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Kell DB, Lip GYH, Pretorius E. Fibrinaloid Microclots and Atrial Fibrillation. Biomedicines 2024; 12:891. [PMID: 38672245 PMCID: PMC11048249 DOI: 10.3390/biomedicines12040891] [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: 03/08/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation (AF) is a comorbidity of a variety of other chronic, inflammatory diseases for which fibrinaloid microclots are a known accompaniment (and in some cases, a cause, with a mechanistic basis). Clots are, of course, a well-known consequence of atrial fibrillation. We here ask the question whether the fibrinaloid microclots seen in plasma or serum may in fact also be a cause of (or contributor to) the development of AF. We consider known 'risk factors' for AF, and in particular, exogenous stimuli such as infection and air pollution by particulates, both of which are known to cause AF. The external accompaniments of both bacterial (lipopolysaccharide and lipoteichoic acids) and viral (SARS-CoV-2 spike protein) infections are known to stimulate fibrinaloid microclots when added in vitro, and fibrinaloid microclots, as with other amyloid proteins, can be cytotoxic, both by inducing hypoxia/reperfusion and by other means. Strokes and thromboembolisms are also common consequences of AF. Consequently, taking a systems approach, we review the considerable evidence in detail, which leads us to suggest that it is likely that microclots may well have an aetiological role in the development of AF. This has significant mechanistic and therapeutic implications.
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Affiliation(s)
- Douglas B. Kell
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- The Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Søltofts Plads, Building 220, 2800 Kongens Lyngby, Denmark
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch 7602, South Africa
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool L7 8TX, UK;
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Etheresia Pretorius
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch 7602, South Africa
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Rathore SS, Atulkar A, Remala K, Corrales VV, Farrukh AM, Puar RK, Yao SJN, Ganipineni VDP, Patel N, Thota N, Kumar A, Deshmukh A. A systematic review and meta-analysis of new-onset atrial fibrillation in the context of COVID-19 infection. J Cardiovasc Electrophysiol 2024; 35:478-487. [PMID: 38185923 DOI: 10.1111/jce.16169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
New-onset atrial fibrillation (NOAF) in COVID-19 raises significant clinical and public health issues. This systematic review and meta-analysis aims to compile and analyze the current literature on NOAF in COVID-19 and give a more comprehensive understanding of the prevalence and outcomes of NOAF in COVID-19. A comprehensive literature search was carried out using several databases. The random effect model using inverse variance method and DerSimonian and Laird estimator of Tua2 was used to calculate the pooled prevalence and associated 95% confidence interval (CI). Results for outcome analysis were presented as odds ratios (ORs) with 95% CI and pooled using the Mantel-Haenszel random-effects model. The pooled prevalence of NOAF in COVID-19 was 7.8% (95% CI: 6.54%-9.32%),a pooled estimate from 30 articles (81 929 COVID-19 patients). Furthermore, our analysis reported that COVID-19 patients with NOAF had a higher risk of developing severe disease compared with COVID-19 patients without a history of atrial fibrillation (OR = 4.78, 95% CI: 3.75-6.09) and COVID-19 patients with a history of pre-existing atrial fibrillation (OR = 2.75, 95% CI: 2.10-3.59). Similarly, our analysis also indicated that COVID-19 patients with NOAF had a higher risk of all-cause mortality compared with, COVID-19 patients without a history of atrial fibrillation (OR = 3.83, 95% CI: 2.99-4.92) and COVID-19 patients with a history of pre-existing atrial fibrillation (OR = 2.32, 95% CI: 1.35-3.96). The meta-analysis did not reveal any significant publication bias. The results indicate a strong correlation between NOAF and a higher risk of severe illness and mortality. These results emphasize the importance of careful surveillance, early detection, and customized NOAF management strategies to improve clinical outcomes for COVID-19 patients.
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Affiliation(s)
- Sawai Singh Rathore
- Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Akanksha Atulkar
- Department of Internal Medicine, Global Remote Research Scholars Program, St. Paul, Minnesota, USA
| | - Kavya Remala
- Department of Internal Medicine, Konaseema Institute of Medical Sciences, Amalapuram, Andhra Pradesh, India
| | | | - Ameer Mustafa Farrukh
- Department of Internal Medicine, University of Galway School of Medicine, Galway, Ireland
| | - Ravinderjeet Kaur Puar
- Department of Internal Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sem Josue Nsanh Yao
- Department of Internal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Nirmal Patel
- Department of Internal Medicine, St. George's University School of Medicine, True Blue, Grenada
| | - Naganath Thota
- Department of Internal Medicine, Baptist Memorial Hospital, Memphis, Tennessee, USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Bagnato G, Imbalzano E, Ioppolo C, La Rosa D, Chiappalone M, De Gaetano A, Viapiana V, Irrera N, Nassisi V, Tringali MC, Singh EB, Falcomatà N, Russo V, Neal Roberts W, Di Micco P, Versace AG. Stratification of COVID-19 Patients with Moderate-to-Severe Hypoxemic Respiratory Failure for Response to High-Flow Nasal Cannula: A Retrospective Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:71. [PMID: 38256332 PMCID: PMC10819134 DOI: 10.3390/medicina60010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/12/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: In patients with COVID-19, high-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) are widely applied as initial treatments for moderate-to-severe acute hypoxemic respiratory failure. The aim of the study was to assess which respiratory supports improve 28-day mortality and to identify a predictive index of treatment response. Materials and Methods: This is a single-center retrospective observational study including 159 consecutive adult patients with COVID-19 and moderate-to-severe hypoxemic acute respiratory failure. Results: A total of 159 patients (82 in the CPAP group and 77 in the HFNC group) were included in the study. Mortality within 28 days was significantly lower with HFNC compared to CPAP (16.8% vs. 50%), while ICU admission and tracheal intubation within 28 days were significantly higher with CPAP compared to HFNC treatment (32% vs. 13%). We identified an index for survival in HFNC by including three variables easily available at admission (LDH, age, and respiratory rate) and the PaO2/FiO2 ratio at 48 h. The index showed high discrimination for survival with an AUC of 0.88, a negative predictive value of 86%, and a positive predictive value of 95%. Conclusions: Treatment with HFNC appears to be associated with greater survival and fewer ICU admission than CPAP. LDH, respiratory rate, age, and PaO2/FiO2 at 48 h were independently associated with survival and an index based on these variables allows for the prediction of treatment success and the assessment of patient allocation to the appropriate intensity of care after 48 h. Further research is warranted to determine effects on other outcomes and to assess the performance of the index in larger cohorts.
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Affiliation(s)
- Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Carmelo Ioppolo
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Daniela La Rosa
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Marianna Chiappalone
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Alberta De Gaetano
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Valeria Viapiana
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Veronica Nassisi
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Maria Concetta Tringali
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Emanuele Balwinder Singh
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Nicola Falcomatà
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Vincenzo Russo
- Department of Medical Translational Sciences, Division of Cardiology, Monaldi Hospital, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | | | - Pierpaolo Di Micco
- Emergency Department, Rizzoli Hospital, Health Authority NA2, 80122 Napoli, Italy
| | - Antonio Giovanni Versace
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
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de la Torre Fonseca LM, González Barcala J, Juan-Salvadores P. Clinical characteristics and hospital course of SARS-CoV-2 infected patients with electrocardiographic abnormalities admitted to the ICU. MEDICINA CLINICA (ENGLISH ED.) 2023; 160:364-365. [PMID: 37113114 PMCID: PMC10099147 DOI: 10.1016/j.medcle.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Luis Mariano de la Torre Fonseca
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico-Quirúrgico Comandante Manuel Fajardo, La Habana, Cuba
- Facultad de Ciencias Médicas Manuel Fajardo, Universidad de Ciencias Médicas de la Habana, La Habana, Cuba
| | - Jessica González Barcala
- Unidad de Medicina Interna, Hospital Álvaro Cunqueiro, Vigo, Spain
- Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Pablo Juan-Salvadores
- Unidad de Investigación Cardiovascular, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, SERGAS, Spain
- Grupo de Investigación Cardiovascular, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain
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Orlando L, Bagnato G, Ioppolo C, Franzè MS, Perticone M, Versace AG, Sciacqua A, Russo V, Cicero AFG, De Gaetano A, Dattilo G, Fogacci F, Tringali MC, Di Micco P, Squadrito G, Imbalzano E. Natural Course of COVID-19 and Independent Predictors of Mortality. Biomedicines 2023; 11:939. [PMID: 36979918 PMCID: PMC10046319 DOI: 10.3390/biomedicines11030939] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND During the SARS-CoV-2 pandemic, several biomarkers were shown to be helpful in determining the prognosis of COVID-19 patients. The aim of our study was to evaluate the prognostic value of N-terminal pro-Brain Natriuretic Peptide (NT-pro-BNP) in a cohort of patients with COVID-19. METHODS One-hundred and seven patients admitted to the Covid Hospital of Messina University between June 2022 and January 2023 were enrolled in our study. The demographic, clinical, biochemical, instrumental, and therapeutic parameters were recorded. The primary outcome was in-hospital mortality. A comparison between patients who recovered and were discharged and those who died during the hospitalization was performed. The independent parameters associated with in-hospital death were assessed by multivariable analysis and a stepwise regression logistic model. RESULTS A total of 27 events with an in-hospital mortality rate of 25.2% occurred during our study. Those who died during hospitalization were older, with lower GCS and PaO2/FiO2 ratio, elevated D-dimer values, INR, creatinine values and shorter PT (prothrombin time). They had an increased frequency of diagnosis of heart failure (p < 0.0001) and higher NT-pro-BNP values. A multivariate logistic regression analysis showed that higher NT-pro-BNP values and lower PT and PaO2/FiO2 at admission were independent predictors of mortality during hospitalization. CONCLUSIONS This study shows that NT-pro-BNP levels, PT, and PaO2/FiO2 ratio are independently associated with in-hospital mortality in subjects with COVID-19 pneumonia. Further longitudinal studies are warranted to confirm the results of this study.
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Affiliation(s)
- Luana Orlando
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Carmelo Ioppolo
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Maria Stella Franzè
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | | | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Vincenzo Russo
- Department of Medical Translational Sciences, Division of Cardiology, Monaldi Hospital, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Arrigo Francesco Giuseppe Cicero
- IRCCS Policlinico S. Orsola—Malpighi, Hypertension and Cardiovascular risk Research Center, DIMEC, University of Bologna, 40100 Bologna, Italy
| | - Alberta De Gaetano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Federica Fogacci
- IRCCS Policlinico S. Orsola—Malpighi, Hypertension and Cardiovascular risk Research Center, DIMEC, University of Bologna, 40100 Bologna, Italy
| | - Maria Concetta Tringali
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Pierpaolo Di Micco
- Department of Medicine, PO Santa Maria delle Grazie Pozzuoli, 80100 Naples, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
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Di Micco P. Editorial for the Special Issue "Emergency Medicine and Emergency Room Medical Issues". MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020380. [PMID: 36837581 PMCID: PMC9960557 DOI: 10.3390/medicina59020380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Together with the "law of entropy", two of the main reasons for the risk of burnout among physicians who work in emergency departments around the world are the variety of clinical issues presented by patients and the absence of guidelines for managing most of them [...].
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Affiliation(s)
- Pierpaolo Di Micco
- AFO Medicina, UOC Medicina Interna, P.O. Santa Maria delle Grazie, 80100 Pozzuoli, Italy
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Fir(e)ing the Rhythm. JACC Basic Transl Sci 2023. [DOI: 10.1016/j.jacbts.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Aragona CO, Bagnato G, Tomeo S, Rosa DL, Chiappalone M, Tringali MC, Singh EB, Versace AG. Echocardiography in Coronavirus Disease 2019 Era: A Single Tool for Diagnosis and Prognosis. J Cardiovasc Echogr 2023; 33:10-16. [PMID: 37426709 PMCID: PMC10328134 DOI: 10.4103/jcecho.jcecho_11_23] [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: 02/04/2023] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 07/11/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by multi-organ involvement, including respiratory and cardiac events. Echocardiography is widely considered the first-choice tool for the evaluation of cardiac structures and function because of its reproducibility, feasibility, easy to use at bedside, and for good cost-effectiveness. The aim of our literature review is to define the utility of echocardiography in the prediction of prognosis and mortality in COVID-19 patients with mild to critical respiratory illness, with or without known cardiovascular disease. Moreover, we focused our attention on classical echocardiographic parameters and the use of speckle tracking to predict the evolution of respiratory involvement. Finally, we tried to explore the possible relationship between pulmonary disease and cardiac manifestations.
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Affiliation(s)
- Caterina Oriana Aragona
- Department of Emergency, Unit of Emergency Mecicine, AOU Policlinico “G.Martino”, University of Messina, Messina, Italy
| | - Gianluca Bagnato
- Department of Emergency, Unit of Emergency Mecicine, AOU Policlinico “G.Martino”, University of Messina, Messina, Italy
| | - Simona Tomeo
- Department of Emergency, Unit of Emergency Mecicine, AOU Policlinico “G.Martino”, University of Messina, Messina, Italy
| | - Daniela La Rosa
- Department of Emergency, Unit of Emergency Mecicine, AOU Policlinico “G.Martino”, University of Messina, Messina, Italy
| | - Marianna Chiappalone
- Department of Emergency, Unit of Emergency Mecicine, AOU Policlinico “G.Martino”, University of Messina, Messina, Italy
| | - Maria Concetta Tringali
- Department of Emergency, Unit of Emergency Mecicine, AOU Policlinico “G.Martino”, University of Messina, Messina, Italy
| | - Emanuele Balwinder Singh
- Department of Emergency, Unit of Emergency Mecicine, AOU Policlinico “G.Martino”, University of Messina, Messina, Italy
| | - Antonio Giovanni Versace
- Department of Emergency, Unit of Emergency Mecicine, AOU Policlinico “G.Martino”, University of Messina, Messina, Italy
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de la Torre Fonseca LM, González Barcala J, Juan-Salvadores P. Clinical characteristics and hospital course of SARS-CoV-2 infected patients with electrocardiographic abnormalities admitted to the ICU. Med Clin (Barc) 2022; 160:364-365. [PMID: 36646553 PMCID: PMC9794473 DOI: 10.1016/j.medcli.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Luis Mariano de la Torre Fonseca
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico-Quirúrgico Comandante Manuel Fajardo, La Habana, Cuba; Facultad de Ciencias Médicas Manuel Fajardo, Universidad de Ciencias Médicas de la Habana, La Habana, Cuba.
| | - Jessica González Barcala
- Unidad de Medicina Interna, Hospital Álvaro Cunqueiro, Vigo, España; Complejo Hospitalario Universitario de Vigo, Vigo, España
| | - Pablo Juan-Salvadores
- Unidad de Investigación Cardiovascular, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, SERGAS, España; Grupo de Investigación Cardiovascular, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, España
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Incident Atrial Fibrillation and In-Hospital Mortality in SARS-CoV-2 Patients. Biomedicines 2022; 10:biomedicines10081940. [PMID: 36009487 PMCID: PMC9406191 DOI: 10.3390/biomedicines10081940] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/15/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Among the different cardiovascular (CV) manifestations of the coronavirus disease 2019 (COVID-19), arrhythmia and atrial fibrillation (AF) in particular have recently received special attention. The aims of our study were to estimate the incidence of AF in patients hospitalized for COVID-19, and to evaluate its role as a possible predictor of in-hospital all-cause mortality. (2) Methods: We enrolled 3435 people with SARS-CoV2 infection admitted to three hospitals in Northern Italy from February 2020 to May 2021. We collected data on their clinical history, laboratory tests, pharmacological treatment and intensive care unit (ICU) admission. Incident AF and all-cause in-hospital mortality were considered as outcomes. (3) Results: 145 (4.2%) patients developed AF during hospitalization, with a median time since admission of 3 days (I-III quartile: 0, 12). Patients with incident AF were admitted more frequently to the ICU (39.3 vs. 12.4%, p < 0.001), and more frequently died (37.2 vs. 16.9%, p < 0.001). In the Cox regression model, the significant determinants of incident AF were age (HR: 1.041; 95% CI: 1.022, 1.060 per year), a history of AF (HR: 2.720; 95% CI: 1.508, 4.907), lymphocyte count (HR: 0.584; 95% CI: 0.384, 0.888 per 103/µL), estimated glomerular filtration rate (eGFR, HR: 0.988; 95% CI: 0.980, 0.996 per mL/min) and ICU admission (HR: 5.311; 95% CI: 3.397, 8.302). Incident AF was a predictor of all-cause mortality (HR: 1.405; 95% CI: 1.027, 1.992) along with age (HR: 1.057; 95% CI: 1.047, 1.067), male gender (HR: 1.315; 95% CI: 1.064; 1.626), dementia (HR: 1.373; 95% CI: 1.045, 1.803), lower platelet (HR: 0.997; 95% CI: 0.996, 0.998 per 103/µL) and lymphocyte counts (HR: 0.843; 95% CI: 0.725, 0.982 per 103/µL), C-Reactive protein values (HR: 1.004; 95% CI: 1.003, 1.005 per mg/L), eGFR (HR: 0.990; 95% CI: 0.986, 0.994 per mL/min), and ICU admission (HR: 1.759; 95% CI: 1.292, 2.395). (4) Conclusions: Incident AF is a common complication in COVID-19 patients during hospitalization, and its occurrence strongly predicts in-hospital mortality.
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Vodička S, Zelko E. Differences in Treating Patients with Palpitations at the Primary Healthcare Level Using Telemedical Device Savvy before and during the COVID-19 Pandemic. MICROMACHINES 2022; 13:mi13081176. [PMID: 35893174 PMCID: PMC9330048 DOI: 10.3390/mi13081176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 12/05/2022]
Abstract
Background: Palpitations are one of most common reasons why a patient visits a general practitioner (GP) and is referred to a cardiologist. Coronavirus disease 2019 (COVID-19) has been associated with new-onset arrhythmias, which are difficult to diagnose at the primary healthcare level during pandemic-related lockdown periods. Methods: A total of 151 patients with a complaint of heart rhythm disorder were included from before and during the COVID-19 pandemic, as well as after the start of vaccination, in this cohort retrospective study. We used a telemedical device—namely, a personal electrocardiographic (ECG) sensor called Savvy—to investigate heart rhythm in patients. The primary outcome of the study was to evaluate the number of actual heart rhythm disorder patients and any differences that infection with or vaccination for COVID-19 had on patients handled in a primary healthcare setting. Results: We found a heart rhythm disorder in 8.6% of patients before the COVID-19 pandemic and in 15.2–17.9% of patients during the COVID-19 pandemic, where the difference was statistically significant (p = 0.002). During the COVID-19 pandemic, we found a heart rhythm disorder in almost 50% of patients that had tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) more than one month ago. After the vaccinations started, we also found a heart rhythm disorder in almost 50% of non-vaccinated patients. Conclusions: Using a telemedical approach or remote consultation is a useful method, at the primary healthcare level, for diagnosing and treating patients with palpitations during times of lockdown.
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