COVID-19 from the interdisciplinary standpoint. Round table

Damage to the Cardiovascular System in Patients with SARS-CoV-2 Coronavirus Infection. Part 2: Correction of Myocardial Systolic Dysfunction

Aim. To study changes in myocardial contractile function when prescribing mineralocorticoid receptor antagonists of spironolactone in patients after coronavirus infection SARS-CoV-2 with symptoms of chronic heart failure (CHF).Materials and methods. The study included 90 hospitalized patients with a diagnosis of SARS-CoV-2 coronavirus infection. The inclusion criteria were: age from 18 to 85 years; the presence of CHF with a preserved or mildly reduced left ventricular ejection fraction (LVEF). The patients were randomized into two groups: group I (n=60) included patients who, for 6 months after discharge from the hospital, in addition to standard drug therapy for CHF, took spironolactone at a dose of 25 mg per day; group II (comparison group; n=30) included patients who received standard drug therapy without additional prescription of spironolactone. The study groups were comparable in age, gender, prevalence of hypertension, coronary heart disease, diabetes mellitus, obesity and severity of CHF; the drug therapy given to the patients had no significant differences. Assessment of LV systolic function, exercise tolerance (six-minute walk test, TSW), quality of life (questionnaire EQ-5D-5L) were performed.Results. When repeated echocardiography was performed after 6 months of treatment, there was a significant improvement in LV systolic function in group I patients. In group I, after 6 months of treatment, there was a significant decrease in the proportion of patients with moderately reduced LVEF (from 30 [50%] to 12 [20%]; p<0.001), and a significant increase in the number of patients with preserved LVEF (from 30 [50%] to 48 [80%], p=0.002). In group II, the number of patients with moderately reduced LVEF did not significantly change. After 6 months of treatment, all patients showed an increase in exercise tolerance. During the test with a six-minute walk, group I patients showed an increase in the index from 316.8±63.5 to 432.9±41.3 meters; group II patients from 337.6±42.7 to 407.6±38.9 meters. The values of the six-minute walking test after 6 months of treatment were significantly higher in group I patients when compared with group II patients. When assessing the quality of life using the EQ-5D-5L questionnaire, it was found that at the time of inclusion of patients in the study, all patients noted the presence of any health problems in one or more components. The average indicator of health status, measured by a 100-point visual analog scale, after 6 months was 71.8±9.2 in patients of group I and was significantly higher than the same indicator in group II – 63.7±9.1. There were no adverse events in the study groups during the entire observation period.Conclusion. A significantly more pronounced improvement in systolic and diastolic left ventricle function, as well as quality of life, was found in the group of CHF patients with preserved or moderately reduced LVEF, who received spironolactone for 6 months after the SARS-CoV-2 infection in addition to standard therapy, compared with patients without aldosterone antagonists.

Telehealth consultations in cardio-oncology

Aim. To evaluate the role of a cardiologist in telehealth counseling of cancer patients at the federal oncology center.

Material and methods. This retrospective study was conducted based on the materials of 215 telehealth consultations on cardiooncology, performed in the period from January 2019 to September 2021. Data on referrals to a cardiologist (cardio-oncologist) from various Russian regions and consultants’ answers were analyzed, taking into account the following data: region, sex, age of a patient, cancer type, stage, participation of other consultants, type of cardiovascular disease, the need for additional information and features of treatment  — surgery, chemotherapy, radiation therapy. Risk was stratified based on a checklist including the main risk factors for cardiotoxicity. The recommendations of consultants for monitoring patients, as well as drug therapy prescriptions, were analyzed.

Results. The most common cancer sites in patients referred for telehealth consultations on cardio-oncology were lungs, larynx and trachea, colon and rectum, kidneys and bladder, ovaries and uterus, and stomach. Cardiologists consulted together with oncologists  — surgeons, medical oncologists, as well as anesthesiologists and radiation oncologists. The most common cardiovascular diseases were hypertension  — 80,9% of patients, heart failure  — 60%, arrhythmias — 41,6% and coronary heart disease — 37,7%. From 71 to 80,3%, 15,6-21% and 3,9-7,8% of patients had preserved, mid-range and reduced left ventricular ejection fraction. In 47,6-66,7% of cases, consultants required additional information. Based on risk stratification of cardiotoxicity of anticancer treatment, 118 (81,9%) patients out of 144 were classified as high and very high risk. Most patients were recommended cardioprotective therapy, which most often included angiotensin-converting enzyme inhibitors/angiotensin receptor blockers  — 43,1-53,1%, beta-blockers  — 44,8-58,6%, and statins  — 22,4-38,3%. An algorithm for creating a request for a cardio-oncology telehealth consultation has been developed.

Conclusion. The important role of cardio-oncology telehealth consultations in the work of the federal oncology center is demonstrated. Consulting cardiologists are part of a single multidisciplinary team of specialists and must act taking into account the characteristics of cancer and antitumor therapy prescribed by oncologists.

COVID-19 and cardiovascular comorbidity: novel approaches to reduce mortality

Cardiovascular diseases (CVDs) remain the leading cause of death worldwide and significantly affect patient quality of life and socioeconomic status. Numerous reports consistently demonstrate that CVDs are a major risk factor for severe course of coronavirus disease 2019 (COVID-19), including higher risks of hospitalizations and inpatient mortality. In the context of the current pandemic, managing patients with CVDs requires special attention from doctors. There are now more and more reports of the long-term effects of COVID-19. The long-term effects on cardiovascular system of millions of COVID-19 survivors are currently unknown. The aim of the review was to systematize the accumulated knowledge about the mutual influence of COVID-19 and CVDs. The features of CVD impact on the course and outcomes of COVID-19, as well as the reasons for the worsening of CVD course in patients with COVID-19 are considered. The impact of redistribution of health care resources and large-scale isolation measures on the management of patients with CVDs is discussed. The review also presents the most relevant data on long COVID. Predictors of a long-term disease course were identified for risk stratification in order to timely implement preventive measures and develop an individualized treatment. The authors focused on finding novel approaches to reduce CVD mortality during a pandemic.