Clinical Characteristics and Factors Associated with Poor Outcomes in Hospitalized Patients with Novel Coronavirus Infection COVID-19.

Aim      To evaluate the clinical picture and factors associated with unfavorable outcomes in admitted patients with COVID-19.Material and methods This study included all patients admitted to the COVID Center of the National Research Center of Cardiology of the Russian Ministry of Health Care from May 1 through May 31, 2020. Clinical demographic, laboratory, and instrumental indexes and associated factors were studied with one-way and multivariate logistic regression analysis.Results This study included 402 patients aged 18 to 95 years (mean age, 62.9±14.6 years); 43.0 % of them were older than 65 years. COVID-19 was frequently associated with chronic comorbidities, including arterial hypertension (74.4 %), obesity (41.6 %), history of ischemic heart disease (12.9 %), atrial fibrillation (18.9 %), type 2 diabetes mellitus (DM) (13.0 %), and oncological diseases (9.2 %). 13.0 % of patients were smokers; less than 10% had chronic lung diseases. 3.9% of patients had a combination of COVID-19 and acute coronary pathology, including acute myocardial infarction (MI) in 3.2 % (13) and unstable angina in 0.7 % (3). The most frequent clinical manifestation of COVID-19 were four symptoms: cough (81.1 %), weakness (80.3 %), shortness of breath (71.6 %), and fever (62.7 %). 46.5% of patients had shortage of breath and chest pain/compression, 40.3% had headache, 31.1% had myalgia, 28.8% had anosmia, and 25.5% had ageusia. Arterial oxygen saturation was <93.0 % in 55.7 % of cases. According to laboratory blood tests the patients had anemia (58.2 %), lymphopenia (34.8 %), neutropenia (19.2 %), thrombocytopenia (11.9 %), and increased levels of high-sensitivity C-reactive protein (hsCRP, 87.3 %), interleukin-6 (89.3 %), ferritin (62.1 %), and D-dimer (49.2 %). 56.2% of patients required various regimens of oxygen support. 83 (20.6%) patients were admitted to intensive care and resuscitation units; invasive artificial ventilation was performed only for 34 (8.5 %) patients. In-hospital mortality was 7.7 % (31 / 402). One-way regression analysis identified major factors associated with death during the stay in the hospital: age >55 years, NEWS scale score >4.0, oxygen saturation <92.0 %, blood glucose >5.4 mmol/l, hs-CRP >25.7 mg/l, and creatinine clearance <72.0 ml/min. Furthermore, the risk increased with increasing degree of changes in each factor. According to results of the multivariate regression analysis, three most significant predictors of the hard endpoint, all-cause death during the stay in the hospital, were more than 5-fold increases in aspartate aminotransferase and/or alanine aminotransferase compared to normal levels (relative risk (RR) 16.8 at 95 % confidence interval (CI) 5.0-56.3, р<0.001), pronounced changes in the lungs consistent with a CT-4 picture as shown by computed tomography (CT) (RR 13.4; 95 % CI 3.9-45.5, р<0.001), and MI/unstable angina during the stay in the hospital (RR 11.3; 95 % CI 1.4-90.6, р=0.023). The probability of death was also considerably increased by chronic obstructive pulmonary disease, impaired kidney function (creatinine clearance estimated by Cockcroft-Gault <60.0 ml/min), type 2 DM, oncological diseases, and dementia.Conclusion      This study established factors associated with unfavorable outcomes in admitted patients with COVID-19. This will allow identifying in advance patients with a high risk of complications that require increased attention to take more active diagnostic and therapeutic measures at prehospital and hospital stages.

[Complications After Transcatheter Aortic Valve Implantation].

PURPOSE: to assess rate of complications after transcatheter aortic valve implantation (TAVI). MATERIAL AND RESULTS: Our study included 99 patients who underwent TAVI. Frequent complications were: bleeding not requiring surgical hemostasis (17.2%), hemopericardium (6%), novel cardiac rhythm disturbances requiring permanent pacemaker implantation (15.1%), delirium in early postoperative period (10.7%), acute kidney injury (8.0%), stroke (7%), ventricular fibrillation (5.1%), myocardial infarction (2%). There were no significant differences in rate and type of complications between transapical and transfemoral TAVI. Comparison of general and local anesthesia showed that rate of ventricular fibrillation was significantly higher among patients subjected to transfemoral TAVI under local anesthesia (p less or equal 0.012).

[DEXMEDETOMIDINE SEDATION DURING TRANSCATHETER AORTIC VALVE IMPLANTATION.]

THE AIM: to determine the efficacy and safety of dexmedetomidinefor sedation and analgesia during transcatheter aortic valve implantation (TA VI) withfemoral access. MATERIALS AND METHODS: the study included 34 high-risk surgical patients with "critical aortic stenosis". All patients underwent TAVI with femoral access. TAVI performed under local anaesthesia: in 18 cases - with midazolam-ketamine sedetion, in 16 cases - with dexmedetomidine sedation. The depth of sedation was evaluated by Richmond agitation-sedation scale (RASS) and Ramsay scale. Assessment includes frequency of complications arising during perioperative period. RESULTS: in dexmedetomidine group compared with a group of midazolam/ketamine was observed significantly greater median of sedation level with RASS and Ramsay scales (- 3.5 and -1.0, p=0,000004, 5.0 and 3.0, respectively, p=0,000001). There was a signficant decrease in rapid pacing episodes in dexmedetomidine group (p = 0.0005). In the structure of complications prevailed delirium, stroke, ventricularfibrillation. There were no significant differences in the incidence and nature of complications in the groups studied. Under midazolam/ ketamine trend toward increased incidence of delirium compared with a group of dexmedetomidine (6.16 % and 6.25 %, respectively, p =0.604). There was no significant difference in the duration of operation and anesthesia in the study groups (p=0.889, p=0.103). There were no significant differences in length of hospital-stay and in the length of ICU-stay in groups studied (p =0.243, p=0.899). CONCLUSIONS: Sedation with dexmedetomidine during TA VI with femoral access demonstrates its safety and effectiveness. Dexmedetomidine provides deep level of sedation with RASS and Ramsay scales without depression of respiratory function. There is a good tolerability of operation and good conditions for long-term use of transesophageal ECHO. In the context of ECHO monitoring further reduces the need for multiple rapid pacing (p = 0.0005), which may reduce frequency of delirium in elderly patients.

[Monitoring of haemodynamics and function of the aortic prosthesis during transcatheter aortic valve replacement].

PURPOSE: To find an advisability of use of invasive monitoring of intracardiac haemodynamics during transfemoral transcatheter aortic valve replacement. PATIENTS AND METHODS: The study included 12 patients underwent transfemoral transcatheter aortic valve replacement (TTAVR). All patients were monitored according to Harvard standard. Additionally, we performed a catheterization of the right heart chambers, transesophageal or transthoracic echocardiography. Pressure in the left ventricle and aorta was measured directly after implantation ofthe aortic prosthesis. RESULTS: Cardiac output was increased authentically in comparison with baseline in all patients. There was cardiac index increasing, however the increasing was not reliable (p ≤ 0.07). In 9 cases, baseline pulmonary artery pressure (PAP) was not changed during surgery. In 3 patients, PAP and pulmonary artery wedge pressure (PAOP) before surgery were increased. In 2 of this 3 patients, PAP and PAOP were significantly decreased after surgery. In 1 case, the pressure in the pulmonary circulation stayed increased. Ejection fraction (EF) of the left ventricle was increased after surgeries in 2 patients from 30 to 40% and from 20 to 25%. The values of stroke volume and stroke index were similar in all patients before and after surgeries. Valvular regurgitation after successful implantation of the aortic prosthesis was found in 11 patients (91.6%). We calculated dia- stolic gradient of left ventricle and the aorta and aortic regurgitation index and compared this parameters with data of echocardiography. The index of aortic regurgitation was 36.5 (35; 46), and diastolic pressure gradient in the aorta and ventricle was 48.0 (40.5; 65.5) mmHg. Calculated systolic pressure gradient in the left ventricle and aorta was 5.5 (3.0; 11.5) mmHg., this data proved that there was no stenosis of aortic prosthesis. CONCLUSION: Invasive monitoring of intracardiac haemodynamics during transfemoral transcatheter aortic valve replace-ment allows to diagnose quality of prosthesis implantation accurately and provides data about valvular regurgitation. Invasive monitoring helps to provide haemodynamic stability in patients with critical aortic stenosis during anaesthesia.