Right heart condition in patients with COVID-19 pneumonia

Aim. To assess right heart condition in patients with coronavirus disease 2019 (COVID-19) pneumonia. Material and methods. One hundred and five patients with COVID-19 pneumonia were divided into 3 groups depending on the involvement of lung parenchyma: group I — 0-25%, II — 25-50%, III — 50-75%. The clinical status of patients was assessed using the NEWS2 and SHOKS-COVID scales. A complete blood count and biochemical blood tests were performed to determine the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin I. Echocardiography was performed to assess the right heart structural, hemodynamic and functional parameters. Results. In patients with COVID-19 pneumonia, with an increase in lung paren-chyma involvement, the intensity of systemic inflammatory response increased: C-reactive protein, group I — (4 [1,9;35] mg/l), in III — (70,5 [33;144] mg/l) (pI-III=0,012);myocardial stress marker level increased: NT-proBNP, group I — 77 [48;150] ng/l, group III — 165 [100;287] ng/l (pI-III =0,047). The dependence of NT-proBNP on C-reactive protein level was revealed (r=0,335, p=0,03). Intergroup comparison did not reveal significant differences between the main right heart functional parameters: TAPSE, Tei index (PW and TDI), FAC of the right ventricle (RV) (p>0,05). However, differences in the tricuspid annular peaks were found as follows: group I — 0,14 [0,12;0,14] m/s, group II — 0,14 [0,12;0,15] m/s, group III — 0,16 [0,14;0,17] m/s (pI-II =0,012, pI-III =0,014) and RV global longitudinal strain: group I — 19,63±7,72%, group III — 27,4±5,93% (pI-III =0,014). The relationship between the RV global longitudinal strain and SHOKS-COVID score was confirmed (r=0,381;p=0,024). Conclusion. Patients with COVID-19 pneumonia showed no signs of right heart dysfunction. The development of RV hyperfunction was noted. Most likely, this is a compensatory mechanism in response to acute RV afterload. NT-proBNP increase under conditions of an inflammatory response may indicate myocardial stress. The results obtained allow to expand our understanding of the right heart condition in patients with COVID-19 pneumonia. © 2021, Silicea-Poligraf. All rights reserved.

Right heart function in patients with viral pneumonia of varying severity caused by SARS-n-COV-2

Purpose: the purpose of this study was to estimate condition of right heart in patients with COVID-19 and viral pneumonia. Material and methods: 87 patients were included (age 53 ± 13, 58% male) with established diagnosis of COVID-19 via PCR and viral pneumonia on CT scans. Patient's clinical condition was assessed by SHOCS-COVID and NEWS scales. Transthoracic echocardiography was performed on 12 ± 4.6 day from the first symptoms of disease. Levels of high-sense Troponin I and NT-proBNP were measured in blood samples. Results: Patients were divided into 3 groups according to pattern of viral pneumonia severity on CT scans. Group I with CT 1 grade (involvement of the pulmonary parenchyma 0-25%) - 11(12.6%) patients;mid age- 48.9 ± 17 years;NEWS score - 1.4 ± 0.9;SHOCS-COVID score - 7.5 ± 3.7. Group II with CT 2 grade (involvement of the pulmonary parenchyma 25-50%). 48 (55.2%) patients;mid age- 51.6 ± 13.1 years;NEWS score - 2 ± 1;SHOCS-COVID score - 9 ± 2.1. Group III with CT 3 grade (involvement of the pulmonary parenchyma 50%-75%). 28 (32.2%) patients;mid age- 57.1 ± 10.3 years;NEWS score - 3.2 ± 1.5;SHOCS-COVID score - 12.4 ± 2. Groups didn't differ in age (p-value >0.05). Highest NEWS and SHOCS-COVID scores were observed in group III (p < 0.0001 and p = 0.01, accordingly). All patients had preserved LV ejection fraction (62 ± 4.2%). Range of right heart echocardiography parameters was higher in patients with more severe grade of viral pneumonia: - pulmonary artery systolic pressure in group I - 26,3 ± 4 mmHg, in II - 28.7 ± 4 mmHg, in III - 29.1 ± 13.2 mmHg (pI-III= 0.002), r = 0.4, p < 0.0001;- myocardial systolic velocity (s') of free tricuspid annulus site by TDI in group I-11 ± 0.5 cm/s, in II-13 ± 2 cm/s, in III -14 ± 2 cm/s (pI-III= 0.02), r = 0.4. p < 0.0001;- GLS of right ventricle (RV) in group I -18.6 ± 3%, in II - 21.6 ± 3.9%, in III - 21 ± 3.9% (pI-III = 0.038), r = 0.4, p = 0.005;- RV mid diameter in apical position in group I- 27 ± 2.8 mm, in II - 31 ± 5.1 mm, in III - 29 ± 4.2 mm (pI-III = 0.03), r = 0.3, p = 0.002. TAPSE and right heart areas didn't differ between groups (p > 0.05). Levels of high-sense Troponin I were under 0.2 ng/ml in all groups (p > 0.05). NT-proBNP level were elevated only in group III - 172 [97,7;330] ng/l (pI-III = 0,03) and correlated with SHOCS-COVID scores (r = 0.4, p = 0.04), CT grade (r = 0.3, p = 0.01) and RV Tei index from pulse-wave Doppler (r = 0.3, p = 0.02). Conclusion: perhaps, RV hyperfunction is compensatory reaction in response to increased afterload of right heart in patients with severe viral pneumonia caused by SARS-n-COV-2. Increased level of NT-proBNP indirectly confirms presence of myocardial stress in patients with severe viral pneumonia caused by SARS-n-COV-2.

[Criteria for the optimal use of interleukin-6 receptor blockers in patients with COVID-19].

AIM: To determine the criteria for the optimal use of IL-6 receptor blockers in patients with COVID-19 community-acquired pneumonia based on predictors of adverse outcomes. MATERIALS AND METHODS: The single-center, non-randomized prospective study included 190 patients with community-acquired pneumonia caused by coronavirus 2 between the beginning of March and the end of May 2020. Of these, 89 patients received tocilizumab and 101 patients received sarilumab. The study inclusion criterion for the patient was indications for initiating therapy with one of the inhibitors of IL-6 receptors (anti-IL-6R) according to the Interim guidelines (versions 4 and 5). The exclusion criterion was the need to re-prescribe genetically engineered biological therapy (GEBT). The severity of the patient's condition was assessed according to the early warning score (NEWS2), the volume of lung tissue lesions was assessed according to computed tomography (CT). Laboratory monitoring included counting the absolute (abs) number of lymphocytes, serum levels of C-reactive protein (CRP), interleukin 6 (IL-6), D-dimer, lactate dehydrogenase, fibrinogen. Statistical data processing was conducted by nonparametric methods using the IBM SPSS Statistics V-22 software. RESULTS: The phenotype of a patient with a negative outcome prognosis was described: a male patient over 50 years of age with aggravated premorbid background (with cardiovascular diseases, obesity and/or chronic renal disease), lung lesion CT 34, saturation less than 93% upon inhalation of atmospheric air, persisting for 2448 hours after GEBT. According to the blood test, lymphopenia was below 1000 U/L and CRP levels were above 50 mg/L. The laboratory parameters and clinical picture of the patient progressively worsened after 911 days of illness, regardless of the use of Anti-IL-6R. The features of patients monitoring when administering IL-6 receptor blockers have been determined. CONCLUSION: IL-6 receptor blockers should be administered to patients hospitalized with severe COVID-19 before the development of hyperinflammatory reactions. The optimal "therapeutic window" is 78 days of illness.

Baricitinib in the treatment of patients with COVID-19: A review of international data and analysis of clinical results in the Russian Population

The effects of baricitinib, a selective reversible inhibitor of Janus kinase 1 and 2, in the treatment of COVID-19 are associated with different aspects of pathogenesis - inhibition of viral endocytosis, reduction of excessive inflammatory response, and mitigation of vascular and pulmonary damage, which is a strong rationale for using baricitinib to treat patients with COVID-19. In the period from April to May 2020, City Clinical Hospital No. 52 obtained clinical experience of baricitinib clinical use in the therapy of 113 patients with COVID-19:58 (51%) women and 55 (49%) men, whose average age was 57±12.6 years old. Analysis of the results of using baricitinib showed that therapy with baricitinib against the background of standard pathogenetic therapy was found to be effective in 95 (84%) patients and ineffective in 18 (16%). Significant positive changes were shown in comparison with the baseline level of the following indicators: body temperature (from 37.2+0.8°C to 36, ±0.68°C, P=0.000), blood oxygen saturation (from 95.5±3.0% to 96.5±2.2%, P=0.011), C-reactive protein (from 46.1±48.0 mg/L to 33.5±43.7 mg/L, P=0.010), National Early Warning Score (NEWS) (from 1.7±1.3 to 1.1±1.2, p=0.001).From the safety point of view, patients showed a slight decrease in the average value of the number of neutrophils - from (3.1±1.4)xl09 to (3.0±2.0)xl09 and lymphocytes - from (1.8±0,9) x 109 to (1.7±0.9) x 109, as well as minimal multidirectional changes in the mean values of transaminase activity - alanine aminotransferase changed from 33.9±23.6 U/L to 34.9±47.5 U/L, aspartate aminotransferase - from 40.6±49.0 U/L to 38.5±25.5 U/L. In general, the results obtained within the experience of the clinical use of baricitinib in 113 Russian patients with COVID-19 are consistent with the available data from foreign clinical studies and confirm the efficacy and safety of baricitinib. © Team of Authors, 2021.

COVID-19 management: Who needs electrocardiographic monitoring and why

Chloroquine phosphate and hydroxychloroquine sulfate are used for treatment and prevention of complications associated with COVID-19. The use of these drugs has the potential to cause QT interval prolongation. The combination of antimalarial drugs with fluoroquinolones and macrolides increases the risk of rhythm disturbance. Objective. Based on analysis of own clinical data to determine the QTc-interval value for correction of monitoring of patients with COVID-19-associated extra-hospital pneumonia during antiprotozoic course in combination with antibacterial agents with cardiovascular toxicity (macrolide or fluoroquinolone). Material and methods. A single-center non-randomized prospective study to evaluate the safety of therapy in 98 patients with COVID- 19 community-acquired pneumonia. Patients were divided into two subgroups: patients with (n=39) and without (n=59) cardiovascular diseases. Results. QTc prolongation from baseline (360 ms, from 350 to 380) was observed on fifth (390 ms, from 360 to 400;p=0.003) and 10th (400 ms, from 390 to 430;p=0.005). In patients with cardiovascular diseases, QTc prolongation from baseline was detected only on the 10th day (360 ms, from 340 to 410 ms vs 400, from 370 to 450 ms;p=0.03). Conclusions. Co-administration of hydroxychloroquine sulfate with fluoroquinolones or macrolides in patients with COVID- 19 was not associated with severe QTc prolongation or arrhythmias. © 2020, Media Sphera Publishing Group. All rights reserved.