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Garrity K, Docherty C, Mangion K, Woodward R, Shaw M, Roditi G, Shelley B, Quasim T, McCall P, McPeake J. Characterizing Cardiac Function in ICU Survivors of Sepsis: A Pilot Study Protocol. CHEST CRITICAL CARE 2024; 2:100050. [PMID: 38524255 PMCID: PMC10958646 DOI: 10.1016/j.chstcc.2024.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Background Sepsis is one of the most common reasons for ICU admission and a leading cause of mortality worldwide. More than one-half of survivors experience significant physical, psychological, or cognitive impairments, often termed post-intensive care syndrome (PICS). Sepsis is recognized increasingly as being associated with a risk of adverse cardiovascular events that is comparable with other major cardiovascular risk factors. It is plausible that sepsis survivors may be at risk of unidentified cardiovascular disease, and this may play a role in functional impairments seen after ICU discharge. Research Question What is the prevalence of myocardial dysfunction after an ICU admission with sepsis and to what extent might it be associated with physical impairments in PICS? Study Design and Methods Characterisation of Cardiovascular Function in ICU Survivors of Sepsis (CONDUCT-ICU) is a prospective, multicenter, pilot study characterizing cardiovascular function and functional impairments in survivors of sepsis taking place in the west of Scotland. Survivors of sepsis will be recruited at ICU discharge and followed up 6 to 10 weeks after hospital discharge. Biomarkers of myocardial injury or dysfunction (high sensitivity troponin and N-terminal pro B-type natriuretic peptide) and systemic inflammation (C-reactive protein, IL-1β, IL-6, IL-10, and tumor necrosis factor alpha) will be measured in 69 patients at recruitment and at follow-up. In addition, a cardiovascular magnetic resonance substudy will be performed at follow-up in 35 patients. We will explore associations between cardiovascular magenetic resonance indexes of cardiac function, biomarkers of cardiac dysfunction and inflammation, and patient-reported outcome measures. Interpretation CONDUCT-ICU will provide data regarding the cause and prevalence of cardiac dysfunction in survivors of sepsis and will explore associations with functional impairment. It will provide feasibility data and operational learning for larger studies investigating mechanisms of functional impairment after ICU admission and the association between sepsis and adverse cardiovascular events. Trial Registry ClinicalTrials.gov; No.: NCT05633290; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Kevin Garrity
- Academic Unit of Anaesthesia, Critical Care and Peri-Operative Medicine, University of Glasgow, Glasgow
- Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, Glasgow
| | - Christie Docherty
- Academic Unit of Anaesthesia, Critical Care and Peri-Operative Medicine, University of Glasgow, Glasgow
- University Hospital Crosshouse; NHS Ayrshire and Arran, Crosshouse
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow
| | - Rosie Woodward
- Imaging Centre of Excellence, Queen Elizabeth University Hospital; NHS Greater Glasgow & Clyde, Glasgow
| | - Martin Shaw
- Academic Unit of Anaesthesia, Critical Care and Peri-Operative Medicine, University of Glasgow, Glasgow
| | - Giles Roditi
- Imaging Centre of Excellence, Queen Elizabeth University Hospital; NHS Greater Glasgow & Clyde, Glasgow
| | - Benjamin Shelley
- Academic Unit of Anaesthesia, Critical Care and Peri-Operative Medicine, University of Glasgow, Glasgow
- Golden Jubilee National Hospital, NHS Scotland, Clydebank, Scotland
| | - Tara Quasim
- Academic Unit of Anaesthesia, Critical Care and Peri-Operative Medicine, University of Glasgow, Glasgow
- Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, Glasgow
| | - Philip McCall
- Academic Unit of Anaesthesia, Critical Care and Peri-Operative Medicine, University of Glasgow, Glasgow
- Golden Jubilee National Hospital, NHS Scotland, Clydebank, Scotland
| | - Joanne McPeake
- THIS Institute, University of Cambridge, Cambridge, England
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Morrow AJ, Sykes R, Saleh M, Zahra B, MacIntosh A, Kamdar A, Bagot C, Bayes HK, Blyth KG, Bulluck H, Carrick D, Church C, Corcoran D, Findlay I, Gibson VB, Gillespie L, Grieve D, Barrientos PH, Ho A, Lang NN, Lowe DJ, Lennie V, Macfarlane PW, Mayne KJ, Mark PB, McConnachie A, McGeoch R, Nordin S, Payne A, Rankin AJ, Robertson K, Ryan N, Roditi G, Sattar N, Stobo D, Allwood-Spiers S, Touyz RM, Veldtman G, Weeden S, Weir R, Watkins S, Welsh P, Mangion K, Berry C. Socioeconomic deprivation and illness trajectory in the Scottish population after COVID-19 hospitalization. COMMUNICATIONS MEDICINE 2024; 4:32. [PMID: 38418616 PMCID: PMC10901805 DOI: 10.1038/s43856-024-00455-5] [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: 01/27/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The associations between deprivation and illness trajectory after hospitalisation for coronavirus disease-19 (COVID-19) are uncertain. METHODS A prospective, multicentre cohort study was conducted on post-COVID-19 patients, enrolled either in-hospital or shortly post-discharge. Two evaluations were carried out: an initial assessment and a follow-up at 28-60 days post-discharge. The study encompassed research blood tests, patient-reported outcome measures, and multisystem imaging (including chest computed tomography (CT) with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging). Primary and secondary outcomes were analysed in relation to socioeconomic status, using the Scottish Index of Multiple Deprivation (SIMD). The EQ-5D-5L, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire-4 (PHQ-4) for Anxiety and Depression, and the Duke Activity Status Index (DASI) were used to assess health status. RESULTS Of the 252 enrolled patients (mean age 55.0 ± 12.0 years; 40% female; 23% with diabetes), deprivation status was linked with increased BMI and diabetes prevalence. 186 (74%) returned for the follow-up. Within this group, findings indicated associations between deprivation and lung abnormalities (p = 0.0085), coronary artery disease (p = 0.0128), and renal inflammation (p = 0.0421). Furthermore, patients with higher deprivation exhibited worse scores in health-related quality of life (EQ-5D-5L, p = 0.0084), illness perception (BIPQ, p = 0.0004), anxiety and depression levels (PHQ-4, p = 0.0038), and diminished physical activity (DASI, p = 0.002). At the 3-month mark, those with greater deprivation showed a higher frequency of referrals to secondary care due to ongoing COVID-19 symptoms (p = 0.0438). However, clinical outcomes were not influenced by deprivation. CONCLUSIONS In a post-hospital COVID-19 population, socioeconomic deprivation was associated with impaired health status and secondary care episodes. Deprivation influences illness trajectory after COVID-19.
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Affiliation(s)
- Andrew J Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Merna Saleh
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Baryab Zahra
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Anna Kamdar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, Glasgow, UK
| | - Hannah K Bayes
- Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - David Carrick
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | - Colin Church
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - David Corcoran
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Iain Findlay
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Vivienne B Gibson
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, Glasgow, UK
| | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Douglas Grieve
- Department of Respiratory Medicine, Royal Alexandra Hospital, Glasgow, UK
| | | | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Ninian N Lang
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Lowe
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Vera Lennie
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Peter W Macfarlane
- Electrocardiology Core Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kaitlin J Mayne
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Patrick B Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ross McGeoch
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Sabrina Nordin
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alexander Payne
- Department of Cardiology, University Hospital Crosshouse, Kilmarnock, UK
| | - Alastair J Rankin
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Keith Robertson
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Nicola Ryan
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Giles Roditi
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - David Stobo
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | | | - Rhian M Touyz
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Gruschen Veldtman
- Scottish Adult Congenital Cardiac Service, NHS Golden Jubilee, Clydebank, UK
| | - Sarah Weeden
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Robin Weir
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Stuart Watkins
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK.
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Wang Y, Zhang Y, Wang F, Xue Y. Case report: Right coronary artery to left ventricular fistula complicated with coronary artery dilation presenting as persistent cardiogenic ischemic chest pain. Front Cardiovasc Med 2023; 10:1238034. [PMID: 37771664 PMCID: PMC10526361 DOI: 10.3389/fcvm.2023.1238034] [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: 06/10/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023] Open
Abstract
We reported a patient with a fistula of the right coronary artery to the left ventricle, accompanied by dilation of the right coronary artery and persistent chest pain. This patient underwent surgical fistula closure surgery, but the fistula recurred. Persistent chest pain reappeared after encountering COVID-19 infection. We analyzed the mechanism of persistent myocardial ischemic chest pain caused by coronary artery fistula in this patient, the impact of surgery on the patient's disease, the possible mechanism of COVID-19 causing persistent ischemic chest pain in this patient, and the possible mechanism of metoprolol in alleviating myocardial ischemic chest pain in this patient.
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Affiliation(s)
- Yuehai Wang
- Cardiology Department, Liaocheng People’s Hospital of Shandong University and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, China
- Laboratory Animal Center, Liaocheng People’s Hospital of Shandong University and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Yuqiang Zhang
- Cardiology Department, Liaocheng People’s Hospital of Shandong University and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, China
- Laboratory Animal Center, Liaocheng People’s Hospital of Shandong University and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Fei Wang
- Department of Cardiology, Shandong Corps Hospital of Chinese People’s Armed Police Forces, Jinan, China
| | - Yuzeng Xue
- Cardiology Department, Liaocheng People’s Hospital of Shandong University and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, China
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4
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Mangion K, Morrow AJ, Sykes R, Kamdar A, Bagot C, Bruce G, Connelly P, Delles C, Gibson VB, Gillespie L, Barrientos PH, Lennie V, Roditi G, Sattar N, Stobo D, Allwood-Spiers S, McConnachie A, Berry C. Post-COVID-19 illness and associations with sex and gender. BMC Cardiovasc Disord 2023; 23:389. [PMID: 37553628 PMCID: PMC10408208 DOI: 10.1186/s12872-023-03412-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Post-COVID-19 syndromes have associated with female sex, but the pathophysiological basis is uncertain. AIM There are sex differences in myocardial inflammation identified using cardiac magnetic resonance (CMR) in post-COVID-19 patients, and in patient reported health outcomes following COVID-19 infection. DESIGN This prospective study investigated the time-course of multiorgan injury in survivors of COVID-19 during convalescence. METHODS Clinical information, blood biomarkers, and patient reported outcome measures were prospectively acquired at enrolment (visit 1) and 28-60 days post-discharge (visit 2). Chest computed tomography (CT) and CMR were performed at visit 2. Follow-up was carried out for serious adverse events, including death and rehospitalization. RESULTS Sixty-nine (43%) of 159 patients recruited were female. During the index admission, females had a lower peak C-reactive protein (74 mg/l (21,163) versus 123 mg/l (70, 192) p = 0.008) and peak ferritin (229 μg/l (103, 551) versus 514 μg/l (228, 1122) p < 0.001). Using the Modified Lake-Louise criteria, females were more likely to have definite evidence of myocardial inflammation (54% (37/68) versus 33% (30/90) p = 0.003). At enrolment and 28-60 days post-discharge, enhanced illness perception, higher levels of anxiety and depression and lower predicted maximal oxygen utilization occurred more commonly in women. The mean (SD, range) duration of follow-up after hospital discharge was 450 (88) days (range 290, 627 days). Compared to men, women had lower rates of cardiovascular hospitalization (0% versus 8% (7/90); p = 0.018). CONCLUSIONS Women demonstrated worse patient reported outcome measures at index admission and 28-60 days follow-up though cardiovascular hospitalization was lower.
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Affiliation(s)
- Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK.
| | - Andrew J Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Anna Kamdar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - George Bruce
- Department of Medical Physics, NHS G Reater Glasgow and Clyde Health Board, Glasgow, UK
| | - Paul Connelly
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Vivienne B Gibson
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | | | - Vera Lennie
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Giles Roditi
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - David Stobo
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Sarah Allwood-Spiers
- Department of Medical Physics, NHS G Reater Glasgow and Clyde Health Board, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
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5
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Sykes RA, Neves KB, Alves-Lopes R, Caputo I, Fallon K, Jamieson NB, Kamdar A, Legrini A, Leslie H, McIntosh A, McConnachie A, Morrow A, McFarlane RW, Mangion K, McAbney J, Montezano AC, Touyz RM, Wood C, Berry C. Vascular mechanisms of post-COVID-19 conditions: Rho-kinase is a novel target for therapy. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2023; 9:371-386. [PMID: 37019821 PMCID: PMC10236521 DOI: 10.1093/ehjcvp/pvad025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/24/2023] [Accepted: 04/04/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND In post-coronavirus disease-19 (post-COVID-19) conditions (long COVID), systemic vascular dysfunction is implicated, but the mechanisms are uncertain, and the treatment is imprecise. METHODS AND RESULTS Patients convalescing after hospitalization for COVID-19 and risk factor matched controls underwent multisystem phenotyping using blood biomarkers, cardiorenal and pulmonary imaging, and gluteal subcutaneous biopsy (NCT04403607). Small resistance arteries were isolated and examined using wire myography, histopathology, immunohistochemistry, and spatial transcriptomics. Endothelium-independent (sodium nitroprusside) and -dependent (acetylcholine) vasorelaxation and vasoconstriction to the thromboxane A2 receptor agonist, U46619, and endothelin-1 (ET-1) in the presence or absence of a RhoA/Rho-kinase inhibitor (fasudil), were investigated. Thirty-seven patients, including 27 (mean age 57 years, 48% women, 41% cardiovascular disease) 3 months post-COVID-19 and 10 controls (mean age 57 years, 20% women, 30% cardiovascular disease), were included. Compared with control responses, U46619-induced constriction was increased (P = 0.002) and endothelium-independent vasorelaxation was reduced in arteries from COVID-19 patients (P < 0.001). This difference was abolished by fasudil. Histopathology revealed greater collagen abundance in COVID-19 arteries {Masson's trichrome (MT) 69.7% [95% confidence interval (CI): 67.8-71.7]; picrosirius red 68.6% [95% CI: 64.4-72.8]} vs. controls [MT 64.9% (95% CI: 59.4-70.3) (P = 0.028); picrosirius red 60.1% (95% CI: 55.4-64.8), (P = 0.029)]. Greater phosphorylated myosin light chain antibody-positive staining in vascular smooth muscle cells was observed in COVID-19 arteries (40.1%; 95% CI: 30.9-49.3) vs. controls (10.0%; 95% CI: 4.4-15.6) (P < 0.001). In proof-of-concept studies, gene pathways associated with extracellular matrix alteration, proteoglycan synthesis, and viral mRNA replication appeared to be upregulated. CONCLUSION Patients with post-COVID-19 conditions have enhanced vascular fibrosis and myosin light change phosphorylation. Rho-kinase activation represents a novel therapeutic target for clinical trials.
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Affiliation(s)
- Robert A Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Karla B Neves
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Rhéure Alves-Lopes
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
| | - Ilaria Caputo
- Università degli Studi di Padova, 35122 Padova, Italy
| | - Kirsty Fallon
- Clinical Research Facility, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde Health Board, Glasgow, UK
| | - Nigel B Jamieson
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Anna Kamdar
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
| | - Assya Legrini
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Holly Leslie
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andrew Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | | | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - John McAbney
- Institute of Biomedical and Life Sciences (FBLS), University of Glasgow, Glasgow G12 8QQ, UK
| | - Augusto C Montezano
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC H4A 3J1, Canada
| | - Rhian M Touyz
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC H4A 3J1, Canada
| | - Colin Wood
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
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6
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Sykes R, Morrow AJ, McConnachie A, Kamdar A, Bagot C, Bayes H, Blyth KG, Briscoe M, Bulluck H, Carrick D, Church C, Corcoran D, Delles C, Findlay I, Gibson VB, Gillespie L, Grieve D, Barrientos PH, Ho A, Lang NN, Lowe DJ, Lennie V, MacFarlane P, Mayne KJ, Mark P, McIntosh A, McGeoch R, McGinley C, Mckee C, Nordin S, Payne A, Rankin A, Robertson KE, Ryan N, Roditi GH, Sattar N, Stobo DB, Allwood-Spiers S, Touyz R, Veldtman G, Weeden S, Watkins S, Welsh P, Wereski R, Mangion K, Berry C. Adjudicated myocarditis and multisystem illness trajectory in healthcare workers post-COVID-19. Open Heart 2023; 10:openhrt-2022-002192. [PMID: 36822817 PMCID: PMC9950584 DOI: 10.1136/openhrt-2022-002192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND We investigated the associations of healthcare worker status with multisystem illness trajectory in hospitalised post-COVID-19 individuals. METHODS AND RESULTS One hundred and sixty-eight patients were evaluated 28-60 days after the last episode of hospital care. Thirty-six (21%) were healthcare workers. Compared with non-healthcare workers, healthcare workers were of similar age (51.3 (8.7) years vs 55.0 (12.4) years; p=0.09) more often women (26 (72%) vs 48 (38%); p<0.01) and had lower 10-year cardiovascular risk (%) (8.1 (7.9) vs 15.0 (11.5); p<0.01) and Coronavirus Clinical Characterisation Consortium in-hospital mortality risk (7.3 (10.2) vs 12.7 (9.8); p<0.01). Healthcare worker status associated with less acute inflammation (peak C reactive protein 48 mg/L (IQR: 14-165) vs 112 mg/L (52-181)), milder illness reflected by WHO clinical severity score distribution (p=0.04) and shorter duration of admission (4 days (IQR: 2-6) vs 6 days (3-12)).In adjusted multivariate logistic regression analysis, healthcare worker status associated with a binary classification (probable/very likely vs not present/unlikely) of adjudicated myocarditis (OR: 2.99; 95% CI (1.01 to 8.89) by 28-60 days postdischarge).After a mean (SD, range) duration of follow-up after hospital discharge of 450 (88) days (range 290, 627 days), fewer healthcare workers died or were rehospitalised (1 (3%) vs 22 (17%); p=0.038) and secondary care referrals for post-COVID-19 syndrome were common (42%) and similar to non-healthcare workers (38%; p=0.934). CONCLUSION Healthcare worker status was independently associated with the likelihood of adjudicated myocarditis, despite better antecedent health. Two in five healthcare workers had a secondary care referral for post-COVID-19 syndrome. TRIAL REGISTRATION NUMBER NCT04403607.
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Affiliation(s)
- Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Andrew J Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Anna Kamdar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - C Bagot
- Haematology, Glasgow Royal Infirmary, Glasgow, UK
| | - Hannah Bayes
- Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Kevin G Blyth
- School of Cancer Sciences, University of Glasgow, Glasgow, UK.,Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Michael Briscoe
- Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Heeraj Bulluck
- Cardiology, Leeds General Infirmary, Leeds, West Yorkshire, UK
| | - David Carrick
- Cardiology, University Hospital Hairmyres, East Kilbride, South Lanarkshire, UK
| | - Colin Church
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Scottish Pulmonary Vascular Unit, Golden Jubilee Hospital, Clydebank, UK
| | - David Corcoran
- Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - C Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Iain Findlay
- Cardiology, Royal Alexandra Hospital, Paisley, Renfrewshire, UK
| | | | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Glasgow, UK
| | - Douglas Grieve
- Respiratory Medicine, Royal Alexandra Hospital, Paisley, Renfrewshire, UK
| | | | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - N N Lang
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Lowe
- Emergency Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Vera Lennie
- Cardiology, Aberdeen Royal Infirmary, Aberdeen, Aberdeen, UK
| | - Peter MacFarlane
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Kaithlin J Mayne
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Patrick Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ross McGeoch
- Cardiology, University Hospital Hairmyres, East Kilbride, South Lanarkshire, UK
| | | | - Connor Mckee
- Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sabrina Nordin
- Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alexander Payne
- Cardiology, University Hospital Crosshouse, Kilmarnock, East Ayrshire, UK
| | - Alastair Rankin
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Keith E Robertson
- Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Nicola Ryan
- Cardiology, Aberdeen Royal Infirmary, Aberdeen, Aberdeen, UK
| | - Giles H Roditi
- Radiology, NHS Greater Glasgow and Clyde, Glasgow, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - David B Stobo
- Radiology, NHS Greater Glasgow and Clyde, Glasgow, Glasgow, UK
| | | | - Rhian Touyz
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Gruschen Veldtman
- Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Sarah Weeden
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Stuart Watkins
- Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Ryan Wereski
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.,Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK .,Cardiology, Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre, Glasgow, UK.,Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
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7
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Rabbat MG, Kwong RY, Heitner JF, Young AA, Shanbhag SM, Petersen SE, Selvanayagam JB, Berry C, Nagel E, Heydari B, Maceira AM, Shenoy C, Dyke C, Bilchick KC. The Future of Cardiac Magnetic Resonance Clinical Trials. JACC Cardiovasc Imaging 2022; 15:2127-2138. [PMID: 34922874 DOI: 10.1016/j.jcmg.2021.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 05/17/2021] [Accepted: 07/27/2021] [Indexed: 01/13/2023]
Abstract
Over the past 2 decades, cardiac magnetic resonance (CMR) has become an essential component of cardiovascular clinical care and contributed to imaging-guided diagnosis and management of coronary artery disease, cardiomyopathy, congenital heart disease, cardio-oncology, valvular, and vascular disease, amongst others. The widespread availability, safety, and capability of CMR to provide corresponding anatomical, physiological, and functional data in 1 imaging session can improve the design and conduct of clinical trials through both a reduction of sample size and provision of important mechanistic data that may augment clinical trial findings. Moreover, prospective imaging-guided strategies using CMR can enhance safety, efficacy, and cost-effectiveness of cardiovascular pathways in clinical practice around the world. As the future of large-scale clinical trial design evolves to integrate personalized medicine, cost-effectiveness, and mechanistic insights of novel therapies, the integration of CMR will continue to play a critical role. In this document, the attributes, limitations, and challenges of CMR's integration into the future design and conduct of clinical trials will also be covered, and recommendations for trialists will be explored. Several prominent examples of clinical trials that test the efficacy of CMR-imaging guided pathways will also be discussed.
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Affiliation(s)
- Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Chicago, Illinois, USA; Division of Cardiology, Edward Hines Jr VA Hospital, Hines, Illinois, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - John F Heitner
- Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Alistair A Young
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Sujata M Shanbhag
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Steffen E Petersen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom; National Institute for Health Research Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Joseph B Selvanayagam
- College of Medicine, Flinders University of South Australia, Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, and Cardiac Imaging Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, and British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, Klinikum der Johann Wolfgang Goethe-Universitat Frankfurt, Frankfurt am Main, Germany
| | - Bobak Heydari
- Stephenson Cardiac Imaging Centre and Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, and Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alicia M Maceira
- Cardiovascular Unit, Ascires Biomedical Group, and Department of Medicine, Health Sciences School, UCH-CEU University, Valencia, Spain
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Christopher Dyke
- Division of Cardiology, National Jewish Health, Denver, Colorado, USA
| | - Kenneth C Bilchick
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
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8
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Morrow A, Gray SR, Bayes HK, Sykes R, McGarry E, Anderson D, Boiskin D, Burke C, Cleland JGF, Goodyear C, Ibbotson T, Lang CC, McConnachie, Mair F, Mangion K, Patel M, Sattar N, Taggart D, Taylor R, Dawkes S, Berry C. Prevention and early treatment of the long-term physical effects of COVID-19 in adults: design of a randomised controlled trial of resistance exercise-CISCO-21. Trials 2022; 23:660. [PMID: 35971155 PMCID: PMC9376905 DOI: 10.1186/s13063-022-06632-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/04/2022] [Indexed: 11/11/2022] Open
Abstract
Background Coronavirus disease-19 (COVID-19) infection causes persistent health problems such as breathlessness, chest pain and fatigue, and therapies for the prevention and early treatment of post-COVID-19 syndromes are needed. Accordingly, we are investigating the effect of a resistance exercise intervention on exercise capacity and health status following COVID-19 infection. Methods A two-arm randomised, controlled clinical trial including 220 adults with a diagnosis of COVID-19 in the preceding 6 months. Participants will be classified according to clinical presentation: Group A, not hospitalised due to COVID but persisting symptoms for at least 4 weeks leading to medical review; Group B, discharged after an admission for COVID and with persistent symptoms for at least 4 weeks; or Group C, convalescing in hospital after an admission for COVID. Participants will be randomised to usual care or usual care plus a personalised and pragmatic resistance exercise intervention for 12 weeks. The primary outcome is the incremental shuttle walks test (ISWT) 3 months after randomisation with secondary outcomes including spirometry, grip strength, short performance physical battery (SPPB), frailty status, contacts with healthcare professionals, hospitalisation and questionnaires assessing health-related quality of life, physical activity, fatigue and dyspnoea. Discussion Ethical approval has been granted by the National Health Service (NHS) West of Scotland Research Ethics Committee (REC) (reference: GN20CA537) and recruitment is ongoing. Trial findings will be disseminated through patient and public forums, scientific conferences and journals. Trial registration ClinicialTrials.gov NCT04900961. Prospectively registered on 25 May 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06632-y.
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Affiliation(s)
- A Morrow
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - H K Bayes
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - R Sykes
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - E McGarry
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - D Anderson
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - D Boiskin
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - C Burke
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - J G F Cleland
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C Goodyear
- Institute of Inflammation, Infection and Immunity, University of Glasgow, Glasgow, UK
| | - T Ibbotson
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C C Lang
- School of Medicine, University of Dundee, Dundee, UK
| | - McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - F Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - K Mangion
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - M Patel
- University Hospital Wishaw, NHS Lanarkshire, Wishaw, UK
| | - N Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D Taggart
- NHS Project Management Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - R Taylor
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - S Dawkes
- School for Nursing Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - C Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
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9
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Mangion K, Berry C. Multisystem involvement in COVID-19: what have we learnt? Br J Hosp Med (Lond) 2022; 83:1-5. [DOI: 10.12968/hmed.2022.0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The COVID-19 illness trajectory involves persistent cardio-renal inflammation, activation of the haemostatic pathway and lung involvement. Results of a study carried out by the authors' team demonstrate a link between post-COVID-19 syndrome (people who have long COVID) and multisystem disease, which partly explains the lingering impairments in patient-reported health-related quality of life, physical function and psychological wellbeing after COVID-19. This article discusses what hospital physicians need to be aware of when considering the likelihood of myocarditis in patients with post-COVID-19 syndrome and the implications in the longer term.
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Affiliation(s)
- Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Elizabeth University Hospital, Glasgow, UK
- Department of Cardiology, Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Cardiology, Elizabeth University Hospital, Glasgow, UK
- Department of Cardiology, Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
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10
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Topriceanu CC, Pierce I, Moon JC, Captur G. T 2 and T 2⁎ mapping and weighted imaging in cardiac MRI. Magn Reson Imaging 2022; 93:15-32. [PMID: 35914654 DOI: 10.1016/j.mri.2022.07.012] [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: 03/07/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
Cardiac imaging is progressing from simple imaging of heart structure and function to techniques visualizing and measuring underlying tissue biological changes that can potentially define disease and therapeutic options. These techniques exploit underlying tissue magnetic relaxation times: T1, T2 and T2*. Initial weighting methods showed myocardial heterogeneity, detecting regional disease. Current methods are now fully quantitative generating intuitive color maps that do not only expose regionality, but also diffuse changes - meaning that between-scan comparisons can be made to define disease (compared to normal) and to monitor interval change (compared to old scans). T1 is now familiar and used clinically in multiple scenarios, yet some technical challenges remain. T2 is elevated with increased tissue water - oedema. Should there also be blood troponin elevation, this oedema likely reflects inflammation, a key biological process. T2* falls in the presence of magnetic/paramagnetic materials - practically, this means it measures tissue iron, either after myocardial hemorrhage or in myocardial iron overload. This review discusses how T2 and T2⁎ imaging work (underlying physics, innovations, dependencies, performance), current and emerging use cases, quality assurance processes for global delivery and future research directions.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK; UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Iain Pierce
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Gabriella Captur
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK; UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK; The Royal Free Hospital, Centre for Inherited Heart Muscle Conditions, Cardiology Department, Pond Street, Hampstead, London, UK.
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11
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Luo Y, Liu BT, Yuan WF, Zhao CX. Frontiers of COVID-19-related myocarditis as assessed by cardiovascular magnetic resonance. World J Clin Cases 2022; 10:6784-6793. [PMID: 36051125 PMCID: PMC9297411 DOI: 10.12998/wjcc.v10.i20.6784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/16/2022] [Accepted: 06/18/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In some patients, COVID-19 is complicated with myocarditis. Early detection of myocardial injury and timely intervention can significantly improve the clinical outcomes of COVID-19 patients. Although endomyocardial biopsy (EMB) is currently recognized as the ‘gold standard’ for the diagnosis of myocarditis, there are large sampling errors, many complications and a lack of unified diagnostic criteria. In addition, the clinical methods of treating acute and chronic COVID-19-related myocarditis are different. Cardiac magnetic resonance (CMR) can evaluate the morphology of the heart, left and right ventricular functions, myocardial perfusion, capillary leakage and myocardial interstitial fibrosis to provide a noninvasive and radiation-free diagnostic basis for the clinical detection, efficacy and risk assessment, and follow-up observation of COVID-19-related myocarditis. However, for the diagnosis of COVID-19-related myocarditis, the Lake Louise Consensus Criteria may not be fully applicable. COVID-19-related myocarditis is different from myocarditis related to other viral infections in terms of signal intensity and lesion location as assessed by CMR, which is used to visualize myocardial damage, locate lesions and quantify pathological changes based on various sequences. Therefore, the standardized application of CMR to timely and accurately evaluate heart injury in COVID-19-related myocarditis and develop rational treatment strategies could be quite effective in improving the prognosis of patients and preventing potential late-onset effects in convalescent patients with COVID-19.
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Affiliation(s)
- Yi Luo
- Department of Radiology, The First People’s Hospital of Longquanyi District, Chengdu 610100, Sichuan Province, China
| | - Ben-Tian Liu
- Department of Radiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
| | - Wei-Feng Yuan
- Department of Radiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Can-Xian Zhao
- Department of Medical Imaging, Chengdu Second People’s Hospital, Chengdu 610011, Sichuan Province, China
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12
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Morrow AJ, Sykes R, McIntosh A, Kamdar A, Bagot C, Bayes HK, Blyth KG, Briscoe M, Bulluck H, Carrick D, Church C, Corcoran D, Findlay I, Gibson VB, Gillespie L, Grieve D, Hall Barrientos P, Ho A, Lang NN, Lennie V, Lowe DJ, Macfarlane PW, Mark PB, Mayne KJ, McConnachie A, McGeoch R, McGinley C, McKee C, Nordin S, Payne A, Rankin AJ, Robertson KE, Roditi G, Ryan N, Sattar N, Allwood-Spiers S, Stobo D, Touyz RM, Veldtman G, Watkins S, Weeden S, Weir RA, Welsh P, Wereski R, Mangion K, Berry C. A multisystem, cardio-renal investigation of post-COVID-19 illness. Nat Med 2022; 28:1303-1313. [PMID: 35606551 PMCID: PMC9205780 DOI: 10.1038/s41591-022-01837-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/25/2022] [Indexed: 12/27/2022]
Abstract
The pathophysiology and trajectory of post-Coronavirus Disease 2019 (COVID-19) syndrome is uncertain. To clarify multisystem involvement, we undertook a prospective cohort study including patients who had been hospitalized with COVID-19 (ClinicalTrials.gov ID NCT04403607 ). Serial blood biomarkers, digital electrocardiography and patient-reported outcome measures were obtained in-hospital and at 28-60 days post-discharge when multisystem imaging using chest computed tomography with pulmonary and coronary angiography and cardio-renal magnetic resonance imaging was also obtained. Longer-term clinical outcomes were assessed using electronic health records. Compared to controls (n = 29), at 28-60 days post-discharge, people with COVID-19 (n = 159; mean age, 55 years; 43% female) had persisting evidence of cardio-renal involvement and hemostasis pathway activation. The adjudicated likelihood of myocarditis was 'very likely' in 21 (13%) patients, 'probable' in 65 (41%) patients, 'unlikely' in 56 (35%) patients and 'not present' in 17 (11%) patients. At 28-60 days post-discharge, COVID-19 was associated with worse health-related quality of life (EQ-5D-5L score 0.77 (0.23) versus 0.87 (0.20)), anxiety and depression (PHQ-4 total score 3.59 (3.71) versus 1.28 (2.67)) and aerobic exercise capacity reflected by predicted maximal oxygen utilization (20.0 (7.6) versus 29.5 (8.0) ml/kg/min) (all P < 0.01). During follow-up (mean, 450 days), 24 (15%) patients and two (7%) controls died or were rehospitalized, and 108 (68%) patients and seven (26%) controls received outpatient secondary care (P = 0.017). The illness trajectory of patients after hospitalization with COVID-19 includes persisting multisystem abnormalities and health impairments that could lead to substantial demand on healthcare services in the future.
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Affiliation(s)
- Andrew J Morrow
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Robert Sykes
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Anna Kamdar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Hannah K Bayes
- Department of Respiratory Medicine, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Michael Briscoe
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - David Carrick
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | - Colin Church
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Iain Findlay
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Vivienne B Gibson
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Douglas Grieve
- Department of Respiratory Medicine, Royal Alexandra Hospital, Glasgow, UK
| | | | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, Institute of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Ninian N Lang
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Vera Lennie
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - David J Lowe
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Peter W Macfarlane
- Electrocardiology Core Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Kaitlin J Mayne
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ross McGeoch
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | | | - Connor McKee
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sabrina Nordin
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alexander Payne
- Department of Cardiology, University Hospital Crosshouse, Kilmarnock, UK
| | - Alastair J Rankin
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Keith E Robertson
- West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Giles Roditi
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Nicola Ryan
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Sarah Allwood-Spiers
- Department of Respiratory Medicine, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - David Stobo
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Rhian M Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Gruschen Veldtman
- Scottish Adult Congenital Cardiac Services, NHS Golden Jubilee, Clydebank, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Sarah Weeden
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robin A Weir
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Ryan Wereski
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK.
- West of Scotland Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK.
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14
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Raman B, Bluemke DA, Lüscher TF, Neubauer S. Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus. Eur Heart J 2022; 43:1157-1172. [PMID: 35176758 PMCID: PMC8903393 DOI: 10.1093/eurheartj/ehac031] [Citation(s) in RCA: 253] [Impact Index Per Article: 126.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 02/07/2023] Open
Abstract
Emerging as a new epidemic, long COVID or post-acute sequelae of coronavirus disease 2019 (COVID-19), a condition characterized by the persistence of COVID-19 symptoms beyond 3 months, is anticipated to substantially alter the lives of millions of people globally. Cardiopulmonary symptoms including chest pain, shortness of breath, fatigue, and autonomic manifestations such as postural orthostatic tachycardia are common and associated with significant disability, heightened anxiety, and public awareness. A range of cardiovascular (CV) abnormalities has been reported among patients beyond the acute phase and include myocardial inflammation, myocardial infarction, right ventricular dysfunction, and arrhythmias. Pathophysiological mechanisms for delayed complications are still poorly understood, with a dissociation seen between ongoing symptoms and objective measures of cardiopulmonary health. COVID-19 is anticipated to alter the long-term trajectory of many chronic cardiac diseases which are abundant in those at risk of severe disease. In this review, we discuss the definition of long COVID and its epidemiology, with an emphasis on cardiopulmonary symptoms. We further review the pathophysiological mechanisms underlying acute and chronic CV injury, the range of post-acute CV sequelae, and impact of COVID-19 on multiorgan health. We propose a possible model for referral of post-COVID-19 patients to cardiac services and discuss future directions including research priorities and clinical trials that are currently underway to evaluate the efficacy of treatment strategies for long COVID and associated CV sequelae.
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Affiliation(s)
- Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - David A. Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 3252 Clinical Science Center, 600 Highland Ave, Madison, WI 53792, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 3252 Clinical Science Center, 600 Highland Ave, Madison, WI 53792, USA
| | - Thomas F. Lüscher
- Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, London, UK
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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15
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Affiliation(s)
- Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
- Corresponding author. British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK. Tel: +44 141 330 1671, Fax: +44 141 330 2522,
| | - Hannah K. Bayes
- Department of Respiratory Medicine, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
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16
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Korompoki E, Gavriatopoulou M, Fotiou D, Ntanasis‐Stathopoulos I, Dimopoulos MA, Terpos E. Late-onset hematological complications post COVID-19: An emerging medical problem for the hematologist. Am J Hematol 2022; 97:119-128. [PMID: 34687462 PMCID: PMC8646944 DOI: 10.1002/ajh.26384] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/28/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 19 (COVID‐19) is considered a multisystemic disease. Several studies have reported persistent symptoms or late‐onset complications after acute COVID‐19, including post‐COVID‐19 hematological disorders. COVID‐19‐induced coagulopathy, an immunothrombotic state, has been linked to thromboembolic and hemorrhagic events. Late‐onset thrombocytopenia related to immune system dysregulation has also been reported as a rare manifestation post COVID‐19. Close monitoring of laboratory dynamics is considered essential to identify timely abnormal values that need further investigation, providing supportive care whenever indicated. The role of hematologists is essential in terms of the multidisciplinary approach of long COVID‐19. This review summarizes all the available evidence on post‐acute COVID‐19 hematological complications.
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Affiliation(s)
- Eleni Korompoki
- Department of Clinical Therapeutics, School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Despina Fotiou
- Department of Clinical Therapeutics, School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Ioannis Ntanasis‐Stathopoulos
- Department of Clinical Therapeutics, School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine National and Kapodistrian University of Athens Athens Greece
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17
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Thornton GD, Shetye A, Knight DS, Knott K, Artico J, Kurdi H, Yousef S, Antonakaki D, Razvi Y, Chacko L, Brown J, Patel R, Vimalesvaran K, Seraphim A, Davies R, Xue H, Kotecha T, Bell R, Manisty C, Cole GD, Moon JC, Kellman P, Fontana M, Treibel TA. Myocardial Perfusion Imaging After Severe COVID-19 Infection Demonstrates Regional Ischemia Rather Than Global Blood Flow Reduction. Front Cardiovasc Med 2021; 8:764599. [PMID: 34950713 PMCID: PMC8688537 DOI: 10.3389/fcvm.2021.764599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/06/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Acute myocardial damage is common in severe COVID-19. Post-mortem studies have implicated microvascular thrombosis, with cardiovascular magnetic resonance (CMR) demonstrating a high prevalence of myocardial infarction and myocarditis-like scar. The microcirculatory sequelae are incompletely characterized. Perfusion CMR can quantify the stress myocardial blood flow (MBF) and identify its association with infarction and myocarditis. Objectives: To determine the impact of the severe hospitalized COVID-19 on global and regional myocardial perfusion in recovered patients. Methods: A case-control study of previously hospitalized, troponin-positive COVID-19 patients was undertaken. The results were compared with a propensity-matched, pre-COVID chest pain cohort (referred for clinical CMR; angiography subsequently demonstrating unobstructed coronary arteries) and 27 healthy volunteers (HV). The analysis used visual assessment for the regional perfusion defects and AI-based segmentation to derive the global and regional stress and rest MBF. Results: Ninety recovered post-COVID patients {median age 64 [interquartile range (IQR) 54-71] years, 83% male, 44% requiring the intensive care unit (ICU)} underwent adenosine-stress perfusion CMR at a median of 61 (IQR 29-146) days post-discharge. The mean left ventricular ejection fraction (LVEF) was 67 ± 10%; 10 (11%) with impaired LVEF. Fifty patients (56%) had late gadolinium enhancement (LGE); 15 (17%) had infarct-pattern, 31 (34%) had non-ischemic, and 4 (4.4%) had mixed pattern LGE. Thirty-two patients (36%) had adenosine-induced regional perfusion defects, 26 out of 32 with at least one segment without prior infarction. The global stress MBF in post-COVID patients was similar to the age-, sex- and co-morbidities of the matched controls (2.53 ± 0.77 vs. 2.52 ± 0.79 ml/g/min, p = 0.10), though lower than HV (3.00 ± 0.76 ml/g/min, p< 0.01). Conclusions: After severe hospitalized COVID-19 infection, patients who attended clinical ischemia testing had little evidence of significant microvascular disease at 2 months post-discharge. The high prevalence of regional inducible ischemia and/or infarction (nearly 40%) may suggest that occult coronary disease is an important putative mechanism for troponin elevation in this cohort. This should be considered hypothesis-generating for future studies which combine ischemia and anatomical assessment.
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Affiliation(s)
- George D. Thornton
- Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College, London, United Kingdom
| | - Abhishek Shetye
- Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College, London, United Kingdom
| | - Dan S. Knight
- Institute of Cardiovascular Science, University College, London, United Kingdom
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Kris Knott
- Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
| | - Jessica Artico
- Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College, London, United Kingdom
| | - Hibba Kurdi
- Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
| | - Souhad Yousef
- Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
| | | | - Yousuf Razvi
- Royal Free London NHS Foundation Trust, London, United Kingdom
- Division of Medicine, National Amyloidosis Center, University College, London, United Kingdom
| | - Liza Chacko
- Royal Free London NHS Foundation Trust, London, United Kingdom
- Division of Medicine, National Amyloidosis Center, University College, London, United Kingdom
| | - James Brown
- Royal Free London NHS Foundation Trust, London, United Kingdom
- Division of Medicine, National Amyloidosis Center, University College, London, United Kingdom
| | - Rishi Patel
- Royal Free London NHS Foundation Trust, London, United Kingdom
- Division of Medicine, National Amyloidosis Center, University College, London, United Kingdom
| | - Kavitha Vimalesvaran
- Imperial College Healthcare NHS Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Andreas Seraphim
- Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College, London, United Kingdom
| | - Rhodri Davies
- Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College, London, United Kingdom
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, MD, United States
| | - Tushar Kotecha
- Institute of Cardiovascular Science, University College, London, United Kingdom
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Robert Bell
- Department of Cardiology, University College London Hospitals NHS Trust, London, United Kingdom
| | - Charlotte Manisty
- Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College, London, United Kingdom
| | - Graham D. Cole
- Imperial College Healthcare NHS Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - James C. Moon
- Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College, London, United Kingdom
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, MD, United States
| | - Marianna Fontana
- Royal Free London NHS Foundation Trust, London, United Kingdom
- Division of Medicine, National Amyloidosis Center, University College, London, United Kingdom
| | - Thomas A. Treibel
- Barts Heart Center, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College, London, United Kingdom
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18
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Touyz RM, Boyd MO, Guzik T, Padmanabhan S, McCallum L, Delles C, Mark PB, Petrie JR, Rios F, Montezano AC, Sykes R, Berry C. Cardiovascular and Renal Risk Factors and Complications Associated With COVID-19. CJC Open 2021; 3:1257-1272. [PMID: 34151246 PMCID: PMC8205551 DOI: 10.1016/j.cjco.2021.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/28/2021] [Indexed: 01/08/2023] Open
Abstract
The current COVID-19 pandemic, caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus, represents the largest medical challenge in decades. It has exposed unexpected cardiovascular vulnerabilities at all stages of the disease (pre-infection, acute phase, and subsequent chronic phase). The major cardiometabolic drivers identified as having epidemiologic and mechanistic associations with COVID-19 are abnormal adiposity, dysglycemia, dyslipidemia, and hypertension. Hypertension is of particular interest, because components of the renin-angiotensin system (RAS), which are critically involved in the pathophysiology of hypertension, are also implicated in COVID-19. Specifically, angiotensin-converting enzyme-2 (ACE2), a multifunctional protein of the RAS, which is part of the protective axis of the RAS, is also the receptor through which SARS-CoV-2 enters host cells, causing viral infection. Cardiovascular and cardiometabolic comorbidities not only predispose people to COVID-19, but also are complications of SARS-CoV-2 infection. In addition, increasing evidence indicates that acute kidney injury is common in COVID-19, occurs early and in temporal association with respiratory failure, and is associated with poor prognosis, especially in the presence of cardiovascular risk factors. Here, we discuss cardiovascular and kidney disease in the context of COVID-19 and provide recent advances on putative pathophysiological mechanisms linking cardiovascular disease and COVID-19, focusing on the RAS and ACE2, as well as the immune system and inflammation. We provide up-to-date information on the relationships among hypertension, diabetes, and COVID-19 and emphasize the major cardiovascular diseases associated with COVID-19. We also briefly discuss emerging cardiovascular complications associated with long COVID-19, notably postural tachycardia syndrome (POTS).
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Affiliation(s)
- Rhian M. Touyz
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Marcus O.E. Boyd
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Tomasz Guzik
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Linsay McCallum
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Patrick B. Mark
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - John R. Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Francisco Rios
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Augusto C. Montezano
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Robert Sykes
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
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19
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Affiliation(s)
- Robert Sykes
- West of Scotland Heart and Lung Centre, Beardmore Street, Clydebank, G81 4HX, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126, University Place, Glasgow G12 8TA, UK
| | - Andrew Morrow
- West of Scotland Heart and Lung Centre, Beardmore Street, Clydebank, G81 4HX, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126, University Place, Glasgow G12 8TA, UK
| | - Kenneth Mangion
- West of Scotland Heart and Lung Centre, Beardmore Street, Clydebank, G81 4HX, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126, University Place, Glasgow G12 8TA, UK.,Department of Cardiology, Queen Elizabeth University Hospital, 1345 Govan Rd,, Glasgow G51 4TF, UK
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20
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Affiliation(s)
- Tushar Kotecha
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, London WC1e 6DD, UK
| | - Daniel S Knight
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, London WC1e 6DD, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London WC1e 6DD, UK
- Department of Cardiovascular Magnetic Resonance, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Graham D Cole
- Department of Cardiology, Imperial Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Marianna Fontana
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- National Amyloidosis Centre, Division of Medicine, University College London, Rowland Hill Street, London NW3 2PF, UK
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21
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Gorecka M, McCann GP, Berry C, Ferreira VM, Moon JC, Miller CA, Chiribiri A, Prasad S, Dweck MR, Bucciarelli-Ducci C, Dawson D, Fontana M, Macfarlane PW, McConnachie A, Neubauer S, Greenwood JP. Demographic, multi-morbidity and genetic impact on myocardial involvement and its recovery from COVID-19: protocol design of COVID-HEART-a UK, multicentre, observational study. J Cardiovasc Magn Reson 2021; 23:77. [PMID: 34112195 PMCID: PMC8190746 DOI: 10.1186/s12968-021-00752-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although coronavirus disease 2019 (COVID-19) is primarily a respiratory illness, myocardial injury is increasingly reported and associated with adverse outcomes. However, the pathophysiology, extent of myocardial injury and clinical significance remains unclear. METHODS COVID-HEART is a UK, multicentre, prospective, observational, longitudinal cohort study of patients with confirmed COVID-19 and elevated troponin (sex-specific > 99th centile). Baseline assessment will be whilst recovering in-hospital or recently discharged, and include cardiovascular magnetic resonance (CMR) imaging, quality of life (QoL) assessments, electrocardiogram (ECG), serum biomarkers and genetics. Assessment at 6-months includes repeat CMR, QoL assessments and 6-min walk test (6MWT). The CMR protocol includes cine imaging, T1/T2 mapping, aortic distensibility, late gadolinium enhancement (LGE), and adenosine stress myocardial perfusion imaging in selected patients. The main objectives of the study are to: (1) characterise the extent and nature of myocardial involvement in COVID-19 patients with an elevated troponin, (2) assess how cardiac involvement and clinical outcome associate with recognised risk factors for mortality (age, sex, ethnicity and comorbidities) and genetic factors, (3) evaluate if differences in myocardial recovery at 6 months are dependent on demographics, genetics and comorbidities, (4) understand the impact of recovery status at 6 months on patient-reported QoL and functional capacity. DISCUSSION COVID-HEART will provide detailed characterisation of cardiac involvement, and its repair and recovery in relation to comorbidity, genetics, patient-reported QoL measures and functional capacity. CLINICAL TRIAL REGISTRATION ISRCTN 58667920. Registered 04 August 2020.
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Affiliation(s)
- Miroslawa Gorecka
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Gerry P. McCann
- University of Leicester and The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Vanessa M. Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - James C. Moon
- Institute of Cardiovascular Science, University College London, London, UK
| | - Christopher A. Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, BHF Centre of Excellence and the NIHR Biomedical Research Centre at Guy’s and St. Thomas’ NHS Foundation Trust, The Rayne Institute, St. Thomas’ Hospital, London, UK
| | - Sanjay Prasad
- National Heart and Lung Institute, Imperial College, London, UK
| | - Marc R. Dweck
- University of Edinburgh and British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Research Centre, University of Bristol and University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - Dana Dawson
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, UK
| | - Marianna Fontana
- Division of Medicine, Royal Free Hospital, University College London, London, UK
| | - Peter W. Macfarlane
- Electrocardiology Core Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - John P. Greenwood
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
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22
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Berry C, Mangion K. Cardiovascular Complications Are Uncommon in Healthcare Workers With Mild or Asymptomatic COVID-19 Infection. JACC Cardiovasc Imaging 2021; 14:2167-2169. [PMID: 34119431 PMCID: PMC8105427 DOI: 10.1016/j.jcmg.2021.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; The West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland.
| | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; The West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland
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23
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Getting to the Heart of the Matter: Myocardial Injury, Coagulopathy, and Other Potential Cardiovascular Implications of COVID-19. Int J Vasc Med 2021; 2021:6693895. [PMID: 34035963 PMCID: PMC8118745 DOI: 10.1155/2021/6693895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 was primarily identified as a respiratory illness, but reports of patients presenting initially with cardiovascular complaints are rapidly emerging. Many patients also develop cardiovascular complications during and after COVID-19 infection. Underlying cardiovascular disease increases the severity of COVID-19 infection; however, it is unclear if COVID-19 increases the risk of or causes cardiovascular complications in patients without preexisting cardiovascular disease. The review is aimed at informing the primary care physicians of the potential cardiovascular complications, especially in patients without underlying cardiovascular disease. A comprehensive literature review was performed on cardiac and vascular complications of COVID-19. The primary cardiac and vascular complications include myocarditis, acute coronary syndrome, myocardial injury, arrhythmia, heart failure, shock, multisystem inflammatory syndrome, venous and arterial thrombotic events, stroke, and coagulopathy. A detailed analysis of the pathogenesis revealed six possible mechanisms: direct cardiac damage, hypoxia-induced injury, inflammation, a dysfunctional endothelial response, coagulopathy, and the catecholamine stress response. Autopsy reports from studies show cardiomegaly, hypertrophy, ventricular dilation, infarction, and fibrosis. A wide range of cardiac and vascular complications should be considered when treating patients with confirmed or suspected COVID-19 infection. Elevated troponin and natriuretic peptides indicate an early cardiac involvement in COVID-19. Continuous monitoring of coagulation by measuring serum D-dimer can potentially prevent vascular complications. A long-term screening protocol to follow-up the patients in the primary care settings is needed to follow-up with the patients who recovered from COVID cardiovascular complications.
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24
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Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, Cook JR, Nordvig AS, Shalev D, Sehrawat TS, Ahluwalia N, Bikdeli B, Dietz D, Der-Nigoghossian C, Liyanage-Don N, Rosner GF, Bernstein EJ, Mohan S, Beckley AA, Seres DS, Choueiri TK, Uriel N, Ausiello JC, Accili D, Freedberg DE, Baldwin M, Schwartz A, Brodie D, Garcia CK, Elkind MSV, Connors JM, Bilezikian JP, Landry DW, Wan EY. Post-acute COVID-19 syndrome. Nat Med 2021; 27:601-615. [PMID: 33753937 PMCID: PMC8893149 DOI: 10.1038/s41591-021-01283-z] [Citation(s) in RCA: 2422] [Impact Index Per Article: 807.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 02/09/2021] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.
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Affiliation(s)
- Ani Nalbandian
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Kartik Sehgal
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Correspondence should be addressed to K.S. or E.Y.W. ;
| | - Aakriti Gupta
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Mahesh V. Madhavan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Claire McGroder
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Jacob S. Stevens
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Joshua R. Cook
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Anna S. Nordvig
- Department of Neurology, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Daniel Shalev
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York, New York, USA
| | - Tejasav S. Sehrawat
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Neha Ahluwalia
- Division of Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Behnood Bikdeli
- Harvard Medical School, Boston, Massachusetts, USA.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Donald Dietz
- Division of Infectious Diseases, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Caroline Der-Nigoghossian
- Clinical Pharmacy, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Nadia Liyanage-Don
- Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Gregg F. Rosner
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Elana J. Bernstein
- Division of Rheumatology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Akinpelumi A. Beckley
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - David S. Seres
- Institute of Human Nutrition and Division of Preventive Medicine and Nutrition, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Toni K. Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - John C. Ausiello
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Domenico Accili
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Daniel E. Freedberg
- Division of Digestive and Liver Diseases, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Matthew Baldwin
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Allan Schwartz
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Christine Kim Garcia
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jean M. Connors
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Hematology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - John P. Bilezikian
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Donald W. Landry
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Elaine Y. Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.,Correspondence should be addressed to K.S. or E.Y.W. ;
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25
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Briscoe M, Sykes R, Krystofiak T, Peck O, Mangion K, Berry C. Clinical significance of coronavirus disease 2019 in hospitalized patients with myocardial injury. Clin Cardiol 2021; 44:332-339. [PMID: 33501708 PMCID: PMC7943910 DOI: 10.1002/clc.23530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 12/15/2022] Open
Abstract
Background The clinical significance of Coronavirus disease 2019 (COVID‐19) as an associate of myocardial injury is controversial. Hypothesis Type 2 MI/Myocardial Injury are associated with worse outcomes if complicated by COVID‐19. Methods This longitudinal cohort study involved consecutive patients admitted to a large urban hospital. Myocardial injury was determined using laboratory records as ≥1 hs‐TnI result >99th percentile (male: >34 ng/L; female: >16 ng/L). Endotypes were defined according to the Fourth Universal Definition of Myocardial Infarction (MI) and COVID‐19 determined using PCR. Outcomes of patients with myocardial injury with and without COVID‐19 were assessed. Results Of 346 hospitalized patients with elevated hs‐TnI, 35 (10.1%) had laboratory‐confirmed COVID‐19 (median age [IQR]; 65 [59–74]; 64.8% male vs. COVID‐19 negative: 74 [63–83] years; 43.7% male). Cardiac endotypes by COVID‐19 status (yes vs. no) were: Type 1 MI (0 [0%] vs. 115 [100%]; p < .0005), Type 2 MI (13 [16.5%] vs. 66 [83.5%]; p = .045), and non‐ischemic myocardial injury (cardiac: 4 [5.8%] vs. 65 [94.2%]; p = .191, non‐cardiac:19 [22.9%] vs. 64 [77.%]; p < .0005). COVID‐19 patients had less comorbidity (median [IQR] Charlson Comorbidity Index: 3.0 [3.0] vs. 5.0 [4.0]; p = .001), similar hs‐TnI concentrations (median [IQR] initial: 46 [113] vs. 62 [138]; p = .199, peak: 122 [474] vs. 79 [220] ng/L; p = .564), longer admission (days) (median [IQR]: 14[19] vs. 6[12]; p = .001) and higher in‐hospital mortality (63.9% vs. 11.3%; OR = 13.2; 95%CI: 5.90, 29.7). Conclusions Cardiac sequelae of COVID‐19 typically manifest as Non‐cardiac myocardial injury/Type 2MI in younger patients with less co‐morbidity. Paradoxically, the admission duration and in‐hospital mortality are increased.
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Affiliation(s)
- Michael Briscoe
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Robert Sykes
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Thomas Krystofiak
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Oliver Peck
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Kenneth Mangion
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Colin Berry
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
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26
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Castelli V, Cimini A, Ferri C. Cytokine Storm in COVID-19: "When You Come Out of the Storm, You Won't Be the Same Person Who Walked in". Front Immunol 2020; 11:2132. [PMID: 32983172 PMCID: PMC7492381 DOI: 10.3389/fimmu.2020.02132] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023] Open
Abstract
In December 2019, a novel coronavirus, COVID-19, was discovered to be the causal agent of a severe respiratory infection named SARS-CoV-2, and it has since been recognized worldwide as a pandemic. There are still numerous doubts concerning its pathogenesis and particularly the underlying causes of the various clinical courses, ranging from severe manifestations to asymptomatic forms, including acute respiratory distress syndrome. The major factor responsible for acute respiratory distress syndrome is the so-called "cytokine storm," which is an aberrant response from the host immune system that induces an exaggerated release of proinflammatory cytokines/chemokines. In this review, we will discuss the role of cytokine storm in COVID-19 and potential treatments with which counteract this aberrant response, which may be valuable in the clinical translation.
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Affiliation(s)
- Vanessa Castelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
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