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Mansoor M, Shahid S, Tariq S, Aziz A, Zaidi E. Letter to Editor: Prevalence and Determinants of Delay in Time-to-Diagnosis for Pulmonary Arterial Hypertension (PAH) Patients in Gansu China: An Observational Cohort Study. Curr Probl Cardiol 2024; 49:102133. [PMID: 37852557 DOI: 10.1016/j.cpcardiol.2023.102133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Misha Mansoor
- Allama Iqbal Medical College Lahore, Lahore, Pakistan.
| | - Sameen Shahid
- Allama Iqbal Medical College Lahore, Lahore, Pakistan
| | - Shameen Tariq
- Allama Iqbal Medical College Lahore, Lahore, Pakistan
| | - Ansherah Aziz
- Allama Iqbal Medical College Lahore, Lahore, Pakistan
| | - Erum Zaidi
- Allama Iqbal Medical College Lahore, Lahore, Pakistan
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Hryzhak I, Pryshliak O, Kobryn T, Fedorov S, Boichuk O, Marynchak O, Kvasniuk V, Protsyk A, Miziuk R, Kucher A, Simchych M, Hryzhak L, Kuravkin M. Clinical and echocardiographic findings in patients with COVID-19 across different severity levels. J Med Life 2023; 16:1692-1700. [PMID: 38406777 PMCID: PMC10893567 DOI: 10.25122/jml-2023-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/08/2023] [Indexed: 02/27/2024] Open
Abstract
Cardiovascular pathology can complicate the course of COVID-19. The study aimed to identify echocardiographic abnormalities and key prognostic factors influencing severe and fatal COVID-19 outcomes. This retrospective cohort study included clinical and echocardiogram data from 194 medical records of hospitalized patients with COVID-19: 100 moderate cases, 34 severe cases with favorable outcomes, and 60 severe cases with fatal outcomes. Severe patients with favorable outcomes had greater reductions in left ventricular systolic fraction of left ventricle compared to moderate cases (23.5% vs. 7.0%, respectively, p=0.008) and ejection fraction of left ventricle (14.7% vs. 3.0%, respectively, p=0.013), grade I diastolic dysfunction of the left ventricle (20.6% vs. 8.0%, respectively, p=0.044), and pulmonary hypertension (29.41% vs. 10.0%, respectively, p=0.006). Patients with fatal outcomes had a mean age of 67.1±1.51 years, chronic heart failure functional class II (58.3%), hypertension (50.0%), type 2 diabetes (43.3%), and obesity (33.3%). Compared to severe cases but with favorable outcomes, fatal cases had a greater decrease in left ventricular ejection fraction (36.7% vs. 14.7%, respectively, p=0.024), various types of myocardial dysfunction (51.7% vs. 29.4%, respectively, p=0.037) and a trend towards increased pulmonary hypertension (48.3% vs. 29.4%, respectively, p=0.074). Consequently, chronic heart failure class II, reduced left ventricular ejection fraction, various myocardial dysfunctions, and pulmonary hypertension emerged as key cardiac risk factors for severe disease progression and mortality in patients with COVID-19.
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Affiliation(s)
- Ihor Hryzhak
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Oleksandra Pryshliak
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Taras Kobryn
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Sergiy Fedorov
- Department of Therapy, Family and Emergency Medicines of Postgraduate Education, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Oleksandr Boichuk
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Oleksandra Marynchak
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Viktoriia Kvasniuk
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Andrii Protsyk
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Ruslan Miziuk
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Andrii Kucher
- Department of Airborne Infections of Communal Non-Commercial Enterprise, Ivano-Frankivsk Phthisiatry-Pulmonology Center, Ivano-Frankivsk, Ukraine
| | - Marianna Simchych
- Department of Airborne Infections of Communal Non-Commercial Enterprise, Ivano-Frankivsk Phthisiatry-Pulmonology Center, Ivano-Frankivsk, Ukraine
| | - Lilia Hryzhak
- Department of Airborne Infections of Communal Non-Commercial Enterprise, Ivano-Frankivsk Phthisiatry-Pulmonology Center, Ivano-Frankivsk, Ukraine
| | - Mariia Kuravkin
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
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Barros LSA, Castillo JM, Lacerda HR. Abnormal right ventricular echocardiographic findings in recovered patients associated with severe acute respiratory syndrome in COVID-19. Echocardiography 2023; 40:227-234. [PMID: 36799211 DOI: 10.1111/echo.15538] [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: 09/29/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Right ventricular (RV) echocardiographic changes such as dilation or systolic dysfunction, and pulmonary arterial hypertension were observed in patients with COVID-19. The aim of our study was to determine the frequency of RV echocardiographic changes in patients who have recovered from COVID-19 and to verify the association between severe acute respiratory syndrome (SARS) and echocardiographic findings. METHODS Patients who had recovered from COVID-19 undergoing outpatient follow-up underwent transthoracic echocardiography, and based on the findings, were divided into two groups: normal and abnormal. It was then verified whether there is an association between SARS and RV echocardiographic abnormalities in recovered patients. RESULTS The study included 61 patients, with a mean age of 54.2 ± 12.0 years, 57.4% had presented with SARS. The mean period of time between COVID-19 and the echocardiographic examination was 11.9 ± 7.0 months. Patients presented normal left ventricular systolic function. The frequency of RV echocardiographic changes in patients who had recovered from COVID-19 was 44.3%. RV systolic dysfunction was identified in 31.1%, followed by ventricular dilation in 14.7% and pulmonary hypertension in 9.8%. An association was observed between SARS and RV echocardiographic changes in recovered patients during outpatient follow-up (OR: 4.96; 95% CI: 1.37-17.9; p = 0.015). An association was also demonstrated between SARS and RV dilation (p = 0.007) and between SARS and systolic dysfunction (p = 0.028). CONCLUSION SARS is a risk factor for abnormal RV echocardiographic findings in patients recovered from COVID-19.
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Affiliation(s)
- Leandro S A Barros
- Postgraduate Program in Tropical Medicine, Universidade Federal de Pernambuco, Recife, Brazil.,Department of Cardiology, Hospital Agamenon Magalhães, Recife, Brazil
| | - José M Castillo
- Escola de Ecografia de Pernambuco, Recife, Brazil.,Universidade Católica de Pernambuco, Recife, Brazil
| | - Heloísa R Lacerda
- Postgraduate Program in Tropical Medicine, Universidade Federal de Pernambuco, Recife, Brazil.,Department of Tropical Medicine, Universidade Federal de Pernambuco, Recife, Brazil
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Farkas D, Bogamuwa S, Piper B, Newcomb G, Gunturu P, Bednash JS, Londino JD, Elhance A, Nho R, Mejia OR, Yount JS, Horowitz JC, Goncharova EA, Mallampalli RK, Robinson RT, Farkas L. A role for Toll-like receptor 3 in lung vascular remodeling associated with SARS-CoV-2 infection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.25.524586. [PMID: 36747676 PMCID: PMC9900759 DOI: 10.1101/2023.01.25.524586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Cardiovascular sequelae of severe acute respiratory syndrome (SARS) coronavirus-2 (CoV-2) disease 2019 (COVID-19) contribute to the complications of the disease. One potential complication is lung vascular remodeling, but the exact cause is still unknown. We hypothesized that endothelial TLR3 insufficiency contributes to lung vascular remodeling induced by SARS-CoV-2. In the lungs of COVID-19 patients and SARS-CoV-2 infected Syrian hamsters, we discovered thickening of the pulmonary artery media and microvascular rarefaction, which were associated with decreased TLR3 expression in lung tissue and pulmonary artery endothelial cells (ECs). In vitro , SARS-CoV-2 infection reduced endothelial TLR3 expression. Following infection with mouse-adapted (MA) SARS-CoV-2, TLR3 knockout mice displayed heightened pulmonary artery remodeling and endothelial apoptosis. Treatment with the TLR3 agonist polyinosinic:polycytidylic acid reduced lung tissue damage, lung vascular remodeling, and endothelial apoptosis associated with MA SARS-CoV-2 infection. In conclusion, repression of endothelial TLR3 is a potential mechanism of SARS-CoV-2 infection associated lung vascular remodeling and enhancing TLR3 signaling is a potential strategy for treatment.
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Erdem K, Duman A. Pulmonary artery pressures and right ventricular dimensions of post-COVID-19 patients without previous significant cardiovascular pathology. Heart Lung 2023; 57:75-79. [PMID: 36084399 PMCID: PMC9424511 DOI: 10.1016/j.hrtlng.2022.08.023] [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: 03/15/2022] [Revised: 08/10/2022] [Accepted: 08/28/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pulmonary hypertension is a significant complication of COVID-19, but follow-up data on pulmonary artery pressure after recovery from COVID-19 are limited. OBJECTIVES To investigate pulmonary artery pressure and heart dimensions in post-COVID-19 patients without a history of significant cardiac pathology. METHODS Data for 91 eligible adult patients were subjected to 2 analyses. First, patients were grouped according to where they received COVID-19 treatment: the ICU, COVID-19 ward, or outpatient clinic. Second, the severity of COVID-19 was grouped as no pulmonary involvement, non-severe pulmonary involvement, or severe pulmonary involvement based on thoracic computed tomography scores. Heart dimensions were measured and pulmonary artery pressure was estimated using transthoracic echocardiography. The correlation between transthoracic echocardiography findings and COVID-19 severity was assessed. RESULTS Pulmonary artery pressure and right-heart dimensions were significantly elevated in the post-COVID-19 patients without a history of risk factors for pulmonary hypertension that presented to the cardiology outpatient clinic with cardiac complaints. Both of these findings were correlated with the severity of COVID-19 and the extent of lung involvement based on thoracic computed tomography. CONCLUSION The present findings confirm that increases in systolic pulmonary artery pressure and right ventricular dimensions persist 2-3 months after recovery from COVID-19 in patients without a history of risk factor for pulmonary hypertension. Furthermore, the increase in pulmonary artery pressure and right ventricular dimensions correlate with the severity of COVID-19 and the extent of lung involvement based on thoracic computed tomography.
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Affiliation(s)
- Kenan Erdem
- Department of Cardiology, Selcuk University, Faculty of Medicine, Ardıçlı, No:313, 42250 Selçuklu/Konya, Turkey.
| | - Ates Duman
- Department of Anesthesiology and Intensive Care, Selcuk University, Faculty of Medicine, Ardıçlı, No:313, 42250 Selçuklu/Konya Konya, Turkey
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Mickael C, Lee MH, Graham BB. The COVID-19 pandemic and pulmonary arterial hypertension in Italy: adaptation, outcomes and valuable lessons learned. Eur Respir J 2022; 60:2200796. [PMID: 36202406 PMCID: PMC9924355 DOI: 10.1183/13993003.00796-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 11/05/2022]
Abstract
This editorial summarises the key findings of R. Badagliacca and co-workers regarding the changes in care and clinical outcomes of PAH patients during the initial COVID-19 pandemic in Italy https://bit.ly/3ytgIjk
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Affiliation(s)
- Claudia Mickael
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael H Lee
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Brian B Graham
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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