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Shu H, Li Q, Zhang X, Zhao G, Cui Y, Zhu X. Fatal arrhythmia associated with novel coronavirus 2019 infection: Case report and literature review. Medicine (Baltimore) 2024; 103:e37894. [PMID: 38640277 PMCID: PMC11029986 DOI: 10.1097/md.0000000000037894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 04/21/2024] Open
Abstract
RATIONALE The novel coronavirus of 2019 (COVID-19) has inflicted significant harm on the cardiovascular system. Patients presenting with fatal chronic arrhythmias after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are rare, arrhythmia caused by SARS-CoV-2 infection need to be taken seriously. PATIENT CONCERNS Three female patients were admitted to the hospital with syncopal symptoms. Previously, they had been identified to have COVID-19 infection and none of the patients had a preexisting history of arrhythmia, and upon hospital admission, no electrolyte imbalances associated with arrhythmias were observed. However, following SARS-CoV-2 infection, patients exhibit varying degrees of syncope symptoms. DIAGNOSES A high-degree atrioventricular block was diagnosed after a comprehensive evaluation of the patient's clinical manifestations and electrocardiogram (ECG) performance. INTERVENTIONS We performed ECG monitoring of the patient and excluded other causes of arrhythmia. The patient was discharged from the hospital after permanent pacemaker implantation and symptomatic treatment. OUTCOMES The outpatient follow-ups did not reveal a recurrence of syncope or complications related to the pacemaker in any of the three patients. LESSONS Some patients did not exhibit any obvious respiratory symptoms or signs following SARS-CoV-2 infection. This suggests that the cardiac conduction system may be the preferred target for some SARS-CoV-2 variants. Therefore, in addition to investigating the causes of malignant arrhythmias, special attention should be paid to SARS-CoV-2 infection in patients with developing arrhythmias. Additionally, permanent pacemaker implantation may be the most suitable option for patients who already have malignant arrhythmias.
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Affiliation(s)
- Hongyun Shu
- Department of Cardiovascular Medicine, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People’s Hospital, Guangdong, China
- Guangzhou Medical University, Guangzhou, China
| | - Qiaowen Li
- Institute of Gerontology, Guangzhou Geriatric Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoyong Zhang
- Department of Cardiovascular Medicine, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People’s Hospital, Guangdong, China
| | - Guojun Zhao
- Department of Cardiovascular Medicine, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People’s Hospital, Guangdong, China
- Guangzhou Medical University, Guangzhou, China
| | - Yaqian Cui
- Department of Cardiovascular Medicine, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People’s Hospital, Guangdong, China
- Guangzhou Medical University, Guangzhou, China
| | - Xiyan Zhu
- Department of Cardiovascular Medicine, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People’s Hospital, Guangdong, China
- Guangzhou Medical University, Guangzhou, China
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2
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Kell DB, Lip GYH, Pretorius E. Fibrinaloid Microclots and Atrial Fibrillation. Biomedicines 2024; 12:891. [PMID: 38672245 PMCID: PMC11048249 DOI: 10.3390/biomedicines12040891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation (AF) is a comorbidity of a variety of other chronic, inflammatory diseases for which fibrinaloid microclots are a known accompaniment (and in some cases, a cause, with a mechanistic basis). Clots are, of course, a well-known consequence of atrial fibrillation. We here ask the question whether the fibrinaloid microclots seen in plasma or serum may in fact also be a cause of (or contributor to) the development of AF. We consider known 'risk factors' for AF, and in particular, exogenous stimuli such as infection and air pollution by particulates, both of which are known to cause AF. The external accompaniments of both bacterial (lipopolysaccharide and lipoteichoic acids) and viral (SARS-CoV-2 spike protein) infections are known to stimulate fibrinaloid microclots when added in vitro, and fibrinaloid microclots, as with other amyloid proteins, can be cytotoxic, both by inducing hypoxia/reperfusion and by other means. Strokes and thromboembolisms are also common consequences of AF. Consequently, taking a systems approach, we review the considerable evidence in detail, which leads us to suggest that it is likely that microclots may well have an aetiological role in the development of AF. This has significant mechanistic and therapeutic implications.
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Affiliation(s)
- Douglas B. Kell
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- The Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Søltofts Plads, Building 220, 2800 Kongens Lyngby, Denmark
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch 7602, South Africa
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool L7 8TX, UK;
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Etheresia Pretorius
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch 7602, South Africa
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3
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Zuin M, Ojeda-Fernández L, Torrigiani G, Bertini M. Risk of incident atrial fibrillation after COVID-19 infection: A systematic review and meta-analysis. Heart Rhythm 2024:S1547-5271(24)02391-9. [PMID: 38636931 DOI: 10.1016/j.hrthm.2024.04.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Data regarding the risk of atrial fibrillation (AF) during the post-acute phase of COVID-19 are lacking. OBJECTIVE We assessed the risk of incident AF in COVID-19 recovered patients by performing a systematic review and meta-analysis of the available data. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched Medline and Scopus to locate all articles published up to December 1, 2023, reporting the risk of AF in patients recovered from COVID-19 infection compared with noninfected patients in whom the arrhythmia developed during the same follow-up period. AF risk was evaluated by the Mantel-Haenszel random effects model with hazard ratio as the effect measure with 95% confidence interval (CI); heterogeneity was assessed by Higgins I2 statistic. RESULTS Overall, 19,478,173 patients (mean age, 56.5 years; 63.0% male) enrolled in 5 observational studies were included in the analysis. Of these, 5,692,510 recovered from severe acute respiratory syndrome coronavirus 2 infection. During a mean follow-up of 14.5 ± 3.2 months, a random effects model revealed a pooled incidence of new-onset AF in 2.6% of cases (95% CI, 1.8%-6.18%). Recovered COVID-19 patients presented with a higher risk of incident AF (hazard ratio, 1.57; 95% CI, 1.24-1.99; P < .0001; I2 = 77.9%) compared with noninfected patients during the same follow-up period. Sensitivity analyses confirmed the yielded results. A multivariable metaregression including age, male sex, history of hypertension, coronary artery disease, and length of follow-up was able to explain a significant part of the heterogeneity (R2 = 54.3%; P = .01). CONCLUSION Recovered COVID-19 patients have a higher risk of AF events compared with individuals from the general population.
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Affiliation(s)
- Marco Zuin
- Division of Cardiology, University of Ferrara, Ferrara, Italy
| | - Luisa Ojeda-Fernández
- Laboratory of Cardiovascular Prevention, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ginevra Torrigiani
- Laboratory of Cardiovascular Prevention, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Matteo Bertini
- Division of Cardiology, University of Ferrara, Ferrara, Italy.
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Sizova ZM, Zakharova VL, Shindryaeva NN, Lapidus NI, Melnik MV, Shikh EV, Grebenshchikova LY, Beloborodova AV, Polovikov IP. Atrial fibrillation and COVID-19: an analysis of the ambulatory database. Front Cardiovasc Med 2024; 11:1384826. [PMID: 38689861 PMCID: PMC11058836 DOI: 10.3389/fcvm.2024.1384826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
Atrial fibrillation (AF) is the most common heart rhythm disorder in clinical practice. It worsens the quality of life of patients, leads to an increase in the mortality rate because of its association with a high risk of thromboembolic complications. The current pandemic of a new coronavirus infection, which began in March 2020, was marked by an increase in cardiovascular diseases, including an increase in the number of patients with AF. That is why it is extremely relevant to find answers to questions about the association and mutual influence of AF and coronavirus infection to reduce the risk of vascular complications. However, most research in this area has focused on hospital patients. In this study, an electronic database of outpatients with AF, including patients with a history of COVID-19 infection was analyzed in order to assess the most significant risk factors for complications.
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Affiliation(s)
| | | | - Natalya N. Shindryaeva
- Sechenov First Moscow Medical State University, Moscow, Russia
- City Polyclinic No 2 of the Moscow Healthcare Department, Moscow, Russia
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5
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Miljoen H, Favere K, Van De Heyning C, Corteville B, Dausin C, Herbots L, Teulingkx T, Bekhuis Y, Lyssens M, Bogaert J, Heidbuchel H, Claessen G. Low rates of myocardial fibrosis and ventricular arrhythmias in recreational athletes after SARS-CoV-2 infection. Front Cardiovasc Med 2024; 11:1372028. [PMID: 38628312 PMCID: PMC11018940 DOI: 10.3389/fcvm.2024.1372028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/26/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction High rates of cardiac involvement were reported in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. This led to anxiety in the athletic population. The current study was set up to assess the prevalence of myocardial fibrosis and ventricular arrhythmias in recreational athletes with the recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Consecutive adult recreational athletes (≥18 years old, ≥4 h of mixed type or endurance sports/week) underwent systematic cardiac evaluation after a prior confirmed COVID-19 infection. Evaluation included clinical history, electrocardiogram (ECG), 5-day Holter monitoring, and cardiac magnetic resonance (CMR) imaging with simultaneous measurement of high-sensitive cardiac Troponin I. Data from asymptomatic or mildly symptomatic athletes (Group 1) were compared with those with moderate to severe symptoms (Groups 2-3). Furthermore, a comparison with a historical control group of athletes without COVID-19 (Master@Heart) was made. Results In total, 35 athletes (18 Group 1, 10 female, 36.9 ± 2.2 years, mean 143 ± 20 days following diagnosis) were evaluated. The baseline characteristics for the Group 1 and Groups 2-3 athletes were similar. None of the athletes showed overt myocarditis on CMR based on the updated Lake Louise criteria for diagnosis of myocarditis. The prevalence of non-ischemic late gadolinium enhancement [1 (6%) Group 1 vs. 2 (12%) Groups 2-3; p = 0.603] or ventricular arrhythmias [1 Group 1 athlete showed non-sustained ventricular tachycardia (vs. 0 in Groups 2-3: p = 1.000)] were not statistically different between the groups. When the male athletes were compared with the Master@Heart athletes, again no differences regarding these criteria were found. Conclusion In our series of recreational athletes with prior confirmed COVID-19, we found no evidence of ongoing myocarditis, and no more detection of fibrosis or ventricular arrhythmias than in a comparable athletic pre-COVID cohort. This points to a much lower cardiac involvement of COVID-19 in athletes than originally suggested.
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Affiliation(s)
- Hielko Miljoen
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
| | - Kasper Favere
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Caroline Van De Heyning
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
| | - Ben Corteville
- Department of Cardiology, Jan Palfijn Hospital, Ghent, Belgium
| | - Christophe Dausin
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Lieven Herbots
- Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Youri Bekhuis
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Leuven University Hospitals, Leuven, Belgium
- Department of Cardiovascular Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Malou Lyssens
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Guido Claessen
- Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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6
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Omar R, Tavolacci SC, Liou L, Villavisanis DF, Broza YY, Haick H. Real-time prognostic biomarkers for predicting in-hospital mortality and cardiac complications in COVID-19 patients. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002836. [PMID: 38446834 PMCID: PMC10917247 DOI: 10.1371/journal.pgph.0002836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/07/2024] [Indexed: 03/08/2024]
Abstract
Hospitalized patients with Coronavirus disease 2019 (COVID-19) are highly susceptible to in-hospital mortality and cardiac complications such as atrial arrhythmias (AA). However, the utilization of biomarkers such as potassium, B-type natriuretic peptide, albumin, and others for diagnosis or the prediction of in-hospital mortality and cardiac complications has not been well established. The study aims to investigate whether biomarkers can be utilized to predict mortality and cardiac complications among hospitalized COVID-19 patients. Data were collected from 6,927 hospitalized COVID-19 patients from March 1, 2020, to March 31, 2021 at one quaternary (Henry Ford Health) and five community hospital registries (Trinity Health Systems). A multivariable logistic regression prediction model was derived using a random sample of 70% for derivation and 30% for validation. Serum values, demographic variables, and comorbidities were used as input predictors. The primary outcome was in-hospital mortality, and the secondary outcome was onset of AA. The associations between predictor variables and outcomes are presented as odds ratio (OR) with 95% confidence intervals (CIs). Discrimination was assessed using area under ROC curve (AUC). Calibration was assessed using Brier score. The model predicted in-hospital mortality with an AUC of 90% [95% CI: 88%, 92%]. In addition, potassium showed promise as an independent prognostic biomarker that predicted both in-hospital mortality, with an AUC of 71.51% [95% Cl: 69.51%, 73.50%], and AA with AUC of 63.6% [95% Cl: 58.86%, 68.34%]. Within the test cohort, an increase of 1 mEq/L potassium was associated with an in-hospital mortality risk of 1.40 [95% CI: 1.14, 1.73] and a risk of new onset of AA of 1.55 [95% CI: 1.25, 1.93]. This cross-sectional study suggests that biomarkers can be used as prognostic variables for in-hospital mortality and onset of AA among hospitalized COVID-19 patients.
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Affiliation(s)
- Rawan Omar
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, Israel
| | - Sooyun Caroline Tavolacci
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Lathan Liou
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Dillan F. Villavisanis
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Yoav Y. Broza
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hossam Haick
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, Israel
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7
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Yu L, Liu Y, Feng Y. Cardiac arrhythmia in COVID-19 patients. Ann Noninvasive Electrocardiol 2024; 29:e13105. [PMID: 38339786 PMCID: PMC10858328 DOI: 10.1111/anec.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/07/2023] [Accepted: 12/24/2023] [Indexed: 02/12/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) was first introduced in December 2019, which is known as severe acute respiratory syndrome caused by coronavirus-2 (SARS-CoV-2) that is a serious and life-threatening disease. Although pneumonia is the most common manifestation of COVID-19 and was initially introduced as a respiratory infection, in fact, the infection of COVID-19 is a subset of complications and damage to various organs. There are several reports of cardiac involvement with COVID-19. A wide range of cardiac complications may occur following COVID-19 infection, including systolic heart failure, myocarditis, pericarditis, atrial and ventricular arrhythmias, and thromboembolic events. There are various hypotheses about the pathophysiology of cardiovascular involvement by this virus. At the top of these hypotheses is the release of cytokines to the heart. Although there are other assumptions, considering that one of the causes of death in patients with COVID-19 is arrhythmia. It is necessary to know correctly about its pathophysiology and etiology. Therefore, in this study, we have reviewed the articles of recent years in the field of pathophysiology and etiology of arrhythmia in patients with COVID-19 infection. The purpose of this study was to provide a basis for a correct and more comprehensive understanding of the pathogenesis of arrhythmia in patients with COVID-19 infection.
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Affiliation(s)
- Lei Yu
- Department of CardiologyJinan Third People's HospitalJinanChina
| | - Ying Liu
- Department of CardiologyShandong Second Provincial General HospitalJinanChina
| | - Yanjing Feng
- Department of CardiologyShandong Second Provincial General HospitalJinanChina
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8
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Liu J, Cepeda M, Frangaj B, Shimbo D. The Burden of Cardiovascular Disease in the Post-COVID Era. Prim Care 2024; 51:1-11. [PMID: 38278564 DOI: 10.1016/j.pop.2023.08.001] [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] [Indexed: 01/28/2024]
Abstract
In 2019, before the COVID-19 pandemic, cardiovascular disease (CVD) was the leading cause of death. Since 2020, the pandemic has had far-reaching effects on the landscape of health care including CVD prevention and management. Recent decreases in life expectancy in the United States could potentially be explained by issues related to disruptions in CVD prevention and control of CVD risk factors from the COVID-19 pandemic. This article reviews the effects of the SARS-CoV-2 virus and the accompanying pandemic on CVD risk factor prevention and management in the United States. Potential solutions are also proposed for these patients.
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Affiliation(s)
- Justin Liu
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, 60 Haven Avenue (Tower 1), Level B2 (Lobby Level) - Office Suite B234, New York, NY 10032, USA
| | - Maria Cepeda
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, 60 Haven Avenue (Tower 1), Level B2 (Lobby Level) - Office Suite B234, New York, NY 10032, USA
| | - Brulinda Frangaj
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, 60 Haven Avenue (Tower 1), Level B2 (Lobby Level) - Office Suite B234, New York, NY 10032, USA
| | - Daichi Shimbo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, 60 Haven Avenue (Tower 1), Level B2 (Lobby Level) - Office Suite B234, New York, NY 10032, USA.
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Duloquin G, Pommier T, Georges M, Giroud M, Guenancia C, Béjot Y, Laurent G, Rabec C. Is COVID-19 Infection a Multiorganic Disease? Focus on Extrapulmonary Involvement of SARS-CoV-2. J Clin Med 2024; 13:1397. [PMID: 38592697 PMCID: PMC10932259 DOI: 10.3390/jcm13051397] [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: 01/21/2024] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
First described in December 2019 in Wuhan (China), COVID-19 disease rapidly spread worldwide, constituting the biggest pandemic in the last 100 years. Even if SARS-CoV-2, the agent responsible for COVID-19, is mainly associated with pulmonary injury, evidence is growing that this virus can affect many organs, including the heart and vascular endothelial cells, and cause haemostasis, CNS, and kidney and gastrointestinal tract abnormalities that can impact in the disease course and prognosis. In fact, COVID-19 may affect almost all the organs. Hence, SARS-CoV-2 is essentially a systemic infection that can present a large number of clinical manifestations, and it is variable in distribution and severity, which means it is potentially life-threatening. The goal of this comprehensive review paper in the series is to give an overview of non-pulmonary involvement in COVID-19, with a special focus on underlying pathophysiological mechanisms and clinical presentation.
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Affiliation(s)
- Gauthier Duloquin
- Department of Neurology, CHU Dijon-Bourgogne, 21000 Dijon, France; (G.D.); (M.G.); (Y.B.)
- Laboratory of Cerebro-Vascular Pathophysiology and Epidemiology (PEC2) EA 7460, University of Bourgogne, 21000 Dijon, France; (T.P.); (C.G.); (G.L.)
| | - Thibaut Pommier
- Laboratory of Cerebro-Vascular Pathophysiology and Epidemiology (PEC2) EA 7460, University of Bourgogne, 21000 Dijon, France; (T.P.); (C.G.); (G.L.)
- Department of Cardiology, University Hospital of Dijon, 21000 Dijon, France
| | - Marjolaine Georges
- Department of Pneumology and Intensive Care Unit, Reference Centre for Rare Lung Diseases, Dijon University Hospital, 14 Boulevard Gaffarel, 21000 Dijon, France;
- Centre des Sciences du Goût et de l’Alimentation, INRA, UMR 6265 CNRS 1234, University of Bourgogne Franche-Comté, 21000 Dijon, France
| | - Maurice Giroud
- Department of Neurology, CHU Dijon-Bourgogne, 21000 Dijon, France; (G.D.); (M.G.); (Y.B.)
- Laboratory of Cerebro-Vascular Pathophysiology and Epidemiology (PEC2) EA 7460, University of Bourgogne, 21000 Dijon, France; (T.P.); (C.G.); (G.L.)
| | - Charles Guenancia
- Laboratory of Cerebro-Vascular Pathophysiology and Epidemiology (PEC2) EA 7460, University of Bourgogne, 21000 Dijon, France; (T.P.); (C.G.); (G.L.)
- Department of Cardiology, University Hospital of Dijon, 21000 Dijon, France
| | - Yannick Béjot
- Department of Neurology, CHU Dijon-Bourgogne, 21000 Dijon, France; (G.D.); (M.G.); (Y.B.)
- Laboratory of Cerebro-Vascular Pathophysiology and Epidemiology (PEC2) EA 7460, University of Bourgogne, 21000 Dijon, France; (T.P.); (C.G.); (G.L.)
| | - Gabriel Laurent
- Laboratory of Cerebro-Vascular Pathophysiology and Epidemiology (PEC2) EA 7460, University of Bourgogne, 21000 Dijon, France; (T.P.); (C.G.); (G.L.)
- Department of Cardiology, University Hospital of Dijon, 21000 Dijon, France
| | - Claudio Rabec
- Department of Pneumology and Intensive Care Unit, Reference Centre for Rare Lung Diseases, Dijon University Hospital, 14 Boulevard Gaffarel, 21000 Dijon, France;
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Ashine TM, Heliso AZ, Babore GO, Ezo E, Saliya SA, Birehanu Muluneh B, Alaro MG, Adeba TS, Sebro SF, Hailu AG, Abdisa EN. Incidence and Predictors of Cardiac Arrest Among Patients Admitted to the Intensive Care Units of a Comprehensive Specialized Hospital in Central Ethiopia. Patient Relat Outcome Meas 2024; 15:31-43. [PMID: 38375416 PMCID: PMC10875971 DOI: 10.2147/prom.s452338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
Background Cardiac arrest (CA) is a common public health problem. Worldwide, cardiac arrest ranks highly among hospitalised patients' public health concerns, particularly in low-income nations. Data on cardiac arrest in intensive care units in low-income countries are relatively scarce. Determining the incidence and predictors of cardiac arrest among ICU patients will be a very crucial and fruitful clinical practice in resource-limited areas like Ethiopia. Methods A retrospective cohort study was conducted by reviewing charts of 422 systematically selected patients admitted to the ICU from 2018 to 2022 in Wachemo University Comprehensive Specialized Hospital. The extraction tool was used for the data collection, Epi-data version 4.6.0 for data entry, and STATA version 14 for data cleaning and analysis. Kaplan-Meier, log rank test, and life table were used to describe the data. The Cox proportional hazard regression model was used for analysis. Results The findings of this study revealed that the overall occurrence of cardiac arrest among critically ill ICU patients was 27% (95% CI: 23, 32). The incidence density rate of cardiac arrest among intensive care unit patients was 19.6 per 1000 person-days of observation. In a multivariable analysis, patients with chronic kidney disease, oxygen saturation <90%, delirium, intubation, and patients admitted to the ICU with cardiovascular disease were found to be independent predictors of cardiac arrest in the Intensive Care Unit. Conclusion The incidence density rate of cardiac arrest among intensive care unit patients was high. This study also revealed that chronic kidney disease, delirium, intubation, oxygen saturation level below 90% and patients admitted with cardiovascular disease were independent predictors of the occurrence of cardiac arrest among intensive care unit patients. Finally, we recommend that clinician pays attention to those identified as preventable risk factors for early interventions to improve the recovery process of patients in the ICU.
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Affiliation(s)
- Taye Mezgebu Ashine
- Emergency medicine and Critical Care nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Asnakech Zekiwos Heliso
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Getachew Ossabo Babore
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Elias Ezo
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Sentayehu Admasu Saliya
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Bethelhem Birehanu Muluneh
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Michael Geletu Alaro
- Emergency medicine and Critical Care nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Tadesse Sahle Adeba
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Sisay Foga Sebro
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Awoke Girma Hailu
- Emergency medicine and Critical Care nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Elias Nigusu Abdisa
- Department of Psychiatry and Mental Health, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
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11
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Speranza M, López-López JD, Schwartzmann P, Morr I, Rodríguez-González MJ, Buitrago A, Pow-Chon-Long F, Passos LC, Rossel V, Perna ER, Escalante M, Romero A, Arteaga-Tobar AA, Quesada D, Alarco W, Gómez-Mesa JE. Cardiovascular Complications in Patients with Heart Failure and COVID-19: CARDIO COVID 19-20 Registry. J Cardiovasc Dev Dis 2024; 11:34. [PMID: 38392248 PMCID: PMC10889647 DOI: 10.3390/jcdd11020034] [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: 11/10/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 02/24/2024] Open
Abstract
Since early 2020, different studies have shown an increased prevalence of COVID-19 and poorer prognosis in older adults with cardiovascular comorbidities. This study aimed to assess the impact of heart failure (HF) on cardiovascular complications, intensive care unit (ICU) admissions, and in-hospital mortality in patients hospitalized with COVID-19. The CARDIO COVID 19-20 registry includes 3260 hospitalized patients with a COVID-19 serological diagnosis between May 2020 and June 2021 from Latin American countries. A history of HF was identified in 182 patients (5.6%). In patients with and without previous HF, the incidence of supraventricular arrhythmia was 16.5% vs. 6.3%, respectively (p = 0.001), and that of acute coronary syndrome was 7.1% vs. 2.7%, respectively (p = 0.001). Patients with a history of HF had higher rates of ICU admission (61.5% vs. 53.1%, respectively; p = 0.031) and in-hospital mortality (41.8% vs. 24.5%, respectively; p = 0.001) than patients without HF. Cardiovascular mortality at discharge (42.1% vs. 18.5%, respectively; p < 0.001) and at 30 days post-discharge (66.7% vs. 18.0%, respectively) was higher for patients with a history of HF than for patients without HF. In patients hospitalized with COVID-19, previous history of HF was associated with a more severe cardiovascular profile, with increased risk of cardiovascular complications, and poor in-hospital and 30-day outcomes.
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Affiliation(s)
- Mario Speranza
- Department of Cardiology, Hospital Clínica Bíblica, San José 10104, Costa Rica
- Consejo Interamericano de Falla Cardiaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City 01000, Mexico
| | - Juan D López-López
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali 760026, Colombia
- Department of Health Sciences, Universidad Icesi, Cali 760031, Colombia
| | - Pedro Schwartzmann
- Department of Cardiology, CAPED-Advanced Research Center and Hospital Unimed, Ribeirão Preto 14000-000, Brazil
| | - Igor Morr
- Department of Tropical Cardiology, Sociedad Venezolana de Cardiología, Caracas 1060, Venezuela
| | | | - Andrés Buitrago
- Department of Cardiology, Fundación Santa Fe, Bogotá D.C. 110111, Colombia
| | - Freddy Pow-Chon-Long
- Consejo Interamericano de Falla Cardiaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City 01000, Mexico
- Department of Cardiology, Hospital Luis Vernaza, Guayaquil 090313, Ecuador
- Department of Cardiology, Universidad Espíritu Santo, Guayaquil 092301, Ecuador
| | | | - Víctor Rossel
- Consejo Interamericano de Falla Cardiaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City 01000, Mexico
- Instituto Nacional del Tórax, Heart Transplant Program, Santiago de Chile 8320000, Chile
| | - Eduardo Roque Perna
- Consejo Interamericano de Falla Cardiaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City 01000, Mexico
- Division of Heart Failure and Pulmonary Hypertension, Instituto de Cardiología J.F. Cabral, Corrientes 3400, Argentina
| | - Manuela Escalante
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali 760026, Colombia
| | - Alexander Romero
- Consejo Interamericano de Falla Cardiaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City 01000, Mexico
- Department of Cardiology, Hospital Santo Tomás, Panama City 07093, Panama
| | - Andrea Alejandra Arteaga-Tobar
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali 760026, Colombia
- Department of Cardiology, Fundación Valle del Lili, Cali 760026, Colombia
| | - Daniel Quesada
- Consejo Interamericano de Falla Cardiaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City 01000, Mexico
- Department of Cardiology, Hospital San Vicente de Paúl, Heredia 40101, Costa Rica
| | - Walter Alarco
- Consejo Interamericano de Falla Cardiaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City 01000, Mexico
- Department of Cardiology, Instituto Nacional Cardiovascular, Lima 15072, Peru
| | - Juan Esteban Gómez-Mesa
- Consejo Interamericano de Falla Cardiaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City 01000, Mexico
- Department of Health Sciences, Universidad Icesi, Cali 760031, Colombia
- Department of Cardiology, Fundación Valle del Lili, Cali 760026, Colombia
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12
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Ashok D, Liu T, Criscione J, Prakash M, Kim B, Chow J, Craney M, Papanicolaou KN, Sidor A, Brian Foster D, Pekosz A, Villano J, Kim DH, O'Rourke B. Innate Immune Activation and Mitochondrial ROS Invoke Persistent Cardiac Conduction System Dysfunction after COVID-19. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.05.574280. [PMID: 38260287 PMCID: PMC10802485 DOI: 10.1101/2024.01.05.574280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Cardiac risk rises during acute SARS-CoV-2 infection and in long COVID syndrome in humans, but the mechanisms behind COVID-19-linked arrhythmias are unknown. This study explores the acute and long term effects of SARS-CoV-2 on the cardiac conduction system (CCS) in a hamster model of COVID-19. Methods Radiotelemetry in conscious animals was used to non-invasively record electrocardiograms and subpleural pressures after intranasal SARS-CoV-2 infection. Cardiac cytokines, interferon-stimulated gene expression, and macrophage infiltration of the CCS, were assessed at 4 days and 4 weeks post-infection. A double-stranded RNA mimetic, polyinosinic:polycytidylic acid (PIC), was used in vivo and in vitro to activate viral pattern recognition receptors in the absence of SARS-CoV-2 infection. Results COVID-19 induced pronounced tachypnea and severe cardiac conduction system (CCS) dysfunction, spanning from bradycardia to persistent atrioventricular block, although no viral protein expression was detected in the heart. Arrhythmias developed rapidly, partially reversed, and then redeveloped after the pulmonary infection was resolved, indicating persistent CCS injury. Increased cardiac cytokines, interferon-stimulated gene expression, and macrophage remodeling in the CCS accompanied the electrophysiological abnormalities. Interestingly, the arrhythmia phenotype was reproduced by cardiac injection of PIC in the absence of virus, indicating that innate immune activation was sufficient to drive the response. PIC also strongly induced cytokine secretion and robust interferon signaling in hearts, human iPSC-derived cardiomyocytes (hiPSC-CMs), and engineered heart tissues, accompanied by alterations in electrical and Ca 2+ handling properties. Importantly, the pulmonary and cardiac effects of COVID-19 were blunted by in vivo inhibition of JAK/STAT signaling or by a mitochondrially-targeted antioxidant. Conclusions The findings indicate that long term dysfunction and immune cell remodeling of the CCS is induced by COVID-19, arising indirectly from oxidative stress and excessive activation of cardiac innate immune responses during infection, with implications for long COVID Syndrome.
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13
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Ali S, Khanal R, Najam M, Fakhra S, Manasrah N, Keisham B, Farooq F, Duhan S, Sattar Y, Changezi H, Alraies MC. Short-Term Outcomes of Cardiac Arrhythmias Among COVID-19 Patients: A Propensity Matched National Study. Curr Probl Cardiol 2024; 49:102087. [PMID: 37716538 DOI: 10.1016/j.cpcardiol.2023.102087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/18/2023]
Abstract
The risk of arrhythmia is high in patients with COVID-19. The current literature is limited in understanding the clinical impact of arrhythmias and the extent of healthcare utilization in COVID-19 patients. The Nationwide In-patient Sample Database (NIS) from 2019 to 2020 was queried to identify COVID-19 patients who developed arrhythmias vs those without. Multivariate regression for adjusted odds ratios (aOR) and propensity score matching (PSM) were done to compare outcomes among both cohorts. A total of 1,664,240 patients (weighted) were hospitalized with COVID-19 infection, 380,915 (22.89%) of whom were diagnosed with an arrhythmia. After propensity matching COVID-19 with arrhythmias had higher rates of in-hospital mortality (22.4% vs 13.5%, P < 0.001), acute kidney injury (PSM 39.4% vs 35.7%, P < 0.001), acute heart failure (AHF) (18.2% vs 12.6%, P < 0.001), acute stroke (0.76% vs 0.57%, P < 0.001), cardiogenic shock (1.38% vs 0.5%, P < 0.001), cardiac arrest (5.26% vs 2.3%, P < 0.001) acute myocardial infarction (AMI) (12.8% vs 7.8%, P < 0.001), intracerebral hemorrhage (0.63% vs 0.45%, P < 0.001), major bleeding (2.6% vs 1.8%, P < 0.001) and endotracheal intubation (17.04% vs 10.17% < 0.001) compared to arrhythmias without COVID-19. This cohort also had lower odds of receiving interventions such as cardiac pacing (aOR 0.15 95% Cl 0.13-0.189 P < 0.001), cardioversion (aOR 0.43 95% CI 0.40-0.46, P < 0.001), and defibrillator (aOR 0.087 95% Cl 0.061-0.124, P < 0.001) compared to arrhythmia patients without COVID-19. Cardiac arrhythmias associated with COVID-19 resulted in longer length of hospital stay and higher total costs of hospitalizations. Arrhythmias associated with COVID-19 had worse clinical outcomes with an increased rate of in-hospital mortality, longer length of hospital stay, and higher total cost. These patients also had lower odds of receiving interventions during the index hospitalization.
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Affiliation(s)
- Shafaqat Ali
- Department of Internal Medicine, Louisiana State University, Shreveport, LA
| | - Resha Khanal
- Department of Internal Medicine, Promedica Physician Group, Toledo, OH
| | - Maria Najam
- Department of Internal Medicine, University of Texas Rio Grande Valley, TX
| | - Sadaf Fakhra
- University of Nevada, Las Vegas-Kirk Kerkorian School of Medicine, NV
| | | | - Bijeta Keisham
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD
| | - Faryal Farooq
- Department of Internal Medicine, Allama Iqbal Medical College Lahore, Punjab, Pakistan
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, WV
| | - Hameem Changezi
- Department of Cardiology, Mclaren Healthcare Corp, Flint, MI
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14
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Spruit JR, Jansen RWMM, de Groot JR, de Vries TAC, Hemels MEW, Douma RA, de Haan LR, Brinkman K, Moeniralam HS, de Kruif M, Dormans T, Appelman B, Reidinga AC, Rusch D, Gritters van den Oever NC, Schuurman RJ, Beudel M, Simsek S. Does atrial fibrillation affect prognosis in hospitalised COVID-19 patients? A multicentre historical cohort study in the Netherlands. BMJ Open 2023; 13:e071137. [PMID: 38070891 PMCID: PMC10729035 DOI: 10.1136/bmjopen-2022-071137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES The aim of this multicentre COVID-PREDICT study (a nationwide observational cohort study that aims to better understand clinical course of COVID-19 and to predict which COVID-19 patients should receive which treatment and which type of care) was to determine the association between atrial fibrillation (AF) and mortality, intensive care unit (ICU) admission, complications and discharge destination in hospitalised COVID-19 patients. SETTING Data from a historical cohort study in eight hospitals (both academic and non-academic) in the Netherlands between January 2020 and July 2021 were used in this study. PARTICIPANTS 3064 hospitalised COVID-19 patients >18 years old. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the incidence of new-onset AF during hospitalisation. Secondary outcomes were the association between new-onset AF (vs prevalent or non-AF) and mortality, ICU admissions, complications and discharge destination, performed by univariable and multivariable logistic regression analyses. RESULTS Of the 3064 included patients (60.6% men, median age: 65 years, IQR 55-75 years), 72 (2.3%) patients had prevalent AF and 164 (5.4%) patients developed new-onset AF during hospitalisation. Compared with patients without AF, patients with new-onset AF had a higher incidence of death (adjusted OR (aOR) 1.71, 95% CI 1.17 to 2.59) an ICU admission (aOR 5.45, 95% CI 3.90 to 7.61). Mortality was non-significantly different between patients with prevalent AF and those with new-onset AF (aOR 0.97, 95% CI 0.53 to 1.76). However, new-onset AF was associated with a higher incidence of ICU admission and complications compared with prevalent AF (OR 6.34, 95% CI 2.95 to 13.63, OR 3.04, 95% CI 1.67 to 5.55, respectively). CONCLUSION New-onset AF was associated with an increased incidence of death, ICU admission, complications and a lower chance to be discharged home. These effects were far less pronounced in patients with prevalent AF. Therefore, new-onset AF seems to represent a marker of disease severity, rather than a cause of adverse outcomes.
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Affiliation(s)
| | | | - Joris R de Groot
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Martin E W Hemels
- Department of Cardiology, Rijnstate, Arnhem, Arnhem, Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Renee A Douma
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
- Flevo Hospital, Almere, Netherlands
| | - Lianne R de Haan
- Flevo Hospital, Almere, Netherlands
- Medical Centre Alkmaar, Alkmaar, Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, OLVG, Amsterdam, Netherlands
| | - Hazra S Moeniralam
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Martijn de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | - Tom Dormans
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Brent Appelman
- Amsterdam UMC Locatie Meibergdreef, Amsterdam, Netherlands
| | - Auke C Reidinga
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Daisy Rusch
- Research, Martini Ziekenhuis, Groningen, Netherlands
| | | | | | - Martijn Beudel
- Neurology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
- Department of Internal Medicine, Section of Endocrinology, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
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15
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Rosh B, Naoum I, Barnett-Griness O, Najjar-Debbiny R, Saliba W. Association between SARS-CoV-2 infection and new-onset atrial fibrillation. Int J Cardiol 2023; 392:131298. [PMID: 37652274 DOI: 10.1016/j.ijcard.2023.131298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/06/2023] [Accepted: 08/27/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with substantial morbidity and mortality. New-onset AF (NOAF) has been related recently to SARS-CoV-2 infection; however, the evidence supporting this link is still scarce. We aimed to examine the association between SARS-CoV-2 infection and NOAF. METHODS We conducted a nested-case control study in a cohort of 2,931,046 adults from the largest healthcare provider in Israel. Subjects were followed from March 1st, 2020, until June 30th, 2022, for the occurrence of NOAF. Ten randomly selected controls were matched to each case of NOAF on age, sex, and duration of follow-up. Exposure to SARS-CoV-2 infection in the prior 30 days was assessed in cases and controls. To account for surveillance bias we performed a lag-time analysis and assessed the association with a negative control exposure (low back pain). Data was analyzed using conditional logistic regression. RESULTS During the follow-up 18,981 patients developed NOAF and were matched to 189,810 controls. The mean age of cases and matched controls was 73.8 ± 13 years, and 51.1% of them were women. Multivariable analysis showed that SARS-CoV-2 infection was associated with an increased risk of NOAF; adjusted-OR, 4.24 (95% CI, 3.89-4.62). The association remained significant on lag-time analysis; however, the strength of the association was gradually attenuated with increasing lag-time but stabilized around a lag-time of 20 days. The negative control exposure (low back pain) was associated only with small increased risk of NOAF; adjusted-OR of 1.13 (95% CI, 1.02-1.26). CONCLUSION SARS-CoV-2 infection appears to be associated with increased risk of NOAF.
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Affiliation(s)
- Bar Rosh
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ibrahim Naoum
- Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Ofra Barnett-Griness
- Statistical Unit, Lady Davis Carmel Medical Center, Haifa, Israel; Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Ronza Najjar-Debbiny
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Infection Control and Prevention Unit, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Walid Saliba
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel; Translational Epidemiology Unit and Research Authority, Lady Davis Carmel Medical Center, Haifa, Israel
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16
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Zakynthinos GE, Tsolaki V, Oikonomou E, Vavouranakis M, Siasos G, Zakynthinos E. New-Onset Atrial Fibrillation in the Critically Ill COVID-19 Patients Hospitalized in the Intensive Care Unit. J Clin Med 2023; 12:6989. [PMID: 38002603 PMCID: PMC10672690 DOI: 10.3390/jcm12226989] [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: 08/29/2023] [Revised: 10/28/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
New-onset atrial fibrillation (NOAF) is the most frequently encountered cardiac arrhythmia observed in patients with COVID-19 infection, particularly in Intensive Care Unit (ICU) patients. The purpose of the present review is to delve into the occurrence of NOAF in COVID-19 and thoroughly review recent, pertinent data. However, the causality behind this connection has yet to be thoroughly explored. The proposed mechanisms that could contribute to the development of AF in these patients include myocardial damage resulting from direct virus-induced cardiac injury, potentially leading to perimyocarditis; a cytokine crisis and heightened inflammatory response; hypoxemia due to acute respiratory distress; disturbances in acid-base and electrolyte levels; as well as the frequent use of adrenergic drugs in critically ill patients. Additionally, secondary bacterial sepsis and septic shock have been suggested as primary causes of NOAF in ICU patients. This notion gains strength from the observation of a similar prevalence of NOAF in septic non-COVID ICU patients with ARDS. It is plausible that both myocardial involvement from SARS-CoV-2 and secondary sepsis play pivotal roles in the onset of arrhythmia in ICU patients. Nonetheless, there exists a significant variation in the prevalence of NOAF among studies focused on severe COVID-19 cases with ARDS. This discrepancy could be attributed to the inclusion of mixed populations with varying degrees of illness severity, encompassing not only patients in general wards but also those admitted to the ICU, whether intubated or not. Furthermore, the occurrence of NOAF is linked to increased morbidity and mortality. However, it remains to be determined whether NOAF independently influences outcomes in critically ill COVID-19 ICU patients or if it merely reflects the disease's severity. Lastly, the management of NOAF in these patients has not been extensively studied. Nevertheless, the current guidelines for NOAF in non-COVID ICU patients appear to be effective, while accounting for the specific drugs used in COVID-19 treatment that may prolong the QT interval (although drugs like lopinavir/ritonavir, hydrochlorothiazide, and azithromycin have been discontinued) or induce bradycardia (e.g., remdesivir).
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Affiliation(s)
- George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
| | - Vasiliki Tsolaki
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Epaminondas Zakynthinos
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
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17
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Lee PY, Garan H, Wan EY, Scully BE, Biviano A, Yarmohammadi H. Cardiac arrhythmias in viral infections. J Interv Card Electrophysiol 2023; 66:1939-1953. [PMID: 36929368 PMCID: PMC10019413 DOI: 10.1007/s10840-023-01525-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The current COVID-19 pandemic has led to many studies examining its arrhythmogenic effects. However, there are many other viruses that are capable of inducing arrhythmias that have not received as much attention. The objective of this study was to review common viruses and identify studies highlighting their arrhythmogenic effects. METHODS AND RESULTS In this review, we examined 15 viruses and the literature regarding their arrhythmogenic effects. The common mechanisms of action appear to be direct invasion of myocytes leading to immune mediated damage, infection of vascular endothelium, and alteration of cardiac ion channels. CONCLUSIONS This review highlights the growing evidence that supports the involvement of other viral infections in the development of arrhythmia. Physicians should be aware of these potentially life-threatening effects when caring for patients with these viruses, some of which are very common. Additional studies are required to better understand the complex mechanism and risk factors of cardiac arrhythmias in patients suffered from viral infections to determine whether the processes can be reversed or even prevented.
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Affiliation(s)
- Paul Y Lee
- Department of Medicine, Rutgers University, Newark, NJ, USA
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Brian E Scully
- Department of Medicine, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Angelo Biviano
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
- Cardiology and Cardiac Electrophysiology, Columbia University, 177 Fort Washington Avenue, New York, NY, 10032, USA.
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18
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Teaima T, Shoura S, Gajjar RA, Khalil C, Atluri R, Aziz I, Shilbayeh AR, Battikh N, Huang HD. Impact of Co-existing Paroxysmal Atrial Fibrillation on Different Outcomes of Hospitalized COVID-19 Patients: Nationwide Inpatient Sample Analysis (2020) With Propensity Score Matching. Curr Probl Cardiol 2023; 48:101992. [PMID: 37487852 DOI: 10.1016/j.cpcardiol.2023.101992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
Various studies in the medical literature reported significant cardiovascular involvement in patients with coronavirus disease 2019 (COVID-19) pneumonia. Atrial fibrillation (AF) was identified as the most commonly observed arrhythmia complicating COVID-19 infection with an increased risk of short-term mortality. We used the National Inpatient Sample Database (NIS) of 2020 to conduct this retrospective cohort study. Our study's population consisted of adult patients hospitalized for COVID-19 Pneumonia with or without the presence of paroxysmal atrial fibrillation (PAF). Encounters with COVID-19 and co-existing PAF had higher adjusted odds of inpatient mortality (Adjusted odds ratio [aOR]: 1.19, 95% CI: 1.11-1.28, P < 0.001), longer mean length of hospital stay (LOS) of 1.17 days (95% confidence interval [CI]: 1.03-1.38, P < 0.001), and higher odds of different in-hospital complications. Based on these results, conducting more prospective/retrospective cohort studies with an emphasis on long-term follow-up on patients who develop PAF following COVID-19 infection is warranted.
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Affiliation(s)
- Taha Teaima
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Sami Shoura
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Rohan A Gajjar
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Charl Khalil
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Ramtej Atluri
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Imran Aziz
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | - Naim Battikh
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Henry D Huang
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush medical center, Chicago, IL.
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19
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Pari B, Babbili A, Kattubadi A, Thakre A, Thotamgari S, Gopinathannair R, Olshansky B, Dominic P. COVID-19 Vaccination and Cardiac Arrhythmias: A Review. Curr Cardiol Rep 2023; 25:925-940. [PMID: 37530946 DOI: 10.1007/s11886-023-01921-7] [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] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW In this review, we aim to delve into the existing literature, seeking to uncover the mechanisms, investigate the electrocardiographic changes, and examine the treatment methods of various cardiac arrhythmias that occur after administration of the COVID-19 vaccine. RECENT FINDINGS A global survey has exposed an incidence of arrhythmia in 18.27% of hospitalized COVID-19 patients. Furthermore, any type of COVID-19 vaccine - be it mRNA, adenovirus vector, whole inactivated, or protein subunit - appears to instigate cardiac arrhythmias. Among the cardiac adverse events reported post-COVID-19 vaccination, myocarditis emerges as the most common and is thought to be a potential cause of bradyarrhythmia. When a patient post-COVID-19 vaccination presents a suspicion of cardiac involvement, clinicians should perform a comprehensive history and physical examination, measure electrolyte levels, conduct ECG, and carry out necessary imaging studies. In our extensive literature search, we uncovered various potential mechanisms that might lead to cardiac conduction abnormalities and autonomic dysfunction in patients who have received the COVID-19 vaccine. These mechanisms encompass direct viral invasion through molecular mimicry/spike (S) protein production, an escalated inflammatory response, hypoxia, myocardial cell death, and the eventual scar/fibrosis. They correspond to a range of conditions including atrial tachyarrhythmias, bradyarrhythmia, ventricular arrhythmias, sudden cardiac death, and the frequently occurring myocarditis. For treating these COVID-19 vaccination-induced arrhythmias, we should incorporate general treatment strategies, similar to those applied to arrhythmias from other causes.
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Affiliation(s)
- Bavithra Pari
- Department of Medicine, LSUHSC-S, Shreveport, LA, USA
| | | | | | - Anuj Thakre
- Department of Medicine, LSUHSC-S, Shreveport, LA, USA
| | | | - Rakesh Gopinathannair
- The Kansas City Heart Rhythm Institute (KCHRI) & Research Foundation, Overland Park Regional Medical Center, KS, Kansas City, USA
| | - Brian Olshansky
- Division of Cardiology, Department of Medicine, The University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Paari Dominic
- Division of Cardiology, Department of Medicine, The University of Iowa, Carver College of Medicine, Iowa City, IA, USA.
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20
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Llucià-Carol L, Muiño E, Cullell N, Cárcel-Márquez J, Lledós M, Gallego-Fabrega C, Martin-Campos J, Martí-Fàbregas J, Aguilera-Simón A, Planas AM, DeDiego ML, de Felipe Mimbrera A, Masjuan J, García-Madrona S, Segura T, González-Villar E, Serrano-Heras G, Domínguez Mayoral A, Menéndez-Valladares P, Montaner J, Migeotte I, Rahmouni S, Darcis G, Bernardo D, Rojo S, Schulte EC, Protzer U, Fricke L, Winter C, Niemi MEK, Cordioli M, Delgado P, Fernández-Cadenas I. Genetic Architecture of Ischaemic Strokes after COVID-19 Shows Similarities with Large Vessel Strokes. Int J Mol Sci 2023; 24:13452. [PMID: 37686257 PMCID: PMC10487930 DOI: 10.3390/ijms241713452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
We aimed to analyse whether patients with ischaemic stroke (IS) occurring within eight days after the onset of COVID-19 (IS-COV) are associated with a specific aetiology of IS. We used SUPERGNOVA to identify genome regions that correlate between the IS-COV cohort (73 IS-COV cases vs. 701 population controls) and different aetiological subtypes. Polygenic risk scores (PRSs) for each subtype were generated and tested in the IS-COV cohort using PRSice-2 and PLINK to find genetic associations. Both analyses used the IS-COV cohort and GWAS from MEGASTROKE (67,162 stroke patients vs. 454,450 population controls), GIGASTROKE (110,182 vs. 1,503,898), and the NINDS Stroke Genetics Network (16,851 vs. 32,473). Three genomic regions were associated (p-value < 0.05) with large artery atherosclerosis (LAA) and cardioembolic stroke (CES). We found four loci targeting the genes PITX2 (rs10033464, IS-COV beta = 0.04, p-value = 2.3 × 10-2, se = 0.02), previously associated with CES, HS6ST1 (rs4662630, IS-COV beta = -0.04, p-value = 1.3 × 10-3, se = 0.01), TMEM132E (rs12941838 IS-COV beta = 0.05, p-value = 3.6 × 10-4, se = 0.01), and RFFL (rs797989 IS-COV beta = 0.03, p-value = 1.0 × 10-2, se = 0.01). A statistically significant PRS was observed for LAA. Our results suggest that IS-COV cases are genetically similar to LAA and CES subtypes. Larger cohorts are needed to assess if the genetic factors in IS-COV cases are shared with the general population or specific to viral infection.
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Affiliation(s)
- Laia Llucià-Carol
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
- Departament de Genètica i de Microbiologia, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
- Department of Neurology, Hospital Universitari MútuaTerrassa, Fundació Docència i Recerca MútuaTerrassa, 08221 Terrassa, Spain
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
| | - Miquel Lledós
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
| | - Jesús Martin-Campos
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
| | - Joan Martí-Fàbregas
- Department of Neurology, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Ana Aguilera-Simón
- Department of Neurology, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Anna M. Planas
- Institute for Biomedical Research of Barcelona (IIBB), Spanish National Research Council (CSIC), 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Marta L. DeDiego
- Department of Molecular and Cell Biology, Centro Nacional de Biotecnología (CNB-CSIC), Campus Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Alicia de Felipe Mimbrera
- Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón Y Cajal, 28034 Madrid, Spain
| | - Jaime Masjuan
- Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón Y Cajal, 28034 Madrid, Spain
| | - Sebastián García-Madrona
- Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón Y Cajal, 28034 Madrid, Spain
| | - Tomás Segura
- Department of Neurology, University Hospital of Albacete, 02006 Albacete, Spain
| | | | - Gemma Serrano-Heras
- Department of Neurology, University Hospital of Albacete, 02006 Albacete, Spain
| | - Ana Domínguez Mayoral
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 410113 Seville, Spain
- Department of Neurology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
| | - Paloma Menéndez-Valladares
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 410113 Seville, Spain
- Department of Neurology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
| | - Joan Montaner
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 410113 Seville, Spain
- Department of Neurology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
| | - Isabelle Migeotte
- Fonds de la Recherche Scientifique (FNRS), 1000 Brussels, Belgium
- Centre de Génétique Humaine, Hopital Erasme, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Souad Rahmouni
- Fonds de la Recherche Scientifique (FNRS), 1000 Brussels, Belgium
- Department of Biomedical and Preclinical Sciences, Faculty of Medicine, GIGA-Insitute, University of Liege, 4000 Liège, Belgium
| | - Gilles Darcis
- Fonds de la Recherche Scientifique (FNRS), 1000 Brussels, Belgium
- CHU of Liege, 4000 Liège, Belgium
| | - David Bernardo
- Mucosal Immunology Lab, Unidad de Excelencia del Instituto de Biomedicina y Genética Molecular (IBGM), Universidad de Valladolid-CSIC, 47005 Valladolid, Spain
| | - Silvia Rojo
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), 47003 Valladolid, Spain
| | - Eva C. Schulte
- Institute of Virology, Technical University Munich/Helmholtz Zentrum München, 81377 Munich, Germany
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich University, 80336 Munich, Germany
- Department of Psychiatry, University Hospital, LMU Munich University, 80336 Munich, Germany
- Institute of Human Genetics, University Hospital Bonn, Medical Faculty, University of Bonn, 53127 Bonn, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Medical Faculty, University of Bonn, 53127 Bonn, Germany
| | - Ulrike Protzer
- Institute of Virology, Technical University Munich/Helmholtz Zentrum München, 81377 Munich, Germany
| | - Lisa Fricke
- Department of Internal Medicine II, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany;
| | - Christof Winter
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technische Universität München (TUM), 81675 Munich, Germany
- TranslaTUM, Center for Translational Cancer Research, Technische Universität München, 81675 Munich, Germany
| | - Mari E. K. Niemi
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (M.E.K.N.)
| | - Mattia Cordioli
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (M.E.K.N.)
| | - Pilar Delgado
- Department of Neurology, Hospital Universitari de la Vall d’Hebrón, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Israel Fernández-Cadenas
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
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21
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Bostanghadiri N, Ziaeefar P, Mofrad MG, Yousefzadeh P, Hashemi A, Darban-Sarokhalil D. COVID-19: An Overview of SARS-CoV-2 Variants-The Current Vaccines and Drug Development. BIOMED RESEARCH INTERNATIONAL 2023; 2023:1879554. [PMID: 37674935 PMCID: PMC10480030 DOI: 10.1155/2023/1879554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/07/2023] [Accepted: 08/04/2023] [Indexed: 09/08/2023]
Abstract
The world is presently in crisis facing an outbreak of a health-threatening microorganism known as COVID-19, responsible for causing uncommon viral pneumonia in humans. The virus was first reported in Wuhan, China, in early December 2019, and it quickly became a global concern due to the pandemic. Challenges in this regard have been compounded by the emergence of several variants such as B.1.1.7, B.1.351, P1, and B.1.617, which show an increase in transmission power and resistance to therapies and vaccines. Ongoing researches are focused on developing and manufacturing standard treatment strategies and effective vaccines to control the pandemic. Despite developing several vaccines such as Pfizer/BioNTech and Moderna approved by the U.S. Food and Drug Administration (FDA) and other vaccines in phase 4 clinical trials, preventive measures are mandatory to control the COVID-19 pandemic. In this review, based on the latest findings, we will discuss different types of drugs as therapeutic options and confirmed or developing vaccine candidates against SARS-CoV-2. We also discuss in detail the challenges posed by the variants and their effect on therapeutic and preventive interventions.
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Affiliation(s)
- Narjess Bostanghadiri
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Pardis Ziaeefar
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morvarid Golrokh Mofrad
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Parsa Yousefzadeh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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22
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Anesi GL, Degnan K, Dutcher L, Saw S, Maguire C, Binkley A, Patel S, Athans V, Barton TD, Binkley S, Candeloro CL, Herman DJ, Kasbekar N, Kennedy L, Millstein JH, Meyer NJ, Talati NJ, Patel H, Pegues DA, Sayre PJ, Tebas P, Terico AT, Murphy KM, O’Donnell JA, White M, Hamilton KW. The Penn Medicine COVID-19 Therapeutics Committee-Reflections on a Model for Rapid Evidence Review and Dynamic Practice Recommendations During a Public Health Emergency. Open Forum Infect Dis 2023; 10:ofad428. [PMID: 37663091 PMCID: PMC10468749 DOI: 10.1093/ofid/ofad428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023] Open
Abstract
The Penn Medicine COVID-19 Therapeutics Committee-an interspecialty, clinician-pharmacist, and specialist-front line primary care collaboration-has served as a forum for rapid evidence review and the production of dynamic practice recommendations during the 3-year coronavirus disease 2019 public health emergency. We describe the process by which the committee went about its work and how it navigated specific challenging scenarios. Our target audiences are clinicians, hospital leaders, public health officials, and researchers invested in preparedness for inevitable future threats. Our objectives are to discuss the logistics and challenges of forming an effective committee, undertaking a rapid evidence review process, aligning evidence-based guidelines with operational realities, and iteratively revising recommendations in response to changing pandemic data. We specifically discuss the arc of evidence for corticosteroids; the noble beginnings and dangerous misinformation end of hydroxychloroquine and ivermectin; monoclonal antibodies and emerging viral variants; and patient screening and safety processes for tocilizumab, baricitinib, and nirmatrelvir-ritonavir.
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Affiliation(s)
- George L Anesi
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kathleen Degnan
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lauren Dutcher
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Stephen Saw
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Christina Maguire
- Department of Pharmacy, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Amanda Binkley
- Department of Pharmacy, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Sonal Patel
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Vasilios Athans
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Todd D Barton
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Shawn Binkley
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Christina L Candeloro
- Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - David J Herman
- Division of Infectious Diseases, Penn Medicine Princeton Medical Center, University of Pennsylvania Health System, Princeton, New Jersey, USA
| | - Nishaminy Kasbekar
- Department of Pharmacy, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Leigh Kennedy
- Division of Infectious Diseases, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Jeffrey H Millstein
- Regional Physician Practices of Penn Medicine, Woodbury Heights, New Jersey, USA
| | - Nuala J Meyer
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Naasha J Talati
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Hinal Patel
- Department of Pharmacy, Penn Medicine Princeton Medical Center, University of Pennsylvania Health System, Princeton, New Jersey, USA
| | - David A Pegues
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Patrick J Sayre
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pablo Tebas
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adrienne T Terico
- Department of Pharmacy, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Kathleen M Murphy
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Judith A O’Donnell
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Melissa White
- Department of Pharmacy, Penn Medicine Lancaster General Health, University of Pennsylvania Health System, Lancaster, Pennsylvania, USA
| | - Keith W Hamilton
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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23
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Wang C, Hao W. Cardiac arrhythmia and immune response in COVID-19 patients. Allergol Immunopathol (Madr) 2023; 51:63-70. [PMID: 37422781 DOI: 10.15586/aei.v51i4.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/15/2023] [Indexed: 07/11/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has presented substantial challenges for providing health care due to the numerous complications on the respiratory and cardiovascular systems of people. Cardiac arrhythmia is one of the cardiac complications, and it was observed in COVID-19 patients. Moreover, arrhythmia and cardiac arrest are common in COVID-19 patients in the intensive care unit. The occurrence of cardiac arrhythmia in COVID-19 patients is associated with hypoxia, cytokine storm, myocardial ischemia and inflammatory disease such as congestive heart failure. It is necessary to know the occurrence and mechanisms of tachyarrhythmia and bradyarrhythmia in patients with COVID-19 infection for their proper management. This review provides an overview of the association between COVID-19 and arrhythmias by detailing possible pathophysiological mechanisms.
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Affiliation(s)
- Chunlian Wang
- Institute for Prevention and Control of Chronic Non-communicable Diseases, Harbin Center for Disease Control and Prevention, Harbin, China
| | - Wenqiang Hao
- The Second Ward of Internal Medicine, The Second Hospital of Heilongjiang Province, Harbin, China; ;
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24
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Asanin M, Ercegovac M, Krljanac G, Djukic T, Coric V, Jerotic D, Pljesa-Ercegovac M, Matic M, Milosevic I, Viduljevic M, Stevanovic G, Ranin J, Simic T, Bukumiric Z, Savic-Radojevic A. Antioxidant Genetic Variants Modify Echocardiography Indices in Long COVID. Int J Mol Sci 2023; 24:10234. [PMID: 37373377 DOI: 10.3390/ijms241210234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Although disturbance of redox homeostasis might be responsible for COVID-19 cardiac complications, this molecular mechanism has not been addressed yet. We have proposed modifying the effects of antioxidant proteins polymorphisms (superoxide dismutase 2 (SOD2), glutathione peroxidase 1 (GPX1), glutathione peroxidase 3 (GPX3) and nuclear factor erythroid 2-related factor 2, (Nrf2)) in individual susceptibility towards the development of cardiac manifestations of long COVID-19. The presence of subclinical cardiac dysfunction was assessed via echocardiography and cardiac magnetic resonance imaging in 174 convalescent COVID-19 patients. SOD2, GPX1, GPX3 and Nrf2 polymorphisms were determined via the appropriate PCR methods. No significant association of the investigated polymorphisms with the risk of arrhythmia development was found. However, the carriers of variant GPX1*T, GPX3*C or Nrf2*A alleles were more than twice less prone for dyspnea development in comparison with the carriers of the referent ones. These findings were even more potentiated in the carriers of any two variant alleles of these genes (OR = 0.273, and p = 0.016). The variant GPX alleles were significantly associated with left atrial and right ventricular echocardiographic parameters, specifically LAVI, RFAC and RV-EF (p = 0.025, p = 0.009, and p = 0.007, respectively). Based on the relation between the variant SOD2*T allele and higher levels of LV echocardiographic parameters, EDD, LVMI and GLS, as well as troponin T (p = 0.038), it can be proposed that recovered COVID-19 patients, who are the carriers of this genetic variant, might have subtle left ventricular systolic dysfunction. No significant association between the investigated polymorphisms and cardiac disfunction was observed when cardiac magnetic resonance imaging was performed. Our results on the association between antioxidant genetic variants and long COVID cardiological manifestations highlight the involvement of genetic propensity in both acute and long COVID clinical manifestations.
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Affiliation(s)
- Milika Asanin
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Cardiology, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Marko Ercegovac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Neurology, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Cardiology, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Tatjana Djukic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
| | - Vesna Coric
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
| | - Djurdja Jerotic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
| | - Marija Pljesa-Ercegovac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
| | - Marija Matic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
| | - Ivana Milosevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Infectious and Tropical Diseases, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | | | - Goran Stevanovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Infectious and Tropical Diseases, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Jovan Ranin
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Infectious and Tropical Diseases, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Tatjana Simic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
- Department of Medical Sciences, Serbian Academy of Sciences and Arts, 11000 Belgrade, Serbia
| | - Zoran Bukumiric
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Medical Statistics and Informatics, 11000 Belgrade, Serbia
| | - Ana Savic-Radojevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
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25
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Speedie A, Manickavasagam A, Patloori SCS, Karuppusamy R, James R, S M, Chase D, Jacob JR. Does Cardiac Arrhythmia Predict Worse Outcome in Mild or Moderate Covid-19 Infection? SN COMPREHENSIVE CLINICAL MEDICINE 2023; 5:162. [PMID: 37325161 PMCID: PMC10251310 DOI: 10.1007/s42399-023-01497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/17/2023]
Abstract
Covid-19 is a multisystem disease with the lungs being predominantly affected. Cardiac involvement is mostly seen as a rise in troponins, arrhythmias, and ventricular dysfunction. This study aimed to estimate the incidence of arrhythmias seen in Covid-19 infection and assess if arrhythmias predict worsening or mortality. Prospective observational study involving patients with mild to moderate Covid illness admitted in a tertiary care centre. Among the 85 patients (Mean age 45.8 + 14.1 years; 75.31% men), worsening of Covid-19 illness was seen in 29 (34.1%) patients. New onset arrhythmias were detected on Holter in 9 (10.5%) patients. Supraventricular tachycardia was seen in 7 (8.2%) patients of whom 6 showed worsening which was statistically significant (p-value-0.006). Risk factors associated with worsening on univariate analysis were male gender (OR [95%CI] = 6.93(1.49-32.31), p-value - 0.014), new onset supraventricular tachycardia (OR [95% CI] = 14.35 [1.64-125.94], p-value - 0.016) and D-dimer elevation (OR [95% CI] = 1.00(1.00-1.01), p-value - 0.02). On multivariate analysis D-dimer (OR [95% CI] = 1.00(1.00-1.01; p-value 0.046) and supraventricular arrhythmias (OR [95% CI] = 11.12 (1.22-101.14); p-value - 0.033) were independently associated with worsening. Covid-19 infection can lead to cardiac arrhythmias. The development of supraventricular tachycardia in patients with Covid-19 infection predicts higher morbidity and worsening.
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Affiliation(s)
- Abraham Speedie
- Department of Cardiology, Cardiac Electrophysiology Unit, Christian Medical College and Hospital, Vellore, TN 632004 India
| | - Anand Manickavasagam
- Department of Cardiology, Cardiac Electrophysiology Unit, Christian Medical College and Hospital, Vellore, TN 632004 India
| | | | - Reka Karuppusamy
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, TN 632004 India
| | - Rintu James
- Department of Cardiology, Cardiac Electrophysiology Unit, Christian Medical College and Hospital, Vellore, TN 632004 India
| | - Mahalakshmi S
- Department of Cardiology, Cardiac Electrophysiology Unit, Christian Medical College and Hospital, Vellore, TN 632004 India
| | - David Chase
- Department of Cardiology, Cardiac Electrophysiology Unit, Christian Medical College and Hospital, Vellore, TN 632004 India
| | - John Roshan Jacob
- Department of Cardiology, Cardiac Electrophysiology Unit, Christian Medical College and Hospital, Vellore, TN 632004 India
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Kuck KH, Schlüter M, Vogler J, Heeger CH, Tilz RR. Has COVID-19 changed the spectrum of arrhythmias and the incidence of sudden cardiac death? Herz 2023:10.1007/s00059-023-05186-2. [PMID: 37277617 DOI: 10.1007/s00059-023-05186-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/07/2023]
Abstract
Arrhythmic manifestations of COVID-19 include atrial arrhythmias such as atrial fibrillation or atrial flutter, sinus node dysfunction, atrioventricular conduction abnormalities, ventricular tachyarrhythmias, sudden cardiac arrest, and cardiovascular dysautonomias including the so-called long COVID syndrome. Various pathophysiological mechanisms have been implicated, such as direct viral invasion, hypoxemia, local and systemic inflammation, changes in ion channel physiology, immune activation, and autonomic dysregulation. The development of atrial or ventricular arrhythmias in hospitalized COVID-19 patients has been shown to portend a higher risk of in-hospital death. Management of these arrhythmias should be based on published evidence-based guidelines, with special consideration of the acuity of COVID-19 infection, concomitant use of antimicrobial and anti-inflammatory drugs, and the transient nature of some rhythm disorders. In view of new SARS-CoV‑2 variants that may evolve, the development and use of newer antiviral and immunomodulator drugs, and the increasing adoption of vaccination, clinicians must remain vigilant for other arrhythmic manifestations that may occur in association with this novel but potentially deadly disease.
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Affiliation(s)
- Karl-Heinz Kuck
- Medizinische Klinik II - Kardiologie, Angiologie, Intensivmedizin,Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- LANS Cardio, Hamburg, Germany.
| | | | - Julia Vogler
- Medizinische Klinik II - Kardiologie, Angiologie, Intensivmedizin,Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christian Hendrik Heeger
- Medizinische Klinik II - Kardiologie, Angiologie, Intensivmedizin,Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Roland Richard Tilz
- Medizinische Klinik II - Kardiologie, Angiologie, Intensivmedizin,Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Cerezo Manchado JJ, Iturbe Hernández T, Martínez Pacheco MDC, Gil Ortega I, Campoy D, Canals Pernas T, Martínez Serra L, Flores Aparco KJ, Velásquez Escandón CA, Martínez Francés A, Olivera P. Impact of atrial fibrillation and anticoagulation on the risk of death, thromboembolic disease and bleeding in patients with COVID-19: the ACO-VID Registry. Curr Med Res Opin 2023; 39:811-817. [PMID: 37189306 DOI: 10.1080/03007995.2023.2204009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To describe the clinical profile, risk of complications and impact of anticoagulation in COVID-19 hospitalized patients, according to the presence of atrial fibrillation (AF). METHODS Multicenter, retrospective, and observational study that consecutively included patients >55 years admitted with COVID-19 from March to October 2020. In AF patients, anticoagulation was chosen based on clinicians' judgment. Patients were followed-up for 90 days. RESULTS A total of 646 patients were included, of whom 75.2% had AF. Overall, mean age was 75 ± 9.1 years and 62.4% were male. Patients with AF were older and had more comorbidities. The most common anticoagulants used during hospitalization in patients with AF were edoxaban (47.9%), low molecular weight heparin (27.0%), and dabigatran (11.7%) and among patients without AF, these numbers were 0%, 93.8% and 0%. Overall, during the study period (68 ± 3 days), 15.2% of patients died, 8.2% of patients presented a major bleeding and 0.9% had a stroke/systemic embolism. During hospitalization, patients with AF had a higher risk of major bleeding (11.3% vs 0.7%; p < .01), COVID-19-related deaths (18.0% vs 4.5%; p = .02), and all-cause deaths (20.6% vs 5.6%; p = .02). Age (HR 1.5; 95% CI 1.0-2.3) and elevated transaminases (HR 3.5; 95% CI 2.0-6.1) were independently associated with all-cause mortality. AF was independently associated with major bleeding (HR 2.2; 95% CI 1.1-5.3). CONCLUSIONS Among patients hospitalized with COVID-19, patients with AF were older, had more comorbidities and had a higher risk of major bleeding. Age and elevated transaminases during hospitalization, but not AF nor anticoagulant treatment increased the risk of all-cause death.
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Affiliation(s)
| | | | | | - Ignacio Gil Ortega
- Department of Cardiology, Hospital Clínico Universitario Santa Lucía, Cartagena, Spain
| | - Desirée Campoy
- Thrombosis and Hemostasis Unit, Department of Hematology, Valld'Hebron University Hospital, Barcelona, Spain
| | - Tania Canals Pernas
- Departament of Hematology, Hospital Universitario Sant Joan de Reus, Reus, Spain
| | - Laia Martínez Serra
- Department of Hematology, University Hospital Sant Joan de Reus, Tarragona, Spain
| | | | | | | | - Pável Olivera
- Thrombosis and Hemostasis Unit, Department of Hematology, Valld'Hebron University Hospital, Barcelona, Spain
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Gupta P, Bansal S, Gupta A, Gupta K, Saluja S, Kattumannil SK. Prevalence of arrhythmia in COVID-19 patients with mild/moderate and severe illness: a prospective cohort study. Expert Rev Cardiovasc Ther 2023; 21:453-461. [PMID: 37204921 DOI: 10.1080/14779072.2023.2216456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/21/2023] [Accepted: 05/17/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES The type of arrhythmias, and their prevalence in mild/moderate and severe COVID-19 patients admitted to the hospital are unknown from a prospective cohort study. METHODS We did continuous electrocardiograms along with multiple ECGs in 305 consecutive hospitalized COVID-19 patients. RESULTS The incidence of arrhythmias was 6.8% (21/305) in the target population. The incidence of arrhythmias was 9.2% (17/185) in patients with severe COVID-19 illness and 3.3% (4/120) in patients with mild/moderate COVID-19 illness with no significant difference (p = 0.063). All the arrhythmias were new-onset arrhythmias in this study. 95% (20/21) of these arrhythmias were atrial arrhythmia with 71.42% (15/21) being atrial fibrillation and one episode of sustained polymorphic ventricular tachycardia. No episode of high-grade atrioventricular block, sustained monomorphic ventricular arrhythmia, or torsades de pointes arrhythmias were observed in this study. The patients with arrhythmias were admitted to the intensive care unit (80.9% vs. 50.7%; p: 0.007), were on a ventilator (47.6% vs. 21.4%; p: 0.006), and had high in-hospital mortality (57.1% vs. 21.1%; p: 0.0001) than patients without arrhythmias. CONCLUSION Atrial arrhythmias were the most frequent arrhythmias in hospital-admitted COVID-19 patients with atrial fibrillation being the most common arrhythmia. TRIAL REGISTRATION Clinical Trial Registry India (CTRI) (CTRI/2021/01/030788). (https://www.ctri.nic.in/).
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Affiliation(s)
- Praveen Gupta
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sandeep Bansal
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Anunay Gupta
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Kapil Gupta
- Department of Anesthesia and Critical Care, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sumita Saluja
- Department of Hematology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
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29
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Antwi-Amoabeng D, Beutler BD, Ulanja MB, Neelam V, Gbadebo TD. Effect of atrial fibrillation on mortality in SARS-CoV-2 patients: A propensity score-matched analysis of nationwide hospitalizations in the United States. Heliyon 2023; 9:e17199. [PMID: 37325454 PMCID: PMC10256628 DOI: 10.1016/j.heliyon.2023.e17199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023] Open
Abstract
Background Atrial fibrillation (AF) is one of the most common arrhythmias encountered in patients with SARS-CoV-2 infection. There are racial disparities in the incidence of AF and COVID-19. Several studies have reported an association between AF and mortality. However, it remains to be determined if AF represents an independent risk factor for COVID-19-related mortality. Methods A propensity score-matched (PSM) analysis was performed using data from the National Inpatient Sample to assess the risk of mortality among patients hospitalized with SARS-CoV-2 infection and incident AF from March 2020 through December 2020. Results AF was less common among patients who tested positive for SARS-CoV-2 as compared to those who tested negative (6.8% vs 7.4%, p < 0.001). White individuals with the virus had an increased incidence of AF but had lower mortality rates relative to Black and Hispanic patients. After PSM analysis, AF retained a significantly increased odds of mortality among patients with SARS-CoV-2 (OR: 1.35, CI: 1.29-1.41, p < 0.001). Conclusion This PSM analysis shows that AF is an independent risk factor for inpatient mortality in those with SARS-CoV-2 infection and that White patients, while having a higher burden of SARS-CoV-2 and AF, demonstrate a significantly lower mortality rate as compared to their Black and Hispanic counterparts.
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Affiliation(s)
| | - Bryce D Beutler
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Mark B Ulanja
- Christus Ochsner St. Patrick Hospital, Lake Charles, LA, USA
| | - Vijay Neelam
- Christus Ochsner St. Patrick Hospital, Lake Charles, LA, USA
| | - T David Gbadebo
- East Atlanta Cardiology, Atlanta, GA, USA
- Emory Decatur Hospital, Atlanta, GA, USA
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30
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Fiedler L, Motloch LJ, Dieplinger AM, Jirak P, Davtyan P, Gareeva D, Badykova E, Badykov M, Lakman I, Agapitov A, Sadikova L, Pavlov V, Föttinger F, Mirna M, Kopp K, Hoppe UC, Pistulli R, Cai B, Yang B, Zagidullin N. Prophylactic rivaroxaban in the early post-discharge period reduces the rates of hospitalization for atrial fibrillation and incidence of sudden cardiac death during long-term follow-up in hospitalized COVID-19 survivors. Front Pharmacol 2023; 14:1093396. [PMID: 37324463 PMCID: PMC10266094 DOI: 10.3389/fphar.2023.1093396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/18/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction: While acute Coronavirus disease 2019 (COVID-19) affects the cardiovascular (CV) system according to recent data, an increased CV risk has been reported also during long-term follow-up (FU). In addition to other CV pathologies in COVID-19 survivors, an enhanced risk for arrhythmic events and sudden cardiac death (SCD) has been observed. While recommendations on post-discharge thromboprophylaxis are conflicting in this population, prophylactic short-term rivaroxaban therapy after hospital discharge showed promising results. However, the impact of this regimen on the incidence of cardiac arrhythmias has not been evaluated to date. Methods: To investigate the efficacy of this therapy, we conducted a single center, retrospective analysis of 1804 consecutive, hospitalized COVID-19 survivors between April and December 2020. Patients received either a 30-day post-discharge thromboprophylaxis treatment regimen using rivaroxaban 10 mg every day (QD) (Rivaroxaban group (Riva); n = 996) or no thromboprophylaxis (Control group (Ctrl); n = 808). Hospitalization for new atrial fibrillation (AF), new higher-degree Atrioventricular-block (AVB) as well as incidence of SCD were investigated in 12-month FU [FU: 347 (310/449) days]. Results: No differences in baseline characteristics (Ctrl vs Riva: age: 59.0 (48.9/66.8) vs 57 (46.5/64.9) years, p = n.s.; male: 41.5% vs 43.7%, p = n.s.) and in the history of relevant CV-disease were observed between the two groups. While hospitalizations for AVB were not reported in either group, relevant rates of hospitalizations for new AF (0.99%, n = 8/808) as well as a high rate of SCD events (2.35%, n = 19/808) were seen in the Ctrl. These cardiac events were attenuated by early post-discharge prophylactic rivaroxaban therapy (AF: n = 2/996, 0.20%, p = 0.026 and SCD: n = 3/996, 0.30%, p < 0.001) which was also observed after applying a logistic regression model for propensity score matching (AF: χ 2-statistics = 6.45, p = 0.013 and SCD: χ 2-statistics = 9.33, p = 0.002). Of note, no major bleeding complications were observed in either group. Conclusion: Atrial arrhythmic and SCD events are present during the first 12 months after hospitalization for COVID-19. Extended prophylactic Rivaroxaban therapy after hospital discharge could reduce new onset of AF and SCD in hospitalized COVID-19 survivors.
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Affiliation(s)
- Lukas Fiedler
- University Department of Internal Medicine II, Cardiology and Internal Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
- Department of Internal Medicine, Nephrology and Intensive Care Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Lukas J. Motloch
- University Department of Internal Medicine II, Cardiology and Internal Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Anna-Maria Dieplinger
- Nursing Science Program, Institute for Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Peter Jirak
- University Department of Internal Medicine II, Cardiology and Internal Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Paruir Davtyan
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
| | - Diana Gareeva
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
| | - Elena Badykova
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
| | - Marat Badykov
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
| | - Irina Lakman
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
- Scientific Laboratory for the Socio-Economic Region Problems Investigation, Ufa University of Science and Technology, Ufa, Russia
| | - Aleksandr Agapitov
- Scientific Laboratory for the Socio-Economic Region Problems Investigation, Ufa University of Science and Technology, Ufa, Russia
| | - Liana Sadikova
- Scientific Laboratory for the Socio-Economic Region Problems Investigation, Ufa University of Science and Technology, Ufa, Russia
| | - Valentin Pavlov
- Department of Urology, Bashkir State Medical University, Ufa, Russia
| | - Fabian Föttinger
- University Department of Internal Medicine II, Cardiology and Internal Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Moritz Mirna
- University Department of Internal Medicine II, Cardiology and Internal Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Kristen Kopp
- University Department of Internal Medicine II, Cardiology and Internal Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Uta C. Hoppe
- University Department of Internal Medicine II, Cardiology and Internal Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Rudin Pistulli
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
| | - Benzhi Cai
- Department of Pharmacology (The Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Baofeng Yang
- Department of Pharmacology (The Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, China
| | - Naufal Zagidullin
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
- Department of Biomedical Engineering, Ufa University of Science and Technology, Ufa, Russia
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Kole C, Stefanou Ε, Karvelas N, Schizas D, Toutouzas KP. Acute and Post-Acute COVID-19 Cardiovascular Complications: A Comprehensive Review. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07465-w. [PMID: 37209261 DOI: 10.1007/s10557-023-07465-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE OF REVIEW The risk of cardiovascular complications due to SARS-CoV-2 are significantly increased within the first 6 months of the infection. Patients with COVID-19 have an increased risk of death, and there is evidence that many may experience a wide range of post-acute cardiovascular complications. Our work aims to provide an update on current clinical aspects of diagnosis and treatment of cardiovascular manifestations during acute and long-term COVID-19. RECENT FINDINGS SARS-CoV-2 has been shown to be associated with increased incidence of cardiovascular complications such as myocardial injury, heart failure, and dysrhythmias, as well as coagulation abnormalities not only during the acute phase but also beyond the first 30 days of the infection, associated with high mortality and poor outcomes. Cardiovascular complications during long-COVID-19 were found regardless of comorbidities such as age, hypertension, and diabetes; nevertheless, these populations remain at high risk for the worst outcomes during post-acute COVID-19. Emphasis should be given to the management of these patients. Treatment with low-dose oral propranolol, a beta blocker, for heart rate management may be considered, since it was found to significantly attenuate tachycardia and improve symptoms in postural tachycardia syndrome, while for patients on ACE inhibitors or angiotensin-receptor blockers (ARBs), under no circumstances should these medications be withdrawn. In addition, in patients at high risk after hospitalization due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days improved clinical outcomes compared with no extended thromboprophylaxis. In this work we provide a comprehensive review on acute and post-acute COVID-19 cardiovascular complications, symptomatology, and pathophysiology mechanisms. We also discuss therapeutic strategies for these patients during acute and long-term care and highlight populations at risk. Our findings suggest that older patients with risk factors such as hypertension, diabetes, and medical history of vascular disease have worse outcomes during acute SARS-CoV-2 infection and are more likely to develop cardiovascular complications during long-COVID-19.
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Affiliation(s)
- Christo Kole
- Cardiology Department, Sismanoglio General Hospital of Attica, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Εleni Stefanou
- Artificial Kidney Unit, General Hospital of Messinia, Kalamata, Greece
| | - Nikolaos Karvelas
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Ghimire LV, Chou FS, Aljohani OA, Moon-Grady AJ. Impact of congenital heart disease on outcomes among pediatric patients hospitalized for COVID-19 infection. BMC Pediatr 2023; 23:240. [PMID: 37194031 DOI: 10.1186/s12887-023-04058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND COVID-19 infection is generally regarded as an acute self-limiting illness in children, but it can cause significant morbidity and mortality in both healthy and high-risk children. There are limited data on the outcomes of children with congenital heart disease (CHD) and COVID-19. This study aimed to examine the risks of mortality, in-hospital cardiovascular and non-cardiovascular complications in this patient population. METHODS We analyzed data from hospitalized pediatric patients from 2020 using the nationally representative National Inpatient Sample (NIS). Children hospitalized for COVID-19 were included, and weighted data were used to compare in-hospital mortality and morbidities between children with and without CHD. RESULTS Out of 36,690 children admitted with a diagnosis of COVID-19 infection(ICD-10 code:U07.1 and B97.29) during calendar year 2020, 1240 (3.4%) had CHD. The risk of mortality in children with CHD was not significantly higher than those without CHD(1.2% vs. 0.8%, p = 0.50), with adjusted OR (aOR) of 1.7 (95% CI: 0.6-5.3). Tachyarrhythmias and heart block were more likely in CHD children with an aOR of 4.2 (95% CI: 1.8-9.9) and aOR of 5.0 (95% CI: 2.4-10.8), respectively. Similarly, respiratory failure [aOR = 2.0 (1.5-2.8)], respiratory failure requiring non-invasive mechanical ventilation [aOR = 2.7 (1.4-5.2)] and invasive mechanical ventilation [aOR = 2.6 (1.6-4.0)], and acute kidney injury [aOR = 3.4 (2.2-5.4)] were all significantly higher among patients with CHD. Median length of hospital stay in children with CHD was longer than those without CHD [5 days (IQR: 2-11) vs. 3 days (IQR: 2-5), p = < 0.001]. CONCLUSIONS Children with CHD hospitalized with COVID-19 infection were at increased risk of serious cardiovascular and non-cardiovascular adverse clinical outcomes. They also had increased length of hospital stay and utilization of healthcare resources.
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Affiliation(s)
- Laxmi V Ghimire
- Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco, Fresno, CA, USA
| | - Fu-Sheng Chou
- Department of Neonatal-Perinatal Medicine, Kaiser Permanente Riverside Medical Center, Riverside, CA, USA
| | - Othman A Aljohani
- Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco, 550 16th Street 5th Floor, San Francisco, CA, 94158, USA
| | - Anita J Moon-Grady
- Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco, 550 16th Street 5th Floor, San Francisco, CA, 94158, USA.
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Yugar-Toledo JC, Yugar LBT, Sedenho-Prado LG, Schreiber R, Moreno H. Pathophysiological effects of SARS-CoV-2 infection on the cardiovascular system and its clinical manifestations-a mini review. Front Cardiovasc Med 2023; 10:1162837. [PMID: 37260945 PMCID: PMC10229057 DOI: 10.3389/fcvm.2023.1162837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/18/2023] [Indexed: 06/02/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 may have a mild presentation, with few symptoms, or progress to a severe condition, characterized by generalized inflammation, systemic microvascular involvement, coagulopathy, and pulmonary and cardiovascular complications. Men present with more severe symptoms than women, especially men who are older and who present with comorbidities such as hypertension, diabetes mellitus, and a history of atherosclerotic diseases. Owing to its association with endothelial dysfunction, inflammation, thrombosis, and microvascular obstruction, SARS-CoV-2 infection can cause lesions in several organs, including the myocardium and the coronary arterial bed, which can result in clinical manifestations involving the cardiovascular system. In this mini review, we summarize the effects of SARS-CoV-2 infection on the cardiovascular system in both children and adults and characterize the various clinical manifestations associated with this disease.
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Affiliation(s)
| | | | | | - Roberto Schreiber
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Heitor Moreno
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
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34
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Boulos PK, Freeman SV, Henry TD, Mahmud E, Messenger JC. Interaction of COVID-19 With Common Cardiovascular Disorders. Circ Res 2023; 132:1259-1271. [PMID: 37167359 PMCID: PMC10171313 DOI: 10.1161/circresaha.122.321952] [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: 05/13/2023]
Abstract
The onset and widespread dissemination of the severe acute respiratory syndrome coronavirus-2 in late 2019 impacted the world in a way not seen since the 1918 H1N1 pandemic, colloquially known as the Spanish Flu. Much like the Spanish Flu, which was observed to disproportionately impact young adults, it became clear in the early days of the coronavirus disease 2019 (COVID-19) pandemic that certain groups appeared to be at higher risk for severe illness once infected. One such group that immediately came to the forefront and garnered international attention was patients with preexisting cardiovascular disease. Here, we examine the available literature describing the interaction of COVID-19 with a myriad of cardiovascular conditions and diseases, paying particular attention to patients diagnosed with arrythmias, heart failure, and coronary artery disease. We further discuss the association of acute COVID-19 with de novo cardiovascular disease, including myocardial infarction due to coronary thrombosis, myocarditis, and new onset arrhythmias. We will evaluate various biochemical theories to explain these findings, including possible mechanisms of direct myocardial injury caused by the severe acute respiratory syndrome coronavirus-2 virus at the cellular level. Finally, we will discuss the strategies employed by numerous groups and governing bodies within the cardiovascular disease community to address the unprecedented challenges posed to the care of our most vulnerable patients, including heart transplant recipients, end-stage heart failure patients, and patients suffering from acute coronary syndromes, during the early days and height of the COVID-19 pandemic.
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Affiliation(s)
- Peter K. Boulos
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Scott V. Freeman
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (T.D.H.)
| | - Ehtisham Mahmud
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla (E.M.)
| | - John C. Messenger
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
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35
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Torabizadeh C, Iloonkashkooli R, Haghshenas H, Fararouei M. Prevalence of Cardiovascular Complications in Coronavirus Disease 2019 adult Patients: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:243-267. [PMID: 37791325 PMCID: PMC10542931 DOI: 10.30476/ijms.2022.93701.2504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/03/2022] [Accepted: 04/26/2022] [Indexed: 10/05/2023]
Abstract
Background It has been found that the new coronavirus can affect various parts of the cardiovascular system. Cardiovascular complications caused by coronavirus disease 2019 (COVID-19) are often serious and can increase the mortality rate among infected patients. This study aimed to investigate the prevalence of cardiovascular complications in COVID-19 adult patients. Methods A systematic review and meta-analysis of observational studies published in English were conducted between December 2019 and February 2021. A complete search was performed in PubMed (PubMed Central and MEDLINE), Google Scholar, Cochrane Library, Science Direct, Ovid, Embase, Scopus, CINAHL, Web of Science, and WILEY, as well as BioRXiv, MedRXiv, and gray literature. A random effect model was used to examine the prevalence of cardiovascular complications among COVID-19 patients. The I2 test was used to measure heterogeneity across the included studies. Results A total of 74 studies involving 34,379 COVID-19 patients were included for meta-analysis. The mean age of the participants was 61.30±14.75 years. The overall pooled prevalence of cardiovascular complications was 23.45%. The most prevalent complications were acute myocardial injury (AMI) (19.38%, 95% CI=13.62-26.81, test for heterogeneity I2=97.5%, P<0.001), arrhythmia (11.16%, 95% CI=8.23-14.96, test for heterogeneity I2=91.5%, P<0.001), heart failure (HF) (7.56%, 95% CI=4.50-12.45, test for heterogeneity I2=96.3%, P<0.001), and cardiomyopathy (2.78%, 95% CI=0.34-9.68). The highest pooled prevalence of cardiac enzymes was lactate dehydrogenase (61.45%), troponin (23.10%), and creatine kinase-myocardial band or creatine kinase (14.52%). Conclusion The high prevalence of serious cardiovascular complications in COVID-19 patients (AMI, arrhythmia, and HF) necessitates increased awareness by healthcare administrators.
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Affiliation(s)
- Camellia Torabizadeh
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hajar Haghshenas
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- HIV/AIDs Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Kanuri SH, Jayesh Sirrkay P, Ulucay AS. COVID-19 HEART unveiling as atrial fibrillation: pathophysiology, management and future directions for research. Egypt Heart J 2023; 75:36. [PMID: 37120772 PMCID: PMC10149046 DOI: 10.1186/s43044-023-00359-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND COVID-19 infections are known to cause numerous systemic complications including cardiovascular disorders. In this regard, clinicians recently noticed that patients recovering from COVID-19 infections presented with diverse set of cardiovascular disorders in addition to those admitted to ICU (intensive care unit). COVID-19 heart has multifaceted presentation ranging from dysrhythmias, myocarditis, stroke, coronary artery disease, thromboembolism to heart failure. Atrial fibrillation is the most common cardiac arrhythmia among COVID-19 patients. In the background section, we briefly discussed epidemiology and spectrum of cardiac arrhythmias in COVID-19 patients. MAIN BODY In this state-of-the-art review we present here, we present the information regarding COVID-19-induced A-fib in sections, namely mechanism of action, clinical presentation, diagnosis and treatment. Unfortunately, its occurrence significantly increases the mortality and morbidity with a potential risk of complications such as cardiac arrest and sudden death. We included separate sections on complications including thromboembolism and ventricular arrhythmias. Since its mechanism is currently a gray area, we included a separate section on basic science research studies that are warranted in the future to comprehend its underlying pathogenic mechanisms. CONCLUSIONS Taken together, this review builds upon the current literature of COVID-19-induced A-fib, including pathophysiology, clinical presentation, treatment and complications. Furthermore, it provides recommendations for future research moving forward that can open avenues for developing novel remedies that can prevent as well as hasten clinical recovery of atrial fibrillation in COVID-19 patients.
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de la Torre Fonseca LM, González Barcala J, Juan-Salvadores P. Clinical characteristics and hospital course of SARS-CoV-2 infected patients with electrocardiographic abnormalities admitted to the ICU. MEDICINA CLINICA (ENGLISH ED.) 2023; 160:364-365. [PMID: 37113114 PMCID: PMC10099147 DOI: 10.1016/j.medcle.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Luis Mariano de la Torre Fonseca
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico-Quirúrgico Comandante Manuel Fajardo, La Habana, Cuba
- Facultad de Ciencias Médicas Manuel Fajardo, Universidad de Ciencias Médicas de la Habana, La Habana, Cuba
| | - Jessica González Barcala
- Unidad de Medicina Interna, Hospital Álvaro Cunqueiro, Vigo, Spain
- Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Pablo Juan-Salvadores
- Unidad de Investigación Cardiovascular, Hospital Álvaro Cunqueiro, Área Sanitaria de Vigo, SERGAS, Spain
- Grupo de Investigación Cardiovascular, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain
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Jurisic S, Komminoth M, Todorov A, Bertschi DA, Jurisic M, Vranjic I, Wiggli B, Schmid H, Gebhard C, Gebhard CE, Heidecker B, Beer JH, Patriki D. Long-Term Mortality after New-Onset Atrial Fibrillation in COVID-19. J Clin Med 2023; 12:jcm12082925. [PMID: 37109261 PMCID: PMC10146060 DOI: 10.3390/jcm12082925] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Background: Atrial fibrillation (AF) has been described as a common cardiovascular manifestation in patients suffering from coronavirus disease 2019 (COVID-19) and has been suggested to be a potential risk factor for a poor clinical outcome. Methods: In this observational study, all patients hospitalized due to COVID-19 in 2020 in the Cantonal Hospital of Baden were included. We assessed clinical characteristics, in-hospital outcomes as well as long-term outcomes with a mean follow-up time of 278 (±90) days. Results: Amongst 646 patients diagnosed with COVID-19 (59% male, median age: 70 (IQR: 59-80)) in 2020, a total of 177 (27.4%) patients were transferred to the intermediate/intensive care unit (IMC/ICU), and 76 (11.8%) were invasively ventilated during their hospitalization. Ninety patients (13.9%) died. A total of 116 patients (18%) showed AF on admission of which 34 (29%) had new-onset AF. Patients with COVID-19 and newly diagnosed AF were more likely to require invasive ventilation (OR: 3.5; p = 0.01) but did not encounter an increased in-hospital mortality. Moreover, AF neither increased long-term mortality nor the number of rehospitalizations during follow-up after adjusting for confounders. Conclusions: In patients suffering from COVID-19, the new-onset of AF on admission was associated with an increased risk of invasive ventilation and transfer to the IMC/ICU but did not affect in-hospital or long-term mortality.
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Affiliation(s)
- Stjepan Jurisic
- Department of Internal Medicine, Cantonal Hospital of Baden, 5404 Baden, Switzerland
- Department of Cardiology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Mathis Komminoth
- Department of Internal Medicine, Cantonal Hospital of Baden, 5404 Baden, Switzerland
| | - Atanas Todorov
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Daniela A Bertschi
- Department of Internal Medicine, Cantonal Hospital of Baden, 5404 Baden, Switzerland
| | - Martin Jurisic
- Department of Cardiovascular Diseases, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany
| | - Ivica Vranjic
- Department of Internal Medicine, Cantonal Hospital of Baden, 5404 Baden, Switzerland
| | - Benedikt Wiggli
- Department of Infectious Diseases & Infection Control, Cantonal Hospital of Baden, 5404 Baden, Switzerland
| | - Hansruedi Schmid
- Department of Internal Medicine, Cantonal Hospital of Baden, 5404 Baden, Switzerland
| | - Catherine Gebhard
- Department of Internal Medicine, Cantonal Hospital of Baden, 5404 Baden, Switzerland
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952 Schlieren, Switzerland
| | - Caroline E Gebhard
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Bettina Heidecker
- Deutsches Herzzentrum der Charité, Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Jürg-Hans Beer
- Department of Internal Medicine, Cantonal Hospital of Baden, 5404 Baden, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952 Schlieren, Switzerland
| | - Dimitri Patriki
- Department of Internal Medicine, Cantonal Hospital of Baden, 5404 Baden, Switzerland
- Department of Cardiology, University Hospital of Zurich, 8091 Zurich, Switzerland
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Chyou JY, Barkoudah E, Dukes JW, Goldstein LB, Joglar JA, Lee AM, Lubitz SA, Marill KA, Sneed KB, Streur MM, Wong GC, Gopinathannair R. Atrial Fibrillation Occurring During Acute Hospitalization: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e676-e698. [PMID: 36912134 DOI: 10.1161/cir.0000000000001133] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Acute atrial fibrillation is defined as atrial fibrillation detected in the setting of acute care or acute illness; atrial fibrillation may be detected or managed for the first time during acute hospitalization for another condition. Atrial fibrillation after cardiothoracic surgery is a distinct type of acute atrial fibrillation. Acute atrial fibrillation is associated with high risk of long-term atrial fibrillation recurrence, warranting clinical attention during acute hospitalization and over long-term follow-up. A framework of substrates and triggers can be useful for evaluating and managing acute atrial fibrillation. Acute management requires a multipronged approach with interdisciplinary care collaboration, tailoring treatments to the patient's underlying substrate and acute condition. Key components of acute management include identification and treatment of triggers, selection and implementation of rate/rhythm control, and management of anticoagulation. Acute rate or rhythm control strategy should be individualized with consideration of the patient's capacity to tolerate rapid rates or atrioventricular dyssynchrony, and the patient's ability to tolerate the risk of the therapeutic strategy. Given the high risks of atrial fibrillation recurrence in patients with acute atrial fibrillation, clinical follow-up and heart rhythm monitoring are warranted. Long-term management is guided by patient substrate, with implications for intensity of heart rhythm monitoring, anticoagulation, and considerations for rhythm management strategies. Overall management of acute atrial fibrillation addresses substrates and triggers. The 3As of acute management are acute triggers, atrial fibrillation rate/rhythm management, and anticoagulation. The 2As and 2Ms of long-term management include monitoring of heart rhythm and modification of lifestyle and risk factors, in addition to considerations for atrial fibrillation rate/rhythm management and anticoagulation. Several gaps in knowledge related to acute atrial fibrillation exist and warrant future research.
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Louis DW, Saad M, Vijayakumar S, Ilyas S, Kokkirala A, Aronow HD. The Cardiovascular Manifestations of COVID-19. Heart Fail Clin 2023; 19:153-161. [PMID: 36863807 PMCID: PMC9973545 DOI: 10.1016/j.hfc.2022.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The Coronavirus 2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus, has resulted in unprecedented morbidity and mortality worldwide. While COVID-19 typically presents as viral pneumonia, cardiovascular manifestations such as acute coronary syndromes, arterial and venous thrombosis, acutely decompensated heart failure (HF), and arrhythmia are frequently observed. Many of these complications are associated with poorer outcomes, including death. Herein we review the relationship between cardiovascular risk factors and outcomes among patients with COVID-19, cardiovascular manifestations of COVID-19, and cardiovascular complications associated with COVID-19 vaccination.
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Affiliation(s)
- David W. Louis
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Marwan Saad
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Shilpa Vijayakumar
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Suleman Ilyas
- Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Aravind Kokkirala
- United States Department of Veterans Affairs Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, USA
| | - Herbert D. Aronow
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA,Corresponding author. 593 Eddy Street, RIH APC 730, Providence, RI 02903
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Philip B, Mukherjee P, Khare Y, Ramesh P, Zaidi S, Sabry H, Harky A. COVID-19 and its long-term impact on the cardiovascular system. Expert Rev Cardiovasc Ther 2023; 21:211-218. [PMID: 36856339 DOI: 10.1080/14779072.2023.2184800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
INTRODUCTION TheSARS-CoV-2 virus caused a pandemic affecting healthcare deliveryglobally. Despite the presentation of COVID-19 infection beingfrequently dominated by respiratory symptoms; it is now notorious tohave potentially serious cardiovascular sequelae. This articleexplores current data to provide a comprehensive overview of thepathophysiology, cardiovascular risk factors, and implications ofCOVID-19. AREAS COVERED Inherentstructure of SARS-CoV-2, and its interaction with both ACE-2 andnon-ACE-2 mediated pathways have been implicated in the developmentof cardiovascular manifestations, progressively resulting in acuterespiratory distress syndrome, multiorgan failure, cytokine releasesyndrome, and subsequent myocardial damage. The interplay betweenexisting and de novo cardiac complications must be noted. Forindividuals taking cardiovascular medications, pharmacologicinteractions are a crucial component. Short-term cardiovascularimpacts include arrhythmia, myocarditis, pericarditis, heart failure,and thromboembolism, whereas long-term impacts include diabetes andhypertension. To identify suitable studies, a PubMed literaturesearch was performed including key words such as 'Covid 19,''Cardiovascular disease,' 'Long covid,' etc. EXPERT OPINION Moresophisticated planning and effective management for cardiologyhealthcare provision is crucial, especially for accommodatingchallenges associated with Long-COVID. With the potential applicationof AI and automated data, there are many avenues and sequelae thatcan be approached for investigation.
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Affiliation(s)
- Bejoy Philip
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Yuti Khare
- School of Medicine, St George's University London, London, UK
| | - Pranav Ramesh
- School of Medicine, University of Leicester, Leicester, UK
| | - Sara Zaidi
- School of Medicine, King's College London, London, UK
| | - Haytham Sabry
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Abstract
PURPOSE OF REVIEW Cardiac consequences occur in both acute COVID-19 and post-acute sequelae of COVID-19 (PASC). Here, we highlight the current understanding about COVID-19 cardiac effects, based upon clinical, imaging, autopsy, and molecular studies. RECENT FINDINGS COVID-19 cardiac effects are heterogeneous. Multiple, concurrent cardiac histopathologic findings have been detected on autopsies of COVID-19 non-survivors. Microthrombi and cardiomyocyte necrosis are commonly detected. Macrophages often infiltrate the heart at high density but without fulfilling histologic criteria for myocarditis. The high prevalences of microthrombi and inflammatory infiltrates in fatal COVID-19 raise the concern that recovered COVID-19 patients may have similar but subclinical cardiac pathology. Molecular studies suggest that SARS-CoV-2 infection of cardiac pericytes, dysregulated immunothrombosis, and pro-inflammatory and anti-fibrinolytic responses underlie COVID-19 cardiac pathology. The extent and nature by which mild COVID-19 affects the heart is unknown. Imaging and epidemiologic studies of recovered COVID-19 patients suggest that even mild illness confers increased risks of cardiac inflammation, cardiovascular disorders, and cardiovascular death. The mechanistic details of COVID-19 cardiac pathophysiology remain under active investigation. The ongoing evolution of SARS-CoV-2 variants and vast numbers of recovered COVID-19 patients portend a burgeoning global cardiovascular disease burden. Our ability to prevent and treat cardiovascular disease in the future will likely depend on comprehensive understanding of COVID-19 cardiac pathophysiologic phenotypes.
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Affiliation(s)
- Lorenzo R. Sewanan
- Department of Medicine, Columbia University Irving Medical Center, New York, NY USA
| | - Kevin J. Clerkin
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Irving Medical Center, New York, NY USA
| | | | - Emily J. Tsai
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Irving Medical Center, New York, NY USA
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Kacha AK, Hicks MH, Mahrous C, Dalton A, Ben-Jacob TK. Management of Intraoperative Cardiac Arrest. Anesthesiol Clin 2023; 41:103-119. [PMID: 36871994 DOI: 10.1016/j.anclin.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Perioperative arrests are both uncommon and heterogeneous and have not been described or studied to the same extent as cardiac arrest in the community. These crises are usually witnessed, frequently anticipated, and involve a rescuer physician with knowledge of the patient's comorbidities and coexisting anesthetic or surgically related pathophysiology ultimately leading to better outcomes. This article reviews the most probable causes of intraoperative arrest and their management.
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Affiliation(s)
- Aalok K Kacha
- Department of Anesthesia and Critical Care, Section of Critical Care Medicine, University of Chicago, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA; Department of Surgery, Section of Transplant Surgery, University of Chicago, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA.
| | - Megan Henley Hicks
- Department of Anesthesiology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Christopher Mahrous
- Department of Anesthesiology, Cooper Medical School of Rowan University, One Cooper Plaza, Dorrance 2nd Floor, Camden, NJ 08103, USA
| | - Allison Dalton
- Department of Anesthesia and Critical Care, Section of Critical Care Medicine, University of Chicago, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA
| | - Talia K Ben-Jacob
- Department of Anesthesiology, Division of Critical Care, Cooper Medical School of Rowan University, One Cooper Plaza, Dorrance 2nd Floor, Camden, NJ 08103, USA
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Wang L, Hoang L, Aten K, Abualfoul M, Canela V, Prathivada S, Vu M, Zhao Y, Sidhu M. Mortality and Major Adverse Cardiovascular Events in Hospitalized Patients With Atrial Fibrillation With COVID-19. Am J Cardiol 2023; 189:41-48. [PMID: 36502570 PMCID: PMC9731831 DOI: 10.1016/j.amjcard.2022.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/08/2022] [Accepted: 11/19/2022] [Indexed: 12/13/2022]
Abstract
COVID-19 results in increased incidence of cardiac arrhythmias, including atrial fibrillation (AF). However, little is known about the combined effect of AF and COVID-19 on patient outcomes. This study aimed to determine if AF, specifically new-onset AF (NOAF), is associated with increased risk of mortality and major adverse cardiovascular events (MACEs) in hospitalized patients with COVID-19. This multicenter retrospective analysis identified 2,732 patients with COVID-19 admitted between March and December 2020. Data points were manually reviewed in the patients' electronic health records. Multivariate logistic regression was used to assess if AF was associated with death or MACE. Patients with AF (6.4%) had an increased risk of mortality (risk ratio 2.249, 95% confidence interval [CI] 1.766 to 2.864, p <0.001) and MACE (risk ratio 1.753, 95% CI 1.473 to 2.085, p <0.001) compared with those with sinus rhythm. Patients with NOAF had an increased risk of mortality compared with those with existing AF (odds ratio 19.30, 95% CI 5.39 to 69.30, p <0.001); the risk of MACE was comparable between NOAF and patients with existing AF (p = 1). AF during hospitalization with COVID-19 is associated with a higher risk of mortality and MACE. NOAF in patients with COVID-19 is associated with a higher risk of mortality but a similar risk of MACE compared with patients with existing AF.
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Affiliation(s)
- Lucas Wang
- Department of Internal Medicine,Corresponding author: Tel: 254-716-0273; fax: (214) 947-8181
| | | | | | | | | | - Sri Prathivada
- Clinical Research Institute, Methodist Dallas Medical Center, Dallas, Texas
| | | | - Yi Zhao
- Department of Internal Medicine
| | - Manavjot Sidhu
- Methodist Dallas Cardiovascular Consultants, Methodist Medical Group, Division of Cardiology
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Hockham C, Linschoten M, Asselbergs FW, Ghossein C, Woodward M, Peters SAE. Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study. BMJ MEDICINE 2023; 2:e000245. [PMID: 37067859 PMCID: PMC10083523 DOI: 10.1136/bmjmed-2022-000245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 12/14/2022] [Indexed: 04/18/2023]
Abstract
Objective To assess whether the risk of cardiovascular complications of covid-19 differ between the sexes and to determine whether any sex differences in risk are reduced in individuals with pre-existing cardiovascular disease. Design Registry based observational study. Setting 74 hospitals across 13 countries (eight European) participating in CAPACITY-COVID (Cardiac complicAtions in Patients With SARS Corona vIrus 2 regisTrY), from March 2020 to May 2021. Participants All adults (aged ≥18 years), predominantly European, admitted to hospital with highly suspected covid-19 disease or covid-19 disease confirmed by positive laboratory test results (n=11 167 patients). Main outcome measures Any cardiovascular complication during admission to hospital. Secondary outcomes were in-hospital mortality and individual cardiovascular complications with ≥20 events for each sex. Logistic regression was used to examine sex differences in the risk of cardiovascular outcomes, overall and grouped by pre-existing cardiovascular disease. Results Of 11 167 adults (median age 68 years, 40% female participants) included, 3423 (36% of whom were female participants) had pre-existing cardiovascular disease. In both sexes, the most common cardiovascular complications were supraventricular tachycardias (4% of female participants, 6% of male participants), pulmonary embolism (3% and 5%), and heart failure (decompensated or de novo) (2% in both sexes). After adjusting for age, ethnic group, pre-existing cardiovascular disease, and risk factors for cardiovascular disease, female individuals were less likely than male individuals to have a cardiovascular complication (odds ratio 0.72, 95% confidence interval 0.64 to 0.80) or die (0.65, 0.59 to 0.72). Differences between the sexes were not modified by pre-existing cardiovascular disease; for the primary outcome, the female-to-male ratio of the odds ratio in those without, compared with those with, pre-existing cardiovascular disease was 0.84 (0.67 to 1.07). Conclusions In patients admitted to hospital for covid-19, female participants were less likely than male participants to have a cardiovascular complication. The differences between the sexes could not be attributed to the lower prevalence of pre-existing cardiovascular disease in female individuals. The reasons for this advantage in female individuals requires further research.
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Affiliation(s)
- Carinna Hockham
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Marijke Linschoten
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Chahinda Ghossein
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sanne A E Peters
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
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Vosko I, Zirlik A, Bugger H. Impact of COVID-19 on Cardiovascular Disease. Viruses 2023; 15:508. [PMID: 36851722 PMCID: PMC9962056 DOI: 10.3390/v15020508] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a viral infection with the novel severe acute respiratory distress syndrome corona virus 2 (SARS-CoV-2). Until now, more than 670 million people have suffered from COVID-19 worldwide, and roughly 7 million death cases were attributed to COVID-19. Recent evidence suggests an interplay between COVID-19 and cardiovascular disease (CVD). COVID-19 may serve as a yet underappreciated CVD risk modifier, including risk factors such as diabetes mellitus or arterial hypertension. In addition, recent data suggest that previous COVID-19 may increase the risk for many entities of CVD to an extent similarly observed for traditional cardiovascular (CV) risk factors. Furthermore, increased CVD incidence and worse clinical outcomes in individuals with preexisting CVD have been observed for myocarditis, acute coronary syndrome, heart failure (HF), thromboembolic complications, and arrhythmias. Direct and indirect mechanisms have been proposed by which COVID-19 may impact CVD and CV risk, including viral entry into CV tissue or by the induction of a massive systemic inflammatory response. In the current review, we provide an overview of the literature reporting an interaction between COVID-19 and CVD, review potential mechanisms underlying this interaction, and discuss preventive and treatment strategies and their interference with CVD that were evaluated since the onset of the COVID-19 pandemic.
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Affiliation(s)
| | | | - Heiko Bugger
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria
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Ghazaryan N, Hovakimyan T. Successful management of near-incessant bidirectional ventricular tachycardia in one-year-old child with COVID-19 infection: a case report. Eur Heart J Case Rep 2023; 7:ytad064. [PMID: 36819878 PMCID: PMC9933944 DOI: 10.1093/ehjcr/ytad064] [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: 08/23/2022] [Revised: 09/13/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
Background The COVID-19 is an infectious disease, caused by SARS-CoV-2 virus. Cardiovascular complications of COVID-19 are reported more often, from inflammatory cardiac diseases to acute coronary syndromes, thromboembolic events and arrhythmias. Sometimes, these arrhythmias may be life threatening and require urgent intervention. Case summary This is a case of one-year-old boy, who was referred to our hospital because of premature ventricular complexes on ECG. The child had genetic chimerism with a karyotype of 46XY(12)/46XX(3) and small patent ductus arteriosus. We observed non-sustained episodes of bidirectional ventricular tachycardia (VT) on 24 h Holter monitor, which increased over time and caused multiple planned and urgent shocks, despite antiarrhythmic drugs and deep sedation and intubation. Patient was tested positive for COVID-19 using PCR. After thorough echocardiographic testing and a negative genetic analysis for arrhythmogenic disorders he was diagnosed with COVID-19 associated ventricular tachycardia, taking into account that he also developed multisystem inflammatory syndrome. Further, a significant decrease of ventricular activity was observed, which allowed us to implant a cardioverter-defibrillator (ICD). Soon after the implantation the storm of ventricular tachycardia restarted with multiple shocks of the device. This time left partial thoracic sympathectomy was performed and the patient didn't have ICD shocks any more. Discussion COVID-19 infection can be associated with significant arrhythmias, including fatal ventricular arrhythmias also in children. Left partial thoracic sympathectomy can be a helpful option in patients with sustained ventricular tachycardia and multiple ICD shocks, in whom antiarrhythmic treatment or VT ablation is useless or not available.
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Fir(e)ing the Rhythm. JACC Basic Transl Sci 2023. [DOI: 10.1016/j.jacbts.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Donniacuo M, De Angelis A, Rafaniello C, Cianflone E, Paolisso P, Torella D, Sibilio G, Paolisso G, Castaldo G, Urbanek K, Rossi F, Berrino L, Cappetta D. COVID-19 and atrial fibrillation: Intercepting lines. Front Cardiovasc Med 2023; 10:1093053. [PMID: 36755799 PMCID: PMC9899905 DOI: 10.3389/fcvm.2023.1093053] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
Almost 20% of COVID-19 patients have a history of atrial fibrillation (AF), but also a new-onset AF represents a frequent complication in COVID-19. Clinical evidence demonstrates that COVID-19, by promoting the evolution of a prothrombotic state, increases the susceptibility to arrhythmic events during the infective stages and presumably during post-recovery. AF itself is the most frequent form of arrhythmia and is associated with substantial morbidity and mortality. One of the molecular factors involved in COVID-19-related AF episodes is the angiotensin-converting enzyme (ACE) 2 availability. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses ACE2 to enter and infect multiple cells. Atrial ACE2 internalization after binding to SARS-CoV-2 results in a raise of angiotensin (Ang) II, and in a suppression of cardioprotective Ang(1-7) formation, and thereby promoting cardiac hypertrophy, fibrosis and oxidative stress. Furthermore, several pharmacological agents used in COVID-19 patients may have a higher risk of inducing electrophysiological changes and cardiac dysfunction. Azithromycin, lopinavir/ritonavir, ibrutinib, and remdesivir, used in the treatment of COVID-19, may predispose to an increased risk of cardiac arrhythmia. In this review, putative mechanisms involved in COVID-19-related AF episodes and the cardiovascular safety profile of drugs used for the treatment of COVID-19 are summarized.
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Affiliation(s)
- Maria Donniacuo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy,*Correspondence: Maria Donniacuo,
| | - Antonella De Angelis
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Concetta Rafaniello
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Eleonora Cianflone
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium,Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Daniele Torella
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | | | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giuseppe Castaldo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, Naples, Italy,CEINGE Advanced Biotechnologies, Naples, Italy
| | - Konrad Urbanek
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, Naples, Italy,CEINGE Advanced Biotechnologies, Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Liberato Berrino
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Donato Cappetta
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy,Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
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Vásquez-Guillén M, Vásquez-Guillén A, Inglessis-Aguilar JA, Contreras M, Carrero Y. Complicaciones Cardiovasculares asociadas a infección por SARS-CoV-2. Revisión Sistemática. KASMERA 2023. [DOI: 10.56903/kasmera.5137658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
El COVID-19 es una enfermedad que ha afectado a la población mundial, convirtiéndose en una de las peores pandemias de nuestra generación, representando un reto social y sanitario sin precedentes; afecta principalmente el sistema respiratorio, sin embargo, diversos estudios han demostrado el compromiso cardiovascular, generando preocupación, que se traduce en una mayor vulnerabilidad en los pacientes con patologías cardiovasculares subyacentes. Se ha establecido que la presencia de comorbilidades, como hipertensión, diabetes y enfermedad arterial coronaria, se asocian con tasas de mortalidad elevadas, afectando a pacientes cardiovasculares crónicos y causando alteraciones cardiovasculares en pacientes sin antecedentes, por lo cual es necesario el monitoreo de biomarcadores cardíacos para un mejor abordaje de la enfermedad. Estudios clínicos han evidenciado que la patología cardiovascular que principalmente se asocia al COVID-19 es la insuficiencia cardíaca (IC), que se manifiesta con un aumento en los niveles de troponina, miopericarditis, shock cardiogénico, lesión cardíaca aguda, trastornos de coagulación y trombosis, arritmias, además del síndrome coronario agudo y la enfermedad de Kawasaki. Este artículo es una revisión de las complicaciones cardíacas asociadas al COVID-19 y sus posibles mecanismos de acción, que permitan un mejor entendimiento por parte del personal médico y de salud (PROSPERO ID 316364).
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Affiliation(s)
- María Vásquez-Guillén
- Universidad de Los Andes. Facultad de Medicina. Departamento de Microbiología. Mérida-Mérida. Venezuela
| | - Andrea Vásquez-Guillén
- Universidad de Los Andes. Facultad de Medicina. Departamento de Microbiología. Mérida-Mérida. Venezuela
| | | | - Mike Contreras
- Universidad Federal de Goiás. Campus Colemar Natal e Silva. Instituto de Patologia Tropical e Saúde Publica. Área de imunologia. Goiânia-Goiás. Brasil
| | - Yenddy Carrero
- Universidad Técnica de Ambato. Facultad de Ciencias de la Salud. Carrera de Medicina. Campus Ingahurco. Ambato-Tungurahua. Ecuador
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