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Mohammed Y, Tran K, Carlsten C, Ryerson C, Wong A, Lee T, Cheng MP, Vinh DC, Lee TC, Winston BW, Sweet D, Boyd JH, Walley KR, Haljan G, McGeer A, Lamontagne F, Fowler R, Maslove D, Singer J, Patrick DM, Marshall JC, Murthy S, Jain F, Borchers CH, Goodlett DR, Levin A, Russell JA. Proteomic Evolution from Acute to Post-COVID-19 Conditions. J Proteome Res 2024; 23:52-70. [PMID: 38048423 PMCID: PMC10775146 DOI: 10.1021/acs.jproteome.3c00324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023]
Abstract
Many COVID-19 survivors have post-COVID-19 conditions, and females are at a higher risk. We sought to determine (1) how protein levels change from acute to post-COVID-19 conditions, (2) whether females have a plasma protein signature different from that of males, and (3) which biological pathways are associated with COVID-19 when compared to restrictive lung disease. We measured protein levels in 74 patients on the day of admission and at 3 and 6 months after diagnosis. We determined protein concentrations by multiple reaction monitoring (MRM) using a panel of 269 heavy-labeled peptides. The predicted forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO) were measured by routine pulmonary function testing. Proteins associated with six key lipid-related pathways increased from admission to 3 and 6 months; conversely, proteins related to innate immune responses and vasoconstriction-related proteins decreased. Multiple biological functions were regulated differentially between females and males. Concentrations of eight proteins were associated with FVC, %, and they together had c-statistics of 0.751 (CI:0.732-0.779); similarly, concentrations of five proteins had c-statistics of 0.707 (CI:0.676-0.737) for DLCO, %. Lipid biology may drive evolution from acute to post-COVID-19 conditions, while activation of innate immunity and vascular regulation pathways decreased over that period. (ProteomeXchange identifiers: PXD041762, PXD029437).
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Affiliation(s)
- Yassene Mohammed
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center, Leiden 2333 ZA, The Netherlands
- UVic-Genome
BC Proteomics Centre, University of Victoria, Victoria V8Z 5N3, BC Canada
- Gerald
Bronfman Department of Oncology, McGill
University, Montreal, QC H3A 0G4, Canada
| | - Karen Tran
- Division
of General Internal Medicine, Vancouver
General Hospital and University of British Columbia, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - Chris Carlsten
- Division
of Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Christopher Ryerson
- Division
of Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Alyson Wong
- Division
of Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Terry Lee
- Centre for
Health Evaluation and Outcome Science (CHEOS), St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Matthew P. Cheng
- Division
of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, PQ H4A 3J1, Canada
| | - Donald C. Vinh
- Division
of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, PQ H4A 3J1, Canada
| | - Todd C. Lee
- Division
of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, PQ H4A 3J1, Canada
| | - Brent W. Winston
- Departments
of Critical Care Medicine, Medicine and Biochemistry and Molecular
Biology, Foothills Medical Centre and University
of Calgary, 1403 29 Street
NW, Calgary, Alberta T2N 4N1, Canada
| | - David Sweet
- Division
of Critical Care Medicine, Vancouver General
Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - John H. Boyd
- Centre
for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Keith R. Walley
- Centre
for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Greg Haljan
- Department of Medicine, Surrey Memorial
Hospital, 13750 96th
Avenue, Surrey, BC V3V 1Z2, Canada
| | - Allison McGeer
- Mt. Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada
| | | | - Robert Fowler
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - David Maslove
- Department
of Critical Care, Kingston General Hospital
and Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7, Canada
| | - Joel Singer
- Centre for
Health Evaluation and Outcome Science (CHEOS), St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - David M. Patrick
- British Columbia Centre for Disease Control
(BCCDC) and University
of British Columbia, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - John C. Marshall
- Department of Surgery, St. Michael’s
Hospital, 30 Bond Street, Toronto, ON M5B
1W8, Canada
| | - Srinivas Murthy
- BC Children’s Hospital and University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Fagun Jain
- Black Tusk Research Group, Vancouver, BC V6Z 2C7, Canada
| | - Christoph H. Borchers
- Segal Cancer Proteomics, Centre, Lady Davis
Institute
for Medical Research, McGill University, Montreal, QC H3T 1E2, Canada
- Gerald Bronfman Department of Oncology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Division of Experimental Medicine, McGill
University, Montreal, QC H3T 1E2, Canada
- Department of Pathology, McGill
University, Montreal, QC H3T 1E2, Canada
| | - David R. Goodlett
- UVic-Genome
BC Proteomics Centre, University of Victoria, Victoria V8Z 5N3, BC Canada
| | - Adeera Levin
- Division of Nephrology, St.
Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - James A. Russell
- Centre
for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - ARBs CORONA I Consortium
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center, Leiden 2333 ZA, The Netherlands
- UVic-Genome
BC Proteomics Centre, University of Victoria, Victoria V8Z 5N3, BC Canada
- Gerald
Bronfman Department of Oncology, McGill
University, Montreal, QC H3A 0G4, Canada
- Division
of General Internal Medicine, Vancouver
General Hospital and University of British Columbia, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
- Division
of Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Centre for
Health Evaluation and Outcome Science (CHEOS), St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division
of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, PQ H4A 3J1, Canada
- Departments
of Critical Care Medicine, Medicine and Biochemistry and Molecular
Biology, Foothills Medical Centre and University
of Calgary, 1403 29 Street
NW, Calgary, Alberta T2N 4N1, Canada
- Division
of Critical Care Medicine, Vancouver General
Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
- Centre
for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Department of Medicine, Surrey Memorial
Hospital, 13750 96th
Avenue, Surrey, BC V3V 1Z2, Canada
- Mt. Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- University of Sherbrooke, Sherbrooke, PQ J1K 2R1, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
- Department
of Critical Care, Kingston General Hospital
and Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7, Canada
- British Columbia Centre for Disease Control
(BCCDC) and University
of British Columbia, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
- Department of Surgery, St. Michael’s
Hospital, 30 Bond Street, Toronto, ON M5B
1W8, Canada
- BC Children’s Hospital and University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
- Black Tusk Research Group, Vancouver, BC V6Z 2C7, Canada
- Segal Cancer Proteomics, Centre, Lady Davis
Institute
for Medical Research, McGill University, Montreal, QC H3T 1E2, Canada
- Gerald Bronfman Department of Oncology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Division of Experimental Medicine, McGill
University, Montreal, QC H3T 1E2, Canada
- Department of Pathology, McGill
University, Montreal, QC H3T 1E2, Canada
- Division of Nephrology, St.
Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Pietraszko P, Zorawski M, Bielecka E, Sielatycki P, Zbroch E. Mid-Regional Proadrenomedullin in COVID-19-May It Act as a Predictor of Prolonged Cardiovascular Complications? Int J Mol Sci 2023; 24:16821. [PMID: 38069140 PMCID: PMC10705931 DOI: 10.3390/ijms242316821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
The rising prevalence of cardiovascular disease (CVD) and the impact of the SARS-CoV-2 pandemic have both led to increased mortality rates, affecting public health and the global economy. Therefore, it is essential to find accessible, non-invasive prognostic markers capable of identifying patients at high risk. One encouraging avenue of exploration is the potential of mid-regional proadrenomedullin (MR-proADM) as a biomarker in various health conditions, especially in the context of CVD and COVID-19. MR-proADM presents the ability to predict mortality, heart failure, and adverse outcomes in CVD, offering promise for improved risk assessment and treatment strategies. On the other hand, an elevated MR-proADM level is associated with disease severity and cytokine storms in patients with COVID-19, making it a predictive indicator for intensive care unit admissions and mortality rates. Moreover, MR-proADM may have relevance in long COVID, aiding in the risk assessment, triage, and monitoring of individuals at increased risk of developing prolonged cardiac issues. Our review explores the potential of MR-proADM as a predictor of enduring cardiovascular complications following COVID-19 infection.
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Affiliation(s)
| | | | | | | | - Edyta Zbroch
- Department of Internal Medicine and Hypertension, Medical University of Bialystok, 15-089 Bialystok, Poland; (P.P.); (M.Z.); (E.B.); (P.S.)
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Santangelo G, Toriello F, Faggiano A, Henein MY, Carugo S, Faggiano P. Role of cardiac and lung ultrasound in the COVID-19 era. Minerva Cardiol Angiol 2023; 71:387-401. [PMID: 35767237 DOI: 10.23736/s2724-5683.22.06074-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
INTRODUCTION The primary diagnostic method of Coronavirus disease 2019 is reverse transcription polymerase chain reaction of the nucleic acid of severe acute respiratory syndrome coronavirus 2 in nasopharyngeal swabs. There is growing evidence regarding the 2019 coronavirus disease imaging results on chest X-rays and computed tomography but the accessibility to standard diagnostic methods may be limited during the pandemic. EVIDENCE ACQUISITION Databases used for the search were MEDLINE (PubMed), Scopus Search, and Cochrane Library. The research took into consideration studies published in English until March 2022 and was conducted using the following research query: ((((sars cov [MeSH Terms])) OR (COVID-19)) OR (Sars-Cov2)) OR (Coronavirus)) AND (((((2d echocardiography [MeSH Terms]) OR (doppler ultrasound imaging [MeSH Terms]))) OR (echography [MeSH Terms])) OR (LUS)) OR ("LUNG ULTRASOUND")). EVIDENCE SYNTHESIS Pulmonary and cardiac ultrasound are cost-effective, widely available, and provide information that can influence management. CONCLUSIONS Point-of-care ultrasonography is a method that can provide relevant clinical and therapeutic information in patients with COVID-19 where other diagnostic methods may not be easily accessible.
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Affiliation(s)
- Gloria Santangelo
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Filippo Toriello
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Faggiano
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, University of Umea, Umea, Sweden
| | - Stefano Carugo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pompilio Faggiano
- Unit of Cardiovascular Disease, Cardiovascular Department, Poliambulanza Foundation, Brescia, Italy -
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Gryglewska-Wawrzak K, Sakowicz A, Banach M, Bytyçi I, Bielecka-Dabrowa A. Diagnostic Usefulness of Spiroergometry and Risk Factors of Long COVID in Patients with Normal Left Ventricular Ejection Fraction. J Clin Med 2023; 12:4160. [PMID: 37373853 DOI: 10.3390/jcm12124160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic has brought forth various clinical manifestations and long-term complications, including a condition known as long COVID. Long COVID refers to a persistent set of symptoms that continue beyond the acute phase of the disease. This study investigated the risk factors and the utility of spiroergometry parameters for diagnosing patients with long COVID symptoms. The 146 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with normal left ventricular ejection fraction and without respiratory diseases were included and divided into two groups: the group demonstrating long COVID symptoms [n = 44] and the group without long COVID symptoms [n = 102]. The clinical examinations, laboratory test results, echocardiography, non-invasive body mass analysis, and spiroergometry were evaluated. ClinicalTrials.gov Identifier: NCT04828629. Patients with long COVID symptoms had significantly higher age [58 (vs.) 44 years; p < 0.0001], metabolic age [53 vs. 45 years; p = 0.02)], left atrial diameter (LA) [37 vs. 35 mm; p = 0.04], left ventricular mass index (LVMI) [83 vs. 74 g/m2, p = 0.04], left diastolic filling velocity (A) [69 vs. 64 cm/s, p = 0.01], the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion (E/E') [7.35 vs. 6.05; p = 0.01], and a lower ratio of early to late diastolic transmitral flow velocity (E/A) [1.05 vs. 1.31; p = 0.01] compared to the control group. In cardiopulmonary exercise testing (CPET), long COVID patients presented lower forced vital capacity (FVC) [3.6 vs. 4.3 L; p < 0.0001], maximal oxygen consumption measured during incremental exercise indexed per kilogram (VO2max) [21 vs. 23 mL/min/kg; p = 0.04], respiratory exchange ratio (RER) [1.0 vs. 1.1; p = 0.04], forced expiratory volume in one second (FEV1) [2.90 vs. 3.25 L; p = 0.04], and a higher ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC%) [106 vs. 100%; p = 0.0002]. The laboratory results pointed out that patients with long COVID symptoms also had a lower rate of red blood cells (RBC) [4.4 vs. 4.6 × 106/uL; p = 0.01]; a higher level of glucose [92 vs. 90 mg/dL; p = 0.03]; a lower glomerular filtration rate (GFR) estimate by Modification of Diet in Renal Disease (MDRD) [88 vs. 95; p = 0.03]; and a higher level of hypersensitive cardiac Troponin T (hs-cTnT) [6.1 vs. 3.9 pg/mL; p = 0.04]. On the multivariate model, only FEV1/FVC% (OR 6.27, 95% CI: 2.64-14.86; p < 0.001) independently predicted the long COVID symptoms. Using the ROC analysis, the FEV1/FVC% ≥ 103 was the most powerful predictor of spiroergometry parameters (0.67 sensitive, 0.71 specific, AUC of 0.73; p < 0.001) in predicting the symptoms of long COVID. Spiroergometry parameters are useful in diagnosing long COVID and differentiating it from cardiovascular disease.
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Affiliation(s)
- Katarzyna Gryglewska-Wawrzak
- Heart Failure Unit, Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), 93-338 Lodz, Poland
| | - Agata Sakowicz
- Department of Medical Biotechnology, Medical University of Lodz, 90-752 Lodz, Poland
| | - Maciej Banach
- Heart Failure Unit, Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), 93-338 Lodz, Poland
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 93-338 Lodz, Poland
| | - Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo
| | - Agata Bielecka-Dabrowa
- Heart Failure Unit, Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), 93-338 Lodz, Poland
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 93-338 Lodz, Poland
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Boles S, Ashok SR. Pre-assessment and management of long COVID patients requiring elective surgery: challenges and guidance. Perioper Med (Lond) 2023; 12:20. [PMID: 37277879 DOI: 10.1186/s13741-023-00305-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 04/25/2023] [Indexed: 06/07/2023] Open
Abstract
Whilst most patients infected with COVID-19 make a full recovery, around 1 in 33 patients in the UK report ongoing symptoms post-infection, termed 'long COVID'. Studies have demonstrated that infection with early COVID-19 variants increases postoperative mortality and pulmonary complications for around 7 weeks after acute infection. Furthermore, this increased risk persists for those with ongoing symptoms beyond 7 weeks. Patients with long COVID may therefore also be at increased postoperative risk, and despite the significant prevalence of long COVID, there are minimal guidelines on how best to assess and manage these patients perioperatively. Long COVID shares several clinical and pathophysiological similarities with conditions such as myalgic encephalitis/chronic fatigue syndrome and postural tachycardia syndrome; however, there are no current guidelines for the preoperative management of these patients to help develop something similar for long COVID patients. Developing guidelines for long COVID patients is further complicated by its heterogenous presentation and pathology. These patients can have persistent abnormalities on pulmonary function tests and echocardiography 3 months after acute infection, correlating with a reduced functional capacity. Conversely, some long COVID patients can continue to experience symptoms of dyspnoea and fatigue despite normal pulmonary function tests and echocardiography, yet demonstrating significantly reduced aerobic capacity on cardiopulmonary exercise testing even a year after initial infection. How to comprehensively risk assess these patients is therefore challenging. Existing preoperative guidelines for elective patients with recent COVID-19 generally focus on the timing of surgery and recommendations for pre-assessment if surgery is required before this time interval has elapsed. How long to delay surgery in those with ongoing symptoms and how to manage them perioperatively are less clear. We suggest that multidisciplinary decision-making is required for these patients, using a systems-based approach to guide discussion with specialists and the need for further preoperative investigations. However, without a better understanding of the postoperative risks for long COVID patients, it is difficult to obtain a multidisciplinary consensus and obtain informed patient consent. Prospective studies of long COVID patients undergoing elective surgery are urgently required to help quantify their postoperative risk and develop comprehensive perioperative guidelines for this complex patient group.
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Affiliation(s)
- Sophie Boles
- Department of Anaesthesia and Intensive Care Medicine, Croydon University Hospital, Surrey, UK.
| | - Sundar Raj Ashok
- Department of Anaesthesia and Intensive Care Medicine, Croydon University Hospital, Surrey, UK
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Long COVID-19 Syndrome Severity According to Sex, Time from the Onset of the Disease, and Exercise Capacity-The Results of a Cross-Sectional Study. Life (Basel) 2023; 13:life13020508. [PMID: 36836865 PMCID: PMC9961608 DOI: 10.3390/life13020508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Symptoms of long COVID-19 syndrome (long COVID-19) are reported by 80% of convalescents up to several months after contracting the coronavirus-19 disease (COVID-19). The study aimed to assess the frequency and correlations of long COVID symptoms with sex, disease severity, time since the onset of the disease, and exercise capacity in a population of Polish convalescents hospitalized as a part of a rehabilitation program after COVID-19. The retrospective analysis was carried out based on medical records concerning reported symptoms, comorbidities, exercise capacity, fatigue and dyspnea on Borg's scale, arterial oxygen saturation (SpO2), spirometric parameters, chest X-rays/computed tomography scans, systolic pulmonary artery pressure, and left ventricular ejection fraction. The study involved 471 patients aged 63.83 ± 9.93 years who had been hospitalized 191.32 ± 75.69 days from the onset of COVID-19, of which 269 (57.1%) were women. The most common symptoms were fatigue (99.57%), dyspnea (99.36%), and myalgia (97.03%). Women reported more symptoms than men (p < 0.001) and rated their fatigue as more severe (p = 0.021). Patients with depressed moods reported more physical symptoms than others (p < 0.001). Most long COVID symptoms, including dyspnea, fatigue, and depressive symptoms, were found with the same frequency in patients 12-24 weeks and >24 weeks after recovery (p = 0.874, p = 0.400, and p = 0.320, respectively), regardless of acute COVID-19 severity (p = 0.240, p = 0.826, and p = 0.108, respectively). Dyspnea severity correlated with forced vital capacity (FVC) (r = -0.153, p = 0.005), and forced expiratory volume in one second (FEV1) (r = -0.142, p = 0.008). Fatigue severity correlated with impaired FVC and FEV1 (both r = -0.162, p = 0.003). Fatigue and dyspnea inversely correlated with the distance in a six-minute walk test (r = -0.497, p < 0.001, and r = -0.327, p < 0.001). In conclusion, in our cohort, long COVID symptoms are more common in women. Dyspnea/fatigue and depressive symptoms do not tend to subside after an average six-month recovery period. The intensity of perceived fatigue may be exaggerated by the coexistence of neuropsychiatric disorders. Increased fatigue and dyspnea correlate with impaired spirometric parameters and significantly affects convalescents' exercise capacity.
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7
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Altersberger M, Goliasch G, Khafaga M, Schneider M, Cho Y, Winkler R, Funk G, Binder T, Huber G, Zwick R, Genger M. Echocardiography and Lung Ultrasound in Long COVID and Post-COVID Syndrome, a Review Document of the Austrian Society of Pneumology and the Austrian Society of Ultrasound in Medicine. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:269-277. [PMID: 35906952 PMCID: PMC9353420 DOI: 10.1002/jum.16068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 05/08/2023]
Abstract
Lung ultrasound has the potential to enable standardized follow-up without radiation exposure and with lower associated costs in comparison to CT scans. It is a valuable tool to follow up on patients after a COVID-19 infection and evaluate if there is pulmonary fibrosis developing. Echocardiography, including strain imaging, is a proven tool to assess various causes of dyspnea and adds valuable information in the context of long COVID care. Including two-dimensional (2D) strain imaging, a better comprehension of myocardial damage in post-COVID syndrome can be made. Especially 2D strain imaging (left and the right ventricular strain) can provide information about prognosis.
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Affiliation(s)
- Martin Altersberger
- Department of CardiologyNephrology and Intensive Care Medicine, State Hospital SteyrSteyrAustria
| | - Georg Goliasch
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaViennaAustria
| | - Mounir Khafaga
- Rehabilitation Center Hochegg for Cardiovascular and Respiratory DiseasesGrimmensteinAustria
| | - Matthias Schneider
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaViennaAustria
| | - Yerin Cho
- Department of CardiologyNephrology and Intensive Care Medicine, State Hospital SteyrSteyrAustria
| | - Roland Winkler
- Rehabilitation Center Hochegg for Cardiovascular and Respiratory DiseasesGrimmensteinAustria
| | - Georg‐Christian Funk
- Department of Internal Medicine II, Division of PulmonologyHospital OttakringViennaAustria
| | - Thomas Binder
- Medical University of Vienna, Teaching CenterViennaAustria
| | | | - Ralf‐Harun Zwick
- Therme Wien Med—Outpatient Pulmonary RehabilitationViennaAustria
| | - Martin Genger
- Department of CardiologyNephrology and Intensive Care Medicine, State Hospital SteyrSteyrAustria
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8
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Chen H, Peng J, Wang T, Wen J, Chen S, Huang Y, Zhang Y. Counter-regulatory renin-angiotensin system in hypertension: Review and update in the era of COVID-19 pandemic. Biochem Pharmacol 2023; 208:115370. [PMID: 36481346 PMCID: PMC9721294 DOI: 10.1016/j.bcp.2022.115370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease is the major cause of mortality and disability, with hypertension being the most prevalent risk factor. Excessive activation of the renin-angiotensin system (RAS) under pathological conditions, leading to vascular remodeling and inflammation, is closely related to cardiovascular dysfunction. The counter-regulatory axis of the RAS consists of angiotensin-converting enzyme 2 (ACE2), angiotensin (1-7), angiotensin (1-9), alamandine, proto-oncogene Mas receptor, angiotensin II type-2 receptor and Mas-related G protein-coupled receptor member D. Each of these components has been shown to counteract the effects of the overactivated RAS. In this review, we summarize the latest insights into the complexity and interplay of the counter-regulatory RAS axis in hypertension, highlight the pathophysiological functions of ACE2, a multifunctional molecule linking hypertension and COVID-19, and discuss the function and therapeutic potential of targeting this counter-regulatory RAS axis to prevent and treat hypertension in the context of the current COVID-19 pandemic.
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Affiliation(s)
- Hongyin Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518000, Guangdong, China
| | - Jiangyun Peng
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China,Nanhai Translational Innovation Center of Precision Immunology, Sun Yat-sen Memorial Hospital, Foshan 528200, Guangdong, China
| | - Tengyao Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China,Nanhai Translational Innovation Center of Precision Immunology, Sun Yat-sen Memorial Hospital, Foshan 528200, Guangdong, China
| | - Jielu Wen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China,Nanhai Translational Innovation Center of Precision Immunology, Sun Yat-sen Memorial Hospital, Foshan 528200, Guangdong, China
| | - Sifan Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China,Nanhai Translational Innovation Center of Precision Immunology, Sun Yat-sen Memorial Hospital, Foshan 528200, Guangdong, China
| | - Yu Huang
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, China,Corresponding authors
| | - Yang Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518000, Guangdong, China,Corresponding authors
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9
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Kumar R, Aktay-Cetin Ö, Craddock V, Morales-Cano D, Kosanovic D, Cogolludo A, Perez-Vizcaino F, Avdeev S, Kumar A, Ram AK, Agarwal S, Chakraborty A, Savai R, de Jesus Perez V, Graham BB, Butrous G, Dhillon NK. Potential long-term effects of SARS-CoV-2 infection on the pulmonary vasculature: Multilayered cross-talks in the setting of coinfections and comorbidities. PLoS Pathog 2023; 19:e1011063. [PMID: 36634048 PMCID: PMC9836319 DOI: 10.1371/journal.ppat.1011063] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its sublineages pose a new challenge to healthcare systems worldwide due to its ability to efficiently spread in immunized populations and its resistance to currently available therapies. COVID-19, although targeting primarily the respiratory system, is also now well established that later affects every organ in the body. Most importantly, despite the available therapy and vaccine-elicited protection, the long-term consequences of viral infection in breakthrough and asymptomatic individuals are areas of concern. In the past two years, investigators accumulated evidence on how the virus triggers our immune system and the molecular signals involved in the cross-talk between immune cells and structural cells in the pulmonary vasculature to drive pathological lung complications such as endothelial dysfunction and thrombosis. In the review, we emphasize recent updates on the pathophysiological inflammatory and immune responses associated with SARS-CoV-2 infection and their potential long-term consequences that may consequently lead to the development of pulmonary vascular diseases.
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Affiliation(s)
- Rahul Kumar
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Öznur Aktay-Cetin
- Max Planck Institute for Heart and Lung Research, Member of the German Center for Lung Research (DZL), Member of the Cardio-Pulmonary Institute (CPI), Bad Nauheim, Germany
- Institute for Lung Health (ILH), Justus Liebig University, Giessen, Germany
| | - Vaughn Craddock
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Daniel Morales-Cano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Djuro Kosanovic
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Angel Cogolludo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Ciber Enfermedades Respiratorias (Ciberes), Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
| | - Francisco Perez-Vizcaino
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Ciber Enfermedades Respiratorias (Ciberes), Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
| | - Sergey Avdeev
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ashok Kumar
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Anil Kumar Ram
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Stuti Agarwal
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University Medical Center, California, United States of America
| | - Ananya Chakraborty
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University Medical Center, California, United States of America
| | - Rajkumar Savai
- Max Planck Institute for Heart and Lung Research, Member of the German Center for Lung Research (DZL), Member of the Cardio-Pulmonary Institute (CPI), Bad Nauheim, Germany
- Institute for Lung Health (ILH), Justus Liebig University, Giessen, Germany
- Department of Internal Medicine, Justus Liebig University Giessen, Member of the DZL, Member of CPI, Giessen, Germany
- Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt am Main, Germany
| | - Vinicio de Jesus Perez
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University Medical Center, California, United States of America
| | - Brian B. Graham
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Ghazwan Butrous
- Cardiopulmonary Sciences, University of Kent, Canterbury, United Kingdom
| | - Navneet K. Dhillon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
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10
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Giner-Galvañ V, Asensio-Tomás M, Díez-Herrero D, Wikman-Jorgensen P. Another way to approach post-COVID syndrome. From functionality to the symptoms. Rev Clin Esp 2023; 223:62-64. [PMID: 35821001 PMCID: PMC9270685 DOI: 10.1016/j.rceng.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023]
Affiliation(s)
- V. Giner-Galvañ
- Servicio de Medicina Interna, Hospital Clínico Universitario San Juan, San Juan de Alicante, Alicante, Spain,Departamento de Medicina Clínica, Facultad de Medicina, Universidad Miguel Hernández, Elche, Alicante, Spain,Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain,Corresponding author
| | - M.L. Asensio-Tomás
- Servicio de Medicina Interna, Hospital Clínico Universitario San Juan, San Juan de Alicante, Alicante, Spain,Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain
| | - D. Díez-Herrero
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain,Centro de Salud Cabo de las Huertas, Departamento de Salud de San Juan, San Juan de Alicante, Alicante, Spain
| | - P. Wikman-Jorgensen
- Servicio de Medicina Interna, Hospital Clínico Universitario San Juan, San Juan de Alicante, Alicante, Spain,Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain
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11
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Al-Oraibi A, Naidu JS, Chaka A, Woolf K, B Nellums L, Tarrant C, Pan D, Sze S, Martin CA, Gogoi M, Nazareth J, Pareek M. Prevalence of long COVID-19 among healthcare workers: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e065234. [PMID: 36600349 PMCID: PMC9729843 DOI: 10.1136/bmjopen-2022-065234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION A proportion of those who survive the acute phase of COVID-19 experience prolonged symptoms, commonly known as long COVID-19. Given that healthcare workers (HCWs) face an elevated risk of acute COVID-19 compared with the general population, the global burden of long COVID-19 in HCWs is likely to be large; however, there is limited understanding of the prevalence of long COVID-19 in HCWs, or its symptoms and their clustering. This review will aim to estimate the pooled prevalence and the symptoms of long COVID-19 among HCWs infected with SARS-CoV-2 globally, and investigate differences by country, age, sex, ethnicity, vaccination status and occupation. METHODS AND ANALYSIS A systematic review and meta-analysis will be conducted. Medline (via Ovid), CINAHL (via EBSCO), Embase (via Ovid), PsycINFO (via EBSCO), OpenGrey (grey literature) and medRxiv (preprint server) will be searched from the 31 December 2019 onward. All research studies and preprint articles reporting any primary data on the prevalence and/or the symptoms of long COVID-19 among adult HCWs will be included. Methodological quality will be assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Outcomes are anticipated to be the prevalence of long COVID-19 among HCWs around the world and trajectory of symptoms. Data synthesis will include random-effect meta-analysis for studies reporting prevalence data of long COVID-19 following SARS-CoV-2 infection among HCWs. The results will be presented with a 95% CI as an estimated effect across studies. Heterogeneity will be assessed using I² statistic. Where meta-analysis is inappropriate, a narrative synthesis of the evidence will be conducted. ETHICS AND DISSEMINATION Ethical approval is not needed as data will be obtained from published articles. We will publish our findings in a peer-reviewed journal and disseminate the results of our review at conferences. PROSPERO REGISTRATION NUMBER CRD42022312781.
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Affiliation(s)
- Amani Al-Oraibi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Aasiya Chaka
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Laura B Nellums
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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12
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Coronavirus Disease 2019 (COVID-19). BIOLOGY 2022; 11:biology11081250. [PMID: 36009877 PMCID: PMC9404726 DOI: 10.3390/biology11081250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
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13
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Liu L, Jing H, Wu X, Xiang M, Novakovic VA, Wang S, Shi J. The cross-talk of lung and heart complications in COVID-19: Endothelial cells dysfunction, thrombosis, and treatment. Front Cardiovasc Med 2022; 9:957006. [PMID: 35990983 PMCID: PMC9390946 DOI: 10.3389/fcvm.2022.957006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/11/2022] [Indexed: 01/08/2023] Open
Abstract
The pandemic respiratory illness SARS-CoV-2 has increasingly been shown to be a systemic disease that can also have profound impacts on the cardiovascular system. Although associated cardiopulmonary sequelae can persist after infection, the link between viral infection and these complications remains unclear. There is now a recognized link between endothelial cell dysfunction and thrombosis. Its role in stimulating platelet activation and thrombotic inflammation has been widely reported. However, the procoagulant role of microparticles (MPs) in COVID-19 seems to have been neglected. As membrane vesicles released after cell injury or apoptosis, MPs exert procoagulant activity mainly by exposing phosphatidylserine (PS) on their lipid membranes. It can provide a catalytic surface for the assembly of the prothrombinase complex. Therefore, inhibiting PS externalization is a potential therapeutic strategy. In this paper, we describe the pathophysiological mechanism by which SARS-CoV-2 induces lung and heart complications through injury of endothelial cells, emphasizing the procoagulant effect of MPs and PS, and demonstrate the importance of early antithrombotic therapy. In addition, we will detail the mechanisms underlying hypoxia, another serious pulmonary complication related to SARS-CoV-2-induced endothelial cells injury and discuss the use of oxygen therapy. In the case of SARS-CoV-2 infection, virus invades endothelial cells through direct infection, hypoxia, imbalance of the RAAS, and cytokine storm. These factors cause endothelial cells to release MPs, form MPs storm, and eventually lead to thrombosis. This, in turn, accelerates hypoxia and cytokine storms, forming a positive feedback loop. Given the important role of thrombosis in the disease, early antithrombotic therapy is an important tool for COVID-19. It may maintain normal blood circulation, accelerating the clearance of viruses, waning the formation of MPs storm, and avoiding disease progression.
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Affiliation(s)
- Langjiao Liu
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Haijiao Jing
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Xiaoming Wu
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Mengqi Xiang
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Valerie A. Novakovic
- Department of Research, VA Boston Healthcare System, Harvard Medical School, Boston, MA, United States
| | - Shuye Wang
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
- Shuye Wang
| | - Jialan Shi
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
- Department of Research, VA Boston Healthcare System, Harvard Medical School, Boston, MA, United States
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
- *Correspondence: Jialan Shi ;
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14
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Montani D, Savale L, Noel N, Meyrignac O, Colle R, Gasnier M, Corruble E, Beurnier A, Jutant EM, Pham T, Lecoq AL, Papon JF, Figueiredo S, Harrois A, Humbert M, Monnet X. Post-acute COVID-19 syndrome. Eur Respir Rev 2022; 31:31/163/210185. [PMID: 35264409 PMCID: PMC8924706 DOI: 10.1183/16000617.0185-2021] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/27/2021] [Indexed: 01/08/2023] Open
Abstract
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic that has resulted in millions of deaths and a major strain on health systems worldwide. Medical treatments for COVID-19 (anticoagulants, corticosteroids, anti-inflammatory drugs, oxygenation therapy and ventilation) and vaccination have improved patient outcomes. The majority of patients will recover spontaneously or after acute-phase management, but clinicians are now faced with long-term complications of COVID-19 including a large variety of symptoms, defined as "post-acute COVID-19 syndrome". Most studies have focused on patients hospitalised for severe COVID-19, but acute COVID-19 syndrome is not restricted to these patients and exists in outpatients. Given the diversity of symptoms and the high prevalence of persistent symptoms, the management of these patients requires a multidisciplinary team approach, which will result in the consumption of large amounts of health resources in the coming months. In this review, we discuss the presentation, prevalence, pathophysiology and evolution of respiratory complications and other organ-related injuries associated with post-acute COVID-19 syndrome.
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Affiliation(s)
- David Montani
- Université Paris-Saclay, AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital de Bicêtre, DMU 5 Thorinno, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Laurent Savale
- Université Paris-Saclay, AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital de Bicêtre, DMU 5 Thorinno, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Nicolas Noel
- Université Paris-Saclay, AP-HP, Service de Médecine Interne et Immunologie Clinique, Hôpital de Bicêtre, DMU 7 Endocrinologie-Immunités-Inflammations-Cancer-Urgences, Le Kremlin-Bicêtre, France
| | - Olivier Meyrignac
- Université Paris-Saclay, AP-HP, Service de Radiologie Diagnostique et Interventionnelle, Hôpital de Bicêtre, DMU 14 Smart Imaging, BioMaps, Le Kremlin-Bicêtre, France
| | - Romain Colle
- Université Paris-Saclay, AP-HP, Service de Psychiatrie, Hôpital de Bicêtre, DMU 11 Psychiatrie, Santé Mentale, Addictologie et Nutrition, Équipe MOODS, Inserm U1178, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Le Kremlin-Bicêtre, France
| | - Matthieu Gasnier
- Université Paris-Saclay, AP-HP, Service de Psychiatrie, Hôpital de Bicêtre, DMU 11 Psychiatrie, Santé Mentale, Addictologie et Nutrition, Équipe MOODS, Inserm U1178, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Le Kremlin-Bicêtre, France
| | - Emmanuelle Corruble
- Université Paris-Saclay, AP-HP, Service de Psychiatrie, Hôpital de Bicêtre, DMU 11 Psychiatrie, Santé Mentale, Addictologie et Nutrition, Équipe MOODS, Inserm U1178, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Le Kremlin-Bicêtre, France
| | - Antoine Beurnier
- Université Paris-Saclay, AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital de Bicêtre, DMU 5 Thorinno, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Etienne-Marie Jutant
- Université Paris-Saclay, AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital de Bicêtre, DMU 5 Thorinno, Inserm UMR_S999, Le Kremlin-Bicêtre, France.,Université de Poitiers, CHU de Poitiers, Service de Pneumologie, Inserm CIC 1402, Poitiers, France
| | - Tài Pham
- Université Paris-Saclay, AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Dœur et des Vaisseaux, Inserm UMR_S999, FHU Sepsis, CARMAS, Le Kremlin-Bicêtre, France
| | - Anne-Lise Lecoq
- Université Paris-Saclay, AP-HP, Centre de Recherche Clinique Paris-Saclay, DMU 13 Santé Publique, Information Médicale, Appui à la Recherche Clinique, Le Kremlin-Bicêtre, France
| | - Jean-François Papon
- Université Paris-Saclay, AP-HP, Service d'ORL et de Chirurgie Cervico-faciale, DMU 9 Neurosciences, Inserm U955, E13, CNRS ERL7000, Le Kremlin-Bicêtre, France
| | - Samy Figueiredo
- Université Paris-Saclay, AP-HP, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital de Bicêtre, DMU 12 Anesthésie, Réanimation, Douleur, Le Kremlin-Bicêtre, France
| | - Anatole Harrois
- Université Paris-Saclay, AP-HP, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital de Bicêtre, DMU 12 Anesthésie, Réanimation, Douleur, Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Université Paris-Saclay, AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital de Bicêtre, DMU 5 Thorinno, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- Université Paris-Saclay, AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Dœur et des Vaisseaux, Inserm UMR_S999, FHU Sepsis, CARMAS, Le Kremlin-Bicêtre, France
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15
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Clinical patterns of somatic symptoms in patients suffering from post-acute long COVID: a systematic review. Eur J Clin Microbiol Infect Dis 2022; 41:515-545. [PMID: 35142947 PMCID: PMC8830952 DOI: 10.1007/s10096-022-04417-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/31/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Long COVID-19 may affect patients after hospital discharge. AIMS This study aims to describe the burden of the long-term persistence of clinical symptoms in COVID-19 patients. METHODS We conducted a systematic review by using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. The PubMed and Google Scholar databases were searched for studies that included information on the prevalence of somatic clinical symptoms lasting at least 4 weeks after the onset of a PCR- or serology-confirmed diagnosis of COVID-19. The prevalence of persisting clinical symptoms was assessed and risk factors were described when investigated. Psychological symptoms and cognitive disorders were not evaluated in this study. RESULTS Thirty-seven articles met the inclusion criteria. Eighteen studies involved in-patients only with a duration of follow-up of either less than 12 weeks, 12 weeks to 6 months, or more. In these studies, fatigue (16-64%), dyspnea (15-61%), cough (2-59%), arthralgia (8-55%), and thoracic pain (5-62%) were the most frequent persisting symptoms. In nineteen studies conducted in a majority of out-patients, the persistence of these symptoms was lower and 3% to 74% of patients reported prolonged smell and taste disorders. The main risk factors for persisting symptoms were being female, older, having comorbidities and severity at the acute phase of the disease. CONCLUSION COVID-19 patients should have access to dedicated multidisciplinary healthcare allowing a holistic approach. Effective outpatient care for patients with long-COVID-19 requires coordination across multiple sub-specialties, which can be proposed in specialized post-COVID units.
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16
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Visco V, Vitale C, Rispoli A, Izzo C, Virtuoso N, Ferruzzi GJ, Santopietro M, Melfi A, Rusciano MR, Maglio A, Di Pietro P, Carrizzo A, Galasso G, Vatrella A, Vecchione C, Ciccarelli M. Post-COVID-19 Syndrome: Involvement and Interactions between Respiratory, Cardiovascular and Nervous Systems. J Clin Med 2022; 11:jcm11030524. [PMID: 35159974 PMCID: PMC8836767 DOI: 10.3390/jcm11030524] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023] Open
Abstract
Though the acute effects of SARS-CoV-2 infection have been extensively reported, the long-term effects are less well described. Specifically, while clinicians endure to battle COVID-19, we also need to develop broad strategies to manage post-COVID-19 symptoms and encourage those affected to seek suitable care. This review addresses the possible involvement of the lung, heart and brain in post-viral syndromes and describes suggested management of post-COVID-19 syndrome. Post-COVID-19 respiratory manifestations comprise coughing and shortness of breath. Furthermore, arrhythmias, palpitations, hypotension, increased heart rate, venous thromboembolic diseases, myocarditis and acute heart failure are usual cardiovascular events. Among neurological manifestations, headache, peripheral neuropathy symptoms, memory issues, lack of concentration and sleep disorders are most commonly observed with varying frequencies. Finally, mental health issues affecting mental abilities and mood fluctuations, namely anxiety and depression, are frequently seen. Finally, long COVID is a complex syndrome with protracted heterogeneous symptoms, and patients who experience post-COVID-19 sequelae require personalized treatment as well as ongoing support.
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Affiliation(s)
- Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
| | - Carolina Vitale
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
| | - Antonella Rispoli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
| | - Carmine Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
| | - Nicola Virtuoso
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84081 Salerno, Italy; (N.V.); (A.M.)
| | - Germano Junior Ferruzzi
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
| | - Mario Santopietro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
| | - Americo Melfi
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84081 Salerno, Italy; (N.V.); (A.M.)
| | - Maria Rosaria Rusciano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
| | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
| | - Paola Di Pietro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
- Vascular Physiopathology Unit, IRCCS Neuromed Mediterranean Neurological Institute, 86077 Pozzilli, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
- Vascular Physiopathology Unit, IRCCS Neuromed Mediterranean Neurological Institute, 86077 Pozzilli, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; (V.V.); (C.V.); (A.R.); (C.I.); (G.J.F.); (M.S.); (M.R.R.); (A.M.); (P.D.P.); (A.C.); (G.G.); (A.V.); (C.V.)
- Correspondence: ; Tel.: +39-08996-5021
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17
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Tudoran C, Tudoran M, Cut TG, Lazureanu VE, Oancea C, Marinescu AR, Pescariu SA, Pop GN, Bende F. Evolution of Echocardiographic Abnormalities Identified in Previously Healthy Individuals Recovering from COVID-19. J Pers Med 2022; 12:jpm12010046. [PMID: 35055360 PMCID: PMC8778114 DOI: 10.3390/jpm12010046] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Although the infection with the SARS-CoV-2 virus affects primarily the lungs, it is well known that associated cardiovascular (CV) complications are important contributors to the increased morbidity and mortality of COVID-19. Thus, in some situations, their diagnosis is overlooked, and during recovery, some patients continue to have symptoms enclosed now in the post-acute COVID-19 syndrome. (2) Methods: In 102 patients, under 55 years old, and without a history of CV diseases, all diagnosed with post-acute COVID-19 syndrome, we assessed by transthoracic echocardiography (TTE) four patterns of abnormalities frequently overlapping each other. Their evolution was followed at 3 and 6 months. (3) Results: In 35 subjects, we assessed impaired left ventricular function (LVF), in 51 increased systolic pulmonary artery pressure, in 66 diastolic dysfunction (DD) with normal LVF, and in 23 pericardial effusion/thickening. All TTE alterations alleviated during the follow-up, the best evolution being observed in patients with pericarditis, and a considerably worse one in those with DD, thus with a reduction in severity (4) Conclusions: In patients with post-acute COVID-19 syndrome, several cardiac abnormalities may be assessed by TTE, most of them alleviating in time. Some of them, especially DD, may persist, raising the presumption of chronic alterations.
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Affiliation(s)
- Cristina Tudoran
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (C.T.); (M.T.); (F.B.)
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- County Emergency Hospital, Liviu Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
| | - Mariana Tudoran
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (C.T.); (M.T.); (F.B.)
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- County Emergency Hospital, Liviu Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
- Correspondence: (M.T.); (T.G.C.); Tel.: +40-722310302 (M.T.)
| | - Talida Georgiana Cut
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (C.O.); (A.R.M.)
- Doctoral School, Victor Baes university of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Correspondence: (M.T.); (T.G.C.); Tel.: +40-722310302 (M.T.)
| | - Voichita Elena Lazureanu
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (C.O.); (A.R.M.)
| | - Cristian Oancea
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (C.O.); (A.R.M.)
| | - Adelina Raluca Marinescu
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (C.O.); (A.R.M.)
- Doctoral School, Victor Baes university of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Silvius Alexandru Pescariu
- Doctoral School, Victor Baes university of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department VI, Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
| | - Gheorghe Nicusor Pop
- Department VI, Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
| | - Felix Bende
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (C.T.); (M.T.); (F.B.)
- County Emergency Hospital, Liviu Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
- Center of Advanced Research in Gastroenterology and Hepatology, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania
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Silvapulle E, Johnson D, Darvall JN. Risk stratification of individuals undergoing surgery after COVID-19 recovery. Br J Anaesth 2022; 128:e37-e39. [PMID: 34742543 PMCID: PMC8501215 DOI: 10.1016/j.bja.2021.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 01/04/2023] Open
Affiliation(s)
- Earlene Silvapulle
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - Douglas Johnson
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Jai N Darvall
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Critical Care, University of Melbourne, Parkville, VIC, Australia
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19
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Spielmanns M, Buelow MM, Pekacka-Egli AM, Cecon M, Spielmanns S, Windisch W, Hermann M. Clinical and Functional Predictors of Response to a Comprehensive Pulmonary Rehabilitation in Severe Post-COVID-19 Patients. Microorganisms 2021; 9:microorganisms9122452. [PMID: 34946054 PMCID: PMC8708417 DOI: 10.3390/microorganisms9122452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Pulmonary rehabilitation (PR) following severe and very severe COVID-19 infection is known to be effective, according to typical assessments. However, not all patients benefit from PR to the same extent. This analysis aimed to identify the impact of different factors on PR outcomes in post-COVID-19 patients. Methods: This prospective observational study included 184 post-COVID-19 patients. The achievement of the predicted reference walking distance (6 min walking distance (6-MWD)) served as a parameter with which to identify responders and non-responders to PR. Several parameters (e.g., Functional Independent Measurement (FIM); pulmonary function testing (Forced Vital Capacity, FVC); 6MWD) were assessed in order to estimate their impact on PR success. Logistic regression models and classification and regression trees were used for multivariate analysis. Results: A total of 94 patients (51%) reached their reference 6MWD by the end of PR. FVC (0.95 (0.93–0.97)), 6MWD at admission (0.99 (0.99–1.00)), and FIM motoric (0.96 (0.93–0.99)) correlated with the risk not reaching the reference distance. The most important variable was the 6MWD at admission. Classification and regression tree identified 6MWD ≥ 130 m at admission and FVC predicted of >83% as the strongest predictor for reaching predicted 6-MWD. Conclusion: Post-COVID-19 patients with lower 6MWD, lower motoric FIM scores and lower FVC at admission have a high risk of not reaching their target values of physical performance despite intensive rehabilitation. As well as identifying them, it is of utmost importance to develop optimal PR concepts for these patients.
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Affiliation(s)
- Marc Spielmanns
- Pulmonary Medicine and Sleep Medicine Center, Zurich RehaCenter Klinik Wald, CH-8636 Wald, Switzerland; (M.M.B.); (A.M.P.-E.); (M.C.); (S.S.)
- Department of Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, D-58455 Witten, Germany;
- Correspondence: ; Tel.: +41-55-256-6111
| | - Melissa Masha Buelow
- Pulmonary Medicine and Sleep Medicine Center, Zurich RehaCenter Klinik Wald, CH-8636 Wald, Switzerland; (M.M.B.); (A.M.P.-E.); (M.C.); (S.S.)
- Department of Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, D-58455 Witten, Germany;
| | - Anna Maria Pekacka-Egli
- Pulmonary Medicine and Sleep Medicine Center, Zurich RehaCenter Klinik Wald, CH-8636 Wald, Switzerland; (M.M.B.); (A.M.P.-E.); (M.C.); (S.S.)
- Neurological Rehabilitation, Zurich RehaCenter Klinik Wald, CH-8636 Wald, Switzerland
| | - Mikis Cecon
- Pulmonary Medicine and Sleep Medicine Center, Zurich RehaCenter Klinik Wald, CH-8636 Wald, Switzerland; (M.M.B.); (A.M.P.-E.); (M.C.); (S.S.)
| | - Sabine Spielmanns
- Pulmonary Medicine and Sleep Medicine Center, Zurich RehaCenter Klinik Wald, CH-8636 Wald, Switzerland; (M.M.B.); (A.M.P.-E.); (M.C.); (S.S.)
| | - Wolfram Windisch
- Department of Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, D-58455 Witten, Germany;
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Koeln GmbH, D-51109 Koeln, Germany
| | - Matthias Hermann
- Department of Cardiology, University Heart Centre, University Hospital Zurich, CH-8006 Zurich, Switzerland;
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20
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Tudoran C, Tudoran M, Lazureanu VE, Marinescu AR, Cut TG, Oancea C, Pescariu SA, Pop GN. Factors Influencing the Evolution of Pulmonary Hypertension in Previously Healthy Subjects Recovering from a SARS-CoV-2 Infection. J Clin Med 2021; 10:jcm10225272. [PMID: 34830554 PMCID: PMC8625017 DOI: 10.3390/jcm10225272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 01/10/2023] Open
Abstract
(1) Background: While the COVID-19 pandemic has been persisting for almost 2 years, more and more people are diagnosed with residual complications such as pulmonary hypertension (PH) and right ventricular dysfunction (RVD). This study aims to evaluate the course of PH and borderline PH (BPH) at 3 and 6 months after the acute COVID-19 infection and investigate if there are differences regarding its evolution between the patients from the first three waves of this disease. (2) Methods: We analyzed, by transthoracic echocardiography (TTE), the 3 and 6 months' evolution of the echocardiographically estimated systolic pulmonary artery pressures (esPAP) in 116 patients already diagnosed with PH or BPH due to COVID-19 during the first three subsequent waves of COVID-19. (3) Results: We documented a gradual, statistically significant reduction in esPAP values, but also an improvement of the parameters characterizing RVD after 3 and 6 months (p < 0.001). This evolution was somewhat different between subjects infected with different viral strains and was related to the initial severity of the pulmonary injury and PH (adjusted R2 = 0.722, p < 0.001). (4) Conclusions: PH and RVD alleviate gradually during the recovery after COVID-19, but in some cases, they persist, suggesting the activation of pathophysiological mechanisms responsible for the self-propagation of PH.
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Affiliation(s)
- Cristina Tudoran
- Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Cardiology Clinic, County Emergency Hospital “Pius Brinzeu”, L. Rebreanu Str., Nr. 156, 300723 Timisoara, Romania
| | - Mariana Tudoran
- Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Cardiology Clinic, County Emergency Hospital “Pius Brinzeu”, L. Rebreanu Str., Nr. 156, 300723 Timisoara, Romania
- Correspondence: or ; Tel.: +40-722310302
| | - Voichita Elena Lazureanu
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (A.R.M.); (T.G.C.); (C.O.)
| | - Adelina Raluca Marinescu
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (A.R.M.); (T.G.C.); (C.O.)
| | - Talida Georgiana Cut
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (A.R.M.); (T.G.C.); (C.O.)
| | - Cristian Oancea
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (A.R.M.); (T.G.C.); (C.O.)
| | - Silvius Alexandru Pescariu
- Department VI, Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (S.A.P.); (G.N.P.)
| | - Gheorghe Nicusor Pop
- Department VI, Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (S.A.P.); (G.N.P.)
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21
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Kopanczyk R, Kumar N, Papadimos T. Post-Acute COVID-19 Syndrome for Anesthesiologists: A Narrative Review and a Pragmatic Approach to Clinical Care. J Cardiothorac Vasc Anesth 2021; 36:2727-2737. [PMID: 34688543 PMCID: PMC8487462 DOI: 10.1053/j.jvca.2021.09.051] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 02/07/2023]
Abstract
Post-acute coronavirus disease 2019 (COVID-19) syndrome is a novel, poorly understood clinical entity with life-impacting ramifications. Patients with this syndrome, also known as "COVID-19 long-haulers," often present with nonspecific ailments involving more than one body system. The most common complaints include dyspnea, fatigue, brain fog, and chest pain. There currently is no single agreed-upon definition for post-acute COVID-19 syndrome, but most agree that criterion for this syndrome is the persistence of mental and physical health consequences after initial infection. Given the millions of acute infections in the United States over the course of the pandemic, perioperative providers will encounter these patients in clinical practice in growing numbers. Symptoms of the COVID-19 long-haulers should not be minimized, as these patients are at higher risk for postoperative respiratory complications and perioperative mortality for up to seven weeks after initial illness. Instead, a cautious multidisciplinary preoperative evaluation should be performed. Perioperative care should be viewed through the prism of best practices already in use, such as avoidance of benzodiazepines in patients with cognitive impairment and use of lung-protective ventilation. Recommendations especially relevant to the COVID-19 long-haulers include assessment of critical care myopathies and neuropathies to determine suitable neuromuscular blocking agents and reversal, preoperative workup of insidious cardiac or pulmonary pathologies in previously healthy patients, and, thorough medication review, particularly of anticoagulation regimens and chronic steroid use. In this article, the authors define the syndrome, synthesize the available scientific evidence, and make pragmatic suggestions regarding the perioperative clinical care of COVID-19 long-haulers.
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Affiliation(s)
- Rafal Kopanczyk
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Nicolas Kumar
- The Ohio State University College of Medicine, Columbus, OH
| | - Thomas Papadimos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
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