Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 94
Filter
2.
J Am Heart Assoc ; 11(16): e025369, 2022 08 16.
Article in English | MEDLINE | ID: covidwho-1986530

ABSTRACT

Background Initial protocols for return to play cardiac testing in young competitive athletes following SARS-CoV-2 infection recommended cardiac troponin (cTn) to screen for cardiac involvement. This study aimed to define the diagnostic yield of cTn in athletes undergoing cardiovascular testing following SARS-CoV-2 infection. Methods and Results This prospective, observational cohort study from ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) included collegiate athletes who underwent cTn testing as a component of return to play protocols following SARS-CoV-2 infection. The cTn values were stratified as undetectable, detectable but within normal limits, and abnormal (>99% percentile). The presence of probable or definite SARS-CoV-2 myocardial involvement was compared between those with normal versus abnormal cTn levels. A total of 3184/3685 (86%) athletes in the ORCCA database met the inclusion criteria for this study (age 20±1 years, 32% female athletes, 28% Black race). The median time from SARS-CoV-2 diagnosis to cTn testing was 13 days (interquartile range, 11, 18 days). The cTn levels were undetectable in 2942 athletes (92%), detectable but within normal limits in 210 athletes (7%), and abnormal in 32 athletes (1%). Of the 32 athletes with abnormal cTn testing, 19/32 (59%) underwent cardiac magnetic resonance imaging, 30/32 (94%) underwent transthoracic echocardiography, and 1/32 (3%) did not have cardiac imaging. One athlete with abnormal troponin met the criteria for definite or probable SARS-CoV-2 myocardial involvement. In the total cohort, 21/3184 (0.7%) had SARS-CoV-2 myocardial involvement, among whom 20/21 (95%) had normal troponin testing. Conclusions Abnormal cTn during routine return to play cardiac screening among competitive athletes following SARS-CoV-2 infection appears to have limited diagnostic utility.


Subject(s)
COVID-19 , Heart Diseases , Adult , Athletes , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , Female , Heart Diseases/diagnosis , Heart Diseases/epidemiology , Humans , Male , Prospective Studies , Return to Sport , SARS-CoV-2 , Troponin , Young Adult
3.
Pediatr Emerg Care ; 38(10): e1584-e1589, 2022 Oct 01.
Article in English | MEDLINE | ID: covidwho-1985187

ABSTRACT

OBJECTIVES: This study aimed to assess whether elevations in cardiac biomarkers are associated with pediatric cardiac diagnoses in the era of COVID-19 and multisystem inflammatory syndrome in children (MIS-C). STUDY DESIGN: This single-center retrospective study analyzed children with a troponin drawn in the emergency department or inpatient unit between April 21 and December 31, 2020. The primary outcome was the presence of a cardiac diagnosis or MIS-C. Relationships among demographics, complaint, cardiac diagnostics, and cardiac biomarkers were analyzed. RESULTS: Four hundred eighty-six patients (mean ± SD; age 13.1 ± 7.8 years; 46.7% women) met inclusion criteria, for whom a cardiac diagnosis (excluding MIS-C) was made in 27 (5.6%) patients, with MIS-C diagnosed in 14 (2.9%) patients. The sensitivity and specificity of an elevated initial high-sensitivity troponin T (hsTropT) value (>14 ng/L) in predicting the composite outcome of a cardiac diagnosis or MIS-C were 54% and 89%, respectively. Four percent of patients with negative initial troponin values were found to have a cardiac diagnosis or MIS-C. Multivariable regression analysis demonstrated that elevated hsTropT (>14 ng/L; odds ratio [OR] [95% confidence interval]: 4.9 [1.70-14.0]) and elevated N-terminal pro B-type natriuretic peptide values (>500 pg/mL; 6.4 [2.01-20.1]) were associated with increased odds of a cardiac diagnosis or MIS-C. CONCLUSIONS: Children with elevated cardiac biomarkers have increased odds of a cardiac diagnosis or MIS-C and warrant workup regardless of indication for testing. Although a negative hsTropT may reassure providers, further investigation is critical in developing algorithms to reliably exclude cardiac disease.


Subject(s)
COVID-19 , Heart Diseases , Adolescent , Adult , Biomarkers , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , Child , Child, Preschool , Female , Heart Diseases/diagnosis , Heart Diseases/epidemiology , Humans , Male , Natriuretic Peptide, Brain , Pandemics , Retrospective Studies , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/epidemiology , Troponin , Troponin T , Young Adult
5.
Curr Cardiol Rev ; 18(4): e220222201354, 2022.
Article in English | MEDLINE | ID: covidwho-1951870

ABSTRACT

With the incidence of the unabated spreading of the COVID-19 (coronavirus disease 2019) pandemic with an increase in heart-related complications in COVID-19 patients, laboratory investigations on general health and diseases of heart have greater importance. The production of a higher level of clots in the blood in COVID-19 individuals carries a high risk of severe lethal pneumonia, pulmonary embolism, or widespread thromboembolism. The COVID-19 pandemic has raised awareness regarding the severe consequences for the cardiac system that might cause due to severe acute respiratory distress syndrome (SARS-CoV-2). COVID-19 causes acute respiratory distress syndrome (ARDS), acute myocardial infarction, venous thromboembolism, and acute heart failure in people with preexisting cardiac illness. However, as COVID-19 is primarily a respiratory infectious disease, there is still a lot of debate on whether and how cardiac biomarkers should be used in COVID-19 patients. Considering the most practical elucidation of cardiac biomarkers in COVID-19, it is important to note that recent findings on the prognostic role of cardiac biomarkers in COVID-19 patients are similar to those found in pneumonia and ARDS studies. The use of natriuretic peptides and cardiac troponin concentrations as quantitative variables should help with COVID-19/pneumonia risk classification and ensure that these biomarkers sustain their high diagnostic precision for acute myocardial infarction and heart failure. Serial assessment of D-dimers will possibly aid clinicians in the assortment of patients for venous thromboembolism imaging in addition to the increase of anticoagulation from preventive to marginally higher or even therapeutic dosages because of the central involvement of endothelitis and thromboembolism in COVID-19. Therefore, cardiac biomarkers are produced in this phase because of some pathological processes; this review will focus on major cardiac biomarkers and their significant role in COVID-19.


Subject(s)
COVID-19 , Heart Diseases , Heart Failure , Myocardial Infarction , Respiratory Distress Syndrome , Venous Thromboembolism , Biomarkers , Heart Diseases/diagnosis , Heart Failure/complications , Heart Failure/diagnosis , Humans , Myocardial Infarction/complications , Pandemics , SARS-CoV-2 , Venous Thromboembolism/diagnosis , Venous Thromboembolism/etiology
6.
Clin J Sport Med ; 32(4): 382-386, 2022 07 01.
Article in English | MEDLINE | ID: covidwho-1909018

ABSTRACT

OBJECTIVE: The objective of this study was to determine the utility of "standard" cardiac screening with EKG, echocardiography, and serum troponin T (hs-Tn T) testing after COVID infection in competitive college athletes. DESIGN: Prospective cohort study. SETTING: Tertiary cardiology clinic, university training room. PARTICIPANTS: Sixty-five Division 1 athletes recovered from COVID-19 and 465 controls. ASSESSMENT: All COVID-recovered athletes underwent cardiac screening on return to campus in fall 2020. Controls were screened if indicated by preparticipation examination. Students cleared for sports participation were followed for the development of cardiac complications. MAIN OUTCOME MEASURE: Incidence of cardiac complications after COVID infection. RESULTS: Infected athletes experienced mild (26/65), moderate (8/65), or no (31/65) COVID symptoms. No athletes had severe symptoms. Men were more likely to have been asymptomatic (20/31), and women were more likely to have had moderate (7/8) symptoms (P = 0.015). All athletes, except 2 with anosmia, were asymptomatic at the time of cardiac testing. One athlete had persistently elevated hs-Tn T but no evidence of myocarditis on cardiac MRI. All other cardiac testing was negative. No athletes were diagnosed with myocarditis (95% CI: 0%-5.5%). All athletes were cleared for athletic participation. None suffered complications over the next 9 months. CONCLUSIONS: After COVID-19 infection, no college athletes with mild, moderate, or no symptoms had signs of myocarditis, and all returned to play without cardiac complication. These findings support consensus opinion recommendations that college-age athletes who recovered from COVID-19 and who experienced mild or no symptoms may return to play without cardiac testing.


Subject(s)
COVID-19 , Heart Diseases , Myocarditis , Athletes , COVID-19/complications , Female , Heart Diseases/diagnosis , Heart Diseases/etiology , Humans , Male , Myocarditis/diagnosis , Myocarditis/etiology , Prospective Studies
7.
J Physiol Pharmacol ; 73(1)2022 Feb.
Article in English | MEDLINE | ID: covidwho-1876428

ABSTRACT

Coronavirus disease 2019 (COVID-19) causes cardiovascular damage in the acute period. Knowledge regarding cardiovascular damage after COVID-19 infection and during longer-term follow-up is currently limited. In our study, we aimed to compare cardiac and inflammatory markers and echocardiographic parameters between patients who had recovered from COVID-19 and control group. A total of 224 individuals were included, comprising 126 patients with a history of COVID-19 and 98 healthy controls. The demographic characteristics of the two groups were similar. Complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), N-terminal pro-B type natriuretic peptide (NT-ProBNP), D-dimer, haemoglobin A1C, troponin T and creatine kinase myocardial band (CK-MB) levels were compared between both groups. The mean follow-up period of the COVID-19 group was 58.39 ± 39.1 days (range:10 - 180 days post-COVID-19). Red cell distribution width (RDW), ESR, CRP, NT-ProBNP, D-dimer and troponin T values were significantly higher in the COVID-19 group compared to the control group. Left ventricular ejection fraction (LVEF) was significantly lower in the COVID-19 group. Left ventricular diastolic diameter (LVDD) and incidence of pericardial effusion were higher in the COVID-19 group. For multivariate analysis, possible factors identified by univariate analysis were subjected to multivariate logistic regression analysis to determine independent predictors of COVID-19. Among these factors, RDW, CRP and LVEF were independently higher in the COVID-19 group than in the control group. We conclude that although the clinical and prognostic significance of cardiac and other inflammatory markers in the acute phase of COVID-19 is known, we found that these biomarkers and echocardiography parameters can also be used in the follow-up of cardiac injury for a mid-term period post-infection.


Subject(s)
COVID-19 , Heart Diseases , Biomarkers , C-Reactive Protein/metabolism , Echocardiography , Heart Diseases/diagnosis , Heart Diseases/virology , Humans , Stroke Volume , Troponin T , Ventricular Function, Left
8.
Pan Afr Med J ; 41: 45, 2022.
Article in English | MEDLINE | ID: covidwho-1856322

ABSTRACT

Many cases of severe cardiac complications due to Coronavirus disease 2019 (COVID-19) were reported. Cancer and chemotherapy appear to be risk and prognostic factors for COVID-19. A 49-year-old Female, with a history of breast cancer treated by tumorectomy and anthracycline-based chemotherapy was admitted with acute respiratory distress syndrome (ARDS) confirmed as COVID-19. She also had elevated troponin I level (up to 43 g/L), and diffuse myocardial hypokinesia along with severe left ventricle dysfunction on echocardiography. Initial treatment included hydroxychloroquine, azithromycin, corticosteroids and mechanical ventilation. The evolution was marked by QT interval prolongation (QTc=523 ms) and occurrence of cardiogenic shock. The patient died of hemodynamic instability reluctant to resuscitation measures at the 2ndday of hospitalization. COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. Receiving chemotherapy especially anthracyclines may be a precipitating and prognostic factor of cardiac manifestations in COVID-19 cancer patients.


Subject(s)
Breast Neoplasms , COVID-19 , Heart Diseases , Heart Failure , Breast Neoplasms/complications , Breast Neoplasms/drug therapy , Female , Heart Diseases/chemically induced , Heart Diseases/diagnosis , Heart Failure/etiology , Humans , Middle Aged , Shock, Cardiogenic/etiology
9.
Cardiovasc Diabetol ; 21(1): 24, 2022 02 14.
Article in English | MEDLINE | ID: covidwho-1686015

ABSTRACT

BACKGROUND: Pre-existing cardiometabolic comorbidities place SARS-CoV-2 positive patients at a greater risk for poorer clinical course and mortality than those without it. We aimed to analyze real-world registry data focused primarily on participants with cardiometabolic diseases (CMD), which were remotely obtained via a digital platform. METHODS: Participants were divided into two groups: CMD or no cardiometabolic disease (non-CMD). They were evaluated based on their medical history, current medications/supplements, COVID-19 status, demographics, and baseline characteristics. The frequency of medications/supplements for CMD were compared using relative risks and 95% confidence intervals. The WHO (Five) Well-Being Index (WHO-5) were collected monthly for 6 months to assess psychological well-being which included cheerfulness, calmness, vigor, rest, and engagement with daily activities of interest. RESULTS: The 791 enrollees represented 49 U.S. states. The CMD group had significantly higher (p < 0.0001) BMI (mean + 3.04 kg/m2) and age (mean + 9.15 years) compared to non-CMD group. In the CMD group, participants who tested positive for COVID-19 had lower (p < 0.0001) well-being scores than those without COVID-19. For the 274 participants on CMD medications/supplements, there was no statistical difference in risk of COVID-19 contracture based on medication/supplement type; however, all six participants who were not being treated for CMD were COVID-19 positive (RR ~ 104). For 89 participants who were on treatment for diabetes or insulin resistance, there was a 90% reduced risk of COVID-19 incidence (p = 0.0187). CONCLUSION: The well-being score of the CMD group was dependent on whether they tested positive for COVID-19. Type of CMD treatment did not impact COVID-19 status, but absence of treatment significantly increased COVID-19 incidence. With respect to SARS-CoV-2, our analysis supports continued use of the statins, ACE-I, ARBs, and diabetes medications in CMD patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04348942.


Subject(s)
COVID-19/epidemiology , Heart Diseases/epidemiology , Metabolic Diseases/epidemiology , Adult , COVID-19/diagnosis , Cardiometabolic Risk Factors , Comorbidity , Female , Heart Diseases/diagnosis , Heart Diseases/therapy , Humans , Incidence , Longitudinal Studies , Male , Metabolic Diseases/diagnosis , Metabolic Diseases/therapy , Middle Aged , Prognosis , Prospective Studies , Registries , Risk Assessment , Time Factors , United States/epidemiology
11.
Endocr Metab Immune Disord Drug Targets ; 21(6): 980-993, 2021.
Article in English | MEDLINE | ID: covidwho-1613453

ABSTRACT

Biomarkers are increasingly recognized to have significant clinical value in early identification and progression of various cardiovascular diseases. There are many heart conditions, such as congestive heart failure (CHF), ischemic heart diseases (IHD), and diabetic cardiomyopathy (DCM), and cardiac remodeling, in which the severity of the cardiac pathology can be mirrored through these cardiac biomarkers. From the emergency department (ED) evaluation of acute coronary syndromes (ACS) or suspected acute myocardial infarction (AMI) with cardiac marker Troponin to the diagnosis of chronic conditions like Heart Failure (HF) with natriuretic peptides, like B-type natriuretic peptide (BNP), N-terminal pro-B- type natriuretic peptide (Nt-proBNP) and mid regional pro-atrial natriuretic peptide (MR- proANP), their use is continuously increasing. Their clinical importance has led to the discovery of newer biomarkers, such as the soluble source of tumorigenicity 2 (sST2), galectin-3 (Gal-3), growth differentiation factor-15 (GDF-15), and various micro ribonucleic acids (miRNAs). Since cardiac pathophysiology involves a complex interplay between inflammatory, genetic, neurohormonal, and biochemical levels, these biomarkers could be enzymes, hormones, and biologic substances showing cardiac injury, stress, and malfunction. Therefore, multi-marker approaches with different combinations of novel cardiac biomarkers, and continual assessment of cardiac biomarkers are likely to improve cardiac risk prediction, stratification, and overall patient wellbeing. On the other hand, these biomarkers may reflect coexisting or isolated disease processes in different organ systems other than the cardiovascular system. Therefore, knowledge of cardiac biomarkers is imperative. In this article, we have reviewed the role of cardiac biomarkers and their use in the diagnosis and prognosis of various cardiovascular diseases from different investigations conducted in recent years.


Subject(s)
COVID-19/blood , COVID-19/diagnosis , Heart Diseases/blood , Heart Diseases/diagnosis , Animals , Biomarkers/blood , COVID-19/epidemiology , Heart Diseases/epidemiology , Humans , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Troponin T/blood
13.
Open Heart ; 8(2)2021 11.
Article in English | MEDLINE | ID: covidwho-1518151

ABSTRACT

OBJECTIVE: To determine the prevalence of cardiac abnormalities and their relationship to markers of myocardial injury and mortality in patients admitted to hospital with COVID-19. METHODS: A retrospective and prospective observational study of inpatients referred for transthoracic echocardiography for suspected cardiac pathology due to COVID-19 within a London NHS Trust. Echocardiograms were performed to assess left ventricular (LV), right ventricular (RV) and pulmonary variables along with collection of patient demographics, comorbid conditions, blood biomarkers and outcomes. RESULT: In the predominant non-white (72%) population, RV dysfunction was the primary cardiac abnormality noted in 50% of patients, with RV fractional area change <35% being the most common marker of this RV dysfunction. By comparison, LV systolic dysfunction occurred in 18% of patients. RV dysfunction was associated with LV systolic dysfunction and the presence of a D-shaped LV throughout the cardiac cycle (marker of significant pulmonary artery hypertension). LV systolic dysfunction (p=0.002, HR 3.82, 95% CI 1.624 to 8.982), pulmonary valve acceleration time (p=0.024, HR 0.98, 95% CI 0.964 to 0.997)-marker of increased pulmonary vascular resistance, age (p=0.047, HR 1.027, 95% CI 1.000 to 1.055) and an episode of tachycardia measured from admission to time of echo (p=0.004, HR 6.183, 95% CI 1.772 to 21.575) were independently associated with mortality. CONCLUSIONS: In this predominantly non-white population hospitalised with COVID-19, the most common cardiac pathology was RV dysfunction which is associated with both LV systolic dysfunction and elevated pulmonary artery pressure. The latter two, not RV dysfunction, were associated with mortality.


Subject(s)
COVID-19/ethnology , Heart Diseases/ethnology , Heart Ventricles/diagnostic imaging , Population Surveillance , Comorbidity , Cross-Sectional Studies , Echocardiography, Doppler , Heart Diseases/diagnosis , Hospitalization/trends , Humans , Pandemics , Prevalence , Quebec/epidemiology , Retrospective Studies , Survival Rate/trends
14.
Pan Afr Med J ; 39: 173, 2021.
Article in English | MEDLINE | ID: covidwho-1468745

ABSTRACT

The coronavirus disease-19 (COVID-19), first appearing in Wuhan, China, and later declared as a pandemic, has caused serious morbidity and mortality worldwide. Severe cases usually present with acute respiratory distress syndrome (ARDS), pneumonia, acute kidney injury (AKI), liver damage, or septic shock. However, with recent advances in severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) research, the virus´s effect on cardiac tissues has become evident. Reportedly, an increased number of COVID-19 patients manifested serious cardiac complications such as heart failure, increased troponin, and N-terminal pro-B-type natriuretic peptide levels (NT-proBNP), cardiomyopathies, and myocarditis. These cardiac complications initially present as chest tightness, chest pain, and heart palpitations. Diagnostic investigations such as telemetry, electrocardiogram (ECG), cardiac biomarkers (troponin, NT-proBNP), and inflammatory markers (D-dimer, fibrinogen, PT, PTT), must be performed according to the patient´s condition. The best available options for treatment are the provision of supportive care, anti-viral therapy, hemodynamic monitoring, IL-6 blockers, statins, thrombolytic, and anti-hypertensive drugs. Cardiovascular disease (CVD) healthcare workers should be well-informed about the evolving research regarding COVID-19 and approach as a multi-disciplinary team to devise effective strategies for challenging situations to reduce cardiac complications.


Subject(s)
COVID-19/complications , Heart Diseases/virology , SARS-CoV-2/isolation & purification , Biomarkers/metabolism , COVID-19/diagnosis , COVID-19 Testing , Heart Diseases/diagnosis , Heart Diseases/physiopathology , Humans , Patient Care Team/organization & administration
15.
Viruses ; 13(9)2021 09 21.
Article in English | MEDLINE | ID: covidwho-1430982

ABSTRACT

Evidence is emerging that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect various organs of the body, including cardiomyocytes and cardiac endothelial cells in the heart. This review focuses on the effects of SARS-CoV-2 in the heart after direct infection that can lead to myocarditis and an outline of potential treatment options. The main points are: (1) Viral entry: SARS-CoV-2 uses specific receptors and proteases for docking and priming in cardiac cells. Thus, different receptors or protease inhibitors might be effective in SARS-CoV-2-infected cardiac cells. (2) Viral replication: SARS-CoV-2 uses RNA-dependent RNA polymerase for replication. Drugs acting against ssRNA(+) viral replication for cardiac cells can be effective. (3) Autophagy and double-membrane vesicles: SARS-CoV-2 manipulates autophagy to inhibit viral clearance and promote SARS-CoV-2 replication by creating double-membrane vesicles as replication sites. (4) Immune response: Host immune response is manipulated to evade host cell attacks against SARS-CoV-2 and increased inflammation by dysregulating immune cells. Efficiency of immunosuppressive therapy must be elucidated. (5) Programmed cell death: SARS-CoV-2 inhibits programmed cell death in early stages and induces apoptosis, necroptosis, and pyroptosis in later stages. (6) Energy metabolism: SARS-CoV-2 infection leads to disturbed energy metabolism that in turn leads to a decrease in ATP production and ROS production. (7) Viroporins: SARS-CoV-2 creates viroporins that lead to an imbalance of ion homeostasis. This causes apoptosis, altered action potential, and arrhythmia.


Subject(s)
COVID-19/complications , COVID-19/virology , Heart Diseases/etiology , SARS-CoV-2/physiology , Apoptosis , Autophagy , Disease Management , Disease Susceptibility , Endothelial Cells/ultrastructure , Endothelial Cells/virology , Heart Diseases/diagnosis , Heart Diseases/therapy , Host-Pathogen Interactions/immunology , Humans , Myocarditis/diagnosis , Myocarditis/etiology , Myocarditis/therapy , Viroporin Proteins , Virus Replication
16.
Heart Rhythm ; 18(6): 855-861, 2021 06.
Article in English | MEDLINE | ID: covidwho-1390228

ABSTRACT

BACKGROUND: Accumulating data suggest blood biomarkers could inform stroke etiology. OBJECTIVE: The purpose of this study was to investigate the performance of multiple blood biomarkers in elucidating stroke etiology with a focus on new-onset atrial fibrillation (AF) and cardioembolism. METHODS: Between January and December 2017, information on clinical and laboratory parameters and stroke characteristics was prospectively collected from ischemic stroke patients recruited from the National University Hospital, Singapore. Multiple blood biomarkers (N-terminal pro-brain natriuretic peptide [NT-proBNP], d-dimer, S100ß, neuron-specific enolase, vitamin D, cortisol, interleukin-6, insulin, uric acid, and albumin) were measured in plasma. These variables were compared with stroke etiology and the risk of new-onset AF and cardioembolism using multivariable regression methods. RESULTS: Of the 515 ischemic stroke patients (mean age 61 years; 71% men), 44 (8.5%) were diagnosed with new-onset AF, and 75 (14.5%) had cardioembolism. The combination of 2 laboratory parameters (total cholesterol ≤169 mg/dL; triglycerides ≤44.5 mg/dL) and 3 biomarkers (NT-proBNP ≥294 pg/mL; S100ß ≥64 pg/mL; cortisol ≥471 nmol/l) identified patients with new-onset AF (negative predictive value [NPV] 90%; positive predictive value [PPV] 73%; area under curve [AUC] 85%). The combination of 2 laboratory parameters (total cholesterol ≤169 mg/dL; triglycerides ≤44.5 mg/dL) and 2 biomarkers (NT-proBNP ≥507 pg/mL; S100ß ≥65 pg/mL) identified those with cardioembolism (NPV 86%; PPV 78%; AUC 87%). Adding clinical predictors did not improve the performance of these models. CONCLUSION: Blood biomarkers could identify patients with increased likelihood of cardioembolism and direct the search for occult AF.


Subject(s)
Atrial Fibrillation/diagnosis , Biomarkers/blood , Embolism/diagnosis , Heart Diseases/diagnosis , Ischemic Stroke/diagnosis , Aged , Atrial Fibrillation/blood , Atrial Fibrillation/complications , Embolism/blood , Embolism/etiology , Female , Follow-Up Studies , Heart Diseases/blood , Heart Diseases/etiology , Humans , Ischemic Stroke/blood , Ischemic Stroke/etiology , Male , Middle Aged , Retrospective Studies
17.
Cardiovasc Diabetol ; 20(1): 176, 2021 09 04.
Article in English | MEDLINE | ID: covidwho-1388767

ABSTRACT

BACKGROUND: It remains uncertain if prior use of oral anticoagulants (OACs) in COVID-19 outpatients with multimorbidity impacts prognosis, especially if cardiometabolic diseases are present. Clinical outcomes 30-days after COVID-19 diagnosis were compared between outpatients with cardiometabolic disease receiving vitamin K antagonist (VKA) or direct-acting OAC (DOAC) therapy at time of COVID-19 diagnosis. METHODS: A study was conducted using TriNetX, a global federated health research network. Adult outpatients with cardiometabolic disease (i.e. diabetes mellitus and any disease of the circulatory system) treated with VKAs or DOACs at time of COVID-19 diagnosis between 20-Jan-2020 and 15-Feb-2021 were included. Propensity score matching (PSM) was used to balance cohorts receiving VKAs and DOACs. The primary outcomes were all-cause mortality, intensive care unit (ICU) admission/mechanical ventilation (MV) necessity, intracranial haemorrhage (ICH)/gastrointestinal bleeding, and the composite of any arterial or venous thrombotic event(s) at 30-days after COVID-19 diagnosis. RESULTS: 2275 patients were included. After PSM, 1270 patients remained in the study (635 on VKAs; 635 on DOACs). VKA-treated patients had similar risks and 30-day event-free survival than patients on DOACs regarding all-cause mortality, ICU admission/MV necessity, and ICH/gastrointestinal bleeding. The risk of any arterial or venous thrombotic event was 43% higher in the VKA cohort (hazard ratio 1.43, 95% confidence interval 1.03-1.98; Log-Rank test p = 0.029). CONCLUSION: In COVID-19 outpatients with cardiometabolic diseases, prior use of DOAC therapy compared to VKA therapy at the time of COVID-19 diagnosis demonstrated lower risk of arterial or venous thrombotic outcomes, without increasing the risk of bleeding.


Subject(s)
Ambulatory Care/methods , Anticoagulants/administration & dosage , COVID-19/drug therapy , Heart Diseases/drug therapy , Metabolic Diseases/drug therapy , Vitamin K/antagonists & inhibitors , Administration, Oral , Aged , Aged, 80 and over , Anticoagulants/adverse effects , COVID-19/diagnosis , COVID-19/mortality , Factor Xa Inhibitors/administration & dosage , Female , Follow-Up Studies , Heart Diseases/diagnosis , Heart Diseases/mortality , Hemorrhage/chemically induced , Hemorrhage/mortality , Humans , Intensive Care Units/trends , Male , Metabolic Diseases/diagnosis , Metabolic Diseases/mortality , Middle Aged , Mortality/trends , Treatment Outcome
18.
Europace ; 23(1): 123-129, 2021 01 27.
Article in English | MEDLINE | ID: covidwho-1387869

ABSTRACT

AIMS: The main severe complications of SARS-CoV-2 infection are pneumonia and respiratory distress syndrome. Recent studies, however, reported that cardiac injury, as assessed by troponin levels, is associated with a worse outcome in these patients. No study hitherto assessed whether the simple standard electrocardiogram (ECG) may be helpful for risk stratification in these patients. METHODS AND RESULTS: We studied 324 consecutive patients admitted to our Emergency Department with a confirmed diagnosis of SARS-CoV-2 infection. Standard 12-lead ECG recorded on admission was assessed for cardiac rhythm and rate, atrioventricular and intraventricular conduction, abnormal Q/QS wave, ST segment and T wave changes, corrected QT interval, and tachyarrhythmias. At a mean follow-up of 31 ± 11 days, 44 deaths occurred (13.6%). Most ECG variables were significantly associated with mortality, including atrial fibrillation (P = 0.002), increasing heart rate (P = 0.002), presence of left bundle branch block (LBBB; P < 0.001), QRS duration (P <0 .001), a QRS duration of ≥110 ms (P < 0.001), ST segment depression (P < 0.001), abnormal Q/QS wave (P = 0.034), premature ventricular complexes (PVCs; P = 0.051), and presence of any ECG abnormality [hazard ratio (HR) 4.58; 95% confidence interval (CI) 2.40-8.76; P < 0.001]. At multivariable analysis, QRS duration (P = 0.002), QRS duration ≥110 ms (P = 0.03), LBBB (P = 0.014) and presence of any ECG abnormality (P = 0.04) maintained a significant independent association with mortality. CONCLUSION: Our data show that standard ECG can be helpful for an initial risk stratification of patients admitted for SARS-CoV-2 infectious disease.


Subject(s)
COVID-19/complications , Electrocardiography , Heart Conduction System/physiopathology , Heart Diseases/diagnosis , Heart Rate , Action Potentials , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , Female , Heart Diseases/etiology , Heart Diseases/mortality , Heart Diseases/physiopathology , Hospital Mortality , Hospitalization , Humans , Male , Middle Aged , Predictive Value of Tests , Prognosis , Risk Assessment , Risk Factors , Time Factors
19.
Am Heart J ; 241: 83-86, 2021 11.
Article in English | MEDLINE | ID: covidwho-1384824

ABSTRACT

SARS-CoV-2 infection has been associated with cardiovascular disease in children, but which children need cardiac evaluation is unclear. We describe our experience evaluating 206 children for cardiac disease following SARS-CoV-2 infection (one of whom had ventricular ectopy) and propose a new guideline for management of these children. Routine cardiac screening after SARS-CoV-2 infection in children without any cardiac signs or symptoms does not appear to be high yield.


Subject(s)
Aftercare , COVID-19/physiopathology , Heart Diseases/diagnosis , Referral and Consultation , Adolescent , Ambulatory Care , Atrioventricular Block/diagnosis , Atrioventricular Block/etiology , Atrioventricular Block/physiopathology , Bradycardia/diagnosis , Bradycardia/etiology , Bradycardia/physiopathology , COVID-19/complications , Cardiology , Chest Pain/physiopathology , Child , Child, Preschool , Dyspnea/physiopathology , Echocardiography , Electrocardiography , Fatigue/physiopathology , Female , Heart Diseases/etiology , Heart Diseases/physiopathology , Humans , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/physiopathology , Hypertrophy, Right Ventricular/diagnosis , Hypertrophy, Right Ventricular/etiology , Hypertrophy, Right Ventricular/physiopathology , Implementation Science , Male , Pediatrics , Practice Guidelines as Topic , SARS-CoV-2 , Severity of Illness Index , Syncope/physiopathology , Ventricular Premature Complexes/diagnosis , Ventricular Premature Complexes/etiology , Ventricular Premature Complexes/physiopathology , Young Adult
SELECTION OF CITATIONS
SEARCH DETAIL