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Li Q, Chen Z, Zhou X, Li G, Zhang C, Yang Y. Ferroptosis and multi-organ complications in COVID-19: mechanisms and potential therapies. Front Genet 2023; 14:1187985. [PMID: 37303950 PMCID: PMC10250669 DOI: 10.3389/fgene.2023.1187985] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023] Open
Abstract
COVID-19 is an infectious disease caused by SARS-CoV-2, with respiratory symptoms as primary manifestations. It can progress to severe illness, leading to respiratory failure and multiple organ dysfunction. Recovered patients may experience persistent neurological, respiratory, or cardiovascular symptoms. Mitigating the multi-organ complications of COVID-19 has been highlighted as a crucial part of fighting the epidemic. Ferroptosis is a type of cell death linked to altered iron metabolism, glutathione depletion, glutathione peroxidase 4 (GPX4) inactivation, and increased oxidative stress. Cell death can prevent virus replication, but uncontrolled cell death can also harm the body. COVID-19 patients with multi-organ complications often exhibit factors related to ferroptosis, suggesting a possible connection. Ferroptosis inhibitors can resist SARS-CoV-2 infection from damaging vital organs and potentially reduce COVID-19 complications. In this paper, we outline the molecular mechanisms of ferroptosis and, based on this, discuss multi-organ complications in COVID-19, then explore the potential of ferroptosis inhibitors as a supplementary intervention for COVID-19. This paper will provide a reference for the possible treatment of SARS-CoV-2 infected disease to reduce the severity of COVID-19 and its subsequent impact.
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Affiliation(s)
- Qi Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zeyuan Chen
- Department of Pharmacy, Luxian People’s Hospital, Luzhou, China
| | - Xiaoshi Zhou
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guolin Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Changji Zhang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yong Yang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Jordan-Rios A, Nuzzi V, Bromage DI, McDonagh T, Sinagra G, Cannata A. Reshaping care in the aftermath of the pandemic. Implications for cardiology health systems. Eur J Intern Med 2023; 109:4-11. [PMID: 36462964 PMCID: PMC9709614 DOI: 10.1016/j.ejim.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/12/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022]
Abstract
In the last two years, the COVID-19 pandemic has undeniably changed everyday life and significantly reshaped the healthcare systems. Besides the direct effect on daily care leading to significant excess mortality, several collateral damages have been observed during the pandemic. The impact of the pandemic led to staff shortages, disrupted education, worse healthcare professional well-being, and a lack of proper clinical training and research. In this review we highlight the results of these important changes and how can the healthcare systems can adapt to prevent unprecedented events in case of future catastrophes.
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Affiliation(s)
- Antonio Jordan-Rios
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK
| | - Vincenzo Nuzzi
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Daniel I Bromage
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK
| | - Theresa McDonagh
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Antonio Cannata
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.
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Cesaro A, De Michele G, Gragnano F, Calabrò P. How has COVID-19 impacted the care of patients with acute coronary syndromes? Expert Rev Cardiovasc Ther 2023; 21:1-4. [PMID: 36534926 DOI: 10.1080/14779072.2023.2159809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Division of Cardiology, A.O.R.N. "Sant'Anna E San Sebastiano", Caserta, Italy
| | - Gianantonio De Michele
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Division of Cardiology, A.O.R.N. "Sant'Anna E San Sebastiano", Caserta, Italy
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Division of Cardiology, A.O.R.N. "Sant'Anna E San Sebastiano", Caserta, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Division of Cardiology, A.O.R.N. "Sant'Anna E San Sebastiano", Caserta, Italy
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Galvão Braga C, Araújo Gonçalves P, Cardoso P, Fiarresga A, Santos L, Domingues A, Costa M, Ferreira R, Duarte J, Seixo F, Campante Teles R, Pereira H, Silva JC, Fernandes R, Baptista J, Braga P, Costa J, Farto e Abreu P, Costa Ferreira P, Caires G, Martins D, Sousa P, Brum da Silveira J. Impact of the COVID-19 pandemic on percutaneous coronary interventions in Portugal. Rev Port Cardiol 2023; 42:1-6. [PMID: 36043164 PMCID: PMC9411142 DOI: 10.1016/j.repc.2021.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has imposed an unprecedented burden on healthcare systems worldwide, changing the profile of interventional cardiology activity. OBJECTIVES To quantify and compare the number of percutaneous coronary interventions (PCIs) performed for acute and chronic coronary syndromes during the first COVID-19 outbreak with the corresponding period in previous years. METHODS Data on PCI from the prospective multicenter Portuguese Registry on Interventional Cardiology (RNCI) were used to analyze changes in PCI for ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndromes (NSTE-ACS) and chronic coronary syndromes (CCS). The number of PCIs performed during the initial period of the COVID-19 outbreak in Portugal, from March 1 to May 2, 2020, was compared with the mean frequency of PCIs performed during the corresponding period in the previous three years (2017-2019). RESULTS The total number of PCIs procedures was significantly decreased during the initial COVID-19 outbreak in Portugal (-36%, p<0.001). The reduction in PCI procedures for STEMI, NSTE-ACS and CCS was, respectively, -25% (p<0.019), -20% (p<0.068) and -59% (p<0.001). CONCLUSIONS Compared with the corresponding period in the previous three years, the number of PCI procedures performed for STEMI and CCS decreased markedly during the first wave of the COVID-19 pandemic in Portugal.
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Affiliation(s)
| | | | - Pedro Cardoso
- Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal
| | | | - Lino Santos
- Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Ana Domingues
- Associação Portuguesa de Intervenção Cardiovascular, Lisboa, Portugal
| | - Marco Costa
- Centro Hospitalar e Universitário de Coimbra EPE, Lisboa, Portugal
| | - Rui Ferreira
- Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - José Duarte
- Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal
| | - Filipe Seixo
- Centro Hospitalar de Setúbal EPE, Setúbal, Portugal
| | | | - Hélder Pereira
- Garcia de Orta Hospital: Hospital Garcia de Orta EPE, Almada, Portugal
| | | | | | | | - Pedro Braga
- Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | | | | | | | | | - Dinis Martins
- Hospital do Divino Espírito Santo de Ponta Delgada EPE, Ponta Delgada, Portugal
| | - Paulino Sousa
- Centro Hospitalar de Trás-os-Montes e Alto Douro EPE, Vila Real, Portugal
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Vidal-Perez R, Brandão M, Pazdernik M, Kresoja KP, Carpenito M, Maeda S, Casado-Arroyo R, Muscoli S, Pöss J, Fontes-Carvalho R, Vazquez-Rodriguez JM. Cardiovascular disease and COVID-19, a deadly combination: A review about direct and indirect impact of a pandemic. World J Clin Cases 2022; 10:9556-9572. [PMID: 36186196 PMCID: PMC9516905 DOI: 10.12998/wjcc.v10.i27.9556] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is known to present with respiratory symptoms, which can lead to severe pneumonia and respiratory failure. However, it can have multisystem complications such as cardiovascular manifestations. The cardiovascular manifestations reported comprise myocarditis, cardiogenic shock, arrhythmias, pulmonary embolism, deep vein embolism, acute heart failure, and myocardial infarction. There is also an indirect impact of the pandemic on the management of cardiovascular care that has been shown clearly in multiple publications. In this review, we summarize the deadly relation of COVID-19 with cardiovascular events and the wider impact on several cardiovascular care areas by the pandemic situation
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Affiliation(s)
- Rafael Vidal-Perez
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, Spain
| | - Mariana Brandão
- Department of Cardiology, Centro Hospitalar de Gaia, Gaia 4400-020, Portugal
| | - Michal Pazdernik
- Intensive Care Unit, Department of Cardiology, Institute for Clinical and Experimental Medicine Prague, Prague 14021, Czech Republic
| | | | - Myriam Carpenito
- Unit of Cardiac Sciences, Department of Medicine, Campus Bio-Medico University of Rome, Rome 00128, Italy
| | - Shingo Maeda
- Arrhythmia Advanced Therapy Center, AOI Universal Hospital, Kawasaki 210-0822, Japan
| | - Rubén Casado-Arroyo
- Department of Cardiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels 1070, Belgium
| | - Saverio Muscoli
- Unit of Cardiology, Policlinico Tor Vergata, Rome 00133, Italy
| | - Janine Pöss
- Heart Center Leipzig, University of Leipzig, Leipzig 04289, Germany
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Gaia, Gaia 4400-020, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto 4200-319, Portugal
| | - Jose Manuel Vazquez-Rodriguez
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, Spain
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Barbato E, Dudek D. EAPCI Presidential "criss-cross". EUROINTERVENTION 2022; 18:450-451. [PMID: 35983745 PMCID: PMC10241256 DOI: 10.4244/eij-e-22-00028] [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: 01/13/2023]
Affiliation(s)
- Emanuele Barbato
- Cardiovascular Center Aalst, Aalst, Belgium
- University of Naples Federico II, Naples, Italy
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
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Tsigkou V, Siasos G, Oikonomou E, Bletsa E, Vavuranakis M, Tousoulis D. “Heart failure in COVID-19 patients: Critical care experience”: A letter to the editor. World J Virol 2022; 11:216-220. [PMID: 36159614 PMCID: PMC9372782 DOI: 10.5501/wjv.v11.i4.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/15/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is associated with poor cardiovascular outcomes in patients with heart failure (HF) of all categories of ejection fraction (EF), but mainly in patients with HF with reduced EF. Moreover, cardiac transplant patients exhibit worse cardiovascular prognosis, high mortality, and more admissions to the intensive care unit. In general, COVID-19 seems to de-teriorate the clinical status of HF and favors the development of acute respiratory distress syndrome and multiorgan failure, especially in the presence of cardiovascular comorbidities such as diabetes mellitus, kidney dysfunction, and older age. COVID-19 may induce new-onset HF with complex mechanisms that involve myocardial injury. Indeed, myocardial injury comprises a large category of detrimental effects for the myocardium, such as myocardial infarction type 1 or type 2, Takotsubo cardiomyopathy, microvascular dysfunction and myocarditis, which are not easily distinguished by HF. The pathophysiologic mechanisms mainly involve direct myocardial damage by severe acute respiratory syndrome coronavirus 2, cytokine storm, hypercoagulation, inflammation, and endothelial dysfunction. The proper management of patients with COVID-19 involves careful patient evaluation and ongoing monitoring for complications such as HF.
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Affiliation(s)
- Vasiliki Tsigkou
- Department of Cardiology, ‘Sotiria’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Gerasimos Siasos
- Department of Cardiology, ‘Sotiria’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
- Division of Cardiovascular, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Evangelos Oikonomou
- Department of Cardiology, ‘Sotiria’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Evanthia Bletsa
- Department of Cardiology, ‘Sotiria’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Manolis Vavuranakis
- Department of Cardiology, ‘Sotiria’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Dimitris Tousoulis
- Department of Cardiology, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
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Tang L, Wang ZJ, Hu XQ, Fang ZF, Zheng ZF, Zeng JP, Jiang LP, Ouyang F, Liu CH, Zeng GF, Guo YH, Zhou SH. Impact of the COVID-19 Pandemic on ST-Elevation Myocardial Infarction Management in Hunan Province, China: A Multi-Center Observational Study. Front Cardiovasc Med 2022; 9:851214. [PMID: 35433881 PMCID: PMC9008248 DOI: 10.3389/fcvm.2022.851214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to investigate the impact of the COVID-19 pandemic on ST-segment elevation myocardial infarction (STEMI) care in China. Methods We conducted a multicenter, retrospective cohort study in Hunan province (adjacent to the epidemic center), China. Consecutive patients presenting with STEMI within 12 h of symptom onset and receiving primary percutaneous coronary intervention, pharmaco-invasive strategy and only thrombolytic treatment, were enrolled from January 23, 2020 to April 8, 2020 (COVID-19 era group). The same data were also collected for the equivalent period of 2019 (pre-COVID-19 era group). Results A total of 610 patients with STEMI (COVID-19 era group n = 286, pre-COVID-19 era group n = 324) were included. There was a decline in the number of STEMI admissions by 10.5% and STEMI-related PCI procedures by 12.7% in 2020 compared with the equivalent period of 2019. The key time intervals including time from symptom onset to first medical contact, symptom onset to door, door-to-balloon, symptom onset to balloon and symptom onset to thrombolysis showed no significant difference between these two groups. There were no significant differences for in-hospital death and major adverse cardiovascular events between these two groups. Conclusion During the COVID-19 pandemic outbreak in China, we observed a decline in the number of STEMI admissions and STEMI-related PCI procedures. However, the key quality indicators of STEMI care were not significantly affected. Restructuring health services during the COVID-19 pandemic has not significantly adversely influenced the in-hospital outcomes.
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Affiliation(s)
- Liang Tang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhao-jun Wang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xin-qun Hu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhen-fei Fang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhao-fen Zheng
- Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | | | | | - Fan Ouyang
- Zhuzhou Central Hospital, Zhuzhou, China
| | - Chang-hui Liu
- The First Affiliated Hospital of University of South China, Hengyang, China
| | - Gao-feng Zeng
- The Second Affiliated Hospital of University of South China, Hengyang, China
| | - Yong-hong Guo
- Department of Geriatric, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Yong-hong Guo,
| | - Sheng-hua Zhou
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
- Sheng-hua Zhou,
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Firman D, Mangkuanom AS, Iryuza N, Fahri I, Artha IMJR, Mulia E, Syukri M, Yonas E, Pranata R, Alkatiri AA. Decrease in the Number of Patients Presenting With ST-Segment Elevation Myocardial Infarction Across Catheterization Centers in Indonesia During the Coronavirus Disease 2019 Pandemic. Front Cardiovasc Med 2021; 8:676592. [PMID: 34490361 PMCID: PMC8418056 DOI: 10.3389/fcvm.2021.676592] [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: 03/05/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has become a global problem, put a heavy burden on the health care system, and resulted in many fatalities across the globe. A reduction in the number of cardiac emergencies, especially ST-segment elevation myocardial infarction (STEMI), is observed worldwide. In this study, we aimed to analyze the trends of cases and presentation of STEMI across several cardiac catheterization centers in Indonesia. Method: This retrospective study was performed by combining medical record data from five different hospitals in Indonesia. We compared data from the time period between February to June 2019 with those between February and June 2020. Patients who were diagnosed with STEMI and underwent primary percutaneous coronary intervention (PPCI) procedures were included in the study. Results: There were 41,396 emergency department visits in 2019 compared with 29,542 in 2020. The number of patients with STEMI declined significantly from 338 in 2019 to 190 in 2020. Moreover, the total number of PPCI procedures reduced from 217 in 2019 to 110 in 2020. The proportion of PPCI was not significantly reduced (64.2 vs. 57.9%). The majority of the patients were men, with a mean age of 54 years in 2019 and 55 years in 2020. We observed a significantly longer door-to-balloon time in 2020 than in 2019 (p < 0.001). We also observed a difference in the door-to-balloon time and ischemic time between the two periods. Conclusion: We observed a decline in the number of patients presenting with STEMI to our centers. However, we observed no significant decline in the percentage of PPCI performed across our centers during this pandemic.
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Affiliation(s)
- Doni Firman
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Arwin Saleh Mangkuanom
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Nanda Iryuza
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Ismir Fahri
- Department of Cardiology and Vascular Medicine, Mohammad Yunus General Hospital, Bengkulu, Indonesia
| | - I Made Junior Rina Artha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Indonesia
| | - Erwin Mulia
- Department of Cardiology and Vascular Medicine, Bumi Waras Hospital, Lampung, Indonesia
| | - Muhammad Syukri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Andalas, DR. M. Djamil General Hospital, Padang, Indonesia
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Banten, Indonesia
| | - Amir Aziz Alkatiri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Abstract
Coronavirus disease 2019 (COVID-19) can cause a wide range of cardiovascular diseases, including ST-segment elevation myocardial infarction (STEMI) and STEMI-mimickers (such as myocarditis, Takotsubo cardiomyopathy, among others). We performed a systematic review to summarize the clinical features, management, and outcomes of patients with COVID-19 who had ST-segment elevation. We searched electronic databases from inception to September 30, 2020 for studies that reported clinical data about COVID-19 patients with ST-segment elevation. Differences between patients with and without obstructive coronary artery disease (CAD) on coronary angiography were evaluated. Forty-two studies (35 case reports and seven case series) involving 161 patients were included. The mean age was 62.7 ± 13.6 years and 75% were men. The most frequent symptom was chest pain (78%). Eighty-three percent of patients had obstructive CAD. Patients with non-obstructive CAD had more diffuse ST-segment elevation (13% versus 1%, p = 0.03) and diffuse left ventricular wall-motion abnormality (23% versus 3%, p = 0.02) compared to obstructive CAD. In patients with previous coronary stent (n = 17), the 76% presented with stent thrombosis. In the majority of cases, the main reperfusion strategy was primary percutaneous coronary intervention instead of fibrinolysis. The in-hospital mortality was 30% without difference between patients with (30%) or without (31%) obstructive CAD. Our data suggest that a relatively high proportion of COVID-19 patients with ST-segment elevation had non-obstructive CAD. The prognosis was poor across groups. However, our findings are based on case reports and case series that should be confirmed in future studies.
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Kessler T, Wiebe J, Graf T, Schunkert H, Kastrati A, Sager HB. SARS-CoV-2 Infection in Asymptomatic Patients Hospitalized for Cardiac Emergencies: Implications for Patient Management. Front Cardiovasc Med 2021; 7:599299. [PMID: 33425999 PMCID: PMC7793638 DOI: 10.3389/fcvm.2020.599299] [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: 08/26/2020] [Accepted: 12/01/2020] [Indexed: 12/18/2022] Open
Abstract
Background: The coronavirus disease (COVID-19) pandemic imposed diverse challenges on the health care system. Morbidity and mortality of non-COVID-19 emergencies might also have changed because hospitals may not be able to provide optimal care due to restructured resources and uncertainties how to deal with potentially infected patients. It has been recommended to stratify treatment of cardiovascular emergencies according to cardiovascular risk. However, data on the prevalence of asymptomatic SARS-CoV-2 infection in patients presenting with cardiac emergencies remain scarce. Methods: We retrospectively analyzed patients' data from a tertiary cardiology department between April 15 and May 31, 2020. All patients were screened on admission for COVID-19 symptoms using a questionnaire and body temperature measurements. All hospitalized patients were routinely screened using nasopharyngeal swab testing. Results: In total, we counted 710 urgent and emergency admissions. Nasopharyngeal swab tests were available in 689 (97%) patients, 409 and 280 of which presented as urgent and emergency admissions, respectively. Among 280 emergency admissions, none tested positive for SARS-CoV-2. Conclusion: In cardiac emergency patients which were screened negative for COVID-19 symptoms, the prevalence of SARS-CoV-2 infection in regions with a modest overall prevalence is low. This finding might be helpful to better determine timing of emergency procedures and reasonable usage of protective equipment during the COVID-19 crisis and the future.
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Affiliation(s)
- Thorsten Kessler
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Jens Wiebe
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Tobias Graf
- Universitätsklinikum Schleswig-Holstein, Medizinische Klinik II, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Hendrik B Sager
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
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Banning AP, Sabate M, Valgimigli M. The impact of the COVID-19 pandemic upon patients, staff, and on the future practices of percutaneous coronary intervention. Eur Heart J Suppl 2020; 22:P13-P18. [PMID: 33390864 PMCID: PMC7757716 DOI: 10.1093/eurheartj/suaa171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The COVID pandemic in 2020 had unpredictable consequences on the presentation and management of patients with ischaemic heart disease. Subsequent to these initial responses the impact of the initial pandemic can be reviewed and responses can be considered. It is clear that there are new opportunities for optimising patient management pathways and in particular enhanced use of information technology. Changes in attitudes towards health and perceived risk are evident within both the catheter lab teams and our patient cohorts. Summating both the intellectual and emotional experiences of the pandemic are essential to prepare for either a second wave of COVID 19 or any new pandemic threat in the future.
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Affiliation(s)
- Adrian P Banning
- Department of Cardiology, Oxford University Hospitals, Oxford, Oxfordshire, OX9 3DU, UK
| | - Manel Sabate
- Department of Cardiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marco Valgimigli
- Department of Cardiology, Inselspital Universitätsspital, Bern Freiburgstrasse 4, Bern 3010, Switzerland
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13
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Ortega-Paz L, Capodanno D, Montalescot G, Angiolillo DJ. Coronavirus Disease 2019-Associated Thrombosis and Coagulopathy: Review of the Pathophysiological Characteristics and Implications for Antithrombotic Management. J Am Heart Assoc 2020; 10:e019650. [PMID: 33228447 PMCID: PMC7955431 DOI: 10.1161/jaha.120.019650] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Coronavirus disease 2019 (COVID‐19) is an infectious disease caused by severe acute respiratory syndrome coronavirus‐2, which has posed a significant threat to global health. Although the infection is frequently asymptomatic or associated with mild symptoms, in a small proportion of patients it can produce an intense inflammatory and prothrombotic state that can lead to acute respiratory distress syndrome, multiple organ failure, and death. Angiotensin‐converting enzyme 2, highly expressed in the respiratory system, has been identified as a functional receptor for severe acute respiratory syndrome coronavirus‐2. Notably, angiotensin‐converting enzyme 2 is also expressed in the cardiovascular system, and there are multiple cardiovascular implications of COVID‐19. Cardiovascular risk factors and cardiovascular disease have been associated with severe manifestations and poor prognosis in patients with COVID‐19. More important, patients with COVID‐19 may have thrombotic and coagulation abnormalities, promoting a hypercoagulable state and resulting in an increased rate of thrombotic and thromboembolic events. This review will describe the pathophysiological characteristics of the cardiovascular involvement following infection by severe acute respiratory syndrome coronavirus‐2, with a focus on thrombotic and thromboembolic manifestations and implications for antithrombotic management.
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Affiliation(s)
- Luis Ortega-Paz
- Cardiovascular Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele" University of Catania Catania Italy
| | - Gilles Montalescot
- ACTION Study Group Institut de Cardiologie Assistance Publique - Hôpitaux de Paris Hôpital Pitié-SalpêtrièreUniversity Paris 6INSERM UMRS 1166 Paris France
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14
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Rangé G, Hakim R, Beygui F, Angoulvant D, Marcollet P, Godin M, Deballon R, Bonnet P, Fichaux O, Barbey C, Viallard L, Lesault PF, Durand E, Boiffard E, Dutheil G, Collet JP, Benamer H, Commeau P, Montalescot G, Koning R, Motreff P. Incidence, delays, and outcomes of STEMI during COVID-19 outbreak: Analysis from the France PCI registry. J Am Coll Emerg Physicians Open 2020; 1:1168-1176. [PMID: 33363285 PMCID: PMC7753646 DOI: 10.1002/emp2.12325] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives The aim of this study was to assess the impact of the coronavirus disease 2019 (COVID‐19) outbreak on incidence, delays, and outcomes of ST‐elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) in France. Methods We analyzed all patients undergoing PPCI <24 hours STEMI included in the prospective France PCI registry. The 2 groups were compared on mean monthly number of patients, delays in the pathway care, and in‐hospital major adverse cardiac events (MACE: death, stent thrombosis, myocardial infarction, unplanned coronary revascularization, stroke, and major bleeding). Results From January 15, 2019 to April 14, 2020, 2064 STEMI patients undergoing PPCI were included: 1942 in the prelockdown group and 122 in the lockdown group. Only 2 cases in the lockdown group were positive for COVID‐19. A significant drop (12%) in mean number of STEMI/month was observed in the lockdown group compared with prelockdown (139 vs 122, P < 0.04). A significant increase in “symptom onset to first medical contact” delay was found for patients who presented directly to the emergency department (ED) (238 minutes vs 450 minutes; P = 0.04). There were higher rates of in‐hospital MACE (7.7% vs 12.3%; P = 0.06) and mortality (4.9% vs 8.2%; P = 0.11) in the lockdown group but the differences were not significant. Conclusion According to the multicenter France PCI registry, the COVID‐19 outbreak in France was associated with a significant decline in STEMI undergoing PPCI and longer transfer time for patients who presented directly to the ED. Mortality rates doubled, but the difference was not statistically significant.
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Affiliation(s)
- Grégoire Rangé
- Cardiology department Les hôpitaux de Chartres Chartres France
| | - Radwan Hakim
- Cardiology department Les hôpitaux de Chartres Chartres France
| | - Farzin Beygui
- Cardiology Department Centre Hospitalier Universitaire de Caen Caen France
| | - Denis Angoulvant
- Cardiology Department Centre Hospitalier Universitaire de Tours Tours France
| | - Pierre Marcollet
- Cardiology Department Centre Hospitalier Jacques Coeur Bourges France
| | - Matthieu Godin
- Cardiology Department Clinique Saint-Hilaire Rouen France
| | | | - Philippe Bonnet
- Cardiology Department Centre Hospitalier Le Havre Le Havre France
| | - Olivier Fichaux
- Cardiology Department Centre Hospitalier Régional d'Orléans Orléans France
| | - Christophe Barbey
- Cardiology Department Nouvelle Clinique Tourengelle, Saint-Cyr-sur-Loire France
| | - Louis Viallard
- Cardiology Department Centre Hospitalier Henri Mondor Aurillac France
| | | | - Eric Durand
- Cardiology Department UNIROUEN INSERM U1096 Rouen University Hospital Department of Cardiology Normandie Univ FHU REMOD-VHF Rouen F76000 France
| | - Emmanuel Boiffard
- Cardiology Department Centre Hospitalier Départemental Vendée La Roche-sur-Yon France
| | - Gerard Dutheil
- Cardiology Department Clinique Bergouignan Evreux France
| | | | - Hakim Benamer
- Cardiology Department Clinique de la Roseraie Soissons France
| | | | | | - Rene Koning
- Cardiology Department Clinique Saint-Hilaire Rouen France
| | - Pascal Motreff
- Cardiology Department Centre Hospitalier Universitaire de Clermont-Ferrand Clermont-Ferrand France
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15
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Rashid Hons M, Gale Hons CP, Curzen Hons N, Ludman Hons P, De Belder Hons M, Timmis Hons A, Mohamed Hons MO, Lüscher Hons TF, Hains Hons J, Wu J, Shoaib A, Kontopantelis E, Roebuck C, Denwood T, Deanfield J, Mamas MA. Impact of Coronavirus Disease 2019 Pandemic on the Incidence and Management of Out-of-Hospital Cardiac Arrest in Patients Presenting With Acute Myocardial Infarction in England. J Am Heart Assoc 2020; 9:e018379. [PMID: 33023348 PMCID: PMC7763705 DOI: 10.1161/jaha.120.018379] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Studies have reported significant reduction in acute myocardial infarction-related hospitalizations during the coronavirus disease 2019 (COVID-19) pandemic. However, whether these trends are associated with increased incidence of out-of-hospital cardiac arrest (OHCA) in this population is unknown. Methods and Results Acute myocardial infarction hospitalizations with OHCA during the COVID-19 period (February 1-May 14, 2020) from the Myocardial Ischaemia National Audit Project and British Cardiovascular Intervention Society data sets were analyzed. Temporal trends were assessed using Poisson models with equivalent pre-COVID-19 period (February 1-May 14, 2019) as reference. Acute myocardial infarction hospitalizations during COVID-19 period were reduced by >50% (n=20 310 versus n=9325). OHCA was more prevalent during the COVID-19 period compared with the pre-COVID-19 period (5.6% versus 3.6%), with a 56% increase in the incidence of OHCA (incidence rate ratio, 1.56; 95% CI, 1.39-1.74). Patients experiencing OHCA during COVID-19 period were likely to be older, likely to be women, likely to be of Asian ethnicity, and more likely to present with ST-segment-elevation myocardial infarction. The overall rates of invasive coronary angiography (58.4% versus 71.6%; P<0.001) were significantly lower among the OHCA group during COVID-19 period with increased time to reperfusion (mean, 2.1 versus 1.1 hours; P=0.05) in those with ST-segment-elevation myocardial infarction. The adjusted in-hospital mortality probability increased from 27.7% in February 2020 to 35.8% in May 2020 in the COVID-19 group (P<.001). Conclusions In this national cohort of hospitalized patients with acute myocardial infarction, we observed a significant increase in incidence of OHCA during COVID-19 period paralleled with reduced access to guideline-recommended care and increased in-hospital mortality.
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Affiliation(s)
- Muhammad Rashid Hons
- Keele Cardiovascular Research Group Institute for Prognosis Research School of Primary Care Keele University Newcastle UK.,Department of Cardiology Royal Stoke Hospital Stoke-on-Trent UK
| | - Chris P Gale Hons
- Leeds Institute for Data Analytics University of Leeds Leeds UK.,Leeds Teaching Hospitals NHS Trust Leeds UK.,Leeds Institute for Cardiovascular and Metabolic Medicine University of Leeds Leeds UK
| | - Nick Curzen Hons
- Coronary Research Group University Hospital Southampton and Faculty of Medicine University of Southampton Southampton UK
| | - Peter Ludman Hons
- Department of Cardiology Queen Elizabeth Hospital Birmingham Birmingham UK
| | - Mark De Belder Hons
- National Institute for Cardiovascular Outcomes Research Barts Health NHS Trust London UK
| | | | - Mohamed O Mohamed Hons
- Keele Cardiovascular Research Group Institute for Prognosis Research School of Primary Care Keele University Newcastle UK.,Department of Cardiology Royal Stoke Hospital Stoke-on-Trent UK
| | - Thomas F Lüscher Hons
- Royal Brompton and Harefield Hospitals and Imperial College London UK.,Center for Molecular Cardiology University of Zürich Zürich Switzerland
| | - Julian Hains Hons
- National Institute for Cardiovascular Outcomes Research Barts Health NHS Trust London UK
| | - Jianhua Wu
- Leeds Institute for Data Analytics University of Leeds Leeds UK.,Leeds Teaching Hospitals NHS Trust Leeds UK.,Leeds Institute for Cardiovascular and Metabolic Medicine University of Leeds Leeds UK
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group Institute for Prognosis Research School of Primary Care Keele University Newcastle UK.,Department of Cardiology Royal Stoke Hospital Stoke-on-Trent UK
| | - Evangelos Kontopantelis
- Division of Population Health Health Services Research and Primary Care University of Manchester Manchester UK
| | | | | | - John Deanfield
- Institute of Cardiovascular Sciences University College London London UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group Institute for Prognosis Research School of Primary Care Keele University Newcastle UK.,Department of Cardiology Royal Stoke Hospital Stoke-on-Trent UK.,Department of Medicine Thomas Jefferson University Philadelphia PA
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16
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Affiliation(s)
- Sukhjinder Singh Nijjer
- Cardiology, Chelsea & Westminster NHS Foundation Trust, London, United Kingdom
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ricardo Petraco
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sayan Sen
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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17
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Greco A, Spagnolo M, Capodanno D. Unmasking psychological reasons of delay in acute coronary syndromes presentation during the COVID-19 pandemic. Catheter Cardiovasc Interv 2020; 98:407-408. [PMID: 32583925 PMCID: PMC7361224 DOI: 10.1002/ccd.29103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/07/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Antonio Greco
- C.A.S.T., A.O.U. "Policlinico-Vittorio Emanuele"-University of Catania, Catania, Italy
| | - Marco Spagnolo
- C.A.S.T., A.O.U. "Policlinico-Vittorio Emanuele"-University of Catania, Catania, Italy
| | - Davide Capodanno
- C.A.S.T., A.O.U. "Policlinico-Vittorio Emanuele"-University of Catania, Catania, Italy
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18
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Montone RA, Iannaccone G, Meucci MC, Gurgoglione F, Niccoli G. Myocardial and Microvascular Injury Due to Coronavirus Disease 2019. Eur Cardiol 2020; 15:e52. [PMID: 32617121 PMCID: PMC7325215 DOI: 10.15420/ecr.2020.22] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/30/2020] [Indexed: 12/15/2022] Open
Abstract
Over the past few months, health systems worldwide have been put to the test with the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Even though the leading clinical manifestations of the SARS-CoV-2 infection involve the respiratory tract, there is a non-negligible risk of systemic involvement leading to the onset of multi-organ failure with fatal consequences. Since the onset of COVID-19, patients with underlying cardiovascular disease have been at increased risk of poor clinical outcomes with higher death rates. Moreover, the occurrence of new-onset cardiac complications is not uncommon among patients hospitalised for COVID-19. Of importance, a significant portion of COVID-19 patients present with myocardial injury. Herein, the authors discuss the mechanisms leading to myocardial and microvascular injury in SARS-CoV-2 infection and their clinical implications.
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Affiliation(s)
- Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Giulia Iannaccone
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
| | - Maria Chiara Meucci
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
| | - Filippo Gurgoglione
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
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