1
|
Li P, Shi A, Lu X, Li C, Cai P, Teng C, Wu L, Shu Y, Pan S, Dixon RAF, Liu Q, Wang B. Incidence and Impact of Takotsubo Syndrome in Hospitalized Patients With COVID-19. Tex Heart Inst J 2024; 51:e238309. [PMID: 38708821 DOI: 10.14503/thij-23-8309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Takotsubo syndrome has been reported in patients with COVID-19, although minimal data are available. This investigation assessed the incidence and impact of takotsubo syndrome on patients hospitalized with COVID-19. METHODS A retrospective cohort study was conducted using International Statistical Classification of Diseases, Tenth Revision, codes to identify patients with a primary diagnosis of COVID-19 with or without takotsubo syndrome in the National Inpatient Sample 2020 database. Outcomes between groups were compared after propensity score matching for patient and hospital demographics and comorbidities. RESULTS A total of 211,448 patients with a primary diagnosis of COVID-19 were identified. Of these, 171 (0.08%) had a secondary diagnosis of takotsubo syndrome. Before matching, patients with COVID-19 and takotsubo syndrome, compared with patients without takotsubo syndrome, were older (68.95 vs 64.26 years; P < .001); more likely to be female (64.3% vs 47.2%; P < .001); and more likely to have anxiety (24.6% vs 12.8%; P < .001), depression (17.5% vs 11.4%; P = .02), and chronic obstructive pulmonary disease (24.6% vs 14.7%; P < .001). The takotsubo syndrome group had worse outcomes than the non-takotsubo syndrome group for death (30.4% vs 11.1%), cardiac arrest (7.6% vs 2.1%), cardiogenic shock (12.9% vs 0.4%), length of hospital stay (10.7 vs 7.5 days), and total charges ($152,685 vs $78,468) (all P < .001). After matching and compared with the non-takotsubo syndrome group (n = 508), the takotsubo syndrome group (n = 170) had a higher incidence of inpatient mortality (30% vs 14%; P < .001), cardiac arrest (7.6% vs 2.8%; P = .009), and cardiogenic shock (12.4% vs 0.4%; P < .001); a longer hospital stay (10.7 vs 7.6 days; P < .001); and higher total charges ($152,943 vs $79,523; P < .001). CONCLUSION Takotsubo syndrome is a rare but severe in-hospital complication in patients with COVID-19.
Collapse
Affiliation(s)
- Pengyang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Ao Shi
- Faculty of Medicine, St George's, University of London, London, United Kingdom
| | - Xiaojia Lu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Chenlin Li
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Catherine Teng
- Division of Cardiology, Department of Medicine, University of Texas at San Antonio, San Antonio, Texas
| | - Lingling Wu
- Department of Medicine, Eastern Carolina University Health Medical Center, Greenville, North Carolina
| | - Yuan Shu
- The Second Clinical Medical College of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Su Pan
- Wafic Said Molecular Cardiology Research Laboratory, The Texas Heart Institute, Houston, Texas
| | - Richard A F Dixon
- Wafic Said Molecular Cardiology Research Laboratory, The Texas Heart Institute, Houston, Texas
| | - Qi Liu
- Wafic Said Molecular Cardiology Research Laboratory, The Texas Heart Institute, Houston, Texas
| | - Bin Wang
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| |
Collapse
|
2
|
Kirkpatrick JN, Swaminathan M, Adedipe A, Garcia-Sayan E, Hung J, Kelly N, Kort S, Nagueh S, Poh KK, Sarwal A, Strachan GM, Topilsky Y, West C, Wiener DH. American Society of Echocardiography COVID-19 Statement Update: Lessons Learned and Preparation for Future Pandemics. J Am Soc Echocardiogr 2023; 36:1127-1139. [PMID: 37925190 DOI: 10.1016/j.echo.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The COVID-19 pandemic has evolved since the publication of the initial American Society of Echocardiography (ASE) statements providing guidance to echocardiography laboratories. In light of new developments, the ASE convened a diverse, expert writing group to address the current state of the COVID-19 pandemic and to apply lessons learned to echocardiography laboratory operations in future pandemics. This statement addresses important areas specifically impacted by the current and future pandemics: (1) indications for echocardiography, (2) application of echocardiographic services in a pandemic, (3) infection/transmission mitigation strategies, (4) role of cardiac point-of-care ultrasound/critical care echocardiography, and (5) training in echocardiography.
Collapse
Affiliation(s)
| | | | | | | | - Judy Hung
- Massachusetts General Hospital, Boston, Massachusetts
| | - Noreen Kelly
- Sanger Heart Institute, Charlotte, North Carolina
| | - Smadar Kort
- Stony Brook University Medical Center, Stony Brook, New York
| | | | - Kian Keong Poh
- Department of Cardiology, National University of Singapore, Singapore
| | - Aarti Sarwal
- Wake Forest Baptist Health Center, Winston-Salem, North Carolina
| | - G Monet Strachan
- Division of Cardiology, University of California, San Francisco, California
| | - Yan Topilsky
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Cathy West
- Royal Brompton Hospital, London, United Kingdom
| | - David H Wiener
- Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
3
|
Rosh B, Naoum I, Stein N, Jaffe R, Saliba W. Trends in occurrence of takotsubo syndrome and association with SARS-CoV-2 infection and COVID-19 vaccination. J Cardiovasc Med (Hagerstown) 2023; 24:815-821. [PMID: 37577873 DOI: 10.2459/jcm.0000000000001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
AIMS Takotsubo syndrome (TTS) is a serious heart disease associated with significant morbidity and mortality. TTS has been related to SARS-CoV-2 infection and COVID-19 vaccine; however, the current data are scarce. We aimed to examine the associations between SARS-CoV-2 infection and its vaccine with TTS. METHODS We conducted a nested case-control study in a cohort of 3 237 909 adults from the largest healthcare provider in Israel. Patients were followed from 1 March 2020 until 31 December 2021 for the occurrence of TTS. Ten randomly selected controls were matched to each case of TTS on age, sex, and duration of follow-up. Exposure to SARS-CoV-2 infection and COVID-19 vaccine in the prior 30 days was assessed in cases and controls. RESULTS During the follow-up 144 patients developed TTS and were matched to 1440 controls. The mean age of cases and their matched controls was 71.4 ± 12 years, and 136 (94.4%) of them were women. Conditional logistic regression analysis showed that SARS-CoV-2 infection and COVID-19 vaccine were not associated with an increased risk of TTS; odds ratio (OR) = 2.04 [95% confidence interval (CI), 0.50-8.2] and 0.87 (0.49-1.54), respectively. The absolute number of TTS cases in the prepandemic period (March-December 2018-2019) was 82 in 2018 and 80 in 2019. The number of TTS cases decreased to 56 during the corresponding period of 2020 (first pandemic year) and increased back to 81 in 2022. CONCLUSION No significant association was found between SARS-CoV-2 infection or COVID-19 vaccination and TTS occurrence.
Collapse
Affiliation(s)
- Bar Rosh
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology
| | - Ibrahim Naoum
- Department of Cardiology, Lady Davis Carmel Medical Center
| | - Nili Stein
- Statistics Unit, Lady Davis Carmel Medical Center
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Ronen Jaffe
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology
- Department of Cardiology, Lady Davis Carmel Medical Center
| | - Walid Saliba
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| |
Collapse
|
4
|
Alim S, Shah H, Zahera SM, Rahmatova J, Irfan M, Mahmood Z, Zahra SA. An update on Takotsubo syndrome. J Cardiovasc Med (Hagerstown) 2023; 24:691-699. [PMID: 37577868 DOI: 10.2459/jcm.0000000000001528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
ABSTRACT Takotsubo syndrome (TTS) can be described as an acute, transiently occurring form of heart failure. It typically causes systolic dysfunction of the left ventricle (LV). Perhaps what is of most significance is the reversible nature of TTS, with many patients achieving recovery within a few weeks to months. TTS can be referred to by other names, attributed to its various precipitants, as well as the structural manifestations of the syndrome. Physical and emotional stressors have been identified as the most common of causes, hence the terms 'stress cardiomyopathy' and 'broken heart syndrome'. Precipitants can range from psychological, and hormonal, to molecular mechanisms. The symptoms of TTS can coalesce with other conditions and hence give rise to many differential diagnoses. Most patients present with dyspnoea and chest pain. The latter also presents in acute coronary syndrome (ACS); thus, ACS is a common differential diagnosis for TTS. The coronavirus disease 2019 (COVID-19) pandemic saw a drastic increase in mental health concerns which have persisted beyond this period. Further studies into personality disorders and their potential predisposition to COVID-19 and thus TTS would advance our understanding of the neuropsychiatric triggers of TTS. There is also a need for a single sensitive and specific diagnostic test for TTS as its diagnosis relies on the culmination of clinical presentation, echocardiography, cardiac catheterization, and cardiovascular magnetic resonance imaging (CMR).
Collapse
Affiliation(s)
- Samina Alim
- St George's, University of London Medical School
| | - Halia Shah
- St George's, University of London Medical School
| | | | | | | | | | - Syeda Anum Zahra
- The Hillingdon Hospital NHS Trust
- Imperial College School of Medicine, UK
| |
Collapse
|
5
|
Shoura SJ, Teaima T, Sana MK, Abbasi A, Atluri R, Yilmaz M, Hammo H, Ali L, Kanitsoraphan C, Park DY, Alyousef T. Outcomes in patients with COVID-19 and new onset heart blocks: Insight from the National Inpatient Sample database. World J Cardiol 2023; 15:448-461. [PMID: 37900263 PMCID: PMC10600784 DOI: 10.4330/wjc.v15.i9.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/16/2023] [Accepted: 07/17/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a worldwide health crisis since it first appeared. Numerous studies demonstrated the virus's predilection to cardiomyocytes; however, the effects that COVID-19 has on the cardiac conduction system still need to be fully understood. AIM To analyze the impact that COVID-19 has on the odds of major cardiovascular complications in patients with new onset heart blocks or bundle branch blocks (BBB). METHODS The 2020 National Inpatient Sample (NIS) database was used to identify patients admitted for COVID-19 pneumonia with and without high-degree atrioventricular blocks (HDAVB) and right or left BBB utilizing ICD-10 codes. The patients with pre-existing pacemakers, suggestive of a prior diagnosis of HDAVB or BBB, were excluded from the study. The primary outcome was inpatient mortality. Secondary outcomes included total hospital charges (THC), the length of hospital stay (LOS), and other major cardiac outcomes detailed in the Results section. Univariate and multivariate regression analyses were used to adjust for confounders with Stata version 17. RESULTS A total of 1058815 COVID-19 hospitalizations were identified within the 2020 NIS database, of which 3210 (0.4%) and 17365 (1.6%) patients were newly diagnosed with HDAVB and BBB, respectively. We observed a significantly higher odds of in-hospital mortality, cardiac arrest, cardiogenic shock, sepsis, arrythmias, and acute kidney injury in the COVID-19 and HDAVB group. There was no statistically significant difference in the odds of cerebral infarction or pulmonary embolism. Encounters with COVID-19 pneumonia and newly diagnosed BBB had a higher odds of arrythmias, acute kidney injury, sepsis, need for mechanical ventilation, and cardiogenic shock than those without BBB. However, unlike HDAVB, COVID-19 pneumonia and BBB had no significant impact on mortality compared to patients without BBB. CONCLUSION In conclusion, there is a significantly higher odds of inpatient mortality, cardiac arrest, cardiogenic shock, sepsis, acute kidney injury, supraventricular tachycardia, ventricular tachycardia, THC, and LOS in patients with COVID-19 pneumonia and HDAVB as compared to patients without HDAVB. Likewise, patients with COVID-19 pneumonia in the BBB group similarly have a higher odds of supraventricular tachycardia, atrial fibrillation, atrial flutter, ventricular tachycardia, acute kidney injury, sepsis, need for mechanical ventilation, and cardiogenic shock as compared to those without BBB. Therefore, it is essential for healthcare providers to be aware of the possible worse predicted outcomes that patients with new-onset HDAVB or BBB may experience following SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Sami J Shoura
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Taha Teaima
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Muhammad Khawar Sana
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Ayesha Abbasi
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Ramtej Atluri
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Mahir Yilmaz
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Hasan Hammo
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Laith Ali
- Department of Cardiology, John H. Stroger Jr Hospital of Cook County, Chicago, IL 60612, United States
| | - Chanavuth Kanitsoraphan
- Department of Cardiology, John H. Stroger Jr Hospital of Cook County, Chicago, IL 60612, United States
| | - Dae Yong Park
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Tareq Alyousef
- Department of Cardiology, John H. Stroger Jr Hospital of Cook County, Chicago, IL 60612, United States.
| |
Collapse
|
6
|
Damarlapally N, Desai R, Sawhney A, Verma J, Singh Klair H, Kolli D, Singh Sibia B, Chalasani V, Reddy R, Kolli J, Ogbu I, Gummadi J. Relationship between Cardiovascular Risk Factors and Composite Cardiovascular Outcomes in Patients Hospitalized with Takotsubo Syndrome: A Nationwide Analysis. Med Sci (Basel) 2023; 11:62. [PMID: 37755166 PMCID: PMC10536314 DOI: 10.3390/medsci11030062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
The association of traditional cardiovascular disease (CVD) risk factors with outcomes of Takotsubo syndrome (TTS) is not well-defined. This study examined how modifiable CVD risk factors affect composite cardiovascular outcomes in TTS hospitalizations. TTS admissions were identified using ICD-10 codes and compared for demographics and comorbidities using the 2019 National Inpatient Sample. A multivariable regression examined the association of traditional CVD risk variables with adverse composite cardiovascular outcomes in TTS, controlling for confounders including sociodemographic or hospital-level characteristics and other relevant comorbidities. A total of 16,055 (38.1%) of the 41,855 adult TTS admissions had composite cardiovascular outcomes (TACCO). The TACCO cohort was 81.5% white, 77.3% female, and 72 years old. This group had higher rates of diabetes and peripheral vascular disease (PVD). The results showed that a higher prevalence of diabetes with chronic complications (OR = 1.18) and complicated hypertension (HTN) (OR = 1.1) predicted TACCO, whereas tobacco use disorder (OR = 0.84), hyperlipidemia (OR = 0.76), and uncomplicated HTN (OR = 0.65) (p < 0.001) showed a paradoxical effect with TACCO. TACCO had fewer routine discharges (35.3% vs. 63.4%), longer stays (6 vs. 3 days), and higher median hospital costs (78,309 USD vs. 44,966 USD). This population-based study found that complicated HTN and DM with chronic complications are strongly associated with adverse cardiovascular outcomes in TTS hospitalizations. But still, some risk factors, such as hyperlipidemia and uncomplicated HTN, have counterintuitive effects that require further evaluation. To prevent cardiac events in TTS patients, traditional CVD risk factors must be addressed.
Collapse
Affiliation(s)
- Nanush Damarlapally
- Department of Health Sciences, Houston Community College (Coleman), Houston, TX 77030, USA;
| | - Rupak Desai
- Independent Researcher, Atlanta, GA 30033, USA;
| | - Aanchal Sawhney
- Department of Internal Medicine, Crozer Chester Medical Center, Upland, PA 19015, USA;
| | - Jyoti Verma
- Department of Internal Medicine, North Alabama Medical Center, Florence, AL 35630, USA;
| | | | - Dhanush Kolli
- Department of Medicine, Kasturba Medical College, Manipal 576104, India; (D.K.); (B.S.S.); (V.C.); (R.R.)
| | - Birimroz Singh Sibia
- Department of Medicine, Kasturba Medical College, Manipal 576104, India; (D.K.); (B.S.S.); (V.C.); (R.R.)
| | - Vardhan Chalasani
- Department of Medicine, Kasturba Medical College, Manipal 576104, India; (D.K.); (B.S.S.); (V.C.); (R.R.)
| | - Rasya Reddy
- Department of Medicine, Kasturba Medical College, Manipal 576104, India; (D.K.); (B.S.S.); (V.C.); (R.R.)
| | - Jithin Kolli
- Department of Medicine, Jagadguru Sri Shivarathreeshwara Medical College, Mysore 570015, India;
| | - Ikechukwu Ogbu
- Department of Internal Medicine, Mountainview Hospital Sunrise GME, Las Vegas, NV 89128, USA;
| | - Jyotsna Gummadi
- Department of Medicine, Medstar Franklin Square Medical Center, Baltimore, MD 21237, USA
| |
Collapse
|
7
|
Alonzo A, Di Fusco SA, Castello L, Matteucci A, Spinelli A, Marino G, Aquilani S, Imperoli G, Colivicchi F. Tako-Tsubo syndrome in patients with COVID-19: a single centre retrospective case series. Monaldi Arch Chest Dis 2023. [PMID: 37675931 DOI: 10.4081/monaldi.2023.2675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023] Open
Abstract
Growing evidence shows that COVID-19 is associated with an increase in Tako-Tsubo syndrome (TTS) incidence. We collected data from patients hospitalized in our multidisciplinary COVID-19 department who had a diagnosis of TTS during the second and third wave of the pandemic in Italy. We reported four cases of TTS associated with COVID-19. No patient had any classical trigger for TTS except for COVID-19. Mean age was 72 years (67-81) and all patients had a SARS-CoV-2-related interstitial pneumonia confirmed by computed tomography. Typical apical ballooning and transitory reduction in left ventricle (LV) systolic function with a complete recovery before discharge were observed in all patients. The mean LV ejection fraction (LVEF) at TTS onset was 42% (40-48%). ECG showed ST-segment elevation in two cases, while an evolution with negative T waves and QTc prolongation was observed in all patients. Three patients underwent coronary angiography. Two patients had Alzheimer's disease. The time interval from hospital admission to TTS onset was 4 (2-6) days, and the time interval from COVID-19 symptom onset to TTS diagnosis was 10 (8-12) days. COVID-19 may be a trigger for TTS, though TTS pathophysiology in COVID-19 patients remains unclear, likely due to its multifactorial nature.
Collapse
Affiliation(s)
- Alessandro Alonzo
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
| | | | - Lorenzo Castello
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
| | - Andrea Matteucci
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
| | - Antonella Spinelli
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
| | - Gaetano Marino
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
| | - Stefano Aquilani
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
| | - Giuseppe Imperoli
- Medicine Unit, Emergency Department, San Filippo Neri Hospital, Rome.
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
| |
Collapse
|
8
|
Corcoran E, Hopkins P, Fisher R, Wong A, Rose L. Intensive care nurse-led point of care ultrasound in the assessment and management of the critically ill COVID-19 patient: A single centre case series. Nurs Crit Care 2023; 28:781-788. [PMID: 36575807 PMCID: PMC9880746 DOI: 10.1111/nicc.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/16/2022] [Accepted: 11/28/2022] [Indexed: 12/29/2022]
Abstract
Focused ultrasound can be used to rapidly diagnose COVID-19 disease, assess disease severity, and inform management of COVID-19 and associated pathologies, reducing radiation exposure from other imaging modalities and minimizing spread of infection. Ultrasound examinations performed by trained nurses in the intensive care unit (ICU) enable more patients to receive these assessments. This case series evaluates the use of nurse-led focused cardiac and lung ultrasound for clinical management of ICU patients with COVID-19. We describe common pathophysiological findings and how findings were used to inform clinical decision-making. An ultrasound trained ICU nurse performed Focused Ultrasound in Intensive Care (FUSIC) cardiac and lung scans enabling calculation of a lung severity score on adult ICU patients with a confirmed COVID-19 diagnosis in a single-centre setting. Fifteen scans were performed on 15 patients. Thirteen (87%) patients had normal left ventricular function; 12 (80%) normal right ventricular function. All 15 (100%) scans identified abnormal lung findings including irregular thickened pleura, B-lines, sub-pleural consolidation and hepatization. Worse lung severity scores were correlated with higher Acute Physiology and Chronic Health Evaluation (APACHE II) scores (r = 0.70; p = .003). Of the 15 scans, 10 (67%) identified abnormal pathology contributing to a change in clinical management. This included targeted fluid removal (4, 27%), change in respiratory management (3, 20%) and need for formal echocardiographic assessment (3, 20%). Findings from five (33%) scans required no intervention. This case series demonstrates nurse-led ultrasound could be a useful adjunct in the management of the COVID-19 patient.
Collapse
Affiliation(s)
| | - Phil Hopkins
- Intensive Care Research TeamKing's College HospitalLondonUK
| | - Richard Fisher
- Intensive Care Research TeamKing's College HospitalLondonUK
| | - Adrian Wong
- Intensive Care Research TeamKing's College HospitalLondonUK
| | - Louise Rose
- Intensive Care Research TeamKing's College HospitalLondonUK
| |
Collapse
|
9
|
Liu TH, Chuang MH, Wu JY, Huang PY, Tsai YW, Hsu WH, Lai CC. Effectiveness of oral antiviral agents on long-term cardiovascular risk in nonhospitalized patients with COVID-19: A multicenter matched cohort study. J Med Virol 2023; 95:e28992. [PMID: 37522355 DOI: 10.1002/jmv.28992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/22/2023] [Accepted: 07/15/2023] [Indexed: 08/01/2023]
Abstract
Although a novel oral antiviral agent can improve short-term COVID-19 outcomes, its effects on the long-term outcomes, namely the risk of major adverse cardiovascular events (MACEs), remains unknown. This retrospective cohort study used the TriNetX research network to identify nonhospitalized adult patients with COVID-19 between March 1, 2020, and January 1, 2022. A propensity score matching method was used to form two matched cohorts with and without receiving nirmatrelvir-ritonavir (NMV-r) or molnupiravir. The primary outcome was the incidence of MACEs within a 30-day to 1-year period following a diagnosis of COVID-19. Two cohorts of each 80 888 patients with balanced baseline characteristics were formed using propensity score matching. During the follow-up period, 976 patients in the study group and 1609 patients in the control group developed MACE. Overall, the study group had a significantly lower risk of MACE than the control group (hazard ratio [HR], 0.683; 95% confidence interval: 0.630-0.739). The significantly lower HRs of overall MACEs were consistently observed in most subgroup analyses (age: >41-≤64 years: 0.60 [0.52-0.89]; age: ≥65 years: 0.68 [0.62-0.76]; women: 0.63 [0.57-0.71]; men: 0.62 [0.55-0.70]; vaccinated: 0.74 [0.63-0.88]; unvaccinated: 0.66 [0.60-0.73]; NMV-r; 0.65 [0.59-0.71]; and molnupiravir: 0.75 [0.61-0.92]). In conclusion, novel oral antiviral agents, namely NMV-r and molnupiravir, were effective in reducing long-term MACEs among nonhospitalized patients with COVID-19, particularly when treated with NMV-r or in patients aged ≥40 years. These findings suggest the potential role of novel antiviral agents as a preventive measure to reduce further adverse cardiovascular outcomes.
Collapse
Affiliation(s)
- Ting-Hui Liu
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
| | - Min-Hsiang Chuang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan
| | - Po-Yu Huang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ya-Wen Tsai
- Center of Integrative Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan
| | - Wan-Hsuan Hsu
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Internal Medicine, Chi Mei Medical Center, Division of Hospital Medicine, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| |
Collapse
|
10
|
Barth KE, Spottiswoode N, Hurabielle C, Subbaraj L, Calfee CS, Matthay MA, French S, Connolly A, Hewitt SM, Vannella KM, Barnett C, Langelier CR, Patterson S. Clinical and biological heterogeneity of multisystem inflammatory syndrome in adults following SARS-CoV-2 infection: a case series. Front Med (Lausanne) 2023; 10:1187420. [PMID: 37484839 PMCID: PMC10357379 DOI: 10.3389/fmed.2023.1187420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Importance Multisystem inflammatory syndrome in adults (MIS-A) is a poorly understood complication of SARS-CoV-2 infection with significant morbidity and mortality. Objective Identify clinical, immunological, and histopathologic features of MIS-A to improve understanding of the pathophysiology and approach to treatment. Design Three cases of MIS-A following SARS-CoV-2 infection were clinically identified between October 2021 - March 2022 using the U.S. Centers for Disease Control and Prevention diagnostic criteria. Clinical, laboratory, imaging, and tissue data were assessed. Findings All three patients developed acute onset cardiogenic shock and demonstrated elevated inflammatory biomarkers at the time of hospital admission that resolved over time. One case co-occurred with new onset Type 1 diabetes and sepsis. Retrospective analysis of myocardial tissue from one case identified SARS-CoV-2 RNA. All three patients fully recovered with standard of care interventions plus immunomodulatory therapy that included intravenous immunoglobulin, corticosteroids, and in two cases, anakinra. Conclusion MIS-A is a severe post-acute sequela of COVID-19 characterized by systemic elevation of inflammatory biomarkers. In this series of three cases, we find that although clinical courses and co-existent diseases vary, even severe presentations have potential for full recovery with prompt recognition and treatment. In addition to cardiogenic shock, glucose intolerance, unmasking of autoimmune disease, and sepsis can be features of MIS-A, and SARS-CoV-2 myocarditis can lead to a similar clinical syndrome.
Collapse
Affiliation(s)
- Kaia E. Barth
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Natasha Spottiswoode
- Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, United States
| | - Charlotte Hurabielle
- Division of Rheumatology, University of California, San Francisco, San Francisco, CA, United States
| | - Lakshmi Subbaraj
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | | | - Carolyn S. Calfee
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Michael A. Matthay
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Sarah French
- Division of Rheumatology, University of California, San Francisco, San Francisco, CA, United States
| | - Andrew Connolly
- Department of Pathology, University of California, San Francisco, San Francisco, CA, United States
| | - Stephen M. Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Kevin M. Vannella
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - Christopher Barnett
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States
| | - Charles R. Langelier
- Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, United States
- Chan Zuckerberg Biohub, San Francisco, CA, United States
| | - Sarah Patterson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Division of Rheumatology, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
11
|
Militaru S, Mihu A, Genunche-Dumitrescu AV, Neagoe CD, Avramescu TE, Istratoaie O, Gheonea IA, Militaru C. Multimodality Cardiac Imaging in COVID-19 Infection. Medicina (Kaunas) 2023; 59:1223. [PMID: 37512035 PMCID: PMC10384118 DOI: 10.3390/medicina59071223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
COVID-19 infection often produces cardiovascular complications, which can range from mild to severe and influence the overall prognosis. Imaging is the cornerstone for diagnosing initial COVID-19 cardiovascular involvement as well as treatment guidance. In this review, we present the current state of the literature on this subject while also emphasizing possible algorithms for indicating and executing these investigations.
Collapse
Affiliation(s)
- Sebastian Militaru
- Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
- Department of cardiology, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania
- Sport Medicine and Physiotherapy Faculty, University of Craiova, 200585 Craiova, Romania
- Cardiomed Clinic, 200513 Craiova, Romania
| | - Anca Mihu
- Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
- Department of cardiology, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania
- Sport Medicine and Physiotherapy Faculty, University of Craiova, 200585 Craiova, Romania
- Cardiomed Clinic, 200513 Craiova, Romania
| | | | | | - Taina Elena Avramescu
- Sport Medicine and Physiotherapy Faculty, University of Craiova, 200585 Craiova, Romania
| | - Octavian Istratoaie
- Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
- Department of cardiology, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania
| | | | - Cristian Militaru
- Department of cardiology, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania
- Sport Medicine and Physiotherapy Faculty, University of Craiova, 200585 Craiova, Romania
- Cardiomed Clinic, 200513 Craiova, Romania
| |
Collapse
|
12
|
Polednikova K, Kozel M, Linkova H, Novackova M, Trinh MD, Tousek P. Triggers, characteristics, and hospital outcome of patients with Takotsubo syndrome: 10 years experience in a large university hospital centre. Eur Heart J Suppl 2023; 25:E10-E16. [PMID: 37234233 PMCID: PMC10206857 DOI: 10.1093/eurheartjsupp/suad105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A unique clinical feature of Takotsubo syndrome (TTS) is the stress trigger factor. Different types of triggers exist, generally divided into emotional and physical stressor. The aim was to create long-term registry of all consecutive patients with TTS across all disciplines in our large university hospital. We enrolled patients on the basis of meeting the diagnostic criteria of the international InterTAK Registry. We aimed to determine type of triggers, clinical characteristics, and outcome of TTS patients during 10 years period. In our prospective, academic, single centre registry, we enrolled 155 consecutive patients with diagnoses of TTS between October 2013 and October 2022. The patients were divided into three groups, those having unknown (n = 32; 20.6%), emotional (n = 42; 27.1%), or physical (n = 81; 52.3%) triggers. Clinical characteristics, cardiac enzyme levels, echocardiographic findings, including ejection fraction, and TTS type did not differ among the groups. Chest pain was less common in the group of patients with a physical trigger. On the other hand, arrhythmogenic disorders such as prolonged QT intervals, cardiac arrest requiring defibrillation, and atrial fibrillation were more common among the TTS patients with unknown triggers compared with the other groups. The highest in-hospital mortality was observed between patients having physical trigger (16% vs. 3.1% in TTS with emotional trigger and 4.8% in TTS with unknown trigger; P = 0.060). Conclusion: More than half of the patients with TTS diagnosed in a large university hospital had a physical trigger as a stress factor. An essential part of caring for these types of patients is the correct identification of TTS in the context of severe other conditions and the absence of typical cardiac symptoms. Patients with physical trigger have a significantly higher risk of acute heart complications. Interdisciplinary cooperation is essential in the treatment of patients with this diagnosis.
Collapse
Affiliation(s)
| | - Martin Kozel
- Cardiocentre of University Hospital Kralovske Vinohrady, Srobarova 1150/50, Prague 100 34, Czechia
- Third Faculty of Medicine, Charles University, Ruska 2411, Prague 100 00, Czechia
| | - Hana Linkova
- Cardiocentre of University Hospital Kralovske Vinohrady, Srobarova 1150/50, Prague 100 34, Czechia
- Third Faculty of Medicine, Charles University, Ruska 2411, Prague 100 00, Czechia
| | - Marketa Novackova
- Cardiocentre of University Hospital Kralovske Vinohrady, Srobarova 1150/50, Prague 100 34, Czechia
- Third Faculty of Medicine, Charles University, Ruska 2411, Prague 100 00, Czechia
| | - Minh Duc Trinh
- Cardiocentre of University Hospital Kralovske Vinohrady, Srobarova 1150/50, Prague 100 34, Czechia
- Third Faculty of Medicine, Charles University, Ruska 2411, Prague 100 00, Czechia
| | | |
Collapse
|
13
|
Sousa Rêgo LO, Alves Braga LL, Vilas-Boas GS, Oliveira Cardoso MS, Duraes AR. Cardiovascular and Neurological Complications of COVID-19: A Narrative Review. J Clin Med 2023; 12:jcm12082819. [PMID: 37109156 PMCID: PMC10142816 DOI: 10.3390/jcm12082819] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/25/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
A novel coronavirus emerged in China in late 2019 as a disease named coronavirus disease 2019. This pathogen was initially identified as causing a respiratory syndrome, but later, it was found that COVID-19 could also affect other body systems, such as the neurological and cardiovascular systems. For didactic purposes, cardiovascular and neurological manifestations of SARS-CoV-2 have been classified in three different groups: acute complications, late complications, and post-vaccine complications. Therefore, the following study has the goal to summarize and disseminate the present knowledge about the cardiovascular and neurological manifestations of COVID-19 based on the latest and most up-to-date data available and, thus, promote more prepared medical care for these conditions as the medical team is updated. Based on what is brought on this revision and its understanding, the medical service becomes more aware of the causal relationship between some conditions and COVID-19 and can better prepare for the most prevalent conditions to associate and, consequently, to treat patients earlier. Therefore, there is a chance of better prognoses in this context and the need to increase the number of studies about complications related to SARS-CoV-2 infection for a better understanding of other associated conditions.
Collapse
Affiliation(s)
- Luma Ornelas Sousa Rêgo
- Bahiana School of Medicine and Public Health, BAHIANA/EBMSP, 275, Av. Dom João VI, Brotas, Salvador 40290-000, Brazil
| | - Lara Landulfo Alves Braga
- Bahiana School of Medicine and Public Health, BAHIANA/EBMSP, 275, Av. Dom João VI, Brotas, Salvador 40290-000, Brazil
| | - Gustavo Sampaio Vilas-Boas
- Bahiana School of Medicine and Public Health, BAHIANA/EBMSP, 275, Av. Dom João VI, Brotas, Salvador 40290-000, Brazil
| | | | - Andre Rodrigues Duraes
- Bahiana Medical School of Federal University of Bahia, UFBA/FAMEB, PPGMS-EMBSP-Bahia Federal University, Salvador 40170-110, Brazil
| |
Collapse
|
14
|
Davis MG, Bobba A, Majeed H, Bilal MI, Nasrullah A, Ratmeyer GM, Chourasia P, Gangu K, Farooq A, Avula SR, Sheikh AB. COVID-19 With Stress Cardiomyopathy Mortality and Outcomes Among Patients Hospitalized in the United States: A Propensity Matched Analysis Using the National Inpatient Sample Database. Curr Probl Cardiol 2023; 48:101607. [PMID: 36690311 PMCID: PMC9859766 DOI: 10.1016/j.cpcardiol.2023.101607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Takotsubo syndrome (stress cardiomyopathy) has become a well-known complication of COVID-19 infections, with limited large-scale studies evaluating outcomes. We used the National Inpatient Sample (NIS) database to compare COVID-19 patients with and without stress cardiomyopathy. A total of 1,659,040 patients were included in the study: COVID-19 with stress cardiomyopathy (n = 1665, 0.1%) and COVID-19 without stress cardiomyopathy (n = 1657, 375, and 99.9%). The primary outcome was in-hospital mortality, with secondary analysis with propensity matching performed to confirm results from traditional multivariate analysis. COVID-19 patients with stress cardiomyopathy had significantly increased in-hospital mortality compared to COVID-19 patients without stress cardiomyopathy (32.8% vs 14.6%, adjusted OR [aOR]: 2.3 [95% CI, 1.2-4.5], P = 0.01) along with significantly increased mechanical ventilation and vasopressor support, hospitalization charge, acute kidney injury requiring hemodialysis, cardiogenic shock, and cardiac arrest. These results emphasize the need for more research to reduce worse outcomes with COVID-19-related stress cardiomyopathy patients.
Collapse
Affiliation(s)
- Monique G Davis
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Aniesh Bobba
- Department of Medicine, John H Stronger Hospital, Cook County, Chicago, IL
| | - Harris Majeed
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Muhammad I Bilal
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Adeel Nasrullah
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, PA
| | - Glenn M Ratmeyer
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Prabal Chourasia
- Department of Hospital Medicine, Mary Washington Hospital, Fredericksburg, VA.
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Asif Farooq
- Department of Family and Community Medicine, Texas Tech Health Sciences Center, Lubbock, TX
| | - Sindhu R Avula
- Department of Interventional Cardiology, Division of Cardiology, University of Kansas, St Francis Campus, Kansas City, KS
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| |
Collapse
|
15
|
Rivera-Torres J, Girón N, San José E. COVID-19: A Comprehensive Review on Cardiovascular Alterations, Immunity, and Therapeutics in Older Adults. J Clin Med 2023; 12. [PMID: 36675416 DOI: 10.3390/jcm12020488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Abstract
Here, we present a review focusing on three relevant issues related to COVID-19 and its impact in older adults (60 years and older). SARS-CoV-2 infection starts in the respiratory system, but the development of systemic diseases accompanied by severe clinical manifestations has also been reported, with cardiovascular and immune system dysfunction being the major ones. Additionally, the presence of comorbidities and aging represent major risk factors for the severity and poor prognosis of the disease. Since aging-associated decline has been largely related to immune and cardiovascular alterations, we sought to investigate the consequences and the underlying mechanisms of these pathologies to understand the severity of the illness in this population. Understanding the effects of COVID-19 on both systems should translate into comprehensive and improved medical care for elderly COVID-19 patients, preventing cardiovascular as well as immunological alterations in this population. Approved therapies that contribute to the improvement of symptoms and a reduction in mortality, as well as new therapies in development, constitute an approach to managing these disorders. Among them, we describe antivirals, cytokine antagonists, cytokine signaling pathway inhibitors, and vaccines.
Collapse
|
16
|
José SG, Carrizales-Sepúlveda EF, Vera-Pineda R, Morales-Rendón EJ, de Jesús Ortiz-Corona J, Flores-Ramírez R. Takotsubo Cardiomyopathy and COVID-19: A Case Report and Literature Review. Curr Cardiol Rev 2023; 19:e180822207660. [PMID: 35984028 PMCID: PMC10201897 DOI: 10.2174/1573403x18666220818155039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/03/2022] [Accepted: 06/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy is characterized by transient regional ventricular abnormalities in the absence of coronary artery disease and is reported as a complication of COVID-19. CASE PRESENTATION It can have a diverse clinical presentation, occasionally resembling an acute coronary syndrome, and progress to acute heart failure and cardiogenic shock, adversely affecting patients' prognosis. A high index of suspicion and a thorough diagnostic approach supported by ancillary studies like echocardiography and coronary angiography is key for an accurate diagnosis and correct medical treatment. Herein, we report a patient with severe COVID-19 who developed Takotsubo cardiomyopathy. CONCLUSION We also present a detailed literature review regarding the relationship between COVID-19 and Takotsubo cardiomyopathy.
Collapse
Affiliation(s)
- Solís Gabriel José
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | | | - Raymundo Vera-Pineda
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Eliu Jefte Morales-Rendón
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
- Division of Interventional Cardiology, Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - José de Jesús Ortiz-Corona
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
- Division of Interventional Cardiology, Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Ramiro Flores-Ramírez
- Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
- Echocardiography Laboratory, Cardiology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| |
Collapse
|
17
|
Ghasemi H, Kazemian S, Nejadghaderi SA, Shafie M. Takotsubo syndrome and COVID‐19: A systematic review. Health Sci Rep 2023; 6:e972. [PMID: 36479387 PMCID: PMC9718950 DOI: 10.1002/hsr2.972] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/30/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Aims Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is characterized by acute and transient left ventricular dysfunction and has increased during the COVID-19 pandemic. Herein, we aim to review studies on TTS that were associated with COVID-19 infection, vaccine, and other COVID-19-related etiologies including psychosocial stressors. Methods We systematically searched PubMed, EMBASE, and Scopus up to May 12, 2022. We included case reports, case series, and original articles that reported at least one TTS case associated with COVID-19, or TTS cases after receiving COVID-19 vaccines, or TTS cases secondary to psychological stress due to the COVID-19 pandemic. The quality assessment was conducted using the Joanna Briggs Institute checklist. Results Sixty-seven articles including 102 cases were included. Hypertension was the most frequently accompanying comorbidity (N = 67 [65.6%]) and the mean left ventricular ejection fraction was 36.5%. Among COVID-19 patients, the in-hospital mortality rate was 33.3%. On the other hand, only one COVID-19-negative individual expired (2.3%). The most common presenting clinical symptom was dyspnea in 42 (73.6%) patients. the mean time interval from the first symptom to admission was 7.2 days. The most common chest imaging finding was ground-glass opacity which was reported in 14 (31.1%) participants. The most common abnormalities were T-wave inversion in 35 (43.2%) and ST-segment elevation in 30 (37%). Brain natriuretic peptide and troponin were elevated in 94.7% and 95.9% of participants, respectively. Conclusion The TTS in patients with COVID-19 is almost rare, whereas it could lead to a great mortality and morbidity. An individual with COVID-19, especially an elderly woman, presented with dyspnea in addition to a rise in brain natriuretic peptide and troponin should be evaluated for TTS.
Collapse
Affiliation(s)
- Hoomaan Ghasemi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran
| | - Sina Kazemian
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Seyed Aria Nejadghaderi
- Research Center for Integrative Medicine in Aging, Aging Research Institute Tabriz University of Medical Sciences Tabriz Iran
- Systematic Review and Meta‐Analysis Expert Group (SRMEG) Universal Scientific Education and Research Network (USERN) Tehran Iran
| | - Mahan Shafie
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| |
Collapse
|
18
|
Hajra A, Malik A, Bandyopadhyay D, Goel A, Isath A, Gupta R, Krishnan S, Rai D, Krittanawong C, Virani SS, Fonarow GC, Lavie CJ. Impact of COVID-19 in patients hospitalized with stress cardiomyopathy: A nationwide analysis. Prog Cardiovasc Dis 2023; 76:25-30. [PMID: 36528166 PMCID: PMC9749379 DOI: 10.1016/j.pcad.2022.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
Stress cardiomyopathy was noted to occur at a higher incidence during coronavirus disease of 2019 (COVID-19) pandemic. This database analysis has been done to compare the in-hospital outcomes in patients with stress cardiomyopathy and concurrent COVID-19 infection with those without COVID-19 infection. The National Inpatient Sample database for the year 2020 was queried to identify all admissions diagnosed with stress cardiomyopathy. These patients were then stratified based on whether they had concomitant COVID-19 infection or not. A 1:1 propensity score matching was performed. Multivariate logistic regression analysis was done to identify predictors of mortality. We identified 41,290 hospitalizations for stress cardiomyopathy, including 1665 patients with concurrent diagnosis of COVID-19. The female preponderance was significantly lower in patients with stress cardiomyopathy and COVID-19. Patients with concomitant COVID-19 were more likely to be African American, diabetic and have chronic kidney disease. After propensity matching, the incidence of complications, including acute kidney injury (AKI), AKI requiring dialysis, coagulopathy, sepsis, cardiogenic shock, cases with prolonged intubation of >24 h, requirement of vasopressor and inpatient mortality, were noted to be significantly higher in patients with COVID-19. Concomitant COVID-19 infection was independently associated with worse outcomes and increased mortality in patients hospitalized with stress cardiomyopathy.
Collapse
Affiliation(s)
- Adrija Hajra
- Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aaqib Malik
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | | | - Akshay Goel
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Rahul Gupta
- Department of Cardiology, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
| | - Suraj Krishnan
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Devesh Rai
- Department of Cardiology, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | | | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA., USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| |
Collapse
|
19
|
Smer A, Squires RW, Bonikowske AR, Allison TG, Mainville RN, Williams MA. Cardiac Complications of COVID-19 Infection and the Role of Physical Activity. J Cardiopulm Rehabil Prev 2023; 43:8-14. [PMID: 35839441 PMCID: PMC9828583 DOI: 10.1097/hcr.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Since December 2019, the newly emerging coronavirus has become a global pandemic with >250 million people infected and >5 million deaths worldwide. Infection with coronavirus disease-2019 (COVID-19) causes a severe immune response and hypercoagulable state leading to tissue injury, organ damage, and thrombotic events. It is well known that COVID-19 infection predominately affects the lungs; however, the cardiovascular complications of the disease have been a major cause of morbidity and mortality. In addition, patients with cardiovascular disease are vulnerable to contract a severe form of the illness and increased mortality. A significant number of patients who survived the disease may experience post-COVID-19 syndrome with a variety of symptoms and physical limitations. Here, we review the cardiac complications of COVID-19 infection and the results of cardiopulmonary exercise testing and guidelines for exercise training after infection.
Collapse
Affiliation(s)
- Aiman Smer
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Ray W. Squires
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Amanda R. Bonikowske
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Thomas G. Allison
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Rylie N. Mainville
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Mark A. Williams
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| |
Collapse
|
20
|
Chen YC, Lin GM, Takimoto E, Lin CS, Lin WY, Wu CH, Huang CL, Cheng CC, Cheng SM, Lin SH, Komuro I, Liu PY. Takotsubo Syndrome Occurring after mRNA COVID-19 Vaccination in a Patient with Graves' Disease. Medicina (Kaunas) 2022; 59:94. [PMID: 36676717 DOI: 10.3390/medicina59010094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023]
Abstract
Cardiovascular events such as myocarditis following mRNA COVID-19 vaccination are increasing. We present a 67-year-old postmenopausal woman with Takotsubo Syndrome and Graves' disease after mRNA COVID-19 vaccination. She developed chest pain and shortness of breath one week after vaccination. An electrocardiogram revealed ST elevation in the precordial leads. Coronary angiography revealed the absence of obstructive coronary artery disease, and the left ventriculography showed a typical feature with apical ballooning. Laboratory workup showed the elevation of free T4 and thyrotropin receptor antibodies. It was presumed that Takotsubo Syndrome and Graves' disease were probably related to the COVID-19 mRNA vaccination. The patient was treated with low-dose bisoprolol, diuretics, carbimazole, and steroid and discharged uneventfully. The mRNA COVID-19 vaccination is still safe and effective to defend against COVID-19 pandemic. However, clinicians should be aware of the possible cardiovascular adverse events other than myocarditis following vaccination.
Collapse
|
21
|
Emad H. Abdeldayem, Basant M. Raief Mosaad, Aya Yassin, Ahmed S. Abdelrahman. Cardiac MRI in patients with COVID-19 infection. Eur Radiol 2022. [PMID: 36512043 PMCID: PMC9745285 DOI: 10.1007/s00330-022-09325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
Objective COVID-19 infection is a systemic disease with various cardiovascular symptoms and complications. Cardiac MRI with late gadolinium enhancement is the modality of choice for the assessment of myocardial involvement. T1 and T2 mapping can increase diagnostic accuracy and improve further management. Our study aimed to evaluate the different aspects of myocardial damage in cases of COVID-19 infection using cardiac MRI. Methods This descriptive retrospective study included 86 cases, with a history of COVID-19 infection confirmed by positive RT-PCR, who met the inclusion criteria. Patients had progressive chest pain or dyspnoea with a suspected underlying cardiac cause, either by an abnormal electrocardiogram or elevated troponin levels. Cardiac MRI was performed with late contrast-enhanced (LGE) imaging, followed by T1 and T2 mapping. Results Twenty-four patients have elevated hsTnT with a median hsTnT value of 133 ng/L (IQR: 102 to 159 ng/L); normal value < 14 ng/L. Other sixty-two patients showed elevated hsTnI with a median hsTnI value of 1637 ng/L (IQR: 1340 to 2540 ng/L); normal value < 40 ng/L. CMR showed 52 patients with acute myocarditis, 23 with Takotsubo cardiomyopathy, and 11 with myocardial infarction. Invasive coronary angiography was performed only in selected patients. Conclusion Different COVID-19-related cardiac injuries may cause similar clinical symptoms. Cardiac MRI is the modality of choice to differentiate between the different types of myocardial injury such as Takotsubo cardiomyopathy and infection-related cardiomyopathy or even acute coronary syndrome secondary to vasculitis or oxygen-demand mismatch. Key Points • It is essential to detect early COVID-related cardiac injury using different cardiac biomarkers and cardiac imaging, as it has a significant impact on patient management and outcome. • Cardiac MRI is the modality of choice to differentiate between the different aspects of COVID-related myocardial injury.
Collapse
|
22
|
Li M, Nguyen CN, Toleva O, Mehta PK. Takotsubo syndrome: A current review of presentation, diagnosis, and management. Maturitas 2022; 166:96-103. [PMID: 36108540 DOI: 10.1016/j.maturitas.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 12/25/2022]
Abstract
Takotsubo syndrome is a syndrome of acute heart failure due to left ventricular systolic dysfunction that is associated with increased cardiovascular morbidity and mortality. It occurs in both sexes and at all ages, but predominates in post-menopausal women for reasons that are unclear. In a patient who presents with cardiac symptoms, electrocardiographic changes, and/or biomarker elevation indicating myocardial stress (i.e. troponin elevation), this condition should be considered in the differential diagnosis. Cardiac imaging is critical for a timely diagnosis of this condition and has management implications. This syndrome can occur with or without underlying coronary artery disease, and while there are various characteristic myocardial patterns described on imaging, the most common one is left ventricular dysfunction due to apical stunning with basal hyperkinesis. In the acute phase, Takotsubo syndrome can lead to life-threatening sequelae, including cardiogenic shock, pulmonary edema, thromboembolism, and arrhythmias. Multiple pathophysiologic mechanisms are implicated, including an acute increase in left ventricular afterload in the setting of sympathetic activation with a catecholamine storm, multi-vessel coronary vasospasm, coronary endothelial microvascular dysfunction, and inflammation. In this review, we discuss the current knowledge surrounding presentation, diagnosis, and treatment of this under-diagnosed condition.
Collapse
Affiliation(s)
- Monica Li
- J. Willis Hurst Internal Medicine Residency Training Program, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Christopher N Nguyen
- Northside Hospital Gwinnett Internal Medicine Residency Program, Lawrenceville, GA, United States of America
| | - Olga Toleva
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, United States of America; Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Puja K Mehta
- Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America.
| |
Collapse
|
23
|
Khalid Ahmed S, Gamal Mohamed M, Abdulrahman Essa R, Abdelaziz Ahmed Rashad Dabou E, Omar Abdulqadir S, Muhammad Omar R. Global reports of takotsubo (stress) cardiomyopathy following COVID-19 vaccination: A systematic review and meta-analysis. IJC Heart & Vasculature 2022; 43:101108. [PMID: 35992364 PMCID: PMC9381427 DOI: 10.1016/j.ijcha.2022.101108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/31/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
Concerns have been raised recently about takotsubo cardiomyopathy (TCM) after receiving COVID-19 vaccines, particularly the messenger RNA (mRNA) vaccines. The goal of this study was to compile case reports to provide a comprehensive overview of takotsubo cardiomyopathy (TCM) associated with COVID-19 vaccines. A systematic literature search was conducted in PubMed, Scopus, Embase, Web of Science, and Google Scholar between 2020 and June 1, 2022. The study included individuals who developed cardiac takotsubo cardiomyopathy from receiving COVID-19 vaccinations. Ten studies, including 10 cases, participated in the current systematic review. The mean age was 61.8 years; 90 % were female, while 10 % were male. 80 % of the patients received the mRNA COVID-19 vaccine, while 20 % received other types. In addition, takotsubo cardiomyopathy (TCM) occurred in 50 % of patients receiving the first dose and another 40 % after the second dose of COVID-19 vaccines. Moreover, the mean number of days to the onset of symptoms was 2.62 days. All cases had an elevated troponin test and abnormal ECG findings. The left ventricular ejection fraction (LVEF) was lower than 50 % in 90 % of patients. In terms of the average length of hospital stay, 50 % stayed for 10.2 days, and all cases recovered from their symptoms. In conclusion, takotsubo (stress) cardiomyopathy (TCM) complications associated with COVID-19 vaccination are rare but can be life-threatening. Chest pain should be considered an alarming symptom, especially in those who have received the first and second doses of the COVID-19 vaccine.
Collapse
Affiliation(s)
- Sirwan Khalid Ahmed
- Department of Emergency, Ranya Teaching Hospital, Ranya, Sulaimani, Kurdistan-region, Iraq
- Raparin Research Group (RRG), Ranya, Sulaimani, Kurdistan-region, Iraq
- Corresponding author at: Department of Emergency, Ranya Teaching Hospital, Ranya, Sulaimani, Kurdistan-region, Iraq.
| | - Mona Gamal Mohamed
- Department of Adult Nursing, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE
| | - Rawand Abdulrahman Essa
- Department of Emergency, Ranya Teaching Hospital, Ranya, Sulaimani, Kurdistan-region, Iraq
- Raparin Research Group (RRG), Ranya, Sulaimani, Kurdistan-region, Iraq
| | | | - Salar Omar Abdulqadir
- Department of Nursing, University of Raparin, Ranya, Sulaimani, Kurdistan-region, Iraq
- Raparin Research Group (RRG), Ranya, Sulaimani, Kurdistan-region, Iraq
| | - Rukhsar Muhammad Omar
- Department of Nursing, University of Raparin, Ranya, Sulaimani, Kurdistan-region, Iraq
- Raparin Research Group (RRG), Ranya, Sulaimani, Kurdistan-region, Iraq
| |
Collapse
|
24
|
Hamdan R, Nassef ME, Khan J, Cheriyan A, Yaseen N, Singer NAHM, Kadri Z, Nooryani AA. Reverse TakoTsubo or Fulminant myocarditis ? Life saving VA ECMO in a COVID 19 patient. Ann Cardiol Angeiol (Paris) 2022; 71:228-231. [PMID: 35940968 PMCID: PMC9212260 DOI: 10.1016/j.ancard.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022]
|
25
|
Zuin M, Mugnai G, Anselmi M, Bonapace S, Bozzini P, Chirillo F, Cutolo A, Grassi G, Mancuso D, Meneghin S, Molon G, Mugnolo A, Pantano I, Polo A, Purita P, Roncon L, Saccà S, Scarpa D, Tavella D, Themistoclakis S, Turiano G, Valle R, Widmann M, Zakja E, Zamboni A, Rigatelli G, Bilato C. Takotsubo Syndrome during COVID-19 Pandemic in the Veneto Region, Italy. Viruses 2022; 14. [PMID: 36146778 DOI: 10.3390/v14091971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background: During the COVID-19 pandemic, the risk of SARS-CoV-2 infection, the public health measures of social distancing, the freedom limitations, quarantine, and the enforced homeworking under the lockdown period, as well as medical causes including COVID-19 infection per se, may have caused major emotional distress, especially in the most vulnerable patients. We aimed to evaluate the variations in the number of admissions due to Takotsubo syndrome (TTS) during the COVID-19 pandemic in the Veneto region. Methods: We retrospectively reviewed and analyzed the number of admissions because of TTS in 13 Divisions of Cardiology located in the Veneto region, the northeastern area of Italy, covering a population of more than 2.5 million inhabitants, during the two major pandemic waves of COVID-19 (the first between 15 March and 30 April 2020 and the second between 15 November and 30 December 2020) that occurred in 2020. Results: In total, 807 acute coronary syndromes were admitted in the 13 enrolling hospitals. Among these, 3.9% had TTS. Compared to the corresponding 2018 and 2019 time periods, we observed a significant increase in the number of TTS cases (+15.6%, p = 0.03 and +12.5%, p = 0.04, comparing 2018 to 2020 and 2019 to 2020, respectively). Geographical distribution of the TTS cases reflected the broad spread of the SARS-CoV-2 infection with a significant direct relationship between TTS incidence and the number of COVID-19 infections according to Pearson’s correlation (r = 0.798, p < 0.001). Conclusions: The higher incidence of TTS during the 2020 COVID-19 pandemic waves, especially in the areas that were hit hardest in terms of morbidity and mortality by the SARS-CoV-2 infection, suggest a strong direct and/or indirect role of COVID-19 in the pathogenesis of TTS.
Collapse
|
26
|
Canavero I, Rifino N, Bussotti M, Carrozzini T, Potenza A, Gorla G, Pollaci G, Storti B, Parati EA, Gatti L, Bersano A. The Octopus Trap of Takotsubo and Stroke: Genetics, Biomarkers and Clinical Management. J Pers Med 2022; 12:1244. [PMID: 36013193 PMCID: PMC9410002 DOI: 10.3390/jpm12081244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Takotsubo cardiomyopathy (TC) is a reversible cardiomyopathy mimicking an acute coronary syndrome, usually observed in response to acute stress situations. The association between acute ischemic stroke and TC is already known, since it has been previously reported that ischemic stroke can be both a consequence and a potential cause of TC. However, the precise pathophysiological mechanism linking the two conditions is still poorly understood. The aim of our review is to expand insights regarding the genetic susceptibility and available specific biomarkers of TC and to investigate the clinical profile and outcomes of patients with TC and stroke. Since evidence and trials on TC and stroke are currently lacking, this paper aims to fill a substantial gap in the literature about the relationship between these pathologies.
Collapse
|
27
|
Abstract
Myocardial injury, diagnosed by troponin elevation, is common in COVID-19 patients, but cardiac involvement with clinical manifestations occurs less frequently. We analyzed the literature on COVID-19 (2020) and systematically reviewed the cases where individual patient data were presented. We searched PubMed and Google Scholar for "COVID," "COVID-19," and "coronavirus" in combination with "myocarditis," "heart failure," "takotsubo," "cardiomyopathy," and "cardiogenic shock." We identified 90 cases of COVID-19 with myocardial involvement, mean age 52.9 ± 18.3 years, 54.5% males. Of them, 55 survived (61.1%), 20 died (22.2%), and in 15 (16.7%) the outcome was unknown at the time of publication. Among patients with known outcome, mortality was 26%. The nadir LVEF was 31.7 ± 13.1% and recovered to 50.1 ± 16.0%. Pericardial effusion was a common finding, reported in 21 (23.3%) of patients, including moderate size effusion in 8.9% and large in 7.8%. The effusion caused tamponade in 11 (12.2%) of patients. Out of 83 patients who experienced a decrease in LVEF, 30 could be classified as takotsubo syndrome. The takotsubo patients were older than those with myocarditis, and with relatively high proportion of males. About one third of the cases was complicated by cardiogenic shock. Myocardial involvement in COVID-19 patients most often presents as a new, rapid decrease in LVEF, although normal LVEF or takotsubo-like wall motion pattern does not rule out myocarditis. Moderate and large pericardial effusion is common, and cardiac tamponade occurs in 12.2% of patients. Cardiogenic shock develops in one third of the patients. Mortality appears to be high at 26%.
Collapse
Affiliation(s)
- Maya Guglin
- Krannert Institute of Cardiology, Indiana University, 1801 Senate Blvd Suite 2000, IN, 46202, Indianapolis, USA.
| | - Kareem Ballut
- Krannert Institute of Cardiology, Indiana University, 1801 Senate Blvd Suite 2000, IN, 46202, Indianapolis, USA
| | - Onyedika Ilonze
- Krannert Institute of Cardiology, Indiana University, 1801 Senate Blvd Suite 2000, IN, 46202, Indianapolis, USA
| | - Mark Jones
- Krannert Institute of Cardiology, Indiana University, 1801 Senate Blvd Suite 2000, IN, 46202, Indianapolis, USA
| | - Roopa Rao
- Krannert Institute of Cardiology, Indiana University, 1801 Senate Blvd Suite 2000, IN, 46202, Indianapolis, USA
| |
Collapse
|
28
|
Hong GH, Hays AG, Gilotra NA. The Evolving Role of Echocardiography During the Coronavirus Disease 2019 Pandemic. Heart Int 2022; 16:28-36. [PMID: 36275350 PMCID: PMC9524667 DOI: 10.17925/hi.2022.16.1.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/19/2022] [Indexed: 04/12/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) has been associated with a wide spectrum of cardiovascular manifestations. Since the beginning of the pandemic, echocardiography has served as a valuable tool for triaging, diagnosing and managing patients with COVID-19. More recently, speckle-tracking echocardiography has been shown to be effective in demonstrating subclinical myocardial dysfunction that is often not detected in standard echocardiography. Echocardiographic findings in COVID-19 patients include left or right ventricular dysfunction, including abnormal longitudinal strain and focal wall motion abnormalities, valvular dysfunction and pericardial effusion. Additionally, some of these echocardiographic abnormalities have been shown to correlate with biomarkers and adverse clinical outcomes, suggesting an additional prognostic value of echocardiography. With increasing evidence of cardiac sequelae of COVID-19, the use of echocardiography has expanded to patients with cardiopulmonary symptoms after recovery from initial infection. This article aims to highlight the available echocardiographic tools and to summarize the echocardiographic findings across the full spectrum of COVID-19 disease and their correlations with biomarkers and mortality.
Collapse
Affiliation(s)
- Gloria H Hong
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
29
|
Kanelidis AJ, Miller PJ, Singh A, Addetia K, Lang RM. Takotsubo Syndrome from COVID-19 Infection. J Am Soc Echocardiogr 2022; 35:883-885. [PMID: 35491010 PMCID: PMC9047401 DOI: 10.1016/j.echo.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/28/2022] [Accepted: 04/19/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Anthony J Kanelidis
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Patrick J Miller
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Amita Singh
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Karima Addetia
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Roberto M Lang
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| |
Collapse
|
30
|
Bairashevskaia AV, Belogubova SY, Kondratiuk MR, Rudnova DS, Sologova SS, Tereshkina OI, Avakyan EI. Update of Takotsubo cardiomyopathy: Present experience and outlook for the future. Int J Cardiol Heart Vasc 2022; 39:100990. [PMID: 35281752 PMCID: PMC8913320 DOI: 10.1016/j.ijcha.2022.100990] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/21/2022]
Abstract
Takotsubo cardiomyopathy (TTS) has become a recognised clinical entity since the Japanese scientist Sato first described it in 1990. Despite an increasing number of confirmed cases, especially during the COVID-19 pandemic, its pathophysiology remains incompletely understood, and decision-making differs in the diagnosis and treatment. In addition, it is not evident whether a significant increase in TTS is due to better understanding among practitioners and widespread access to coronary angiography, or if it is a reflection of an actual increase in incidence. We analysed a series of international research studies from 1990 to 2021. Beyond epidemiology and clinical presentation, we evaluated and summarised fundamental knowledge about various predisposing factors, with particular attention to the iatrogenic impact of certain drugs, namely antidepressants, chemotherapy, and antiarrhythmics. Furthermore, we highlighted the main pathophysiological theories to date. In addition, based on published studies and clinical cases, we investigated the role of numerous diagnostic approaches in the differential diagnosis of TTS and identified predictors of TTS complications, such as cardiogenic shock, ventricular fibrillation, and left ventricular thrombi. Accordingly, we sought to propose a diagnostic algorithm and further treatment management of TTS under the presence of possible complications to help practitioners make more informed decisions, as the initial presentation continues to pose a challenge due to its close similarity to acute coronary syndrome with ST-elevation. In conclusion, this article examines Takotsubo cardiomyopathy from different perspectives and, along with future systematic reviews and meta-analyses, can be of particular interest to practising cardiologists and researchers in developing clinical guidelines.
Collapse
Affiliation(s)
- Anastasiia V Bairashevskaia
- Department of Paediatrics, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Sofiya Y Belogubova
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia.,AMEE International Networking Centre, Sechenov First Moscow State Medical University (Sechenov University), 123242 Moscow, Russia
| | - Mikhail R Kondratiuk
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Daria S Rudnova
- International School "Medicine of the Future", Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Susanna S Sologova
- Department of Pharmacology, Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), 119571 Moscow, Russia
| | - Olga I Tereshkina
- Department of Pharmacology, Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), 119571 Moscow, Russia
| | - Esma I Avakyan
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia.,AMEE International Networking Centre, Sechenov First Moscow State Medical University (Sechenov University), 123242 Moscow, Russia
| |
Collapse
|
31
|
Abstract
COVID-19 started as an unknown viral illness and has been a challenging pandemic to overcome. The virus has been associated with multiple organ involvement, including the heart. Takotsubo cardiomyopathy (TSCM), a stress cardiomyopathy, is an uncommon complication in patients diagnosed with COVID-19. The pathogenesis is historically a result of stress onto the body that leads to a catecholamine surge. However, COVID-19 may cause direct damage to the cardiac myocytes via spike protein and angiotensin-converting enzyme 2 (ACE2) receptors which can further exacerbate the stressful insult on the patient and lower the threshold for developing TSCM. In this case report, we discuss a 94-year-old female who presented with signs and symptoms of acute coronary syndrome but, upon cardiac catheterization, was found to have basal hypercontraction with apical ballooning, consistent with TSCM.
Collapse
|
32
|
Fan X, Yang G, Kowitz J, Akin I, Zhou X, El-Battrawy I. Takotsubo Syndrome: Translational Implications and Pathomechanisms. Int J Mol Sci 2022; 23:ijms23041951. [PMID: 35216067 PMCID: PMC8875072 DOI: 10.3390/ijms23041951] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 02/07/2023] Open
Abstract
Takotsubo syndrome (TTS) is identified as an acute severe ventricular systolic dysfunction, which is usually characterized by reversible and transient akinesia of walls of the ventricle in the absence of a significant obstructive coronary artery disease (CAD). Patients present with chest pain, ST-segment elevation or ischemia signs on ECG and increased troponin, similar to myocardial infarction. Currently, the known mechanisms associated with the development of TTS include elevated levels of circulating plasma catecholamines and their metabolites, coronary microvascular dysfunction, sympathetic hyperexcitability, inflammation, estrogen deficiency, spasm of the epicardial coronary vessels, genetic predisposition and thyroidal dysfunction. However, the real etiologic link remains unclear and seems to be multifactorial. Currently, the elusive pathogenesis of TTS and the lack of optimal treatment leads to the necessity of the application of experimental models or platforms for studying TTS. Excessive catecholamines can cause weakened ventricular wall motion at the apex and increased basal motion due to the apicobasal adrenoceptor gradient. The use of beta-blockers does not seem to impact the outcome of TTS patients, suggesting that signaling other than the beta-adrenoceptor-associated pathway is also involved and that the pathogenesis may be more complex than it was expected. Herein, we review the pathophysiological mechanisms related to TTS; preclinical TTS models and platforms such as animal models, human-induced pluripotent stem cell-derived cardiomyocyte (hiPSC-CM) models and their usefulness for TTS studies, including exploring and improving the understanding of the pathomechanism of the disease. This might be helpful to provide novel insights on the exact pathophysiological mechanisms and may offer more information for experimental and clinical research on TTS.
Collapse
Affiliation(s)
- Xuehui Fan
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (X.F.); (J.K.); (I.A.)
- Key Laboratory of Medical Electrophysiology, Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Collaborative Innovation Center for Prevention of Cardiovascular Diseases, Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, China
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
| | - Guoqiang Yang
- Department of Acupuncture and Rehabilitation, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China;
- Research Unit of Molecular Imaging Probes, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jacqueline Kowitz
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (X.F.); (J.K.); (I.A.)
| | - Ibrahim Akin
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (X.F.); (J.K.); (I.A.)
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
| | - Xiaobo Zhou
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (X.F.); (J.K.); (I.A.)
- Key Laboratory of Medical Electrophysiology, Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Collaborative Innovation Center for Prevention of Cardiovascular Diseases, Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, China
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
- Correspondence: (X.Z.); (I.E.-B.)
| | - Ibrahim El-Battrawy
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (X.F.); (J.K.); (I.A.)
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
- Correspondence: (X.Z.); (I.E.-B.)
| |
Collapse
|
33
|
Valiton V, Bendjelid K, Pache JC, Roffi M, Meyer P. Coronavirus disease 2019-associated coronary endotheliitis and thrombotic microangiopathy causing cardiogenic shock: a case report. Eur Heart J Case Rep 2022; 6:ytac061. [PMID: 35295732 PMCID: PMC8922686 DOI: 10.1093/ehjcr/ytac061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/17/2021] [Accepted: 02/01/2022] [Indexed: 12/15/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) primarily affects the respiratory tract but serious cardiovascular complications have been reported. Up to one-third of patients admitted to the intensive care unit may develop an acute myocardial injury, characterized by cardiac troponin elevation. However, the pathology underlying COVID-19-associated myocardial injury has rarely been reported. Case summary Three days after being diagnosed for a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, a 52-year-old woman without a notable past medical history developed cardiogenic shock with severely reduced left ventricular ejection fraction (LVEF) at 25%. Coronary angiography was normal. Endomyocardial biopsy demonstrated coronary endotheliitis with multiple microvascular thromboses but no lymphocytic infiltrate and a negative polymerase chain reaction for SARS-CoV-2. The patient was implanted with a short-term LV assist device (Impella CP®, Abiomed, Aachen, Germany) and treated with therapeutic anticoagulation. She suffered from concomitant respiratory failure that required 14 days of orotracheal intubation, 10 days of dexamethasone, and broad-spectrum antibiotics. Clinical outcome was favourable with weaning of the Impella device after 6 days and full recovery of LVEF (65%) at 30 days. Cardiac magnetic resonance performed at Day 30 showed no evidence of myocarditis or scars and confirmed the normalization of LVEF. Discussion This case highlights how COVID-19-associated coronary endotheliitis and thrombotic microangiopathy, in the absence of myocarditis, may induce transient severe LV dysfunction and cardiogenic shock.
Collapse
Affiliation(s)
- Valérian Valiton
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Karim Bendjelid
- Intensive Care Division, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Switzerland
| | - Jean-Claude Pache
- Division of Clinical Pathology, Department of Genetic and Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marco Roffi
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Philippe Meyer
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| |
Collapse
|
34
|
Rusu I, Turlacu M, Micheu MM. Acute myocardial injury in patients with COVID-19: Possible mechanisms and clinical implications. World J Clin Cases 2022; 10:762-776. [PMID: 35127893 PMCID: PMC8790431 DOI: 10.12998/wjcc.v10.i3.762] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/15/2021] [Accepted: 12/21/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 infection affects not only the lungs, but also the cardiovascular system, having a major impact on patients' outcomes. Myocardial injury (MI) occurs in the context of coronavirus infectious disease 2019 (COVID-19) and is associated with a higher risk of severe clinical outcome and mortality. COVID-19-related MI can have various clinical manifestations, of which the main ones are myocarditis, stress cardiomyopathy, acute coronary syndrome, and pulmonary embolism. The exact mechanisms of how MI occurs in these patients are not yet fully known. Direct injury, through direct viral myocardial invasion, and indirect injury, through interaction with angiotensin I converting enzyme 2, increased inflammation, and thrombocyte and endothelial dysfunction, could be involved in acute MI in patients with COVID-19. A better understanding of these multiple potential mechanisms may help to develop new targeted therapeutic strategies. The purpose of this review is to provide the current understanding of the potential mechanisms involved in MI induced by COVID-19 and to discuss the current progress in the therapeutic strategies.
Collapse
Affiliation(s)
- Iulia Rusu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest 014461, Romania
| | - Malina Turlacu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest 014461, Romania
| | - Miruna Mihaela Micheu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest 014461, Romania
| |
Collapse
|
35
|
Abstract
We present an unusual case of takotsubo cardiomyopathy (TTC) following administration of the second dose of the DNA ChadOX1 nCOV-19 (AZD122) vaccination. This woman in her early 50s presented to the emergency department 8 days following her vaccine with central chest pain. Initial investigations revealed a raised troponin and evolving T wave inversion on ECG. Acute coronary syndrome management was commenced. Further investigations revealed non-obstructive coronary arteries on coronary angiography and imaging revealed hypokinesia of the anterior and anterior-septal walls in the apex and midcavity level, myocardial oedema and no infarction, all in keeping with TTC. Given the large-scale roll out of vaccinations during the COVID-19 pandemic better understanding of potential adverse events is essential. This is the first case report of TTC following a second dose of the DNA ChadOX1 nCOV-19 (AZD122) vaccination.
Collapse
Affiliation(s)
- Caitlin Stewart
- Cardiology and Cardiovascular Research Unit, University of Aberdeen, Aberdeen, UK
| | - David T Gamble
- Cardiology and Cardiovascular Research Unit, University of Aberdeen, Aberdeen, UK
- Cardiology Department, NHS Grampian, Aberdeen, UK
| | - Dana Dawson
- Cardiology and Cardiovascular Research Unit, University of Aberdeen, Aberdeen, UK
- Cardiology Department, NHS Grampian, Aberdeen, UK
| |
Collapse
|
36
|
Ramadan MS, Bertolino L, Marrazzo T, Florio MT, Durante-Mangoni E. Cardiac complications during the active phase of COVID-19: review of the current evidence. Intern Emerg Med 2021; 16:2051-2061. [PMID: 34046852 PMCID: PMC8158084 DOI: 10.1007/s11739-021-02763-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022]
Abstract
Growing reports since the beginning of the pandemic and till date describe increased rates of cardiac complications (CC) in the active phase of coronavirus disease 2019 (COVID-19). CC commonly observed include myocarditis/myocardial injury, arrhythmias and heart failure, with an incidence reaching about a quarter of hospitalized patients in some reports. The increased incidence of CC raise questions about the possible heightened susceptibility of patients with cardiac disease to develop severe COVID-19, and whether the virus itself is involved in the pathogenesis of CC. The wide array of CC seems to stem from multiple mechanisms, including the ability of the virus to directly enter cardiomyocytes, and to indirectly damage the heart through systemic hyperinflammatory and hypercoagulable states, endothelial injury of the coronary arteries and hypoxemia. The induced CC seem to dramatically impact the prognosis of COVID-19, with some studies suggesting over 50% mortality rates with myocardial damage, up from ~ 5% overall mortality of COVID-19 alone. Thus, it is particularly important to investigate the relation between COVID-19 and heart disease, given the major effect on morbidity and mortality, aiming at early detection and improving patient care and outcomes. In this article, we review the growing body of published data on the topic to provide the reader with a comprehensive and robust description of the available evidence and its implication for clinical practice.
Collapse
Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy
| | - Lorenzo Bertolino
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy
| | - Tommaso Marrazzo
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy
| | - Maria Teresa Florio
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy.
| |
Collapse
|
37
|
Ben Ammar H, Bouguira E, Brahmi L, Hamdi G, Bouallagui A, Khelifa E, Mnif L. Simultaneous occurrence of a Takotsubo syndrome and paranoia delirium, related to Covid-19 pandemic: A case report. Clin Case Rep 2021; 9:e05026. [PMID: 34765206 PMCID: PMC8572332 DOI: 10.1002/ccr3.5026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 11/07/2022] Open
Abstract
Some psychosomatic diseases, like Tako-tsubo cardiomyopathy, may occur because of exposure to a stressful event like COVID-19. The simultaneous development of psychosis and Tako-tsubo cardiomyopathy suggests a field of vulnerability. Specific measures need to be taken to help vulnerable people to manage these stressful events.
Collapse
Affiliation(s)
- Hanen Ben Ammar
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
| | - Emna Bouguira
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
| | - Lina Brahmi
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
| | - Ghada Hamdi
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
| | - Azza Bouallagui
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
| | - Emira Khelifa
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
| | - Leila Mnif
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
| |
Collapse
|
38
|
Abstract
Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged as a global pandemic with an unprecedented death toll worldwide. Although it primarily affects the respiratory tract presenting as pneumonia or acute respiratory failure, it is also known to cause significant cardiovascular complications, including acute coronary syndrome (ACS), arrhythmia, myopericarditis, cardiomyopathy, venous thromboembolism, heart failure, and cardiogenic shock. Morbidity and mortality secondary to cardiovascular complications are higher in patients with preexisting cardiovascular risk factors. Here, we present a case report of a 69-year-old male who was recently diagnosed with COVID-19 illness presenting with ST-elevation myocardial infarction (STEMI) and eventually with Takotsubo cardiomyopathy (TTC), and the course was complicated by right atrial thrombus and a pulmonary embolism (PE).
Collapse
Affiliation(s)
- Lalith Namburu
- Internal Medicine, East Tennessee State University Quillen College of Medicine, Johnson City, USA
| | - Sukhdeep S Bhogal
- Cardiology, East Tennessee State University Quillen College of Medicine, Johnson City, USA
| | - Vijay K Ramu
- Cardiology, East Tennessee State University Quillen College of Medicine, Johnson City, USA
| |
Collapse
|
39
|
Wildemann B, Jarius S, Lehmann LH, André F, Frey N, Schnitzler P, Jäger L, Gumbinger C, Viehöver A. COVID-19-related severe MS exacerbation with life-threatening Takotsubo cardiomyopathy in a previously stable patient and interference of MS therapy with long-term immunity against SARS-CoV-2. J Neurol 2021. [PMID: 34617145 DOI: 10.1007/s00415-021-10779-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 02/03/2023]
|
40
|
Belli O, Ardissino M, Bottiroli M, Soriano F, Blanda C, Oreglia J, Mondino M, Moreo A. Emergency cardiac imaging for coronavirus disease 2019 (COVID-19) in practice: a case of takotsubo stress cardiomyopathy. Cardiovasc Ultrasound 2021; 19:31. [PMID: 34429107 PMCID: PMC8383239 DOI: 10.1186/s12947-021-00251-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular complications of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV2) are known to be associated with poor outcome. A small number of case series and reports have described cases of myocarditis and ischaemic events, however, knowledge on the aetiology of acute cardiac failure in SARS-CoV2 remains limited. We describe the occurrence and risk stratification imaging correlates of 'takotsubo' stress cardiomyopathy presenting in a patient with Coronavirus Disease 2019 (COVID-19) in the intensive care unit. An intubated 53-year old patient with COVID19 suffered acute haemodynamic collapse in the intensive care unit, and was thus investigated with transthoracic echocardiography (TTE), 12-lead electrocardiograms (ECG) and serial troponins and blood tests, and eventually coronary angiography due to clinical suspicion of ischaemic aetiology. Echocardiography revealed a reduced ejection fraction, with evident extensive apical akinesia spanning multiple coronary territories. Troponins and NT-proBNP were elevated, and ECG revealed ST elevation: coronary angiography was thus performed. This revealed no significant coronary stenosis. Repeat echocardiography performed within the following week revealed a substantial recovery of ejection fraction and wall motion abnormalities. Despite requirement of a prolonged ICU stay, the patient now remains clinically stable, and is on spontaneous breathing. CONCLUSION This case report presents a case of takotsubo stress cardiomyopathy occurring in a critically unwell patient with COVID19 in the intensive care setting. Stress cardiomyopathy may be an acute cardiovascular complication of COVID-19 infection. In the COVID19 critical care setting, urgent bedside echocardiography is an important tool for initial clinical assessment of patients suffering haemodynamic compromise.
Collapse
Affiliation(s)
- Oriana Belli
- Division, of Cardiology, 'A. De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Maddalena Ardissino
- Department of Medicine, Imperial College London, Exhibition Road, London, UK
| | - Maurizio Bottiroli
- Division of Anaesthetics and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Soriano
- Division, of Cardiology, 'A. De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Calogero Blanda
- Division of Anaesthetics and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jacopo Oreglia
- Division, of Cardiology, 'A. De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Michele Mondino
- Division of Anaesthetics and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonella Moreo
- Division, of Cardiology, 'A. De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| |
Collapse
|
41
|
Nakamura Y, Katano H, Nakajima N, Sato Y, Suzuki T, Sekizuka T, Kuroda M, Izutani Y, Morimoto S, Maruyama J, Koie M, Kitamura T, Ishikura H. SARS-CoV-2 is localized in cardiomyocytes: a post-mortem biopsy case. Int J Infect Dis 2021; 111:43-46. [PMID: 34384897 PMCID: PMC8351278 DOI: 10.1016/j.ijid.2021.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/16/2022] Open
Abstract
A 72-year-old patient was admitted to the intensive care unit due to acute respiratory distress syndrome caused by COVID-19. On day 20, the patient experienced shock. The electrocardiogram showed ST segment elevation in leads V3–V6 and severe left ventricular dysfunction with an ejection fraction of 35%–40%. The left ventricle showed basal hypokinesis and apical akinesis, while the creatine kinase level was normal, indicating Takotsubo cardiomyopathy. On day 24, the patient died of multiple organ failure. In post-mortem biopsy, SARS-CoV-2 antigen was detected in cardiomyocytes by immunostaining. Moreover, SARS-CoV-2 RNA was detected in heart tissue. We need to further analyse the direct link between SARS-CoV-2 and cardiomyocytes.
Collapse
Affiliation(s)
- Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-8180, Japan.
| | - Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan.
| | - Noriko Nakajima
- Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan.
| | - Yuko Sato
- Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan.
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan.
| | - Tsuyoshi Sekizuka
- Pathogen Genomics Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan.
| | - Makoto Kuroda
- Pathogen Genomics Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan.
| | - Yoshito Izutani
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-8180, Japan.
| | - Shinichi Morimoto
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-8180, Japan.
| | - Junichi Maruyama
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-8180, Japan.
| | - Megumi Koie
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-8180, Japan.
| | - Taisuke Kitamura
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-8180, Japan.
| | - Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-8180, Japan.
| |
Collapse
|
42
|
Ragonetti C, Martinazzo EO, Fazionato FM, Ferreira GOG, Santana MP, Hartmann C. SARS-CoV-2 and Myocardical Injury with ST-Elevation without Coronary Disease. Arq Bras Cardiol 2021; 117:411-414. [PMID: 34495242 PMCID: PMC8395782 DOI: 10.36660/abc.20201268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/28/2021] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Carolina Ragonetti
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | - Enzo Oku Martinazzo
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | - Felipe Montesano Fazionato
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | | | - Milena Piccolo Santana
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | - Camila Hartmann
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
- Hospital Marcelino ChampagnatCuritibaPRBrasilHospital Marcelino Champagnat, Curitiba, PR - Brasil
| |
Collapse
|
43
|
Nassar M, Nso N, Alfishawy M, Novikov A, Yaghi S, Medina L, Toz B, Lakhdar S, Idrees Z, Kim Y, Gurung DO, Siddiqui RS, Zheng D, Agladze M, Sumbly V, Sandhu J, Castillo FC, Chowdhury N, Kondaveeti R, Bhuiyan S, Perez LG, Ranat R, Gonzalez C, Bhangoo H, Williams J, Osman AE, Kong J, Ariyaratnam J, Mohamed M, Omran I, Lopez M, Nyabera A, Landry I, Iqbal S, Gondal AZ, Hassan S, Daoud A, Baraka B, Trandafirescu T, Rizzo V. Current systematic reviews and meta-analyses of COVID-19. World J Virol 2021; 10:182-208. [PMID: 34367933 PMCID: PMC8316876 DOI: 10.5501/wjv.v10.i4.182] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/13/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has left a significant impact on the world's health, economic and political systems; as of November 20, 2020, more than 57 million people have been infected worldwide, with over 1.3 million deaths. While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life.
AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence, highlight gaps in knowledge, and elucidate further meta-analyses and umbrella reviews that are yet to be performed.
METHODS We explored studies based on systematic reviews and meta-analyses with the key-terms, including severe acute respiratory syndrome (SARS), SARS virus, coronavirus disease, COVID-19, and SARS coronavirus-2. The included studies were extracted from Embase, Medline, and Cochrane databases. The publication timeframe of included studies ranged between January 01, 2020, to October 30, 2020. Studies that were published in languages other than English were not considered for this systematic review. The finalized full-text articles are freely accessible in the public domain.
RESULTS Searching Embase, Medline, and Cochrane databases resulted in 1906, 669, and 19 results, respectively, that comprised 2594 studies. 515 duplicates were subsequently removed, leaving 2079 studies. The inclusion criteria were systematic reviews or meta-analyses. 860 results were excluded for being a review article, scope review, rapid review, panel review, or guideline that produced a total of 1219 studies. After screening articles were categorized, the included articles were put into main groups of clinical presentation, epidemiology, screening and diagnosis, severity assessment, special populations, and treatment. Subsequently, there was a second subclassification into the following groups: gastrointestinal, cardiovascular, neurological, stroke, thrombosis, anosmia and dysgeusia, ocular manifestations, nephrology, cutaneous manifestations, D-dimer, lymphocyte, anticoagulation, antivirals, convalescent plasma, immunosuppressants, corticosteroids, hydroxychloroquine, renin-angiotensin-aldosterone system, technology, diabetes mellitus, obesity, pregnancy, children, mental health, smoking, cancer, and transplant.
CONCLUSION Among the included articles, it is clear that further research is needed regarding treatment options and vaccines. With more studies, data will be less heterogeneous, and statistical analysis can be better applied to provide more robust clinical evidence. This study was not designed to give recommendations regarding the management of COVID-19.
Collapse
Affiliation(s)
- Mahmoud Nassar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Nso Nso
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mostafa Alfishawy
- Department of Infectious Diseases, Infectious Diseases Consultants and Academic Researchers of Egypt (IDCARE), Cairo 11221, Outside of the US, Egypt
| | - Anastasia Novikov
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Salim Yaghi
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Luis Medina
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Bahtiyar Toz
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sofia Lakhdar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Zarwa Idrees
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Yungmin Kim
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Dawa Ongyal Gurung
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Raheel S Siddiqui
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - David Zheng
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mariam Agladze
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Vikram Sumbly
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Jasmine Sandhu
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Francisco Cuevas Castillo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Nadya Chowdhury
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ravali Kondaveeti
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sakil Bhuiyan
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Laura Guzman Perez
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Riki Ranat
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Carlos Gonzalez
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Harangad Bhangoo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - John Williams
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Alaa Eldin Osman
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Joyce Kong
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Jonathan Ariyaratnam
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mahmoud Mohamed
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Knoxville City, TN 38103, United States
| | - Ismail Omran
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mariely Lopez
- Department of Medical, St. George's University, West Indies 38901, Grenada
| | - Akwe Nyabera
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ian Landry
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Saba Iqbal
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Anoosh Zafar Gondal
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sameen Hassan
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ahmed Daoud
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11221, Egypt
| | - Bahaaeldin Baraka
- Department of Oncology, Broomfiled Hospital, Mid and South Essex NHS Foundation Trust, ESSEX, Chelmsford 12422, United Kingdom
| | - Theo Trandafirescu
- Department of Critical Care Unit, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Vincent Rizzo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| |
Collapse
|
44
|
Abstract
The article highlights the pathogenesis, clinical manifestations of lesions of the central and peripheral nervous system that have arisen or persist in patients in the postcoid period (Long-COVID-19). Their correct assessment, the use of effective methods of complex treatment, targeted neurorehabilitation contribute to the reversibility of functional disorders, prevention, reduction of disability, improvement of quality of life indicators, prevention of the progression of cognitive, emotional, behavioral disorders initiated by SARS-CoV-2.
Collapse
|
45
|
Marziliano N, Medoro A, Mignogna D, Saccon G, Folzani S, Reverberi C, Russo C, Intrieri M. Sudden Cardiac Death Caused by a Fatal Association of Hypertrophic Cardiomyopathy ( MYH7, p.Arg719Trp), Heterozygous Familial Hypercholesterolemia ( LDLR, p.Gly343Lys) and SARS-CoV-2 B.1.1.7 Infection. Diagnostics (Basel) 2021; 11:1229. [PMID: 34359312 PMCID: PMC8307649 DOI: 10.3390/diagnostics11071229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 01/31/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) and heterozygous familial hypercholesterolemia (HeFH), two of the most common genetic cardiovascular disorders, can lead to sudden cardiac death. These conditions could be complicated by concomitant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as in the case herein described. A young amateur soccer player died in late October 2020 after a fatal arrhythmia and the autopsy revealed the presence of HCM with diffuse non-obstructive coronary disease. The molecular autopsy revealed a compound condition with a first mutation in the MYH7 gene (p.Arg719Trp) and a second mutation in the LDLR gene (p.Gly343Cys): both have already been described as associated with HCM and HeFH, respectively. In addition, molecular analyses showed the presence of SARS-CoV-2 lineage B.1.1.7 (UK variant with high titer in the myocardium. Co-segregation analysis within the family (n = 19) showed that heterozygous LDLR mutation was maternally inherited, while the heterozygous MYH7 genetic lesion was de novo. All family member carriers of the LDLR mutation (n = 13) had systematic higher LDL plasma concentrations and positive records of cardiac and vascular ischemic events at young age. Considering that HCM mutations are in themselves involved in the predisposition to malignant arrhythmogenicity and HeFH could cause higher risk of cardiac complications in SARS-CoV-2 infection, this case could represent an example of a potential SARS-CoV-2 infection role in triggering or unmasking inherited cardiovascular disease, whose combination might represent the cause of fatal arrhythmia at such a young age. Additionally, it can provide clues in dating the presence of the SARS-CoV-2 lineage B.1.1.7 in Northern Italy in the early phases of the second pandemic wave.
Collapse
Affiliation(s)
- Nicola Marziliano
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (A.M.); (D.M.); (G.S.); (C.R.); (M.I.)
- Clinical Pathology Laboratory, ASST Rhodense, Rho, 20017 Milan, Italy
| | - Alessandro Medoro
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (A.M.); (D.M.); (G.S.); (C.R.); (M.I.)
| | - Donatella Mignogna
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (A.M.); (D.M.); (G.S.); (C.R.); (M.I.)
| | - Giovanni Saccon
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (A.M.); (D.M.); (G.S.); (C.R.); (M.I.)
| | - Stefano Folzani
- Poliambulatorio Città di Collecchio, Collecchio, 43044 Parma, Italy; (S.F.); (C.R.)
| | - Claudio Reverberi
- Poliambulatorio Città di Collecchio, Collecchio, 43044 Parma, Italy; (S.F.); (C.R.)
| | - Claudio Russo
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (A.M.); (D.M.); (G.S.); (C.R.); (M.I.)
| | - Mariano Intrieri
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (A.M.); (D.M.); (G.S.); (C.R.); (M.I.)
| |
Collapse
|
46
|
Brojakowska A, Eskandari A, Bisserier M, Bander J, Garikipati VNS, Hadri L, Goukassian DA, Fish KM. Comorbidities, sequelae, blood biomarkers and their associated clinical outcomes in the Mount Sinai Health System COVID-19 patients. PLoS One 2021; 16:e0253660. [PMID: 34228746 PMCID: PMC8260001 DOI: 10.1371/journal.pone.0253660] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/10/2021] [Indexed: 01/16/2023] Open
Abstract
With the continuing rise of SARS-CoV2 infection globally and the emergence of various waves in different countries, understanding characteristics of susceptibility to infection, clinical severity, and outcomes remain vital. In this retrospective study, data was extracted for 39,539 patients from the de-identified Mount Sinai Health System COVID-19 database. We assessed the risk of mortality based on the presence of comorbidities and organ-specific sequelae in 7,032 CoV2 positive (+) patients. Prevalence of cardiovascular and metabolic comorbidities was high among SARS-CoV2+ individuals. Diabetes, obesity, coronary artery disease, hypertension, atrial fibrillation, and heart failure all increased overall mortality risk, while asthma did not. Ethnicity modified the risk of mortality associated with these comorbidities. With regards to secondary complications in the setting of infection, individuals with acute kidney injury and acute myocardial injury showed an increase in mortality risk. Cerebral infarcts and acute venous thromboembolic events were not associated with increased risk of mortality. Biomarkers for cardiovascular injury, coagulation, and inflammation were compared between deceased and survived individuals. We found that cardiac and coagulation biomarkers were elevated and fell beyond normal range more often in deceased patients. Several, but not all, inflammatory markers evaluated were increased in deceased patients. In summary, we identified comorbidities and sequelae along with peripheral blood biomarkers that were associated with elevated clinical severity and poor outcomes in COVID-19 patients. Overall, these findings detail the granularity of previously reported factors which may impact susceptibility, clinical severity, and mortality during the course of COVID-19 disease.
Collapse
Affiliation(s)
- Agnieszka Brojakowska
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Abrisham Eskandari
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Malik Bisserier
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Jeffrey Bander
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | | | - Lahouaria Hadri
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - David A. Goukassian
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Kenneth M. Fish
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| |
Collapse
|
47
|
Mester A, Benedek I, Rat N, Tolescu C, Polexa SA, Benedek T. Imaging Cardiovascular Inflammation in the COVID-19 Era. Diagnostics (Basel) 2021; 11:1114. [PMID: 34207266 DOI: 10.3390/diagnostics11061114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/29/2022] Open
Abstract
Cardiac complications are among the most frequent extrapulmonary manifestations of COVID-19 and are associated with high mortality rates. Moreover, positive SARS-CoV-2 patients with underlying cardiovascular disease are more likely to require intensive care and are at higher risk of death. The underlying mechanism for myocardial injury is multifaceted, in which the severe inflammatory response causes myocardial inflammation, coronary plaque destabilization, acute thrombotic events, and ischemia. Cardiac magnetic resonance (CMR) imaging is the non-invasive method of choice for identifying myocardial injury, and it is able to differentiate between underlying causes in various and often challenging clinical scenarios. Multimodal imaging protocols that incorporate CMR and computed tomography provide a complex evaluation for both respiratory and cardiovascular complications of SARS-CoV2 infection. This, in relation to biological evaluation of systemic inflammation, can guide appropriate therapeutic management in every stage of the disease. The use of artificial intelligence can further improve the diagnostic accuracy of these imaging techniques, thus enabling risk stratification and evaluation of prognosis. The present manuscript aims to review the current knowledge on the possible modalities for imaging COVID-related myocardial inflammation or post-COVID coronary inflammation and atherosclerosis.
Collapse
|
48
|
Fath AR, Aglan A, Varkoly KS, Eldaly AS, Beladi RN, Forlemu A, Mihyawi N, Solsi A, Israr S, Lucas AR. Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19. J Investig Med High Impact Case Rep 2021; 9:23247096211019559. [PMID: 34036814 PMCID: PMC8161849 DOI: 10.1177/23247096211019559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In this article, we report a case of a 61-year-old male who was diagnosed with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), presenting with acute respiratory distress syndrome requiring intubation and hemodynamic support, marked D-Dimer and troponin I elevation, worsening ST-elevation myocardial infarction on repeat electrocardiograms, and a negative coronary angiogram ruling out a coronary artery thrombosis or occlusion. With worsening diffuse ST-segment elevation on electrocardiograms and reduced ejection fraction on echocardiography in the setting of systemic inflammation, fulminant myocarditis was highly suspected. Despite optimal medical treatment, the patient’s condition deteriorated and was complicated by cardiac arrest that failed resuscitation. Although myocarditis was initially suspected, the autopsy revealed no evidence of myocarditis or pericarditis but did demonstrate multiple microscopic sites of myocardial ischemia together with thrombi in the left atrium and pulmonary vasculature. Additionally, scattered microscopic cardiomyocyte necrosis with pathological diagnosis of small vessel micro-thrombotic occlusions. These findings are potentially exacerbated by inflammation-induced coagulopathy, hypoxia, hypotension, and stress, that is, a multifactorial etiology. Further research and an improved understanding are needed to define the precise pathophysiology of the coagulopathic state causing widespread micro-thrombosis with subsequent myocardial and pulmonary injury.
Collapse
Affiliation(s)
| | - Amro Aglan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | | | - Alexandra R Lucas
- Creighton University, Phoenix, AZ, USA.,Arizona State University, Tempe, AZ, USA
| |
Collapse
|
49
|
Affiliation(s)
- Frederico Scuotto
- Hospital Samaritano Higienopolis, United Health Group, Sao Paulo, Brazil
| | | | | | - Rodolfo Staico
- Hospital Samaritano Higienopolis, United Health Group, Sao Paulo, Brazil
| | - Renato Samy Assad
- Hospital Samaritano Higienopolis, United Health Group, Sao Paulo, Brazil
| | - Claudio Cirenza
- Hospital Samaritano Higienopolis, United Health Group, Sao Paulo, Brazil
| |
Collapse
|
50
|
Almas T, Khedro T, Haadi A, Ahmed R, Alshaikh L, Al-Awaid AH, Panhwar MS, Hassan Virk HU. COVID-19-induced takotsubo cardiomyopathy: Venturing beyond the obvious. Ann Med Surg (Lond) 2021; 65:102291. [PMID: 33981423 PMCID: PMC8082200 DOI: 10.1016/j.amsu.2021.102291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/04/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tarek Khedro
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Abdul Haadi
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Reema Ahmed
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Lamees Alshaikh
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Muhammad Siyab Panhwar
- Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|