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OBJECTIVE@#To investigate the risk factors for acute myocardial injury in coronavirus disease 2019 (COVID-19) patients.@*METHODS@#This is a retrospective analysis of a COVID-19 cohort, in which 149 confirmed COVID-19 patients enrolled were divided into the group of myocardial injury (19 cases) and the group of non-myocardial injury (130 cases). Myocardial injury was defined according to Fourth universal definition of myocardial infarction released by European Society of Cardiology (ESC) in 2018, that cardiac troponin (cTn) was above 99th percentile of the reference level. Clinical information and results of laboratory tests of the eligible patients were collected. Factors associated with myocardial injury in COVID-19 patients were evaluated.@*RESULTS@#Compared with the group of non-injury, the patients in the group of injury were older and had a larger proportion of severe or critical cases (P < 0.05), higher respiratory rate and lower percutaneous oxygen saturation (SpO2) without oxygen therapy on admission (P < 0.05). All inflammatory indexes except for tumor necrosis factor α (TNF-α) showed significant elevation in the patients of the group of injury (P < 0.05). Analyzed by Spearman correlation test, we showed that the levels of circulatory cTnI were in positive correlation with the levels of high-sensitivity C-reactive protein (hs-CRP), ferritin, receptor of interleukin-2 (IL-2R), interleukin-6 (IL-6) and interleukin-8 (IL-8) (ρ > 0, P < 0.05). Lower SpO2 without oxygen therapy on admission (OR: 0.860, 95%CI: 0.779-0.949, P=0.003) and higher plasma IL-6 levels (OR: 1.068, 95%CI: 1.019-1.120, P=0.006) were independent risk factors for acute myocardial injury in the patients with COVID-19 by multivariate Logistic regression analyses.@*CONCLUSION@#Hypoxic state and inflammation may play a key role in the pathogenesis of acute myocardial injury in COVID-19 patients.
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Humans , Biomarkers , COVID-19 , Hypoxia , Inflammation , Retrospective Studies , Risk Factors , SARS-CoV-2ABSTRACT
Objective To evaluate the left ventricular morphology and function related to complete left bundle branch block(CLBBB)in patients with systolic heart failure with cardiac magnetic resonance.Methods Thirteen consecutive patients with left ventricular ejection fraction(LVEF)＜50％evaluated by echocardiography and CLBBB were included as the study group,and patients with other reasons leading to heart failure were excluded.During At the same period,patients with primary dilated cardiomyopathy were selected as the control group(n=19)whose age,sex and LVEF were matched with the study group.All patients received contrast magnetic resonance imaging examination.Results Left ventricular end-diastolic volume(LVEDV)in patients with CLBBB was(173.8±23.1)ml and left ventricular end-systolic volume(LVESV)was(123.1±18.7)ml,while LVEDV in patients without CLBBB was(247.9±60.7)ml and LVESV was(188.2±57.1)ml respectively.All LV measurements/indexes were smaller in patient with CLBBB when compared to the control(all P＞0.05).Right atrium area was also smaller in CLBBB patients(P=0.037).The maximal wall thickness in the patients with CLBBB [(8.3±1.4)mm] was thicker than that in the patients without CLBBB[(7.2±1.1)mm](P=0.016).Conclusions CLBBB may play an important role in the progress of heart failure and LV dilation may not have similar significant contribution with relative thicker ventricular wall.
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Objective To investigate the relation of post-exercise heart rate recovery(HRR)with exercise capacity, and the predictive value on long-term prognosis in patients of ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods A total of 260 patients were investigated from July 2011 to December 2014. All the patients were conducted cardiopulmonary exercise testing(CPET)within 30 days after STEMI, and heart rate recovery at 1 minute (HRR1)were calculated. The correlation between HRR with exercise tolerance was analysed. The median followup duration was 55 months(42,72), and the cardiovascular endpoint events were collected. Results The mean HRR1 was 26.0±12.2 beats in the whole study population who completed CPET.(1)HRR1 was positively correlated to peak oxygen uptake(VO2peak)(r=0.129, P<0.001).Multiple linear regression analysis demonstrated that VO2peak was independently positively associated with HRR1. (2) Cardiovascular endpoint events occurred in 60 cases (23.1%). Single factor screening through Cox regression model showed that decreased HRR1 (HRR1 ≤ 12 beats)(P=0.010)significantly correlated with the cardiovascular endpoint events. After adjusted by multiple factors, the risk of cardiovascular endpoint events in the group of decreased HRR(HRR1 ≤ 12 beats)was 2.671 times as the group of HRR1>12 beats. Conclusions Decreased HRR1 is associated with lower exercise tolerance, and it shows signifi cant prognostic values in increasing cardiovascular endpoint events in STEMI patients treated with primary PCI.
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Objective To investigate the diff erential expression of microRNA in microparticles from coronary blood and peripheral blood in patients with acute myocardial infarction, and to provide clues for further study on the role of myocardial in the pathogenesis of myocardial infarction. Methods Coronary and peripheral blood samples were collected from patients with acute myocardial infarction undergoing thrombus aspiration. Microparticles from coronary and peripheral blood samples were isolated by centrifugation and gene chips were used to sequence the microRNA from the microparticles in the two groups. The diff erences in microRNA expression were identifi ed between two groups and the function of these microRNA were analyzed. Results There were signifi cant diff erences between the microRNA in the microparticles from the coronary blood and peripheral blood in patients with acute myocardial infarction. By constructing expression profi les, 307 diff erentially expressed microRNA were found, with 221 of them were up regulated and 86 of them were down regulated. Conclusion There is signifi cant diff erence between the expression of microRNA in microparticles from the coronary blood and the peripheral blood of patients with acute myocardial infarction forty nine of them are closely related to cardiovascular disease, which can be used as the target of further research.