke, mass effect, microhemorrhages, white matter changes, microvascular disease (MVD), and volume loss). More patients in the neurological cohort were discharged to acute rehabilitation (10.39% versus 3.34%, p < 0.001) or skilled nursing facilities (35.75% versus 25.35%, p < 0.001) and fewer to home (50.24% versus 66.64%, p < 0.001) than matched controls. Incidence of readmission for any reason (65.70% versus 60.72%, p = 0.036), stroke (6.28% versus 2.34%, p < 0.001), and MACE (20.53% versus 16.51%, p = 0.032) was higher in the neurological cohort post-discharge. Per Kaplan-Meier univariate survival curve analysis, such patients in the neurological cohort were more likely to die post-discharge compared to controls (hazard ratio: 2.346, (95% confidence interval (CI) [1.586, 3.470]; p < 0.001)). Across both cohorts, the major causes of death post-discharge were heart disease (13.79% neurological, 15.38% control), sepsis (8.63%, 17.58%), influenza and pneumonia (13.79%, 9.89%), COVID-19 (10.34%, 7.69%), and acute respiratory distress syndrome (ARDS) (10.34%, 6.59%). Factors associated with mortality after leaving the hospital involved the neurological cohort (odds ratio (OR): 1.802 (95% CI [1.237, 2.608]; p = 0.002)), discharge disposition (OR: 1.508 (95% CI [1.276, 1.775]; p < 0.001)), congestive heart failure (OR: 2.281 (95% CI [1.429, 3.593]; p < 0.001)), higher COVID-19 severity score (OR: 1.177 (95% CI [1.062, 1.304]; p = 0.002)), and older age (OR: 1.027 (95% CI [1.010, 1.044]; p = 0.002)). There were no group differences in radiological findings, except that the neurological cohort showed significantly more age-adjusted brain volume loss (p = 0.045) than controls. The study's patient cohort was limited to patients infected with COVID-19 during the first wave of the pandemic, when hospitals were overburdened, vaccines were not yet available, and treatments were limited. Patient profiles might differ when interrogating subsequent waves. CONCLUSIONS Patients with COVID-19 with neurological manifestations had worse long-term outcomes compared to matched controls. These findings raise awareness and the need for closer monitoring and timely interventions for patients with COVID-19 with neurological manifestations, as their disease course involving initial neurological manifestations is associated with enhanced morbidity and mortality.
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Affiliation(s)
- Anna Eligulashvili
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Moshe Gordon
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Jimmy S. Lee
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Jeylin Lee
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Shiv Mehrotra-Varma
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Jai Mehrotra-Varma
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Kevin Hsu
- Department of Radiology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Imanyah Hilliard
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Kristen Lee
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Arleen Li
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Muhammed Amir Essibayi
- Department of Neurological Surgery, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Judy Yee
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - David J. Altschul
- Department of Neurological Surgery, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Emad Eskandar
- Department of Neurological Surgery, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Mark F. Mehler
- Department of Neurology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Tim Q. Duong
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
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Del Vecchio L, Balafa O, Dounousi E, Ekart R, Fernandez BF, Mark PB, Sarafidis P, Valdivielso JM, Ferro CJ, Mallamaci F. COVID-19 and cardiovascular disease in patients with chronic kidney disease. Nephrol Dial Transplant 2024; 39:177-189. [PMID: 37771078 PMCID: PMC10828215 DOI: 10.1093/ndt/gfad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Indexed: 09/30/2023] Open
Abstract
Millions of people worldwide have chronic kidney disease (CKD). Affected patients are at high risk for cardiovascular (CV) disease for several reasons. Among various comorbidities, CKD is associated with the more severe forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This is particularly true for patients receiving dialysis or for kidney recipients. From the start of the SARS-CoV-2 pandemic, several CV complications have been observed in affected subjects, spanning acute inflammatory manifestations, CV events, thrombotic episodes and arrythmias. Several pathogenetic mechanisms have been hypothesized, including direct cytopathic viral effects on the myocardium, endothelial damage and hypercoagulability. This spectrum of disease can occur during the acute phase of the infection, but also months after recovery. This review is focussed on the CV complications of coronavirus disease 2019 (COVID-19) with particular interest in their implications for the CKD population.
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Affiliation(s)
- Lucia Del Vecchio
- Department of Nephrology and Dialysis, Sant'Anna Hospital, ASST Lariana, Como, Italy
| | - Olga Balafa
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece
| | - Evangelia Dounousi
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Robert Ekart
- Department of Dialysis, Clinic for Internal Medicine, University Medical Center Maribor, Maribor, Slovenia
| | | | - Patrick B Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Pantelis Sarafidis
- 1st Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jose M Valdivielso
- Vascular and Renal Translational Research Group, Institute for Biomedical Research on Lleida (IRBLleida), Lleida, Spain
| | - Charles J Ferro
- Department of Renal Medicine, University Hospitals Birmingham and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham,UK
| | - Francesca Mallamaci
- Francesca Mallamaci Department of Nephrology, Dialysis, and Transplantation Azienda Ospedaliera “Bianchi-Melacrino-Morelli” & CNR-IFC, Reggio Calabria, Italy
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3
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Lu JY, Boparai MS, Shi C, Henninger EM, Rangareddy M, Veeraraghavan S, Mirhaji P, Fisher MC, Duong TQ. Long-term outcomes of COVID-19 survivors with hospital AKI: association with time to recovery from AKI. Nephrol Dial Transplant 2023; 38:2160-2169. [PMID: 36702551 DOI: 10.1093/ndt/gfad020] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Although coronavirus disease 2019 (COVID-19) patients who develop in-hospital acute kidney injury (AKI) have worse short-term outcomes, their long-term outcomes have not been fully characterized. We investigated 90-day and 1-year outcomes after hospital AKI grouped by time to recovery from AKI. METHODS This study consisted of 3296 COVID-19 patients with hospital AKI stratified by early recovery (<48 hours), delayed recovery (2-7 days) and prolonged recovery (>7-90 days). Demographics, comorbidities and laboratory values were obtained at admission and up to the 1-year follow-up. The incidence of major adverse cardiovascular events (MACE) and major adverse kidney events (MAKE), rehospitalization, recurrent AKI and new-onset chronic kidney disease (CKD) were obtained 90-days after COVID-19 discharge. RESULTS The incidence of hospital AKI was 28.6%. Of the COVID-19 patients with AKI, 58.0% experienced early recovery, 14.8% delayed recovery and 27.1% prolonged recovery. Patients with a longer AKI recovery time had a higher prevalence of CKD (P < .05) and were more likely to need invasive mechanical ventilation (P < .001) and to die (P < .001). Many COVID-19 patients developed MAKE, recurrent AKI and new-onset CKD within 90 days, and these incidences were higher in the prolonged recovery group (P < .05). The incidence of MACE peaked 20-40 days postdischarge, whereas MAKE peaked 80-90 days postdischarge. Logistic regression models predicted 90-day MACE and MAKE with 82.4 ± 1.6% and 79.6 ± 2.3% accuracy, respectively. CONCLUSION COVID-19 survivors who developed hospital AKI are at high risk for adverse cardiovascular and kidney outcomes, especially those with longer AKI recovery times and those with a history of CKD. These patients may require long-term follow-up for cardiac and kidney complications.
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Affiliation(s)
- Justin Y Lu
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Montek S Boparai
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Caroline Shi
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Erin M Henninger
- Center for Health Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Mahendranath Rangareddy
- Center for Health Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Sudhakar Veeraraghavan
- Center for Health Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Parsa Mirhaji
- Center for Health Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Molly C Fisher
- Department of Medicine, Nephrology Division, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tim Q Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
- Center for Health Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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Jung HS, Choi JW. Association between COVID-19 and incidence of cardiovascular disease and all-cause mortality among patients with diabetes. Front Endocrinol (Lausanne) 2023; 14:1230176. [PMID: 37576978 PMCID: PMC10414181 DOI: 10.3389/fendo.2023.1230176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Although the risk of coronavirus disease 2019 (COVID-19) infection is higher in patients who are diagnosed with diabetes than in those who are not, research on the risk of cardiovascular disease (CVD) in COVID-19 infected patients diagnosed with diabetes compared to those who are not infected by COVID-19 is lacking. This study aimed to examine the association between COVID-19, incidence of CVD, and all-cause mortality in patients with diabetes. Methods This study used data from the Health Insurance Review and Assessment, and included 16,779 patients with COVID-19 and 16,779 matched controls between January 2017 and June 2021. The outcomes included cardiovascular disease (CVD), coronary heart disease, stroke, and all-cause mortality. Cox proportional hazards regression models were used to evaluate these associations. Results Patients with diabetes hospitalized because of COVID-19 had a significantly increased risk of CVD (adjusted hazard ratio [AHR], 2.12; 95% confidence interval [CI]: 1.97, 2.27) than those without COVID-19. The risks of coronary heart disease (AHR, 2.00; 95% CI: 1.85, 2.17) and stroke (AHR, 2.21; 95% CI: 1.90, 2.57) were higher in the intervention group than in the control group. In the case of all-cause mortality for middle-aged adults, we observed a higher risk in diabetes patients hospitalized due to COVID-19 than in patients without COVID-19 (AHR, 1.37; 95% CI: 1.18, 1.59). Conclusions This study showed that patients with diabetes hospitalized due to COVID-19 had an increased risk of CVD, coronary heart disease, stroke incidence, and mortality than those who were not COVID-19 infected, suggesting more careful prevention and management among patients with COVID-19.
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Affiliation(s)
- Hee Sun Jung
- Big Data Department, Health Insurance Review and Assessment, Won-ju, Gangwon, Republic of Korea
| | - Jae Woo Choi
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Won-ju, Gangwon, Republic of Korea
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Yan J, Wang J, Ding L, Liu S, Zhan Y, Lu J, Li Z, Gu L, Li P, Zhu M, Gao Y, Gong X, Ban H, Cai H, Mou S. Adaptive immune dysfunction in patients with COVID-19 and impaired kidney function during the omicron surge. Clin Immunol 2023; 248:109271. [PMID: 36806705 PMCID: PMC9938757 DOI: 10.1016/j.clim.2023.109271] [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: 12/14/2022] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Little is known about the characteristics of lymphocyte subsets and the association with patient outcomes in COVID-19 with and without impaired kidney function. METHODS Lymphocyte subsets were compared in COVID-19 patients with or without kidney dysfunction. The primary outcome was a composite of all-cause mortality or intensive care unit admission. Secondary outcomes included duration of viral shedding, length of hospital stay, and acute kidney injury. RESULTS Lymphocyte subset cell counts demonstrated the lowest in patients with severe/critical COVID-19 and kidney dysfunction. Among all lymphocyte subset parameters, Th cell count was the most significant indicator for outcomes. ROC of the combined model of Th cell count and eGFR presented better predictive value than that of the other parameters. Th cell count <394.5 cells/μl and eGFR <87.5 ml/min/1·73m2 were independently associated with poor outcomes. The propensity score matching analysis revealed consistent results. CONCLUSIONS Reduced Th cell count and eGFR may be applied as promising predictive indicators for identifying COVID-19 patients with high risk and poor outcomes.
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Affiliation(s)
- Jiayi Yan
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201210, China
| | - Jieying Wang
- Clinical Research Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Li Ding
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Shang Liu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yaping Zhan
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jiayue Lu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Zhenyuan Li
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Leyi Gu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Ping Li
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Mingli Zhu
- Department of Critical Care Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yuan Gao
- Department of Critical Care Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - XingRong Gong
- Department of medical administration, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Haiqun Ban
- Infection management office, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Hong Cai
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
| | - Shan Mou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201210, China.
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6
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Lambourg EJ, Gallacher PJ, Hunter RW, Siddiqui M, Miller-Hodges E, Chalmers JD, Pugh D, Dhaun N, Bell S. Cardiovascular outcomes in patients with chronic kidney disease and COVID-19: a multi-regional data-linkage study. Eur Respir J 2022; 60:2103168. [PMID: 35551093 PMCID: PMC9101552 DOI: 10.1183/13993003.03168-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Data describing cardiovascular outcomes in patients with coronavirus disease 2019 (COVID-19) and chronic kidney disease (CKD) are lacking. We compared cardiovascular outcomes of patients with and without COVID-19, stratified by CKD status. METHODS This retrospective, multi-regional data-linkage study utilised individual patient-level data from two Scottish cohorts. All patients tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Cohort 1 between 1 February 2020 and 31 March 2021 and in Cohort 2 between 28 February 2020 and 8 February 2021 were included. RESULTS Overall, 86 964 patients were tested for SARS-CoV-2. There were 36 904 patients (mean±sd age 61±21 years; 58.1% women; 15.9% CKD; 10.1% COVID-19 positive) in Cohort 1 and 50 060 patients (mean±sd age 63±20 years; 62.0% women; 16.4% CKD; 9.1% COVID-19 positive) in Cohort 2. In CKD patients, COVID-19 increased the risk of cardiovascular death by more than two-fold within 30 days (cause-specific hazard ratio (csHR) meta-estimate 2.34, 95% CI 1.83-2.99) and by 57% at the end of study follow-up (csHR meta-estimate 1.57, 95% CI 1.31-1.89). Similarly, the risk of all-cause death in COVID-19 positive versus negative CKD patients was greatest within 30 days (HR 4.53, 95% CI 3.97-5.16). Compared with patients without CKD, those with CKD had a higher risk of testing positive (11.5% versus 9.3%). Following a positive test, CKD patients had higher rates of cardiovascular death (11.1% versus 2.7%), cardiovascular complications and cardiovascular hospitalisations (7.1% versus 3.3%) than those without CKD. CONCLUSIONS COVID-19 increases the risk of cardiovascular and all-cause death in CKD patients, especially in the short-term. CKD patients with COVID-19 are also at a disproportionate risk of cardiovascular complications than those without CKD.
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Affiliation(s)
- Emilie J Lambourg
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
- These authors contributed equally
| | - Peter J Gallacher
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- These authors contributed equally
| | - Robert W Hunter
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Dept of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Moneeza Siddiqui
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Eve Miller-Hodges
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Dept of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - James D Chalmers
- Dept of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Dan Pugh
- Dept of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Dept of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
- These authors contributed equally
| | - Samira Bell
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
- These authors contributed equally
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7
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Mochizuki J, Nakaura T, Matsumi H, Hata Y. Evaluation of coronavirus-2019-related arterial thrombosis in noncontrast spectral computed tomography with electron density imaging. Radiol Case Rep 2022; 18:49-52. [PMID: 36317095 PMCID: PMC9612951 DOI: 10.1016/j.radcr.2022.09.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 11/07/2022] Open
Abstract
Thrombosis can be associated with coronavirus disease 2019 infection. Computed tomography is essential for the diagnosis of pneumonia in these patients and conventionally contrast agents are required for the assessment of thrombus. In this study, we report a patient with coronavirus disease 2019 who was diagnosed with thrombosis using spectral noncontrast computed tomography with electron density imaging. The patient was a 76-year-old man who presented with a 2-day history of lower-leg pain. Tachycardia and atrial fibrillation were identified, with elevated D-dimer, N-terminal pro-B-type natriuretic peptide, creatine kinase, and C-reactive protein levels. Polymerase chain reaction testing for severe acute respiratory syndrome coronavirus-2 was positive. Conventional computed tomography showed pulmonary changes consistent with coronavirus disease 2019 and no changes in the aorta, but spectral computed tomography with electron density imaging of noncontrast computed tomography showed a thrombus in the right external iliac artery. Spectral computed tomography with electron density imaging provides more data compared with conventional computed tomography and has the potential to depict thrombus without the use of contrast media.
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Affiliation(s)
- Junji Mochizuki
- Department of Radiology, Minamino Cardiovascular Hospital, 1-25-1 Hyoue, Hachioji, Tokyo 192-0918, Japan
- Corresponding author.
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroaki Matsumi
- Department of Cardiology, Minamino Cardiovascular Hospital, 1-25-1 Hyoue, Hachioji, Tokyo 192-0918, Japan
| | - Yoshiki Hata
- Department of Cardiology, Minamino Cardiovascular Hospital, 1-25-1 Hyoue, Hachioji, Tokyo 192-0918, Japan
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8
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Lin L, Chen Y, Han D, Yang A, Wang AY, Qi W. Cardiorenal Syndrome in COVID-19 Patients: A Systematic Review. Front Cardiovasc Med 2022; 9:915533. [PMID: 35837606 PMCID: PMC9273837 DOI: 10.3389/fcvm.2022.915533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/03/2022] [Indexed: 12/15/2022] Open
Abstract
Aims To perform a systematic review assessing the clinical manifestations and outcomes of cardiorenal syndrome or the presence of both cardiac and renal complications in the 2019 coronavirus disease (COVID-19) patients. Methods All relevant studies about cardiorenal syndrome or both cardiac and renal complications in COVID-19 patients were retrieved on PUBMED, MEDLINE, and EMBASE from December 1, 2019 to February 20, 2022. Results Our search identified 15 studies including 637 patients with a diagnosis of cardiorenal syndrome or evidence of both cardiac and renal complications followingSARS-CoV-2 infection. They were male predominant (66.2%, 422/637), with a mean age of 58 years old. Cardiac complications included myocardial injury (13 studies), heart failure (7 studies), arrhythmias (5 studies), or myocarditis and cardiomyopathy (2 studies). Renal complications manifested as acute kidney injury with or without oliguria. Patients with cardiorenal injury were often associated with significantly elevated levels of inflammatory markers (CRP, PCT, IL-6). Patients with a diagnosis of cardiorenal syndrome or evidence of both cardiac and renal complications had more severe disease and poorer prognosis (9 studies). Conclusion The presence of either cardiorenal syndrome or concurrent cardiac and renal complications had a significant impact on the severity of the disease and the mortality rate among patients with COVID-19 infection. Therefore, careful assessment and management of potential cardiac and renal complications in patients with COVID-19 infection are important to improve their outcomes.
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Affiliation(s)
- Ling Lin
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yangqin Chen
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Dongwan Han
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Andrew Yang
- Department of General and Acute Care Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
- Concord Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Amanda Y. Wang
- Concord Clinical School, The University of Sydney, Sydney, NSW, Australia
- Division of the Renal and Metabolic, George Institute for Global Health, TheUniversity of New South Wales, Sydney, NSW, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia
- *Correspondence: Amanda Y. Wang
| | - Wenjie Qi
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Wenjie Qi
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9
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Long-term cardio-vascular risk assessment in chronic kidney disease and kidney transplanted patients following SARS-COV-2 disease: protocol for multi-center observational match controlled trial. BMC Nephrol 2022; 23:176. [PMID: 35524223 PMCID: PMC9077937 DOI: 10.1186/s12882-022-02809-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) produced a pandemic since March 2020 by affecting more than 243 million people with more than 5 million deaths globally. SARS-CoV-2 infection is produced by binding to angiotensin-converting enzyme, which among other sites is highly expressed in the endothelial cells of the blood vessels, pericytes and the heart, as well as in renal podocytes and proximal tubular epithelial cells. SARS-CoV-2 and cardiovascular disease (CVD) are interconnected by risk factors association with an increased incidence of the disease and by determining de novo cardiac complications. At the same time, COVID-19 disease can lead to acute kidney injury directly, or due to sepsis, multi-organ failure and shock. Therefore, the pre-existence of both CVD and chronic kidney disease (CKD) is linked with a higher risk of severe disease and worse prognosis. METHODS The main aim of this study is to assess the CV risk in a CKD (stage 3 to 5), dialysis and kidney transplanted population, following SARS-CoV-2 infection, with focus on the endothelial dysfunction as compared to a control group of matched patients. By using clinical evaluation, flow-mediated dilatation, carotid-femoral pulse wave velocity, intima-media thickness, echocardiographic parameters, lung ultrasound, bioimpedance spectroscopy and a series of novel biomarkers, the investigators will determine the long-term impact of this disease on CV and renal outcomes. DISCUSSION This study will address the challenges and implications in long-term CV sequeale of COVID-19 and focus on a better understanding of the underlying mechanisms and possible therapeutic options. TRIAL REGISTRATION Patient enrolment in the trial started in January 2021 and is expected to finish at the end of 2022. The study can be found on ClinicalTrials.gov database with NCT05125913 identifier. Registered on 18 November 2021 - Retrospectively registered.
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10
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Lu JY, Buczek A, Fleysher R, Hoogenboom WS, Hou W, Rodriguez CJ, Fisher MC, Duong TQ. Outcomes of Hospitalized Patients With COVID-19 With Acute Kidney Injury and Acute Cardiac Injury. Front Cardiovasc Med 2022; 8:798897. [PMID: 35242818 PMCID: PMC8886161 DOI: 10.3389/fcvm.2021.798897] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/27/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose This study investigated the incidence, disease course, risk factors, and mortality in COVID-19 patients who developed both acute kidney injury (AKI) and acute cardiac injury (ACI), and compared to those with AKI only, ACI only, and no injury (NI). Methods This retrospective study consisted of hospitalized COVID-19 patients at Montefiore Health System in Bronx, New York between March 11, 2020 and January 29, 2021. Demographics, comorbidities, vitals, and laboratory tests were collected during hospitalization. Predictive models were used to predict AKI, ACI, and AKI-ACI onset. Longitudinal laboratory tests were analyzed with time-lock to discharge alive or death. Results Of the 5,896 hospitalized COVID-19 patients, 44, 19, 9, and 28% had NI, AKI, ACI, and AKI-ACI, respectively. Most ACI presented very early (within a day or two) during hospitalization in contrast to AKI (p < 0.05). Patients with combined AKI-ACI were significantly older, more often men and had more comorbidities, and higher levels of cardiac, kidney, liver, inflammatory, and immunological markers compared to those of the AKI, ACI, and NI groups. The adjusted hospital-mortality odds ratios were 17.1 [95% CI = 13.6–21.7, p < 0.001], 7.2 [95% CI = 5.4–9.6, p < 0.001], and 4.7 [95% CI = 3.7–6.1, p < 0.001] for AKI-ACI, ACI, and AKI, respectively, relative to NI. A predictive model of AKI-ACI onset using top predictors yielded 97% accuracy. Longitudinal laboratory data predicted mortality of AKI-ACI patients up to 5 days prior to outcome, with an area-under-the-curve, ranging from 0.68 to 0.89. Conclusions COVID-19 patients with AKI-ACI had markedly worse outcomes compared to those only AKI, ACI and NI. Common laboratory variables accurately predicted AKI-ACI. The ability to identify patients at risk for AKI-ACI could lead to earlier intervention and improvement in clinical outcomes.
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Affiliation(s)
- Justin Y Lu
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Alexandra Buczek
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Roman Fleysher
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Wouter S Hoogenboom
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Wei Hou
- Department of Family, Population and Preventive Medicine, Stony Brook Medicine, New York, NY, United States
| | - Carlos J Rodriguez
- Cardiology Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Molly C Fisher
- Nephrology Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Tim Q Duong
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
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11
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Bayrakci N, Özkan G, Şakaci M, Sedef S, Erdem İ, Tuna N, Mutlu LC, Yildirim İ, Kiraz N, Erdal B, Gelgeç E, Erer A, Saraç Ö, Yavuz A, Dolap U, Hayri UB, Kocadelioğlu İ, Batmaz E. The incidence of acute kidney injury and its association with mortality in patients diagnosed with COVID-19 followed up in intensive care unit. Ther Apher Dial 2022; 26:889-896. [PMID: 34990070 DOI: 10.1111/1744-9987.13790] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/07/2021] [Accepted: 12/31/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The kidneys are some of the most frequently affected organs during coronavirus disease 2019 (COVID-19). This multicenter study evaluated the incidence of and risk factors for acute kidney injury (AKI) in COVID-19 patients followed up in intensive care unit (ICU) and its association with mortality. METHODS Three hundred twenty-eight patients diagnosed with COVID-19 and hospitalized in ICU were included. Risk factors associated with AKI and mortality were evaluated. RESULTS Eighty-eight patients (27.9%) were diagnosed with AKI. AKI was significantly associated with older age, higher baseline creatinine level, lower albumin level, and coexistence of cardiovascular disease and chronic obstructive pulmonary disease. Mortality in the entire study group was significantly associated with AKI, older age, requirement of invasive mechanical ventilation, higher neutrophil level, lower lymphocyte, and albumin levels. CONCLUSION AKI is frequently seen during the course of COVID-19 and is associated with high mortality. Identifying AKI-related risk factors appears essential in the management of COVID-19 patients.
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Affiliation(s)
- Nergiz Bayrakci
- Department of Nephrology, School of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Gülsüm Özkan
- Department of Nephrology, School of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Murat Şakaci
- Department of Nephrology, Tekirdag Dr. İsmail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - Samet Sedef
- Department of Internal Medicine, Tekirdag City Hospital, Tekirdag, Turkey
| | - İlknur Erdem
- Department of Infectious Diseases, School of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Nazan Tuna
- Department of Infectious Diseases, School of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Levent Cem Mutlu
- Department of Pulmonary Medicine, School of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - İlker Yildirim
- Department of Anesthesiology and Reanimation, School of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Nuri Kiraz
- Department of Microbiology, School of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Berna Erdal
- Department of Microbiology, School of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Ebru Gelgeç
- Department of Anesthesiology and Reanimation, Tekirdag Dr. İsmail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - Ayşen Erer
- Department of Anesthesiology and Reanimation, Tekirdag Dr. İsmail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - Ömürhan Saraç
- Department of Anesthesiology and Reanimation, Tekirdag Dr. İsmail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - Ahmet Yavuz
- Department of Nephrology, Tekirdag Dr. İsmail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - Uysal Dolap
- Department of Pulmonary Medicine, Tekirdag Dr. İsmail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - Uluğ Bey Hayri
- Department of Pulmonary Medicine, Tekirdag Dr. İsmail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - İnci Kocadelioğlu
- Department of Pulmonary Medicine, Tekirdag Dr. İsmail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - Emrah Batmaz
- Department of Pulmonary Medicine, Tekirdag Dr. İsmail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
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12
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Cardiovascular complications after COVID-19 in chronic kidney disease, dialysis and kidney transplant patients. Int Urol Nephrol 2021; 54:1551-1563. [PMID: 34811606 PMCID: PMC8608362 DOI: 10.1007/s11255-021-03059-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/11/2021] [Indexed: 02/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is associated with increased mortality in patients with chronic kidney disease (CKD), dialysis patients and kidney transplant recipients (KTR). Cardiovascular complications, such as sudden arrhythmias, thromboembolic events, coronary events, cardiomyopathies and heart failure, may present in about 10–20% of patients with COVID-19. Patients with CKD, dialysis patients and KTR are all at increased cardiovascular risk and present with more cardiovascular complications after COVID-19 compared to the general population. During the pandemic, health care giving has rapidly changed by reducing elective outpatient reviews, which may refrain these high-risk patients from the appropriate management of their medical conditions, further increasing cardiovascular risk. Importantly, acute kidney injury (AKI) is another common complication of severe COVID-19 and associates with increased mortality. A large proportion of the AKI patients need renal replacement treatment, while 30% of them may not present renal function recovery and remain dialysis-dependent after discharge, thereby having potentially increased future cardiovascular risk. This review summarizes current knowledge regarding the cardiovascular events and mortality in patients with CKD or undergoing hemodialysis and in KTR.
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13
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Stevens LM, de Lemos JA, Das SR, Rutan C, Alger HM, Elkind MSV, Zhao J, Iyer K, Figueroa CA, Hall JL. American Heart Association Precision Medicine Platform Addresses Challenges in Data Sharing. Circ Cardiovasc Qual Outcomes 2021; 14:e007949. [PMID: 34517729 PMCID: PMC8452247 DOI: 10.1161/circoutcomes.121.007949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Laura M Stevens
- Department of Cardiology and Computational Bioscience Program, University of Colorado, Aurora (L.M.S.).,Quality, Outcomes Research and Analytics, American Heart Association, Dallas, TX (L.M.S., C.R., H.A., J.L.H.)
| | | | - Sandeep R Das
- UT Southwestern Medical Center, Dallas, TX (J.A.d.L., S.R.D.).,Center for Innovation and Value at Parkland, Dallas, TX (S.R.D.)
| | - Christine Rutan
- Quality, Outcomes Research and Analytics, American Heart Association, Dallas, TX (L.M.S., C.R., H.A., J.L.H.)
| | - Heather M Alger
- Quality, Outcomes Research and Analytics, American Heart Association, Dallas, TX (L.M.S., C.R., H.A., J.L.H.)
| | - Mitchell S V Elkind
- Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, NewYork-Presbyterian Hospital (M.S.V.E.)
| | - Juan Zhao
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN (J.Z.)
| | - Kritika Iyer
- Departments of Biomedical Engineering (K.I. and C.A.F.), University of Michigan, Ann Arbor
| | - C Alberto Figueroa
- Departments of Biomedical Engineering (K.I. and C.A.F.), University of Michigan, Ann Arbor.,Surgery (C.A.F.), University of Michigan, Ann Arbor
| | - Jennifer L Hall
- Quality, Outcomes Research and Analytics, American Heart Association, Dallas, TX (L.M.S., C.R., H.A., J.L.H.).,Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.)
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