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1.
J Cardiovasc Med (Hagerstown) ; 22(3): 190-196, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1054967

RESUMEN

AIM: The aim of this study was to detect predisposing CV risks factors and ECGs changes in COVID-19 patients. METHODS: The study population included 60 noncritically ill patients with COVID-19 pneumonia admitted to our hospital between 16 March and 11 May 2020. Electrographic changes, evaluated from ECGs acquired at admission and at 7 days after starting COVID-19 therapy, were analysed. We also compared 45 patients without CV involvement with 15 patients with new onset of cardiac adverse events during hospitalization. RESULTS: ECGs under treatment showed a lower heart rate (HR) (69.45 ±â€Š8.06 vs 80.1 ±â€Š25.1 beats/min, P = 0,001) and a longer QRS (102.46 ±â€Š15.08 vs 96.75 ±â€Š17.14, P = 0.000) and QT corrected (QTc) interval (452.15 ±â€Š37.55 vs 419.9 ±â€Š33.41, P = 0,000) duration than ECGs before therapy. Fifteen patients (25%) showed clinical CV involvement. Within this group, female sex, lower ejection fraction (EF), low serum haemoglobin, high Troponin I levels (TnI), low lymphocytes count, high serum IL-6 levels, or use of Tocilizumab (TCZ) were more represented. CONCLUSIONS: Patients admitted for SARS-CoV2 infection and treated with anti-COVID-19 drug therapy develop ECG changes such as reduction in HR and increase in QRS duration and QTc interval. One in four patients developed CV events. Gender, EF, heamoglobin values, TnI, lymphocytes count, IL-6 and use of TCZ can be considered as predisposing factors for CV involvement.


Asunto(s)
Antivirales/uso terapéutico , /tratamiento farmacológico , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/virología , Electrocardiografía , Adulto , Anciano , Antivirales/efectos adversos , Biomarcadores/sangre , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Neumonía Viral/virología , Factores de Riesgo , Factores Sexuales , Volumen Sistólico
2.
J Am Heart Assoc ; 9(19): e017126, 2020 10 20.
Artículo en Inglés | MEDLINE | ID: covidwho-852817

RESUMEN

Background After the coronavirus disease 2019 outbreak, social isolation measures were introduced to contain infection. Although there is currently a slowing down of the infection, a reduction of hospitalizations, especially for myocardial infarction, was observed. The aim of our study is to evaluate the impact of the infectious disease on ST-segment-elevation myocardial infarction (STEMI) care during the coronavirus disease 2019 pandemic, through the analysis of recent cases of patients who underwent percutaneous coronary intervention. Methods and Results Consecutive patients affected by STEMI from March 1 to 31, 2020, during social restrictions of Italian government, were collected and compared with patients with STEMI treated during March 2019. During March 2020, we observed a 63% reduction of patients with STEMI who were admitted to our catheterization laboratory, when compared with the same period of 2019 (13 versus 35 patients). Changes in all time components of STEMI care were notably observed, particularly for longer median time in symptom-to-first medical contact, spoke-to-hub, and the cumulative symptom-to-wire delay. Procedural data and in-hospital outcomes were similar between the 2 groups, whereas the length of hospitalization was longer in patients of 2020. In this group, we also observed higher levels of cardiac biomarkers and a worse left ventricular ejection fraction at baseline and discharge. Conclusions The coronavirus disease 2019 outbreak induced a reduction of hospital access for STEMI with an increase in treatment delay, longer hospitalization, higher levels of cardiac biomarkers, and worse left ventricular function.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Ventrículos Cardíacos/fisiopatología , Neumonía Viral/epidemiología , Infarto del Miocardio con Elevación del ST/epidemiología , Anciano , Comorbilidad , Ecocardiografía Doppler en Color , Electrocardiografía , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/diagnóstico por imagen , Mortalidad Hospitalaria/tendencias , Hospitalización/tendencias , Humanos , Incidencia , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Intervención Coronaria Percutánea/métodos , Pronóstico , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/cirugía , Volumen Sistólico/fisiología , Tasa de Supervivencia/tendencias
3.
JACC Heart Fail ; 8(10): 789-799, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-816609

RESUMEN

The PARADIGM-HF (Prospective Comparison of Angiotensin II Receptor Blocker Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial reported that sacubitril/valsartan (S/V), an angiotensin receptor-neprilysin inhibitor, significantly reduced mortality and heart failure (HF) hospitalization in HF patients with a reduced ejection fraction (HFrEF). However, fewer than 1% of patients in the PARADIGM-HF study had New York Heart Association (NYHA) functional class IV symptoms. Accordingly, data that informed the use of S/V among patients with advanced HF were limited. The LIFE (LCZ696 in Hospitalized Advanced Heart Failure) study was a 24-week prospective, multicenter, double-blinded, double-dummy, active comparator trial that compared the safety, efficacy, and tolerability of S/V with those of valsartan in patients with advanced HFrEF. The trial planned to randomize 400 patients ≥18 years of age with advanced HF, defined as an EF ≤35%, New York Heart Association functional class IV symptoms, elevated natriuretic peptide concentration (B-type natriuretic peptide [BNP] ≥250 pg/ml or N-terminal pro-B-type natriuretic peptide [NT-proBNP] ≥800 pg/ml), and ≥1 objective finding of advanced HF. Following a 3- to 7-day open label run-in period with S/V (24 mg/26 mg twice daily), patients were randomized 1:1 to S/V titrated to 97 mg/103 mg twice daily versus 160 mg of V twice daily. The primary endpoint was the proportional change from baseline in the area under the curve for NT-proBNP levels measured through week 24. Secondary and tertiary endpoints included clinical outcomes and safety and tolerability. Because of the COVID-19 pandemic, enrollment in the LIFE trial was stopped prematurely to ensure patient safety and data integrity. The primary analysis consists of the first 335 randomized patients whose clinical follow-up examination results were not severely impacted by COVID-19. (Entresto [LCZ696] in Advanced Heart Failure [LIFE STUDY] [HFN-LIFE]; NCT02816736).


Asunto(s)
Aminobutiratos/uso terapéutico , Antagonistas de Receptores de Angiotensina/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Tetrazoles/uso terapéutico , Betacoronavirus , Cardiotónicos/uso terapéutico , Infecciones por Coronavirus , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Combinación de Medicamentos , Terminación Anticipada de los Ensayos Clínicos , Tasa de Filtración Glomerular , Insuficiencia Cardíaca/metabolismo , Insuficiencia Cardíaca/fisiopatología , Trasplante de Corazón , Corazón Auxiliar , Hospitalización/estadística & datos numéricos , Humanos , Hipotensión/inducido químicamente , Péptido Natriurético Encefálico/metabolismo , Pandemias , Fragmentos de Péptidos/metabolismo , Neumonía Viral , Volumen Sistólico
6.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 48-54, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-788972

RESUMEN

INTRODUCTION: In the current literature, there has been an upsurge of cases of COVID-19-induced acute myocarditis. In this case-based review, we aimed to describe the clinical characteristics, imaging findings, and in-hospital course of acute myocarditis. In addition, the limitations of the myocarditis diagnosis were discussed since only fulminant myocarditis cases have been mentioned in the current literature. METHODS: We performed a review of the literature of all patients who were diagnosed with COVID-19-induced acute myocarditis using the databases of PubMed, Embase, and the Cochrane. RESULTS: 16 case reports were found to be related to COVID-19-induced acute myocarditis. We observed that the ECG findings in most of the COVID-19 patients were non-specific, including diffuse ST-segment elevation, non-specific intraventricular conduction delay, sinus tachycardia, and inverted T-waves in anterior leads. Echocardiographic findings of COVID-19-induced acute myocarditis patients ranged from preserved left ventricular ejection fraction (LVEF) without segmental abnormalities to reduced LVEF with global hypokinesia. Interestingly, a few patients with COVID-19-induced acute fulminant myocarditis were steroid-responsive and had an amelioration with glucocorticoid and immunoglobulin therapy. CONCLUSION: Despite the COVID-19 pandemic worldwide, a limited number of cases has been shared in the current literature. There are a lot of difficulties in the differential diagnosis of acute myocarditis in the context of COVID-19.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Coronavirus/aislamiento & purificación , Miocarditis/diagnóstico , Pandemias , Neumonía Viral/diagnóstico , Función Ventricular Izquierda/fisiología , Enfermedad Aguda , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Electrocardiografía , Humanos , Miocarditis/complicaciones , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Volumen Sistólico
7.
JACC Heart Fail ; 8(10): 789-799, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-649186

RESUMEN

The PARADIGM-HF (Prospective Comparison of Angiotensin II Receptor Blocker Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial reported that sacubitril/valsartan (S/V), an angiotensin receptor-neprilysin inhibitor, significantly reduced mortality and heart failure (HF) hospitalization in HF patients with a reduced ejection fraction (HFrEF). However, fewer than 1% of patients in the PARADIGM-HF study had New York Heart Association (NYHA) functional class IV symptoms. Accordingly, data that informed the use of S/V among patients with advanced HF were limited. The LIFE (LCZ696 in Hospitalized Advanced Heart Failure) study was a 24-week prospective, multicenter, double-blinded, double-dummy, active comparator trial that compared the safety, efficacy, and tolerability of S/V with those of valsartan in patients with advanced HFrEF. The trial planned to randomize 400 patients ≥18 years of age with advanced HF, defined as an EF ≤35%, New York Heart Association functional class IV symptoms, elevated natriuretic peptide concentration (B-type natriuretic peptide [BNP] ≥250 pg/ml or N-terminal pro-B-type natriuretic peptide [NT-proBNP] ≥800 pg/ml), and ≥1 objective finding of advanced HF. Following a 3- to 7-day open label run-in period with S/V (24 mg/26 mg twice daily), patients were randomized 1:1 to S/V titrated to 97 mg/103 mg twice daily versus 160 mg of V twice daily. The primary endpoint was the proportional change from baseline in the area under the curve for NT-proBNP levels measured through week 24. Secondary and tertiary endpoints included clinical outcomes and safety and tolerability. Because of the COVID-19 pandemic, enrollment in the LIFE trial was stopped prematurely to ensure patient safety and data integrity. The primary analysis consists of the first 335 randomized patients whose clinical follow-up examination results were not severely impacted by COVID-19. (Entresto [LCZ696] in Advanced Heart Failure [LIFE STUDY] [HFN-LIFE]; NCT02816736).


Asunto(s)
Aminobutiratos/uso terapéutico , Antagonistas de Receptores de Angiotensina/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Tetrazoles/uso terapéutico , Betacoronavirus , Cardiotónicos/uso terapéutico , Infecciones por Coronavirus , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Combinación de Medicamentos , Terminación Anticipada de los Ensayos Clínicos , Tasa de Filtración Glomerular , Insuficiencia Cardíaca/metabolismo , Insuficiencia Cardíaca/fisiopatología , Trasplante de Corazón , Corazón Auxiliar , Hospitalización/estadística & datos numéricos , Humanos , Hipotensión/inducido químicamente , Péptido Natriurético Encefálico/metabolismo , Pandemias , Fragmentos de Péptidos/metabolismo , Neumonía Viral , Volumen Sistólico
8.
J Am Soc Echocardiogr ; 33(10): 1278-1284, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-714636

RESUMEN

BACKGROUND: Despite growing evidence of cardiovascular complications associated with coronavirus disease 2019 (COVID-19), there are few data regarding the performance of transthoracic echocardiography (TTE) and the spectrum of echocardiographic findings in this disease. METHODS: A retrospective analysis was performed among adult patients admitted to a quaternary care center in New York City between March 1 and April 3, 2020. Patients were included if they underwent TTE during the hospitalization after a known positive diagnosis for COVID-19. Demographic and clinical data were obtained using chart abstraction from the electronic medical record. RESULTS: Of 749 patients, 72 (9.6%) underwent TTE following positive results on severe acute respiratory syndrome coronavirus-2 polymerase chain reaction testing. The most common clinical indications for TTE were concern for a major acute cardiovascular event (45.8%) and hemodynamic instability (29.2%). Although most patients had preserved biventricular function, 34.7% were found to have left ventricular ejection fractions ≤ 50%, and 13.9% had at least moderately reduced right ventricular function. Four patients had wall motion abnormalities suggestive of stress-induced cardiomyopathy. Using Spearman rank correlation, there was an inverse relationship between high-sensitivity troponin T and left ventricular ejection fraction (ρ = -0.34, P = .006). Among 20 patients with prior echocardiograms, only two (10%) had new reductions in LVEF of >10%. Clinical management was changed in eight individuals (24.2%) in whom TTE was ordered for concern for acute major cardiovascular events and three (14.3%) in whom TTE was ordered for hemodynamic evaluation. CONCLUSIONS: This study describes the clinical indications for use and diagnostic performance of TTE, as well as findings seen on TTE, in hospitalized patients with COVID-19. In appropriately selected patients, TTE can be an invaluable tool for guiding COVID-19 clinical management.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Ecocardiografía/métodos , Cardiopatías/diagnóstico , Ventrículos Cardíacos/diagnóstico por imagen , Neumonía Viral/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/epidemiología , Femenino , Estudios de Seguimiento , Cardiopatías/etiología , Cardiopatías/fisiopatología , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología , Función Ventricular Derecha/fisiología , Adulto Joven
9.
J Investig Med High Impact Case Rep ; 8: 2324709620947577, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-695219

RESUMEN

A 66-year-old male patient with coronavirus disease-19 (COVID-19) developed cardiogenic shock with echocardiographic evidence of decreased left ventricular ejection fraction and global hypokinesia concomitant with a robust systemic inflammatory response. Following the administration of convalescent plasma therapy and inotropic support, left ventricular function recovered fully in accordance with the decrease in the concentration of the inflammatory markers. Thus, we demonstrate the presence of transient reversible cardiomyopathy in a patient with severe COVID-19 and illustrate the association of acute cardiac dysfunction with profound systemic inflammation among COVID-19 patients.


Asunto(s)
Betacoronavirus , Cardiomiopatías/terapia , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Anciano , Cardiomiopatías/complicaciones , Cardiomiopatías/inmunología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/metabolismo , Humanos , Inmunización Pasiva/métodos , Masculino , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/inmunología , Volumen Sistólico , Resultado del Tratamiento , Función Ventricular Izquierda
11.
Pediatr Cardiol ; 41(7): 1391-1401, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-593665

RESUMEN

Children were relatively spared during COVID-19 pandemic. However, the recently reported hyperinflammatory syndrome with overlapping features of Kawasaki disease and toxic shock syndrome-"Paediatric Inflammatory Multisystem Syndrome-temporally associated with SARS-CoV-2" (PIMS-TS) has caused concern. We describe cardiac findings and short-term outcomes in children with PIMS-TS at a tertiary children's hospital. Single-center observational study of children with PIMS-TS from 10th April to 9th May 2020. Data on ECG and echocardiogram were retrospectively analyzed along with demographics, clinical features and blood parameters. Fifteen children with median age of 8.8 (IQR 6.4-11.2) years were included, all were from African/Afro-Caribbean, South Asian, Mixed or other minority ethnic groups. All showed raised inflammatory/cardiac markers (CRP, ferritin, Troponin I, CK and pro-BNP). Transient valve regurgitation was present in 10 patients (67%). Left Ventricular ejection fraction was reduced in 12 (80%), fractional shortening in 8 (53%) with resolution in all but 2. Fourteen (93%) had coronary artery abnormalities, with normalization in 6. ECG abnormalities were present in 9 (60%) which normalized in 6 by discharge. Ten (67%) needed inotropes and/or vasopressors. None needed extracorporeal life support. Improvement in cardiac biochemical markers was closely followed by improvement in ECG/echocardiogram. All patients were discharged alive and twelve (80%) have been reviewed since. Our entire cohort with PIMS-TS had cardiac involvement and this degree of involvement is significantly more than other published series and emphasizes the need for specialist cardiac review. We believe that our multi-disciplinary team approach was crucial for the good short-term outcomes.


Asunto(s)
Infecciones por Coronavirus/terapia , Cardiopatías/complicaciones , Hospitales Pediátricos , Neumonía Viral/terapia , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Betacoronavirus , Niño , Infecciones por Coronavirus/complicaciones , Ecocardiografía , Femenino , Cardiopatías/diagnóstico por imagen , Cardiopatías/terapia , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Síndrome Mucocutáneo Linfonodular/complicaciones , Pandemias , Alta del Paciente , Neumonía Viral/complicaciones , Estudios Retrospectivos , Volumen Sistólico , Síndrome de Respuesta Inflamatoria Sistémica/complicaciones , Resultado del Tratamiento , Reino Unido , Vasoconstrictores/uso terapéutico , Función Ventricular Izquierda
12.
Can J Cardiol ; 36(8): 1326.e5-1326.e7, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-549053
14.
Infection ; 48(5): 773-777, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-45828

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) has been demonstrated to be the cause of pneumonia. Nevertheless, it has not been reported as the cause of acute myocarditis or fulminant myocarditis. CASE PRESENTATION: A 63-year-old male was admitted with pneumonia and cardiac symptoms. He was genetically confirmed as having COVID-19 according to sputum testing on the day of admission. He also had elevated troponin I (Trop I) level (up to 11.37 g/L) and diffuse myocardial dyskinesia along with a decreased left ventricular ejection fraction (LVEF) on echocardiography. The highest level of interleukin-6 was 272.40 pg/ml. Bedside chest radiographs showed typical ground-glass changes indicative of viral pneumonia. Laboratory test results for viruses that cause myocarditis were all negative. The patient conformed to the diagnostic criteria of the Chinese expert consensus statement for fulminant myocarditis. After receiving antiviral therapy and mechanical life support, Trop I was reduced to 0.10 g/L, and interleukin-6 was reduced to 7.63 pg/mL. Moreover, the LVEF of the patient gradually recovered to 68%. The patient died of aggravation of secondary infection on the 33rd day of hospitalization. CONCLUSION: COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. This is the first report of COVID-19 complicated with fulminant myocarditis. The mechanism of cardiac pathology caused by COVID-19 needs further study.


Asunto(s)
Infecciones por Bacteroides/complicaciones , Betacoronavirus/patogenicidad , Candidiasis/complicaciones , Infecciones por Coronavirus/complicaciones , Miocarditis/complicaciones , Neumonía Viral/complicaciones , Enfermedad Aguda , Antivirales/uso terapéutico , Infecciones por Bacteroides/diagnóstico por imagen , Infecciones por Bacteroides/tratamiento farmacológico , Infecciones por Bacteroides/virología , Betacoronavirus/efectos de los fármacos , Biomarcadores/sangre , Candidiasis/diagnóstico por imagen , Candidiasis/tratamiento farmacológico , Candidiasis/virología , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/virología , Combinación de Medicamentos , Ecocardiografía , Resultado Fatal , Humanos , Interleucina-6/sangre , Lopinavir/uso terapéutico , Masculino , Persona de Mediana Edad , Miocarditis/diagnóstico por imagen , Miocarditis/tratamiento farmacológico , Miocarditis/virología , Pandemias , Combinación Piperacilina y Tazobactam/uso terapéutico , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/virología , Ritonavir/uso terapéutico , Volumen Sistólico/efectos de los fármacos , Tomografía Computarizada por Rayos X , Troponina I/sangre
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