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2.
Int J Environ Res Public Health ; 19(10)2022 05 12.
Article in English | MEDLINE | ID: covidwho-1855596

ABSTRACT

SARS-CoV2 infection, responsible for the COVID-19 disease, can determine cardiac as well as respiratory injury. In COVID patients, viral myocarditis can represent an important cause of myocardial damage. Clinical presentation of myocarditis is heterogeneous. Furthermore, the full diagnostic algorithm can be hindered by logistical difficulties related to the transportation of COVID-19 patients in a critical condition to the radiology department. Our aim was to study longitudinal systolic cardiac function in patients with COVID-19-related myocarditis with echocardiography and to compare these findings with cardiac magnetic resonance (CMR) results. Patients with confirmed acute myocarditis and age- and gender-matched healthy controls were enrolled. Both patients with COVID-19-related myocarditis and healthy controls underwent standard transthoracic echocardiography and speckle-tracking analysis at the moment of admission and after 6 months of follow-up. The data of 55 patients with myocarditis (mean age 46.4 ± 15.3, 70% males) and 55 healthy subjects were analyzed. The myocarditis group showed a significantly reduced global longitudinal strain (GLS) and sub-epicardial strain, compared to the control (p < 0.001). We found a positive correlation (r = 0.65, p < 0.0001) between total scar burden (TSB) on CMR and LV GLS. After 6 months of follow-up, GLS showed marked improvements in myocarditis patients on optimal medical therapy (p < 0.01). Furthermore, we showed a strong association between baseline GLS, left ventricular ejection fraction (LVEF) and TSB with LVEF at 6 months of follow-up. After a multivariable linear regression analysis, baseline GLS, LVEF and TSB were independent predictors of a functional outcome at follow-up (p < 0.0001). Cardiac function and myocardial longitudinal deformation, assessed by echocardiography, are associated with TSB at CMR and have a predictive value of functional recovery in the follow-up.


Subject(s)
COVID-19 , Myocarditis , Adult , COVID-19/diagnostic imaging , Cicatrix/complications , Cicatrix/diagnostic imaging , Echocardiography/methods , Female , Humans , Male , Middle Aged , Myocarditis/complications , Myocarditis/diagnostic imaging , Prognosis , RNA, Viral , SARS-CoV-2 , Stroke Volume , Ventricular Function, Left
3.
Journal of Arrhythmia ; n/a(n/a), 2022.
Article in English | Wiley | ID: covidwho-1782628

ABSTRACT

Background The effects of lockdown on non-COVID patients are varied and unexpected. The aim is to evaluate the burden of cardiac arrhythmias during a lockdown period because of COVID-19 pandemics in a population implanted with cardiac defibrillators and followed by remote monitoring. Methods In this retrospective, multicentre cohort study, we included 574 remotely monitored implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) recipients implanted before January 1, 2019, at seven hospitals in the Campania region, comparing the burden of arrhythmias occurred during the lockdown period because of COVID-19 epidemics (from March 9 to May 1, 2020) with the arrhythmias burden of the corresponding period in 2019 (reference period). Data collection was performed through remote monitoring. Results During the lockdown period, we observed ventricular tachyarrhythmias (ventricular tachycardia or fibrillation) in 25 (4.8%) patients while in seasonal reference period we documented ventricular tachyarrhythmias in 12 (2.3%) patients;the comparison between the periods is statistically significant (P?<?.04). Atrial arrhythmias were detected in 38 (8.2%) subjects during the lockdown period and in 24 (5.2%) during the reference period (P?<?.004). Conclusion In seven hospitals in the Campania region, during the pandemic lockdown period, we observed a higher burden of arrhythmic events in ICD/CRT-D patients through device remote monitoring.

4.
Medicina (Kaunas) ; 58(4)2022 Apr 11.
Article in English | MEDLINE | ID: covidwho-1785810

ABSTRACT

Background and objectives: COVID-19 is associated with an aberrant inflammatory response that may trigger new-onset cardiac arrhythmias. The aim of this study was to assess the mortality risk in hospitalized COVID-19 patients according to IL-6 serum levels and new-onset atrial fibrillation (AF) according to PaO2/FiO2 stratification. Materials and Methods: 175 COVID-19 patients (25 new-onset AF, 22 other types of AF and 128 no-AF) were included in this single-center, retrospective study; clinical and demographic data, vital signs, electrocardiograms and laboratory results were collected and analyzed. The primary outcome of the study was to evaluate the mortality rate in new-onset AF patients according to IL-6 serum levels and PaO2/FiO2 stratification. Results: The incidence of new-onset AF in the study population was 14.2%. Compared to the no-AF group, new-onset AF patients were older with a positive history of chronic kidney disease and heart failure, had higher IL-6, creatinine and urea serum levels whereas their platelet count was reduced. After PaO2/FiO2 stratification, 5-days mortality rate was higher in new-onset AF patients compared to patients with other types of AF and no-AF patients, and mortality risk increases 5.3 fold compared to no-AF (p = 0.0014) and 4.8 fold compared to other forms of AF (p = 0.03). Conclusions: New-onset AF is common in COVID-19 patients and is associated with increased IL-6 serum levels and early mortality. Further studies are needed to support the use of IL-6 as an early molecular target for COVID-19 patients to reduce their high rate of mortality.


Subject(s)
Atrial Fibrillation , COVID-19 , Respiratory Distress Syndrome , Atrial Fibrillation/epidemiology , COVID-19/complications , Dyspnea , Female , Humans , Interleukin-6 , Male , Retrospective Studies , Risk Factors
5.
Eur J Clin Invest ; : e13781, 2022 Mar 28.
Article in English | MEDLINE | ID: covidwho-1764910

ABSTRACT

INTRODUCTION: Some abnormal electrocardiographic findings were independently associated with increased mortality in patients admitted for COVID-19; however, no studies have focussed on the prognosis impact of the interatrial block (IAB) in this clinical setting. The aim of our study was to assess the prevalence and clinical implications of IAB, both partial and advanced, in hospitalized COVID-19 patients. MATERIALS: We retrospectively evaluated 300 consecutive COVID-19 patients (63.22 ± 15.16 years; 70% males) admitted to eight Italian Hospitals from February 2020 to April 2020 who underwent twelve lead electrocardiographic recording at admission. The study population has been dichotomized into two groups according to the evidence of IAB at admission, both partial and advanced. The differences in terms of ARDS in need of intubation, in-hospital mortality and thromboembolic events (a composite of myocardial infarction, stroke and transient ischaemic attack) have been evaluated. RESULTS: The presence of IAB was noticed in 64 patients (21%). In the adjusted logistic regression model, the partial interatrial block was found to be an independent predictor of ARDS in need of intubation (HR: 1.92; p: .04) and in-hospital mortality (HR: 2.65; p: .02); moreover, the advanced interatrial block was an independent predictor of thrombotic events (HR: 7.14; p < .001). CONCLUSIONS: Among COVID-19 patients hospitalized in medical wards, the presence of interatrial block is more frequent than in the general population and it might be useful as an early predictor for increased risk of incident thrombotic events, ARDS in need of intubation and in-hospital mortality.

6.
Medicina (Kaunas) ; 58(3)2022 Mar 07.
Article in English | MEDLINE | ID: covidwho-1732122

ABSTRACT

Background and objectives: Pre-existing atrial fibrillation (AF) is a frequent comorbidity in hospitalized patients with COVID-19; however, little is still known about its prognostic role in infected patients. The aim of our study was to evaluate whether the pre-existing AF as comorbidity would contribute to increase the risk for severe forms of COVID-19, worse prognosis, or even higher mortality. Materials and Methods: We retrospectively evaluated all consecutive COVID-19 patients admitted to the emergency department of nine Italian Hospitals from 1 March to 30 April 2020.The prevalence and the type of pre-existing AF have been collected. The correlation between the history and type of AF and the development of severe ARDS and in-hospital mortality has been evaluated. Results: In total, 467 patients (66.88 ± 14.55 years; 63% males) with COVID-19 were included in the present study. The history of AF was noticed in 122 cases (26.1%), of which 12 (2.6%) with paroxysmal, 57 (12.2%) with persistent and 53 (11.3%) with permanent AF. Among our study population, COVID-19 patients with AF history were older compared to those without AF history (71.25 ± 12.39 vs. 65.34 ± 14.95 years; p < 0.001); however, they did not show a statistically significant difference in cardiovascular comorbidities or treatments. Pre-existing AF resulted in being independently associated with an increased risk of developing severe ARDS during the hospitalization; in contrast, it did not increase the risk of in-hospital mortality. Among patients with AF history, no significant differences were detected in severe ARDS and in-hospital mortality between patients with permanent and non-permanent AF history. Conclusions: Pre-existing AF is a frequent among COVID-19 patients admitted to hospital, accounting up to 25% of cases. It is independently associated with an increased risk of severe ARDS in hospitalized COVID-19 patients; in contrast, it did not affect the risk of death. The type of pre-existing AF (permanent or non-permanent) did not impact the clinical outcome.


Subject(s)
Atrial Fibrillation , COVID-19 , Atrial Fibrillation/complications , Atrial Fibrillation/epidemiology , COVID-19/complications , Female , Humans , Male , Prognosis , Retrospective Studies , Risk Factors
7.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-323356

ABSTRACT

Background: After the outbreak of a novel coronavirus (i.e. SARS COV2) in China and its diffusion around the world, great attentions was reserved to the increased incidence of venous thromboembolism in these patients. A specific antiviral action of heparins toward SARS COV2 has been reported in vitro such as a well know action of heparins to prevent VTE in inpatients with infective disease has already been reported since several years. Yet, because fondaparinux represent the pharmacological antithrombotic active sequence of all heparins and because its clinical indication o prevent VTE in inpatients is similar to heprains, we realized a retrospective analysis in inpatients with SARS COV2 on the incidence of VTE during pharmacological prophylaxis with enoxaparin or fondaparinux. This retrospective analysis was named FONDENOXAVID. Methods: We conducted a retrospective cohort study that used patients with SARS COV2 during the Italian outbreak from February 18, 2020 to April 30, 2020. Our aim was to compare the clinical characteristics, prophylactic treatment and outcomes in inpatients positive to SARS COV2 at risk to develop venous thromboembolism, in particular venous thrombosis with or without pulmonary embolism, during in-hospital primary thromboprophylaxis with enoxaparin (40 mg or 60 mg once daily) or fondaparinux (2.5 mg once daily). Statistical analysis was conducted with using MatLab R2016B and eventually ad hoc functions. Results: There were not significative differences in clinical characteristics between patients that used enoxaparin or fondaparinux as thromboprpophylaxis for SARS COV2. The cumulative incidence of thrombotic events was not different in patients that used enoxaparin or fondaparinux as thromboprpophylaxis. No differences were found also in d-dimer and fibrinogen levels test at the admission and after 3 weeks as markers of prolonged inflammation due to SARS COV2. Discussion: The increased incidence of VTE in vivo has been reported in several studies although prophylaxis with low molecular weight heparin was conducted in some of them. The clinical indication to prevent VTE was similar for heparins and fondaparinux. In our results a non-inferiority to prevent VTE was recorded when inpatients with SARS COV2 were treated with prophylactic doses of enoxaparin or fondaparinux according to international guidelines. The incidence of VTE in this retrospective analysis showed that Fondaparinux at fixed doses of 2.5 mg daily was not inferior to enoxaparin (4000 UI daily). Our results testify that fondaparinux and enoxaparin showed the same efficacy to reduce the incidence of VTE in inpatients with SARS COV2.

8.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-309767

ABSTRACT

Aims: to evaluate the incidence of cardiac arrhythmias during a lockdown period due to COVID-19 pandemics in a population followed by remote monitoring through implanted cardiac defibrillators. Methods and results In this retrospective, multicentre cohort study, we included 574 remotely monitored automatic (AICD) and cardiac resynchronization devices (CRT-D) recipients implanted before January 1st 2019 at seven Hospitals of Campania Region, comparing the incidence of arrhythmias occurred during the lockdown period due to COVID-19 epidemics (from March 9th to May 1st 2020) with the arrhythmias rate of the corresponding period in 2019. An effective retrospective data collection was performed through remote monitoring, as this tool allows the direct transfer of the the information stored by the implantable devices to medical personnel. During the lockdown period, we observed ventricular tachyarrhythmias (ventricular tachycardia or fibrillation) in 25 (4.8%) patients as compared to 12 (2.3%) during the corresponding 2019 period (p < 0.04);new-onset atrial fibrillation was detected in 38 (8.2%) subjects during lockdown period and in 24 (5.2%) during the reference period (p < 0.004). Conclusion During pandemics lockdown period we observed an higher incidence of arrhythmic events in ICD/CRT-D patients followed up through device remote monitoring by seven hospitals of Campania region.

9.
Int J Environ Res Public Health ; 19(3)2022 Feb 02.
Article in English | MEDLINE | ID: covidwho-1667171

ABSTRACT

Italy was the second country to be affected by COVID-19 in early 2020, after China. The confrontation with the pandemic led to great changes in the world of work and, consequently, to the personal world of workers. In such a challenging situation, it is essential to be able to rely on resources that facilitate individual coping. The aim of this study was to understand the association between personal resources (optimism and humor) and exhaustion, and the role of self-compassion in this relationship. A structural equation model (SEM) was used to test the hypotheses on a heterogeneous sample of 422 Italian workers during the first lockdown in April-May 2020. The results revealed that optimism and humor were positively associated with self-compassion; optimism and humor also had a negative association with exhaustion; and self-compassion had a mediating role between the two personal resources and exhaustion. These results confirmed the importance of personal resources in maintaining workers' wellbeing during a challenging period such as the pandemic. The present study also contributes to the body of knowledge on self-compassion, a relatively new construct that has been little studied in the organizational field.


Subject(s)
Burnout, Professional , COVID-19 , Burnout, Professional/epidemiology , Communicable Disease Control , Empathy , Humans , Pandemics , SARS-CoV-2
11.
J Pers Med ; 12(2)2022 Jan 26.
Article in English | MEDLINE | ID: covidwho-1649806

ABSTRACT

The characteristics and clinical course of hospitalized patients with coronavirus disease 2019 (COVID-19) have been widely described, while long-term data are still poor. The aim of this study was to evaluate the long-term clinical outcome and its association with right ventricular (RV) dysfunction in hospitalized patients with COVID-19. This was a prospective multicenter study of consecutive COVID-19 patients hospitalized at seven Italian Hospitals from 28 February to 20 April 2020. The study population was divided into two groups according to echocardiographic evidence of RV dysfunction. The primary study outcome was 1-year mortality. The propensity score matching was performed to balance for potential baseline confounders. The study population consisted of 224 patients (mean age 69 ± 14, male sex 62%); RV dysfunction was diagnosed in 63 cases (28%). Patients with RV dysfunction were older (75 vs. 67 years, p < 0.001), had higher prevenance of coronary artery disease (27% vs. 11%, p = 0.003), and lower left ventricular ejection fraction (50% vs. 55%, p < 0.001). The rate of 1-year mortality (67% vs. 28%; p ≤ 0.001) was significantly higher in patients with RV dysfunction compared with patients without. After propensity score matching, patients with RV dysfunction showed a worse long-term survival (62% vs. 29%, p < 0.001). The multivariable Cox regression model showed an independent association of RV dysfunction with 1-year mortality. RV dysfunction is a relatively common finding in hospitalized COVID-19 patients, and it is independently associated with an increased risk of 1-year mortality.

12.
J Clin Med ; 11(3)2022 Jan 18.
Article in English | MEDLINE | ID: covidwho-1649579

ABSTRACT

PCSK9 inhibitors (PCSK9i) are monoclonal antibodies that have been shown to be effective in reducing both LDL cholesterol (LDL-C) values and major cardiovascular events in patients at high cardiovascular risk. Adherence to PCSK9i is critical for the success of the treatment. The aim of the present study is to evaluate patients' adherence to PCSK9i during the COVID-19 pandemic. Patients referred to the Cardiac Diagnostic Unit of the University of Campania "Luigi Vanvitelli" Naples, taking PCSK9i, and who missed the cardiological follow-up visit during the first national COVID-19 lockdown (9 March-17 May 2020), were included. Each patient underwent medical teleconsultation to collect current clinical conditions, adherence to drug treatments, and lipid profile laboratory tests. Among 151 eligible patients, 20 were excluded for missing or untraceable telephone numbers and one for refusing to join the interview. The selected study population consisted of 130 patients (64 ± 9 years, 68% males), of whom 11 (8.5%) reported a temporary interruption of the PCSK-9 therapy for a mean period of 65 ± 1.5 days. The non-adherent patients showed a marked increase in LDL-C than in the pre-pandemic period (90.8 ± 6.0 vs. 54.4 ± 7.7 mg/dL, p < 0.0001), and 82% of patients moved out of the LDL-C therapeutic range. The non-adherent group was more likely to have a very high cardiovascular risk compared to the adherent group (81.8 vs. 33.6%, p < 0.001). Causes of interruption included drug prescription failure (63.6%) due to temporary interruption of the non-urgent outpatient visits and failure in drug withdrawal (36.4%) due to patients' fear of becoming infected during the pandemic. The COVID-19 lockdown caused a remarkable lack of adherence to PCSK9i therapy, risking negative implications for the health status of patients at high cardiovascular risk. Facilitating patients' access to PCSK9i and enhancing telemedicine seem to be effective strategies to ensure the continuity of care and appropriate management of these patients.

13.
European heart journal supplements : journal of the European Society of Cardiology ; 23(Suppl G), 2021.
Article in English | EuropePMC | ID: covidwho-1602512

ABSTRACT

Aims Coronavirus disease 2019 (COVID-19) is a recently recognized viral infective disease which can be complicated by acute respiratory stress syndrome (ARDS) and cardiovascular complications including severe arrhythmias, acute coronary syndromes, myocarditis, and pulmonary embolism. The aim of the present study was to identify the clinical conditions and echocardiographic parameters associated with in-hospital mortality in COVID-19. Methods and results This is a multicentre retrospective observational study including seven Italian centres. Patients hospitalized with COVID-19 from 1 March to 22 April 2020, were included into the study population. The association between baseline variables and the risk of in-hospital mortality was assessed through multivariable logistic regression and competing risk analyses. Out of 1401 patients admitted at the participating centres with confirmed diagnosis of COVID-19, 226 (16.1%) underwent transthoracic echocardiography (TTE) and were included in the present analysis. The mean age was 68.9 ± 13.9 years and male sex was reported in 141 patients (62.4%). Admission in intensive care unit was required for 72 patients (31.9%);in-hospital death occurred in 68 patients (30.1%). At multivariable analysis, left ventricular ejection fraction (LVEF, P < 0.001), tricuspid annular plane systolic excursion (TAPSE, P < 0.001), and ARDS (P < 0.001) were independently associated with in-hospital mortality. At competing risk analysis, we found a significantly higher risk of mortality in patients with ARDS vs. those without ARDS (HR: 7.66;CI: 3.95–14.8), in patients with TAPSE ≤ 17 mm vs. those with TAPSE > 17 mm (HR: 5.08;CI: 3.15–8.19), and in patients with LVEF ≤ 50% vs. those with LVEF > 50% (HR: 4.06;CI: 2.50–6.59) (Figure). Conclusions TTE might be a useful tool in risk stratification of patients with COVID-19. In particular, reduced LVEF as well as reduced TAPSE may help to identify patients at higher risk of death during hospitalization. Our preliminary findings need to be confirmed in larger, prospective studies.618 Figure 1

14.
European heart journal supplements : journal of the European Society of Cardiology ; 23(Suppl G), 2021.
Article in English | EuropePMC | ID: covidwho-1602070

ABSTRACT

A 68-years-old man, affected by arterial hypertension in treatment with angiotensin-receptor blocker (cardesartan 32 mg), was admitted to emergency department for fever and dyspnoea. The molecular swab for SARS-CoV-2 was positive. Chest CT showed bilateral interstitial pneumonia with Chung severity score index 15/20. The laboratory examinations showed: PCR 21 mg/dl, IL-6 17 pg/ml, d-dimer 374 ng/ml, lymphopenia, glycaemia 218 mg/dl, total cholesterol 245 mg/dl. At COVID-19 diagnosis he started the following therapy: Azithromycin 500 mg once a day, Methylprednisolone 20 mg twice a day, Remdesivir 200 mg once a day, Enoxaparin 6000 UI twice a day, Insulin Lispro 6/8/8 UI three times a day, High FlowNasal Cannula (FiO2 45%). No lipid-lowering therapy was prescribed. During the hospitalization, the patient experienced a progressive improvement in clinical and laboratory parameters. On the 28th day, there was a sudden worsening of dyspnoea with evidence of ST-elevation in DI, aVL, V2–V6 leads. A primary percutaneous coronary intervention at COVID-19 HUB hospital (2.9 km away) was required. Because of massive demand for emergency vehicles, the patient was admitted to the Chat Lab 3 h and 23 min later. Due to evidence of critical stenosis of the proximal and intermediate left anterior descending artery, a PTCA with stenting was performed. 12 h later, the patient developed left hemiplegia (NIHSS score: 7). The brain CT revealed an acute right frontal ischaemic lesion;no indication to fibrinolysis was given by the consultant neurologist. Our case report describes the rare concomitance of two thrombotic events in a COVID-19 patient with many cardiovascular risk factors, offering the opportunity to underline the need of their appropriate treatment during the hospitalization for SARS-CoV-2 infection. Moreover, a dedicated treatment pathways should be provided for COVID-19 patients in order to ensure the timely and correct application of the protocols suggested by the international guidelines. 659 Figure 1 ECG performed at the onset of acute dyspnoea.659 Figure 2 Critical stenosis on LAD and subcritical stenosis on first and second obtuse marginal arteries.

15.
J Clin Med ; 11(1)2021 Dec 31.
Article in English | MEDLINE | ID: covidwho-1580630

ABSTRACT

To realize a machine learning (ML) model to estimate the dose of low molecular weight heparin to be administered, preventing thromboembolism events in COVID-19 patients with active cancer. Methods: We used a dataset comprising 131 patients with active cancer and COVID-19. We considered five ML models: logistic regression, decision tree, random forest, support vector machine and Gaussian naive Bayes. We decided to implement the logistic regression model for our study. A model with 19 variables was analyzed. Data were randomly split into training (70%) and testing (30%) sets. Model performance was assessed by confusion matrix metrics on the testing data for each model as positive predictive value, sensitivity and F1-score. Results: We showed that the five selected models outperformed classical statistical methods of predictive validity and logistic regression was the most effective, being able to classify with an accuracy of 81%. The most relevant result was finding a patient-proof where python function was able to obtain the exact dose of low weight molecular heparin to be administered and thereby to prevent the occurrence of VTE. Conclusions: The world of machine learning and artificial intelligence is constantly developing. The identification of a specific LMWH dose for preventing VTE in very high-risk populations, such as the COVID-19 and active cancer population, might improve with the use of new training ML-based algorithms. Larger studies are needed to confirm our exploratory results.

16.
Viruses ; 13(12)2021 12 11.
Article in English | MEDLINE | ID: covidwho-1572662

ABSTRACT

Low molecular weight heparin, enoxaparin, has been one of most used drugs to fight the SARS-CoV-2 pandemic. Pharmacological properties of heparin recognize its specific ability, as with other oligosaccharides and glycosaminoglycan, to bind several types of viruses during their pass through the extracellular matrix of the respiratory tract, as well as its anticoagulant activity to prevent venous thromboembolism. Antithrombotic actions of enoxaparin have been testified both for inpatients with COVID-19 in regular ward and for inpatients in Intensive Care Units (ICUs). Prophylactic doses seem to be able to prevent venous thromboembolism (VTE) in inpatients in the regular ward, while intermediate or therapeutic doses have been frequently adopted for inpatients with COVID-19 in ICU. On the other hand, although we reported several useful actions of heparin for inpatients with COVID-19, an increased rate of bleeding has been recorded, and it may be related to several conditions such as underlying diseases with increased risks of bleeding, increased doses or prolonged administration of heparin, personal trend to bleed, and so on.


Subject(s)
COVID-19 , Heparin , Venous Thromboembolism , Anticoagulants/therapeutic use , COVID-19/complications , Enoxaparin , Fondaparinux , Hemorrhage , Heparin, Low-Molecular-Weight , Humans , Inpatients , Intensive Care Units , Pandemics , SARS-CoV-2 , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control
17.
J Pers Med ; 11(12)2021 Nov 24.
Article in English | MEDLINE | ID: covidwho-1542636

ABSTRACT

AIMS: Pulmonary involvement in Coronavirus disease 2019 (COVID-19) may affect right ventricular (RV) function and pulmonary pressures. The prognostic value of tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (PAPS), and TAPSE/PAPS ratios have been poorly investigated in this clinical setting. METHODS AND RESULTS: This is a multicenter Italian study, including consecutive patients hospitalized for COVID-19. In-hospital mortality and pulmonary embolism (PE) were identified as the primary and secondary outcome measures, respectively. The study included 227 (16.1%) subjects (mean age 68 ± 13 years); intensive care unit (ICU) admission was reported in 32.2%. At competing risk analysis, after stratifying the population into tertiles, according to TAPSE, PAPS, and TAPSE/PAPS ratio values, patients in the lower TAPSE and TAPSE/PAPS tertiles, as well as those in the higher PAPS tertiles, showed a significantly higher incidence of death vs. the probability to be discharged during the hospitalization. At univariable logistic regression analysis, TAPSE, PAPS, and TAPSE/PAPS were significantly associated with a higher risk of death and PE, both in patients who were and were not admitted to ICU. At adjusted multivariable regression analysis, TAPSE, PAPS, and TAPSE/PAPS resulted in independently associated risk of in-hospital death (TAPSE: OR 0.85, CI 0.74-0.97; PAPS: OR 1.08, CI 1.03-1.13; TAPSE/PAPS: OR 0.02, CI 0.02 × 10-1-0.2) and PE (TAPSE: OR 0.7, CI 0.6-0.82; PAPS: OR 1.1, CI 1.05-1.14; TAPSE/PAPS: OR 0.02 × 10-1, CI 0.01 × 10-2-0.04). CONCLUSIONS: Echocardiographic evidence of RV systolic dysfunction, increased PAPS, and poor RV-arterial coupling may help to identify COVID-19 patients at higher risk of mortality and PE during hospitalization.

18.
Acta Myol ; 40(3): 113-115, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1464223

ABSTRACT

COVID-19 outbreak has quickly reached alarming morbidity and mortality with vaccines being the only weapon to fight. Although the critical situation, no international guidelines on the vaccination management of patients with neuromuscular disorders (NMDs) has still been issued. We aimed to address some unmet needs about the management of COVID-19 vaccination in patients with NMDs.


Subject(s)
COVID-19 Vaccines/administration & dosage , Health Services Needs and Demand , Neuromuscular Diseases , Female , Humans , Male , Pandemics , Patient Safety , SARS-CoV-2
20.
Medicina (Kaunas) ; 57(10)2021 Sep 22.
Article in English | MEDLINE | ID: covidwho-1438662

ABSTRACT

SARS-CoV-2 induced a pandemic that is reported to have started in Asia and was then extended to other countries in the world. Main clinical aspects of this viral infection have been lung injuries with severe pneumonia requiring prolonged hospitalization and associated morbidities such as venous thromboembolism and/or superinfection by bacteria, fungus or other pests. Immediately there was a need to develop a sustainable therapeutic strategy, such as vaccination. Vaccines against Covid-19, in fact, exert a protective action for common people and reduce viral diffusion. Yet, vaccination of a large number of people raises the question of a well-known complication of several types of vaccines; this complication is immune thrombocytopenia, which is sometimes associated with thrombosis as well. In this short review, we summarized mechanisms involved in the pathogenesis of vaccine-induced prothrombotic immune thrombocytopenia and vaccine-induced thrombocytopenic thrombosis.


Subject(s)
COVID-19 , Purpura, Thrombocytopenic, Idiopathic , Thrombosis , Vaccines , COVID-19 Vaccines , Humans , SARS-CoV-2
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