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BACKGROUND: According to the results of the ESSE-RF study, the frequency of obesity in the population reached 29.7%. Obesity is one of the main risk factors for the development of cardiovascular diseases. Features of the course of COVID-19 in patients with obesity is a very urgent problem. AIM: The aim of the study was a comparative investigation of clinical and laboratory-instrumental parameters in AH patients with or without obesity who had COVID-19 associated pneumonia, to identify the role of obesity as a potential predictor of post-COVID cardiovascular complications 3 months after discharge from the hospital. MATERIALS AND METHODS: Materials and methods. The study included 174 patients with COVID-19-associated pneumonia. Group 1 included 78 patients with AH without obesity, group 2 - 96 patients with AH and obesity. All patients were tested with a blood sample at the time of admission and 3 months after discharge from the hospital. We assessed parameters of general blood test, biochemistry, hemostasis, inflammation biomarkers - concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine, IL-6, etc. All patients initially underwent computed tomography of the chest. In both groups, 24-hour blood pressure monitoring was performed using BPLaB device, according to the standard protocol;echocardiography using an expert class ultrasound diagnostic system Vivid S70. The study is registered with the Clinical Trials.gov database Identifier: NCT04501822. RESULT(S): Results. The biomarker that significantly distinguished the both groups of patients, as well as subgroups according to the degree of obesity was the concentration of maxCRP and hs-CRP, which was significantly higher in group 2. In addition, the registered maximum values of MPO, NT-proBNP, IL-1,6, TNA-alpha and NRL parameters in group 2 of patients with 2-3 degrees of obesity, may indicate the highest probability of developing delayed adverse cardiovascular complications in this group of patients. Mean systolic blood pressure, variability of systolic and diastolic blood pressure, and heart rate at night were significantly higher in AH patients with obesity. Numerous correlations of obesity with laboratory and instrumental parameters have been registered, which may indicate an increased likelihood of delayed unwanted cardiovascular complications in this particular group of patients. Multiple regression showed that obesity is an independent predictor of an increase in LDH, hs-CRP and right atrium. CONCLUSION(S): Dynamic control of the studied parameters in patients with AH and OB registered an increased concentration of CRP at the initial stage and 3 months after treatment, with a general trend towards a decrease in the increased initial structural parameters of ECHO CG. The logistic regression method showed that the presence of OB in patients with AH is an independent factor causing increased levels of immune inflammation (CRP), a marker of tissue destruction (LDH), and load on the right atrium.Copyright © Endocrinology Research Centre, 2022.
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BACKGROUND: According to the results of the ESSE-RF study, the frequency of obesity in the population reached 29.7%. Obesity is one of the main risk factors for the development of cardiovascular diseases. Features of the course of COVID-19 in patients with obesity is a very urgent problem. AIM: The aim of the study was a comparative investigation of clinical and laboratory-instrumental parameters in AH patients with or without obesity who had COVID-19 associated pneumonia, to identify the role of obesity as a potential predictor of post-COVID cardiovascular complications 3 months after discharge from the hospital. MATERIALS AND METHODS: Materials and methods. The study included 174 patients with COVID-19-associated pneumonia. Group 1 included 78 patients with AH without obesity, group 2 - 96 patients with AH and obesity. All patients were tested with a blood sample at the time of admission and 3 months after discharge from the hospital. We assessed parameters of general blood test, biochemistry, hemostasis, inflammation biomarkers - concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine, IL-6, etc. All patients initially underwent computed tomography of the chest. In both groups, 24-hour blood pressure monitoring was performed using BPLaB device, according to the standard protocol;echocardiography using an expert class ultrasound diagnostic system Vivid S70. The study is registered with the Clinical Trials.gov database Identifier: NCT04501822. RESULT(S): Results. The biomarker that significantly distinguished the both groups of patients, as well as subgroups according to the degree of obesity was the concentration of maxCRP and hs-CRP, which was significantly higher in group 2. In addition, the registered maximum values of MPO, NT-proBNP, IL-1,6, TNA-alpha and NRL parameters in group 2 of patients with 2-3 degrees of obesity, may indicate the highest probability of developing delayed adverse cardiovascular complications in this group of patients. Mean systolic blood pressure, variability of systolic and diastolic blood pressure, and heart rate at night were significantly higher in AH patients with obesity. Numerous correlations of obesity with laboratory and instrumental parameters have been registered, which may indicate an increased likelihood of delayed unwanted cardiovascular complications in this particular group of patients. Multiple regression showed that obesity is an independent predictor of an increase in LDH, hs-CRP and right atrium. CONCLUSION(S): Dynamic control of the studied parameters in patients with AH and OB registered an increased concentration of CRP at the initial stage and 3 months after treatment, with a general trend towards a decrease in the increased initial structural parameters of ECHO CG. The logistic regression method showed that the presence of OB in patients with AH is an independent factor causing increased levels of immune inflammation (CRP), a marker of tissue destruction (LDH), and load on the right atrium.Copyright © Endocrinology Research Centre, 2022.
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Aim. To investigate the relationship between echocardiographic parameters and laboratory immune inflammation signs in patients after coronavirus disease 2019 (COVID-19) pneumonia depending on the left ventricular (LV) involvement according to speckle tracking echocardiography (STE). Material and methods. The study included 216 patients (men, 51,1%, mean age, 50,1+/-11,1 years). The examination was carried out in patients 3 months after COVID-19 pneumonia. Patients were divided in 3 groups: group I (n=41) - diffuse decrease (>=4 segments the same LV level) of longitudinal strain (LS) according to STE;group II (n=67) - patients with regional decrease (LS reduction >=3 segments corresponding to systems of the anterior, circumflex or right coronary arteries);group III - patients without visual left ventricle involvement (n=108). Results. There were no significant differences in LV ejection fraction - 68,9+/-4,1% in group I, 68,5+/-4,4% in group II and 68,6+/-4,3 in group III (p=0,934). A decrease in the global longitudinal left ventricle strain was detected significantly more often in groups I and II compared with group III (-17,8+/-2,0, -18,5+/-2,0 and -20,8+/-1,8%, respectively;p<0,001). At the same time, LS depression of LV basal level (-14,9+/-1,5, -16,8+/-1,2% and -19,1+/-1,7%;p<0,001), as well as a decrease in LS of LV inferior-posterior segments in group with diffuse involvement was detected significantly more often than in groups II and III. In addition, we revealed a significant difference in interleukin-6 concentration - 3,1 [2,5;4,0], 3,1 [2,4;3,8] and 2,5 [3,8;1,7] pg/ml, (p=0,033), C-reactive protein - 4,0 [2,2;7,9], 5,7 [3,2;7,9] and 2,4 [1,1;4,7] mg/l, (p<0,001), tumor necrosis factor-alpha - 5,9+/-1,9, 6,2+/-1,9 and 5,2+/-2,0 pg/ml, (p=0,004) and ferritin - 130,7 [56,5;220,0], 92,2 [26,0;129,4] and 51,0 [23,2;158,9] microg/l, respectively (p=0,025). Conclusion. A relationship was found between diffuse and regional left ventricular involvement according to STE and signs of immune inflammation in patients 3 months after COVID-19 pneumonia.Copyright © 2023 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.
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BACKGROUND: According to the results of the ESSE-RF study, the frequency of obesity in the population reached 29.7%. Obesity is one of the main risk factors for the development of cardiovascular diseases. Features of the course of COVID-19 in patients with obesity is a very urgent problem. AIM: The aim of the study was a comparative investigation of clinical and laboratory-instrumental parameters in AH patients with or without obesity who had COVID-19 associated pneumonia, to identify the role of obesity as a potential predictor of post-COVID cardiovascular complications 3 months after discharge from the hospital. MATERIALS AND METHODS: Materials and methods. The study included 174 patients with COVID-19-associated pneumonia. Group 1 included 78 patients with AH without obesity, group 2 - 96 patients with AH and obesity. All patients were tested with a blood sample at the time of admission and 3 months after discharge from the hospital. We assessed parameters of general blood test, biochemistry, hemostasis, inflammation biomarkers - concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine, IL-6, etc. All patients initially underwent computed tomography of the chest. In both groups, 24-hour blood pressure monitoring was performed using BPLaB device, according to the standard protocol;echocardiography using an expert class ultrasound diagnostic system Vivid S70. The study is registered with the Clinical Trials.gov database Identifier: NCT04501822. RESULT(S): Results. The biomarker that significantly distinguished the both groups of patients, as well as subgroups according to the degree of obesity was the concentration of maxCRP and hs-CRP, which was significantly higher in group 2. In addition, the registered maximum values of MPO, NT-proBNP, IL-1,6, TNA-alpha and NRL parameters in group 2 of patients with 2-3 degrees of obesity, may indicate the highest probability of developing delayed adverse cardiovascular complications in this group of patients. Mean systolic blood pressure, variability of systolic and diastolic blood pressure, and heart rate at night were significantly higher in AH patients with obesity. Numerous correlations of obesity with laboratory and instrumental parameters have been registered, which may indicate an increased likelihood of delayed unwanted cardiovascular complications in this particular group of patients. Multiple regression showed that obesity is an independent predictor of an increase in LDH, hs-CRP and right atrium. CONCLUSION(S): Dynamic control of the studied parameters in patients with AH and OB registered an increased concentration of CRP at the initial stage and 3 months after treatment, with a general trend towards a decrease in the increased initial structural parameters of ECHO CG. The logistic regression method showed that the presence of OB in patients with AH is an independent factor causing increased levels of immune inflammation (CRP), a marker of tissue destruction (LDH), and load on the right atrium.Copyright © Endocrinology Research Centre, 2022.
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The aim. To study peculiarities and association of psychological and laboratory indicators in patients with cardiovascular diseases (CVD) who underwent COVID-19 to clarify the factors affecting the possibility of developing delayed psychological and cardiovascular adverse events. Methods. The study enrolled 350 patients with COVID-19. Group 1 consisted of 92 patients without CVD, Group 2 - of 258 patients with CVD. Indicators of laboratory and psychological parameters were assessed according to the data of psychological questionnaire using GAD-7 (General Anxiety Disorder-7), PHQ-9 (Patient Health Questionnaire-9), PSS (Perceived Stress Scale) screening scales and SF-36. Parameters of complete blood count and biochemical blood tests were measured during hospitalization and three months after discharge from the monohospital. Results. After three months, in the general group of patients, signs of anxiety and depression were detected in more than 30 % of the examined patients, signs of stress - in 10.4 %. In the group with CVD, psycho-emotional disorders were identified in 1/4 of the patients, and severe stress - in 8 % of those included in the study. In addition, it was registered that the indicators of erythrocyte sedimentation rate, fibrinogen, high-sensitivity C-reactive protein (CRP), homocysteine andIL-6remained at a higher level in the second group. Correlation analysis showedthatthe psychologicalcomponentofhealthis interconnectedwiththe levelofneutrophils (p= 0.044)andfibrinogen (p= 0.050);the physical component of health is correlated with the level of erythrocytes (p = 0.030), hemoglobin (p = 0.015), CRP (p = 0.002), creatine phosphokinase (p = 0.036) and glucose (p = 0.017). Regression analysis revealed that in patients with CVD three months after hospitalization, an increased glucose index contributes to deterioration, andincreasedhematocritandmean hemoglobin concentration improve the quality of life of patients. Conclusion. Laboratory markers that maintain the duration of a prolonged vascular reaction, violation of the rheological and metabolic properties of blood, determine the nature of the development of both psychological and cardiovascular complications. © 2023 Voprosy Literatury. All rights reserved.
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Coronavirus disease 2019 (COVID-19) affects the function of all organs and systems. Today, studying the effect of COVID-19 on cardiovascular system, including on echocardiographic characteristics, is relevant. Aim. To study the prevalence of symptoms, cardiovascular disease and changes in echocardiographic data in persons after documented COVID-19 pneumonia 3 months after discharge from the hospital. Material and methods. The study included 106 patients after documented COVID-19 pneumonia. The patients underwent a comprehensive examination during hospitalization and 3 months+/-2 weeks after discharge from the hospital. The mean age of participants was 47+/-16 years (19-84 years);49% of subjects were women. Results. Three months after hospital discharge, the symptoms persisted in 86% of examined patients. There were significant echocardiographic changes as follows: a decrease in LV end-diastolic, end-systolic and stroke volume (113,8+/-26,8 ml vs 93,5+/-29,4 ml;37,7+/-13,0 ml vs 31,3+/-14,2 ml;77,2+/-17,8 ml vs 62,2+/-18,7 ml, respectively, p<0,001 for all). The right ventricular anteroposterior dimension and the pulmonary trunk diameter decreased over time (26,0 [24,0-29,3] mm vs 25,0 [23,0-27,0] mm, p=0,004;21,7+/-3,6 mm vs 18,7+/-2,5 mm, p<0,001), the same as the pulmonary artery systolic pressure, estimated by tricuspid regurgitation gradient (28,0 [25,0-32,25] mm Hg vs 21,5 [17,0-25,0] mm Hg). The right atrial volume (42,0 [37,0-50,0] ml vs 31,0 [22,0-36,5] ml, p<0,001) and maximum width (36,1+/-4,6 mm vs 34,5+/-6,5 mm, p=0,023) decreased, while the right atrial maximum length increased (46,7+/-6,8 mm vs 48,6+/-7,1 mm, p=0,021). Conclusion. In survivors of COVID-19 pneumonia three months after hospital discharge, complaints persisted in 86% of cases. Cardiovascular diseases were detected in 52% of participants, including hypertension in 48,1% and coronary artery disease in 15,1%. Compared with in-hospital data, the echocardiographic characteristics improved, which was expressed mainly in a decrease in right heart load. Copyright © 2021, Silicea-Poligraf. All rights reserved.
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Funding Acknowledgements Type of funding sources: None. Background COVID-19 affects firstly the respiratory system, however the cardiovascular system is also damaged. To study the long-term effect of COVID-19 pneumonia on cardiovascular system, in particular on echocardiography (EchoCG) parameters of right heart is important for patients rehabilitation. Purpose To compare EchoCG parameters of right heart in patients with proven COVID-19 pneumonia 3 months and one year after discharge. Methods A total of 116 patients with confirmed COVID-19 pneumonia were included from April 2020 to July 2021. All patients underwent clinical examination including transthoracic EchoCG 3 months ±2 weeks and one year ±3 weeks after discharge. Mean age of patients was 49.0 ± 14.4 years (19-84 years), females were 49.6%. During hospitalization, chest computed tomography (CT) detected mild lesions in 31.3%, moderate lesions in 33.3%, severe lesions in 29.3% and critical lesions in 6.1%. Results The rate of resolution of lung abnormalities according to CT was 55.9%. Mean body mass index was 28.7 ± 5.8 kg/m2 3 months after discharge, and it significantly increased to one year after discharge – 29.4 ± 6.1 kg/m2 (p < 0,001). The mean anteroposterior right ventricular (RV) diameter index decreased over the observation period (13.5 ± 1.9 vs 13.0 ± 1.5 mm/m2, p <0.001), as well as the indices of end-diastolic and end-systolic RV area (8.0 ± 1.8 vs 7.5 ± 1.5 cm2/m2 and 3.8 ± 1.1 vs 3.3 ± 0.8 cm2/m2, respectively, both p < 0.001). The basal RV diameter increased (30.4 ± 5.4 versus 31.1 ± 4.1 mm, p = 0.045), the mid-cavitary RV diameter did not change (25.8 ± 5.4 and 25.8 ± 4.2 mm, p = 0.852), and the base to apex RV length decreased (69.5 ± 8.8 vs 63.9 ± 8.3 mm, p < 0.001). Basal and mid RV sphericity indices (RVSI) increased (0.44 ± 0.07 vs 0.49 ± 0.07 and 0.37 ± 0.07 vs 0.41 ± 0.07, respectively, both p < 0.001). The systolic excursion of the fibrous ring of the tricuspid valve (TAPSE) (22.7 ± 3.2 and 22.8 ± 2.3 mm, p = 0.637) and the tricuspid annular peak systolic velocity S" did not change significantly (10.4 ± 2.6 and 10,1 ± 3.0 cm/s, p = 0.289). The fraction of change in the RV area (FAC RV) increased (52.6 ± 8.2 vs 55.0 ± 8.9%, p = 0.019). The right ventricular outflow tract velocity time integral (RVOT VTI) decreased (18.1 ± 4.0 vs 16.4 ± 3.7 cm, p < 0.001). There were tendencies to increase in the systolic pulmonary artery pressure (PAPs) (22.5 ± 7.1 and 23.3 ± 6.3 mm Hg, p = 0.076) and to increase of the right atrium (RA) long axis dimension (48.7 ± 6.5 vs 49.5 ± 6.3 mm, p = 0.074). Conclusions Compared to three months after discharge, in patients one year after COVID-19 pneumonia EchoCG showed the anteroposterior RV diameter and the end-diastolic RV area decreased, the FAC RV increased. However, increase of the basal and mid RVSI, decrease in the RVOT VTI and tendencies to increase of the PAPs and the RA long axis dimension was observed. A subgroup analysis is planned depending on the severity of lung damage during hospitalization.
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Funding Acknowledgements Type of funding sources: None. Background The long-term effect of a complicated course of COVID-19 on echocardiography (EchoCG) parameters, in particular on left heart, has not been sufficiently studied. Purpose To compare EchoCG parameters of left heart in patients with proven COVID-19 pneumonia 3 months and one year after discharge. Methods The patients were identified according to the data of the medical information system of the monohospital from April 2020 to July 2021 within the framework of "One-year Cardiac Follow-up of COVID-19 Pneumonia". A total of 116 men and women were included, mean age 49 ± 14.4 years, females 49.6%. During hospitalization, chest computed tomography detected mild lesions in 31.3%, moderate lesions in 33.3%, severe lesions in 29.3% and critical lesions in 6.1%. All patients underwent clinical examination including transthoracic EchoCG with 3 months ± 2 weeks and one year ± 3 weeks after discharge. All images were digitally stored and analyzed using off-line post processing with TomTec (Philips). The LV global and segmental longitudinal strain (LS) were studied in 100 individuals with satisfactory visualization quality 3 month after discharge and in 81 individuals one year after discharge. Results During the observation, the average body mass index of the subjects increased (28.7 ± 5.8 kg/m2 3 months after discharge vs 29.4 ± 6.1% one year after discharge, p < 0.001), as well as the rate of cardiovascular diseases (67% 3 months after discharge versus 79% one year after discharge, p = 0.008). Significant dynamics of mean left heart EchoCG parameters were observed. The mean index of left atrium (LA) maximal volume decreased (26.0 ± 7.2 vs 25.3 ± 7.4, p = 0.015), index of LA minimal volume increased (9.9 ± 5.4 vs 10.8 ± 5.6 ml/m2, p = 0.011). Left ventricular (LV) end-diastolic, end-systolic and stroke volume indexes decreased (49.3 ± 11.3 vs 46.9 ± 9.9 ml/m2, p = 0.008;16.0 ± 5.6 vs 14.4 ± 4.1 ml/m2, p = 0.001;36.7 ± 12.8 vs 30.8 ± 8.1 ml/m2, p < 0,001, respectively). The LV myocardial mass index increased (70.0 [60.8–84.0] vs 75.4 [68.2–84.9] g/m², p = 0.024). LV ejection fraction increased (68.1 ± 5.3 vs 69.7 ± 4.6%, p = 0.013). The LV global LS (-20.3 ± 2.2 vs -19.4 ± 2.7%, p = 0.001) and the LV segmental LS worsened: in mid segments (antero-septal -21.1 ± 3.3 vs -20.4 ± 4.1%, p = 0.039;inferior -21.0 ± 2.7 vs -20.0 ± 2.9%, p = 0.039;lateral -18.4 ± 3.7 vs -17.6 ± 4.4%, p = 0.021), and in apical segments (anterior -22.3 ± 5.0 vs -20.8 ± 5.2%, p = 0.006;inferior -24.6 ± 4.9 vs -22.7 ± 4.6, p = 0.003;lateral -22.7 ± 4.5 vs -20.4 ± 4.8%, p < 0.001;septal -25.3 ± 4.2 vs -23.1 ± 4,4%, p < 0.001;apical -23.7 ± 4.1 vs -21.8 ± 4.1%, p < 0.001). Conclusions Compared to 3 month after discharge, in patients one year after COVID-19 pneumonia the LA maximal volume, LV end-diastolic, end-systolic and stroke volumes decrease, and the LV ejection fraction increased. However, the LA minimal volume increased, and the LV global and segmental LS of the apical and mid LV segments worsened.
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Aim To study changes in clinical and echocardiographic parameters in patients after documented COVID-19 pneumonia at 3 months and one year following discharge from the hospital. Material and methods The study included 116 patients who have had documented COVID-19 pneumonia. Patients underwent a comprehensive clinical evaluation at 3 months ± 2 weeks (visit 1) and at one year ± 3 weeks after discharge from the hospital (visit 2). Mean age of the patients was 49.0±14.4 years (from 19 to 84 years); 49.6â% were women. Parameters of global and segmentary longitudinal left ventricular (LV) myocardial strain were studied with the optimal quality of visualization during visit 1 in 99 patients and during visit 2 in 80 patients.Results During the follow-up period, the incidence rate of cardiovascular diseases (CVD) increased primarily due to development of arterial hypertension (AH) (58.6 vs. 64.7â%, Ñ=0.039) and chronic heart failure (CHF) (35.3% vs. 40.5â%, Ñ=0.031). Echocardiography (EchoCG) showed decreases in values of end-diastolic dimension and volume, LV end-systolic and stroke volumes (25.1±2.6 vs. 24.5±2.2âmmâ/m2, p<0.001; 49.3±11.3 vs. 46.9±9.9âmlâ/m2, p=0.008; 16.0±5.6 vs. 14.4±4.1âmlâ/m2, p=0.001; 36.7±12.8 vs. 30.8±8.1âmlâ/m2, p<0.001, respectively). LV external short-axis area (37.1 [36.6-42.0] vs. 38.7 [35.2-43.1]âcm2, Ñ=0.001) and LV myocardial mass index calculated with the area-length formula (70.0 [60.8-84.0] vs. 75.4 [68.2-84.9]âgâ/m², Ñ=0.024) increased. LV early diastolic filling velocity (76.7±17.9 vs. 72.3±16.0âcmâ/sec, Ñ=0.001) and lateral and septal early diastolic mitral annular velocities decreased (12,10±3,9 vs. 11.5±4.1âcmâ/sec, Ñ=0.004 and 9.9±3.3 vs. 8.6±3.0âcmâ/sec, Ñ<0.001, respectively). The following parameters of LV global longitudinal (-20.3±2.2 vs. -19.4±2.7â%, Ñ=0.001) and segmental strain were impaired: apical segments (anterior, from -22.3±5.0 to -20.8±5.2â%, Ñ=0.006; inferior, from -24.6±4.9 to -22.7±4.6, Ñ=0.003; lateral, from -22.7±4.5 to -20.4±4.8â%, Ñ<0.001; septal, from -25.3±4.2 to -23.1±4.4â%, Ñ<0.001; apical, from -23.7±4.1 to -21.8±4.1â%, Ñ<0.001), mid-cavity (anteroseptal, from -21.1±3.3 to -20.4±4.1â%, Ñ=0.039; inferior, from -21.0±2.7 to -20.0±2.9â%, Ñ=0.039; lateral, from -18.4±3.7 to -17.6±4.4â%, Ñ=0.021). RV basal and mid-cavity sphericity indexes increased (0.44±0.07 vs. 0.49±0.07 and 0.37±0.07 vs. 0.41±0.07, respectively, Ñ<0.001 for both). A tendency for increased calculated pulmonary arterial systolic pressure (22.5±7.1 and 23.3±6.3âmm Hg, Ñ=0.076) was observed. Right ventricular outflow tract velocity integral decreased (18.1±4.0 vs. 16.4±3.7âcm, Ñ<0.001).Conclusion Patients after COVID-19 pneumonia one year after discharge from the hospital, compared to the follow-up data 3 months after the discharge, had an increased incidence of CVD, primarily due to the development of AH and CHF. EchoCG revealed changes in ventricular geometry associated with impairment of LV diastolic and systolic function evident as decreases in LV global longitudinal strain and LV myocardial apical and partially mid-cavity strain.
Subject(s)
COVID-19 , Patient Discharge , Adult , Echocardiography , Female , Humans , Middle Aged , SARS-CoV-2 , Stroke Volume , Ventricular Function, LeftABSTRACT
The study of the features and dynamics of the erythrocyte parameters of general blood analysis in patients with cardiovascular diseases who underwent SARS-CoV-2 associated pneumonia is of great practical importance. That was a prospective study. The study included 106 patients with SARS-CoV-2-associated pneumonia. All patients were divided into 2 groups. The first group included 51 patients without CVD, the second group included 55 patients with CVD .Patients in both groups underwent laboratory examination of blood samples at the time of hospitalization and 3 months after discharge from the hospital. Parameters of the erythroid series of the general blood test were assessed. Among inflammatory biomarkers, we examined the concentration of C-reactive protein (CRP), high-sensitivity CRP (hs-CRP) and homocysteine. Initially all patients underwent computed tomography of the chest organs. Revealed what indicators of the erythroid series in the groups of patients with and without CVD had significant differences in a number of parameters: ESR; RDW-SD and RDW-CV with significant excess of parameters in group 2. Three months after discharge from the hospital, patients in both groups had a significant increase in HCT, MCV, MCH. There was detected decrease in both groups in MCHC, RDW-CV (p<0.001 for all parameters), ESR level in group 2.At baseline, CRP exceeded reference values in both groups of patients, reaching maximum values in group 2. After 3 months CRP decreased significantly only in group 1. Increased CRP was associated with elevated hs-CRP in 3 months after discharge and elevated homocysteine levels in both groups, indicating the persistence of prolonged inflammatory vascular reaction in patients after SARS-CoV-2 associated pneumonia, more pronounced in group 2 patients. RDW-CV over 13.6 and lymphocytes / CRP less than 0.6 increase the likelihood of having lung tissue damage over 50% by 9.3 and 5.9 times, respectively. Thus, the data obtained confirm that RDW-CV, the coefficient of variation of erythrocyte distribution width, associated with the parameters of inflammatory response and the lymphocytes / CRP is lung volume marker and of COVID-19 severity. Careful consideration of already known laboratory parameters allows us to expand the number of indicators influencing the risk of COVID-19 complications and enable an earlier response to a difficult situation.
Subject(s)
COVID-19 , SARS-CoV-2 , Biomarkers , Erythrocyte Indices , Erythrocytes , Hematologic Tests , Humans , Prospective Studies , Retrospective StudiesABSTRACT
Background: COVID-19 is the highly contagious infectious disease, which affects different organs and systems. Anxiety and depression symptoms, that are common results of severe diseases, used to make recovery more difficult. Purpose: To study the prevalence of cardiovascular diseases, signs of anxiety, depression, stress, and their relationship in patients with proven COVID-19 pneumonia 3 months after discharge depending of gender. Methods: The study was carried out within “One-year Cardiac Follow-up of COVID-19 Pneumonia”. 103 patients (mean age 46.6±15.8 years) were divided into 2 groups: 52 men (50.9%) and 51 women. Anxiety and depression symptoms were measured by GAD-7 and PHQ-9, respectively. PSS-10 was used to measure stress symptoms. The minimum value of anxiety and depression was a total value of 5 points. Results: 48.5% of patients had cardiovascular diseases, out of which arterial hypertension (AH) was the most common (44.7%). Less common was coronary artery disease (CAD) (16.5%), which in 14.6% of patients was accompanied by AH. Chronic heart failure (CHF) NYHA class I-II was found in 19.4% of patients, and severe CHF (NYHA class III-IV) - in 4.9%. Arrhythmia was detected in 11.7% of patients. According to the clinical characteristics, no significant differences were found between the groups of men and women. AH affected 21.4% of men and 23.3% of women, CAD -10.7% and 5.8%, respectively. NYHA class I-II CHF were found in 8.7% of men and 10.7% of women, and severe CHF (NYHA class III-IV) - in 2 men and 3 women. Arrhythmia had a prevalence of less than 6% among both men and women. Anxiety or depression symptoms were reported in 29.1% and 27.2%, respectively. Combination of anxiety and depression symptoms was determined in 18.4%, symptoms of stress in 8.7% of patients. Symptoms of depression were found in women more often (p=0.023). The value of the median scores of the PHQ-9 questionnaire in the group of women was significantly higher than in the group of men (3.00 [1.00;8.00] and 1.00 [0;3.75], p=0.006). Depression symptoms were associated with female gender (OR 2.83;CI 95% 1.35-7.08). Despite the absence of gender differences in the prevalence of anxiety (18.4% and 10.7%, p=0.072), when comparing the values of the median scores of the GAD-7 questionnaire in the groups of men and women, the difference was statistically significant (1.00 [0;4.00] and 3.00 [2.00;7.00], p=0.001, respectively). Signs of stress among married people were less common in comparison with unmarried (2.9% vs 5.8%, p=0.037). Conclusion: Three months after discharge, no significant differences in clinical characteristics between men and women were found. Signs of anxiety or depression were detected in more than a quarter of patients with proven COVID-19-associated pneumonia. Women experienced symptoms of depression 3 times more often than men. Unmarried patients tended to experience stress more often.
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Background: The coronavirus disease 2019 (COVID-19) has spread around the world with high cardiovascular complications and mortality. Patients with heart pathology and diabetes mellitus were at greatest risk. An accurate and timely laboratory diagnosis is a vital step to help manage cardiovascular disease during this pandemic. Purpose: To conduct a prospective analysis of complete blood count parameters, inflammatory response, endothelial dysfunction of arterial wall and hemostasis in groups of patients undergoing COVID-19 associated pneumonia with and without type 2 diabetes mellitus (DM2);to highlight indicators of long-term adverse cardiovascular events. Methods: The study was carried out within register on one-year cardiac follow-up of patients after COVID-19-associated pneumonia. Patients (n=380) were identified in the period from April to July 2020 according to the data of medical information system of monoinfectious hospital. At the moment, data of the first 65 patients with cardiovascular pathology are obtained. Group 1 included 53 patients without DM2 (mean age 47.83±15.86 years), group 2 consisted of 12 patients with DM2 (61.71±9.12 years). Baseline parameters of complete blood count, biochemistry and hemostasis were assessed on the day of hospitalization. In-depth analysis of laboratory parameters was carried out in 3 months. Results: In group 1 significant decrease of coagulogram parameters: INR (p=0.004), fibrinogen, APTT, thrombocrit, large platelets level (p<0.0001), CRP level, liver enzymes (p<0.0001), leukocytes (p=0.015), erythrocytes (p=0.006) and increase in hematocrit (p<0.0001) were registered in 3 months compared to baseline data. In group 2 positive dynamics of CRP (p=0.018), platelets (p=0046), APTT (p=0.043) and erythrocytes (p=0.028) were revealed, while CRP concentration remained higher than reference values in 3 months. In group 2 in-depth analysis of biomarkers revealed values exceeding normal levels: hs-CRP (4.72±3.33 mg/L), homocysteine (13.17±7.95 μmol/L), myeloperoxidase (47.6±38.51), NT-proBNP (154.56±127.30 mg/ml), P-selectin (141.29±124.71) TgFb1 (6549.86±1987.87 pg/ml). Correlation analysis detected positive association of homocysteine level with platelets level (p=0.002. R=0.998), myeloperoxidase with fibrinogen (p=0.012. R=0.865). Conclusion: Three months after COVID-19 elevated levels of inflammatory markers (CRP, hs-CRP, homocysteine), endothelial dysfunction and thrombophilia (large platelets, P-selectin, TgFb1) are indicators of prolonged arterial inflammatory syndrome and increased predisposition to coagulopathy with thrombosis determining a very high risk of developing adverse cardiovascular events in patients with DM2.
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Introduction: It is currently unknown what effect SARS-CoV-2 infection has on the parameters of aseptic inflammation in patients with cardiovascular diseases (CVD) in the long-term follow-up period and whether there is a relationship between the prolonged inflammatory response and the indicators of the global longitudinal strain, as the earliest marker of systolic dysfunction of left and right ventricles. Purpose: To study the dynamics of markers of the inflammatory response and to assess the potential relationship of biomarkers of inflammation with parameters of left and right ventricular systolic function in patients with CVD who underwent COVID-19-associated pneumonia at the reference point 3 months after hospitalization. Methods: The study included 63 patients (mean age 49.0±16.0 years) within One-year Cardiac Follow-up of COVID-19 Pneumonia. Group 1 (n=26) included patients without a history of CVD, group 2 (n=37) -patients with CVD. Three months after discharge from the hospital, patients came for a visit, where blood sampling and echocardiography with speckle tracking analysis were performed. Results: At the stage of hospitalization, according to the computed tomography data, there were no differences in the volume of lung lesions in the groups. Patients with CVD had a higher level of highly sensitive C-reactive protein (CRP) upon admission to the hospital (group 1-33.12 [4.70-45.00] mg/l;group 2-47.16 [7.75-76.40] mg/L, p=0.039). Naturally, in the general group after 3 months, the indicators reflecting the inflammatory response significantly decreased: CRP from 26.10 [5.02- 57.5] mg/L to 1.86 [0.76-3.43] mg/L, p<0.001;neutrophil-lymphocyte ratio (NLR), from 2.05 [1.08-2.94] to 1.54 [1.27-1.90], p=0.009;coefficient of large platelets, M±SD from 34.30±6.74 to 23.60±6.59, p<0.001. There were no differences between the groups in the dynamics of inflammation biomarkers. In group 1, there were no laboratory biomarkers associated with the parameters of myocardial systolic function. In group 2 negative relationship was recorded between the global longitudinal strain of the left ventricle and the CRP level c (r=-0.388;p=0.037) and with the platelet-lymphocyte ratio (PLR) (r=-0.383;p=0.040);endocardial global longitudinal strain of the right ventricle with CRP level (r=-0.386;p=0.039). Conclusions: In patients who underwent COVID-19-associated pneumonia, after 3 months, the dynamics of laboratory markers of the inflammatory response did not depend on the presence of concomitant cardiac pathology, but only in patients with CVD there was a negative relationship between indicators of systolic function of the left and right ventricles and biomarkers of the inflammatory response.
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COVID-19 (The 2019 Corona Virus Disease) is a highly contagious infectious disease that affects the functioning of many organs and systems. The severe cases of the disease contributes to the development of anxiety-depressive and stressful symptoms that are factors make it difficult to recover. Objective. To study the presence, prevalence of signs of anxiety, depression, stress and their relationship with cardiovascular diseases among patients who have undergone confirmed COVID-19-associated pneumonia 3 months after discharge. Material and methods. The collection of material was carried out as part of the study “One-year cardiovascular observation of patients after COVID-19-associated pneumonia”. The study included 103 patients aged 18 to 85 years (mean age 46.6±15.8 years) who had undergone confirmed COVID-19-associated pneumonia 3 months±2 weeks after discharge from the hospital including 51 (49.1%) woman. The GAD-7 and PHQ-9 scales were used to assess the signs of anxiety and depression, respectively. The minimum value of anxiety and depression was considered a total score of 5 points. Signs of stress were assessed using Stress Severity Scale 10;the minimum threshold value was 30 point. Results. Signs of anxiety and depression were found in approximately the same number of patients (29.1 and 27.2%, respectively), a combination of signs of anxiety and depression — in 18.4% of patients, stress — in 8.7% of patients. In terms of clinical charac-teristics, no significant differences were found between the groups of men and women. The prevalence of depression signs differed significantly depending on gender: significantly more often in women (p=0.023). The value of the median scores of the PHQ-9 questionnaire in the group of women is significantly higher than in the group of men (3.00 [1.00;8.00] and 1.00 [0;3.75], respectively;p=0.006). Logistic regression analysis showed that female gender increases the likelihood of depression by 2.83 times (95% CI 1.35-7.08). Despite the fact that there were no differences in gender in assessing the prevalence of anxiety (18.4 and 10.7% for men and women, respectively;p=0.072) when comparing the values of the median scores of the GAD-7 questionnaire in groups of men and women, the difference was statistically significant (1.00 [0;4.00] and 3.00 [2.00;7.00], respectively;p=0.001). Signs of stress among married people were less common compared with unmarried (2.9% versus 5.8%;p=0.037). Conclusion. Signs of anxiety or depression are characteristic of more than a quarter of patients who have had proven COVID-19-as-sociated pneumonia 3 months after discharge from the hospital. Women experience symptoms of depression 3 times more often than men do. Unmarried patients tend to experience more stress. It seems expedient to organize treatment and prophylactic work with patients who have undergone hospitalization for COVID-19-associated pneumonia using methods of psychological correc-tion and psychotherapy. © 2021, Media Sphera Publishing Group. All rights reserved.
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Coronavirus disease 2019 (COVID-19) is an infectious disease that affects almost all organs and systems. The main target is the respiratory system, but cardiovascular involvement is also common. Today, it is relevant to study the effect of complicated COVID-19 course on the patient’s cardiovascular system after hospital discharge — in particular, echocardiographic parameters. Aim. To study the echocardiographic parameters of patients with COVID-19 pneumonia 3 months after discharge from the hospital. Material and methods. The study included 106 patients with documented COVID-19 pneumonia. Patients underwent a comprehensive examination during hospitalization and 3 months ± 2 weeks after hospital discharge. The mean age of participants was 47±16 years (from 19 to 84 years), while 49% were women. Results. Three months after discharge, the average body mass index of the subjects was 28,2±5,7 kg/m2. Obesity was noted in 37,1%, cardiovascular diseases — in 52%. According to echocardiography, the prevalence of right ventricular (RV) dilatation was 2,9%, a decrease in tricuspid annular plane systolic excursion (TAPSE) — 9,5%, grade ≥2 tricuspid regurgitation — 1,9%, pulmonary hypertension (pulmonary artery systolic pressure >36 mm Hg) — 3,8%. The mean value of RV global longitudinal myocardial strain (GLMS RV) and global longitudinal myocardial strain (GLES RV) was 19,6±4,5 and 20,6±4,6, respectively. We found moderate correlations between GLMS RV and blood flow time through the left ventricular outflow tract (OT) (r=-0,436), through the mitral valve (r=-0,390;both p<0,0001) and through the RVOT (r=-0,348;р=0,004), with cardiac index (CI) (r=0,316;p=0,009), as well as between GLES RV and blood flow time through the LVOT (r=-0,411;p<0,0001) and RVOT (r=-0,300;p=0,005), and with CI (r=0,302;p=0,004). At the same time, the correlation of GLES RV with RV fractional area change (FAC) was weak (r=-0,283;p=0,007), while there was no correlation with the TAPSE. In addition, correlation of GLMS RV with these parameters were not defined. Conclusion. Three months after COVID-19 pneumonia, RV strain parameters were shown to have stronger relationships with time characteristics of flows in LVOT and RVOT, as well as with CI, than with such generally accepted characteristics of RV function as FAC and TAPSE.
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Aim. To compare the cardiovascular and psychological profile of young military population after coronavirus disease 2019 (COVID-19) with/without pneumonia. Material and methods. We examined 26 military men under 30 years of age (22,3±3,7 years/21,0 [19,8;24,3] years) with documented COVID 19 (3 months±2 weeks after two virus-negative polymerase chain reaction tests). The participants were divided into 2 groups: experimental group (n=16) — those with COVID-19 pneumonia;comparison group (n=10) — those without pneumonia. All subjects underwent a complex of clinical and diagnostic tests. Results. Military men with COVID-19 pneumonia were significantly older (23,0 [20,5;28,5] years vs 19,5 [19,0;20,0] years, p=0,001). They had a prolonged PQ interval (154,5 [140,0;163,5] ms vs 137,0 [134,0;144,0] ms;p=0,014). According to echocardiography, the following parameters were significantly larger in experimental group: anteroposterior right ventricular dimension (26,0 [24,5;27,5] mm vs 23,5 [22,0;25,0] mm, p=0,012), right atrium length (48,0 [46,0;51,5] mm and 45,5 [44,0;47,0] mm, p=0,047), tricuspid regurgitation peak gradient (18,0 [15,5;22,0] mm vs 14,0 [12,0;20,0] mm, p=0,047), pulmonary artery systolic pressure (PASP) (30,3 [27,6;34,0] mm Hg vs 23,0 [20,5;30,5] mm Hg, p=0,038), mean pulmonary artery pressure (20,3 [18,9;22,7] mm Hg vs 16,8 [14,5;20,6] mm Hg, p=0,038). The estimated pulmonary vascular resistance was significantly higher in the study group (1,50 [1,2;1,8] Wood units vs 1,17 [1,1;1,2] Wood units, p<0,001). The groups did not differ significantly in terms of symptoms of stress (perceived stress scale score of 10) and anxiety and depression disorders (GAD7 and PHQ9 questionnaires), quality of life (SF-36 survey). Conclusion. In young military personnel, COVID-19 pneumonia in the long term after the disease is associated with longer PQ interval, older age and larger right heart sizes on echocardiography, as well as with a higher tricuspid regurgitation peak gradient, PASP, mean pulmonary artery pressure, and pulmonary vascular resistance. In this category of population, no association was found between the severity of COVID-19 and psychological status parameters.
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Purpose: to study the hemodynamics of the bulbar conjunctiva in patients with dyslipidemia and a history of COVID-19 associated pneumonia who received etiopathogenetic therapy. Material and methods. 54 patients (108 eyes) aged 61 ± 14 with a documented diagnosis of COVID-19-associated pneumonia and dyslipidemia were prospectively examined 3 months after the discharge from hospital. Patients were divided into two groups, identical in gender and age, depending on the presence or absence of metabolic syndrome. For 1 month, both groups received etiotropic therapy: statins, antioxidants thioctic acid pills and topical antioxidant instillations (1 % solution of Emoxipine® three times a day, and instillations of NSAID Broxinac® (in the form of 0.09 % Bromfenacum eyedrops) 1 drop 2 times a day. Results. Improvement was achieved in perivascular parameters (of 54 % of patients of group 1 and 50 % of patients of group 2);in the shape of blood vessels (in 10 and 11 % of cases, respectively);intravascular parameters (in 71 and 78 %, respectively). Conclusion. The proposed etiopathogenetic therapy has a positive effect on the state of damaged bulbar conjunctiva microcirculation. © 2021, Real Time LLC. All rights reserved.
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Objective: To investigate the level and relationship of specific immunoglobulin G (IgG) antibodies to SARS-CoV-2 with laboratory parameters of vascular inflammatory response (VIR) during follow-up of patients with arterial hypertension (AH) in 3 months after disease onset. Design and method: Retrospective, single-center observational study included 76 confirmed cases of COVID-19 associated with pneumonia (April-May 2020). Gr.1 consisted of 32 patients without AH;Gr.2 involved 44 AH patients, including 18 patients with metabolic disorders (abdominal obesity and impaired carbohydrate metabolism). Complete blood count, biochemical and hemostatic parameters were determined on the day of admission. Comprehensive analysis of clinical instrumental and laboratory parameters, including blood pressure, heart rate, IgG (positivity rate), cytokines, NT-pro BNP, endothelial dysfunction markers, cystatin C, glucose and others was performed in 3 months after discharge. Results: In Gr.1, IgG was negatively associated with hemoglobin, red blood cell volume, neutrophils, creatine phosphokinase, homocysteine, those were supplemented by NT-pro BNP, interleukin-6, lactate dehydrogenase, creatinine (p<0.0001-0.034) in Gr.2 and additionally, D-dimer level, transforming growth factor and P-selectin (p <0.001-0.036) in metabolic disorders subgroup. Therewith, in patients aged over 40 years, positive association of IgG with levels of SBP and DBP (p<0.011 and 0.034), MDRD (p <0.01) was registered. Correlation and regression analysis revealed greater association of IgG level <12.9 with vascular inflammatory markers, and IgG level >12.9 with thrombogenic parameters. Conclusions: IgG might be a sensitive indicator of VIR and can play a role in predicting possible unwanted vascular complications in AH patients after suffering from SARS-CoV-2.