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Bilehjani E, Fakhari S, Farzin H, Tajlil A, Nader ND. Diagnosis and treatment of cardiovascular manifestations of COVID-19: a narrative review. Acta Cardiol 2024; 79:267-273. [PMID: 37606350 DOI: 10.1080/00015385.2023.2246200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was the main pathogen in the COVID-19 pandemic. This viral infection has been associated with several respiratory and non-respiratory complications contributing to a higher mortality rate, especially in patients with underlying heart diseases worldwide. Once considered a respiratory tract disease, it is now well-known that COVID-19 patients may experience a wide range of cardiac manifestations. Because of its remarkable direct and indirect effects on the cardiovascular system, herein, we examined the published literature that studied the hypothetical mechanisms of injury, manifestations, and diagnostic modalities, including changes in molecular biomarkers with a predictive value in the prognostication of the disease, as well as emerging evidence regarding the long-term cardiac complications of the disease.
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Affiliation(s)
- Eissa Bilehjani
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Solmaz Fakhari
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haleh Farzin
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arezou Tajlil
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Nader D Nader
- Departments of Anesthesiology and Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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2
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Tangos M, Jarkas M, Akin I, El-Battrawy I, Hamdani N. Cardiac damage and tropism of severe acute respiratory syndrome coronavirus 2. Curr Opin Microbiol 2024; 78:102437. [PMID: 38394964 DOI: 10.1016/j.mib.2024.102437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Until now, the World Health Organization registered over 771 million cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection worldwide, of which 6.97 million resulted in death. Virus-related cardiovascular events and pre-existing heart problems have been identified as major contributing factors to global infection-related morbidity and mortality, emphasizing the necessity for risk assessment and future prevention. In this review, we highlight cardiac manifestations that might arise from an infection with SARS-CoV-2 and provide an overview of known comorbidities that worsen the outcome. Additionally, we aim to summarize the therapeutic strategies proposed to reverse virus-associated myocardial damage, which will be further highlighted in this review, with an outlook to successful recovery and prevention.
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Affiliation(s)
- Melina Tangos
- Institute of Physiology, Department of Cellular and Translational Physiology, Medical Faculty, Ruhr University Bochum, Bochum, Germany; Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital of the Ruhr University Bochum, Bochum, Germany
| | - Muhammad Jarkas
- Institute of Physiology, Department of Cellular and Translational Physiology, Medical Faculty, Ruhr University Bochum, Bochum, Germany; Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital of the Ruhr University Bochum, Bochum, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany
| | - Ibrahim El-Battrawy
- Institute of Physiology, Department of Cellular and Translational Physiology, Medical Faculty, Ruhr University Bochum, Bochum, Germany; Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology and Angiology, Bergmannsheil University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Nazha Hamdani
- Institute of Physiology, Department of Cellular and Translational Physiology, Medical Faculty, Ruhr University Bochum, Bochum, Germany; Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital of the Ruhr University Bochum, Bochum, Germany; HCEMM-SU Cardiovascular Comorbidities Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1089 Budapest, Hungary; Department of Physiology, Cardiovascular Research Institute Maastricht University Maastricht, Maastricht, the Netherlands.
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3
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Mojón-Álvarez D, Giralt T, Carreras-Mora J, Calvo-Fernández A, Izquierdo A, Soler C, Cabero P, Pérez-Fernández S, Vaquerizo B, Ribas Barquet N. Baseline NT-proBNP levels as a predictor of short-and long-term prognosis in COVID-19 patients: a prospective observational study. BMC Infect Dis 2024; 24:58. [PMID: 38191350 PMCID: PMC10773093 DOI: 10.1186/s12879-024-08980-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Up to 20% of COVID-19 patients can suffer COVID-19-related myocardial injury. Elevated cardiac biomarkers, such as hs-cTnT and NT-proBNP, have been related to worse short-term prognosis. However, data on NT-proBNP and long-term prognosis are scarce. We have evaluated the potential association of baseline age-adjusted NT-proBNP levels and outcomes at one-year follow-up in COVID-19 patients. METHODS This was a single-center prospective study of 499 COVID-19 patients in whom NT-proBNP was assessed at hospital admission. NT-proBNP levels were age-adjusted and patients were classified as high or low NT-proBNP. Clinical and demographic characteristics, comorbidities, laboratory results, and in-hospital complications and mortality were compared between the two groups. Survivors of the acute phase of COVID-19 were followed up for one year from admission to detect readmissions and mortality. RESULTS The 68 patients with high NT-proBNP levels at hospital admission were older, with more cardiovascular risk factors, cardiovascular disease, comorbidities, myocardial injury, and higher levels of inflammatory markers than patients with low NT-proBNP levels. They also had more in-hospital complications and a higher acute-phase mortality rate (60.3% vs. 10.2%, p < 0.001). High NT-proBNP levels were an independent marker of death during hospitalization (HR 1.95; CI 1.07-3.52). At one-year follow-up, high NT-proBNP levels were independently associated with mortality (HR 2.69; CI 1.47-4.89). Among survivors of the acute phase of COVID-19, there were no differences in hospital readmissions between those with high vs. low NT-proBNP levels, but survivors with high baseline NT-proBNP levels showed a higher 1-year mortality rate (7.4% vs. 1.3%, p = 0.018). CONCLUSIONS High age-adjusted NT-proBNP levels at the time of hospital admission for COVID-19 are associated with poor short and long-term prognosis. High NT-proBNP seems also to be related to worse prognosis in survivors of the acute phase of COVID-19. A closer follow-up on these patients may be crucial.
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Affiliation(s)
- Diana Mojón-Álvarez
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
| | - Teresa Giralt
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
| | - José Carreras-Mora
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
| | - Alicia Calvo-Fernández
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
| | - Andrea Izquierdo
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
| | - Cristina Soler
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
| | - Paula Cabero
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
| | - Silvia Pérez-Fernández
- Scientific Coordination Facility, Biocruces Bizkaia Health Research Institute, Barakaldo, 48903, Spain
| | - Beatriz Vaquerizo
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
- Heart Disease Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, 08003, Spain
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, 28029, Spain
| | - Núria Ribas Barquet
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain.
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain.
- Heart Disease Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, 08003, Spain.
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4
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Bhatt AS, Kosiborod MN, Claggett BL, Miao ZM, Vaduganathan M, Lam CSP, Hernandez AF, Martinez FA, Inzucchi SE, Shah SJ, de Boer RA, Jhund PS, Desai AS, Fang JC, Han Y, Comin-Colet J, Drożdż J, Vardeny O, Merkely B, Lindholm D, Peterson M, Langkilde AM, McMurray JJV, Solomon SD. Impact of COVID-19 in patients with heart failure with mildly reduced or preserved ejection fraction enrolled in the DELIVER trial. Eur J Heart Fail 2023; 25:2177-2188. [PMID: 37771274 DOI: 10.1002/ejhf.3043] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023] Open
Abstract
AIM COVID-19 may affect clinical risk in patients with heart failure. DELIVER began before and was conducted during the COVID-19 pandemic. This study aimed to evaluate the association between COVID-19 and clinical outcomes among DELIVER participants. METHODS AND RESULTS Participants with chronic heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) were randomized to dapagliflozin or placebo across 350 sites in 20 countries. COVID-19 was investigator-reported and the contribution of COVID-19 to death was centrally adjudicated. We assessed (i) the incidence of COVID-19, (ii) event rates before/during the pandemic, and (iii) risks of death after COVID-19 diagnosis compared to risks of death in participants without COVID-19. Further, we performed a sensitivity analysis assessing treatment effects of dapagliflozin vs. placebo censored at pandemic onset. Of 6263 participants, 589 (9.4%) developed COVID-19, of whom 307 (52%) required/prolonged hospitalization. A total of 155 deaths (15% of all deaths) were adjudicated as definitely/possibly COVID-19-related. COVID-19 cases and deaths did not differ by randomized assignment. Death rate in the 12 months following diagnosis was 56.1 (95% confidence interval [CI] 48.0-65.6) versus 6.4 (95% CI 6.0-6.8)/100 participant-years among trial participants with versus without COVID-19 (adjusted hazard ratio [aHR] 8.60, 95% CI 7.18-10.30). Risk was highest 0-3 months following diagnosis (153.5, 95% CI 130.3-180.8) and remained elevated at 3-6 months (12.6, 95% CI 6.6-24.3/100 participant-years). After excluding investigator-reported fatal COVID-19 events, all-cause death rates in the 12 months following diagnosis among COVID-19 survivors (n = 458) remained higher (aHR 2.46, 95% CI 1.83-3.33) than rates for all trial participants from randomization, with censoring of participants who developed COVID-19 at the time of diagnosis. Dapagliflozin reduced cardiovascular death/worsening HF events when censoring participants at COVID-19 diagnosis (HR 0.81, 95% CI 0.72-0.91) and pandemic onset (HR 0.72, 95% CI 0.58-0.89). There were no diabetic ketoacidosis or major hypoglycaemic events within 30 days of COVID-19. CONCLUSION DELIVER is one of the most extensive experiences with COVID-19 of any cardiovascular trial, with >75% of follow-up time occurring during the pandemic. COVID-19 was common, with >50% of cases leading to hospitalization or death. Treatment benefits of dapagliflozin persisted when censoring at COVID-19 diagnosis and pandemic onset. Patients surviving COVID-19 had a high early residual risk. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03619213.
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Affiliation(s)
- Ankeet S Bhatt
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zi Michael Miao
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore, Singapore
| | | | | | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rudolf A de Boer
- Erasmus Medical Center Department of Cardiology, Rotterdam, The Netherlands
| | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James C Fang
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Yaling Han
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Josep Comin-Colet
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, MN, USA
| | | | - Daniel Lindholm
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, Gothenburg, Sweden
| | - Magnus Peterson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, Gothenburg, Sweden
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, Gothenburg, Sweden
| | - John J V McMurray
- BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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5
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LaRocca G, Skorton DJ. Cardiovascular Complications and Imaging in the Era of the COVID-19 Pandemic 2020 to Present. Curr Probl Cardiol 2023; 48:101937. [PMID: 37422041 DOI: 10.1016/j.cpcardiol.2023.101937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/10/2023]
Abstract
The COVID-19 pandemic has impacted the world that was not previously conceivable. In early 2020, hospitals on all continents were overwhelmed with patients afflicted with this novel virus, with unanticipated mortality worldwide. The virus has had a deleterious effect, particularly the respiratory and cardiovascular systems. Cardiovascular biomarkers demonstrated an array of cardiovascular insults from hypoxia to inflammatory and perfusion abnormalities of the myocardium to life-threatening arrhythmias and heart failure. Patients were at increased risk of a pro-thrombotic state early in the course of the disease. Cardiovascular imaging became a primary tool in diagnosing, prognosing and risk-stratifying patients. Transthoracic echocardiography became the initial imaging modality in management of cardiovascular implications. In addition to cardiac function, LV longitudinal strain (LVLS) and right ventricular free wall strain (RVFWS) were indicators of increased morbidly and mortality. Cardiac MRI has become the diagnostic cardiovascular imaging for myocardial injury and tissue evaluation in the age of COVID-19.
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Affiliation(s)
- Gina LaRocca
- Mount Sinai / Icahn School of Medicine, New York, NY.
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Olszanecka A, Wojciechowska W, Bednarek A, Kusak P, Wizner B, Terlecki M, Stolarz-Skrzypek K, Klocek M, Drożdż T, Sładek K, Bociąga-Jasik M, Garlicki A, Rewiuk K, Matyja A, Małecki M, Sydor W, Krzanowski M, Grodzicki T, Rajzer M. Serial echocardiographic evaluation of COVID-19 patients without prior history of structural heart disease: a 1-year follow-up CRACoV-HHS study. Front Cardiovasc Med 2023; 10:1230669. [PMID: 37781311 PMCID: PMC10533911 DOI: 10.3389/fcvm.2023.1230669] [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: 05/29/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background It is a well-known fact that COVID-19 affects the cardiovascular system by exacerbating heart failure in patients with preexisting conditions. However, there is a poor insight into the cardiovascular involvement and sequelae in patients without preexisting conditions. The aim of the study is to analyse the influence of COVID-19 on cardiac performance in patients without prior history of structural heart disease. The study is part of the CRACoV project, which includes a prospective design and a 12-month follow-up period. Material and methods The study included 229 patients hospitalised with a diagnosis of COVID-19 (median age of 59 years, 81 were women). A standard clinical assessment and laboratory tests were performed in all participants. An extended echocardiographic image acquisition was performed at baseline and at a 3-, 6-, and 12-month follow-up. All analyses were performed off-line. A series of echocardiographic parameters was compared using repeated measures or Friedman analysis of variance. Results In all subjects, the left ventricular (LV) ejection fraction at baseline was preserved [63.0%; Q1:Q3 (60.0-66.0)]. Elevated levels of high-sensitivity cardiac troponin T were detected in 21.3% of the patients, and elevated NT-proBNP levels were detected in 55.8%. At the 1-year follow-up, no significant changes were observed in the LV diameter and volume (LV 48.0 ± 5.2 vs. 47.8 ± 4.8 mm, p = 0.08), while a significant improvement of the parameters in the biventricular strain was observed (LV -19.1 ± 3.3% vs. -19.7 ± 2.5%, p = 0.01, and right ventricular -19.9 ± 4.5% vs. -23.2 ± 4.9%, p = 0.002). In addition, a decrease in the LV wall thickness was also observed (interventricular septum 10.4 ± 1.6 vs. 9.7 ± 2.0 mm, p < 0.001; LV posterior wall 9.8 ± 1.4 vs. 9.1 ± 1.5 mm, p < 0.001). Conclusions In an acute phase of COVID-19, the elevation of cardiac biomarkers in patients with normal left ventricular ejection fraction is a frequent occurrence; however, it does not translate into clinically significant cardiac dysfunction after 1 year. The serial echocardiographic evaluations conducted in patients without preexisting structural heart disease demonstrate an overall trend towards an improved cardiac function and a reduced myocardial thickening at 1-year follow-up. This suggests that the acute cardiac consequences of COVID-19 are associated with systemic inflammation and haemodynamic stress in patients without preexisting conditions.
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Affiliation(s)
- Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
| | - Wiktoria Wojciechowska
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
| | | | - Piotr Kusak
- University Hospital in Kraków, Kraków, Poland
| | - Barbara Wizner
- University Hospital in Kraków, Kraków, Poland
- Department of Internal Diseases and Geriatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Terlecki
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
| | - Katarzyna Stolarz-Skrzypek
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
| | - Marek Klocek
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
| | - Tomasz Drożdż
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
| | - Krzysztof Sładek
- University Hospital in Kraków, Kraków, Poland
- Department of Pulmonology and Allergology, Jagiellonian University Medical College, Kraków, Poland
| | - Monika Bociąga-Jasik
- University Hospital in Kraków, Kraków, Poland
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksander Garlicki
- University Hospital in Kraków, Kraków, Poland
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Rewiuk
- University Hospital in Kraków, Kraków, Poland
- Department of Internal Diseases and Geriatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Matyja
- University Hospital in Kraków, Kraków, Poland
- Department of General, Oncological, Metabolic, and Emergency Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Małecki
- University Hospital in Kraków, Kraków, Poland
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech Sydor
- University Hospital in Kraków, Kraków, Poland
- Center for InnovativeTherapies, Clinical Research Coordination Center, University Hospital in Kraków, Kraków, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Krzanowski
- University Hospital in Kraków, Kraków, Poland
- Department of Nephrology and Dialysis, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Grodzicki
- University Hospital in Kraków, Kraków, Poland
- Department of Internal Diseases and Geriatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Kraków, Kraków, Poland
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7
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Pinesi HT, Giugni FR, Matuck BRS, Pitta FG, Garzillo CL, Lima EG, Kalil Filho R, Serrano Junior CV. Coronavirus disease-2019 and heart: assessment of troponin and cardiovascular comorbidities as prognostic markers in patients hospitalized with coronavirus disease-2019 in a tertiary center in Brazil. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230350. [PMID: 37466607 DOI: 10.1590/1806-9282.20230350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Our study aimed to evaluate the correlation of cardiac troponin T levels with comorbidities and in-hospital outcomes in patients with coronavirus disease-2019 in Brazil. METHODS Data from a cohort of 3,596 patients who were admitted with suspected coronavirus disease-2019 in a Brazilian tertiary center, between March and August 2020, were reviewed. A total of 2,441 (68%) patients had cardiac troponin T determined in the first 72 h of admission and were stratified into two groups: elevated cardiac troponin T (cardiac troponin T >0.014 ng/mL) and normal cardiac troponin T. Associations between troponin, comorbidities, biomarkers, and outcomes were assessed. Regression models were built to assess the association of several variables with in-hospital mortality. RESULTS A total of 2,441 patients were embraced, of which 924 (38%) had normal cardiac troponin T and 1,517 (62%) had elevated cardiac troponin T. Patients with elevated cardiac troponin T were older and had more comorbidities, such as cardiovascular disease, hypertension, diabetes, arrhythmia, renal dysfunction, liver disease, stroke, cancer, and dementia. Patients with abnormal cardiac troponin T also had more altered laboratory parameters on admission (i.e., leukocytes, C-reactive protein, D-dimer, and B-type natriuretic peptide), as well as more need for intensive care unit, vasoactive drugs, mechanical ventilation, dialysis, and blood transfusion. All-cause mortality was markedly higher among patients with increased cardiac troponin T (42 vs. 16%, P<0.001). Multiple regression analysis demonstrated that in-hospital mortality was not independently associated with troponin elevation. CONCLUSION This study showed that cardiac troponin T elevation at admission was common and associated with several comorbidities, biomarkers, and clinical outcomes in patients hospitalized with coronavirus disease-2019, but it was not an independent marker of in-hospital mortality.
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Affiliation(s)
| | | | | | - Fabio Grusnpun Pitta
- Universidade de São Paulo, Instituto do Coracao, Faculdade de Medicina - São Paulo (SP), Brazil
| | - Cibele Larrosa Garzillo
- Universidade de São Paulo, Instituto do Coracao, Faculdade de Medicina - São Paulo (SP), Brazil
| | - Eduardo Gomes Lima
- Universidade de São Paulo, Instituto do Coracao, Faculdade de Medicina - São Paulo (SP), Brazil
| | - Roberto Kalil Filho
- Universidade de São Paulo, Instituto do Coracao, Faculdade de Medicina - São Paulo (SP), Brazil
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8
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Bojti I, Przewosnik AS, Luxenburger H, Hofmann M, Neumann-Haefelin C, Esser JS, Siegel PM, Maier A, Kovacs SB, Kardos L, Csanádi Z, Rieder M, Duerschmied D, Lother A, Bode C, Szabó GT, Czuriga D. Decreased level of serum NT-proCNP associates with disease severity in COVID-19. Respir Res 2023; 24:174. [PMID: 37386635 PMCID: PMC10311835 DOI: 10.1186/s12931-023-02469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND C-type natriuretic peptide (CNP) is an endothelium-derived paracrine molecule with an important role in vascular homeostasis. In septic patients, the serum level of the amino-terminal propeptide of CNP (NT-proCNP) shows a strong positive correlation with inflammatory biomarkers and, if elevated, correlates with disease severity and indicates a poor outcome. It is not yet known whether NT-proCNP also correlates with the clinical outcome of patients suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In the current study, we aimed to determine possible changes in the NT-proCNP levels of patients with coronavirus disease 2019 (COVID-19), with special regard to disease severity and outcome. METHODS In this retrospective analysis, we determined the serum level of NT-proCNP in hospitalized patients with symptoms of upper respiratory tract infection, using their blood samples taken on admission, stored in a biobank. The NT-proCNP levels of 32 SARS-CoV-2 positive and 35 SARS-CoV-2 negative patients were measured to investigate possible correlation with disease outcome. SARS-CoV-2 positive patients were then divided into two groups based on their need for intensive care unit treatment (severe and mild COVID-19). RESULTS The NT-proCNP was significantly different in the study groups (e.g. severe and mild COVID-19 and non-COVID-19 patients), but showed inverse changes compared to previous observations in septic patients: lowest levels were detected in critically ill COVID-19 patients, while highest levels in the non-COVID-19 group. A low level of NT-proCNP on admission was significantly associated with severe disease outcome. CONCLUSIONS Low-level NT-proCNP on hospital admission is associated with a severe COVID-19 disease course. The pathomechanism underlying this observation remains to be elucidated, while future studies in larger patient cohorts are necessary to confirm these observations and reveal therapeutic importance. Trial registration DRKS00026655 Registered 26. November 2021.
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Affiliation(s)
- Istvan Bojti
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Anne-Sophie Przewosnik
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hendrik Luxenburger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- IMM-PACT, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maike Hofmann
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jennifer S Esser
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Patrick M Siegel
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Maier
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sarolta Bojtine Kovacs
- IMM-PACT, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Section of Molecular Hematology, Department of Medicine I, Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Laszlo Kardos
- Clinical Department of Infectious Diseases, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Zoltan Csanádi
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marina Rieder
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Achim Lother
- Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Interdisciplinary Medical Intensive Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabor Tamas Szabó
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Daniel Czuriga
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Bhatt AS, Daniels LB, de Lemos J, Goodrich E, Bohula EA, Morrow DA. Multi-marker risk assessment in patients hospitalized with COVID-19: Results from the American Heart Association COVID-19 Cardiovascular Disease Registry. Am Heart J 2023; 258:149-156. [PMID: 36669711 PMCID: PMC9846881 DOI: 10.1016/j.ahj.2022.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND The pathobiology of inflammation, thrombosis, and myocardial injury associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) may be assessed by circulating biomarkers. However, their relative prognostic importance has been incompletely described. METHODS We analyzed data from patients hospitalized with COVID-19 from January 2020, to April 2021, at 122 US hospitals in the American Heart Association (AHA) COVID-19 cardiovascular (CV) disease registry. Patients with data for D-dimer, C-reactive protein (CRP), ferritin, natriuretic peptides [NP], or cardiac troponin (cTn) at admission were included. cTn quintiles were indexed to the assay-specific 99th percentile reference limits. Using multivariable logistic regression, we assessed the association between each biomarker by quintile [Q] and odds of in-hospital death and a cardiovascular and thrombotic composite outcome. RESULTS Of 32,636 registry patients, 26,424 (81%) had admission values for ≥1 of the key biomarkers, of which 4,527 (17%) had admission values for all 5 biomarkers. Each biomarker revealed a significant gradient for in-hospital mortality from Q1 to Q5: D-dimer 14% to 35%, CRP 11%-32%, ferritin 11% to 30%, cTn 13% to 43%, and NPs 7% to 35% (Ptrend for each <.001). After adjustment for other biomarkers and clinical variables, Q5 for NPs (OR:4.67, 95% CI: 3.05-7.14) retained the greatest relative odds for death; cTn (OR:2.68, 95% CI: 2.00-3.59) and NPs (OR:7.14, 95% CI: 4.92-10.37) were associated with the greatest odds of the CV composite. Q5 for D-dimer was associated with the highest risk of thrombotic events (OR: 9.02, 95% CI: 5.36-15.18). CONCLUSIONS Among patients hospitalized with COVID-19, cTn and NPs identified patients at high risk for an in-hospital adverse cardiovascular outcome, while elevations in D-dimer identified patients at risk for thrombotic complications.
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Affiliation(s)
- Ankeet S Bhatt
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA.
| | - Lori B Daniels
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, CA
| | - James de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX
| | - Erica Goodrich
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Erin A Bohula
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - David A Morrow
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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10
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Cavallazzi R, Bradley J, Chandler T, Furmanek S, Ramirez JA. Severity of Illness Scores and Biomarkers for Prognosis of Patients with Coronavirus Disease 2019. Semin Respir Crit Care Med 2023; 44:75-90. [PMID: 36646087 DOI: 10.1055/s-0042-1759567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The spectrum of disease severity and the insidiousness of clinical presentation make it difficult to recognize patients with coronavirus disease 2019 (COVID-19) at higher risk of worse outcomes or death when they are seen in the early phases of the disease. There are now well-established risk factors for worse outcomes in patients with COVID-19. These should be factored in when assessing the prognosis of these patients. However, a more precise prognostic assessment in an individual patient may warrant the use of predictive tools. In this manuscript, we conduct a literature review on the severity of illness scores and biomarkers for the prognosis of patients with COVID-19. Several COVID-19-specific scores have been developed since the onset of the pandemic. Some of them are promising and can be integrated into the assessment of these patients. We also found that the well-known pneumonia severity index (PSI) and CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) are good predictors of mortality in hospitalized patients with COVID-19. While neither the PSI nor the CURB-65 should be used for the triage of outpatient versus inpatient treatment, they can be integrated by a clinician into the assessment of disease severity and can be used in epidemiological studies to determine the severity of illness in patient populations. Biomarkers also provide valuable prognostic information and, importantly, may depict the main physiological derangements in severe disease. We, however, do not advocate the isolated use of severity of illness scores or biomarkers for decision-making in an individual patient. Instead, we suggest the use of these tools on a case-by-case basis with the goal of enhancing clinician judgment.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Norton Healthcare, Louisville, Kentucky
| | - James Bradley
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Norton Healthcare, Louisville, Kentucky
| | - Thomas Chandler
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
| | - Stephen Furmanek
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
| | - Julio A Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
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Turégano-Yedro M, Ruiz-García A, Castillo-Moraga M, Jiménez-Baena E, Barrios V, Serrano-Cumplido A, Pallarés-Carratalá V. Los péptidos natriuréticos en el diagnóstico de la insuficiencia cardíaca en atención primaria. Semergen 2022; 48:101812. [DOI: 10.1016/j.semerg.2022.101812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/29/2022] [Accepted: 06/06/2022] [Indexed: 10/14/2022]
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12
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Villacorta H, Ávila DXD, Souza TPD, Souza ALCD, Meyas GA, Santos MCV, Mendonça JDC, Costa LMMD, Sousa BDP, Oliveira MVBD, Guimarães JCC, Melo U. The Impact of Cardiovascular Risk Factors and Renal Disease on Outcomes in Patients Hospitalized with COVID-19: An Observational Study from Two Public Hospitals in Brazil. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20220041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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13
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Biomarkers Predictive for In-Hospital Mortality in Patients with Diabetes Mellitus and Prediabetes Hospitalized for COVID-19 in Austria: An Analysis of COVID-19 in Diabetes Registry. Viruses 2022; 14:v14061285. [PMID: 35746755 PMCID: PMC9229324 DOI: 10.3390/v14061285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background: This study assessed the predictive performance of inflammatory, hepatic, coagulation, and cardiac biomarkers in patients with prediabetes and diabetes mellitus hospitalized for COVID-19 in Austria. Methods: This was an analysis of a multicenter cohort study of 747 patients with diabetes mellitus or prediabetes hospitalized for COVID-19 in 11 hospitals in Austria. The primary outcome of this study was in-hospital mortality. The predictor variables included demographic characteristics, clinical parameters, comorbidities, use of medication, disease severity, and laboratory measurements of biomarkers. The association between biomarkers and in-hospital mortality was assessed using simple and multiple logistic regression analyses. The predictive performance of biomarkers was assessed using discrimination and calibration. Results: In our analysis, 70.8% had type 2 diabetes mellitus, 5.8% had type 1 diabetes mellitus, 14.9% had prediabetes, and 8.6% had other types of diabetes mellitus. The mean age was 70.3 ± 13.3 years, and 69.3% of patients were men. A total of 19.0% of patients died in the hospital. In multiple logistic regression analysis, LDH, CRP, IL-6, PCT, AST-ALT ratio, NT-proBNP, and Troponin T were significantly associated with in-hospital mortality. The discrimination of NT-proBNP was 74%, and that of Troponin T was 81%. The calibration of NT-proBNP was adequate (p = 0.302), while it was inadequate for Troponin T (p = 0.010). Conclusion: Troponin T showed excellent predictive performance, while NT-proBNP showed good predictive performance for assessing in-hospital mortality in patients with diabetes mellitus hospitalized with COVID-19. Therefore, these cardiac biomarkers may be used for prognostication of COVID-19 patients.
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14
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Inflammatory and Cardiac Biomarkers in Relation with Post-Acute COVID-19 and Mortality: What We Know after Successive Pandemic Waves. Diagnostics (Basel) 2022; 12:diagnostics12061373. [PMID: 35741183 PMCID: PMC9222082 DOI: 10.3390/diagnostics12061373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 12/19/2022] Open
Abstract
Background: Biomarkers were correlated with mortality in critically ill COVID-19 patients. No prediction tools exist for noncritically ill COVID-19 patients. We aimed to compare the independent prognostic value of inflammation and cardiac biomarkers for post-acute COVID-19 patients and the 30-day mortality rate in noncritically ill COVID-19 patients, as well as the relation with the virus variant involved. Methods: This observational cohort study was conducted at an emergency clinical hospital between 1 October 2020 and 31 December 2021. We included consecutive patients with biomarkers determined within 24 h of presentation, followed up at least 30 days postdischarge. Results: Post-acute COVID-19 was diagnosed in 20.3% of the cases and the all-cause 30-day mortality rate was 35.1% among 978 patients infected with variants of concern. Neutrophil-to-lymphocyte ratio (1.06 [95%CI, 1.01–1.11], p = 0.015) and NT-pro BNP were correlated with 30-daymortality, while the monocyte-to-lymphocyte ratio (2.77 [95%CI, 1.10–6.94], p = 0.03) and NT-pro BNP (1.68 [95%CI, 1.00–2.84], p = 0.05) were correlated with post-acute COVID-19. High-sensitivity to troponin was associated with 30-day mortality (1.55 [95%CI, 1.00–2.42], p = 0.05). A Cox proportional-hazards model confirmed that NT-pro BNP was independently associated with mortality. NT-pro BNP remained independently associated with 30-day mortality during follow-up (1.29 [95%CI, 1.07–1.56], p = 0.007) after adjustment for confounders. Conclusion: Inflammation and cardiac biomarkers, determined upon admission and predischarge, in a cohort of hospitalized noncritically ill COVID-19 patients throughout successive pandemic waves, showed a predictive value for post-acute COVID-19 and 30-day mortality.
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15
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A randomized controlled trial of renin-angiotensin-aldosterone system inhibitor management in patients admitted in hospital with COVID-19. Am Heart J 2022; 247:76-89. [PMID: 35143744 PMCID: PMC8820148 DOI: 10.1016/j.ahj.2022.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 02/06/2023]
Abstract
Background Renin-angiotensin aldosterone system inhibitors (RAASi) are commonly used among patients hospitalized with a severe acute respiratory syndrome coronavirus 2 infection coronavirus disease 2019 (COVID-19). We evaluated whether continuation versus discontinuation of RAASi were associated with short term clinical or biochemical outcomes. Methods The RAAS-COVID-19 trial was a randomized, open label study in adult patients previously treated with RAASi who are hospitalized with COVID-19 (NCT04508985). Participants were randomized 1:1 to discontinue or continue RAASi. The primary outcome was a global rank score calculated from baseline to day 7 (or discharge) incorporating clinical events and biomarker changes. Global rank scores were compared between groups using the Wilcoxon test statistic and the negative binomial test (using incident rate ratio [IRR]) and the intention-to-treat principle. Results Overall, 46 participants were enrolled; 21 participants were randomized to discontinue RAASi and 25 to continue. Patients’ mean age was 71.5 years and 43.5% were female. Discontinuation of RAASi, versus continuation, resulted in a non-statistically different mean global rank score (discontinuation 6 [standard deviation [SD] 6.3] vs continuation 3.8 (SD 2.5); P = .60). The negative binomial analysis identified that discontinuation increased the risk of adverse outcomes (IRR 1.67 [95% CI 1.06-2.62]; P = .027); RAASi discontinuation increased brain natriuretic peptide levels (% change from baseline: +16.7% vs -27.5%; P = .024) and the incidence of acute heart failure (33% vs 4.2%, P = .016). Conclusion RAASi continuation in participants hospitalized with COVID-19 appears safe; discontinuation increased brain natriuretic peptide levels and may increase risk of acute heart failure; where possible, RAASi should be continued.
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Biomarkers Associated with Cardiovascular Disease in COVID-19. Cells 2022; 11:cells11060922. [PMID: 35326373 PMCID: PMC8946710 DOI: 10.3390/cells11060922] [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: 01/25/2022] [Revised: 02/20/2022] [Accepted: 03/05/2022] [Indexed: 02/08/2023] Open
Abstract
Coronavirus disease-19 (COVID-19) emerged late December 2019 in the city of Wuhan, China and has since spread rapidly all over the world causing a global pandemic. While the respiratory system is the primary target of disease manifestation, COVID-19 has been shown to also affect several other organs, making it a rather complex, multi-system disease. As such, cardiovascular involvement has been a topic of discussion since the beginning of the COVID-19 pandemic, primarily due to early reports of excessive myocardial injury in these patients. Treating physicians are faced with multiple challenges in the management and early triage of patients with COVID-19, as disease severity is highly variable ranging from an asymptomatic infection to critical cases rapidly deteriorating to intensive care treatment or even fatality. Laboratory biomarkers provide important prognostic information which can guide decision making in the emergency department, especially in patients with atypical presentations. Several cardiac biomarkers, most notably high-sensitive cardiac troponin (hs-cTn) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), have emerged as valuable predictors of prognosis in patients with COVID-19. The purpose of this review was to offer a concise summary on prognostic cardiac biomarkers in COVID-19 and discuss whether routine measurements of these biomarkers are warranted upon hospital admission.
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Laino ME, Generali E, Tommasini T, Angelotti G, Aghemo A, Desai A, Morandini P, Stefanini GG, Lleo A, Voza A, Savevski V. An individualized algorithm to predict mortality in COVID-19 pneumonia: a machine learning based study. Arch Med Sci 2022; 18:587-595. [PMID: 35591841 PMCID: PMC9103632 DOI: 10.5114/aoms/144980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Identifying SARS-CoV-2 patients at higher risk of mortality is crucial in the management of a pandemic. Artificial intelligence techniques allow one to analyze large amounts of data to find hidden patterns. We aimed to develop and validate a mortality score at admission for COVID-19 based on high-level machine learning. MATERIAL AND METHODS We conducted a retrospective cohort study on hospitalized adult COVID-19 patients between March and December 2020. The primary outcome was in-hospital mortality. A machine learning approach based on vital parameters, laboratory values and demographic features was applied to develop different models. Then, a feature importance analysis was performed to reduce the number of variables included in the model, to develop a risk score with good overall performance, that was finally evaluated in terms of discrimination and calibration capabilities. All results underwent cross-validation. RESULTS 1,135 consecutive patients (median age 70 years, 64% male) were enrolled, 48 patients were excluded, and the cohort was randomly divided into training (760) and test (327) groups. During hospitalization, 251 (22%) patients died. After feature selection, the best performing classifier was random forest (AUC 0.88 ±0.03). Based on the relative importance of each variable, a pragmatic score was developed, showing good performances (AUC 0.85 ±0.025), and three levels were defined that correlated well with in-hospital mortality. CONCLUSIONS Machine learning techniques were applied in order to develop an accurate in-hospital mortality risk score for COVID-19 based on ten variables. The application of the proposed score has utility in clinical settings to guide the management and prognostication of COVID-19 patients.
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Affiliation(s)
- Maria Elena Laino
- Humanitas AI Center, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Elena Generali
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Internal Medicine, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Tobia Tommasini
- Humanitas AI Center, Humanitas Research Hospital IRCCS, Milan, Italy
| | | | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Internal Medicine, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Antonio Desai
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Internal Medicine, Humanitas Research Hospital IRCCS, Milan, Italy
| | | | - Giulio G. Stefanini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Emergency Department, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Internal Medicine, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Cardio Center, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Victor Savevski
- Humanitas AI Center, Humanitas Research Hospital IRCCS, Milan, Italy
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Megiorni F, Pontecorvi P, Gerini G, Anastasiadou E, Marchese C, Ceccarelli S. Sex-Related Factors in Cardiovascular Complications Associated to COVID-19. Biomolecules 2021; 12:biom12010021. [PMID: 35053169 PMCID: PMC8773922 DOI: 10.3390/biom12010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), the pandemic infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents with an extremely heterogeneous spectrum of symptoms and signs. The clinical manifestations seem to be correlated with disease severity. COVID-19 susceptibility and mortality show a significant sex imbalance, with men being more prone to infection and showing a higher rate of hospitalization and mortality compared to women. Such variability can be ascribed to both sex-related biological factors and gender-related behavioral cues. This review will discuss the potential mechanisms accounting for sex/gender influence in vulnerability to COVID-19. Cardiovascular diseases play a central role in determining COVID-19 outcome, whether they are pre-existent or arose upon infection. We will pay particular attention to the impact of sex and gender on cardiovascular manifestations related to COVID-19. Finally, we will discuss the sex-dependent variability in some biomarkers for the evaluation of COVID-19 infection and prognosis. The aim of this work is to highlight the significance of gendered medicine in setting up personalized programs for COVID-19 prevention, clinical evaluation and treatment.
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19
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O'Donnell C, Ashland MD, Vasti EC, Lu Y, Chang AY, Wang P, Daniels LB, de Lemos JA, Morrow DA, Rodriguez F, O'Brien CG. N-Terminal Pro-B-Type Natriuretic Peptide as a Biomarker for the Severity and Outcomes With COVID-19 in a Nationwide Hospitalized Cohort. J Am Heart Assoc 2021; 10:e022913. [PMID: 34889112 PMCID: PMC9075235 DOI: 10.1161/jaha.121.022913] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Currently, there is limited research on the prognostic value of NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) as a biomarker in COVID‐19. We proposed the a priori hypothesis that an elevated NT‐proBNP concentration at admission is associated with increased in‐hospital mortality. Methods and Results In this prospective, observational cohort study of the American Heart Association’s COVID‐19 Cardiovascular Disease Registry, 4675 patients hospitalized with COVID‐19 were divided into normal and elevated NT‐proBNP cohorts by standard age‐adjusted heart failure thresholds, as well as separated by quintiles. Patients with elevated NT‐proBNP (n=1344; 28.7%) were older, with more cardiovascular risk factors, and had a significantly higher rate of in‐hospital mortality (37% versus 16%; P<0.001) and shorter median time to death (7 versus 9 days; P<0.001) than those with normal values. Analysis by quintile of NT‐proBNP revealed a steep graded relationship with mortality (7.1%–40.2%; P<0.001). NT‐proBNP was also associated with major adverse cardiac events, intensive care unit admission, intubation, shock, and cardiac arrest (P<0.001 for each). In subgroup analyses, NT‐proBNP, but not prior heart failure, was associated with increased risk of in‐hospital mortality. Adjusting for cardiovascular risk factors with presenting vital signs, an elevated NT‐proBNP was associated with 2‐fold higher adjusted odds of death (adjusted odds ratio [OR], 2.23; 95% CI, 1.80–2.76), and the log‐transformed NT‐proBNP with other biomarkers projected a 21% increased risk of death for each 2‐fold increase (adjusted OR, 1.21; 95% CI, 1.08–1.34). Conclusions Elevated NT‐proBNP levels on admission for COVID‐19 are associated with an increased risk of in‐hospital mortality and other complications in patients with and without heart failure.
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Affiliation(s)
- Christian O'Donnell
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine Stanford CA.,Department of Medicine Stanford University School of Medicine Stanford CA
| | - Melanie D Ashland
- Stanford Cancer Institute Stanford University School of Medicine Stanford CA
| | - Elena C Vasti
- Department of Medicine Stanford University School of Medicine Stanford CA
| | - Ying Lu
- Stanford Cancer Institute Stanford University School of Medicine Stanford CA.,Department of Biomedical Data Science Stanford University School of Medicine Stanford CA
| | - Andrew Y Chang
- Division of Cardiovascular Medicine The Stanford Prevention Research Center The Cardiovascular Institute Stanford University School of Medicine Stanford CA
| | - Paul Wang
- Division of Cardiovascular Medicine The Stanford Prevention Research Center The Cardiovascular Institute Stanford University School of Medicine Stanford CA
| | - Lori B Daniels
- Division of Cardiovascular Medicine University of California San Diego CA
| | - James A de Lemos
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - David A Morrow
- Cardiovascular Division Department of Medicine Brigham and Women's HospitalHarvard Medical School Boston MA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine The Stanford Prevention Research Center The Cardiovascular Institute Stanford University School of Medicine Stanford CA
| | - Connor G O'Brien
- Division of Cardiovascular Medicine University of California San Francisco San Francisco CA
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20
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Lippi G, Sanchis-Gomar F, Henry BM, Lavie CJ. Cardiac Biomarkers in COVID-19: A Narrative Review. EJIFCC 2021; 32:337-346. [PMID: 34819823 PMCID: PMC8592630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The diagnosis and risk stratification of coronavirus disease 2019 (COVID-19) is primarily based on discretionary use of laboratory resources. Several lines of evidence now attest that cardiovascular disease not only is a frequent complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but its pre-existence may increase the risk of morbidity, disability, and death in patients with COVID-19. To this end, routine assessment of biomarkers of cardiac injury (i.e., cardiac troponin I or T) and dysfunction (e.g., natriuretic peptides) has emerged as an almost essential practice in patients with moderate, severe, and critical COVID-19 illness. Therefore, this narrative review aims to provide an overview of cardiac involvement in patients with SARS-CoV-2 infection as well as the clinical background for including cardiac biomarkers within specific panels of laboratory tests for managing COVID-19 patients.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy,Corresponding author: Prof. Giuseppe Lippi Section of Clinical Biochemistry University Hospital of Verona Piazzale L.A. Scuro, 10 37134 Verona Italy Phone: 0039-045-8122970 Fax: 0039-045-8124308
| | - Fabian Sanchis-Gomar
- University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Brandon Michael Henry
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A.
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, Louisiana, U.S.A.
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