COVID-19 in patients with cardiac disease: Impact and variables associated with mortality in a cardiology center in Brazil.

BACKGROUND: Cardiovascular disease is associated with severe COVID-19. Our aim was to describe clinical and laboratory features (including electrocardiographic and echocardiographic ones) and outcomes of patients with cardiac disease hospitalized with COVID-19. METHODS: This is an observational retrospective study of consecutive adult patients admitted, between March and September of 2020, with confirmed SARSCoV-2 infection. Data were collected as per the ISARIC case report form and complemented with variables related to heart disease. RESULTS: One hundred twenty-one patients were included. Mean age was 60 SD 15.2 years and 80/121(66.1%) were male. Two-thirds of the patients (80/121, 66.1%) had COVID-19 at the time of hospital admission and COVID-19 was the reason for hospitalization in 42 (34.7%). Other reasons for hospital admission were acute coronary syndrome (26%) and decompensated heart failure (14.8%). Chronic cardiac diseases were found in 106/121 (87.6%), mostly coronary artery disease (62%) or valve disease (33.9%). A transthoracic echocardiogram was performed in 93/121(76.8%) and enlarged cardiac chambers were found in 71% (66/93); admission ECG was done in 93 cases (93/121, 76.8%), and 89.2% (83/93) were abnormal. Hospital-acquisition of COVID-19 occurred in 20 (16.5%) of patients and their mortality was 50%. On bivariate analysis for mortality, BNP levels and troponin levels were NOT associated with mortality. On multivariate analysis, only C reactive protein levels and creatinine levels were significant. CONCLUSIONS: COVID-19 impacted the profile of hospital admissions in cardiac patients. BNP and troponin levels were not associated with mortality and may not be good prognostic discriminators in cardiac patients.

Changes in Medical Management after Coronary CT Angiography.

INTRODUCTION: Coronary computed tomography angiography (CCTA) allows for non-invasive coronary artery disease (CAD) phenotyping. There are still some uncertainties regarding the impact this knowledge has on the clinical care of patients. OBJECTIVE: To determine whether CAD phenotyping by CCTA influences clinical decision making by the prescription of cardiovascular drugs and their impact on non-LDL cholesterol (NLDLC) levels. METHODS: We analysed consecutive patients from 2008 to 2011 submitted to CCTA without previous diagnosis of CAD that had two serial measures of NLDLC, one up to 3 months before CCTA and the second from 3 to 6 months after. RESULTS: A total of 97 patients were included, of which 69% were men, mean age 64 ± 12 years. CCTA revealed that 18 (18%) patients had no CAD, 38 (39%) had non-obstructive (< 50%) lesions and 41 (42%) had at least one obstructive ≥ 50% lesion. NLDLC was similar at baseline between the grups (138 ± 52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectively, p = 0.32). We found significative reduction in NLDLC among patients with obstrctive lesions (-18%, p = 0.001). We also found a positive relationship between clinical treatment intensification with aspirin and cholesterol reducing drugs and the severity of CAD. CONCLUSION: Our data suggest that CCTA results were used for cardiovascular clinical treatment titration, with especial intensification seen in patients with obstructive ≥50% CAD.

Changes in Medical Management after Coronary CT Angiography / Mudanças no Manejo Clínico após Angiotomografia Coronariana

AbstractIntroduction:Coronary computed tomography angiography (CCTA) allows for non-invasive coronary artery disease (CAD) phenotyping. There are still some uncertainties regarding the impact this knowledge has on the clinical care of patients.Objective:To determine whether CAD phenotyping by CCTA influences clinical decision making by the prescription of cardiovascular drugs and their impact on non-LDL cholesterol (NLDLC) levels.Methods:We analysed consecutive patients from 2008 to 2011 submitted to CCTA without previous diagnosis of CAD that had two serial measures of NLDLC, one up to 3 months before CCTA and the second from 3 to 6 months after.Results:A total of 97 patients were included, of which 69% were men, mean age 64 ± 12 years. CCTA revealed that 18 (18%) patients had no CAD, 38 (39%) had non-obstructive (< 50%) lesions and 41 (42%) had at least one obstructive ≥ 50% lesion. NLDLC was similar at baseline between the grups (138 ± 52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectively, p = 0.32). We found significative reduction in NLDLC among patients with obstrctive lesions (-18%, p = 0.001). We also found a positive relationship between clinical treatment intensification with aspirin and cholesterol reducing drugs and the severity of CAD.Conclusion:Our data suggest that CCTA results were used for cardiovascular clinical treatment titration, with especial intensification seen in patients with obstructive ≥50% CAD.

ResumoFundamento:A Angiotomografia Coronariana (AngioTC Cor) permite a fenotipagem de Doença Arterial Coronariana (DAC) de forma não invasiva. Ainda há incertezas sobre o impacto que esse conhecimento promove no tratamento clínico do paciente.Objetivo:Avaliar se a fenotipagem da DAC por AngioTC Cor influencia na tomada de decisão sobre o início da terapêutica cardiovascular e seu impacto nos níveis séricos de colesterol não HDL (CNHDL).Métodos:Foram analisados pacientes consecutivos sem diagnóstico prévio de DAC que realizaram AngioTC Cor entre os anos 2008 e 2011 e que possuíam duas dosagens seriadas de colesterol até três meses antes da AngioTC Cor, e de três a seis meses após.Resultados:Um total de 97 pacientes foram incluídos, sendo 69% homens, idade média de 64 ± 12 anos. A AngioTC Cor revelou que 18 (18%) pacientes não tinham lesões detectáveis, 38 (39%) tinham lesões não obstrutivas < 50%, e 41 (42%) tinham ao menos uma lesão obstrutiva ≥ 50%. As medidas de CNHDL basal foram similares entre os grupos, (138 ± 52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectivamente, p = 0,32). Observou-se redução significativa do CNHDL apenas no grupo com lesões obstrutivas ≥ 50% (-18%, p = 0,001). Observa-se ainda relação entre a intensificação do tratamento clínico com AAS e drogas redutoras de colesterol proporcional à gravidade da DAC pela AngioTC Cor.Conclusão:Esses dados sugerem que o resultado da AngioTC Cor foi utilizado para a titulação terapêutica de pacientes com DAC, sendo o tratamento intensificado especialmente em DAC obstrutiva ≥ 50%.