Сoronavirus infection COVID-19 and features of its treatment in a patient with cardiovascular pathology. Clinical case

Patients with cardiovascular disease represent a particularly vulnerable population in a pandemic of the coronavirus infection COVID-19. They are more at risk of infection, a severe course of the disease, as well as a higher mortality rate compared to a healthy population. Currently, there are no randomized clinical trials to determine the most effective approaches to treatment in this category of patients. The presented clinical example demonstrates the possibilities of using various groups of drugs recommended for the treatment of COVID-19, and the high efficiency of treatment with an interleukin-6 receptor inhibitor (IL-6) in a patient with severe new coronavirus infection and the presence of concomitant cardiovascular pathology. © 2020, Media Sphera Publishing Group. All rights reserved.

Sequelae of COVID-19 at long-term after

Aim. To assess long-term sequelae of COVID-19 in hospitalized patients at 3 to 7 months after discharge.Material and Methods. The whole of 700 patients hospitalized to the temporary COVID-19 treatment center hosted by the FSBI "National Medical Research Center of Cardiology" of the Ministry of Health of Russia from April to June 2020 were invited to participate in a follow-up study. At 3-7 months after the index hospitalization, patients or their proxies were contacted via telephone in order to obtain information on their vital status, cardiovascular and other conditions or their complications, and new hospitalizations. In addition, patients were invited to an outpatient visit under the "COVID-19-follow-up" program, encompassing physical examination and a comprehensive battery of laboratory and instrumental tests, including spirometry, chest computed tomography (CT) and the six minute walk test (6MWT). Further, dyspnea was assessed using the mMRC (Modified Medical Research Council) Dyspnea Scale.Results: We were able to contact 87.4% (612/700) of patients or their proxies. At follow-up, 4.4% (27) patients died, of which 96.3% (26) had cardiovascular diseases (CVD). A total of 213 patients aged 19 to 94 years old (mean age 56.8 +/- 12.5, median 57 years [49.0;64.0];men, 55.4%) agreed come for an outpatient visit and to participate in the "COVID-19-follow-up" program. Since discharge, 8% (17) of patients required new hospitalizations, and more than a half of these patients (58.8%;10/17) had CVDrelated hospitalizations. A total of 8.4% (18) patients experienced worsening of hypertension, 9 (4.2%) patients had newly diagnosed hypertension, 2 (0.9%) - coronary artery disease patients experienced new/recurrent angina symptoms. 4 (1.9%) patients had newly diagnosed coronary artery disease, and one patient had an ischemic stroke. At the outpatient visit, 114 (53.5%) patients had some symptoms, most frequently, shortness of breath (33%), fatigue (27.4%), chest pain (11.3%), and abnormal heartbeats (8.5%). Based on the mMRC Scale, 59% of patients had dyspnea of varying severity. Most patients had a normal vital capacity (VC), which was moderately reduced in 3.3% and severely reduced in 0.5% of patients. Chest CT scans were obtained in 78 (36.6%) patients, whose worst lung damage scores during hospitalization were CT3 or CT4. One in ten patients (10.8%) with severe lung damage during acute infection had persisting ground glass opacities, 35.9% developed fibrotic changes, 79.6% of patients had linear or fine focal opacities. According to the 6MWT data, 12.3% of patients walked less than 70% of the predicted distance, 67% walked 71 to 99% of the predicted distance, and 20.7% of patients were able to walk 100% of their predicted distance.Conclusion. These data suggest long-term negative sequelae of COVID-19 in more than half of hospitalized patients.

Sequelae of COVID-19 at long-term follow-up after hospitalization

Aim. To assess long-term sequelae of COVID-19 in hospitalized patients at 3 to 7 months after discharge. Material and Methods. The whole of 700 patients hospitalized to the temporary COVID-19 treatment center hosted by the FSBI “National Medical Research Center of Cardiology” of the Ministry of Health of Russia from April to June 2020 were invited to participate in a follow-up study. At 3-7 months after the index hospitalization, patients or their proxies were contacted via telephone in order to obtain information on their vital status, cardiovascular and other conditions or their complications, and new hospitalizations. In addition, patients were invited to an outpatient visit under the "COVID-19-follow-up" program, encompassing physical examination and a comprehensive battery of laboratory and instrumental tests, including spirometry, chest computed tomography (CT) and the six minute walk test (6MWT). Further, dyspnea was assessed using the mMRC (Modified Medical Research Council) Dyspnea Scale. Results: We were able to contact 87.4% (612/700) of patients or their proxies. At follow-up, 4.4% (27) patients died, of which 96.3% (26) had cardiovascular diseases (CVD). A total of 213 patients aged 19 to 94 years old (mean age 56.8±12.5, median 57 years [49.0;64.0];men, 55.4%) agreed come for an outpatient visit and to participate in the “COVID-19-follow-up” program. Since discharge, 8% (17) of patients required new hospitalizations, and more than a half of these patients (58.8%;10/17) had CVD-related hospitalizations. A total of 8.4% (18) patients experienced worsening of hypertension, 9 (4.2%) patients had newly diagnosed hypertension, 2 (0.9%) – coronary artery disease patients experienced new/recurrent angina symptoms. 4 (1.9%) patients had newly diagnosed coronary artery disease, and one patient had an ischemic stroke. At the outpatient visit, 114 (53.5%) patients had some symptoms, most frequently, shortness of breath (33%), fatigue (27.4%), chest pain (11.3%), and abnormal heartbeats (8.5%). Based on the mMRC Scale, 59% of patients had dyspnea of varying severity. Most patients had a normal vital capacity (VC), which was moderately reduced in 3.3% and severely reduced in 0.5% of patients. Chest CT scans were obtained in 78 (36.6%) patients, whose worst lung damage scores during hospitalization were CT3 or CT4. One in ten patients (10.8%) with severe lung damage during acute infection had persisting ground glass opacities, 35.9% developed fibrotic changes, 79.6% of patients had linear or fine focal opacities. According to the 6MWT data, 12.3% of patients walked less than 70% of the predicted distance, 67% walked 71 to 99% of the predicted distance, and 20.7% of patients were able to walk 100% of their predicted distance. Conclusion. These data suggest long-term negative sequelae of COVID-19 in more than half of hospitalized patients.

Delayed ct scan of the lungs in patients with covid-19 pneumonia

Purpose. Assessment the state of the lungs using CT in the dynamic follow-up of pa-tients who have suffered from viral COVID-19 pneumonia in the delayed period af-ter 6-10 months, and to identify the relationship of residual lung changes with the clinical condition and results of external respiratory function (ERF). Materials and methods. We examined 78 patients who had suffered from bilateral polysegmental viral COVID-19 pneumonia in April-May 2020, using multi-spiral computed tomography (CT) of the lungs. All patients had a medical history, performed CT scans of the lungs in the acute and delayed (6-10 months after hospitalization) phases, and a study of FVD in the delayed phase. The analysis of a series of tomograms of the lungs in dynamics was carried out. We developed an severity score of the lung condition (LungSS), expressed in the total score, which was calculated based on the score of typical patterns characteristic of viral Covid19-pneumonia, as well as residual changes and areas of fibrosis. LungSS was calculated for each patient in the acute and delayed follow-up periods. Results. The present study shows the dynamics of lung changes in the delayed peri-od 6-10 months after the viral Covid19-pneumonia. Residual lung changes were detected in 66 people (84,6%). Of these, 35,9% of patients have areas of fibrosis, but most of the residu-al changes are linear and small-nodular seals (76,9%). The frequency of detection of residual reticular changes and consolidation was low (15,3%, 1,3%, respectively). Attention is drawn to the relatively frequent detection of areas of "Ground-glass opacity "(10,8%). In patients with severe and critical course of viral Covid19-pneumonia (CT3 and CT4), LungSS in the delayed follow-up period did not significantly differ from that in patients with mild and mod-erate course (CT1 and CT2) of the disease (4,5 [0,22], 2,5 [0,16], accordingly, p=0,61). There was no significant correlation between the detected residual lung changes in the delayed period and ERF. Conclusion. In a significant part of patients (84,6%) who have suffered from COVID-19 viral pneumonia, residual changes in the lung parenchyma persist, mainly in the form of linear seals and to a lesser extent fibrosis. These changes did not have a reliable relation-ship with the results of the FVD. LungSS proposed in this study reflects the dynamic picture of lung changes in the acute and delayed period, and can be a good indicator for monitoring patients who have suffered from COVID-19 viral pneumonia.

Dynamics of changes in the acute period and long-term results of chest CT in patients with COVID-19 pneumonia

To demonstrate chest CT changes during the dynamic observation of patients with severe viral COVID-19 pneumonia in the acute period and 6 months after recovery. Materials and methods. We present a clinical experience and follow-up of two patients with severe bilateral viral COVID-19 pneumonia, using chest computed tomography (CT) in the acute period and 6 months after recovery. Series of chest computer tomograms were analyzed in dynamics. CT was performed using a low-dose protocol on a Toshiba Aquilion ONE tomograph. Total patient radiation dose was less than 6.2 mSv, with an average of 1.5-1.6 mSv per study. Results. The ability of monitoring of chest CT indicators is demonstrated for making the choice of therapy in the acute period, as well as to assess the long-term consequences 6 months after recovery. The dynamic of CT patterns was studied depending on the stage of the course and results of treatment of viral pneumonia. Differences of outcomes are shown on patients with a similar clinical course of the disease six months after the same type of treatment. Conclusion. CT diagnostics for coronavirus infection helps not only in making an accurate diagnosis, but is also necessary in dynamic for monitoring the clinical course and evaluating residual changes after viral pneumonia.

LUNG DAMAGE MONITORING by COMPUTED TOMOGRAPHY in TYPICAL CORONAVIRUS DISEASE

urpose. To demonstrate the effectiveness of computed tomography (CT) in lung damage monitoring and the treatment assessment of viral pneumonia caused by the new SARS-CoV-2 coronavirus (Severe Acute Respiratory Syndrome CoronaVirus 2). Materials and methods. 56-year-old patient K. with complaints of fever up to 38.5° C, wet cough, severe weakness, shortness of breath, feeling of tightness in the chest, loss of smell and taste underwent general and biochemical blood tests, performed pulse oximetry, CT of the chest organs, analysis for the detection of SARS-CoV-2 virus RNA by polymerase chain reaction (PCR). Results. Viral COVID-19 pneumonia was detected and confirmed by CT of the chest in a patient with a primary negative test on the SARS-CoV-2 virus. CT allowed to evaluate the effectiveness of the therapy and choose the most optimal treatment, which led to a decrease in the volume of lung damage and further complete recovery. Conclusion. CT is a highly informative method for evaluation of lung damage dynamics in patients with viral pneumonia caused by SARS-CoV-2 coronavirus that allowed to assess the effectiveness of the therapy in patients with lung damage in pneumonia caused by SARS-CoV-2. © 2020 Russian Electronic Journal of Radiology. All rights reserved.

Features of the course and approaches to the treatment of coronavirus infection COVID- 19 patients with cardiovascular diseases

Patients with cardiovascular disease represent a particularly vulnerable population in a pandemic of the coronavirus infection COVID -19. They are more at risk of infection, a severe course of the disease, as well as a higher mortality rate compared to a healthy population. Currently, there are no randomized clinical trials to determine the most effective approaches to treatment in this category of patients. The presented clinical example demonstrates the possibilities of using various groups of drugs recommended for the treatment of COVID-19, and the high efficiency of treatment with an interleukin-6 receptor inhibitor (IL-6) in a patient with severe new coronavirus infection and the presence of concomitant cardiovascular pathology. Пациенты с наличием сердечно-сосудистых заболеваний (ССЗ) представляют особую уязвимую группу населения в условиях пандемии коронавирусной инфекции COVID -19. Они наиболее подвержены риску заражения, тяжелому течению заболевания, а также более высокой летальности по сравнению со здоровой популяцией. В настоящее время отсутствуют рандомизированные клинические исследования, позволяющие определить наиболее эффективные подходы к лечению у данной категории больных. Представленный клинический пример демонстрирует возможности применения различных групп препаратов, рекомендованных для лечения COVID-19 и высокую эффективность терапии ингибитором рецептора интерлейкина - 6 (ИЛ-6) у пациента с тяжелым течением новой коронавирусной инфекции и наличием сопутствующей сердечно-сосудистой патологии.

DYNAMICS OF MSCT-PATTERNS OF LUNG DAMAGE IN SEVERE VIRAL COVID19-PNEUMONIA ON THE BACKGROUND OF INTENSIVE THERAPY

P urpose. To demonstrate the value of chest computed tomography (CT) in patient with severe COVID-19 viral pneumonia in choosing the optimal treatment strategy. Materials and methods. Chest CT dynamic studies of a patient with severe bilateral polysegmental viral COVID-19 pneumonia were performed. The analysis of CT scans images series is provided. Results. The presented clinical case demonstrates the influence of the lung CT results in choosing the optimal therapy, including the cytokine storm prevention using the interleukin-6 (IL6) receptor inhibitors. The dynamic observation of the lungs in monitoring of the intensive therapy results was performed. The changes of CT patterns depending on the disease stage and results of treatment was studied. Conclusion. The paper shows that CT diagnostics for coronavirus COVID-19 infection helps not only in making an accurate diagnosis, but also is necessary in dynamics for monitoring the course of the disease, including helping to determine treatment tactics to prevent the development of a cytokine storm. Ц ель исследования. Продемонстрировать возможности компьютерной томографии (КТ) легких в диагностике и динамическом наблюдении для выбора оптимальной тактики лечения тяжелого течения вирусной COVID-19 пневмонии. Материалы и методы. Предоставляется клинический опыт динамического наблюдения пациента с двусторонней полисегментарной вирусной COVID-19 пневмонией тяжелого течения, с помощью КТ легких. Проведен анализ серии компьютерных томограмм органов грудной клетки в динамике. Результаты. В представленном клиническом примере продемонстрированы возможности мониторинга показателей КТ легких для решения вопроса о выборе терапии, в том числе о применении ингибиторов рецептора интерлейкина-6 (ИЛ6) для предотвращения развития «цитокинового шторма», а также дальнейшего наблюдения за результатами интенсивной терапии. Изучена динамика КТ-паттернов в зависимости от стадии течения и результатов лечения вирусной пневмонии. Заключение. В работе показано, что КТ-диагностика при коронавирусной инфекции помогает не только в постановке точного диагноза, но и необходима в динамике для мониторирования течения болезни, в том числе помогает определиться с тактикой лечения для предотвращения развития «цитокинового шторма».