Frequency of five cardiovascular/hemostatic entities as primary manifestations of SARS-CoV-2 infection: Results of the UMC-19-S2

COVID-19 worsens quality of life in elderly heart failure patients: a clinical study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has significantly worsened the health and quality of life of vulnerable populations, particularly elderly patients with heart failure. This study aimed to assess the effect of COVID-19 infection on the quality of life in elderly patients with heart failure during the pandemic.

METHODS

This retrospective case-control study included elderly heart failure patients admitted to the Second People's Hospital of Lanzhou between December 2022 and December 2023, all of whom were diagnosed during the ongoing COVID-19 pandemic. All patients underwent COVID-19 nucleic acid testing upon admission. Among the 96 heart failure patients who tested positive for COVID-19 and the 68 who tested negative, multiple validated instruments were used to assess both physical and mental health quality of life. These instruments included the Minnesota Living with Heart Failure Questionnaire (MLHFQ), 36-Item Short Form Health Survey physical component summary score (SF-36 PCS), 6-Minute Walking Test (6MWT), Geriatric Depression Scale-15 (GDS-15), Self-Rating Anxiety Scale (SAS) Total, Pittsburgh Sleep Quality Index (PSQI), Mini Nutritional Assessment-Short Form (MNA-SF), and the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) Scale.

RESULTS

Heart failure patients who tested positive for COVID-19 exhibited significantly lower blood pressure, SF-36 scores, and 6MWT distances compared to those who tested negative (P<0.05). Additionally, the COVID-19-positive group had higher MLHFQ scores, older average age, a greater proportion of patients in NYHA class III-IV, more frequent electrolyte imbalances, elevated D-dimer, C-reactive protein (CRP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and longer hospital stays (P<0.05). These patients also exhibited higher levels of anxiety (SAS total), poorer sleep quality (PSQI), and greater frailty (FRAIL Scale) compared to their COVID-19-negative counterparts (P<0.05). In addition, heart failure patients with COVID-19 infection reported more severe symptoms of dyspnea and fatigue (P<0.05). Both age and COVID-19 infection were identified as significant factors negatively affecting the quality of life in this patient population.

CONCLUSION

COVID-19 infection significantly exacerbates the decline in quality of life in elderly patients with heart failure. This highlights the urgent need for strengthened, comprehensive treatment and targeted mental health support for this vulnerable group.

Mechanisms of Pulmonary Vasculopathy in Acute and Long-Term COVID-19: A Review

Despite the end of the pandemic, coronavirus disease 2019 (COVID-19) remains a major public health concern. The first waves of the virus led to a better understanding of its pathogenesis, highlighting the fact that there is a specific pulmonary vascular disorder. Indeed, COVID-19 may predispose patients to thrombotic disease in both venous and arterial circulation, and many cases of severe acute pulmonary embolism have been reported. The demonstrated presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within the endothelial cells suggests that direct viral effects, in addition to indirect effects of perivascular inflammation and coagulopathy, may contribute to pulmonary vasculopathy in COVID-19. In this review, we discuss the pathological mechanisms leading to pulmonary vascular damage during acute infection, which appear to be mainly related to thromboembolic events, an impaired coagulation cascade, micro- and macrovascular thrombosis, endotheliitis and hypoxic pulmonary vasoconstriction. As many patients develop post-COVID symptoms, including dyspnea, we also discuss the hypothesis of pulmonary vascular damage and pulmonary hypertension as a sequela of the infection, which may be involved in the pathophysiology of long COVID.

Respiratory sequelae of COVID-19: pulmonary and extrapulmonary origins, and approaches to clinical care and rehabilitation

Although the exact prevalence of post-COVID-19 condition (also known as long COVID) is unknown, more than a third of patients with COVID-19 develop symptoms that persist for more than 3 months after SARS-CoV-2 infection. These sequelae are highly heterogeneous in nature and adversely affect multiple biological systems, although breathlessness is a frequently cited symptom. Specific pulmonary sequelae, including pulmonary fibrosis and thromboembolic disease, need careful assessment and might require particular investigations and treatments. COVID-19 outcomes in people with pre-existing respiratory conditions vary according to the nature and severity of the respiratory disease and how well it is controlled. Extrapulmonary complications such as reduced exercise tolerance and frailty might contribute to breathlessness in post-COVID-19 condition. Non-pharmacological therapeutic options, including adapted pulmonary rehabilitation programmes and physiotherapy techniques for breathing management, might help to attenuate breathlessness in people with post-COVID-19 condition. Further research is needed to understand the origins and course of respiratory symptoms and to develop effective therapeutic and rehabilitative strategies.

Heart failure during the COVID-19 pandemic: clinical, diagnostic, management, and organizational dilemmas

The coronavirus 2019 (COVID-19) infection pandemic has affected the care of patients with heart failure (HF). Several consensus documents describe the appropriate diagnostic algorithm and treatment approach for patients with HF and associated COVID-19 infection. However, few questions about the mechanisms by which COVID can exacerbate HF in patients with high-risk (Stage B) or symptomatic HF (Stage C) remain unanswered. Therefore, the type of HF occurring during infection is poorly investigated. The diagnostic differentiation and management should be focused on the identification of the HF phenotype, underlying causes, and subsequent tailored therapy. In this framework, the relationship existing between COVID and onset of acute decompensated HF, isolated right HF, and cardiogenic shock is questioned, and the specific management is mainly based on local hospital organization rather than a standardized model. Similarly, some specific populations such as advanced HF, heart transplant, patients with left ventricular assist device (LVAD), or valve disease remain under investigated. In this systematic review, we examine recent advances regarding the relationships between HF and COVID-19 pandemic with respect to epidemiology, pathogenetic mechanisms, and differential diagnosis. Also, according to the recent HF guidelines definition, we highlight different clinical profile identification, pointing out the main concerns in understudied HF populations.

Use of predictive scales for pulmonary thromboembolism in an emergency department

BACKGROUND AND OBJECTIVE

Diagnosing pulmonary thromboembolism (PTE) is difficult. Clinical probability scales (CPS) can help. The aim is to find out which one is the best.

PATIENTS AND METHODS

A retrospective cross-sectional single-center study was conducted. It evaluated four CPS (Pulmonary Embolism Rule Out Criteria [PERC], Wells, Geneva, and YEARS criteria) validity in 200 patients who underwent computerized tomography angiography of the pulmonary arteries. Their degree of use was estimated, as well as the possible correlation between them and DD (D dimer).

RESULTS

The four CPS have a high sensitivity, close to 1 and without differences between them. The YEARS scale is between 2 and 4 times more specific than the others. The degree of use of the scales was estimated at 14% (95% CI: 9.19-18.81). A weak positive correlation was found between the scores on the Wells and Geneva scales and the DD.

CONCLUSIONS

The YEARS scale is shown to be better than the others due to its potential greater number of imaging tests avoided and the degree of application of the CPS could be improved.

Pulmonary embolism severity and in-hospital mortality: An international comparative study between COVID-19 and non-COVID patients

OBJECTIVE

To compare the severity of pulmonary embolism (PE) between patients with and without COVID, and to assess the association between severity and in-hospital-mortality.

METHODS

We performed an analysis of 549 COVID (71.3% PCR-confirmed) and 439 non-COVID patients with PE consecutively included by 62 Spanish and 16 French emergency departments. PE-severity was assessed by size, the presence of right ventricular dysfunction (RVD), and the sPESI. The association of PE-severity and in-hospital-mortality was assessed both in COVID and non-COVID patients, and the interaction of COVID status and PE severity/outcome associations was also evaluated.

RESULTS

COVID patients had PEs of smaller size (43% vs 56% lobar or larger, 42% vs. 35% segmental and 13% vs. 9% subsegmental, respectively; p = 0.01 for trend), less RVD (22% vs. 16%, p =0.02) and lower sPESI (p =0.03 for trend). Risk of in-hospital death was higher in COVID patients (12.8% vs. 5.3%, p < 0.001). PE-severity assessed by RVD and sPESI was independently associated with in-hospital-mortality in COVID patients, while PE size and sPESI were significantly associated with in-hospital-mortality in non-COVID. COVID status showed a significant interaction in the association of PE size and outcome (p =0.01), with OR for in-hospital mortality in COVID and non-COVID patients with lobar or larger PE of 0.92 (95%CI=0.19-4.47) and 4.47 (95%CI=1.60-12.5), respectively. Sensitivity analyses using only PCR-confirmed COVID cases confirmed these results.

CONCLUSION

COVID patients present a differential clinical picture, with PE of less severity than in non-COVID patients. An increased sPESI was associated with the risk of mortality in both groups but, PE size did not seem to be associated with in-hospital mortality in COVID patients.

A case-control analysis of stroke in COVID-19 patients: Results of unusual manifestations of COVID-19-study 11

OBJECTIVE

We investigated the incidence, predictor variables, clinical characteristics, and stroke outcomes in patients with COVID-19 seen in emergency departments (EDs) before hospitalization.

METHODS

We retrospectively reviewed all COVID-19 patients diagnosed with stroke during the COVID-19 outbreak in 62 Spanish EDs. We formed two control groups: COVID-19 patients without stroke (control A) and non-COVID-19 patients with stroke (control B). We compared disease characteristics and four outcomes between cases and controls.

RESULTS

We identified 147 strokes in 74,814 patients with COVID-19 seen in EDs (1.96‰, 95% confidence interval [CI] = 1.66‰ to 2.31‰), being lower than in non-COVID-19 patients (6,541/1,388,879, 4.71‰, 95% CI = 4.60‰ to 4.83‰; odds ratio [OR] = 0.42, 95% CI = 0.35 to 0.49). The estimated that standardized incidences of stroke per 100,000 individuals per year were 124 and 133 for COVID-19 and non-COVID-19 individuals, respectively (OR = 0.93 for COVID patients, 95% CI = 0.87 to 0.99). Baseline characteristics associated with a higher risk of stroke in COVID-19 patients were hypertension, diabetes mellitus, and previous cerebrovascular and coronary diseases. Clinically, these patients more frequently presented with confusion, decreased consciousness, and syncope and higher D-dimer concentrations and leukocyte count at ED arrival. After adjustment for age and sex, the case group had higher hospitalization and intensive care unit (ICU) admission rates (but not mortality) than COVID-19 controls without stroke (OR = 3.41, 95% CI = 1.27 to 9.16; and OR = 3.79, 95% CI = 1.69 to 8.50, respectively) and longer hospitalization and greater in-hospital mortality than stroke controls without COVID-19 (OR = 1.55, 95% CI = 1.24 to 1.94; and OR = 1.77, 95% CI = 1.37 to 2.30, respectively).

CONCLUSIONS

The incidence of stroke in COVID-19 patients presenting to EDs was lower than that in the non-COVID-19 reference sample. COVID-19 patients with stroke had greater need for hospitalization and ICU admission than those without stroke and longer hospitalization and greater in-hospital mortality than non-COVID-19 patients with stroke.