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1.
Dis Markers ; 2022: 9713326, 2022.
Article in English | MEDLINE | ID: covidwho-1770053

ABSTRACT

The use of high-sensitivity cardiac troponin (hs-cTn) assays has become part of the daily practice in most of the laboratories worldwide in the initial evaluation of the typical chest pain. Due to their early surge, the use of hs-cTn may reduce the time needed to recognise myocardial infarctions (MI), which is vital for the patients presenting in the emergency departments for chest pain. The latest European Society of Cardiology Guidelines did not only recognise their central role in the diagnosis algorithm but also recommended their use for rapid rule-in/rule-out of MI. High-sensitivity cardiac troponins are also powerful prognostic markers for long-term events and mortality, not only in a wide spectrum of other cardiovascular diseases (CVD) but also in several non-CVD pathologies. Moreover, these biomarkers became a powerful tool in special populations, such as paediatric patients and, most recently, COVID-19 patients. Although highly investigated, the assessment and interpretation of the hs-cTn changes are still challenging in the patients with basal elevation such as CKD or critically ill patients. Moreover, there are still various analytical characteristics not completely understood, such as circadian or sex variability, with major clinical implications. In this context, the present review focuses on summarizing the most recent research in the current use of hs-cTn, with a main consideration for its role in the diagnosis of MI but also its prognostic value. We have also carefully selected the most important studies regarding the challenges faced by clinicians from different specialties in the correct interpretation of this biomarker. Moreover, future perspectives have been proposed and analysed, as more research and cross-disciplinary collaboration are necessary to improve their performance.


Subject(s)
COVID-19 , Myocardial Infarction , Biomarkers , COVID-19/diagnosis , Chest Pain , Child , Humans , Myocardial Infarction/diagnosis , Troponin
2.
Laeknabladid ; 108(4): 182-188, 2022 Apr.
Article in Icelandic | MEDLINE | ID: covidwho-1766223

ABSTRACT

INTRODUCTON: Nonpharmaceutical interventions to contain the spread of COVID-19 infections in Iceland in 2020 were successful, but the effects of these measures on incidence and diagnosis of other diseases is unknown. The aim of this study was to evaluate the impact of the COVID-19 pandemic on the diagnosis of myocardial infarction (MI) and selected infections with different transmission routes. MATERIALS AND METHODS: Health records of individuals 18 years or older who were admitted to Landspitali University Hospital (LUH) in 2016-2020 with pneumonia or MI were extracted from the hospital registry. We acquired data from the clinical laboratories regarding diagnostic testing for Chlamydia trachomatis, influenza, HIV and blood cultures positive for Enterobacterales species. Standardized incidence ratio (SIR) for 2020 was calculated with 95% confidence intervals (95%CI) and compared to 2016-2019. RESULTS: Discharge diagnoses due to pneumonia decreased by 31% in 2020, excluding COVID-19 pneumonia (SIR 0.69 (95%CI 0.64-0.75)). Discharge diagnoses of MI decreased by 18% (SIR 0.82 (95%CI 0.75-0.90)), and emergency cardiac catheterizations due to acute coronary syndrome by 23% (SIR 0.77 (95%CI 0.71-0.83)), while there was a 15% increase in blood stream infections for Enterobacterales species (SIR 1.15 (95%CI 1.04-1.28)). Testing for Chlamydia trachomatis decreased by 14.8% and positive tests decreased by 16.3%. Tests for HIV were reduced by 10.9%, while samples positive for influenza decreased by 23.6% despite doubling of tests being performed. CONCLUSION: The number of pneumonia cases of other causes than COVID-19 requiring admission dropped by a quarter in 2020. MI, chlamydia and influensa diagnoses decreased notably. These results likely reflect a true decrease, probably due to altered behaviour during the pandemic.


Subject(s)
COVID-19 , Myocardial Infarction , COVID-19/diagnosis , COVID-19/epidemiology , Humans , Iceland/epidemiology , Incidence , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Pandemics/prevention & control
3.
G Ital Cardiol (Rome) ; 23(3): 190-199, 2022 Mar.
Article in Italian | MEDLINE | ID: covidwho-1765603

ABSTRACT

Post-infarction mechanical complications include left ventricular free-wall rupture, ventricular septal rupture, and papillary muscle rupture. With the advent of early reperfusion strategies, including thrombolysis and percutaneous coronary intervention, these events now occur in fewer than 0.3% of patients following acute myocardial infarction. However, unfortunately, there has been no parallel decrease in associated mortality rates over the past two decades. Moreover, during the ongoing COVID-19 pandemic the incidence of mechanical complications resulting from ST-elevation myocardial infarction has possibly risen. Early diagnosis and prompt management are crucial to improving outcomes. Although some percutaneous device repair approaches are available, surgical treatment remains the gold standard for these catastrophic post-infarction complications. The timing of surgery, also related to the type of complication and patient's clinical conditions, and the possible role of mechanical circulatory supports before and after surgery, represent main topics of debate that still need to be fully addressed.


Subject(s)
COVID-19 , Myocardial Infarction , ST Elevation Myocardial Infarction , COVID-19/complications , Early Diagnosis , Humans , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Infarction/therapy , Pandemics , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/therapy
4.
Arch Iran Med ; 24(4): 339-340, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1761684

ABSTRACT

Since the emergence of novel coronavirus and the disease named as COVID-19 in late December of 2019 in Wuhan, Hubei province, China, many aspects of this disease have been reported in the literature (mainly pulmonary manifestations). In patients with COVID-19, rheumatic and cardiovascular manifestations and interactions were reported separately, but they were all very rare. This is the report of a 14-year-old teenager with GPA (previously known as Wegner's granulomatosis) who was in remission with immunosuppressive therapy. Post COVID-19 infection, she developed exacerbation of her disease. Besides the rheumatologic manifestations, she developed epigastric pain found to be acute myocardial infarction (MI) that needed primary percutaneous coronary intervention (PCI).


Subject(s)
COVID-19/complications , COVID-19/diagnosis , Granulomatosis with Polyangiitis/complications , Myocardial Infarction/diagnosis , Myocardial Infarction/etiology , Adolescent , COVID-19/therapy , Female , Humans , Myocardial Infarction/therapy
7.
BMC Cardiovasc Disord ; 21(1): 626, 2021 12 31.
Article in English | MEDLINE | ID: covidwho-1592243

ABSTRACT

INTRODUCTION: The majority of studies evaluating the effect of myocardial injury on the survival of COVID-19 patients have been performed outside of the United States (U.S.). These studies have often utilized definitions of myocardial injury that are not guideline-based and thus, not applicable to the U.S. METHODS: The current study is a two-part investigation of the effect of myocardial injury on the clinical outcome of patients hospitalized with COVID-19. The first part is a retrospective analysis of 268 patients admitted to our healthcare system in Toledo, Ohio, U.S.; the second part is a systematic review and meta-analysis of all similar studies performed within the U.S. RESULTS: In our retrospective analysis, patients with myocardial injury were older (mean age 73 vs. 59 years, P 0.001), more likely to have hypertension (86% vs. 67%, P 0.005), underlying cardiovascular disease (57% vs. 24%, P 0.001), and chronic kidney disease (26% vs. 10%, P 0.004). Myocardial injury was also associated with a lower likelihood of discharge to home (35% vs. 69%, P 0.001), and a higher likelihood of death (33% vs. 10%, P 0.001), acute kidney injury (74% vs. 30%, P 0.001), and circulatory shock (33% vs. 12%, P 0.001). Our meta-analysis included 12,577 patients from 8 U.S. states and 55 hospitals who were hospitalized with COVID-19, with the finding that myocardial injury was significantly associated with increased mortality (HR 2.43, CI 2.28-3.6, P 0.0005). The prevalence of myocardial injury ranged from 9.2 to 51%, with a mean prevalence of 27.2%. CONCLUSION: Hospitalized COVID-19 patients in the U.S. have a high prevalence of myocardial injury, which was associated with poorer survival and outcomes.


Subject(s)
COVID-19/complications , Myocardial Infarction/etiology , Aged , Cardiovascular Diseases/complications , Female , Hospitalization , Humans , Male , Middle Aged , Myocardial Infarction/diagnosis , Ohio , Prognosis , Renal Insufficiency, Chronic/complications , Retrospective Studies , SARS-CoV-2 , Troponin I/blood
8.
Clin Chim Acta ; 527: 33-37, 2022 Feb 15.
Article in English | MEDLINE | ID: covidwho-1593887

ABSTRACT

BACKGROUND: Although cardiac troponin T (cTnT) and troponin I(cTnI) are expressed to similar amount in cardiac tissue, cTnI often reach ten-times higher peak levels compared to cTnT in patients with myocardial necrosis such as in acute myocardial infarction (MI). In contrast, similar levels of cTnT and cTnI are observed in other situations such as stable atrial fibrillation and after strenuous exercise. OBJECTIVE: Examine cTnT and cTnI levels in relation to COVID-19 disease and MI. METHODS: Clinical and laboratory data from the local hospital from an observational cohort study of 27 patients admitted with COVID-19 and 15 patients with myocardial infarction (MI) that were analyzed with paired cTnT and cTnI measurement during hospital care. RESULTS: Levels of cTnI were lower than cTnT in COVID-19 patients (TnI/TnT ratio 0.3, IQR: 0.1-0.6). In contrast, levels of cTnI were 11 times higher compared to cTnT in 15 patients with MI (TnI/TnT ratio 11, IQR: 7-14). The peak cTnI/cTnT ratio among the patients with MI following successful percutaneous intervention were 14 (TnI/TnT ratio 14, IQR: 12-23). The 5 COVID-19 patient samples collected under possible necrotic events had a cTnI/cTnT ratio of 5,5 (IQR: 1,9-8,3). CONCLUSIONS: In patients with COVID-19, cTnT is often elevated to higher levels than cTnI in sharp contrast to patients with MI, indicating that the release of cardiac troponin has a different cause in COVID-19 patients.


Subject(s)
COVID-19 , Myocardial Infarction , Biomarkers , Humans , Myocardial Infarction/diagnosis , SARS-CoV-2 , Troponin I , Troponin T
9.
Arch Cardiovasc Dis ; 115(1): 37-47, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1561396

ABSTRACT

BACKGROUND: Concomitant or cured coronavirus disease 2019 (COVID-19) in patients with myocardial infarction (MI) may lead to difficulties in acute care management and impair prognosis. AIMS: To describe and compare the characteristics, care management and 90-day post discharge outcomes of patients hospitalized for MI who did not have COVID-19 with those of patients with concomitant or previous hospital-diagnosed COVID-19. METHODS: This population-based French study included all patients hospitalized for MI in France (30 December 2019 to 04 October 2020) from the French National Health Data System. Outcomes were described for each COVID-19 group and compared using adjusted logistic regression analysis. RESULTS: Among 55,524 patients hospitalized for MI, 135 had previous hospital-diagnosed COVID-19 and 329 had concomitant COVID-19. Patients with previous hospital-diagnosed COVID-19 had more personal history of cardiovascular diseases than those without concomitant/previous confirmed COVID-19. In-hospital and 90-day post discharge mortality rates of patients with previous COVID-19 were 8.1% and 4.0%, respectively, compared with 3.5% and 3.0% in patients without concomitant/previous confirmed COVID-19 (odds ratio [OR]adjin-hospital 1.83, 95% confidence interval [CI] 0.97-3.46; ORadjpostdischarge 0.77, 95% CI 0.28-2.13). Patients with concomitant COVID-19 had more personal history of cardiovascular diseases, but also a poorer prognosis than their no concomitant/no previous confirmed COVID-19 counterparts; they presented excess cardiac complications during hospitalization (ORadj 1.62, 95% CI 1.29-2.04), in-hospital mortality (ORadj 3.31, 95% CI 2.32-4.72) and 90-day post discharge mortality (ORadj 2.09, 95% CI 1.24-3.51). CONCLUSIONS: In-hospital and 90-day post discharge mortality of patients hospitalized for MI who had previous hospital-diagnosed COVID-19 did not seem to differ from those hospitalized for MI alone. Conversely, concomitant COVID-19 and MI carried a poorer prognosis extending beyond the hospital stay. Special attention should be given to patients with simultaneous COVID-19 and MI, in terms of acute care and secondary prevention.


Subject(s)
COVID-19 , Myocardial Infarction , Aftercare , Hospital Mortality , Hospitalization , Humans , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Patient Discharge , SARS-CoV-2
10.
JNMA J Nepal Med Assoc ; 59(242): 1048-1051, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1547958

ABSTRACT

Silent myocardial infarction or unrecognized myocardial infarction has increased prevalence in elderly population with increased cardiovascular risk factors. However, its prevalence in COVID-19 patients is not well-known. A 77-year-old Caucasian male with COVID-19 pneumonia, presented with silent ST-segment elevation myocardial infarction, diabetic ketoacidosis and multiorgan failure. He underwent cardiac catheterization and drug eluting stent placement in the ostial right coronary artery with safety protocol. He was discharged to extended-care-facility in stable condition. This is a first case report of silent ST-segment elevation myocardial infarction in a patient presenting with COVID-19. In patients with COVID-19, acute myocardial infarction should be ruled out even when asymptomatic, especially in older patients. Prompt intervention using safety protocol is life-saving.


Subject(s)
COVID-19 , Drug-Eluting Stents , Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Aged , Humans , Male , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , SARS-CoV-2 , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/surgery , Treatment Outcome
12.
Am J Emerg Med ; 54: 326.e1-326.e4, 2022 04.
Article in English | MEDLINE | ID: covidwho-1509480

ABSTRACT

COVID-19 has profound direct health consequences, however secondary effects were much broader as rates of hospital visits steeply declined for non-COVID-19 concerns, including myocardial infarction (MI) and stroke, with patients choosing to wait longer before symptoms convince them to seek medical attention. Thus, patients where ischemia leads to tissue loss should be a major concern. METHODS: The months of March to June 2019 and 2020 were compared to each other at 4 Denver area hospitals. Reduction in overall ED visits and an increase in patient refusal for emergency transport were clear in the data collected. During this period in 2019, 49 MI and 90 stroke patients were admitted. In 2020 this was 40 and 90 respectively. All were matched for age and gender. For MI patients ejection fraction and door to EKG and intervention times were measured. For stroke patients last known well time, time to evaluation, and modified Rankin scores were measured. RESULTS: 254 (8.12%) patients refused emergency services transportation before the pandemic compared to 479 (18.35%) during the pandemic (p-value <0.001, chi square test). In the MI cohort, no significant difference was detected in measured ejection fraction (48% vs 49% p-value = 0.682). Additionally, no significant difference was detected between door to EKG time or door to MI intervention time. During the pandemic 8 (22%) expired with an MI prior to discharge, compared to 2 (4%) before the pandemic. The stroke cohort Door to Evaluation Time, Time since last well known, and modified Rankin scores were all found to have insignificant differences. DISCUSSION: ED volume was significantly lower during the early stages of the pandemic. During this time however only death from cardiac events increased, in spite of similar ejection fractions at discharge. The cause of this remains unclear as ejection fraction similarities make it less attributable to loss of tissue than to other factors. Patient behavior significantly changed during the pandemic, making this a likely source of the increase in mortality seen.


Subject(s)
COVID-19 , Ischemic Stroke , Myocardial Infarction , Stroke , COVID-19/epidemiology , Humans , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Pandemics , Retrospective Studies , Stroke/diagnosis , Stroke/epidemiology , Stroke/therapy
13.
Arch Cardiovasc Dis ; 114(12): 768-780, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1509466

ABSTRACT

BACKGROUND: Studies reported a decrease in hospital admissions for myocardial infarction (MI) in early 2020 as a result of the coronavirus disease 2019 (COVID-19) crisis, mainly restricted to the beginning of the pandemic. AIMS: To describe national trends in hospital admissions for MI in 2020, and to compare patient characteristics, in-hospital prognosis and 90-day mortality between patients who had an MI in 2020 and those admitted in 2017-2019. METHODS: All patients hospitalized for MI in France from 2017 to 2020 were selected from the national hospital discharge database. Analyses compared temporal trends in MI admissions, in-hospital cardiac complications and mortality rates in 2020 versus 2017-2019. RESULTS: In 2020, 94,747 patients were hospitalized for MI, corresponding to a 6% decrease in MI admissions compared with 2017-19. This decrease was larger during the first lockdown (-24%; P<0.0001) than during the second lockdown (-8%; P<0.0001). Reductions in MI admissions were more pronounced and longer among patients with non-ST-segment elevation MI, older people and women. An increase in ST-segment elevation MI admissions was observed between lockdowns (+4%; P=0.0005). Globally, and after adjustment for age, sex and calendar year, in-hospital and 90-day post-discharge mortality rates did not differ in 2020 versus 2017-19: incidence rate ratio (IRR)adjin-hospital 1.03, 95% confidence interval (CI) (0.98-1.08); IRRadj90-daypost-discharge 1.06, 95% CI (0.98-1.13). CONCLUSIONS: In 2020, a significant decrease in MI admissions was observed, and was marked at the beginning of the year. This highlights the need to disseminate public information on the importance of maintaining care and regular medical follow-up. The effect of the COVID-19 crisis on acute and 3-month outcomes of patients hospitalized for MI appears limited. Nevertheless, monitoring of chronic MI complications and the impact on non-hospitalized patients should continue.


Subject(s)
COVID-19 , Myocardial Infarction , Aftercare , Aged , Communicable Disease Control , Female , Hospital Mortality , Hospitalization , Humans , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Pandemics , Patient Discharge , Prognosis , SARS-CoV-2
17.
Exp Clin Transplant ; 19(11): 1232-1237, 2021 11.
Article in English | MEDLINE | ID: covidwho-1431093

ABSTRACT

Shortages of grafts for liver transplant remain a persistent problem. The use of lacerated livers for liver transplant can add an option for extended criteria donations, especially during the COVID-19 pandemic. We present the case of a successful liver transplant performed using a high-grade lacerated liver previously treated with superselective arterial embolization and packing for bleeding control. In view of the absence of guidelines for the use of lacerated livers for transplant, we also performed a review of the literature on injured liver grafts that were used for liver transplants. Meticulous care and careful selection of recipients were essential prerequisites for achieving successful outcomes.


Subject(s)
Abdominal Injuries/etiology , COVID-19 , End Stage Liver Disease/surgery , Heart Massage/adverse effects , Liver Transplantation , Liver/injuries , Liver/surgery , Myocardial Infarction/therapy , Takotsubo Cardiomyopathy/complications , Abdominal Injuries/diagnostic imaging , Abdominal Injuries/therapy , Adolescent , Adult , Clinical Decision-Making , Donor Selection , End Stage Liver Disease/diagnosis , Fatal Outcome , Female , Humans , Liver/diagnostic imaging , Liver Transplantation/adverse effects , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/etiology , Risk Assessment , Risk Factors , Takotsubo Cardiomyopathy/diagnosis , Treatment Outcome , Young Adult
19.
Future Cardiol ; 18(2): 135-142, 2022 02.
Article in English | MEDLINE | ID: covidwho-1394693

ABSTRACT

There has been strong evidence of myocardial injury in COVID-19 patients with significantly elevated serum cardiac troponin (cTn). While the exact mechanism of injury is unclear, possible suggested pathological mechanisms of injury are discussed. These include increased susceptibility of the myocardium and endothelium to viral invasion, underlying hyperinflammatory state and subsequent cytokine storm, a hypercoagulable and prothrombotic state, and indirect myocardial injury due to hypoxemia. As a result of these pathological mechanisms in COVID-19 patients, cTn may be elevated largely due to myocarditis, microangiopathy or myocardial infarction. The utility of cTn as a biomarker for measuring myocardial injury in these patients and assessing its ability as a prognostic factor for clinical outcome is also discussed.


Subject(s)
COVID-19 , Cardiovascular Diseases , Myocardial Infarction , Troponin/blood , Biomarkers/blood , COVID-19/diagnosis , Cardiovascular Diseases/diagnosis , Humans , Myocardial Infarction/diagnosis
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