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Coronary calcium score in COVID-19 survivors: Association with cardiac injury and cardiac function after 6 weeks. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 27:100280. [PMID: 36852285 PMCID: PMC9946728 DOI: 10.1016/j.ahjo.2023.100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023]
Abstract
Aims Cardiac manifestations are common in COVID-19, often elevated serum troponin levels or myocardial dysfunction on trans-thoracic echocardiography (TTE) is observed. Both parameters are associated with increased in-hospital mortality. Possibly, subclinical coronary atherosclerosis plays a role, of which severity can be assessed by calculating the coronary artery calcium (CAC) score. This study aims to determine the relation between coronary atherosclerosis and cardiac manifestations in COVID-19 survivors. Methods This study was conducted at the Leiden University Medical Center. All patients admitted for COVID-19 were included and scheduled for a 6-week follow-up visit with trans-thoracic echocardiography (TTE). CAC was assessed according to an ordinal score on non-gated, non-contrast enhanced computed tomography of the chest. Patients with and without CAC were compared on cardiac injury as reflected by elevated serum troponin levels and impaired cardiac function assessed through TTE. Results In total, 146 patients were included. Mean age was 62 years and 62 % of the patients were male. During admission, patients with CAC showed significantly higher levels of troponin (19 ng/L vs 10 ng/L; p < 0.01). Overall, mild echocardiographic abnormalities were seen; 12 % showed reduced left ventricular function (left ventricular ejection fraction of <50 %) and 14 % reduced right ventricular function (tricuspid annular planar systolic excursion ≤17 mm). Following multivariable adjustments, there was no significant relation between CAC and myocardial function at 6 weeks. Conclusion The present study shows that coronary atherosclerosis is associated with cardiac injury in COVID-19 survivors. However, no significant relation with impaired cardiac function was demonstrated.
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Zuin M, Rigatelli G, Bilato C, Quadretti L, Roncon L, Zuliani G. COVID-19 patients with acute pulmonary embolism have a higher mortality risk: systematic review and meta-analysis based on Italian cohorts. J Cardiovasc Med (Hagerstown) 2022; 23:773-778. [PMID: 36166326 PMCID: PMC9671546 DOI: 10.2459/jcm.0000000000001354] [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: 11/11/2021] [Revised: 06/03/2022] [Accepted: 07/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Acute pulmonary embolism has been recognized as a frequent complication of COVID-19 infection influencing the clinical course and outcomes of these patients. OBJECTIVES We performed a systematic review and meta-analysis to evaluate the mortality risk in COVID-19 Italian patients complicated by acute pulmonary embolism in the short-term period. METHODS The study was performed in accordance with the Preferred Report Items for Systematic Reviews and Meta-analyses guidelines. PubMed-MEDLINE and Scopus databases were systematically searched for articles, published in the English language and enrolling Italian cohorts with confirmed COVID-19 infection from inception through 20 October 2021. Mortality risk data were pooled using the Mantel-Haenszel random effects models with odds ratio as the effect measure with 95% confidence interval. Heterogeneity among studies was assessed using Higgins and Thomson I2 statistic. RESULTS Eight investigations enrolling 1.681 patients (mean age 64.9 years, 1125 males) met the inclusion criteria and were considered for the analysis. A random-effect model showed that acute pulmonary embolism was present in 19.0% of Italian patients with COVID-19 infection. Moreover, these patients were at higher mortality risk compared with those without (odds ratio: 1.76, 95% confidence interval: 1.26-2.47, P = 0.001, I2 = 0%). Sensitivity analysis confirmed yielded results. CONCLUSION In Italian patients with COVID-19 infection, acute pulmonary embolism was present in about one out of five and significantly associated with a higher mortality risk in the short-term period. The identification of acute pulmonary embolism in these patients remains critical to promptly identify vulnerable populations who would require prioritization in treatment and prevention and close monitoring.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara
- Department of Cardiology, West Vicenza Hospital, Arzignano
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano
| | | | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, Rovigo
| | - Giovanni Zuliani
- Department of Translational Medicine, University of Ferrara, Ferrara
- Department of Medicine, Porto Viro General Hospital, Rovigo, Italy
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Moll-Bernardes R, Mattos JD, Schaustz EB, Sousa AS, Ferreira JR, Tortelly MB, Pimentel AML, Figueiredo ACBS, Noya-Rabelo MM, Sales ARK, Albuquerque DC, Rosado-de-Castro PH, Camargo GC, Souza OF, Bozza FA, Medei E, Luiz RR. Troponin in COVID-19: To Measure or Not to Measure? Insights from a Prospective Cohort Study. J Clin Med 2022; 11:jcm11195951. [PMID: 36233816 PMCID: PMC9570932 DOI: 10.3390/jcm11195951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022] Open
Abstract
Myocardial injury (MI), defined by troponin elevation, has been associated with increased mortality and adverse outcomes in patients with coronavirus disease 2019 (COVID-19), but the role of this biomarker as a risk predictor remains unclear. Data from adult patients hospitalized with COVID-19 were recorded prospectively. A multiple logistic regression model was used to quantify associations of all variables with in-hospital mortality, including the calculation of odds ratios (ORs) and confidence intervals (CI). Troponin measurement was performed in 1476 of 4628 included patients, and MI was detected in 353 patients, with a prevalence of 23.9%; [95% CI, 21.8–26.1%]. The total in-hospital mortality rate was 10.9% [95% CI, 9.8–12.0%]. The mortality was much higher among patients with MI than among those without MI, with a prevalence of 22.7% [95% CI, 18.5–27.3%] vs. 5.5% [95% CI, 4.3–7.0%] and increased with each troponin level. After adjustment for age and comorbidities, the model revealed that the mortality risk was greater for patients with MI [OR = 2.99; 95% CI, 2.06–4.36%], and for those who did not undergo troponin measurement [OR = 2.2; 95% CI, 1.62–2.97%], compared to those without MI. Our data support the role of troponin as an important risk predictor for these patients, capable of discriminating between those with a low or increased mortality rate. In addition, our findings suggest that this biomarker has a remarkable negative predictive value in COVID-19.
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Affiliation(s)
- Renata Moll-Bernardes
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Correspondence: ; Tel.: +55-21-38836000
| | - João D. Mattos
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
| | | | - Andréa S. Sousa
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Juliana R. Ferreira
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Cardiology Unit, Copa D’Or Hospital, Rio de Janeiro 22031-011, Brazil
| | - Mariana B. Tortelly
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Cardiology Unit, Niterói D’Or Hospital, Rio de Janeiro 24230-251, Brazil
| | - Adriana M. L. Pimentel
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Cardiology Unit, Niterói D’Or Hospital, Rio de Janeiro 24230-251, Brazil
| | - Ana Cristina B. S. Figueiredo
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Cardiology Unit, Glória D’Or Hospital, Rio de Janeiro 22211-230, Brazil
| | - Marcia M. Noya-Rabelo
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Cardiology Department, Bahia School of Medicine and Public Health, Salvador 40290-000, Brazil
- Cardiology Unit, Aliança Hospital, Salvador 41920-180, Brazil
| | - Allan R. K. Sales
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
| | - Denilson C. Albuquerque
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Cardiology Department, Rio de Janeiro State University, Rio de Janeiro 20551-030, Brazil
| | | | - Gabriel C. Camargo
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
| | - Olga F. Souza
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
| | - Fernando A. Bozza
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Emiliano Medei
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Ronir R. Luiz
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Institute for Studies in Public Health—IESC, Federal University of Rio de Janeiro, Rio de Janeiro 21941-592, Brazil
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