ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
The world is in the grip of the pandemic of the new viral infection COVID-19. The number of patients around the world is not only not decreasing, but also progressively increasing. Treatment and prevention of SARS-CoV-2 is a major global healthcare challenge. Effective and safe methods of treatment and prevention are urgently needed that can reduce the risk of infection, reduce the risk of developing the infectious process and mortality from this serious disease in addition to quarantine. Vitamin D is known for its classic role in maintaining bone mineral density. Currently, his contribution has been more and more studied. For example, the immune system is important, as well as adaptive immunity and regulation of the inflammatory cascade. In these reviews, the mechanisms of the effect of vitamin D on cellular and humoral immunity and direct antiviral defense of the body were discovered, and its potential modules – the role in vaccine immunogenicity. The data of observational and randomized clinical trials proving the positive effect of colecalciferol on the frequency and severity of seasonal viral respiratory diseases are presented. The mechanism of penetration and development of coronavirus in the human body, changes in the immune system and humoral factors of the body’s defense against the background of the course of SARS-CoV-2. Coronavirus and more severe course is an infectious process depending on age and associated diseases. In this article, we analyze and summarize the data of modern studies, in which it is proved that the level of vitamin D in the blood has a beneficial effect on the content of vitamins D in the body’s immune and antiviral defense and its role in reducing the risk of infection and the severity of pathological diseases, including COVID-19. Discussion of the doses and regimens of vitamin D therapy against viral infections, including COVID-19, is based on the experience of previous and ongoing studies and guidelines. © 2020, Remedium Group Ltd. All rights reserved.
ABSTRACT
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.
ABSTRACT
The article reviews studies that confirm the relationship of a negative prognosis with the presence of risk factors for cardiovascular complications during respiratory infections, including novel coronavirus infection COVID-19. The article presents the relevant research results that provide evidence on the myocardial damage in coronavirus infection. We present a clinical case of a patient with confirmed diagnosis of COVID-19 and severe viral myocarditis, verified by histological and immunohistochemical studies. Copyright © 2020 All-Russian Public Organization Antihypertensive League. All rights reserved.