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Chan K, Baker J, Conroy A, Rubens M, Ramamoorthy V, Saxena A, Roy M, Jimenez J, Chaparro S. Burden of cardiovascular disease on coronavirus disease 2019 hospitalizations in the USA. Coron Artery Dis 2024:00019501-990000000-00234. [PMID: 38785219 DOI: 10.1097/mca.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Patients with cardiovascular disease (CVD) and risk factors have increased rates of adverse events and mortality after hospitalization for coronavirus disease 2019 (COVID-19). In this study, we attempted to identify and assess the effects of CVD on COVID-19 hospitalizations in the USA using a large national database. METHODS The current study was a retrospective analysis of data from the US National (Nationwide) Inpatient Sample from 2020. All adult patients 18 years of age and older who were admitted with the primary diagnosis of COVID-19 were included. The primary outcome was in-hospital mortality, while secondary outcomes included prolonged hospital length of stay, mechanical ventilation, and disposition other than home. Prolonged hospital length of stay was defined as a length of stay greater than the 75th percentile for the full sample. The diagnoses were identified using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. RESULTS A total of 1 050 040 patients were included in the study, of which 454 650 (43.3%) had prior CVD. Patients with CVD had higher mortality during COVID-19 hospitalization (19.3 vs. 5.0%, P < 0.001). Similarly, these patients had a higher rate of prolonged hospital length of stay (34.5 vs. 21.0%, P < 0.001), required mechanical ventilation (15.4 vs. 5.6%, P < 0.001), and were more likely to be discharged to a disposition other than home (62.5 vs. 32.3%, P < 0.001). Mean hospitalization cost was also higher in patients with CVD during hospitalization ($24 023 vs. $15 320, P < 0.001). Conditional logistic regression analysis showed that the odds of in-hospital mortality [odds ratio (OR), 3.23; 95% confidence interval (CI), 2.91-3.45] were significantly higher for COVID-19 hospitalizations with CVD, compared with those without CVD. Similarly, prolonged hospital length (OR, 1.82; 95% CI, 1.43-2.23), mechanical ventilation (OR, 3.31; 95% CI, 3.06-3.67), and disposition other than home (OR, 2.01; 95% CI, 1.87-2.21) were also significantly higher for COVID-19 hospitalizations with coronary artery disease. CONCLUSION Our study showed that the presence of CVD has a significant negative impact on the prognosis of patients hospitalized for COVID-19. There was an associated increase in mortality, length of stay, ventilator use, and adverse discharge dispositions among COVID-19 patients with CVD. Adjustment in treatment for CVD should be considered when providing care to patients hospitalized for COVID-19 to mitigate some of the adverse hospital outcomes.
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Affiliation(s)
- Kelvin Chan
- Department of Internal Medicine, Nova Southeastern University, Fort Lauderdale
| | - Jiana Baker
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University
| | - Abigail Conroy
- Department of Internal Medicine, Nova Southeastern University, Fort Lauderdale
| | - Muni Rubens
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University
- Department of Heart Failure, Miami Cardiac and Vascular Medicine, Baptist Health South Florida, Miami, Florida, USA
- Universidad Espiritu Santo, Guayaquil, Ecuador
| | | | - Anshul Saxena
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA
| | - Mukesh Roy
- Department of Heart Failure, Miami Cardiac and Vascular Medicine, Baptist Health South Florida, Miami, Florida, USA
| | - Javier Jimenez
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University
- Department of Heart Failure, Miami Cardiac and Vascular Medicine, Baptist Health South Florida, Miami, Florida, USA
| | - Sandra Chaparro
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University
- Department of Heart Failure, Miami Cardiac and Vascular Medicine, Baptist Health South Florida, Miami, Florida, USA
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Artan AS, Dirim AB, Yavuzkilic H, Demir E, Oto OA, Guller N, Safak S, Yazici H, Turkmen A. Thromboembolic complications after COVID-19 in kidney transplant recipients. Nephrology (Carlton) 2024; 29:39-47. [PMID: 37731224 DOI: 10.1111/nep.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/20/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023]
Abstract
AIM Increased venous thrombosis and arterial embolism rates are observed in the general population during or after COVID-19. Data regarding the kidney transplant population are scarce. In this study, we aim to investigate the thrombotic complications and risk factors associated with thrombotic complications in kidney transplant patients. METHODS This retrospective observational study included adult kidney transplant recipients diagnosed with COVID-19 between March 2020 and June 2022. The endpoint was the occurrence of thromboembolic events. RESULTS Four hundred and sixty-nine patients were followed for a median of 10.8 months after COVID-19. Forty patients (8.5%) died. Thromboembolic complications developed in 51 (11.9%) of the surviving patients. Twenty-four patients with thromboembolic events were receiving prophylactic anticoagulation before the event. The patients with mild, moderate, and severe COVID-19 were 292, 129, and 48, respectively. Patients with moderate COVID-19 had a significantly higher percentage of thromboembolic complications than patients with mild COVID-19. Older age, prior heart disease, and moderate COVID-19 were significantly associated with thromboembolic events. The incidence of thromboembolic events after COVID-19 is 10.9 per 100 patient-year. CONCLUSION Thromboembolic complications were observed at increased rates in kidney transplant recipients after COVID-19. Therefore, prospective and cohort studies for post-COVID-19 complications regarding the treatment modalities are urgently needed.
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Affiliation(s)
- Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | - Halil Yavuzkilic
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Erol Demir
- Koç University Transplant Immunology Research Center of Excellence, Koç University Hospital, Koç University, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nurana Guller
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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Koutalos AA, Ntalouka MP, Angelis FA, Hantes M, Arnaoutoglou E. Venous thromboembolism and major adverse cardiovascular events in patients with hip fractures suffering from SARS-CoV-2 infection: a systematic review. Hip Int 2023; 33:1122-1132. [PMID: 36285337 PMCID: PMC9597278 DOI: 10.1177/11207000221132489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 09/05/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Hip fractures represent 1 of the most common injuries in older adults. They are associated with increased perioperative morbidity and mortality. Additionally, current research suggests that SARS-COV-2 infection may worsen the prognosis of the hip fracture patients who undergo hip fixation. The aims of the present study were: (1) to determine the rate of specific adverse events including VTE (venous thromboembolism) and major adverse cardiovascular events (MACEs) in patients with hip fracture and concomitant SARS-CoV-2 infection undergoing surgery; and (2) to examine if the aforementioned population is at increased risk for VTE and MACEs, when compared to SARS-CoV-2 free patients with hip fracture. METHODS PubMed, EMBASE, Cochrane, Web of Science, Google scholar and medRxiv were searched from March 2020 to January 2021 for English language studies with patients suffering from hip fractures and SARS-COV-2 -CoV-2. 2 researchers were involved in the data extraction and the quality assessment of the studies respectively. RESULTS The literature search yielded a total of 1256 articles of which 14 were included in the systematic review and 7 in the meta-analysis respectively. The estimated pooled rate for VTE and MACE were 4.3% and 6.3% respectively. Patients with hip fracture and concomitant SARS-CoV-2 infection who undergo surgery are at increased risk for VTE, when compared to SARS-CoV-2 free patients (odds ratio 2.8 [95% CI, 1.1-7.1]). These patients are also at increased risk for MACE postoperatively as indicated by the odds ratio 2.4 (95% CI, 1.0-5.8). The quality of the studies was moderate. CONCLUSIONS Although there is a lack of high-quality data it seems that patients with hip fractures and concomitant SARS-CoV-2 infection are facing a 2.8 and 2.4 times increased risk for VTE and MACE.
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Affiliation(s)
- Antonios A Koutalos
- Department of Orthopaedic Surgery and
Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University
of Thessaly, Larissa, Greece
| | - Maria P Ntalouka
- Department of Anaesthesiology, Faculty
of Medicine, School of Health Sciences, University of Thessaly, Larissa,
Greece
| | - Fragkiskos A Angelis
- Department of Orthopaedic Surgery and
Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University
of Thessaly, Larissa, Greece
| | - Michael Hantes
- Department of Orthopaedic Surgery and
Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University
of Thessaly, Larissa, Greece
| | - Eleni Arnaoutoglou
- Department of Anaesthesiology, Faculty
of Medicine, School of Health Sciences, University of Thessaly, Larissa,
Greece
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Bikdeli B, Khairani CD, Krishnathasan D, Bejjani A, Armero A, Tristani A, Davies J, Porio N, Assi AA, Nauffal V, Campia U, Almarzooq Z, Wei E, Achanta A, Jesudasen SJ, Tiu BC, Merli GJ, Leiva O, Fanikos J, Sharma A, Vishnevsky A, Hsia J, Nehler MR, Welker J, Bonaca MP, Carroll BJ, Lan Z, Goldhaber SZ, Piazza G. Major cardiovascular events after COVID-19, event rates post-vaccination, antiviral or anti-inflammatory therapy, and temporal trends: Rationale and methodology of the CORONA-VTE-Network study. Thromb Res 2023; 228:94-104. [PMID: 37302267 PMCID: PMC10226776 DOI: 10.1016/j.thromres.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is associated with excess risk of cardiovascular and thrombotic events in the early post-infection period and during convalescence. Despite the progress in our understanding of cardiovascular complications, uncertainty persists with respect to more recent event rates, temporal trends, association between vaccination status and outcomes, and findings within vulnerable subgroups such as older adults (aged 65 years or older), or those undergoing hemodialysis. Sex-informed findings, including results among pregnant and breastfeeding women, as well as adjusted comparisons between male and female adults are similarly understudied. METHODS Adult patients, aged ≥18 years, with polymerase chain reaction-confirmed COVID-19 who received inpatient or outpatient care at the participating centers of the registry are eligible for inclusion. A total of 10,000 patients have been included in this multicenter study, with Brigham and Women's Hospital (Boston, MA) serving as the coordinating center. Other sites include Beth Israel Deaconess Medical Center, Anne Arundel Medical Center, University of Virginia Medical Center, University of Colorado Health System, and Thomas Jefferson University Health System. Data elements will be ascertained manually for accuracy. The two main outcomes are 1) a composite of venous or arterial thrombotic events, and 2) a composite of major cardiovascular events, defined as venous or arterial thrombosis, myocarditis or heart failure with inpatient treatment, new atrial fibrillation/flutter, or cardiovascular death. Clinical outcomes are adjudicated by independent physicians. Vaccination status and time of inclusion in the study will be ascertained for subgroup-specific analyses. Outcomes are pre-specified to be reported separately for hospitalized patients versus those who were initially receiving outpatient care. Outcomes will be reported at 30-day and 90-day follow-up. Data cleaning at the sites and the data coordinating center and outcomes adjudication process are in-progress. CONCLUSIONS The CORONA-VTE-Network study will share contemporary information related to rates of cardiovascular and thrombotic events in patients with COVID-19 overall, as well as within key subgroups, including by time of inclusion, vaccination status, patients undergoing hemodialysis, the elderly, and sex-informed analyses such as comparison of women and men, or among pregnant and breastfeeding women.
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Affiliation(s)
- Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Cardiovascular Research Foundation (CRF), New York, NY, USA
| | - Candrika D Khairani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Darsiya Krishnathasan
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Antoine Bejjani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andre Armero
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony Tristani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Julia Davies
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole Porio
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali A Assi
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Victor Nauffal
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Umberto Campia
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zaid Almarzooq
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric Wei
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aditya Achanta
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sirus J Jesudasen
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Bruce C Tiu
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Geno J Merli
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Orly Leiva
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - John Fanikos
- Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aditya Sharma
- Department of Medicine, Cardiovascular Medicine, University of Virginia Health, Charlottesville, VA, USA
| | - Alec Vishnevsky
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Judith Hsia
- CPC Clinical Research, Aurora, CO, USA; Department of Medicine, University of Colorado, Aurora, CO, USA
| | | | - James Welker
- Anne Arundel Research Institute, Annapolis, MD, USA
| | - Marc P Bonaca
- CPC Clinical Research, Aurora, CO, USA; Department of Medicine, University of Colorado, Aurora, CO, USA
| | - Brett J Carroll
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Zhou Lan
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Clinical Investigation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Samuel Z Goldhaber
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Piazza
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Bhoelan S, Codreanu C, Tichelaar V, Borjas Howard J, Meijer K. Exploring heterogeneity in reported venous thromboembolism risk in COVID-19 and comparison to other viral pneumonias: a systematic review and meta-regression. Res Pract Thromb Haemost 2023; 7:102146. [PMID: 37663366 PMCID: PMC10470259 DOI: 10.1016/j.rpth.2023.102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 09/05/2023] Open
Abstract
Background Sources of heterogeneity in venous thromboembolism (VTE) risk in COVID-19 are unclear and comparisons to other viruses are lacking. Objectives To describe VTE risk in patients with COVID-19, explore sources of heterogeneity, and make comparisons with other viral pneumonia. Methods PubMed and Embase data were searched on March 14, 2021, for studies on VTE in adults hospitalized with viral pneumonia. VTE risk estimates were pooled in a random effects meta-analysis stratified by virus type. Heterogeneity in COVID-19 was explored in multivariable meta-regression. Results Seventy studies in COVID-19 (intensive care [ICU] [47] vs ward [23]), 4 studies in seasonal influenza (ICU [3] vs ward [1]), 2 ICU studies in H1N1 and 1 ICU study in SARS-CoV-1 were included. For COVID-19 ICU, pooled VTE risk was 19.6% (95% confidence interval [CI], 16.2%-23.5; I2 = 92.8%) for nonscreening studies and 30.0% (95% CI, 17.9%-45.7%; I2 = 81.9%) for screening studies. For COVID-19 ward, pooled VTE risk was 3.4% (95% CI, 2.4%-4.7%; I2 = 91.3%) and 22.5% (95% CI, 10.2%-42.7%; I2 = 91.6%) for nonscreening and screening studies, respectively. Higher sample size was associated with lower VTE risk. Pooled VTE risk in seasonal influenza and H1N1 at ICU were 9.0% (95% CI, 5.6%-14.2%; I2 = 39.7%) and 29.2% (95% CI, 8.7%-64.2%; I2 = 77.9%), respectively. At ward, VTE risk of seasonal influenza was 2.4% (95% CI, 2.1%-2.7%). In SARS-CoV-1, VTE risk was 47.8% (95% CI, 34.0-62.0). Conclusion Pooled risk estimates in COVID-19 should be interpreted cautiously as a high degree of heterogeneity is present, which hinders comparison to other viral pneumonia. The association of VTE risk in COVID-19 to sample size suggests publication bias.
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Affiliation(s)
- Soerajja Bhoelan
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Catalina Codreanu
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Vladimir Tichelaar
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Jaime Borjas Howard
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Karina Meijer
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Tiemtore-Kambou BMA, Ouédraogo A, Aziz Dao SB, N’dama Sieba IF, Koama A, Séif Traoré I, Napon S, Ouédraogo W, Desiré Sankara H, Cissé R, Dienderé É. CT-Angiographic Aspects of Pulmonary Embolism on SARS COV-2. J Belg Soc Radiol 2023; 107:22. [PMID: 37034109 PMCID: PMC10077993 DOI: 10.5334/jbsr.3021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/23/2023] [Indexed: 04/07/2023] Open
Abstract
Objectives To study pulmonary embolism during COVID-19 pneumonia. Patients and Methods This was a one-year retrospective and descriptive study of all patients from three imaging sites with SARS-CoV2 infection. Results Two hundred and thirty-nine patients were included. The prevalence of pulmonary embolism was 18.4%. The average age was 55 years old. The sex ratio was 1.65. Dyspnea (58.6%), cough (56.1%), and chest pain (40.2%) were the most common reasons for consultation. In 151 patients (63.2%), chest computed tomography (CT) angiography was performed without checking level of D-dimer. The level of D-dimers was elevated in 47.8%. Grade 5 of CO-RADS accounted for 62.3%. In 70.5% of cases, the pulmonary embolism was bilateral with subsegmental involvement in 47.7%. Condensation in ‘ground glass’ with ‘crazy paving’ were the predominant typical parenchymal lesions with a frequency of 93.7% and 59.4%. In univariate analysis, D-dimers were significantly associated with the occurrence of pulmonary embolism (p < 0.001). Male sex was associated with a non-significantly higher Risk of having a pulmonary embolism (1.18 95% CI: 0.61–2.31, p = 0.622). The critical level increased the risk of pulmonary embolism in a non-significant way. Only the high level of D-dimers was and this, in a significant way. Conclusion Pulmonary embolism was increased in the context of SARS-CoV2. The chest CT-angiography associated with the dosage of D-dimers constitutes a good diagnostic arsenal.
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Cardiovascular Complications of Viral Respiratory Infections and COVID-19. Biomedicines 2022; 11:biomedicines11010071. [PMID: 36672579 PMCID: PMC9856218 DOI: 10.3390/biomedicines11010071] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
Viral respiratory infections (VRI) are the most prevalent type of infectious diseases and constitute one of the most common causes of contact with medical care. Regarding the pathophysiology of the cardiovascular system, VRI can not only exacerbate already existing chronic cardiovascular disease (such as coronary artery disease or heart failure) but also trigger new adverse events or complications (e.g., venous thromboembolism), the latter particularly in subjects with multimorbidity or disease-related immobilization. In the current paper, we provide a narrative review of diverse cardiovascular complications of VRI as well as summarize available data on the pathology of the circulatory system in the course of coronavirus disease 2019 (COVID-19).
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Barazzoni R, Bischoff SC, Busetto L, Cederholm T, Chourdakis M, Cuerda C, Delzenne N, Genton L, Schneider S, Singer P, Boirie Y. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clin Nutr 2022; 41:2869-2886. [PMID: 34140163 PMCID: PMC8110326 DOI: 10.1016/j.clnu.2021.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 01/27/2023]
Abstract
The COVID-19 pandemics has created unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Among other important risk factors for severe COVID-19 outcomes, obesity has emerged along with undernutrition-malnutrition as a strong predictor of disease risk and severity. Obesity-related excessive body fat may lead to respiratory, metabolic and immune derangements potentially favoring the onset of COVID-19 complications. In addition, patients with obesity may be at risk for loss of skeletal muscle mass, reflecting a state of hidden malnutrition with a strong negative health impact in all clinical settings. Also importantly, obesity is commonly associated with micronutrient deficiencies that directly influence immune function and infection risk. Finally, the pandemic-related lockdown, deleterious lifestyle changes and other numerous psychosocial consequences may worsen eating behaviors, sedentarity, body weight regulation, ultimately leading to further increments of obesity-associated metabolic complications with loss of skeletal muscle mass and higher non-communicable disease risk. Therefore, prevention, diagnosis and treatment of malnutrition and micronutrient deficiencies should be routinely included in the management of COVID-19 patients in the presence of obesity; lockdown-induced health risks should also be specifically monitored and prevented in this population. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing clinical practice guidance for nutritional management of COVID-19 patients with obesity in various clinical settings.
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Affiliation(s)
- Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy,Azienda sanitaria universitaria Giuliano Isontina (ASUGI), Cattinara Hospital, Trieste, Italy,Corresponding author. Department of Medical, Surgical and Health Sciences and Azienda sanitaria universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, Strada di Fiume 447, Trieste, Italy
| | - Stephan C. Bischoff
- Department of Nutritional Medicine and Prevention, University of Hohenheim, Stuttgart, Germany
| | - Luca Busetto
- Department of Medicine, University of Padova, Italy
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Laurence Genton
- Clinical Nutrition, Geneva University Hospitals, Geneva, Switzerland
| | - Stephane Schneider
- Gastroenterology and Nutrition, Nice University Hospital, Université Côte d’Azur, Nice, France
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel
| | - Yves Boirie
- Department of Clinical Nutrition, CHU Clermont-Ferrand, University of Clermont Auvergne, Human Nutrition Unit, CRNH Auvergne, F-63000, Clermont-Ferrand, France
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Olsen FJ, Lassen MCH, Skaarup KG, Christensen J, Davidovski FS, Alhakak AS, Sengeløv M, Nielsen AB, Johansen ND, Graff C, Bundgaard H, Hassager C, Jabbari R, Carlsen J, Kirk O, Lindholm MG, Wiese L, Kristiansen OP, Nielsen OW, Lindegaard B, Tønder N, Ulrik CS, Lamberts M, Sivapalan P, Gislason G, Iversen K, Jensen JUS, Schou M, Svendsen JH, Aalen JM, Smiseth OA, Remme EW, Biering-Sørensen T. Myocardial Work in Patients Hospitalized With COVID-19: Relation to Biomarkers, COVID-19 Severity, and All-Cause Mortality. J Am Heart Assoc 2022; 11:e026571. [PMID: 36129046 DOI: 10.1161/jaha.122.026571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background COVID-19 infection has been hypothesized to affect left ventricular function; however, the underlying mechanisms and the association to clinical outcome are not understood. The global work index (GWI) is a novel echocardiographic measure of systolic function that may offer insights on cardiac dysfunction in COVID-19. We hypothesized that GWI was associated with disease severity and all-cause death in patients with COVID-19. Methods and Results In a multicenter study of patients admitted with COVID-19 (n=305), 249 underwent pressure-strain loop analyses to quantify GWI at a median time of 4 days after admission. We examined the association of GWI to cardiac biomarkers (troponin and NT-proBNP [N-terminal pro-B-type natriuretic peptide]), disease severity (oxygen requirement and CRP [C-reactive protein]), and all-cause death. Patients with elevated troponin (n=71) exhibited significantly reduced GWI (1508 versus 1707 mm Hg%; P=0.018). A curvilinear association to NT-proBNP was observed, with increasing NT-proBNP once GWI decreased below 1446 mm Hg%. Moreover, GWI was significantly associated with a higher oxygen requirement (relative increase of 6% per 100-mm Hg% decrease). No association was observed with CRP. Of the 249 patients, 37 died during follow-up (median, 58 days). In multivariable Cox regression, GWI was associated with all-cause death (hazard ratio, 1.08 [95% CI, 1.01-1.15], per 100-mm Hg% decrease), but did not increase C-statistics when added to clinical parameters. Conclusions In patients admitted with COVID-19, our findings indicate that NT-proBNP and troponin may be associated with lower GWI, whereas CRP is not. GWI was independently associated with all-cause death, but did not provide prognostic information beyond readily available clinical parameters. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04377035.
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Huang D, Yang H, Yu H, Wang T, Chen Z, Yao R, Liang Z. A prediction model for major adverse cardiovascular events (MACE) in patients with coronavirus disease 2019 (COVID-19). BMC Pulm Med 2022; 22:343. [PMID: 36096832 PMCID: PMC9466355 DOI: 10.1186/s12890-022-02143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Emerging evidence shows that cardiovascular injuries and events in coronavirus disease 2019 (COVID-19) should be considered. The current study was conducted to develop an early prediction model for major adverse cardiovascular events (MACE) during hospitalizations of COVID-19 patients. Methods This was a retrospective, multicenter, observational study. Hospitalized COVID-19 patients from Wuhan city, Hubei Province and Sichuan Province, China, between January 14 and March 9, 2020, were randomly divided into a training set (70% of patients) and a testing set (30%). All baseline data were recorded at admission or within 24 h after admission to hospitals. The primary outcome was MACE during hospitalization, including nonfatal myocardial infarction, nonfatal stroke and cardiovascular death. The risk factors were selected by LASSO regression and multivariate logistic regression analysis. The nomogram was assessed by calibration curve and decision curve analysis (DCA). Results Ultimately, 1206 adult COVID-19 patients were included. In the training set, 48 (5.7%) patients eventually developed MACE. Six factors associated with MACE were included in the nomogram: age, PaO2/FiO2 under 300, unconsciousness, lymphocyte counts, neutrophil counts and blood urea nitrogen. The C indices were 0.93 (95% CI 0.90, 0.97) in the training set and 0.81 (95% CI 0.70, 0.93) in the testing set. The calibration curve and DCA demonstrated the good performance of the nomogram. Conclusions We developed and validated a nomogram to predict the development of MACE in hospitalized COVID-19 patients. More prospective multicenter studies are needed to confirm our results. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02143-3.
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Affiliation(s)
- Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Huan Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - He Yu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Ting Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zhu Chen
- Department of Infectional Inpatient Ward Two, Chengdu Public Health Clinical Medical Center, Chengdu, Sichuan, China
| | - Rong Yao
- Department of Emergency Medicine, Emergency Medical Laboratory, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China. .,Disaster Medical Center, Sichuan University, Chengdu, Sichuan, China.
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
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11
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Tang Q, Gao L, Tong Z, Li W. Hyperlipidemia, COVID-19 and acute pancreatitis: A tale of three entities. Am J Med Sci 2022; 364:257-263. [PMID: 35381217 PMCID: PMC8977370 DOI: 10.1016/j.amjms.2022.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/04/2022] [Accepted: 03/30/2022] [Indexed: 01/09/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the ongoing pandemic of coronavirus disease 2019 (COVID-19), which presented as not only respiratory symptoms, but various digestive manifestations including pancreatic injury and acute pancreatitis (AP). The underlying mechanism is still unclear. Hypertriglyceridemia has become one of the leading causes of AP in recent years and hyperlipidemia is highly reported in COVID-19 cases. The current narrative review aimed to explore the associations between AP, COVID-19 and hyperlipidemia. Substantial cases of COVID-19 patients complicated with AP were reported, while the incidence of AP in the COVID-19 population was relatively low. Hyperlipidemia was common in COVID-19 patients with a pooled incidence of 32.98%. Hyperlipidemia could be a mediating factor in the pathogenesis of AP in COVID-19 patients. Further studies are warranted to clarify the relationship among AP, lipid metabolism disorders and COVID-19.
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Affiliation(s)
- Qiuyi Tang
- Medical School, Southeast University, Nanjing, Jiangsu, China; Center of Severe Acute Pancreatitis (CSAP), Department of Intensive Care Unit, Jinling Hospital, Nanjing, Jiangsu, China
| | - Lin Gao
- Center of Severe Acute Pancreatitis (CSAP), Department of Intensive Care Unit, Jinling Hospital, Nanjing, Jiangsu, China
| | - Zhihui Tong
- Center of Severe Acute Pancreatitis (CSAP), Department of Intensive Care Unit, Jinling Hospital, Nanjing, Jiangsu, China.
| | - Weiqin Li
- Medical School, Southeast University, Nanjing, Jiangsu, China; Center of Severe Acute Pancreatitis (CSAP), Department of Intensive Care Unit, Jinling Hospital, Nanjing, Jiangsu, China.
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12
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Kerolos MM, Ruge M, Gill A, Planek MI, Volgman AS, Du-Fay-De-Lavallaz JM, Gomez JMD, Suboc TM, Williams KA, Abusin S. Clinical outcomes of COVID-19 infection in patients with pre-existing cardiovascular disease. AMERICAN HEART JOURNAL PLUS: CARDIOLOGY RESEARCH AND PRACTICE 2022; 20:100189. [PMID: 35946042 PMCID: PMC9354393 DOI: 10.1016/j.ahjo.2022.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 01/08/2023]
Abstract
Introduction Patients with pre-existing cardiovascular disease may carry a higher risk for mortality from COVID-19. This study examined the association between individuals with pre-existing cardiovascular disease admitted for COVID-19 and their clinical outcomes. Methods A retrospective cohort study was conducted on patients admitted with COVID-19 to Rush University System for Health (RUSH) to identify cardiovascular risk factors associated with increased mortality and major adverse cardiovascular events (MACE; a composite of cardiovascular death, stroke, myocardial injury, and heart failure exacerbation). Multivariable logistic regression was used to adjust for demographic data and comorbid conditions. Results Of the 1682 patients who met inclusion criteria, the median age was 59. Patients were predominantly African American (34.4 %) and male (54.5 %). Overall, 202 (12 %) patients suffered 60-day mortality. In the multivariable model that assessed risk factors for 60-day mortality, age 60–74 (adjusted odds ratio [aOR] 3.30 [CI: 1.23–10.62]; p < 0.05) and age 75–100 (aOR 4.52 [CI: 1.46–16.15]; p < 0.05) were significant predictors when compared to those aged 19 to 39. This model also showed that those with past medical histories of atrial fibrillation (aOR 2.47 [CI: 1.38–4.38]; p < 0.01) and venous thromboembolism (aOR 2.00 [CI: 1.12–3.50]; p < 0.05) were at higher risk of 60-day mortality. Conclusion In this cohort, patients over 60 years old with a pre-existing history of atrial fibrillation and venous thromboembolism were at increased risk of mortality from COVID-19.
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13
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Cardiovasc Res 2022; 118:1385-1412. [PMID: 34864874 PMCID: PMC8690255 DOI: 10.1093/cvr/cvab342] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular disease (CVD) in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, reported here, focuses on the epidemiology, pathophysiology, and diagnosis of cardiovascular (CV) conditions that may be manifest in patients with COVID-19. The second part, which will follow in a later edition of the journal, addresses the topics of care pathways, treatment, and follow-up of CV conditions in patients with COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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Affiliation(s)
- Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Freiburgstrasse 4, 3010 Bern, Switzerland
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Hospital Clínic
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- ECGen, the Cardiogenetics Focus Group of EHRA
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
- Yale University School of Medicine, New Haven, CT, USA
| | - Elijah R Behr
- ECGen, the Cardiogenetics Focus Group of EHRA
- Cardiology Clinical Academic Group, Institute of Molecular and Clinical Sciences, St George's, University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | - Sergio Berti
- U.O.C. Cardiologia Diagnostica e Interventistica, Dipartimento Cardiotoracico, Fondazione Toscana G. Monasterio - Ospedale del Cuore G. Pasquinucci, Massa, Italy
| | - Héctor Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Davide Capodanno
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco" University of Catania, Catania, Italy
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Center, IRCCS Gruppo MultiMedica, Sesto San Giovanni, Milan, Italy
| | | | - Jean-Philippe Collet
- Sorbonne Université, ACTION study group, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Thomas Cuisset
- Département de Cardiologie, CHU Timone, Marseille, France
- INSERM, UMR1062, Nutrition, Obesity and Risk of Thrombosis, Marseille, France
- Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Hypertension Research Center, Federico II University Hospital, Naples, Italy
| | - Victoria Delgado
- Heart Lung Centrum, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Uhasselt, Diepenbeek, Belgium
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
- Maria Cecilia Hospital, GVM Care&Research, Cotignola (RA), Ravenna, Italy
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Arif Elvan
- Isala Heart Center, Zwolle, The Netherlands
| | - José R González-Juanatey
- Cardiology Department, University Hospital, IDIS, CIBERCV, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mauro Gori
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
| | - Diederick Grobbee
- Julius Global Health, the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Medicine, Jagiellonian University College of Medicine, Kraków, Poland
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Gerhard Hindricks
- Department of Internal Medicine/Cardiology/Electrophysiology, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
- Leipzig Heart Institute (LHI), Leipzig, Germany
| | - Borja Ibanez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Nicole Karam
- Université de Paris, PARCC, INSERM, Paris, France
- European Hospital Georges Pompidou, Paris, France
| | - Hugo Katus
- Department of Internal Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Fredrikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ulf Landmesser
- Department of Cardiology, Charite University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | | | - Sergio Leonardi
- University of Pavia, Pavia, Italy
- Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | | | - Josepa Mauri
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Health Department of the Government of Catalonia, Barcelona, Spain
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Nuccia Morici
- Unità di Cure Intensive Cardiologiche e De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi, Milan, Italy
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anna Sonia Petronio
- Cardiothoracic and Vascular Department, University of Pisa, Ospedale Cisanello, Pisa, Italy
| | - Marija M Polovina
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Tatjana Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Intensive Arrhythmia Care, Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | | | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Susanna Price
- Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College, London, UK
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Oriol Rodríguez-Leor
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Health Department of the Government of Catalonia, Barcelona, Spain
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Rafael Romaguera
- Servicio de Cardiología, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine (Cardiology) and Cologne Cardiovascular Research Center (CCRC), Heart Center at the University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Andrea Sarkozy
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Uhasselt, Diepenbeek, Belgium
| | - Petar Seferovic
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Michele Senni
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
| | - Francesco R Spera
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, Pieve Emanuele - Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano - Milan, Italy
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute (LHI), Leipzig, Germany
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luccia Torracca
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, Pieve Emanuele - Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano - Milan, Italy
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Arthur A Wilde
- ECGen, the Cardiogenetics Focus Group of EHRA
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
- Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
- Department of Clinical Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London, London, UK
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14
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Abstract
Purpose of this Review We discuss the role of observational studies and cardiac registries during the COVID-19 pandemic. We focus on published cardiac registries and highlight contributions to the field that have had clinical implications. Recent Findings We included observational studies of COVID-19 patients published in peer-reviewed medical journals with defined inclusion and exclusion criteria, defined study design, and primary outcomes. A PubMed and MEDLINE literature review results in 437 articles, of which 52 include patients with COVID-19 with cardiac endpoints. From July 2020 to December 2021, the average time from last data collected to publication was 8.9 ± 4.1 months, with an increasing trend over time (R = 0.9444, p < 0.0001). Of the 52 articles that met our inclusion criteria, we summarize main findings of 4 manuscripts on stroke, 14 on acute coronary syndrome, 4 on cardiac arrest, 7 on heart failure, 7 on venous thromboembolism, 5 on dysrhythmia, and 11 on different populations at risk for cardiovascular. Summary Registries are cost effective, not disruptive to essential health services, and can be rapidly disseminated with short intervals between last data point collected and publication. In less than 2 years, cardiac registries have filled important gaps in knowledge and informed the care of COVID-19 patients with cardiovascular conditions. Supplementary Information The online version contains supplementary material available at 10.1007/s11886-022-01686-5.
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15
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Eur Heart J 2022; 43:1033-1058. [PMID: 34791157 PMCID: PMC8690026 DOI: 10.1093/eurheartj/ehab696] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/08/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular disease (CVD) in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, reported here, focuses on the epidemiology, pathophysiology, and diagnosis of cardiovascular (CV) conditions that may be manifest in patients with COVID-19. The second part, which will follow in a later edition of the journal, addresses the topics of care pathways, treatment, and follow-up of CV conditions in patients with COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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16
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Polcwiartek C, Krogager ML, Andersen MP, Butt JH, Pallisgaard J, Fosbøl E, Schou M, Bhatt DL, Singh A, Køber L, Gislason GH, Bang CN, Torp-Pedersen C, Kragholm K, Pareek M. Prognostic implications of serial high-sensitivity cardiac troponin testing among patients with COVID-19: A Danish nationwide registry-based cohort study. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 14:100131. [PMID: 35463196 PMCID: PMC9013153 DOI: 10.1016/j.ahjo.2022.100131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023]
Abstract
Background Although troponin elevation is associated with worse outcomes among patients with coronavirus disease 2019 (COVID-19), prognostic implications of serial troponin testing are lacking. We investigated the association between serial troponin measurements and adverse COVID-19 outcomes. Methods Using Danish registries, we identified COVID-19 patients with a high-sensitivity troponin measurement followed by a second measurement within 1–24 h. All measurements during follow-up were also utilized in subsequent time-varying analyses. We assessed all-cause mortality associated with the absence/presence of myocardial injury (≥1 troponin measurement >99th percentile upper reference limit) and absence/presence of dynamic troponin changes (>20% relative change if first measurement elevated, >50% relative change if first measurement normal). Results Of 346 included COVID-19 patients, 56% had myocardial injury. Overall, 20% had dynamic troponin changes. In multivariable Cox regression models, myocardial injury was associated with all-cause mortality (HR = 2.56, 95%CI = 1.46–4.51), as were dynamic troponin changes (HR = 1.66, 95%CI = 1.04–2.64). We observed a low incidence of myocardial infarction (4%) and invasive coronary procedures (4%) among patients with myocardial injury. Conclusions Myocardial injury and dynamic troponin changes determined using serial high-sensitivity troponin testing were associated with poor prognosis among patients with COVID-19. The risk of developing myocardial infarction requiring invasive management during COVID-19 hospitalization was low.
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Affiliation(s)
- Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Maria L Krogager
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Mikkel P Andersen
- Department of Clinical Research and Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Jawad H Butt
- The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jannik Pallisgaard
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Emil Fosbøl
- The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Avinainder Singh
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
- Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
| | - Lars Køber
- The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Casper N Bang
- Department of Cardiology, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Research and Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Manan Pareek
- Department of Clinical Research and Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
- Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
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17
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Tan Z, Huang S, Mei K, Liu M, Ma J, Jiang Y, Zhu W, Yu P, Liu X. The Prevalence and Associated Death of Ventricular Arrhythmia and Sudden Cardiac Death in Hospitalized Patients With COVID-19: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 8:795750. [PMID: 35127861 PMCID: PMC8814312 DOI: 10.3389/fcvm.2021.795750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/07/2021] [Indexed: 12/31/2022] Open
Abstract
Background Arrhythmia is a very common complication of coronavirus disease 2019 (COVID-19); however, the prevalence of ventricular arrhythmia and associated outcomes are not well-explored. Here, we conducted a systematic review and meta-analysis to determine the prevalence and associated death of ventricular arrhythmia and sudden cardiac death (SCD) in patients with COVID-19. Methods Databases of PubMed, Cochrane Library, Embase, and MdeRxiv were searched. Studies that could calculate the prevalence of ventricular arrhythmia/SCD during hospital admission or associated death in patients with COVID-19 were included. The study was registered with the PROSPERO (CRD42021271328). Results A total of 21 studies with 13,790 patients were included. The pooled prevalence of ventricular arrhythmia was 5% (95% CI: 4–6%), with a relatively high-SCD prevalence (1.8% in hospitalized COVID-19 and 10% in deceased cases of COVID-19). Subgroup analysis showed that ventricular arrhythmia was more common in patients with elevated cardiac troponin T [ES (effect size): 10%, 95% CI: −0.2 to 22%] and in European (ES: 20%, 95% CI: 11–29%) populations. Besides, ventricular arrhythmia was independently associated with an increased risk of death in patients with COVID-19 [odds ratio (OR) = 2.83; 95% CI: 1.78–4.51]. Conclusion Ventricular arrhythmia and SCD resulted as a common occurrence with a high prevalence in patients with COVID-19 admitted to the hospital. Furthermore, ventricular arrhythmia significantly contributed to an increased risk of death in hospitalized patients with COVID-19. Clinicians might be vigilant of ventricular arrhythmias for patients with COVID-19, especially for severe cases. Systematic Review Registration www.york.ac.uk/inst/crd, identifier: CRD42021271328.
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Affiliation(s)
- Ziqi Tan
- Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shan Huang
- Department of Psychiatry, The Third People's Hospital of Ganzhou, Ganzhou, China
| | - Kaibo Mei
- Department of Anesthesiology, The People's Hospital of Shangrao, Shangrao, China
| | - Menglu Liu
- Department of Cardiology, The Seventh People's Hospital of Zhengzhou, Zhengzhou, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Yuan Jiang
- Department of Pharmacy, Harbin Medical University, Harbin, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Peng Yu
- Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Peng Yu
| | - Xiao Liu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Xiao Liu
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18
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Prabhakaran D, Singh K, Kondal D, Raspail L, Mohan B, Kato T, Sarrafzadegan N, Talukder SH, Akter S, Amin MR, Goma F, Gomez-Mesa J, Ntusi N, Inofomoh F, Deora S, Philippov E, Svarovskaya A, Konradi A, Puentes A, Ogah OS, Stanetic B, Issa A, Thienemann F, Juzar D, Zaidel E, Sheikh S, Ojji D, Lam CSP, Ge J, Banerjee A, Newby LK, Ribeiro ALP, Gidding S, Pinto F, Perel P, Sliwa K. Cardiovascular Risk Factors and Clinical Outcomes among Patients Hospitalized with COVID-19: Findings from the World Heart Federation COVID-19 Study. Glob Heart 2022; 17:40. [PMID: 35837356 PMCID: PMC9205371 DOI: 10.5334/gh.1128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/19/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Limited data exist on the cardiovascular manifestations and risk factors in people hospitalized with COVID-19 from low- and middle-income countries. This study aims to describe cardiovascular risk factors, clinical manifestations, and outcomes among patients hospitalized with COVID-19 in low, lower-middle, upper-middle- and high-income countries (LIC, LMIC, UMIC, HIC). METHODS Through a prospective cohort study, data on demographics and pre-existing conditions at hospital admission, clinical outcomes at hospital discharge (death, major adverse cardiovascular events (MACE), renal failure, neurological events, and pulmonary outcomes), 30-day vital status, and re-hospitalization were collected. Descriptive analyses and multivariable log-binomial regression models, adjusted for age, sex, ethnicity/income groups, and clinical characteristics, were performed. RESULTS Forty hospitals from 23 countries recruited 5,313 patients with COVID-19 (LIC = 7.1%, LMIC = 47.5%, UMIC = 19.6%, HIC = 25.7%). Mean age was 57.0 (±16.1) years, male 59.4%, pre-existing conditions included: hypertension 47.3%, diabetes 32.0%, coronary heart disease 10.9%, and heart failure 5.5%. The most frequently reported cardiovascular discharge diagnoses were cardiac arrest (5.5%), acute heart failure (3.8%), and myocardial infarction (1.6%). The rate of in-hospital deaths was 12.9% (N = 683), and post-discharge 30 days deaths was 2.6% (N = 118) (overall death rate 15.1%). The most common causes of death were respiratory failure (39.3%) and sudden cardiac death (20.0%). The predictors of overall mortality included older age (≥60 years), male sex, pre-existing coronary heart disease, renal disease, diabetes, ICU admission, oxygen therapy, and higher respiratory rates (p < 0.001 for each). Compared to Caucasians, Asians, Blacks, and Hispanics had almost 2-4 times higher risk of death. Further, patients from LIC, LMIC, UMIC versus. HIC had 2-3 times increased risk of death. CONCLUSIONS The LIC, LMIC, and UMIC's have sparse data on COVID-19. We provide robust evidence on COVID-19 outcomes in these countries. This study can help guide future health care planning for the pandemic globally.
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Affiliation(s)
- Dorairaj Prabhakaran
- Public Health Foundation India, Centre for Chronic Disease Control, World Heart Federation, London School of Hygiene & Tropical Medicine, GB
| | - Kavita Singh
- Public Health Foundation of India, Gurugram, Haryana, India, and Centre for Chronic Disease Control, New Delhi, IN
- Heidelberg Institute of Global Health, University of Heidelberg, Germany
| | | | | | - Bishav Mohan
- Department of Cardiology, Dayanand Medical College, Ludhiana, Punjab, IN
| | - Toru Kato
- Department of Clinical Research, National Hospital Organization Tochigi Medical Centre, JP
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, JP
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran & School of Population and Public Health, University of British Columbia, Vancouver, CA
| | | | | | | | - Fastone Goma
- Centre for Primary Care Research/Levy Mwanawasa University Teaching Hospital, Lusaka, ZM
| | - Juan Gomez-Mesa
- Head. Cardiology Service. Fundación Valle del Lili. Cali, CO
| | - Ntobeko Ntusi
- Division of Cardiology, Department of Medicine and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, ZA
| | - Francisca Inofomoh
- Internal Medicine Department, Olabisi Onabanjo University Teaching Hospital, PMB 2001, Sagamu, NG
| | - Surender Deora
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, IN
| | - Evgenii Philippov
- Ryazan State Medical University, Ryazan emergency hospital, 85 Stroykova street, Ryazan, RU
| | - Alla Svarovskaya
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, RU
| | | | - Aurelio Puentes
- ISSSTE Clínica Hospital de Guanajuato, Cerro del Hormiguero S/N, Maria de la Luz, 36000 Guanajuato, Gto., Mexico, AS
| | - Okechukwu S Ogah
- Department of Medicine, College of Medicine, University of Ibadan, and University College Hospital Ibadan, NG
| | - Bojan Stanetic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, BA
| | - Aurora Issa
- Instituto Nacional de Cardiologia, Rio de Janeiro, BR
| | - Friedrich Thienemann
- Cape Heart Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa and Department of Internal Medicine, University Hospital Zurich, University of Zurich, CH
| | - Dafsah Juzar
- National Cardiovascular Center Harapan Kita Hospital, Jakarta, ID
- Department Cardiology & Vascular medicine, University of Indonesia, ID
| | - Ezequiel Zaidel
- Cardiology department, Sanatorio Güemes, and Pharmacology department, School of Medicine, University of Buenos Aires. Acuña de Figueroa 1228 (1180AAX), Buenos Aires, AR
| | - Sana Sheikh
- Department of clinical Research, Tabba Heart Institute. ST-1, block 2, Federal B area, Karachi, PK
| | - Dike Ojji
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital, NG
| | - Carolyn S P Lam
- National Heart Center Singapore and Duke-National University of Singapore, SG
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, NL
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University. Shanghai Institute of Cardiovascular Diseases, Shanghai, CN
| | | | - L Kristin Newby
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, US
| | - Antonio Luiz P Ribeiro
- Cardiology Service and Telehealth Center, Hospital das Clínicas, and Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, BR
| | | | - Fausto Pinto
- Santa Maria University Hospital, CAML, CCUL, Faculdade de Medicina da Universidade de Lisboa, Lisbon, PT
| | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, World Heart Federation, CH
| | - Karen Sliwa
- Cape Heart Institute, Department of Medicine & Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa, World Heart Federation, CH
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19
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COVID-19, the Pandemic of the Century and Its Impact on Cardiovascular Diseases. CARDIOLOGY DISCOVERY 2021; 1:233-258. [PMID: 34888547 PMCID: PMC8638821 DOI: 10.1097/cd9.0000000000000038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/19/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection likely ranks among the deadliest diseases in human history. As with other coronaviruses, SARS-CoV-2 infection damages not only the lungs but also the heart and many other organs that express angiotensin-converting enzyme 2 (ACE2), a receptor for SARS-CoV-2. COVID-19 has upended lives worldwide. Dietary behaviors have been altered such that they favor metabolic and cardiovascular complications, while patients have avoided hospital visits because of limited resources and the fear of infection, thereby increasing out-hospital mortality due to delayed diagnosis and treatment. Clinical observations show that sex, age, and race all influence the risk for SARS-CoV-2 infection, as do hypertension, obesity, and pre-existing cardiovascular conditions. Many hospitalized COVID-19 patients suffer cardiac injury, acute coronary syndromes, or cardiac arrhythmia. SARS-CoV-2 infection may lead to cardiomyocyte apoptosis and necrosis, endothelial cell damage and dysfunction, oxidative stress and reactive oxygen species production, vasoconstriction, fibrotic and thrombotic protein expression, vascular permeability and microvascular dysfunction, heart inflammatory cell accumulation and activation, and a cytokine storm. Current data indicate that COVID-19 patients with cardiovascular diseases should not discontinue many existing cardiovascular therapies such as ACE inhibitors, angiotensin receptor blockers, steroids, aspirin, statins, and PCSK9 inhibitors. This review aims to furnish a framework relating to COVID-19 and cardiovascular pathophysiology.
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20
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Sokolski M, Trenson S, Sokolska JM, D'Amario D, Meyer P, Poku NK, Biering-Sørensen T, Højbjerg Lassen MC, Skaarup KG, Barge-Caballero E, Pouleur AC, Stolfo D, Sinagra G, Ablasser K, Muster V, Rainer PP, Wallner M, Chiodini A, Heiniger PS, Mikulicic F, Schwaiger J, Winnik S, Cakmak HA, Gaudenzi M, Mapelli M, Mattavelli I, Paul M, Cabac-Pogorevici I, Bouleti C, Lilliu M, Minoia C, Dauw J, Costa J, Celik A, Mewton N, Montenegro CEL, Matsue Y, Loncar G, Marchel M, Bechlioulis A, Michalis L, Dörr M, Prihadi E, Schoenrath F, Messroghli DR, Mullens W, Lund LH, Rosano GMC, Ponikowski P, Ruschitzka F, Flammer AJ. Heart failure in COVID-19: the multicentre, multinational PCHF-COVICAV registry. ESC Heart Fail 2021; 8:4955-4967. [PMID: 34533287 PMCID: PMC8653014 DOI: 10.1002/ehf2.13549] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022] Open
Abstract
Aims We assessed the outcome of hospitalized coronavirus disease 2019 (COVID‐19) patients with heart failure (HF) compared with patients with other cardiovascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia). We further wanted to determine the incidence of HF events and its consequences in these patient populations. Methods and results International retrospective Postgraduate Course in Heart Failure registry for patients hospitalized with COVID‐19 and CArdioVascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia) was performed in 28 centres from 15 countries (PCHF‐COVICAV). The primary endpoint was in‐hospital mortality. Of 1974 patients hospitalized with COVID‐19, 1282 had cardiovascular disease and/or risk factors (median age: 72 [interquartile range: 62–81] years, 58% male), with HF being present in 256 [20%] patients. Overall in‐hospital mortality was 25% (n = 323/1282 deaths). In‐hospital mortality was higher in patients with a history of HF (36%, n = 92) compared with non‐HF patients (23%, n = 231, odds ratio [OR] 1.93 [95% confidence interval: 1.44–2.59], P < 0.001). After adjusting, HF remained associated with in‐hospital mortality (OR 1.45 [95% confidence interval: 1.01–2.06], P = 0.041). Importantly, 186 of 1282 [15%] patients had an acute HF event during hospitalization (76 [40%] with de novo HF), which was associated with higher in‐hospital mortality (89 [48%] vs. 220 [23%]) than in patients without HF event (OR 3.10 [2.24–4.29], P < 0.001). Conclusions Hospitalized COVID‐19 patients with HF are at increased risk for in‐hospital death. In‐hospital worsening of HF or acute HF de novo are common and associated with a further increase in in‐hospital mortality.
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Affiliation(s)
- Mateusz Sokolski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Sander Trenson
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Justyna M Sokolska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Domenico D'Amario
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Philippe Meyer
- Cardiology Service, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Nana K Poku
- Cardiology Service, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mats C Højbjerg Lassen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer G Skaarup
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Eduardo Barge-Caballero
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), A Coruña, Spain
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Davide Stolfo
- Cardiovascular Department, University Hospital of Trieste - ASUGI, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, University Hospital of Trieste - ASUGI, Trieste, Italy
| | - Klemens Ablasser
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Viktoria Muster
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Markus Wallner
- Division of Cardiology, Medical University of Graz, Graz, Austria.,Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.,Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria
| | - Alessandra Chiodini
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Pascal S Heiniger
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Fran Mikulicic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Judith Schwaiger
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Stephan Winnik
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Huseyin A Cakmak
- Department of Cardiology, Mustafakemalpasa State Hospital, Bursa, Turkey
| | - Margherita Gaudenzi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Matthias Paul
- Heart Center Lucerne, Luzerner Kantonsspital (LUKS), Luzern, Switzerland
| | - Irina Cabac-Pogorevici
- Department of Cardiology, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Republic of Moldova
| | - Claire Bouleti
- Cardiology Department, Clinical Investigation Center (CIC) INSERM 1402, Poitiers Hospital, Poitiers University, Poitiers, France
| | - Marzia Lilliu
- Division of Infectious Diseases, Azienda ULSS 9, M. Magalini Hospital, Verona, Italy
| | - Chiara Minoia
- Emergency Department, Public Health Company Valle Olona, Busto Arsizio, Italy
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Doctoral School for Medicine and Life sciences, LCRC, UHasselt, Diepenbeek, Belgium
| | - Jérôme Costa
- Department of Cardiology, Reims University Hospital Centre, Reims, France
| | - Ahmet Celik
- Department of Cardiology, Mersin University Medical Faculty, Mersin, Turkey
| | - Nathan Mewton
- Cardiovascular Hospital Louis Pradel, Department of Heart Failure, Hospices Civils de Lyon, Lyon, France.,Clinical Investigation Center, Inserm 1407, Lyon, France.,CARMEN Inserm 1060, Claude Bernard University Lyon, Lyon, France
| | - Carlos E L Montenegro
- PROCAPE- Pronto Socorro Cardiológico de Pernambuco, Universidade de Pernambuco, Recife, PE, Brazil
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Michal Marchel
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Aris Bechlioulis
- 2nd Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
| | - Lampros Michalis
- 2nd Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | | | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Daniel R Messroghli
- German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Berlin, Germany.,Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, UHasselt, Diepenbeek, Belgium
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland
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21
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Greco S, Fabbri N, Bella A, Bonsi B, Parini S, Rocchi C, Giaccari S, Gavioli M, Passaro A, Feo CV. COVID-19 inpatients with gastrointestinal onset: sex and care needs' differences in the district of Ferrara, Italy. BMC Infect Dis 2021; 21:739. [PMID: 34344331 PMCID: PMC8329637 DOI: 10.1186/s12879-021-06476-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
Background COVID-19 is characterized by interstitial pneumonia, but a presentation of the disease with digestive symptoms only may occur. This work was aimed at evaluating: (1) the prevalence of presentation with digestive symptoms only in our cohort of COVID-19 inpatients; (2) differences between patients with and without gastrointestinal onset; (3) differences among males and females with gastrointestinal presentation; (4) outcomes of the groups of subjects with and without gastrointestinal onset. Method We retrospectively divided the patients hospitalized with COVID-19 into two groups: (1) the one with digestive symptoms (DSG) and (2) the other without digestive symptoms (NDSG). We compared the subjects of DSG with those of NDSG and males with females in the DSG group only, in terms of demographics (age, sex), inflammation and organ damage indexes, length of stay, in-hospital and 100-day mortality. Results The prevalence of gastrointestinal symptoms at presentation was 12.5%. The DSG group showed a prevalence of females, and these tended to a shorter hospital stay; DSG patients were younger and with a higher load of comorbidities, but no differences concerning inflammation and organ damage indexes, need for intensification of care, in-hospital and 100-day mortality were detected. Among DSG patients, males were younger than females, more comorbid, with higher serum CRP and showed a longer length of hospital stay. Survival functions of DSG patients, in general, are more favourable than those of NDSG if adjusted for sex, age and comorbidities. Conclusions (1) The prevalence of gastrointestinal presentation among hospitalized COVID-19 patients was 12.5%; (2) DSG patients were on average younger, more comorbid and with a prevalence of females, with a shorter hospital stay; (3) in the DSG group, males had a higher Charlson Comorbidity Score and needed a longer hospital stay; (4) DSG subjects seem to survive longer than those of the NDSG group. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06476-y.
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Affiliation(s)
- Salvatore Greco
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy - Via Luigi Borsari, 46, 44121, Ferrara, Emilia Romagna, Italy
| | - Nicolò Fabbri
- Department of General Surgery, Azienda Unità Sanitaria Locale Di Ferrara, Ospedale del Delta, via Valle Oppio, 2, Lagosanto, 44023, Ferrara, Emilia Romagna, Italy
| | - Alessandro Bella
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy - Via Luigi Borsari, 46, 44121, Ferrara, Emilia Romagna, Italy
| | - Beatrice Bonsi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy - Via Luigi Borsari, 46, 44121, Ferrara, Emilia Romagna, Italy
| | - Stefano Parini
- Medical Department, Azienda Unità Sanitaria Locale Di Ferrara, Ospedale del Delta, via Valle Oppio, 2, Lagosanto, 44023, Ferrara, Emilia Romagna, Italy
| | - Cindy Rocchi
- Medical Department, Azienda Unità Sanitaria Locale Di Ferrara, Ospedale del Delta, via Valle Oppio, 2, Lagosanto, 44023, Ferrara, Emilia Romagna, Italy
| | - Sara Giaccari
- Medical Department, Azienda Unità Sanitaria Locale Di Ferrara, Ospedale del Delta, via Valle Oppio, 2, Lagosanto, 44023, Ferrara, Emilia Romagna, Italy
| | - Manuel Gavioli
- Medical Department, Azienda Unità Sanitaria Locale Di Ferrara, Ospedale del Delta, via Valle Oppio, 2, Lagosanto, 44023, Ferrara, Emilia Romagna, Italy
| | - Angelina Passaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy - Via Luigi Borsari, 46, 44121, Ferrara, Emilia Romagna, Italy. .,Medical Department, University Hospital of Ferrara Arcispedale Sant'Anna, Via Aldo Moro, 8, 44124, Ferrara, Emilia Romagna, Italy. .,Department of Translational Medicine and Medical Department, University of Ferrara, University Hospital of Ferrara Arcispedale Sant'Anna, Via Aldo Moro, 8, 44124, Ferrara, Emilia Romagna, Italy.
| | - Carlo V Feo
- Department of General Surgery, Azienda Unità Sanitaria Locale Di Ferrara, Ospedale del Delta, via Valle Oppio, 2, Lagosanto, 44023, Ferrara, Emilia Romagna, Italy
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22
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Wang SY, Singh A, Eder MD, Vadlamani L, Lee AI, Chun HJ, Desai NR. Association of obesity with venous thromboembolism and myocardial injury in COVID-19. Obes Res Clin Pract 2021; 15:512-514. [PMID: 34281793 PMCID: PMC8283573 DOI: 10.1016/j.orcp.2021.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Abstract
Introduction Although both obesity and coronavirus disease 2019 (COVID-19) independently induce inflammation and thrombosis, the association between obesity class and risk of thrombosis in patients with COVID-19 remains unclear. Methods This retrospective cohort study included consecutive patients hospitalized with COVID-19 at a single institution. Patients were categorized based on obesity class. The main outcomes were venous thromboembolism (VTE) and myocardial injury, a marker of microvascular thrombosis in COVID-19. Adjustments were made for sociodemographic variables, cardiovascular disease risk factors and comorbidities. Results 609 patients with COVID-19 were included. 351 (58%) patients were without obesity, 110 (18%) were patients with class I obesity, 76 (12%) were patients with class II obesity, and 72 (12%) were patients with class III obesity. Patients with class I and III obesity had significantly higher risk-adjusted odds of VTE compared to patients without obesity (OR = 2.54, 95% CI: 1.05–6.14 for class I obesity; and OR = 3.95, 95% CI: 1.40–11.14 for class III obesity). Patients with class III obesity had significantly higher risk-adjusted odds of myocardial injury compared to patients without obesity (OR = 2.15, 95% CI: 1.12–4.12). Both VTE and myocardial injury were significantly associated with greater risk-adjusted odds of mortality. Conclusion This study demonstrates that both macrovascular and microvascular thromboses may contribute to the elevated morbidity and mortality in patients with obesity and COVID-19.
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Affiliation(s)
- Stephen Y Wang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Avinainder Singh
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Maxwell D Eder
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Lina Vadlamani
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Alfred I Lee
- Section of Hematology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Hyung J Chun
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, 06510, USA.
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23
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Yetmar ZA, Chesdachai S, Kashour T, Riaz M, Gerberi DJ, Badley AD, Berbari EF, Tleyjeh IM. Prior Statin Use and Risk of Mortality and Severe Disease From Coronavirus Disease 2019: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2021; 8:ofab284. [PMID: 34258316 PMCID: PMC8244756 DOI: 10.1093/ofid/ofab284] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/26/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Statins up-regulate angiotensin-converting enzyme 2, the receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while also exhibiting pleiotropic antiviral, antithrombotic, and anti-inflammatory properties. Uncertainties exist about their effect on the course of SARS-CoV-2 infection. We sought to systematically review the literature and perform a meta-analysis to examine the association between prior statin use and outcomes of patients with coronavirus disease 2019 (COVID-19). METHODS We searched Ovid Medline, Web of Science, Scopus, and the preprint server medRxiv from inception to December 2020. We assessed the quality of eligible studies with the Newcastle-Ottawa quality scale. We pooled adjusted relative risk (aRRs) of the association between prior statin use and outcomes of patients with COVID-19 using the DerSimonian-Laird random-effects model and assessed heterogeneity using the I 2 index. RESULTS Overall, 19 (16 cohorts and 3 case-control) studies were eligible, with a total of 395 513 patients. Sixteen of 19 studies had low or moderate risk of bias. Among 109 080 patients enrolled in 13 separate studies, prior statin use was associated with a lower risk of mortality (pooled aRR, 0.65 [95% confidence interval {CI}, .56-.77], I 2 = 84.1%) and a reduced risk of severe COVID-19 was also observed in 48 110 patients enrolled in 9 studies (pooled aRR, 0.73 [95% CI, .57-.94], I 2 = 82.8%), with no evidence of publication bias. CONCLUSIONS Cumulative evidence suggests that prior statin use is associated with lower risks of mortality or severe disease in patients with COVID-19. These data support the continued use of statins medications in patients with an indication for lipid-lowering therapy during the COVID-19 pandemic.
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Affiliation(s)
- Zachary A Yetmar
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Muhammad Riaz
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elie F Berbari
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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