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1.
PLoS One ; 17(5): e0267327, 2022.
Article in English | MEDLINE | ID: covidwho-2039302

ABSTRACT

OBJECTIVE: The complex link between nutritional status, protein and lipid synthesis, and immunity plays an important prognostic role in patients with heart failure. However, the association between appetite loss at discharge and long-term outcome remains unclear. METHODS: The Kyoto Congestive Heart Failure registry is a prospective cohort study that enrolled consecutive patients hospitalized for acute decompensated heart failure (ADHF) in Japan. We assessed 3528 patients alive at discharge, and for whom appetite and follow-up data were available. We compared one-year clinical outcomes in patients with and without appetite loss at discharge. RESULTS: In the multivariable logistic regression analysis using 19 clinical and laboratory factors with P value < 0.1 by univariate analysis, BMI < 22 kg/m2 (odds ratio (OR): 1.57, 95% confidence interval (CI): 1.11-2.24, P = 0.01), CRP >1.0mg/dL (OR: 1.49, 95%CI: 1.04-2.14, P = 0.03), and presence of edema at discharge (OR: 4.30, 95%CI: 2.99-6.22, P<0.001) were associated with an increased risk of appetite loss at discharge, whereas ambulatory status (OR: 0.57, 95%CI: 0.39-0.83, P = 0.004) and the use of ACE-I/ARB (OR: 0.70, 95% CI: 0.50-0.98, P = 0.04) were related to a decreased risk in the presence of appetite loss. The cumulative 1-year incidence of all-cause death (primary outcome measure) was significantly higher in patients with appetite loss than in those without appetite loss (31.0% vs. 15.0%, P<0.001). The excess adjusted risk of appetite loss relative to no appetite loss remained significant for all-cause death (hazard ratio (HR): 1.63, 95%CI: 1.29-2.07, P<0.001). CONCLUSIONS: Loss of appetite at discharge was associated with worse 1-year mortality in patients with ADHF. Appetite is a simple, reliable, and useful subjective marker for risk stratification of patients with ADHF.


Subject(s)
Heart Failure , Patient Discharge , Angiotensin Receptor Antagonists , Angiotensin-Converting Enzyme Inhibitors , Appetite , Humans , Prognosis , Prospective Studies , Registries
2.
J Cardiol Cases ; 26(4): 305-307, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1914559

ABSTRACT

Coronavirus disease 2019 (COVID-19) has been associated with arterial thrombosis, including aortic thrombus with embolism as well as venous thrombosis. We report a case of a 59-year-old man with COVID-19 showing thrombus in the ascending aorta and occlusion of the lower limb artery on computed tomography. Anticoagulant therapy via continuous intravenous infusion of heparin was started with a therapeutic target range (activated partial thromboplastin time 42-70 s, 1.5-2.5 × patient baseline). The patient was then transferred to warfarin medication and prothrombin time-international normalized ratio was managed at 1.5-2.5. The disappearance of the thrombus was confirmed on the 20th day after starting anticoagulant therapy. Anticoagulant therapy was then discontinued, and computed tomography angiography (CTA) 3 months later showed no recurrence of aortic thrombi or embolism. Anticoagulant therapy alone may be considered for arterial thrombosis in COVID-19 and follow-up CT may allow for early discontinuation of anticoagulant therapy to confirm disappearance of thrombus. Learning objective: Coronavirus disease 2019 (COVID-19) is recognized to cause arterial thrombosis as well as venous thrombosis. However, treatment of aortic thrombosis in patients with COVID-19 has not yet been established. Anticoagulants alone may be effective against aortic thrombi in patients with COVID-19 and follow-up computed tomography may allow for early discontinuation of anticoagulant therapy to confirm disappearance of thrombus.

5.
J Cardiol Cases ; 26(1): 17-20, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1676800

ABSTRACT

There is increasing evidence for myocarditis as a complication of the mRNA coronavirus disease 2019 (COVID-19) vaccination. We report the case of a 20-year-old previously healthy man who presented with fever and chest pain 2 days after the second dose of mRNA-1273 vaccine. Electrocardiogram and laboratory studies showed extensive ST-segment elevation accompanied by elevated cardiac biomarkers. Cardiac magnetic resonance (CMR) revealed late gadolinium enhancement (LGE) characteristics of myocarditis. The patient rapidly improved with conservative management and was discharged on hospital day 6. As an advantage over previous reports, we performed a 1-month follow-up CMR. It showed improvement in myocardial edema but persistence of LGE which may indicate irreversible fibrosis. CMR may be useful not only for diagnosis but also for prognostic evaluation of myocarditis after COVID-19 mRNA vaccination. .

6.
J Cardiol ; 79(4): 501-508, 2022 04.
Article in English | MEDLINE | ID: covidwho-1587218

ABSTRACT

BACKGROUND: Patients with coronavirus disease 2019 (COVID-19) and underlying cardiovascular comorbidities have poor prognoses. Our aim was to identify the impact of serum lactate dehydrogenase (LDH), which is associated with mortality in acute respiratory distress syndrome, on the prognoses of patients with COVID-19 and underlying cardiovascular comorbidities. METHODS: Among 1518 patients hospitalized with COVID-19 enrolled in the CLAVIS-COVID (Clinical Outcomes of COVID-19 Infection in Hospitalized Patients with Cardiovascular Diseases and/or Risk Factors study), 515 patients with cardiovascular comorbidities were analyzed. Patients were divided into tertiles based on LDH levels at admission [tertile 1 (T1), <235 U/L; tertile 2 (T2), 235-355 U/L; and tertile 3 (T3); ≥356 U/L]. We investigated the impact of LDH levels on the in-hospital mortality. RESULTS: The mean age was 70.4 ± 30.0 years, and 65.3% were male. There were significantly more in-hospital deaths in T3 than in T1 and T2 [n = 50 (29.2%) vs. n = 15 (8.7%), and n = 24 (14.0%), respectively; p < 0.001]. Multivariable analysis adjusted for age, comorbidities, vital signs, and laboratory data including D-dimer and high-sensitivity troponin showed T3 was associated with an increased risk of in-hospital mortality (adjusted hazard ratio, 3.04; 95% confidence interval, 1.50-6.13; p = 0.002). CONCLUSIONS: High serum LDH levels at the time of admission are associated with an increased risk of in-hospital death in patients with COVID-19 and known cardiovascular disease and may aid in triage of these patients.


Subject(s)
COVID-19 , Cardiovascular Diseases , Adult , Aged , Aged, 80 and over , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Hospital Mortality , Humans , L-Lactate Dehydrogenase , Male , Middle Aged , Prognosis , Retrospective Studies , SARS-CoV-2
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