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Stubbs HD, Cannon J, Knightbridge E, Durrington C, Roddis C, Gin-Sing W, Massey F, Knight DS, Virsinskaite R, Lordan JL, Sear E, Apple-Pinguel J, Morris E, Johnson MK, Wort SJ. Sendaway capillary NT-proBNP in pulmonary hypertension. BMJ Open Respir Res 2024; 11:e002124. [PMID: 38519115 PMCID: PMC10961571 DOI: 10.1136/bmjresp-2023-002124] [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: 10/10/2023] [Accepted: 03/07/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a biomarker of cardiac ventricular wall stress that is incorporated into pulmonary hypertension (PH) risk stratification models. Sendaway sampling may enable patients to perform NT-proBNP tests remotely. This UK-wide study aimed to assess the agreement of sendaway NT-proBNP with standard venous NT-proBNP and to assess the effect of delayed processing. METHODS Reference venous NT-proBNP was collected from PH patients. Samples for capillary and venous sendaway tests were collected contemporaneously, mailed to a reference laboratory and processed at 3 and 7 days using a Roche Cobas e411 device. Differences in paired measurements were analysed with Passing-Bablok regression, percentage difference plots and the % difference in risk strata. RESULTS 113 patients were included in the study. 13% of day 3 capillary samples were insufficient. Day 3 capillary samples were not equivalent to reference samples (Passing Bablok analysis slope of 0.91 (95% CI 0.88 to 0.93) and intercept of 6.0 (95% CI 0.2 to 15.9)). The relative median difference was -7% and there were acceptable limits of agreement. Day 3 capillary NT-proBNP accurately risk stratified patients in 93.5% of cases. By comparison, day 3 venous results accurately risk stratified patients in 90.1% of cases and were equivalent by Passing-Bablok regression. Delayed sampling of sendaway tests led to an unacceptable level of agreement and systematically underestimated NT-proBNP. CONCLUSIONS Sendaway NT-proBNP sampling may provide an objective measure of right ventricular strain for virtual PH clinics. Results must be interpreted with caution in cases of delayed sampling.
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Affiliation(s)
- Harrison D Stubbs
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Cannon
- Pulmonary Vascular Disease Unit, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Emily Knightbridge
- Pulmonary Vascular Disease Unit, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Charlotte Durrington
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Chloe Roddis
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Wendy Gin-Sing
- Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, UK
| | - Fiona Massey
- Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - James L Lordan
- Pulmonary Vascular Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Eleanor Sear
- Pulmonary Vascular Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Joy Apple-Pinguel
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Eleanor Morris
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Stephen J Wort
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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Wu X, Li J, Ma J, Liu Q, Wang L, Zhu Y, Cui Y, Wang A, Wen C, Qiu L, Yang Y, Lu D, Xu X, Zhu X, Cheng C, Wang D, Jing Z. Vaccination against coronavirus disease 2019 in patients with pulmonary hypertension: A national prospective cohort study. Chin Med J (Engl) 2024; 137:669-675. [PMID: 37439342 PMCID: PMC10950192 DOI: 10.1097/cm9.0000000000002767] [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: 04/17/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has potential risks for both clinically worsening pulmonary hypertension (PH) and increasing mortality. However, the data regarding the protective role of vaccination in this population are still lacking. This study aimed to assess the safety of approved vaccination for patients with PH. METHODS In this national prospective cohort study, patients diagnosed with PH (World Health Organization [WHO] groups 1 and 4) were enrolled from October 2021 to April 2022. The primary outcome was the composite of PH-related major adverse events. We used an inverse probability weighting (IPW) approach to control for possible confounding factors in the baseline characteristics of patients. RESULTS In total, 706 patients with PH participated in this study (mean age, 40.3 years; mean duration after diagnosis of PH, 8.2 years). All patients received standardized treatment for PH in accordance with guidelines for the diagnosis and treatment of PH in China. Among them, 278 patients did not receive vaccination, whereas 428 patients completed the vaccination series. None of the participants were infected with COVID-19 during our study period. Overall, 398 patients received inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine, whereas 30 received recombinant protein subunit vaccine. After adjusting for baseline covariates using the IPW approach, the odds of any adverse events due to PH in the vaccinated group did not statistically significantly increase (27/428 [6.3%] vs. 24/278 [8.6%], odds ratio = 0.72, P = 0.302). Approximately half of the vaccinated patients reported at least one post-vaccination side effects, most of which were mild, including pain at the injection site (159/428, 37.1%), fever (11/428, 2.6%), and fatigue (26/428, 6.1%). CONCLUSIONS COVID-19 vaccination did not significantly augment the PH-related major adverse events for patients with WHO groups 1 and 4 PH, although there were some tolerable side effects. A large-scale randomized controlled trial is warranted to confirm this finding. The final approval of the COVID-19 vaccination for patients with PH as a public health strategy is promising.
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Affiliation(s)
- Xiaohan Wu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jingyi Li
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jieling Ma
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qianqian Liu
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lan Wang
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yongjian Zhu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Yue Cui
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Anyi Wang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Cenjin Wen
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Luhong Qiu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yinjian Yang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Dan Lu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiqi Xu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xijie Zhu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Chunyan Cheng
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Zhicheng Jing
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Stubbs H, Lua S, Ingram J, Jani BD, Brewis M, Church C, Johnson M. Remote exercise testing in pulmonary hypertension (PHRET). Pulm Circ 2023; 13:e12325. [PMID: 38148951 PMCID: PMC10749888 DOI: 10.1002/pul2.12325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/28/2023] Open
Abstract
Remote exercise tests for patients with pulmonary hypertension (PH) would improve the telemedicine strategies in this disease. The PHRET study assessed the validity and feasibility of four remote exercise tests performed by PH patients at home. Participants undergoing diagnostic assessment for PH were included. At baseline, patients completed a 6MWT followed by a range of study tests including a Timed Up and Go (TUG) test, a Sit-to-Stand (STS), a Step Test (ST), and a tele-6MWT (T6MWT) performed outside using a GPS-enabled smartphone. Patients performed these tests at home following discharge and at first follow-up. Analysis focused on comparing the results of study tests to the standard 6MWT. The discontinuation rate was 15%. Ninety-seven percent of patients were able to complete a TUG, 92% a STS, 73% a ST, and 49% a T6MWT. At baseline, correlation between the standard 6MWT and study tests, respectively, was T6MWT 0.93, ST 0.78, STS 0.71, and TUG -0.76 (p < 0.001). Direction of change in the study test agreed with the standard 6MWT in 68% of the follow-up ST, 68% of the STS, 71% of the TUG, and 79% of the T6MWT. Patients were able to complete the tests at home, there were no adverse incidents and ≥92% of patients were happy to continue performing home tests. Remote exercise testing is feasible. The T6MWT was a valid remote measure of exercise capacity, but could only be performed by a limited number of patients. The high discontinuation rate may impact the utility of remote tests.
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Affiliation(s)
- Harrison Stubbs
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Health & WellbeingUniversity of GlasgowGlasgowUK
| | - Stephanie Lua
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
| | - Jamie Ingram
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
| | - Bhautesh D. Jani
- General Practice and Primary Care, School of Health & WellbeingUniversity of GlasgowGlasgowUK
| | - Melanie Brewis
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Cardiovascular & Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Colin Church
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Cardiovascular & Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Martin Johnson
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Cardiovascular & Metabolic HealthUniversity of GlasgowGlasgowUK
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4
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Serati A, Keshmiri MS, Shafaghi S, Mohammad MM, Kashani BS, Naghashzadeh F, Mohamadifar A, Shafaghi M, Noorali S, Hajimoradi M, Astani B, Aghdasi S, Riahi M, Alavi S, Malek R, Movahed MR. The Outcome of Patients with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension during the COVID-19 Pandemic. Crit Pathw Cardiol 2023; 22:60-64. [PMID: 37220659 DOI: 10.1097/hpc.0000000000000317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND The coronavirus 2019 (COVID-19) has affected the lives of many people worldwide. Patients with chronic underlying morbidities are vulnerable to get the severe form of the infection. The goal of this study was to evaluate the outcome of patients with pulmonary arterial hypertension during the COVID-19 pandemic in Iran. METHODS This cross-sectional study was conducted at a large tertiary center for pulmonary artery hypertension (PAH) patients. The primary end point was the prevalence of SARS-CoV-2 infection in PAH patients. The secondary end points were investigating the severity and mortality of COVID-19 infection in PAH patients during the COVID-19 pandemic. RESULTS Totally 75 patients were enrolled in the study from December 2019 to October 2021 and 64% were female. The mean ± SD age was 49 ± 16 years. The prevalence of COVID-19 in PAH/chronic thromboembolic pulmonary hypertension patients was 44%. About 66.7% of patients had comorbidities, which was a prognostic factor for COVID-19 infection in PAH patients (P < 0.001). Fifty-six percent of infected patients were asymptomatic. The most reported symptoms in symptomatic patients were fever (28%) and malaise (29%). Twelve percent of patients were admitted with severe symptoms. The mortality rate in infected individuals was 3.7%. CONCLUSIONS COVID-19 infection in PAH/chronic thromboembolic pulmonary hypertension patients seems to be associated with high mortality and morbidity. More scientific proof is needed to clarify different aspect of COVID-19 infection in this population.
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Affiliation(s)
- Alireza Serati
- From the *Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Keshmiri
- From the *Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Shafaghi
- From the *Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Malek Mohammad
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif Kashani
- From the *Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah Naghashzadeh
- From the *Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezoo Mohamadifar
- From the *Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Shafaghi
- Strategic Planning and Executive Office Manager of International Federation of Inventors' Associations-IFIA, Geneva, Switzerland
| | - Sima Noorali
- From the *Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Hajimoradi
- From the *Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahamin Astani
- From the *Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Aghdasi
- From the *Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Riahi
- From the *Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sima Alavi
- Institute of Technology Development of Canada, Vancouver, Canada
| | - Rayka Malek
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Movahed
- University of Arizona Sarver Heart Center, Tucson, AZ
- University of Arizona, Phoenix, AZ
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5
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Farmakis IT, Giannakoulas G. Management of COVID-19 in Patients with Pulmonary Arterial Hypertension. Heart Fail Clin 2023; 19:107-114. [PMID: 36435565 PMCID: PMC9364740 DOI: 10.1016/j.hfc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In this review, we discuss the evidence regarding the course and management of COVID-19 in patients with pulmonary arterial hypertension (PAH), the challenges in PAH management during the pandemic and, lastly, the long-term complications of COVID-19 in relation to pulmonary vascular disease. The inherent PAH disease characteristics, as well as age, comorbidities, and the patient's functional status act synergistically to define the prognosis of COVID-19 in patients with PAH. Management of COVID-19 should follow the general guidelines, while PAH-targeted therapies should be continued. The pandemic has caused a shift toward telemedicine in the chronic care of patients with PAH. Whether COVID-19 could predispose to the development of chronic pulmonary hypertension is a subject of future investigation.
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Affiliation(s)
- Ioannis T. Farmakis
- Department of Cardiology, AHEPA University Hospital, Stilp. Kiriakidi 1, Thessaloniki 54637, Greece,Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langebeckstr. 1, 55131, Mainz, Germany
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Stilp. Kiriakidi 1, Thessaloniki 54637, Greece,Corresponding author. Aristotle University of Thessaloniki, AHEPA Hospital, Cardiology Department, Stilp. Kiriakidi 1, Thessaloniki 54637, Greece
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6
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Effects of COVID-19 pandemic on the management of pulmonary hypertension. Respir Med 2023; 206:107061. [PMID: 36493604 PMCID: PMC9699715 DOI: 10.1016/j.rmed.2022.107061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
The coronavirus of 2019 (COVID-19) disrupted delivery of healthcare. Patients with pulmonary hypertension (PH), especially pulmonary arterial hypertension (PAH), require significant resources for both diagnosis and management and are at high risk for decompensation due to disruption in their care. A survey consisting of 47 questions related to the care of patients with PH was designed by the American College of Chest Physicians 2020-2021 Pulmonary Vascular Disease (PVD) NetWork Steering Committee and sent to all members of the PVD NetWork, as well as the multiple other professional networks for PH. Participation was voluntary and anonymous. Responses were collected from November 2020 through February 2021. Ninety-five providers responded to this survey. The majority (93%) believe that care of PH patients has been affected by the pandemic. Sixty-seven percent observed decreased referrals for PH evaluation. Prior to the pandemic, only 15% used telemedicine for management of PH patients compared to 84% during the pandemic. Telemedicine was used most for follow up of selected low-risk patients (49%). While 22% respondents were completely willing to prescribe new PAH therapy via telemedicine, 11% respondents were completely unwilling. Comfort levels differed based on type of medication being prescribed. Over 90% of providers experienced disruptions in obtaining testing and 31% experienced disruptions in renewal or approval of medications. Overall, providers perceived that the COVID-19 pandemic caused significant disruption of care for PH patients. Telemedicine utilization increased but was used mostly in low-risk patients. Some providers had a decreased level of comfort prescribing PAH therapy via telemedicine encounters.
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7
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Soliman YMA, Elkorashy RIM, Aziz AA, Abdelnaby A, Magdy S. Impact and predictors of outcome of COVID-19 in pulmonary hypertension patients. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-022-00158-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
The pandemic had a significant impact on those with underlying chronic health conditions being at risk of developing a more severe disease with rapid progression, significant complications, and with increased risk of mortality.
This was also expected in the pulmonary vascular community owing to the vulnerable nature of this population, who are characterized by an increase in the pulmonary vascular resistance leading to right heart failure.
This study is aiming to identify the incidence of COVID-19 infection among pulmonary hypertension patients receiving specific therapy as well as the predictors of the COVID-19 disease severity and outcome in those patients.
Results
Data analysis of 197 PAH and CTEPH patients, showed that the incidence of SARS-CoV-2 infection is 10.66% (n = 21). Seven patients (33.3%) required hospitalization. Mortality rate is 14.3% (3/21).
Severity of COVID19 disease in those patients has statistically significant moderate to strong correlation with higher values of d-dimer (r = 0.821, P = 0.000), ferritin (r = 0.718, p = 0.000), CRP (r = 0.613, p = 0.04), acute renal failure (r = 0.557, p = 0.009), and hypoxemia (r = 0.825, p = 0.000).
Mortality from COVID-19 show moderate to strong statistically significant correlations with acute renal failure (r = 0.795, p = 0.000), hypoxemia (r = 0.645, p = 0.002), higher values of ferritin (r = 0.689, p = 0.001) and d-dimer (r = 0.603, P = 0.004).
Conclusions
COVID-19 in PAH and CTEPH patients is challenging, higher COVID-19 infection rate is present in those patients and is associated with increased disease severity and higher mortality.
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8
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Stubbs H, Brewis M, Church C, Johnson M. Towards telemedicine in pulmonary hypertension: Assessing the feasibility of remote quality of life and exercise capacity assessment. Pulm Circ 2022; 12:e12144. [PMID: 36381292 PMCID: PMC9647124 DOI: 10.1002/pul2.12144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/25/2022] [Accepted: 09/26/2022] [Indexed: 01/22/2024] Open
Abstract
Patients with pulmonary hypertension (PH) are happy to perform simple exercise capacity tests at home and believe this is feasible. A proportion of patients are able to use an electronic form to complete quality of life questionnaires. These findings are being used to build a telemedicine strategy for PH patients.
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Affiliation(s)
- Harrison Stubbs
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Health & WellbeingUniversity of GlasgowGlasgowUK
| | - Melanie Brewis
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Cardiovascular & Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Colin Church
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Cardiovascular & Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Martin Johnson
- Scottish Pulmonary Vascular UnitGolden Jubilee National HospitalGlasgowUK
- School of Cardiovascular & Metabolic HealthUniversity of GlasgowGlasgowUK
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9
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Ryan JJ, Gomberg-Maitland M. Right Heart Catheterization-To Do or Not To Do? Introducing a New Diagnostic Algorithm for Pulmonary Hypertension. J Am Heart Assoc 2022; 11:e026589. [PMID: 36062720 PMCID: PMC9496422 DOI: 10.1161/jaha.122.026589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- John J Ryan
- Division of Cardiovascular Medicine, Department of Medicine University of Utah Salt Lake City UT
| | - Mardi Gomberg-Maitland
- Division of Cardiovascular Medicine George Washington University School of Medicine and Health Sciences Washington DC
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10
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Valipour M, Irannejad H, Emami S. Application of emetine in SARS-CoV-2 treatment: regulation of p38 MAPK signaling pathway for preventing emetine-induced cardiac complications. Cell Cycle 2022; 21:2379-2386. [DOI: 10.1080/15384101.2022.2100575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Mehdi Valipour
- Department of Medicinal Chemistry and Pharmaceutical Sciences Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Irannejad
- Department of Medicinal Chemistry and Pharmaceutical Sciences Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeed Emami
- Department of Medicinal Chemistry and Pharmaceutical Sciences Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
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11
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Taghinezhad F, Kaffashian M, Kalvandi G, Shafiei E. Explanation of COVID-19 Mortality Using Artificial Neural Network Based on Underlying and Laboratory Risk Factors in Ilam, Iran. ARCHIVES OF RAZI INSTITUTE 2022; 77:1327-1332. [PMID: 36618315 PMCID: PMC9759234 DOI: 10.22092/ari.2021.355438.1684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/10/2021] [Indexed: 01/10/2023]
Abstract
The spread of new waves of coronavirus outbreaks, high mortality rates, and time-consuming and numerous challenges in achieving collective safety through vaccination and the need to prioritize the allocation of vaccines to the general population have led to the continued identification of risk factors associated with mortality in patients through innovative strategies and new statistical models. In this study, an artificial neural network (ANN) model was used to predict morbidity in patients with coronavirus disease 2019 (COVID-19). Data of 2,206 patients were extracted from the registry program of Shahid Mostafa Khomeini Hospital in Ilam, Iran, and were randomly analyzed in two training (1,544) and testing (662) groups. By fitting different models of a three-layer neural network, 12 variables could explain more than 77% of the mortality variance in COVID-19 patients. These findings could be used to better mortality management, vaccination prioritization, public education, and quarantine, and allocation of intensive care beds to reduce COVID-19 mortality. The results also confirmed the power of a better explanation of ANN models to predict the mortality of patients.
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Affiliation(s)
- F Taghinezhad
- Clinical Research Development Unit, Mostafa Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - M Kaffashian
- Department of Physiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Gh Kalvandi
- Department of Pediatrics, School of Medicine, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - E Shafiei
- Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
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12
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Valipour M. Different Aspects of Emetine's Capabilities as a Highly Potent SARS-CoV-2 Inhibitor against COVID-19. ACS Pharmacol Transl Sci 2022; 5:387-399. [PMID: 35702393 PMCID: PMC9159504 DOI: 10.1021/acsptsci.2c00045] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Indexed: 01/18/2023]
Abstract
In the global movement to find the appropriate agents to fight the coronavirus disease of 2019 (COVID-19), emetine is one of the strongest anti-SARS-CoV-2 compounds with sub-micromolar EC50 values, identified in several studies and high-throughput screening efforts. The reported anti-SARS-CoV-2 mechanisms indicate the effect of this compound on both virus-based and host-based targets. In addition to having excellent antiviral effects, emetine can relieve COVID-19 patients by reducing inflammation through inhibitory activity against NF-κB by the mechanism of IκBα phosphorylation inhibition; it can also limit the lipopolysaccharide-induced expression of pro-inflammatory cytokines TNFα, IL-1β, and IL-6. Emetine also can well reduce pulmonary arterial hypertension as an important COVID-19 complication by modulating a variety of cellular processes such as the Rho-kinase/CyPA/Bsg signaling pathway. The therapeutic value of emetine for combating COVID-19 was highlighted when in vivo pharmacokinetic studies showed that the concentration of this compound in the lungs increases significantly higher than the EC50 of the drug. Despite its valuable therapeutic effects, emetine has some cardiotoxic effects that limit its use in high doses. However, high therapeutic capabilities make emetine a valuable lead compound that can be used for the design and development of less toxic anti-COVID-19 agents in the future. This Review provides a collection of information on the capabilities of emetine and its potential for the treatment of COVID-19, along with structural analysis which could be used for further research in the future.
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Affiliation(s)
- Mehdi Valipour
- Department of Medicinal Chemistry,
Faculty of Pharmacy, Mazandaran University
of Medical Sciences, 48175-866 Sari, Iran
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13
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Mousa M, Matar M, Matar M, Jaber S, Jaber FS, Al Ajerami Y, Falak A, Abujazar M, Oglat AA, Abu-Odah H. Role of cardiovascular computed tomography parameters and lungs findings in predicting severe COVID-19 patients: a single-centre retrospective study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022; 53:222. [PMCID: PMC9574172 DOI: 10.1186/s43055-022-00910-0] [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] [Indexed: 01/08/2023] Open
Abstract
Background Results Conclusions
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Affiliation(s)
- Mahmoud Mousa
- Department of Radiology, Turkish Friendship Hospital, Gaza Strip, Palestine
| | - Marwan Matar
- Department of Radiology, Turkish Friendship Hospital, Gaza Strip, Palestine
| | - Mohammad Matar
- Department of Radiology, Al-Shifa Medical Complex, Gaza Strip, Palestine
| | - Sadi Jaber
- Department of Radiology, Nasser Medical Complex, Gaza Strip, Palestine
| | - Fouad S. Jaber
- grid.266756.60000 0001 2179 926XInternal Medicine Department, University of Missouri–Kansas City, Missouri, USA
| | - Yasser Al Ajerami
- grid.133800.90000 0001 0436 6817Department of Medical Imaging, Applied Medical Sciences, Al-Azhar University, Gaza Strip, Palestine
| | - Amjad Falak
- grid.6979.10000 0001 2335 3149Department of Advanced Material Technologies, Faculty of Material Engineering, Silesian University of Technology (SUT), Gliwice, Poland
| | - Mohammed Abujazar
- grid.412354.50000 0001 2351 3333Center for Medical Imaging, Uppsala University Hospital, 75185 Uppsala, Sweden
| | - Ammar A. Oglat
- grid.33801.390000 0004 0528 1681Department of Medical Imaging, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, 13133 Jordan
| | - Hammoda Abu-Odah
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, FG 414 a-b, 11 Yuk Choi Rd, Hung Hom, Hong Kong SAR, China
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14
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Morales-Demori R, Mallory GB, Chartan C, Coleman R, Ruiz F, Villafranco N, Whalen E, Varghese N. Outcomes of COVID-19 infection in pediatric pulmonary hypertension: A single-center experience. Pediatr Pulmonol 2021; 56:3960-3965. [PMID: 34460150 PMCID: PMC8662244 DOI: 10.1002/ppul.25650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The global COVID-19 pandemic was particularly concerning for the pediatric pulmonary hypertension (PH) population due to immature immune systems and developmental comorbidities. This study aims to describe a single-center experience of pediatric PH patients diagnosed with COVID-19 disease. METHODS A retrospective cohort study of all pediatric patients followed by the PH Center at Texas Children's Hospital diagnosed with COVID-19 infection from April 2020 to February 2021. RESULTS We identified 23 patients with a median age of 58 months (interquartile range [IQR]: 25-75th, 21-132 months), 48% being Hispanics. Eight patients (35%) required hospitalization; median length of stay was 6 days (IQR: 25-75th, 5-8 days). Only three of these eight patients required increased respiratory support. Targeted PH therapy was escalated in four patients (two in dual and two in triple therapy). There was one mortality in a patient with failing Fontan physiology. Ninety-one percent of patients have had post-COVID outpatient follow-up, median of 101 days (IQR: 25-75th, 50-159 days) from diagnosis. Of the five patients with 6 min walk test (6MWT) data, three (60%) children walked less distance, median of -12 m (IQR: 25-75th, -12 to +49 m) compared to pre-COVID testing. Postinfection pulmonary function testing (PFT) was notable for decrease in predicted forced vital capacity (FVC; median -6%, range -11% to +6%) and forced expiratory volume in one second (FEV1; median -14%, range -12% to -18%) in 75% of the patients with PFT data. CONCLUSION In our institution, COVID-19 was found more frequently in Hispanics and associated with low mortality.
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Affiliation(s)
- Raysa Morales-Demori
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - George B Mallory
- Division of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Corey Chartan
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.,Division of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Ryan Coleman
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.,Division of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Fadel Ruiz
- Division of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Natalie Villafranco
- Division of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Elise Whalen
- Division of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Nidhy Varghese
- Division of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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15
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Fremed MA, Niaz T, Hope KD, Altman CA, Levy VY, Glickstein JS, Johnson JN. Adaptations of paediatric cardiology practice during the COVID-19 pandemic. Cardiol Young 2021; 32:1-5. [PMID: 34657645 PMCID: PMC8545844 DOI: 10.1017/s1047951121004364] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/10/2021] [Accepted: 10/06/2021] [Indexed: 11/25/2022]
Abstract
During the initial surge of the COVID-19 pandemic in the spring and summer of 2020, paediatric heart centres were forced to rapidly alter the way patient care was provided to minimise interruption to patient care as well as exposure to the virus. In this survey-based descriptive study, we characterise changes that occurred within paediatric cardiology practices across the United States and described provider experience and attitudes towards these changes during the pandemic. Common changes that were implemented included decreased numbers of procedures, limiting visitors and shifting towards telemedicine encounters. The information obtained from this survey may be useful in guiding and standardising responses to future public health crises.
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Affiliation(s)
- Michael A. Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Talha Niaz
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kyle D. Hope
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Carolyn A. Altman
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Victor Y. Levy
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Julie S. Glickstein
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Jonathan N. Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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16
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Dayaramani C, De Leon J, Reiss AB. Cardiovascular Disease Complicating COVID-19 in the Elderly. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:833. [PMID: 34441038 PMCID: PMC8399122 DOI: 10.3390/medicina57080833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 12/20/2022]
Abstract
SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). The highly transmissible virus gains entry into human cells primarily by the binding of its spike protein to the angiotensin-converting enzyme 2 receptor, which is expressed not only in lung tissue but also in cardiac myocytes and the vascular endothelium. Cardiovascular complications are frequent in patients with COVID-19 and may be a result of viral-associated systemic and cardiac inflammation or may arise from a virus-induced hypercoagulable state. This prothrombotic state is marked by endothelial dysfunction and platelet activation in both macrovasculature and microvasculature. In patients with subclinical atherosclerosis, COVID-19 may incite atherosclerotic plaque disruption and coronary thrombosis. Hypertension and obesity are common comorbidities in COVID-19 patients that may significantly raise the risk of mortality. Sedentary behaviors, poor diet, and increased use of tobacco and alcohol, associated with prolonged stay-at-home restrictions, may promote thrombosis, while depressed mood due to social isolation can exacerbate poor self-care. Telehealth interventions via smartphone applications and other technologies that document nutrition and offer exercise programs and social connections can be used to mitigate some of the potential damage to heart health.
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Affiliation(s)
| | | | - Allison B. Reiss
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (C.D.); (J.D.L.)
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17
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Potus F, Frump AL, Umar S, R. Vanderpool R, Al Ghouleh I, Lai YC. Recent advancements in pulmonary arterial hypertension and right heart failure research: overview of selected abstracts from ATS2020 and emerging COVID-19 research. Pulm Circ 2021; 11:20458940211037274. [PMID: 34434543 PMCID: PMC8381443 DOI: 10.1177/20458940211037274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/15/2021] [Indexed: 01/10/2023] Open
Abstract
Each year the American Thoracic Society (ATS) Conference brings together scientists who conduct basic, translational and clinical research to present on the recent advances in the field of respirology. Due to the Coronavirus Disease of 2019 (COVID-19) pandemic, the ATS2020 Conference was held online in a series of virtual meetings. In this review, we focus on the breakthroughs in pulmonary hypertension research. We have selected 11 of the best basic science abstracts which were presented at the ATS2020 Assembly on Pulmonary Circulation mini-symposium "What's New in Pulmonary Arterial Hypertension (PAH) and Right Ventricular (RV) Signaling: Lessons from the Best Abstracts," reflecting the current state of the art and associated challenges in PH. Particular emphasis is placed on understanding the mechanisms underlying RV failure, the regulation of inflammation, and the novel therapeutic targets that emerged from preclinical research. The pathologic interactions between pulmonary hypertension, right ventricular function and COVID-19 are also discussed.
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Affiliation(s)
- Francois Potus
- Pulmonary Hypertension Research Group, Centre de Recherche de
l'Institut Universitaire de Cardiologie et Pneumologie de Quebec City, Quebec,
Canada
| | - Andrea L. Frump
- Division of Pulmonary, Critical Care, Sleep and Occupational
Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Soban Umar
- Department of Anesthesiology and Perioperative Medicine, Division of
Molecular Medicine, David Geffen School of Medicine at University of California Los
Angeles, Los Angeles, CA, USA
| | - Rebecca R. Vanderpool
- Division of Translational and Regenerative Medicine, University of
Arizona, Tucson, AZ, USA
| | - Imad Al Ghouleh
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, and
Division of Cardiology, Department of Medicine, University of Pittsburgh School of
Medicine, Pittsburgh, PA, USA
| | - Yen-Chun Lai
- Division of Pulmonary, Critical Care, Sleep and Occupational
Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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18
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Zhang T, Mosier J, Subbian V. Identifying Barriers to and Opportunities for Telehealth Implementation Amidst the COVID-19 Pandemic by Using a Human Factors Approach: A Leap Into the Future of Health Care Delivery? JMIR Hum Factors 2021; 8:e24860. [PMID: 33779566 PMCID: PMC8041052 DOI: 10.2196/24860] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/11/2021] [Accepted: 03/28/2021] [Indexed: 12/16/2022] Open
Abstract
The extensive uptake of telehealth has considerably transformed health care delivery since the beginning of the COVID-19 pandemic and has imposed tremendous challenges to its large-scale implementation and adaptation. Given the shift in paradigm from telehealth as an alternative mechanism of care delivery to telehealth as an integral part of the health system, it is imperative to take a systematic approach to identifying barriers to, opportunities for, and the overall impact of telehealth implementation amidst the current pandemic. In this work, we apply a human factors framework, the Systems Engineering Initiative for Patient Safety model, to guide our holistic analysis and discussion of telehealth implementation, encompassing the health care work system, care processes, and outcomes.
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Affiliation(s)
- Tianyi Zhang
- Department of Systems and Industrial Engineering, College of Engineering, The University of Arizona, Tucson, AZ, United States
| | - Jarrod Mosier
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, United States
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, University of Arizona College of Medicine, Tucson, AZ, United States
- Adult ECMO Service, Banner - University Medical Center Tucson, Tucson, AZ, United States
| | - Vignesh Subbian
- Department of Systems and Industrial Engineering, College of Engineering, The University of Arizona, Tucson, AZ, United States
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, United States
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19
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Nan J, Zhang T, Tian Y, Song K, Li Q, Fu Q, Ma Y, Jin Z. Impact of the 2019 Novel Coronavirus Disease Pandemic on the Performance of a Cardiovascular Department in a Non-epidemic Center in Beijing, China. Front Cardiovasc Med 2021; 8:630816. [PMID: 33681305 PMCID: PMC7929980 DOI: 10.3389/fcvm.2021.630816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/20/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Knowledge of the impact of the 2019 novel coronavirus disease (COVID-19) pandemic on the performance of a cardiovascular department in a medical referral hub center from a non-epidemic area of China is limited. Method: The data on the total number of non-emergency medical cares (including the number of out-patient clinic attendances, the number of patients who were hospitalized in non-intensive care wards, and patients who underwent elective cardiac intervention procedures) and emergency medical cares [including the number of emergency department (ED attendances) and chest pain center (CPC attendances), as well as the number of patients who were hospitalized in coronary care unit (CCU) and the number of patients who underwent emergency cardiac intervention procedures] before and during the pandemic (time before the pandemic: 20th January 2019 to 31st March 2019 and time during the pandemic: 20th January 2020 to 31st March 2020) in the Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University were collected and compared. Results: Both the non-emergency medical and emergency medical cares were affected by the pandemic. The total number of out-patient clinic attendance decreased by 44.8% and the total number of patients who were hospitalized in non-intensive care wards decreased by 56.4%. Pearson correlation analysis showed that the number of out-patient clinic attendance per day was not associated with the number of new confirmed COVID-19 cases and the cumulative number of confirmed COVID-19 patients in Beijing (r = −0.080, p = 0.506 and r = −0.071, p = 0.552, respectively). The total number of patients who underwent non-emergency cardiac intervention procedures decreased during the pandemic, although there were no statistically significant differences except for patent foramen ovale (PFO) occlusion (1.7 ± 2.9 vs. 8.3 ± 2.3, p = 0.035). As for the emergency medical cares, the ED attendances decreased by 22.4%, the total number of CPC attendances increased by 10.3%, and the number of patients who were hospitalized in CCU increased by 8.9%: these differences were not statistically significant. During the pandemic, the proportion of hospitalized patients with ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) significantly increased (19.0 vs. 8.7%, p < 0.001; 28.8 vs. 18.0%, p < 0.001, respectively); also, the number of primary percutaneous coronary intervention (PCI) increased by 10.3%. There was no significant difference between patients before and during the pandemic regarding the age, gender, baseline and discharge medication therapy, as well as length of stay and in-hospital mortality. Conclusions: Our preliminary results demonstrate that both the non-emergency and emergency medical cares were affected by the COVID-19 pandemic even in a referral medical center with low cross-infection risk. The number of the out-patient clinic attendances not associated with the number of confirmed COVID-19 cases could be due to different factors, such as the local government contamination measures. The proportion of hospitalized patients with acute myocardial infarction increased in our center during the pandemic since other hospitals stopped performing primary angioplasty. A hub-and-spoke model could be effective in limiting the collateral damage for patients affected by cardiovascular diseases when the medical system is stressed by disasters, such as COVID-19 pandemic.
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Affiliation(s)
- Jing Nan
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yali Tian
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ke Song
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qun Li
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiang Fu
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan Ma
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zening Jin
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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20
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Alsahabi I, Alobaidi A, Alahmari AS, Almohsen N, Alhamoud AH. Clinical Presentation and Successful Management of an Infant With Down Syndrome and COVID-19 in Riyadh, Saudi Arabia. Cureus 2021; 13:e13188. [PMID: 33575158 PMCID: PMC7870114 DOI: 10.7759/cureus.13188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 01/16/2023] Open
Abstract
Coronavirus is a serious, global disease. Down syndrome (DS) is characterized by immune dysregulation, has various anatomical variations, and is considered as comorbidity. These variations mean that children with DS are at risk of developing a severe case of COVID-19 if the virus is contracted. Here, we report the first case of COVID-19 in a four-month-old infant girl with DS and congenital heart disease (CHD) who was treated in Al-Imam Abdulrahman Al Faisal Hospital in the first health cluster in Riyadh, Saudi Arabia. The medical management and clinical outcome of the infant are reviewed. The infant was admitted after having received previous treatment from other hospitals, with a deteriorating condition. The patient had developed a rash, and oxygen support was required in addition to her baseline medication (furosemide and captopril). Ten days post admission, the patient's condition improved, and she became clinically stable. She was then discharged after two consecutive negative nasopharyngeal swabs. Based on the reported case, infants with DS and CHD should be considered a high-risk patient in terms of COVID-19 infection and require close observation.
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Affiliation(s)
- Ibrahim Alsahabi
- Department of Pediatrics, Al-Imam Abdulrahman Al Faisal Hospital, Ministry of Health, Riyadh, SAU
| | - Abdulaziz Alobaidi
- Department of Pediatrics, Al-Imam Abdulrahman Al Faisal Hospital, Ministry of Health, Riyadh, SAU
| | - Ayman S Alahmari
- Department of Laboratory, Al-Imam Abdulrahman Al Faisal Hospital, Ministry of Health, Riyadh, SAU
| | - Noof Almohsen
- Department of Laboratory, Al-Imam Abdulrahman Al Faisal Hospital, Ministry of Health, Riyadh, SAU
| | - Abdullah H Alhamoud
- Department of Laboratory, Al-Imam Abdulrahman Al Faisal Hospital, First Cluster, Ministry of Health, Riyadh, SAU
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, SAU
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21
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Bailey KL, Samuelson DR, Wyatt TA. Alcohol use disorder: A pre-existing condition for COVID-19? Alcohol 2021; 90:11-17. [PMID: 33080339 PMCID: PMC7568767 DOI: 10.1016/j.alcohol.2020.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
Alcohol misuse is long established as a contributor to the pathophysiology of the lung. The intersection of multi-organ responses to alcohol-mediated tissue injury likely contributes to the modulation of lung in response to injury. Indeed, the negative impact of alcohol on susceptibility to infection and on lung barrier function is now well documented. Thus, the alcohol lung represents a very likely comorbidity for the negative consequences of both COVID-19 susceptibility and severity. In this review, we present the known alcohol misuse ramifications on the lung in the context of the current coronavirus pandemic.
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Affiliation(s)
- Kristina L Bailey
- Research Service, Department of Veterans Affairs Omaha-Western Iowa Health Care System, Omaha, NE, 68105, United States; Pulmonary, Critical Care and Sleep, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-5910, United States.
| | - Derrick R Samuelson
- Pulmonary, Critical Care and Sleep, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-5910, United States.
| | - Todd A Wyatt
- Research Service, Department of Veterans Affairs Omaha-Western Iowa Health Care System, Omaha, NE, 68105, United States; Pulmonary, Critical Care and Sleep, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-5910, United States; Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, NE, 68198-5910, United States.
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22
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Sulica R, Cefali F, Motschwiller C, Fenton R, Barroso A, Sterman D. COVID-19 in Pulmonary Artery Hypertension (PAH) Patients: Observations from a Large PAH Center in New York City. Diagnostics (Basel) 2021; 11:128. [PMID: 33467533 PMCID: PMC7829711 DOI: 10.3390/diagnostics11010128] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/14/2022] Open
Abstract
Information on outcomes of COVID-19 in pulmonary arterial hypertension (PAH) patients is limited to a few case series and surveys. Here, we describe our experience at a large Pulmonary Hypertension Center in New York City at the height of the pandemic. We performed a retrospective chart review of eleven consecutive PAH patients who were diagnosed with SARS-CoV-2 infection. We analyzed demographics, PAH severity, risk factors for COVID-19, and COVID-19 severity and outcomes. We found in our sample that 63.6% of patients required intensive care, and there was a 45.45% overall mortality. Most patients had a known COVID-19 contact and mean duration of symptoms prior to presentation was 12 days. Only 4/11 (36%) patients presented to a center with pulmonary hypertension expertise, all of whom survived. Most patients had at least moderate pulmonary hypertension with an average REVEAL score of 7.81 despite double or triple PAH therapy. Our cases series underscores the gravity of SARS-CoV-2 infection in patients with PAH. It also suggests possible interventions to prevent unfavorable outcomes such as preserving social distancing, PAH management optimization, and early and preferential presentation to a center with specialized expertise in PAH.
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Affiliation(s)
- Roxana Sulica
- Department of Medicine, Pulmonary Critical Care and Sleep Division, New York University Grossman School of Medicine, New York University Langone Health, 462 1st Avenue CD 676, New York, NY 10016, USA; (F.C.); (C.M.); (R.F.); (A.B.); (D.S.)
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23
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Das BB. COVID-19 and Pulmonary Hypertension in Children: What Do We Know So Far? MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E716. [PMID: 33352654 PMCID: PMC7765781 DOI: 10.3390/medicina56120716] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022]
Abstract
The interplay between coronavirus disease 2019 (COVID-19) and pulmonary hypertension (PH) in children is unknown. Adults with PH are at potential risk for severe complications and high mortality due to associated comorbidities. It is difficult to extrapolate the outcomes of COVID-19 in adults to pediatric PH patients. Overall, a small number of COVID-19 cases is reported in patients with preexisting PH. Several factors may be responsible for the low incidence of COVID-19 in children with PH. Pulmonary hypertension is a rare disease, testing is not universal, and patients may have followed more rigorously the Center for Disease Control's guidelines recommended for personal protection with mask-wearing, social distancing, and hand sanitization through ongoing health education. The small number of COVID-19 cases in patients with preexisting PH does not support that PH is protective for COVID-19. However, medications used to treat PH may have some protection against COVID-19. This review discusses the pathophysiology of PH occurring with COVID-19, differences between children and adults with COVID-19, strategies for management of preexisting PH in children during the ongoing pandemic, and its impact within the field of PH.
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Affiliation(s)
- Bibhuti B Das
- Department of Pediatric, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital Austin Specialty Care, Austin, TX 78759, USA
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24
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Avellanas Chavala ML. [Pulmonary arterial hypertension and COVID-19]. Med Intensiva 2020; 44:577-579. [PMID: 32571526 PMCID: PMC7254019 DOI: 10.1016/j.medin.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023]
Affiliation(s)
- M L Avellanas Chavala
- Médico Especialista en Medicina Intensiva, Huesca, España; Profesor del Master en Medicina de Urgencia y Rescate en Montaña. Universidad de Zaragoza, Zaragoza, España.
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25
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Lee JD, Burger CD, Delossantos GB, Grinnan D, Ralph DD, Rayner SG, Ryan JJ, Safdar Z, Ventetuolo CE, Zamanian RT, Leary PJ. A Survey-based Estimate of COVID-19 Incidence and Outcomes among Patients with Pulmonary Arterial Hypertension or Chronic Thromboembolic Pulmonary Hypertension and Impact on the Process of Care. Ann Am Thorac Soc 2020; 17:1576-1582. [PMID: 32726561 PMCID: PMC7706604 DOI: 10.1513/annalsats.202005-521oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/29/2020] [Indexed: 12/20/2022] Open
Abstract
Rationale: Patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) typically undergo frequent clinical evaluation. The incidence and outcomes of coronavirus disease (COVID-19) and its impact on routine management for patients with pulmonary vascular disease is currently unknown.Objectives: To assess the cumulative incidence and outcomes of recognized COVID-19 for patients with PAH/CTEPH followed at accredited pulmonary hypertension centers, and to evaluate the pandemic's impact on clinic operations at these centers.Methods: A survey was e-mailed to program directors of centers accredited by the Pulmonary Hypertension Association. Descriptive analyses and linear regression were used to analyze results.Results: Seventy-seven center directors were successfully e-mailed a survey, and 58 responded (75%). The cumulative incidence of COVID-19 recognized in individuals with PAH/CTEPH was 2.9 cases per 1,000 patients, similar to the general U.S. population. In patients with PAH/CTEPH for whom COVID-19 was recognized, 30% were hospitalized and 12% died. These outcomes appear worse than the general population. A large impact on clinic operations was observed including fewer clinic visits and substantially increased use of telehealth. A majority of centers curtailed diagnostic testing and a minority limited new starts of medical therapy. Most centers did not use experimental therapies in patients with PAH/CTEPH diagnosed with COVID-19.Conclusions: The cumulative incidence of COVID-19 recognized in patients with PAH/CTEPH appears similar to the broader population, although outcomes may be worse. Although the total number of patients with PAH/CTEPH recognized to have COVID-19 was small, the impact of COVID-19 on broader clinic operations, testing, and treatment was substantial.
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Affiliation(s)
| | - Charles D. Burger
- Department of Pulmonary Medicine, Mayo Clinic Florida, Jacksonville, Florida
| | | | - Daniel Grinnan
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | | | | | - John J. Ryan
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Zeenat Safdar
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Corey E. Ventetuolo
- Department of Medicine and Health Services, Policy and Practice, Brown University, Providence, Rhode Island; and
| | | | - Peter J. Leary
- Department of Medicine and
- Department of Epidemiology, University of Washington, Seattle, Washington
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26
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Belge C, Quarck R, Godinas L, Montani D, Escribano Subias P, Vachiéry JL, Nashat H, Pepke-Zaba J, Humbert M, Delcroix M. COVID-19 in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: a reference centre survey. ERJ Open Res 2020; 6:00520-2020. [PMID: 33263061 PMCID: PMC7682715 DOI: 10.1183/23120541.00520-2020] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/20/2020] [Indexed: 12/11/2022] Open
Abstract
According to the US Centers for Disease Control and Prevention (CDC), patients with underlying health conditions, including all types of lung and cardiovascular diseases, have an increased risk of developing serious disease when infected by SARS-CoV-2 [1]. Based on prior publications on the effects of acute right heart failure superimposed on systemic infection [2–5], Ryanet al. [6] suggested that right heart failure and concomitant COVID-19 infection may result in increased mortality in pulmonary arterial hypertension (PAH) patients. Surprisingly, the number of hospitalised PAH-COVID-19 patients remained rather low in Italy and the USA so far [7]. In late March 2020, experts from over 32 US PH expert centres answered a query endorsed by the US Pulmonary Hypertension Association. COVID-19 infection was reported in 13 PAH patients, among whom three required intubation and one died. This is consequently raising the question whether and why PAH patients appear to be at lower risk of developing severe COVID-19 [7]. This international survey highlights that a limited number of PAH and CTEPH patients suffered from severe #COVID19 infectionhttps://bit.ly/3jGuBQq
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Affiliation(s)
- Catharina Belge
- Clinical Dept of Respiratory Diseases, University Hospitals and Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Dept of Chronic Diseases & Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium.,These authors contributed equally
| | - Rozenn Quarck
- Clinical Dept of Respiratory Diseases, University Hospitals and Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Dept of Chronic Diseases & Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium.,These authors contributed equally
| | - Laurent Godinas
- Clinical Dept of Respiratory Diseases, University Hospitals and Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Dept of Chronic Diseases & Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | - David Montani
- Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,Assistance Publique Hôpitaux de Paris, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Pilar Escribano Subias
- Cardiology Dept and Spanish Cardiovascular Research Network (CIBER-CV), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jean-Luc Vachiéry
- Dept of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium
| | - Heba Nashat
- National Pulmonary Hypertension Service at Royal Brompton and Harefield NHS Trust and National Heart and Lung Institute, Imperial College London, London, UK
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - Marc Humbert
- Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,Assistance Publique Hôpitaux de Paris, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Marion Delcroix
- Clinical Dept of Respiratory Diseases, University Hospitals and Laboratory of Respiratory Diseases & Thoracic Surgery (BREATHE), Dept of Chronic Diseases & Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
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27
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Karmouty-Quintana H, Thandavarayan RA, Keller SP, Sahay S, Pandit LM, Akkanti B. Emerging Mechanisms of Pulmonary Vasoconstriction in SARS-CoV-2-Induced Acute Respiratory Distress Syndrome (ARDS) and Potential Therapeutic Targets. Int J Mol Sci 2020; 21:E8081. [PMID: 33138181 PMCID: PMC7662604 DOI: 10.3390/ijms21218081] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
The 1918 influenza killed approximately 50 million people in a few short years, and now, the world is facing another pandemic. In December 2019, a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused an international outbreak of a respiratory illness termed coronavirus disease 2019 (COVID-19) and rapidly spread to cause the worst pandemic since 1918. Recent clinical reports highlight an atypical presentation of acute respiratory distress syndrome (ARDS) in COVID-19 patients characterized by severe hypoxemia, an imbalance of the renin-angiotensin system, an increase in thrombogenic processes, and a cytokine release storm. These processes not only exacerbate lung injury but can also promote pulmonary vascular remodeling and vasoconstriction, which are hallmarks of pulmonary hypertension (PH). PH is a complication of ARDS that has received little attention; thus, we hypothesize that PH in COVID-19-induced ARDS represents an important target for disease amelioration. The mechanisms that can promote PH following SARS-CoV-2 infection are described. In this review article, we outline emerging mechanisms of pulmonary vascular dysfunction and outline potential treatment options that have been clinically tested.
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Affiliation(s)
- Harry Karmouty-Quintana
- Department of Biochemistry and Molecular Biology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Divisions of Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | | | - Steven P. Keller
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA;
| | - Sandeep Sahay
- Co-Director, Pulmonary Vascular Diseases Center, The Methodist Hospital, Houston, TX 77030, USA;
| | - Lavannya M. Pandit
- Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Bindu Akkanti
- Divisions of Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
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28
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Babu AS, Morris NR. Patients support exercise training and rehabilitation-what more should we be doing to ensure cardiopulmonary rehabilitation is more readily available for those with pulmonary hypertension? Pulm Circ 2020; 10:2045894020975312. [PMID: 33354318 PMCID: PMC7734525 DOI: 10.1177/2045894020975312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Abraham S. Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, India
- Department of Cardiology – Austin Health, University of Melbourne, Melbourne, Australia
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Norman R. Morris
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
- Allied Health Research Collaborative, The Prince Charles Hospital, Chermside, Griffith University, Nathan, Australia
- School of Allied Health Sciences and Menzies Health Institute, Griffith University, Nathan, Australia
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29
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Krishnan US, Krishnan SS, Jain S, Chavolla-Calderon MB, Lewis M, Chung WK, Rosenzweig EB. SARS-CoV-2 Infection in Patients with Down Syndrome, Congenital Heart Disease, and Pulmonary Hypertension: Is Down Syndrome a Risk Factor? J Pediatr 2020; 225:246-248. [PMID: 32610168 PMCID: PMC7321054 DOI: 10.1016/j.jpeds.2020.06.076] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/21/2020] [Accepted: 06/25/2020] [Indexed: 01/08/2023]
Abstract
With increasing information available about the epidemiology, pathophysiology, and management of patients affected with severe acute respiratory syndrome corona virus-2 infection, patients with Down syndrome, congenital heart disease, airway obstruction, and pulmonary hypertension present a unique challenge. This case series describes 3 patients with Down syndrome and respiratory failure secondary to coronavirus infection.
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Affiliation(s)
- Usha S Krishnan
- Department of Pediatrics (Cardiology), Columbia University Irving Medical Center, New York, NY.
| | - Sankaran S Krishnan
- Department of Pediatrics (Pulmonology), New York Medical College, Valhalla, NY
| | - Shipra Jain
- Department of Pediatrics at Kings County Hospital Center, New York, NY
| | | | - Matthew Lewis
- Department of Cardiology (Adult Congenital Heart Disease) at Columbia University Irving Medical Center, New York, NY
| | - Wendy K Chung
- Department of Pediatrics and Medicine, Columbia University Irving Medical Center, New York, NY
| | - Erika B Rosenzweig
- Department of Pediatrics (Cardiology), Columbia University Irving Medical Center, New York, NY
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30
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Treatment of Multi-Drug Resistant Gram-Negative Bacterial Pathogenic Infections. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.3.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The multidrug-resistant Gram-negative bacteria (MDR-GNB) infections in severely infected patients present numerous difficulties in terms of treatment failure where antibiotics cannot arrest such drug resistant bacteria. Based on the patient’s medical history and updated microbiological epidemiology data, an effective empirical treatment remains critical for optimal results to safeguard human health. The aim of this manuscript is to review management of MDR-Gram negative pathogenic bacterial infections. Quick diagnosis and narrow antimicrobial spectrum require rapid and timely diagnosis and effective laboratories in accordance with antimicrobial stewardship (AS) principles. Worldwide, there is an increased emergence of Carbapenem-resistant Enterobacteriaceae (CRE), Pseudomonas aeruginosa, and Acinetobacter baumannii. Recently, novel therapeutic options, such as meropenem/vaborbactam, ceftazidime/avibactam, ceftolozane/tazobactam, eravacycline and plazomicin became accessible to effectively counteract severe infections. Optimally using these delays the emergence of resistance to novel therapeutic agents. Further study is required, however, due to uncertainties in pharmacokinetic/pharmacodynamics optimization of dosages and therapeutic duration in severely ill patients. The novel agents should be verified for (i) action on carbapenem resistant Acinetobacter baumannii; (ii) action on CRE of β-lactam/β-lactamase inhibitors dependence on type of carbapenemase; (iii) emergence of resistance to novel antibacterials and dismiss selective pressure promoting development of resistance. Alternative treatments should be approached alike phage therapy or antibacterial peptides. The choice of empirical therapy is complicated by antibiotic resistance and can be combated by accurate antibiotic and their combinations usage, which is critical to patient survival. Noteworthy are local epidemiology, effective teamwork and antibiotic stewardship to guarantee that medications are utilized properly to counter the resistance.
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31
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COVID-19 and the World with Co-Morbidities of Heart Disease, Hypertension and Diabetes. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.3.01] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Newly emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) pandemic has now spread across the globe in past few months while affecting 26 million people and leading to more than 0.85 million deaths as on 2nd September, 2020. Severity of SARS-CoV-2 infection increases in COVID-19 patients due to pre-existing health co-morbidities. This mini-review has focused on the three significant co-morbidities viz., heart disease, hypertension, and diabetes, which are posing high health concerns and increased mortality during this ongoing pandemic. The observed co-morbidities have been found to be associated with the increasing risk factors for SARS-CoV-2 infection and COVID-19 critical illness as well as to be associated positively with the worsening of the health condition of COVID-19 suffering individuals resulting in the high risk for mortality. SARS-CoV-2 enters host cell via angiotensin-converting enzyme 2 receptors. Regulation of crucial cardiovascular functions and metabolisms like blood pressure and sugar levels are being carried out by ACE2. This might be one of the reasons that contribute to the higher mortality in COVID-19 patients having co-morbidities. Clinical investigations have identified higher levels of creatinine, cardiac troponin I, alanine aminotransferase, NT-proBNP, creatine kinase, D-dimer, aspartate aminotransferase and lactate dehydrogenase in patients who have succumbed to death from COVID-19 as compared to recovered individuals. More investigations are required to identify the modes behind increased mortality in COVID-19 patients having co-morbidities of heart disease, hypertension, and diabetes. This will enable us to design and develop suitable therapeutic strategies for reducing the mortality. More attention and critical care need to be paid to such high risk patients suffering from co-morbidities during COVID-19 pandemic.
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32
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Tamura Y, Takeyasu R, Furukawa A, Takada H, Takechi M, Taniguchi H, Kawamura A. How COVID-19 Affected the Introduction of Telemedicine and Patient Reported Outcomes Among Patients With Pulmonary Hypertension - A Report From a Referral Center in Japan. Circ Rep 2020; 2:526-530. [PMID: 33693278 PMCID: PMC7819649 DOI: 10.1253/circrep.cr-20-0088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 11/14/2022] Open
Abstract
Background: COVID-19 is fatal to patients with pulmonary hypertension (PH), so preventive actions are recommended. This study investigated the effectiveness of telemedicine and effects on quality of life (QOL) in the treatment of patients with PH. Methods and Results: Japanese patients with PH (n=40) were recruited from one referral center. Patient self-reported anxiety worsened significantly and elderly patients in particular experienced detrimental lifestyle changes under COVID-19. Telemedicine worked well to decrease the frequency of going out. Conclusions: Telemedicine is effective in reducing travel distances, and frequent remote interventions may be desirable for older, anxious patients.
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Affiliation(s)
- Yuichi Tamura
- Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital Tokyo Japan
- Department of Cardiology, International University of Health and Welfare School of Medicine Narita Japan
| | - Rika Takeyasu
- Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital Tokyo Japan
| | - Asuka Furukawa
- Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital Tokyo Japan
- Department of Cardiology, International University of Health and Welfare School of Medicine Narita Japan
| | - Hiromi Takada
- Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital Tokyo Japan
| | - Mineki Takechi
- Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital Tokyo Japan
| | - Hirohisa Taniguchi
- Department of Cardiology, International University of Health and Welfare School of Medicine Narita Japan
| | - Akio Kawamura
- Department of Cardiology, International University of Health and Welfare School of Medicine Narita Japan
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33
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Mandler D, Lichtblau M, Ulrich S. The course of COVID-19 in a 55-year-old patient diagnosed with severe idiopathic pulmonary arterial hypertension. Pulm Circ 2020; 10:2045894020936659. [PMID: 32782784 DOI: 10.1177/2045894020936659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/01/2020] [Indexed: 01/01/2023] Open
Abstract
We describe a 55-year-old woman with severe idiopathic pulmonary arterial hypertension (mean pulmonary artery pressure 71 mmHg, pulmonary vascular resistance 30 WU at diagnosis five months ago), who was diagnosed with SARS-CoV-2 infection (COVID-19) and experienced a relatively mild course with symptoms resembling a common cold. To date, information about the clinical course of COVID-19 in pre-existing pulmonary arterial hypertension is lacking, and it is thus unknown whether pulmonary arterial hypertension belongs to the risk factors of severe COVID-19 disease.
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Affiliation(s)
- Diana Mandler
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
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34
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Pickworth KK, Blais D. COVID-19 Pandemic: Challenges and Solutions from the Cardiology Pharmacist's Perspective. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020; 3:1138-1146. [PMID: 32838223 PMCID: PMC7404851 DOI: 10.1002/jac5.1307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 11/10/2022]
Abstract
The recent coronavirus disease 2019 (COVID‐19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) challenges pharmacists worldwide. Alongside other specialized pharmacists, we re‐evaluated daily processes and therapies used to treat COVID‐19 patients within our institutions from a cardiovascular perspective and share what we have learned. To develop a collaborative approach for cardiology issues and concerns in the care of confirmed or suspected COVID‐19 patients by drawing on the experiences of cardiology pharmacists across the country. On March 26, 2020, a conference call was convened composed of 24 cardiology residency‐trained pharmacists (23 actively practicing in cardiology and 1 in critical care) from 16 institutions across the United States to discuss cardiology issues each have encountered with COVID‐19 patients. Discussion centered around providing optimal pharmaceutical care while limiting staff exposure. The collaborative of pharmacists found for the ST‐elevation myocardial infarction patient, many institutions were diverting COVID‐19 rule‐out patients to their Emergency Department (ED). Thrombolytics are an alternative to percutaneous coronary intervention (PCI) allowing for timely treatment of patients and decreased staff exposure. An emergency response grab and go kit includes initial drugs and airway equipment so the patient can be treated and the cart can be left outside the room. Cardiology pharmacists have developed policies and procedures to address monitoring of QT prolonging medications, the use of inhaled prostacyclins, and national drug shortages. Technology has allowed us to practice social distancing, while staying in close contact with our teams, patients, and colleagues and continuing to teach. Residents are engaged in unique decision‐making processes with their preceptors and assist as pharmacist extenders. Cardiology pharmacists are in a unique position to work with other pharmacists and health care professionals to implement safe and effective practice changes during the COVID‐19 pandemic. Ongoing monitoring and adjustments are necessary in rapidly changing times.
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35
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Zamanian RT, Pollack CV, Gentile MA, Rashid M, Fox JC, Mahaffey KW, de Jesus Perez V. Outpatient Inhaled Nitric Oxide in a Patient with Vasoreactive Idiopathic Pulmonary Arterial Hypertension and COVID-19 Infection. Am J Respir Crit Care Med 2020; 202:130-132. [PMID: 32369396 PMCID: PMC7328330 DOI: 10.1164/rccm.202004-0937le] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Roham T Zamanian
- Stanford University School of MedicineStanford, California.,Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford, California
| | | | | | | | | | | | - Vinicio de Jesus Perez
- Stanford University School of MedicineStanford, California.,Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford, California
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36
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Vaidya A, Golbus JR, Vedage NA, Mazurek J, Raza F, Forfia PR. Virtual echocardiography screening tool to differentiate hemodynamic profiles in pulmonary hypertension. Pulm Circ 2020; 10:2045894020950225. [PMID: 32994924 PMCID: PMC7504864 DOI: 10.1177/2045894020950225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/21/2020] [Indexed: 01/08/2023] Open
Abstract
This study validated a novel virtual echocardiography screening tool (VEST), which utilized routinely reported echocardiography parameters to predict hemodynamic profiles in pulmonary hypertension (PH) and identify PH due to pulmonary vascular disease (PHPVD). Direct echocardiography imaging review has been shown to predict hemodynamic profiles in PH; however, routine use often overemphasizes Doppler-estimated pulmonary artery systolic pressure (PASPDE), which lacks discriminatory power among hemodynamically varied PH subgroups. In patients with PH of varying subtypes at a tertiary referral center, reported echocardiographic findings needed for VEST, including left atrial size, E:e' and systolic interventricular septal flattening, were obtained. Receiver operating characteristic analyses assessed the predictive performance of VEST vs. PASPDE in identifying PHPVD, which was later confirmed by right heart catheterization. VEST demonstrated far superior discriminatory power than PASPDE in identifying PHPVD. A positive score was 80.0% sensitive and 75.6% specific for PHPVD with an area under the curve of 0.81. PASPDE exhibited poorer discriminatory power with an area under the curve of 0.56. VEST's strong discriminatory ability remained unchanged when validated in a second cohort from another tertiary center. We demonstrated that this novel VEST using three routine parameters that can be easily extracted from standard echocardiographic reports can successfully capture PH patients with a high likelihood of PHPVD. During the Covid-19 pandemic, when right heart catheterization and timely access to experts at accredited PH centers may have limited widespread availability, this may assist physicians to rapidly and remotely evaluate PH patients to ensure timely and appropriate care.
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Affiliation(s)
- Anjali Vaidya
- Department of Medicine, Cardiovascular
Division, Pulmonary Hypertension, Right Heart Failure and CTEPH Program, Temple
University School of Medicine, Philadelphia, PA, USA
| | - Jessica R. Golbus
- Department of Medicine, Cardiovascular
Division, University of Michigan, Ann Arbor, MI, USA
| | - Natasha A. Vedage
- Department of Medicine, Cardiovascular
Division, Pulmonary Hypertension, Right Heart Failure and CTEPH Program, Temple
University School of Medicine, Philadelphia, PA, USA
| | - Jeremy Mazurek
- Department of Medicine, Cardiovascular
Division, Heart Failure and Pulmonary Hypertension Program, Hospital of the
University of Pennsylvania, Philadelphia, PA, USA
| | - Farhan Raza
- Department of Medicine, Cardiovascular
Division, University of Wisconsin, Madison, WI, USA
| | - Paul R. Forfia
- Department of Medicine, Cardiovascular
Division, Pulmonary Hypertension, Right Heart Failure and CTEPH Program, Temple
University School of Medicine, Philadelphia, PA, USA
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37
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Fremed MA, Lytrivi ID, Liberman L, Anderson BR, Barry OM, Choudhury TA, Chrisomalis-Dring S, Ferris A, Glickstein JS, Krishnan U, Levasseur S, Rosenzweig EB, Shah A, Silver ES, Suh S, Turner ME, Weller R, Woo J, Starc TJ. Cardiac workup and monitoring in hospitalised children with COVID- 19. Cardiol Young 2020; 30:907-910. [PMID: 32611457 PMCID: PMC8717675 DOI: 10.1017/s1047951120001778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Approximately, 1.7 million individuals in the United States have been infected with SARS-CoV-2, the virus responsible for the novel coronavirus disease-2019 (COVID-19). This has disproportionately impacted adults, but many children have been infected and hospitalised as well. To date, there is not much information published addressing the cardiac workup and monitoring of children with COVID-19. Here, we share the approach to the cardiac workup and monitoring utilised at a large congenital heart centre in New York City, the epicentre of the COVID-19 pandemic in the United States.
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Affiliation(s)
- Michael A Fremed
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Irene D Lytrivi
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Brett R Anderson
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Oliver M Barry
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Tarif A Choudhury
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Anne Ferris
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Julie S Glickstein
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Usha Krishnan
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Stéphanie Levasseur
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Erika B Rosenzweig
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Amee Shah
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Eric S Silver
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sanghee Suh
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Mariel E Turner
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel Weller
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Joyce Woo
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Thomas J Starc
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
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38
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Qaiser KN, Lane JE, Tonelli AR. Right heart catheterization for pulmonary hypertension during the coronavirus disease 2019 pandemic. Pulm Circ 2020; 10:2045894020948783. [PMID: 32983409 PMCID: PMC7498971 DOI: 10.1177/2045894020948783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/18/2020] [Indexed: 12/21/2022] Open
Abstract
Right heart catheterization is an essential diagnostic modality in the evaluation of pulmonary hypertension. The coronavirus disease 2019 pandemic has resulted in deferral of elective procedures including right heart catheterization. The benefits of proceeding with right heart catheterization, such as further characterization of hemodynamic subtype and severity of pulmonary hypertension, initiation of targeted pulmonary arterial hypertension therapy, as well as further hemodynamic testing, need to be carefully balanced with the risk of potentially exposing both patients and health care personnel to coronavirus disease 2019 infection. This review article aims to provide best clinical practices for safely performing right heart catheterization in pulmonary hypertension patients during the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Kanza N. Qaiser
- Department of Internal Medicine, Cleveland Clinic, Cleveland, USA
| | - James E Lane
- Medical Intensive Care, Nursing Institute, Cleveland Clinic, Cleveland, USA
| | - Adriano R. Tonelli
- Department of Pulmonary, Allergy and Critical
Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, USA
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