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1.
J Am Coll Cardiol ; 76(10): 1244-1258, 2020 Sep 08.
Article in English | MEDLINE | ID: covidwho-735195

ABSTRACT

Increases in cardiac troponin indicative of myocardial injury are common in patients with coronavirus disease-2019 (COVID-19) and are associated with adverse outcomes such as arrhythmias and death. These increases are more likely to occur in those with chronic cardiovascular conditions and in those with severe COVID-19 presentations. The increased inflammatory, prothrombotic, and procoagulant responses following severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection increase the risk for acute nonischemic myocardial injury and acute myocardial infarction, particularly type 2 myocardial infarction, because of respiratory failure with hypoxia and hemodynamic instability in critically ill patients. Myocarditis, stress cardiomyopathy, acute heart failure, and direct injury from SARS-CoV-2 are important etiologies, but primary noncardiac conditions, such as pulmonary embolism, critical illness, and sepsis, probably cause more of the myocardial injury. The structured use of serial cardiac troponin has the potential to facilitate risk stratification, help make decisions about when to use imaging, and inform stage categorization and disease phenotyping among hospitalized COVID-19 patients.


Subject(s)
Coronavirus Infections , Heart Diseases , Pandemics , Pneumonia, Viral , Risk Assessment/methods , Troponin/analysis , Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Heart Diseases/blood , Heart Diseases/diagnosis , Heart Diseases/etiology , Humans , Pneumonia, Viral/complications , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , Severity of Illness Index
2.
BMJ Case Rep ; 13(8)2020 Aug 03.
Article in English | MEDLINE | ID: covidwho-693991

ABSTRACT

We describe a patient with COVID-19 who developed simultaneous pulmonary, intracardiac and peripheral arterial thrombosis. A 58-year-old man, without major comorbidity, was admitted with a 14-day history of breathlessness. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection was confirmed by laboratory testing. Initial imaging revealed COVID-19 pneumonia but no pulmonary thromboembolism (PTE) on CT pulmonary angiography (CTPA). The patient subsequently developed respiratory failure and left foot ischaemia associated with a rising D-dimer. Repeat CTPA and lower limb CT angiography revealed simultaneous bilateral PTE, biventricular cardiac thrombi and bilateral lower limb arterial occlusions. This case highlights a broad range of vascular sequalae associated with COVID-19 and the fact that these can occur despite a combination of prophylactic and treatment dose anticoagulation.


Subject(s)
Coronavirus Infections , Enoxaparin/administration & dosage , Heart Diseases , Pandemics , Peripheral Arterial Disease , Pneumonia, Viral , Pulmonary Embolism , Thrombosis , Warfarin/administration & dosage , Anticoagulants/administration & dosage , Betacoronavirus/isolation & purification , Betacoronavirus/pathogenicity , Clinical Deterioration , Computed Tomography Angiography/methods , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Heart Diseases/diagnosis , Heart Diseases/etiology , Heart Diseases/therapy , Heart Ventricles/diagnostic imaging , Humans , Male , Middle Aged , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/etiology , Peripheral Arterial Disease/therapy , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiology , Pulmonary Embolism/therapy , Thrombosis/diagnosis , Thrombosis/etiology , Thrombosis/therapy , Treatment Outcome
3.
J Cardiovasc Med (Hagerstown) ; 21(10): 759-764, 2020 10.
Article in English | MEDLINE | ID: covidwho-692881

ABSTRACT

BACKGROUND: The prevalence and prognostic implications of acute cardiac injury (ACI), as a complication of coronavirus disease 2019 (COVID-19), remain unclear. OBJECTIVES: We conducted a systematic review and meta-analysis to investigate the relationship between ACI and mortality risk in COVID-19 patients. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE, Scopus and Web of Science to locate all articles published up to 10 April 2020 reporting data of COVID-19 survivors and nonsurvivors developing ACI as a complication of the infection. Quality assessment was performed using the Newcastle-Ottawa quality assessment scale. Data were pooled using the Mantel-Haenszel random effects models with odds ratio as the effect measure with the related 95% confidence interval. Statistical heterogeneity between groups was measured using the Higgins I statistic. RESULTS: Eight studies, enrolling 1686 patients (mean age 59.5 years), met the inclusion criteria and were included in the final analysis. Data regarding the outcome of patients complicated with ACI were available for 1615 patients. Of these, 387 (23.9%) experienced ACIs as COVID-19 complications during the hospitalization. The incidence of ACI was significantly higher among non survivors when compared with survivors (61.6 vs. 6.7%, P < 0.0001). The pooled analysis confirmed a significantly increased risk of death in COVID-19 patients complicated with ACI during the disease (odds ratio: 21.6, 95% confidence interval: 8.6-54.4, P < 0.0001, I = 82%). CONCLUSION: Development of ACI during COVID-19 significantly increases the risk of death during the infection.


Subject(s)
Coronavirus Infections , Heart Diseases , Pandemics , Pneumonia, Viral , Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Heart Diseases/diagnosis , Heart Diseases/etiology , Heart Diseases/mortality , Humans , Incidence , Middle Aged , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Prognosis , Risk Assessment
4.
Med Sci Monit ; 26: e925047, 2020 Jul 28.
Article in English | MEDLINE | ID: covidwho-689085

ABSTRACT

BACKGROUND The aim of this study was to describe the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and compare these parameters in an elderly group with those in a younger group. MATERIAL AND METHODS This retrospective, single-center observational study included 69 hospitalized patients with laboratory-confirmed COVID-19 from a tertiary hospital in Wuhan, China, between January 14, 2020, and February 26, 2020. Epidemiological, demographic, clinical, and laboratory data, as well as treatments, complications, and outcomes were extracted from electronic medical records and compared between elderly patients (aged ≥60 years) and younger patients (aged <60 years). Patients were followed until March 19, 2020. RESULTS Elderly patients had more complications than younger patients, including acute respiratory distress syndrome (ARDS; 9/25, 36% vs. 5/44, 11.4%) and cardiac injury (7/25, 28% vs. 1/44, 2.3%), and they were more likely to be admitted to the intensive care unit (6/25, 24% vs. 2/44, 4.5%). As of March 19, 2020, 60/69 (87%) of the patients had been discharged, 6/69 (8.7%) had died, and 3/69 (4.3%) remained in the hospital. Of those who were discharged or died, the median duration of hospitalization was 13.5 days (interquartile range, 10-18 days). CONCLUSIONS Elderly patients with confirmed COVID-19 were more likely to develop ARDS and cardiac injury than younger patients and were more likely to be admitted to the intensive care unit. In addition to routine monitoring and respiratory support, cardiac monitoring and supportive care should be a focus in elderly patients with COVID-19.


Subject(s)
Age Factors , Coronavirus Infections/epidemiology , Heart Diseases/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome, Adult/epidemiology , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Adult , Aged , Aged, 80 and over , Betacoronavirus , China/epidemiology , Combined Modality Therapy , Coronavirus Infections/blood , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Coronavirus Infections/therapy , Heart Diseases/etiology , Humans , Inpatients , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Multiple Organ Failure/epidemiology , Multiple Organ Failure/etiology , Palliative Care/statistics & numerical data , Pneumonia, Viral/blood , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Respiratory Distress Syndrome, Adult/etiology , Retrospective Studies , Tertiary Care Centers , Treatment Outcome , Young Adult
6.
JACC Cardiovasc Imaging ; 13(8): 1792-1808, 2020 08.
Article in English | MEDLINE | ID: covidwho-612980

ABSTRACT

The severe acute respiratory syndrome-coronavirus-2 outbreak has rapidly reached pandemic proportions and has become a major threat to global health. Although the predominant clinical feature of coronavirus disease-2019 (COVID-19) is an acute respiratory syndrome of varying severity, ranging from mild symptomatic interstitial pneumonia to acute respiratory distress syndrome, the cardiovascular system can be involved in several ways. As many as 40% of patients hospitalized with COVID-19 have histories of cardiovascular disease, and current estimates report a proportion of myocardial injury in patients with COVID-19 of up to 12%. Multiple pathways have been suggested to explain this finding and the related clinical scenarios, encompassing local and systemic inflammatory responses and oxygen supply-demand imbalance. From a clinical point of view, cardiac involvement during COVID-19 may present a wide spectrum of severity, ranging from subclinical myocardial injury to well-defined clinical entities (myocarditis, myocardial infarction, pulmonary embolism, and heart failure), whose incidence and prognostic implications are currently largely unknown because of a significant lack of imaging data. Integrated heart and lung multimodality imaging plays a central role in different clinical settings and is essential in the diagnosis, risk stratification, and management of patients with COVID-19. The aims of this review are to summarize imaging-oriented pathophysiological mechanisms of lung and cardiac involvement in COVID-19 and to provide a guide for integrated imaging assessment in these patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Heart Diseases/diagnosis , Heart/diagnostic imaging , Lung/diagnostic imaging , Multimodal Imaging/methods , Pneumonia, Viral/diagnosis , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Global Health , Heart Diseases/epidemiology , Heart Diseases/etiology , Humans , Incidence , Magnetic Resonance Imaging, Cine/methods , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Tomography, X-Ray Computed/methods
8.
Int J Infect Dis ; 96: 294-297, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-356171

ABSTRACT

OBJECTIVE: To describe the clinical features of coronavirus disease 2019 (COVID-19). METHODS: We recruited 73 patients with COVID-19 [49 men and 24 women; average age: 58.36 years (SD: 14.31)] admitted to the intensive care unit of Wuhan Jinyintan Hospital from December 30, 2019 to February 16, 2020. Demographics, underlying diseases, and laboratory test results on admission were collected and analyzed. Data were compared between survivors and non-survivors. RESULTS: The non-survivors were older (65.46 [SD 9.74]vs 46.23 [12.01]) and were more likely to have chronic medical illnesses. Non-survivors tend to develop more severe lymphopenia, with higher C-reactive protein, interleukin-6, D-dimer, and hs-Troponin I(hs-TnI) levels. Patients with elevated hs-TnI levels on admission had shorter duration from symptom onset to death. Increased hs-TnI level was related to dismal prognosis. Death risk increased by 20.8% when the hs-TnI level increased by one unit. After adjusting for inflammatory or coagulation index, the independent predictive relationship between hs-TnI and death disappeared. CONCLUSIONS: Cardiac injury may occur at the early stage of COVID-19, which is associated with high mortality. Inflammatory factor cascade and coagulation abnormality may be the potential mechanisms of COVID-19 combined with cardiac injury.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Heart Diseases/etiology , Pneumonia, Viral/complications , Troponin I/blood , Adult , Aged , C-Reactive Protein/analysis , Coronavirus Infections/blood , Coronavirus Infections/mortality , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/mortality
9.
Curr Atheroscler Rep ; 22(3): 14, 2020 05 07.
Article in English | MEDLINE | ID: covidwho-262356

ABSTRACT

PURPOSE OF THE REVIEW: Coronavirus disease 2019 (COVID-19), a new infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has reached a pandemic status. Although SARSCoV-2 causes primarily respiratory problems, concurrent cardiac injury cannot be ignored since it may be an independent predictor for adverse outcomes. To resolve these issues, we aim to summarize the prevalence and its underlying mechanisms of acute cardiac injury in the setting of SARS-CoV-2 infection. RECENT FINDINGS: The main clinical manifestation of SARS-CoV-2 infection is pneumonia, cardiovascular complications have also been identified in the earliest reported cases from Wuhan, the epicenter of the outbreak. Given the SARS-CoV-2 likely uses the angiotensin-converting enzyme-2 (ACE2) receptors as its host receptor, ACE2-related signaling pathways may play a key role in mediating myocardial injury. SARS-CoV-2 infection related acute cardiac injury cannot be ignored, and its underlying mechanisms remain speculated. We would suggest that health professionals investigate cardiac function as part of the routine care.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Heart Diseases/etiology , Pneumonia, Viral/complications , Humans , Pandemics , Peptidyl-Dipeptidase A/metabolism , Signal Transduction
13.
Basic Res Cardiol ; 115(3): 31, 2020 04 09.
Article in English | MEDLINE | ID: covidwho-46686

ABSTRACT

From January 2020, coronavirus disease (COVID-19) originated in China has spread around the world. The disease is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The presence of myocarditis, cardiac arrest, and acute heart failure in COVID-19 patients suggests the existence of a relationship between SARS-CoV-2 infection and cardiac disease. The Notch signalling is a major regulator of cardiovascular function and it is also implicated in several biological processes mediating viral infections. In this report we discuss the possibility to target Notch signalling to prevent SARS-CoV-2 infection and interfere with the progression of COVID-19- associated heart and lungs disease.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/drug therapy , Coronavirus Infections/physiopathology , Heart Diseases/drug therapy , Heart Diseases/etiology , Lung Diseases/drug therapy , Lung Diseases/etiology , Pneumonia, Viral/drug therapy , Pneumonia, Viral/physiopathology , Receptors, Notch/antagonists & inhibitors , ADAM17 Protein/antagonists & inhibitors , Betacoronavirus/drug effects , China , Coronavirus Infections/pathology , Coronavirus Infections/virology , Disease Progression , Furin/metabolism , Heart Arrest/etiology , Heart Arrest/pathology , Heart Diseases/pathology , Heart Diseases/physiopathology , Heart Failure/etiology , Heart Failure/pathology , Humans , Interleukin-6/immunology , Lung Diseases/pathology , Lung Diseases/physiopathology , Myocarditis/etiology , Myocarditis/pathology , Pandemics , Peptidyl-Dipeptidase A/deficiency , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , Receptors, Notch/metabolism , Signal Transduction/drug effects
14.
Hellenic J Cardiol ; 61(1): 42-45, 2020.
Article in English | MEDLINE | ID: covidwho-40673

ABSTRACT

OBJECTIVE: Colchicine has been utilized safely in a variety of cardiovascular clinical conditions. Among its potential mechanisms of action is the non-selective inhibition of NLRP3 inflammasome which is thought to be a major pathophysiologic component in the clinical course of patients with COVID-19. GRECCO-19 will be a prospective, randomized, open-labeled, controlled study to assess the effects of colchicine in COVID-19 complications prevention. METHODS: Patients with laboratory confirmed SARS-CoV-2 infection (under RT PCR) and clinical picture that involves temperature >37.5 oC and at least two out of the: i. sustained coughing, ii. sustained throat pain, iii. Anosmia and/or ageusia, iv. fatigue/tiredness, v. PaO2<95 mmHg will be included. Patients will be randomised (1:1) in colchicine or control group. RESULTS: Trial results will be disseminated through peer-reviewed publications and conference presentations. CONCLUSION: GRECCO-19 trial aims to identify whether colchicine may positively intervene in the clinical course of COVID-19. (ClinicalTrials.gov Identifier: NCT04326790).


Subject(s)
Colchicine , Coronavirus Infections , Heart Diseases , Pandemics , Pneumonia, Viral , Antirheumatic Agents/administration & dosage , Antirheumatic Agents/adverse effects , Betacoronavirus/isolation & purification , Clinical Laboratory Techniques/methods , Colchicine/administration & dosage , Colchicine/adverse effects , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Heart Diseases/blood , Heart Diseases/etiology , Heart Diseases/prevention & control , Humans , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Randomized Controlled Trials as Topic , Symptom Assessment/methods , Troponin/analysis
16.
Cardiovasc Res ; 116(6): 1097-1100, 2020 05 01.
Article in English | MEDLINE | ID: covidwho-19719

ABSTRACT

A new type of pneumonia caused by a novel coronavirus SARS-CoV-2 outbreaks recently in China and spreads into many other countries. This disease, named as COVID-19, is similar to patients infected by SARS-CoV and MERS-CoV, and nearly 20% of patients developed severe condition. Cardiac injury is a prevalent complication of severe patients, exacerbating the disease severity in coronavirus disease 2019 (COVID-19) patients. Angiotensin-converting enzyme 2 (ACE2), the key host cellular receptor of SARS-CoV-2, has been identified in multiple organs, but its cellular distribution in human heart is not illuminated clearly. This study performed the first state-of-art single cell atlas of adult human heart, and revealed that pericytes with high expression of ACE2 might act as the target cardiac cell of SARS-CoV-2. The pericytes injury due to virus infection may result in capillary endothelial cells dysfunction, inducing microvascular dysfunction. And patients with basic heart failure disease showed increased ACE2 expression at both mRNA and protein levels, meaning that if infected by the virus these patients may have higher risk of heart attack and critically ill condition. The finding of this study explains the high rate of severe cases among COVID-19 patients with basic cardiovascular disease; and these results also perhaps provide important reference to clinical treatment of cardiac injury among severe patients infected by SARS-CoV-2.


Subject(s)
Betacoronavirus/physiology , Coronavirus Infections/complications , Heart Diseases/etiology , Myocardium/enzymology , Peptidyl-Dipeptidase A/metabolism , Pericytes/enzymology , Pneumonia, Viral/complications , Betacoronavirus/metabolism , Coronavirus Infections/virology , Gene Expression , Gene Expression Profiling , Heart/virology , Humans , Pandemics , Peptidyl-Dipeptidase A/genetics , Pericytes/virology , Pneumonia, Viral/virology , Receptors, Virus/genetics , Receptors, Virus/metabolism , Spike Glycoprotein, Coronavirus/metabolism
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