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Shpigelman E, Hochstadt A, Coster D, Merdler I, Ghantous E, Szekely Y, Lichter Y, Taieb P, Banai A, Sapir O, Granot Y, Lupu L, Borohovitz A, Sadon S, Banai S, Rubinshtein R, Topilsky Y, Shamir R. Clustering of clinical and echocardiographic phenotypes of covid-19 patients. Sci Rep 2023; 13:8832. [PMID: 37258639 DOI: 10.1038/s41598-023-35449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023] Open
Abstract
We sought to divide COVID-19 patients into distinct phenotypical subgroups using echocardiography and clinical markers to elucidate the pathogenesis of the disease and its heterogeneous cardiac involvement. A total of 506 consecutive patients hospitalized with COVID-19 infection underwent complete evaluation, including echocardiography, at admission. A k-prototypes algorithm applied to patients' clinical and imaging data at admission partitioned the patients into four phenotypical clusters: Clusters 0 and 1 were younger and healthier, 2 and 3 were older with worse cardiac indexes, and clusters 1 and 3 had a stronger inflammatory response. The clusters manifested very distinct survival patterns (C-index for the Cox proportional hazard model 0.77), with survival best for cluster 0, intermediate for 1-2 and worst for 3. Interestingly, cluster 1 showed a harsher disease course than cluster 2 but with similar survival. Clusters obtained with echocardiography were more predictive of mortality than clusters obtained without echocardiography. Additionally, several echocardiography variables (E' lat, E' sept, E/e average) showed high discriminative power among the clusters. The results suggested that older infected males have a higher chance to deteriorate than older infected females. In conclusion, COVID-19 manifests differently for distinctive clusters of patients. These clusters reflect different disease manifestations and prognoses. Although including echocardiography improved the predictive power, its marginal contribution over clustering using clinical parameters only does not justify the burden of echocardiography data collection.
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Affiliation(s)
- Eran Shpigelman
- The Blavatnik School of Computer Science, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- Heart Institute, Edith Wolfson Medical Center, Ha-Lokhamim St 62, 5822012, Holon, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Dan Coster
- The Blavatnik School of Computer Science, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
| | - Ilan Merdler
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Eihab Ghantous
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Yishay Szekely
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Yael Lichter
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Philippe Taieb
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Ariel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Orly Sapir
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Yoav Granot
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Lior Lupu
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Ariel Borohovitz
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Sapir Sadon
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Ronen Rubinshtein
- Heart Institute, Edith Wolfson Medical Center, Ha-Lokhamim St 62, 5822012, Holon, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
- The Sackler School of Medicine, The Tel-Aviv University, Tel Aviv, Israel
| | - Ron Shamir
- The Blavatnik School of Computer Science, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel.
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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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Fiore D, Proto MC, Franceschelli S, Pascale M, Bifulco M, Gazzerro P. In Vitro Evidence of Statins’ Protective Role against COVID-19 Hallmarks. Biomedicines 2022; 10:2123. [PMID: 36140223 PMCID: PMC9495908 DOI: 10.3390/biomedicines10092123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the progressions in COVID-19 understanding, the optimization of patient-specific therapies remains a challenge. Statins, the most widely prescribed lipid-lowering drugs, received considerable attention due to their pleiotropic effects, encompassing lipid metabolism control and immunomodulatory and anti-thrombotic effects. In COVID-19 patients, statins improve clinical outcomes, reducing Intensive Care Unit admission, the onset of ARDS, and in-hospital death. However, the safety of statins in COVID-19 patients has been debated, mainly for statins’ ability to induce the expression of the ACE2 receptor, the main entry route of SARS-CoV-2. Unfortunately, the dynamic of statins’ mechanism in COVID-19 disease and prevention remains elusive. Using different in vitro models expressing different levels of ACE2 receptor, we investigated the role of lipophilic and hydrophilic statins on ACE2 receptor expression and subcellular localization. We demonstrated that the statin-mediated increase of ACE2 receptor expression does not necessarily coincide with its localization in lipid rafts domains, particularly after treatments with the lipophilic atorvastatin that disrupt lipid rafts’ integrity. Through a proteomic array, we analyzed the cytokine patterns demonstrating that statins inhibit the release of cytokines and factors involved in mild to severe COVID-19 cases. The results obtained provide additional information to dissect the mechanism underlying the protective effects of statin use in COVID-19.
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