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Mizera L, Rath D, Schoellmann A, Petersen-Uribe A, Avdiu A, Zdanyte M, Jaeger P, Heinzmann D, Müller K, Gawaz M, Eick C, Duckheim M. Deceleration capacity is associated with acute respiratory distress syndrome in COVID-19. Heart Lung 2021; 50:914-918. [PMID: 34428736 PMCID: PMC8326018 DOI: 10.1016/j.hrtlng.2021.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/25/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is considered the main cause of COVID-19 associated morbidity and mortality. Early and reliable risk stratification is of crucial clinical importance in order to identify persons at risk for developing a severe course of disease. Deceleration capacity (DC) of heart rate as a marker of cardiac autonomic function predicts outcome in persons with myocardial infarction and heart failure. We hypothesized that reduced modulation of heart rate may be helpful in identifying persons with COVID-19 at risk for developing ARDS. METHODS We prospectively enrolled 60 consecutive COVID-19 positive persons presenting at the University Hospital of Tuebingen. Arterial blood gas analysis and 24 h-Holter ECG recordings were performed and analyzed at admission. The primary end point was defined as development of ARDS with regards to the Berlin classification. RESULTS 61.7% (37 of 60 persons) developed an ARDS. In persons with ARDS DC was significantly reduced when compared to persons with milder course of infection (3.2 ms vs. 6.6 ms, p < 0.001). DC achieved a good discrimination performance (AUC = 0.76) for ARDS in COVID-19 persons. In a multivariate analysis, decreased DC was associated with the development of ARDS. CONCLUSION Our data suggest a promising role of DC to risk stratification in COVID-19.
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Affiliation(s)
- Lars Mizera
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Dominik Rath
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Anna Schoellmann
- Department of Gastroenterology, Hepatology, Infectiology and Geriatrics, University of Tuebingen, Germany
| | - Alvaro Petersen-Uribe
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Alban Avdiu
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Monika Zdanyte
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Philippa Jaeger
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - David Heinzmann
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Karin Müller
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Meinrad Gawaz
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Christian Eick
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany.
| | - Martin Duckheim
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
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Petersen-Uribe A, Avdiu A, Martus P, Witzel K, Jaeger P, Zdanyte M, Heinzmann D, Tavlaki E, Warm V, Geisler T, Müller K, Gawaz M, Rath D. Impaired Myocardial Function Is Prognostic for Severe Respiratory Failure in the Course of COVID-19 Infection. Front Cardiovasc Med 2021; 8:584108. [PMID: 34150860 PMCID: PMC8213370 DOI: 10.3389/fcvm.2021.584108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 04/30/2021] [Indexed: 12/11/2022] Open
Abstract
COVID-19 may lead to severe acute respiratory distress syndrome (ARDS) resulting in increased morbidity and mortality. Heart failure and/or pre-existing cardiovascular disease may correlate with poor outcomes and thus require special attention from treating physicians. The present study sought to investigate a possible impact of impaired myocardial function as well as myocardial distress markers on mortality or ARDS with need for mechanical ventilation in 157 consecutive patients with confirmed SARS-CoV-2 infection. All patients were admitted and treated at the University Hospital of Tübingen, Germany, during the first wave of the pandemic. Electrocardiography, echocardiography, and routine blood sampling were performed at hospital admission. Impaired left-ventricular and right-ventricular function, tricuspid regurgitation > grade 1, and elevated RV-pressure as well as thrombotic and myocardial distress markers (D-dimers, NT-pro-BNP, and troponin-I) were associated with mechanical ventilation and/or all-cause mortality. Impaired cardiac function is more frequent amidst ARDS, leading to subsequent need for mechanical ventilation, and thus denotes a poor outcome in COVID-19. Since a causal treatment for SARS-CoV-2 infection is still lacking, guideline-compliant cardiovascular evaluation and treatment remains the best approach to improve outcomes in COVID-19 patients with cardiovascular comorbidities.
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Affiliation(s)
- Alvaro Petersen-Uribe
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Alban Avdiu
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Katja Witzel
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Philippa Jaeger
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Monika Zdanyte
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - David Heinzmann
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Elli Tavlaki
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Verena Warm
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Karin Müller
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Dominik Rath
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
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