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Falahati A, Arazi H. Cardiac biomarker responses following high-intensity interval and continuous exercise: the influence of ACE-I/D gene polymorphism and training status in men. Physiol Genomics 2024; 56:436-444. [PMID: 38586874 DOI: 10.1152/physiolgenomics.00129.2023] [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: 10/26/2023] [Revised: 03/03/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024] Open
Abstract
This study aimed to investigate the relationship between pre- and postexercise cardiac biomarker release according to athletic status (trained vs. untrained) and to establish whether the I/D polymorphism in the angiotensin-converting enzyme (ACE) gene had an influence on cardiac biomarkers release with specific regard on the influence of the training state. We determined cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in 29 trained and 27 untrained male soccer players before and after moderate-intensity continuous exercise (MICE) and high-intensity interval exercise (HIIE) running tests. Trained soccer players had higher pre (trained: 0.014 ± 0.007 ng/mL; untrained: 0.010 ± 0.005 ng/mL) and post HIIE (trained: 0.031 ± 0.008 ng/mL; untrained: 0.0179 ± 0.007) and MICE (trained: 0.030 ± 0.007 ng/mL; untrained: 0.018 ± 0.007) cTnI values than untrained subjects, but the change with exercise (ΔcTnI) was similar between groups. There was no significant difference in baseline and postexercise NT-proBNP between groups. NT-proBNP levels were elevated after both HIIE and MICE. Considering three ACE genotypes, the mean pre exercise cTnI values of the trained group (DD: 0.015 ± 0.008 ng/mL, ID: 0.015 ± 0.007 ng/mL, and II: 0.014 ± 0.008 ng/mL) and their untrained counterparts (DD: 0.010 ± 0.004 ng/mL, ID: 0.011 ± 0.004 ng/mL, and II: 0.010 ± 0.006 ng/mL) did not show any significant difference. To sum up, noticeable difference in baseline cTnI was observed, which was related to athletic status but not ACE genotypes. Neither athletic status nor ACE genotypes seemed to affect the changes in cardiac biomarkers in response to HIIE and MICE, indicating that the ACE gene does not play a significant role in the release of exercise-induced cardiac biomarkers indicative of cardiac damage in Iranian soccer players.NEW & NOTEWORTHY Our study investigated the impact of athletic status and angiotensin-converting enzyme (ACE) gene I/D polymorphism on cardiac biomarkers in soccer players. Trained players showed higher baseline cardiac troponin I (cTnI) levels, whereas postexercise ΔcTnI remained consistent across groups. N-terminal pro-brain natriuretic peptide increased after exercise in both groups, staying within normal limits. ACE genotypes did not significantly affect pre-exercise cTnI. Overall, athletic status influences baseline cTnI, but neither it nor ACE genotypes significantly impact exercise-induced cardiac biomarker responses in this population.
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Affiliation(s)
- Akram Falahati
- Department of Exercise Physiology, University Campus, University of Guilan, Rasht, Iran
| | - Hamid Arazi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht, Iran
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Mojón-Álvarez D, Giralt T, Carreras-Mora J, Calvo-Fernández A, Izquierdo A, Soler C, Cabero P, Pérez-Fernández S, Vaquerizo B, Ribas Barquet N. Baseline NT-proBNP levels as a predictor of short-and long-term prognosis in COVID-19 patients: a prospective observational study. BMC Infect Dis 2024; 24:58. [PMID: 38191350 PMCID: PMC10773093 DOI: 10.1186/s12879-024-08980-3] [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: 07/17/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Up to 20% of COVID-19 patients can suffer COVID-19-related myocardial injury. Elevated cardiac biomarkers, such as hs-cTnT and NT-proBNP, have been related to worse short-term prognosis. However, data on NT-proBNP and long-term prognosis are scarce. We have evaluated the potential association of baseline age-adjusted NT-proBNP levels and outcomes at one-year follow-up in COVID-19 patients. METHODS This was a single-center prospective study of 499 COVID-19 patients in whom NT-proBNP was assessed at hospital admission. NT-proBNP levels were age-adjusted and patients were classified as high or low NT-proBNP. Clinical and demographic characteristics, comorbidities, laboratory results, and in-hospital complications and mortality were compared between the two groups. Survivors of the acute phase of COVID-19 were followed up for one year from admission to detect readmissions and mortality. RESULTS The 68 patients with high NT-proBNP levels at hospital admission were older, with more cardiovascular risk factors, cardiovascular disease, comorbidities, myocardial injury, and higher levels of inflammatory markers than patients with low NT-proBNP levels. They also had more in-hospital complications and a higher acute-phase mortality rate (60.3% vs. 10.2%, p < 0.001). High NT-proBNP levels were an independent marker of death during hospitalization (HR 1.95; CI 1.07-3.52). At one-year follow-up, high NT-proBNP levels were independently associated with mortality (HR 2.69; CI 1.47-4.89). Among survivors of the acute phase of COVID-19, there were no differences in hospital readmissions between those with high vs. low NT-proBNP levels, but survivors with high baseline NT-proBNP levels showed a higher 1-year mortality rate (7.4% vs. 1.3%, p = 0.018). CONCLUSIONS High age-adjusted NT-proBNP levels at the time of hospital admission for COVID-19 are associated with poor short and long-term prognosis. High NT-proBNP seems also to be related to worse prognosis in survivors of the acute phase of COVID-19. A closer follow-up on these patients may be crucial.
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Affiliation(s)
- Diana Mojón-Álvarez
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
| | - Teresa Giralt
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
| | - José Carreras-Mora
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
| | - Alicia Calvo-Fernández
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
| | - Andrea Izquierdo
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
| | - Cristina Soler
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
| | - Paula Cabero
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
| | - Silvia Pérez-Fernández
- Scientific Coordination Facility, Biocruces Bizkaia Health Research Institute, Barakaldo, 48903, Spain
| | - Beatriz Vaquerizo
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
- Heart Disease Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, 08003, Spain
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, 28029, Spain
| | - Núria Ribas Barquet
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain.
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain.
- Heart Disease Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, 08003, Spain.
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Spannella F, Giulietti F, Laureti G, Di Rosa M, Di Pentima C, Allevi M, Garbuglia C, Giordano P, Landolfo M, Ferrara L, Fumagalli A, Lattanzio F, Bonfigli AR, Sarzani R. Role of Cardio-Renal Dysfunction, Inflammation Markers, and Frailty on In-Hospital Mortality in Older COVID-19 Patients: A Cluster Analysis. Biomedicines 2023; 11:2473. [PMID: 37760914 PMCID: PMC10525261 DOI: 10.3390/biomedicines11092473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Our study aimed to identify clusters of hospitalized older COVID-19 patients according to their main comorbidities and routine laboratory parameters to evaluate their association with in-hospital mortality. We performed an observational study on 485 hospitalized older COVID-19 adults (aged 80+ years). Patients were aggregated in clusters by a K-medians cluster analysis. The primary outcome was in-hospital mortality. Medical history and laboratory parameters were collected on admission. Frailty, defined by the Clinical Frailty Scale (CFS), referred to the two weeks before hospitalization and was used as a covariate. The median age was 87 (83-91) years, with a female prevalence (59.2%). Three different clusters were identified: cluster 1 (337), cluster 2 (118), and cluster 3 (30). In-hospital mortality was 28.5%, increasing from cluster 1 to cluster 3: cluster 1 = 21.1%, cluster 2 = 40.7%, and cluster 3 = 63.3% (p < 0.001). The risk for in-hospital mortality was higher in clusters 2 [HR 1.96 (95% CI: 1.28-3.01)] and 3 [HR 2.87 (95% CI: 1.62-5.07)] compared to cluster 1, even after adjusting for age, sex, and frailty. Patients in cluster 3 were older and had a higher prevalence of atrial fibrillation, higher admission NT-proBNP and C-reactive protein levels, higher prevalence of concurrent bacterial infections, and lower estimated glomerular filtration rates. The addition of CFS significantly improved the predictive ability of the clusters for in-hospital mortality. Our cluster analysis on older COVID-19 patients provides a characterization of those subjects at higher risk for in-hospital mortality, highlighting the role played by cardio-renal impairment, higher inflammation markers, and frailty, often simultaneously present in the same patient.
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Affiliation(s)
- Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, 60127 Ancona, Italy
- Department of Clinical and Molecular Sciences, “Politecnica delle Marche” University, 60126 Ancona, Italy
| | | | - Giorgia Laureti
- Internal Medicine and Geriatrics, IRCCS INRCA, 60127 Ancona, Italy
- Department of Clinical and Molecular Sciences, “Politecnica delle Marche” University, 60126 Ancona, Italy
| | - Mirko Di Rosa
- Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60127 Ancona, Italy
| | | | - Massimiliano Allevi
- Internal Medicine and Geriatrics, IRCCS INRCA, 60127 Ancona, Italy
- Department of Clinical and Molecular Sciences, “Politecnica delle Marche” University, 60126 Ancona, Italy
| | - Caterina Garbuglia
- Internal Medicine and Geriatrics, IRCCS INRCA, 60127 Ancona, Italy
- Department of Clinical and Molecular Sciences, “Politecnica delle Marche” University, 60126 Ancona, Italy
| | - Piero Giordano
- Internal Medicine and Geriatrics, IRCCS INRCA, 60127 Ancona, Italy
| | - Matteo Landolfo
- Internal Medicine and Geriatrics, IRCCS INRCA, 60127 Ancona, Italy
- Department of Clinical and Molecular Sciences, “Politecnica delle Marche” University, 60126 Ancona, Italy
| | - Letizia Ferrara
- Medical Direction, Risk Manager, IRCCS INRCA, 60127 Ancona, Italy
| | | | | | | | - Riccardo Sarzani
- Internal Medicine and Geriatrics, IRCCS INRCA, 60127 Ancona, Italy
- Department of Clinical and Molecular Sciences, “Politecnica delle Marche” University, 60126 Ancona, Italy
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Mwangi VI, Netto RLA, de Morais CEP, Silva AS, Silva BM, Lima AB, Neves JCF, Borba MGS, Val FFDAE, de Almeida ACG, Costa AG, Sampaio VDS, Gardinassi LG, de Lacerda MVG, Monteiro WM, de Melo GC. Temporal patterns of cytokine and injury biomarkers in hospitalized COVID-19 patients treated with methylprednisolone. Front Immunol 2023; 14:1229611. [PMID: 37662953 PMCID: PMC10468998 DOI: 10.3389/fimmu.2023.1229611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background The novel coronavirus disease 2019 (COVID-19) presents with complex pathophysiological effects in various organ systems. Following the COVID-19, there are shifts in biomarker and cytokine equilibrium associated with altered physiological processes arising from viral damage or aggressive immunological response. We hypothesized that high daily dose methylprednisolone improved the injury biomarkers and serum cytokine profiles in COVID-19 patients. Methods Injury biomarker and cytokine analysis was performed on 50 SARS-Cov-2 negative controls and 101 hospitalized severe COVID-19 patients: 49 methylprednisolone-treated (MP group) and 52 placebo-treated serum samples. Samples from the treated groups collected on days D1 (pre-treatment) all the groups, D7 (2 days after ending therapy) and D14 were analyzed. Luminex assay quantified the biomarkers HMGB1, FABP3, myoglobin, troponin I and NTproBNP. Immune mediators (CXCL8, CCL2, CXCL9, CXCL10, TNF, IFN-γ, IL-17A, IL-12p70, IL-10, IL-6, IL-4, IL-2, and IL-1β) were quantified using cytometric bead array. Results At pretreatment, the two treatment groups were comparable demographically. At pre-treatment (D1), injury biomarkers (HMGB1, TnI, myoglobin and FABP3) were distinctly elevated. At D7, HMGB1 was significantly higher in the MP group (p=0.0448) compared to the placebo group, while HMGB1 in the placebo group diminished significantly by D14 (p=0.0115). Compared to healthy control samples, several immune mediators (IL-17A, IL-6, IL-10, MIG, MCP-1, and IP-10) were considerably elevated at baseline (all p≤0.05). At D7, MIG and IP-10 of the MP-group were significantly lower than in the placebo-group (p=0.0431, p=0.0069, respectively). Longitudinally, IL-2 (MP-group) and IL-17A (placebo-group) had increased significantly by D14. In placebo group, IL-2 and IL-17A continuously increased, as IL-12p70, IL-10 and IP-10 steadily decreased during follow-up. The MP treated group had IL-2, IFN-γ, IL-17A and IL-12p70 progressively increase while IL-1β and IL-10 gradually decreased towards D14. Moderate to strong positive correlations between chemokines and cytokines were observed on D7 and D14. Conclusion These findings suggest MP treatment could ameliorate levels of myoglobin and FABP3, but appeared to have no impact on HMGB1, TnI and NTproBNP. In addition, methylprednisolone relieves the COVID-19 induced inflammatory response by diminishing MIG and IP-10 levels. Overall, corticosteroid (methylprednisolone) use in COVID-19 management influences the immunological molecule and injury biomarker profile in COVID-19 patients.
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Affiliation(s)
- Victor Irungu Mwangi
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | | | - Carlos Eduardo Padron de Morais
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Arineia Soares Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | - Bernardo Maia Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Amanda Barros Lima
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, Brazil
| | | | - Mayla Gabriela Silva Borba
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Fernando Fonseca de Almeida e Val
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Anne Cristine Gomes de Almeida
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás (UFG), Goiânia, Brazil
| | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, Brazil
- Escola de Enfermagem de Manaus, Universidade Federal do Amazonas (UFAM), Manaus, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM) Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | - Vanderson de Souza Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Instituto Todos pela Saúde, São Paulo, São Paulo, Brazil
| | - Luiz Gustavo Gardinassi
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás (UFG), Goiânia, Brazil
| | - Marcus Vinicius Guimarães de Lacerda
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Instituto Leônidas & Maria Deane/Fundação Oswaldo Cruz (ILMD/Fiocruz Amazônia), Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Gisely Cardoso de Melo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM) Universidade do Estado do Amazonas (UEA), Manaus, Brazil
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Eftekhar SP, Sepidarkish M, Amri Maleh P, Jafaripour I, Hedayati MT, Amin K, Pourkia R, Abroutan S, Saravi M, Jalali F, Sadeghi Haddad Zavareh M, Ziaie N. Impact of Negative Fluid Balance on Mortality and Outcome of Patients with Confirmed COVID-19. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:6957341. [PMID: 37313354 PMCID: PMC10260309 DOI: 10.1155/2023/6957341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/30/2023] [Accepted: 05/20/2023] [Indexed: 06/15/2023]
Abstract
Purpose Maintaining the proper fluid balance is a fundamental step in the management of hospitalized patients. The current study evaluated the impact of negative fluid balance on outcomes of patients with confirmed COVID-19. Methods We considered the negative fluid balance as a higher output fluid compared to the input fluid. The fluid balance was categorized into four groups (group 4: -850 to -500 ml/day; group 3: -499 to -200 ml/day, group 2: -199 to 0 ml/day, and group 1 : 1 to 1000 ml/day) and included ordinally in the model. The outcomes were all-cause mortality, length of hospitalization, and improvement in oxygen saturation. Results The fluid balance differed significantly among nonsurvivors and survivors (MD: -317.93, 95% CI: -410.21, -225.69, and p < 0.001). After adjusting for potential confounders, there was a significantly lower frequency of mortality in patients with negative fluid balance compared to the controls (aRR: 0.69, 95% CI: 0.57, 0.84, and p < 0.001). Similarly, the length of hospitalization was significantly shorter in the negative fluid balance group in comparison to the control group (aMD: -1.01, 95% CI: -1.74, -0.28, and p=0.006). Conclusion We determined that the negative fluid balance was associated with favorable outcomes in COVID-19 patients. The negative fluid balance was associated with the reduced mortality rate and length of hospitalization as well as improvement in oxygen saturation. Moreover, the NT-proBNP >781 pg/mL and fluid balance >-430 mL might be the predictors for positive fluid balance and mortality, respectively.
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Affiliation(s)
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Parviz Amri Maleh
- Department of Anesthesiology, Babol University of Medical Sciences, Babol, Iran
| | - Iraj Jafaripour
- Department of Cardiology, Babol University of Medical Sciences, Babol, Iran
| | | | - Kamyar Amin
- Department of Cardiology, Babol University of Medical Sciences, Babol, Iran
| | - Roghayeh Pourkia
- Department of Cardiology, Babol University of Medical Sciences, Babol, Iran
| | - Saeid Abroutan
- Department of Cardiology, Babol University of Medical Sciences, Babol, Iran
| | - Mehrdad Saravi
- Department of Cardiology, Babol University of Medical Sciences, Babol, Iran
| | - Farzad Jalali
- Department of Cardiology, Babol University of Medical Sciences, Babol, Iran
| | - Mahmoud Sadeghi Haddad Zavareh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Naghmeh Ziaie
- Department of Cardiology, Babol University of Medical Sciences, Babol, Iran
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Boulos PK, Freeman SV, Henry TD, Mahmud E, Messenger JC. Interaction of COVID-19 With Common Cardiovascular Disorders. Circ Res 2023; 132:1259-1271. [PMID: 37167359 PMCID: PMC10171313 DOI: 10.1161/circresaha.122.321952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The onset and widespread dissemination of the severe acute respiratory syndrome coronavirus-2 in late 2019 impacted the world in a way not seen since the 1918 H1N1 pandemic, colloquially known as the Spanish Flu. Much like the Spanish Flu, which was observed to disproportionately impact young adults, it became clear in the early days of the coronavirus disease 2019 (COVID-19) pandemic that certain groups appeared to be at higher risk for severe illness once infected. One such group that immediately came to the forefront and garnered international attention was patients with preexisting cardiovascular disease. Here, we examine the available literature describing the interaction of COVID-19 with a myriad of cardiovascular conditions and diseases, paying particular attention to patients diagnosed with arrythmias, heart failure, and coronary artery disease. We further discuss the association of acute COVID-19 with de novo cardiovascular disease, including myocardial infarction due to coronary thrombosis, myocarditis, and new onset arrhythmias. We will evaluate various biochemical theories to explain these findings, including possible mechanisms of direct myocardial injury caused by the severe acute respiratory syndrome coronavirus-2 virus at the cellular level. Finally, we will discuss the strategies employed by numerous groups and governing bodies within the cardiovascular disease community to address the unprecedented challenges posed to the care of our most vulnerable patients, including heart transplant recipients, end-stage heart failure patients, and patients suffering from acute coronary syndromes, during the early days and height of the COVID-19 pandemic.
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Affiliation(s)
- Peter K. Boulos
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Scott V. Freeman
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (T.D.H.)
| | - Ehtisham Mahmud
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla (E.M.)
| | - John C. Messenger
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
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Abstract
Viral infections are a leading cause of myocarditis and pericarditis worldwide, conditions that frequently coexist. Myocarditis and pericarditis were some of the early comorbidities associated with SARS-CoV-2 infection and COVID-19. Many epidemiologic studies have been conducted since that time concluding that SARS-CoV-2 increased the incidence of myocarditis/pericarditis at least 15× over pre-COVID levels although the condition remains rare. The incidence of myocarditis pre-COVID was reported at 1 to 10 cases/100 000 individuals and with COVID ranging from 150 to 4000 cases/100 000 individuals. Before COVID-19, some vaccines were reported to cause myocarditis and pericarditis in rare cases, but the use of novel mRNA platforms led to a higher number of reported cases than with previous platforms providing new insight into potential pathogenic mechanisms. The incidence of COVID-19 vaccine-associated myocarditis/pericarditis covers a large range depending on the vaccine platform, age, and sex examined. Importantly, the findings highlight that myocarditis occurs predominantly in male patients aged 12 to 40 years regardless of whether the cause was due to a virus-like SARS-CoV-2 or associated with a vaccine-a demographic that has been reported before COVID-19. This review discusses findings from COVID-19 and COVID-19 vaccine-associated myocarditis and pericarditis considering the known symptoms, diagnosis, management, treatment, and pathogenesis of disease that has been gleaned from clinical research and animal models. Sex differences in the immune response to COVID-19 are discussed, and theories for how mRNA vaccines could lead to myocarditis/pericarditis are proposed. Additionally, gaps in our understanding that need further research are raised.
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Affiliation(s)
- DeLisa Fairweather
- Department of Cardiovascular Medicine (D.F., D.J.B., D.N.D., L.T.C.), Mayo Clinic, Jacksonville, FL
- Department of Environmental Health Sciences and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (D.F.,)
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN (D.F., D.J.B., D.N.D.)
| | - Danielle J. Beetler
- Department of Cardiovascular Medicine (D.F., D.J.B., D.N.D., L.T.C.), Mayo Clinic, Jacksonville, FL
- Mayo Clinic Graduate School of Biomedical Sciences (D.J.B., D.N.D.), Mayo Clinic, Jacksonville, FL
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN (D.F., D.J.B., D.N.D.)
| | - Damian N. Di Florio
- Department of Cardiovascular Medicine (D.F., D.J.B., D.N.D., L.T.C.), Mayo Clinic, Jacksonville, FL
- Mayo Clinic Graduate School of Biomedical Sciences (D.J.B., D.N.D.), Mayo Clinic, Jacksonville, FL
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN (D.F., D.J.B., D.N.D.)
| | - Nicolas Musigk
- Deutsches Herzzentrum der Charité, Berlin, Germany (N.M., B.H.)
| | | | - Leslie T. Cooper
- Department of Cardiovascular Medicine (D.F., D.J.B., D.N.D., L.T.C.), Mayo Clinic, Jacksonville, FL
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8
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Bashir H, Yildiz M, Cafardi J, Bhatia A, Garcia S, Henry TD, Chung ES. A Review of Heart Failure in patients with COVID-19. Heart Fail Clin 2023; 19:e1-e8. [PMID: 37169437 PMCID: PMC9988711 DOI: 10.1016/j.hfc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
The interplay of COVID-19 and heart failure is complex and involves direct and indirect effects. Patients with existing heart failure develop more severe COVID-19 symptoms and have worse clinical outcomes. Pandemic-related policies and protocols have negatively affected care for cardiovascular conditions and established hospital protocols, which is particularly important for patients with heart failure.
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Affiliation(s)
- Hanad Bashir
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA. https://twitter.com/HanadBashirMD
| | - Mehmet Yildiz
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA
| | - John Cafardi
- Infectious Disease Department, The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA
| | - Ankit Bhatia
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA. https://twitter.com/AKBhatiaMD
| | - Santiago Garcia
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA. https://twitter.com/HenrytTimothy
| | - Eugene S Chung
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA.
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9
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Henning RJ. Cardiovascular complications of COVID-19 severe acute respiratory syndrome. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2022; 12:170-191. [PMID: 36147783 PMCID: PMC9490160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
603,711,760 confirmed cases of COVID-19 have been reported throughout the world and 6,484,136 individuals have died from complications of COVID-19 as of September 7, 2022. Significantly, the Omicron variant has produced the largest number of COVID-19 associated hospitalizations since the beginning of the pandemic. Cardiac injury occurs in ≥20% of the hospitalized patients with COVID-19 and is associated with cardiac dysrhythmias in 17 to 44%, cardiac injury with increases in blood troponin in 22 to 40%, myocarditis in 2 to 7%, heart failure in 4 to 21%, and thromboembolic events in 15 to 39%. Risk factors for cardiac complications include age >70 years, male sex, BMI ≥30 kg/m2, diabetes, pre-existing cardiovascular disease, and moderate to severe pneumonia at hospital presentation. Patients with prior cardiovascular disease who contract COVID-19 and experience a significant increase in their blood troponin concentration are at risk for mortality rates as high as 69%. This review focuses on the prevalence, the pathophysiologic mechanisms of CoV-2 injury to the cardiovascular system and the current recommended treatments in hospitalized patients with COVID-19 in order that medical personnel can decrease the morbidity and mortality of patients with COVID-19 and effectively treat patients with Covid and post Covid syndrome.
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Affiliation(s)
- Robert J Henning
- University of South Florida 13201 Bruce B. Downs Blvd, Tampa, Florida 33612-3805, USA
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10
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Spannella F, Giulietti F, Di Pentima C, Allevi M, Bordoni V, Filipponi A, Falzetti S, Garbuglia C, Scorcella S, Giordano P, Sarzani R. Renin-Angiotensin-System Inhibitors Are Associated With Lower In-hospital Mortality in COVID-19 Patients Aged 80 and Older. Front Cardiovasc Med 2022; 9:916509. [PMID: 35783862 PMCID: PMC9247386 DOI: 10.3389/fcvm.2022.916509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Older adults are at higher risk of morbidity and mortality for coronavirus disease 2019 (COVID-19). Renin-angiotensin-system inhibitors (RASi) were found to have a neutral or protective effect against mortality in COVID-19 adult patients. Aims We investigated whether this association was confirmed also in COVID-19 older patients. Methods This is a prospective observational study on 337 hospitalized older adults (aged 80 years and older). We classified the study population according to usage of RASi before and during hospitalization. A propensity score analysis was also performed to confirm the findings. Results The mean age was 87.4 ± 6.1 years. Patients taking RASi at home were 147 (43.6%). During hospitalization, 38 patients (11.3% of the entire study population) discontinued RASi, while 57 patients (16.9% of the entire study population) started RASi. In-hospital mortality was 43.9%. Patients taking RASi during hospitalization (patients who maintained their home RASi therapy + patients who started RASi during hospitalization) had a significantly lower in-hospital mortality than untreated patients [HR 0.48 (95% CI: 0.34–0.67)], even after adjustment for required respiratory support, functional status, albumin, inflammation, and cardiac biomarkers. The analysis of the groups derived from the “propensity score matching” (58 patients in each group) confirmed these results [HR 0.46 (95% CI: 0.23–0.91)]. Discussion Despite the high risk of death in older COVID-19 patients, RASi therapy during hospitalization was associated with a clinically relevant lower in-hospital mortality, likely due to the benefit of RAS modulation on the cardiopulmonary system during the acute phase of the disease. Conclusion Our findings confirm the protective role of RASi even in COVID-19 patients aged 80 years and older.
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Affiliation(s)
- Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Chiara Di Pentima
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Massimiliano Allevi
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Valentina Bordoni
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Andrea Filipponi
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Sara Falzetti
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Caterina Garbuglia
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Samuele Scorcella
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Piero Giordano
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
- *Correspondence: Riccardo Sarzani
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11
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Serial cardiac biomarkers for risk stratification of patients with COVID-19. Clin Biochem 2022; 107:24-32. [PMID: 35691587 PMCID: PMC9181199 DOI: 10.1016/j.clinbiochem.2022.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/04/2022] [Accepted: 06/07/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Several studies have demonstrated an association between elevated cardiac biomarkers and adverse outcomes in patients with COVID-19. However, the prognostic and predictive capability of a multimarker panel in a prospectively collected, diverse "all-comers" COVID-19 population has not been fully elucidated. DESIGN & METHODS We prospectively assessed high sensitivity cardiac troponin I (hsTnI), NT-pro B-type Natriuretic Peptide (NT-proBNP), Galectin-3 (Gal-3), and procalcitonin (PCT) in 4,282 serial samples from 358 patients admitted with symptomatic, RT-PCR confirmed SARS-CoV-2 infection. Outcomes examined were 30-day in-hospital mortality and requirement for intubation within 10 days. RESULTS Baseline hsTnI had the highest AUC for predicting 30-day mortality (0.81; 95% CI, 0.73-0.88), followed by NT-proBNP (0.80; 0.74-0.86), PCT (0.77; 0.70-0.84), and Gal-3 (0.68; 0.60-0.76). HsTnI < 3.5 ng/L at baseline identified patients at low risk for in-hospital mortality (NPV 95.9%, sensitivity 97.3%) and 10-day intubation (NPV 90.4%, sensitivity 88.5%). Continuous, log-2 increases in troponin concentration were associated with reduced survival (p < 0.001) on Kaplan-Meier curves and increased risk of 30-day mortality: HR 1.26 (1.16-1.37) in univariate and 1.19 (1.03-1.4) in multivariate models. Time-varying doubling of concentrations of hsTnI and Gal-3 were associated with increased risk of 30-day mortality (adjusted HR 1.21, 1.06-1.4, and 1.92, 1.40-2.6). CONCLUSION HsTnI, NT-proBNP, Gal-3, and PCT are elevated at baseline in patients that have worse outcomes from COVID-19. HsTnI was the only independent predictor of 30-day mortality and intubation. Time-varying, doubling in hsTnI and Gal-3 further aided in prognostication of adverse outcomes. These results support the use of hsTnI for triaging patients with COVID-19.
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12
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Lionte C, Sorodoc V, Haliga RE, Bologa C, Ceasovschih A, Petris OR, Coman AE, Stoica A, Sirbu O, Puha G, Constantin M, Dumitrescu G, Gorciac V, Chelariu AC, Catana AN, Jaba E, Sorodoc L. Inflammatory and Cardiac Biomarkers in Relation with Post-Acute COVID-19 and Mortality: What We Know after Successive Pandemic Waves. Diagnostics (Basel) 2022; 12:1373. [PMID: 35741183 PMCID: PMC9222082 DOI: 10.3390/diagnostics12061373] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Biomarkers were correlated with mortality in critically ill COVID-19 patients. No prediction tools exist for noncritically ill COVID-19 patients. We aimed to compare the independent prognostic value of inflammation and cardiac biomarkers for post-acute COVID-19 patients and the 30-day mortality rate in noncritically ill COVID-19 patients, as well as the relation with the virus variant involved. METHODS This observational cohort study was conducted at an emergency clinical hospital between 1 October 2020 and 31 December 2021. We included consecutive patients with biomarkers determined within 24 h of presentation, followed up at least 30 days postdischarge. RESULTS Post-acute COVID-19 was diagnosed in 20.3% of the cases and the all-cause 30-day mortality rate was 35.1% among 978 patients infected with variants of concern. Neutrophil-to-lymphocyte ratio (1.06 [95%CI, 1.01-1.11], p = 0.015) and NT-pro BNP were correlated with 30-daymortality, while the monocyte-to-lymphocyte ratio (2.77 [95%CI, 1.10-6.94], p = 0.03) and NT-pro BNP (1.68 [95%CI, 1.00-2.84], p = 0.05) were correlated with post-acute COVID-19. High-sensitivity to troponin was associated with 30-day mortality (1.55 [95%CI, 1.00-2.42], p = 0.05). A Cox proportional-hazards model confirmed that NT-pro BNP was independently associated with mortality. NT-pro BNP remained independently associated with 30-day mortality during follow-up (1.29 [95%CI, 1.07-1.56], p = 0.007) after adjustment for confounders. CONCLUSION Inflammation and cardiac biomarkers, determined upon admission and predischarge, in a cohort of hospitalized noncritically ill COVID-19 patients throughout successive pandemic waves, showed a predictive value for post-acute COVID-19 and 30-day mortality.
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Affiliation(s)
- Catalina Lionte
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (R.E.H.); (C.B.); (A.S.); (O.S.); (G.P.); (M.C.); (G.D.); (L.S.)
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
| | - Victorita Sorodoc
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (R.E.H.); (C.B.); (A.S.); (O.S.); (G.P.); (M.C.); (G.D.); (L.S.)
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
| | - Raluca Ecaterina Haliga
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (R.E.H.); (C.B.); (A.S.); (O.S.); (G.P.); (M.C.); (G.D.); (L.S.)
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
| | - Cristina Bologa
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (R.E.H.); (C.B.); (A.S.); (O.S.); (G.P.); (M.C.); (G.D.); (L.S.)
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
| | - Alexandr Ceasovschih
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (R.E.H.); (C.B.); (A.S.); (O.S.); (G.P.); (M.C.); (G.D.); (L.S.)
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
| | - Ovidiu Rusalim Petris
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
- Nursing Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Adorata Elena Coman
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
- Preventive Medicine and Interdisciplinarity Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Alexandra Stoica
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (R.E.H.); (C.B.); (A.S.); (O.S.); (G.P.); (M.C.); (G.D.); (L.S.)
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
| | - Oana Sirbu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (R.E.H.); (C.B.); (A.S.); (O.S.); (G.P.); (M.C.); (G.D.); (L.S.)
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
| | - Gabriela Puha
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (R.E.H.); (C.B.); (A.S.); (O.S.); (G.P.); (M.C.); (G.D.); (L.S.)
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
| | - Mihai Constantin
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (R.E.H.); (C.B.); (A.S.); (O.S.); (G.P.); (M.C.); (G.D.); (L.S.)
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
| | - Gabriela Dumitrescu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (R.E.H.); (C.B.); (A.S.); (O.S.); (G.P.); (M.C.); (G.D.); (L.S.)
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
| | - Victoria Gorciac
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
- Rheumatology Department, Clinical Recovery Hospital, 700661 Iasi, Romania
| | - Andrei-Costin Chelariu
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
- Hematology Department, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Andreea Nicoleta Catana
- Infectious Disease Compartment, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania;
| | - Elisabeta Jaba
- Statistics Department, FEEA, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania;
| | - Laurentiu Sorodoc
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania; (R.E.H.); (C.B.); (A.S.); (O.S.); (G.P.); (M.C.); (G.D.); (L.S.)
- Second Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania; (O.R.P.); (A.E.C.); (V.G.); (A.-C.C.)
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Kow CS, Ramachandram DS, Hasan SS. Angiotensin Receptor and Neprilysin Inhibitors for COVID-19 Treatment and Personalized Medicine? OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2022; 26:318-319. [PMID: 35483040 DOI: 10.1089/omi.2022.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Chia Siang Kow
- School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | | | - Syed Shahzad Hasan
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, Australia
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