Cardiovascular Diseases and COVID-19

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Molecular and Translational Medicine".

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 26155

Special Issue Editors


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Guest Editor
Deparment of Medical Surgical and Health Science, University of Trieste, Italy and Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34148 Trieste, Italy
Interests: COVID-19; vitamin D; cardiomyopathies; ischemic heart disease; myocardial infarction; heart failure; biomarkers; inflammation
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
1. Deparment of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
2. Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34148 Trieste, Italy
Interests: COVID-19; cardiovascular disease; heart failure; biomarkers; cytokine; inflammation; oxidative stress; endothelial dysfunction
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The ongoing global pandemic of coronavirus disease 2019 (COVID-19), caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is not only life-threatening but has also affected the socioeconomic situations of people around the world and represented a huge economic burden on health systems since 2019.

Cardiovascular diseases (CVD) are the leading cause of mortality and morbidity worldwide. More importantly, the prevalence of CVD is growing due to population aging and an increase in other risk factors directly correlated with cardiac health, such as diabetes mellitus, obesity, dyslipidemia, sedentary lifestyle, and genetic factors. 

At the outset of the COVID-19 pandemic, it immediately became apparent that individuals with previous cardiovascular diseases, such as coronary artery disease, cardiomyopathies, and heart failure, were at higher risk for severe forms of COVID-19 and adverse outcomes. Remarkably, recent studies have indicated that both symptomatic and asymptomatic SARS-CoV-2 infection has a negative impact on cardiovascular health and is associated with mortality during the period after COVID-19, which means that SARS-CoV-2 infection should be an important risk factor as well.

This Special Issue on "Cardiovascular Diseases and COVID" welcomes original research articles and state-of-the-art reviews in this field. Papers should provide novel data or gather current knowledge regarding the relationship between cardiovascular diseases and COVID-19, with a special focus on pathophysiological aspects of COVID-19 on cardiovascular health, covering (but not be limited to) molecular mechanisms that support deterioration processes such as inflammation, oxidative stress and endothelial dysfunction, useful clinical aspects related to cardiovascular diagnosis injuries, more accurate risk stratification, and finally therapeutic approaches in these specific circumstances.

Dr. Aneta Aleksova
Dr. Milijana Janjušević
Guest Editors

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Keywords

  • COVID-19
  • long COVID-19
  • cytokine storm
  • inflammation
  • oxidative stress
  • cardiovascular disease, coronary heart disease
  • myocarditis
  • cardiomyopathies
  • pulmonary embolism
  • cardiac arrest
  • therapeutic approach
  • risk stratification
  • outcome
  • mortality

Published Papers (13 papers)

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15 pages, 1273 KiB  
Article
Development of a Decision Support Tool for Anticoagulation in Critically Ill Patients Admitted for SARS-CoV-2 Infection: The CALT Protocol
by Victoria Dubar, Tiffany Pascreau, Annabelle Dupont, Sylvain Dubucquoi, Anne-Laure Dautigny, Benoit Ghozlan, Benjamin Zuber, François Mellot, Marc Vasse, Sophie Susen, Julien Poissy and Alexandre Gaudet
Biomedicines 2023, 11(6), 1504; https://doi.org/10.3390/biomedicines11061504 - 23 May 2023
Cited by 1 | Viewed by 1092
Abstract
Severe COVID-19 infections are at high risk of causing thromboembolic events (TEEs). However, the usual exams may be unavailable or unreliable in predicting the risk of TEEs at admission or during hospitalization. We performed a retrospective analysis of two centers (n = 124 [...] Read more.
Severe COVID-19 infections are at high risk of causing thromboembolic events (TEEs). However, the usual exams may be unavailable or unreliable in predicting the risk of TEEs at admission or during hospitalization. We performed a retrospective analysis of two centers (n = 124 patients) including severe COVID-19 patients to determine the specific risk factors of TEEs in SARS-CoV-2 infection at admission and during stays at the intensive care unit (ICU). We used stepwise regression to create two composite scores in order to predict TEEs in the first 48 h (H0–H48) and during the first 15 days (D1–D15) in ICU. We then evaluated the performance of our scores in our cohort. During the period H0–H48, patients with a TEE diagnosis had higher D-Dimers and ferritin values at day 1 (D1) and day 3 (D3) and a greater drop in fibrinogen between D1 and D3 compared with patients without TEEs. Over the period D1-D15, patients with a diagnosis of a TEE showed a more marked drop in fibrinogen and had higher D-Dimers and lactate dehydrogenase (LDH) values at D1 and D3. Based on ROC analysis, the COVID-related acute lung and deep vein thrombosis (CALT) 1 score, calculated at D1, had a diagnostic performance for TEEs at H0–H48, estimated using an area under the curve (AUC) of 0.85 (CI95%: 0.76–0.93, p < 10−3). The CALT 2 score, calculated at D3, predicted the occurrence of TEEs over the period D1-D15 with an estimated AUC of 0.85 (CI95%: 0.77–0.93, p < 10−3). These two scores were used as the basis for the development of the CALT protocol, a tool to assist in the decision to use anticoagulation during severe SARS-CoV-2 infections. The CALT scores showed good performances in predicting the risk of TEEs in severe COVID-19 patients at admission and during ICU stays. They could, therefore, be used as a decision support protocol on whether or not to initiate therapeutic anticoagulation. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and COVID-19)
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10 pages, 660 KiB  
Article
Arrhythmias after SARS-CoV-2 Vaccination in Patients with a Cardiac Implantable Electronic Device: A Multicenter Study
by Naruepat Sangpornsuk, Voravut Rungpradubvong, Nithi Tokavanich, Sathapana Srisomwong, Teetouch Ananwattanasuk, Padoemwut Teerawongsakul, Stephen J. Kerr, Mathurin Suwanwalaikorn, Krit Jongnarangsin and Ronpichai Chokesuwattanaskul
Biomedicines 2022, 10(11), 2838; https://doi.org/10.3390/biomedicines10112838 - 7 Nov 2022
Cited by 6 | Viewed by 2769
Abstract
One of the most concerning adverse events related to the SARS-CoV-2 vaccination is arrhythmia. To ascertain the relationship between vaccination and arrhythmic events, we studied the occurrence of arrhythmia in patients with cardiac implantable electronic devices (CIEDs) before and after a SARS-CoV-2 vaccination. [...] Read more.
One of the most concerning adverse events related to the SARS-CoV-2 vaccination is arrhythmia. To ascertain the relationship between vaccination and arrhythmic events, we studied the occurrence of arrhythmia in patients with cardiac implantable electronic devices (CIEDs) before and after a SARS-CoV-2 vaccination. Patients with CIEDs aged ≥18 who visited the CIED clinic at King Chulalongkorn Memorial Hospital and Vajira hospital from August 2021 to February 2022 were included. Information about the SARS-CoV-2 vaccination and side effects was obtained. One hundred eighty patients were included in our study, which compared the incidence of arrhythmias in the 14 days post-vaccination to the 14 days before vaccination. The median age was 70 years. The number of patients who received one, two, and three doses of the vaccine was 180, 88, and 4, respectively. ChAdOx1 was the primary vaccine used in our institutes, accounting for 86% of vaccinations. The vaccination was significantly associated with a 73% increase incidence of supraventricular tachycardia (SVT). In an adjusted model, factors associated with the incidence of SVT were the post-vaccination period, female sex, increasing BMI, chronic kidney disease, and a history of atrial fibrillation. Increased ventricular arrhythmia (VA) episodes were also associated with the post-vaccination period, female sex, decreasing BMI, and chronic kidney disease, but to a lesser degree than those with SVT episodes. No life-threatening arrhythmia was noted in this study. In conclusion, the incidence of arrhythmia in patients implanted with CIEDs was significantly increased after the SARS-CoV-2 vaccination. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and COVID-19)
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10 pages, 1044 KiB  
Article
Clinical Characteristics and In-Hospital Mortality in Patients with STEMI during the COVID-19 Outbreak in Thailand
by Piyoros Lertsanguansinchai, Ronpichai Chokesuwattanaskul, Thitima Limjaroen, Chaisiri Wanlapakorn, Vorarit Lertsuwunseri, Siriporn Athisakul, Jarkarpun Chaipromprasit, Wasan Udayachalerm, Wacin Buddhari and Suphot Srimahachota
Biomedicines 2022, 10(11), 2671; https://doi.org/10.3390/biomedicines10112671 - 22 Oct 2022
Viewed by 1560
Abstract
Background: Nowadays, current evidence on the effects of the COVID-19 outbreak on ST-elevation myocardial infarction (STEMI) patients is discrepant. The aim of this study was to compare and identify any changes in STEMI patients between the pre-COVID-19 period and during the COVID-19 [...] Read more.
Background: Nowadays, current evidence on the effects of the COVID-19 outbreak on ST-elevation myocardial infarction (STEMI) patients is discrepant. The aim of this study was to compare and identify any changes in STEMI patients between the pre-COVID-19 period and during the COVID-19 outbreak. Methods: We conducted a retrospective cohort study to evaluate consecutive STEMI patients admitted from 1 September 2018 to 30 September 2021. We designated 14 March 2020 as the commencement of the COVID-19 outbreak in Thailand. Results: A total of 513 consecutive STEMI patients were included in this study: 330 (64%) admitted during the pre-COVID-19 outbreak period and 183 (36%) admitted during the COVID-19 outbreak. There was a significant 45% decline in the number of STEMI cases admitted during the COVID-19 outbreak period. During the outbreak, STEMI patients had significantly increased intra-aortic balloon pump (IABP) insertion (23% vs. 15%, p-value = 0.004), higher high-sensitivity troponin T level (11,150 vs. 5213, p-value < 0.001), and lower pre- and post-PCI TIMI flow. The time-to-diagnosis (59 vs. 7 min, p-value < 0.001), pain-to-first medical contact (FMC) time (250 vs. 214 min, p-value = 0.020), FMC-to-wire-crossing time (39 vs. 23 min, p-value < 0.001), and pain-to-wire-crossing time (292 vs. 242 min, p-value = 0.005) were increased in STEMI patients during the outbreak compared with pre-outbreak. There was no statistical difference in in-hospital mortality between both periods (p-value = 0.639). Conclusions: During the COVID-19 outbreak, there was a significant decline in the total number of admitted STEMI cases. Unfortunately, the time-to-diagnosis, pain-to-FMC time, FMC-to-wire-crossing time, and pain-to-wire-crossing time were significantly delayed during the COVID-19 outbreak. However, in-hospital mortality showed no significant differences between these two time periods. Highlights: 45% decline in the number of STEMI cases admitted and a significant delay in the treatment timeline during the COVID-19 outbreak. In-hospital mortality showed no significant difference between these two periods. Our study will motivate healthcare professionals to optimize treatments, screenings, and infectious control protocols to reduce the time from the onset of chest pain to wire crossing in STEMI patients during the outbreak. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and COVID-19)
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14 pages, 574 KiB  
Article
Chronic Endothelial Dysfunction after COVID-19 Infection Shown by Transcranial Color-Coded Doppler: A Cross-Sectional Study
by Marino Marcic, Ljiljana Marcic, Sanja Lovric Kojundzic, Maja Marinovic Guic, Barbara Marcic and Kresimir Caljkusic
Biomedicines 2022, 10(10), 2550; https://doi.org/10.3390/biomedicines10102550 - 13 Oct 2022
Cited by 3 | Viewed by 1497
Abstract
In addition to respiratory symptoms, COVID-19 often causes damage to many other organs, especially in severe forms of the disease. Long-term consequences after COVID-19 are common and often have neurological symptoms. Cerebral vasoreactivity may be impaired after acute COVID-19 and in our study, [...] Read more.
In addition to respiratory symptoms, COVID-19 often causes damage to many other organs, especially in severe forms of the disease. Long-term consequences after COVID-19 are common and often have neurological symptoms. Cerebral vasoreactivity may be impaired after acute COVID-19 and in our study, we wanted to show how constant and reversible are the changes in brain vasoreactivity after infection. This cross-sectional observational study included 49 patients diagnosed with COVID-19 and mild neurological symptoms 300 days after the onset of the disease. We used a transcranial color-coded Doppler (TCCD) and a breath-holding test (BHT) to examine cerebral vasoreactivity and brain endothelial function. We analyzed the parameters of the flow rate through the middle cerebral artery (MCA): peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV), resistance index (RI) and pulsatility index (PI), and we calculated the breath-holding index (BHI). Subjects after COVID-19 infection had lower measured velocity parameters through MCA at rest period and after BHT, lower relative increases of flow velocities after BHT, and lower BHI. We showed that subjects, 300 days after COVID-19, still have impaired cerebral vasoreactivity measured by TCCD and they have chronic endothelial dysfunction. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and COVID-19)
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7 pages, 245 KiB  
Article
Postpartum Blood Loss in COVID-19 Patients—Propensity Score Matched Analysis
by Marcin Januszewski, Małgorzata Santor-Zaczyńska, Laura Ziuzia-Januszewska, Michał Kudan, Alicja A. Jakimiuk, Waldemar Wierzba and Artur J. Jakimiuk
Biomedicines 2022, 10(10), 2517; https://doi.org/10.3390/biomedicines10102517 - 9 Oct 2022
Cited by 6 | Viewed by 1529
Abstract
The aim of this study was to compare the estimated blood loss and the frequency of obstetric hemorrhage among pregnant women with and without COVID-19 infection. The study was carried out in the Department of Obstetrics and Gynecology, at the Central Clinical Hospital [...] Read more.
The aim of this study was to compare the estimated blood loss and the frequency of obstetric hemorrhage among pregnant women with and without COVID-19 infection. The study was carried out in the Department of Obstetrics and Gynecology, at the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Poland. From 15 May 2020 to 26 April 2021, a total of 224 parturients with COVID-19 infection were admitted for labor. The control group consisted of 300 randomly recruited pre-pandemic deliveries that took place between 15 May 2019 and 26 April 2020 at the Department. The primary outcome was the presence of postpartum hemorrhage, defined as an estimated blood loss of ≥500 mL within 24 h after birth or the need to transfuse 2 or more units of packed red blood cells (pRBCs). Secondary outcomes were the difference between hemoglobin and hematocrit levels at 24 h postpartum, the number of pRBCs units transfused, and the need for transperitoneal drainage. After applying the propensity-score-matching procedure for postpartum bleeding risk factors, 325 eligible patients were included in the final analysis, divided into 203 COVID-19 positive and 122 COVID-19 negative prepandemic deliveries. SARS-CoV-2 infected patients were characterized by a longer activated partial thromboplastin time (APTT), a reduced prothrombin time (PT), and lower platelet count at initial presentation. COVID-19 deliveries were found to be associated with a higher frequency of postpartum hemorrhage, an increased estimated blood loss, the more frequent use of peritoneal drainage, and more pRBCs units transfused. During the pandemic, an increased risk of postpartum hemorrhage posed another threat to SARS-CoV-2 infected pregnant women. It is essential to be aware of this when approaching COVID-19 delivery and to implement efficient preventative methods. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and COVID-19)
16 pages, 8807 KiB  
Article
Impact of the First COVID-19 Wave on French Hospitalizations for Myocardial Infarction and Stroke: A Retrospective Cohort Study
by Anne-Sophie Mariet, Gauthier Duloquin, Eric Benzenine, Adrien Roussot, Thibaut Pommier, Jean-Christophe Eicher, Laura Baptiste, Maurice Giroud, Yves Cottin, Yannick Béjot and Catherine Quantin
Biomedicines 2022, 10(10), 2501; https://doi.org/10.3390/biomedicines10102501 - 7 Oct 2022
Cited by 3 | Viewed by 1366
Abstract
The COVID-19 pandemic modified the management of myocardial infarction (MI) and stroke. We aimed to evaluate the effect of the COVID-19 pandemic on the volume and spatial distribution of hospitalizations for MI and stroke, before, during and after the first nationwide lockdown in [...] Read more.
The COVID-19 pandemic modified the management of myocardial infarction (MI) and stroke. We aimed to evaluate the effect of the COVID-19 pandemic on the volume and spatial distribution of hospitalizations for MI and stroke, before, during and after the first nationwide lockdown in France in 2020, compared with 2019. Hospitalization data were extracted from the French National Discharge database. Patient’s characteristics were compared according to COVID-19 status. Changes in hospitalization rates over time were measured using interrupted time series analysis. Possible spatial patterns of over or under-hospitalization rates were investigated using Moran’s indices. We observed a rapid and significant drop in hospitalizations just before the beginning of the lockdown with a nadir at 36.5% for MI and 31.2% for stroke. Hospitalization volumes returned to those seen in 2019 four weeks after the end of the lockdown, except for MI, which rebounded excessively. Older age, male sex, elevated rate of hypertension, diabetes, obesity and mortality characterized COVID-19 patients. There was no evidence of a change in the spatial pattern of over- or under-hospitalization clusters over the three periods. After a steep drop, only MI showed a significant rebound after the first lockdown with no change in the spatial distribution of hospitalizations. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and COVID-19)
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12 pages, 849 KiB  
Article
Incident Atrial Fibrillation and In-Hospital Mortality in SARS-CoV-2 Patients
by Alessandro Maloberti, Cristina Giannattasio, Paola Rebora, Giuseppe Occhino, Nicola Ughi, Marco Biolcati, Elena Gualini, Jacopo Giulio Rizzi, Michela Algeri, Valentina Giani, Claudio Rossetti, Oscar Massimiliano Epis, Giulio Molon, Anna Beltrame, Paolo Bonfanti, Maria Grazia Valsecchi and Simonetta Genovesi
Biomedicines 2022, 10(8), 1940; https://doi.org/10.3390/biomedicines10081940 - 10 Aug 2022
Cited by 7 | Viewed by 1750
Abstract
(1) Background: Among the different cardiovascular (CV) manifestations of the coronavirus disease 2019 (COVID-19), arrhythmia and atrial fibrillation (AF) in particular have recently received special attention. The aims of our study were to estimate the incidence of AF in patients hospitalized for COVID-19, [...] Read more.
(1) Background: Among the different cardiovascular (CV) manifestations of the coronavirus disease 2019 (COVID-19), arrhythmia and atrial fibrillation (AF) in particular have recently received special attention. The aims of our study were to estimate the incidence of AF in patients hospitalized for COVID-19, and to evaluate its role as a possible predictor of in-hospital all-cause mortality. (2) Methods: We enrolled 3435 people with SARS-CoV2 infection admitted to three hospitals in Northern Italy from February 2020 to May 2021. We collected data on their clinical history, laboratory tests, pharmacological treatment and intensive care unit (ICU) admission. Incident AF and all-cause in-hospital mortality were considered as outcomes. (3) Results: 145 (4.2%) patients developed AF during hospitalization, with a median time since admission of 3 days (I-III quartile: 0, 12). Patients with incident AF were admitted more frequently to the ICU (39.3 vs. 12.4%, p < 0.001), and more frequently died (37.2 vs. 16.9%, p < 0.001). In the Cox regression model, the significant determinants of incident AF were age (HR: 1.041; 95% CI: 1.022, 1.060 per year), a history of AF (HR: 2.720; 95% CI: 1.508, 4.907), lymphocyte count (HR: 0.584; 95% CI: 0.384, 0.888 per 103/µL), estimated glomerular filtration rate (eGFR, HR: 0.988; 95% CI: 0.980, 0.996 per mL/min) and ICU admission (HR: 5.311; 95% CI: 3.397, 8.302). Incident AF was a predictor of all-cause mortality (HR: 1.405; 95% CI: 1.027, 1.992) along with age (HR: 1.057; 95% CI: 1.047, 1.067), male gender (HR: 1.315; 95% CI: 1.064; 1.626), dementia (HR: 1.373; 95% CI: 1.045, 1.803), lower platelet (HR: 0.997; 95% CI: 0.996, 0.998 per 103/µL) and lymphocyte counts (HR: 0.843; 95% CI: 0.725, 0.982 per 103/µL), C-Reactive protein values (HR: 1.004; 95% CI: 1.003, 1.005 per mg/L), eGFR (HR: 0.990; 95% CI: 0.986, 0.994 per mL/min), and ICU admission (HR: 1.759; 95% CI: 1.292, 2.395). (4) Conclusions: Incident AF is a common complication in COVID-19 patients during hospitalization, and its occurrence strongly predicts in-hospital mortality. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and COVID-19)
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28 pages, 6072 KiB  
Article
Diminazene Aceturate Reduces Angiotensin II Constriction and Interacts with the Spike Protein of Severe Acute Respiratory Syndrome Coronavirus 2
by John M. Matsoukas, Laura Kate Gadanec, Anthony Zulli, Vasso Apostolopoulos, Konstantinos Kelaidonis, Irene Ligielli, Kalliopi Moschovou, Nikitas Georgiou, Panagiotis Plotas, Christos T. Chasapis, Graham Moore, Harry Ridgway and Thomas Mavromoustakos
Biomedicines 2022, 10(7), 1731; https://doi.org/10.3390/biomedicines10071731 - 18 Jul 2022
Cited by 8 | Viewed by 2873
Abstract
Diminazene aceturate (DIZE) is a putative angiotensin-converting enzyme 2 (ACE2) activator and angiotensin type 1 receptor antagonist (AT1R). Its simple chemical structure possesses a negatively charged triazene segment that is homologous to the tetrazole of angiotensin receptor blockers (ARB), which explains [...] Read more.
Diminazene aceturate (DIZE) is a putative angiotensin-converting enzyme 2 (ACE2) activator and angiotensin type 1 receptor antagonist (AT1R). Its simple chemical structure possesses a negatively charged triazene segment that is homologous to the tetrazole of angiotensin receptor blockers (ARB), which explains its AT1R antagonistic activity. Additionally, the activation of ACE2 by DIZE converts the toxic octapeptide angiotensin II (AngII) to the heptapeptides angiotensin 1–7 and alamandine, which promote vasodilation and maintains homeostatic balance. Due to DIZE’s protective cardiovascular and pulmonary effects and its ability to target ACE2 (the predominant receptor utilized by severe acute respiratory syndrome coronavirus 2 to enter host cells), it is a promising treatment for coronavirus 2019 (COVID-19). To determine DIZE’s ability to inhibit AngII constriction, in vitro isometric tension analysis was conducted on rabbit iliac arteries incubated with DIZE or candesartan and constricted with cumulative doses of AngII. In silico docking and ligand interaction studies were performed to investigate potential interactions between DIZE and other ARBs with AT1R and the spike protein/ACE2 complex. DIZE, similar to the other ARBs investigated, was able to abolish vasoconstriction in response to AngII and exhibited a binding affinity for the spike protein/ACE2 complex (PDB 6LZ6). These results support the potential of DIZE as a treatment for COVID-19. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and COVID-19)
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15 pages, 1139 KiB  
Article
The Impact of Metabolic Syndrome and Obesity on the Evolution of Diastolic Dysfunction in Apparently Healthy Patients Suffering from Post-COVID-19 Syndrome
by Cristina Tudoran, Mariana Tudoran, Talida Georgiana Cut, Voichita Elena Lazureanu, Felix Bende, Renata Fofiu, Alexandra Enache, Silvius Alexandru Pescariu and Dorin Novacescu
Biomedicines 2022, 10(7), 1519; https://doi.org/10.3390/biomedicines10071519 - 27 Jun 2022
Cited by 6 | Viewed by 2016
Abstract
(1) Background: Coronavirus disease 2019 (COVID-19) has a worse prognosis in individuals with obesity and metabolic syndrome (MS), who often develop cardiovascular complications that last throughout recovery. (2) Methods: This study aimed to analyze the evolution of diastolic dysfunction (DD), assessed by transthoracic [...] Read more.
(1) Background: Coronavirus disease 2019 (COVID-19) has a worse prognosis in individuals with obesity and metabolic syndrome (MS), who often develop cardiovascular complications that last throughout recovery. (2) Methods: This study aimed to analyze the evolution of diastolic dysfunction (DD), assessed by transthoracic echocardiography (TTE), in 203 individuals with and without obesity and/or MS diagnosed with post-COVID-19 syndrome. (3) Results: DD was frequently diagnosed in patients with MS and obesity, but also in those without obesity (62.71% and 56.6%, respectively), in comparison to 21.97% of subjects without MS (p ˂ 0.001). Almost half of the patients with obesity and MS had more severe DD (types 2 and 3). As for evolution, the prevalence and severity of DD, particularly types 1 and 2, decreased gradually, in parallel with the improvement of symptoms, progress being more evident in subjects without MS. DD of type 3 did not show a significant reduction (p = 0.47), suggesting irreversible myocardial damages. Multivariate regression analysis indicated that the number of MS factors, the severity of initial pulmonary injury, and protein C levels could explain DD evolution. (4) Conclusions: DD was commonly diagnosed in individuals with post-COVID-19 syndrome, particularly in those with MS and obesity. After 6 months, DD evolution, excepting that of type 3, showed a significant improvement, mostly in patients without MS. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and COVID-19)
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14 pages, 2972 KiB  
Article
Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution
by Franck Nevesny, David C. Rotzinger, Alexander W. Sauter, Laura I. Loebelenz, Lena Schmuelling, Hatem Alkadhi, Lukas Ebner, Andreas Christe, Alexandra Platon, Pierre-Alexandre Poletti and Salah D. Qanadli
Biomedicines 2022, 10(6), 1300; https://doi.org/10.3390/biomedicines10061300 - 2 Jun 2022
Cited by 2 | Viewed by 1754
Abstract
Background: Vascular abnormalities, including venous congestion (VC) and pulmonary embolism (PE), have been recognized as frequent COVID-19 imaging patterns and proposed as severity markers. However, the underlying pathophysiological mechanisms remain unclear. In this study, we aimed to characterize the relationship between VC, PE [...] Read more.
Background: Vascular abnormalities, including venous congestion (VC) and pulmonary embolism (PE), have been recognized as frequent COVID-19 imaging patterns and proposed as severity markers. However, the underlying pathophysiological mechanisms remain unclear. In this study, we aimed to characterize the relationship between VC, PE distribution, and alveolar opacities (AO). Methods: This multicenter observational registry (clinicaltrials.gov identifier NCT04824313) included 268 patients diagnosed with SARS-CoV-2 infection and subjected to contrast-enhanced CT between March and June 2020. Acute PE was diagnosed in 61 (22.8%) patients, including 17 females (27.9%), at a mean age of 61.7 ± 14.2 years. Demographic, laboratory, and outcome data were retrieved. We analyzed CT images at the segmental level regarding VC (qualitatively and quantitatively [diameter]), AO (semi-quantitatively as absent, <50%, or >50% involvement), clot location, and distribution related to VC and AO. Segments with vs. without PE were compared. Results: Out of 411 emboli, 82 (20%) were lobar or more proximal and 329 (80%) were segmental or subsegmental. Venous diameters were significantly higher in segments with AO (p = 0.031), unlike arteries (p = 0.138). At the segmental level, 77% of emboli were associated with VC. Overall, PE occurred in 28.2% of segments with AO vs. 21.8% without (p = 0.047). In the absence of VC, however, AO did not affect PE rates (p = 0.94). Conclusions: Vascular changes predominantly affected veins, and most PEs were located in segments with VC. In the absence of VC, AOs were not associated with the PE rate. VC might result from increased flow supported by the hypothesis of pulmonary arteriovenous anastomosis dysregulation as a relevant contributing factor. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and COVID-19)
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12 pages, 1260 KiB  
Communication
Trends of Myocarditis and Endocarditis Cases before, during, and after the First Complete COVID-19-Related Lockdown in 2020 in France
by Thibaut Pommier, Eric Benzenine, Chloé Bernard, Anne-Sophie Mariet, Yannick Béjot, Maurice Giroud, Marie-Catherine Morgant, Eric Steinmetz, Charles Guenancia, Olivier Bouchot and Catherine Quantin
Biomedicines 2022, 10(6), 1231; https://doi.org/10.3390/biomedicines10061231 - 25 May 2022
Cited by 7 | Viewed by 2300
Abstract
Background. The impact of the COVID-19 pandemic on hospitalization for cardiac infections is not well known. We aimed to evaluate the nationwide trends in hospital stays for myocarditis and endocarditis cases before, during and after the nationwide lockdown for the COVID-19 pandemic in [...] Read more.
Background. The impact of the COVID-19 pandemic on hospitalization for cardiac infections is not well known. We aimed to evaluate the nationwide trends in hospital stays for myocarditis and endocarditis cases before, during and after the nationwide lockdown for the COVID-19 pandemic in France. We then aimed to describe the proportion of myocarditis and endocarditis patients with and without COVID-19 and their clinical characteristics. Methods. Hospitalized cases of cardiac infection were extracted from the French National Discharge database, which collects the medical records of all patients discharged from all public and private hospitals in France. Age, sex, and available cardiovascular risk factors were compared between stays with and without COVID-19 during the lockdown. Results. The number of myocarditis cases was 11% higher in 2020, compared to the average of the three prior years. In 2020, 439 of 3727 cases of myocarditis were associated with COVID-19. For endocarditis, there was an increase in cases by 7% in 2020 versus prior years. For endocarditis, 3% (240 of 8128 cases) of patients with endocarditis had COVID-19. For myocarditis, older age, hypertension, diabetes, obesity, and atrial fibrillation were more frequent in patients with COVID-19 than in those without. For endocarditis, only hypertension was more frequent in patients with COVID-19 than in those without. Conclusion. Our study reports an increase in hospitalizations for both myocarditis and endocarditis in 2020, possibly related to the COVID-19 pandemic. Interestingly, the trends differ according to the COVID-19 status. Knowledge of the factors associating myocarditis or endocarditis and COVID-19 may improve the quality and the type of monitoring for people with COVID-19, the identification of patients at risk of cardiac infections, and the treatment of COVID-19 patients. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and COVID-19)
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Review

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13 pages, 325 KiB  
Review
The Influence of SARS-CoV-2 Infection on Lipid Metabolism—The Potential Use of Lipid-Lowering Agents in COVID-19 Management
by Klaudia Kowalska, Zofia Sabatowska, Joanna Forycka, Ewelina Młynarska, Beata Franczyk and Jacek Rysz
Biomedicines 2022, 10(9), 2320; https://doi.org/10.3390/biomedicines10092320 - 18 Sep 2022
Cited by 12 | Viewed by 2905
Abstract
Several studies have indicated lipid metabolism alterations during COVID-19 infection, specifically a decrease in high-density lipoprotein (HDL) and low-density lipoprotein (LDL) concentrations and an increase in triglyceride (TG) levels during the infection. However, a decline in triglycerides can also be observed in critical [...] Read more.
Several studies have indicated lipid metabolism alterations during COVID-19 infection, specifically a decrease in high-density lipoprotein (HDL) and low-density lipoprotein (LDL) concentrations and an increase in triglyceride (TG) levels during the infection. However, a decline in triglycerides can also be observed in critical cases. A direct correlation can be observed between a decrease in serum cholesterol, HDL-C, LDL-C and TGs, and the severity of the disease; these laboratory findings can serve as potential markers for patient outcomes. The transmission of coronavirus increases proportionally with rising levels of cholesterol in the cell membrane. This is due to the fact that cholesterol increases the number of viral entry spots and the concentration of angiotensin-converting enzyme 2 (ACE2) receptor, crucial for viral penetration. Studies have found that lower HDL-C levels correspond with a higher susceptibility to SARS-CoV-2 infection and infections in general, while higher HDL-C levels were related to a lower risk of developing them. However, extremely high HDL-C levels in serum increase the risk of infectious diseases and is associated with a higher risk of cardiovascular events. Low HDL-C levels are already accepted as a marker for risk stratification in critical illnesses, and higher HDL-C levels prior to the infection is associated with a lower risk of death in older patients. The correlation between LDL-C levels and disease severity is still unclear. However, TG levels were significantly higher in non-surviving severe patients compared to those that survived; therefore, elevated TG-C levels in COVID-19 patients may be considered an indicator of uncontrolled inflammation and an increased risk of death. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and COVID-19)

Other

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8 pages, 11944 KiB  
Case Report
COVID-19-Related Myocarditis: Are We There Yet? A Case Report of COVID-19-Related Fulminant Myocarditis
by Alessandro Pierri, Giulia Gagno, Alessandra Fluca, Davide Radaelli, Diana Bonuccelli, Laura Giusti, Michela Bulfoni, Antonio P. Beltrami, Aneta Aleksova and Stefano D’Errico
Biomedicines 2023, 11(8), 2101; https://doi.org/10.3390/biomedicines11082101 - 26 Jul 2023
Viewed by 1327
Abstract
There is increasing evidence of cardiac involvement in COVID-19 cases, with a broad range of clinical manifestations spanning from acute life-threatening conditions such as ventricular dysrhythmias, myocarditis, acute myocardial ischemia and pulmonary thromboembolism to long-term cardiovascular sequelae. In particular, acute myocarditis represents an [...] Read more.
There is increasing evidence of cardiac involvement in COVID-19 cases, with a broad range of clinical manifestations spanning from acute life-threatening conditions such as ventricular dysrhythmias, myocarditis, acute myocardial ischemia and pulmonary thromboembolism to long-term cardiovascular sequelae. In particular, acute myocarditis represents an uncommon but frightening complication of SARS-CoV-2 infection. Even if many reports of SARS CoV-2 myocarditis are present in the literature, the majority of them lacks histological confirmation of cardiac injury. Here, we report a case of a young lady, who died suddenly a few days after testing positive for SARS-CoV-2, whose microscopic and genetics features suggested a direct cardiac involvement compatible with fulminant myocarditis. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and COVID-19)
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