ABSTRACT
Background and Aim: The inflammatory response plays a critical role in coronavirus disease 2019 (COVID-19) and inflammatory cytokine storm increases the severity of COVID-19. Epicardial adipose tissue serves as a source of inflammatory cytokines and mediators. This study aimed to investigate the association between epicardial fat volume (EFV), inflammatory biomarkers and clinical severity of COVID-19. Methods: This retrospective study included 101 patients hospitalized with COVID-19 between March 11 and April 21, 2020. Laboratory findings, treatment and complications were recorded. The serum inflammatory biomarkers including C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and ferritin levels were measured. Computed tomographic images were analyzed and semi-automated measurements for EFV were obtained. The primary composite endpoint was admission to intensive care unit (ICU) or death. Results: The primary composite endpoint occurred in 25.1% (n=26) of patients (mean age 64.8±14.8 years, 14 male). A total of 10 patients died (mean age 71.9±14.3, 6 male). EFV (115.1±44.0 cm3 vs 94.3±45.5 cm3, respectively, p=0.037), CRP, PCT, ferritin and IL-6 levels were significantly higher in ICU patients. Moreover, a positive correlation between EFV and CRP (r=0.494, p<0.001), PCT (r=.287, p=0.005), ferritin (r=0.265, p=0.01) and IL-6 (r=0.311, p=0.005) was determined. At receiver operating characteristic analysis, patients with EFV >102 cm3 were more likely to have severe complications. Conclusions: Epicardial fat volume and the serum levels of CRP, IL-6, PCT and ferritin can effectively assess disease severity and predict outcome in patients with COVID-19.
ABSTRACT
Background and Aim: Acute coronary syndromes (ACS) are the diseases that requires emergent therapies and if not applicable most of these patients have high morbidity and mortality. Therefore, the management of these syndromes is very well-defined. However, the management of them during an infectious outbreak can be changed to reduce the contamination and thus to protect healthcare providers and other individuals. Nowadays, there is a Coronavirus (COVID-19) pandemic all over the world including Turkey and this pandemic affects lots of people, especially immunocompromised and elderly individuals. We aimed to report an algorithm about the management of ACS patients during COVID-19 pandemic. Methods: According to this algorithm patients who admitted to the emergency department and diagnosed to have ACS divide into two groups within the scope of COVID-19 outbreak. At first group, patients with suspected or confirmed COVID-19 cases are included. At second group unsuspected cases that do not have the signs and symptoms of COVID-19 infection was included.If the patient has STEMI and includes in the first group, thrombolytic therapy (Actilyse 100 and 50 mg) is preferred at first. If the patient has NSTEMI and includes within the first group, the treatment decision is made according to the risk category of the patients. Results: This algorithm was applied on a total of 47 patients who were hospitalized between 12 March 2020 to 31 March 2020 with the diagnosis of ACS. Among 47 ACS patients, 32 had STEMI (16 inferior, 14 anterior and 2 posterior MI, mean age: 52.8±19 years, male/female: 26/6, hypertension (HT) prevalance 53%, diabetes mellitus (DM) prevalance 18%) and 15 had NSTEMI (mean age: 63.0±16 years, male/female: 12/3, HT prevalance 66%, DM prevalance 26%). All STEMI was type I MI. 31 STEMI and 14 NSTEMI patients were included into group 2 patients and treated within our routine procedure protocol. All STEMI patients except one who was referred to cardiovascular surgery due to the LAD rupture were treated with PCI. On the other hand, 14 NSTEMI patients were treated with PCI and one patient was treated with medical therapy. 1 STEMI and 1 NSTEMI patients were included into group 1 because of the suspected COVID-19 infection. Conclusions: The management of ACS patients during pandemics have to be well-planned and organised to protect both of health care workers and other individuals interested with the patients. Thrombolytic therapy is the first option for eligible STEMI patients. However, NSTEMI patients have to be categorised based on their risk and then the management strategy should be determined. CTA is also important for medium and low risk NSTEMI patients to decide the invasive therapy before discharge from the hospital. An isolation catheter room and isolation room in ICU with negative pressure is a requisite for follow-up of these patients and must be included into these management algorithm.