Research

11 pages, 817 KiB

Open AccessArticle

Role of Cardio-Renal Dysfunction, Inflammation Markers, and Frailty on In-Hospital Mortality in Older COVID-19 Patients: A Cluster Analysis

by Francesco Spannella, Federico Giulietti, Giorgia Laureti, Mirko Di Rosa, Chiara Di Pentima, Massimiliano Allevi, Caterina Garbuglia, Piero Giordano, Matteo Landolfo, Letizia Ferrara, Alessia Fumagalli, Fabrizia Lattanzio, Anna Rita Bonfigli and Riccardo Sarzani

Biomedicines 2023, 11(9), 2473; https://doi.org/10.3390/biomedicines11092473 - 06 Sep 2023

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Abstract

Our study aimed to identify clusters of hospitalized older COVID-19 patients according to their main comorbidities and routine laboratory parameters to evaluate their association with in-hospital mortality. We performed an observational study on 485 hospitalized older COVID-19 adults (aged 80+ years). Patients were [...] Read more.

Our study aimed to identify clusters of hospitalized older COVID-19 patients according to their main comorbidities and routine laboratory parameters to evaluate their association with in-hospital mortality. We performed an observational study on 485 hospitalized older COVID-19 adults (aged 80+ years). Patients were aggregated in clusters by a K-medians cluster analysis. The primary outcome was in-hospital mortality. Medical history and laboratory parameters were collected on admission. Frailty, defined by the Clinical Frailty Scale (CFS), referred to the two weeks before hospitalization and was used as a covariate. The median age was 87 (83–91) years, with a female prevalence (59.2%). Three different clusters were identified: cluster 1 (337), cluster 2 (118), and cluster 3 (30). In-hospital mortality was 28.5%, increasing from cluster 1 to cluster 3: cluster 1 = 21.1%, cluster 2 = 40.7%, and cluster 3 = 63.3% (p < 0.001). The risk for in-hospital mortality was higher in clusters 2 [HR 1.96 (95% CI: 1.28–3.01)] and 3 [HR 2.87 (95% CI: 1.62–5.07)] compared to cluster 1, even after adjusting for age, sex, and frailty. Patients in cluster 3 were older and had a higher prevalence of atrial fibrillation, higher admission NT-proBNP and C-reactive protein levels, higher prevalence of concurrent bacterial infections, and lower estimated glomerular filtration rates. The addition of CFS significantly improved the predictive ability of the clusters for in-hospital mortality. Our cluster analysis on older COVID-19 patients provides a characterization of those subjects at higher risk for in-hospital mortality, highlighting the role played by cardio-renal impairment, higher inflammation markers, and frailty, often simultaneously present in the same patient. Full article

(This article belongs to the Special Issue Emerging Trends in COVID-19 and Heart Failure)

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8 pages, 495 KiB

Open AccessCommunication

Pre-Operative SARS-CoV-2 Testing in Asymptomatic Heart Transplantation Recipients

by Peter-Paul Zwetsloot, Wouter L. Smit, Niels P. Van der Kaaij, Mariusz K. Szymanski, Manon G. Van der Meer, Linda W. Van Laake, Annet Troelstra, Marjolijn C. A. Wegdam-Blans and Marish I. F. J. Oerlemans

Biomedicines 2023, 11(8), 2103; https://doi.org/10.3390/biomedicines11082103 - 26 Jul 2023

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Abstract

Introduction: From the start of the coronavirus disease 2019 (COVID-19) pandemic, international guidelines have recommended pre-operative screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before heart transplantation (HTx). Due to the changing prevalence of COVID-19, the chances of false positive results have [...] Read more.

Introduction: From the start of the coronavirus disease 2019 (COVID-19) pandemic, international guidelines have recommended pre-operative screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before heart transplantation (HTx). Due to the changing prevalence of COVID-19, the chances of false positive results have increased. Because of increased immunity in the population and evolution of SARS-CoV-2 to current Omicron variants, associated mortality and morbidity have decreased. We set out to investigate the yield and side effects of SARS-CoV-2 screening in our center. Methods: We performed a retrospective cohort study in the University Medical Center Utrecht. The study period was from March 2019 to January 2023. All data from patients who underwent HTx were collected, including all pre-operative and post-operative SARS-CoV-2 tests. Furthermore, all clinical SARS-CoV-2 tests for the indication of potential HTx were screened. Results: In the period under study, 51 patients underwent HTx. None of the recipients reported any symptoms of a viral infection. Fifty HTx recipients were screened for SARS-CoV-2. Forty-nine out of fifty patients tested negative. One patient had a false positive result, potentially delaying the HTx procedure. There were no cancelled HTx procedures due to a true positive SARS-CoV-2 test result. Conclusion: Pre-operative SARS-CoV-2 screening in asymptomatic HTx recipients did not lead to any true positive cases. In 2% of the cases, screening resulted in a false positive test result. With the current Omicron variants, in combination with a low-prevalence situation, we propose to abandon pre-operative SARS-CoV-2 screening and initiate a symptom-driven approach for the general viral testing of patients who are called in for a potential HTx. Full article

(This article belongs to the Special Issue Emerging Trends in COVID-19 and Heart Failure)

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21 pages, 1535 KiB

Open AccessArticle

Cardiac Involvement in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) in Poland

by Kamila M. Ludwikowska, Nafeesa Moksud, Paweł Tracewski, Mateusz Sokolski and Leszek Szenborn

Biomedicines 2023, 11(5), 1251; https://doi.org/10.3390/biomedicines11051251 - 23 Apr 2023

Cited by 6 | Viewed by 1852

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is an immune-mediated complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cardiovascular system is commonly involved. Acute heart failure (AHF) is the most severe complication of MIS-C, leading to cardiogenic shock. The aim of the [...] Read more.

Multisystem inflammatory syndrome in children (MIS-C) is an immune-mediated complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cardiovascular system is commonly involved. Acute heart failure (AHF) is the most severe complication of MIS-C, leading to cardiogenic shock. The aim of the study was to characterise the course of MIS-C with a focus on cardiovascular involvement, based on echocardiographic (echo) evaluation, in 498 children (median age 8.3 years, 63% boys) hospitalised in 50 cities in Poland. Among them, 456 (91.5%) had cardiovascular system involvement: 190 (48.2%) of patients had (most commonly atrioventricular) valvular insufficiency, 155 (41.0%) had contractility abnormalities and 132 (35.6%) had decreased left ventricular ejection fraction (LVEF < 55%). Most of these abnormalities improved within a few days. Analysis of the results obtained from two echo descriptions (a median of 5 days apart) revealed a >10% increase in LVEF even in children with primarily normal LVEF. Lower levels of lymphocytes, platelets and sodium and higher levels of inflammatory markers on admission were significantly more common among older children with contractility dysfunction, while younger children developed coronary artery abnormality (CAA) more often. The incidence of ventricular dysfunction might be underestimated. The majority of children with AHF improved significantly within a few days. CAAs were relatively rare. Children with impaired contractility as well as other cardiac abnormalities differed significantly from children without such conditions. Due to the exploratory nature of this study, these findings should be confirmed in further studies. Full article

(This article belongs to the Special Issue Emerging Trends in COVID-19 and Heart Failure)

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11 pages, 573 KiB

Open AccessArticle

Factors of Persistent Limited Exercise Tolerance in Patients after COVID-19 with Normal Left Ventricular Ejection Fraction

by Katarzyna Gryglewska-Wawrzak, Agata Sakowicz, Maciej Banach, Marek Maciejewski and Agata Bielecka-Dabrowa

Biomedicines 2022, 10(12), 3257; https://doi.org/10.3390/biomedicines10123257 - 15 Dec 2022

Cited by 7 | Viewed by 1586

Abstract

Exercise intolerance de novo is one of the most common reported symptoms in patients recovering from the Coronavirus Disease 2019 (COVID-19). The present study determines etiological and pathophysiological factors influencing the mechanism of impaired exercise tolerance in patients during Long-COVID. Consequently, the factors [...] Read more.

Exercise intolerance de novo is one of the most common reported symptoms in patients recovering from the Coronavirus Disease 2019 (COVID-19). The present study determines etiological and pathophysiological factors influencing the mechanism of impaired exercise tolerance in patients during Long-COVID. Consequently, the factors affecting the percentage predicted oxygen uptake at peak exercise (%VO₂pred) in patients after COVID-19 with a normal left ventricular ejection fraction (LVEF) were assessment. A total of 120 patients recovering from COVID-19 at three to six months after confirmed diagnosis were included. The clinical examinations, laboratory test results, echocardiography, non-invasive body mass analysis, and spiroergometry were evaluated. The subjects were divided into the following groups: study patients’ group with worsen oxygen uptake (%VO₂pred < 80%; n = 47) and control group presenting%VO₂pred ≥ 80% (n = 73). ClinicalTrials.gov Identifier: NCT04828629. The male gender and the percent of total body water content (TBW%) were significantly higher in the study group compared to the control group (53 vs. 29%, p = 0.007 and 52.67 (±6.41) vs. 49.89 (±4.59), p = 0.02; respectively). Patients with %VO₂pred < 80% presented significantly lower global peak systolic strain (GLPS), tricuspid annular plane systolic excursion (TAPSE), and late diastolic filling (A) velocity (19.34 (±1.72)% vs. 20.10 (±1.35)%, p = 0.03; 21.86 (±4.53) vs. 24.08 (±3.20) mm, p = 0.002 and median 59.5 (IQR: 50.0–71.0) vs. 70.5 (IQR: 62.0–80.0) cm/s, p = 0.004; respectively) compared to the controls. The results of the multiple logistic regression model show that (A) velocity (OR 0.40, 95%CI: 0.17–0.95; p = 0.03) and male gender (OR 2.52, 95%CI: 1.07–5.91; p = 0.03) were independently associated with %VO₂pred. Conclusions: Men have over twice the risk of persistent limited exercise tolerance in Long-COVID than women. The decreased (A) velocity, TAPSE, GLPS, and hydration status are connected with limited exercise tolerance after COVID-19 in patients with normal LVEF. Full article

(This article belongs to the Special Issue Emerging Trends in COVID-19 and Heart Failure)

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Review

Jump to: Research, Other

11 pages, 672 KiB

Open AccessReview

Telemedicine in Heart Failure in the COVID-19 and Post-Pandemic Era: What Have We Learned?

by Mateusz Sokolski, Marta Kalużna-Oleksy, Agnieszka Tycińska and Ewa A. Jankowska

Biomedicines 2023, 11(8), 2222; https://doi.org/10.3390/biomedicines11082222 - 08 Aug 2023

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Abstract

Numerous studies showed that patients with heart failure (HF) and COVID-19 are at high risk of in-hospital complications and long-term mortality. Changes in the organisation of the medical system during the pandemic also worsened access to standard procedures, increasing the general mortality in [...] Read more.

Numerous studies showed that patients with heart failure (HF) and COVID-19 are at high risk of in-hospital complications and long-term mortality. Changes in the organisation of the medical system during the pandemic also worsened access to standard procedures, increasing the general mortality in HF and forcing the systems to be reorganised with the implementation and development of telemedical technologies. The main challenges for HF patients during the pandemic could be solved with new technologies aimed to limit the risk of SARS-CoV-2 transmission, optimise and titrate the therapy, prevent the progression and worsening of HF, and monitor patients with acute HF events in the course of and after COVID-19. Dedicated platforms, phone calls or video conferencing and consultation, and remote non-invasive and invasive cardiac monitoring became potential tools used to meet the aforementioned challenges. These solutions showed to be effective in the model of care for patients with HF and undoubtedly will be developed after the experience of the pandemic. However, the multitude of possibilities requires central coordination and collaboration between institutes with data protection and cost reimbursement to create effective mechanisms in HF management. It is crucial that lessons be learned from the pandemic experience to improve the quality of care for HF patients. Full article

(This article belongs to the Special Issue Emerging Trends in COVID-19 and Heart Failure)

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13 pages, 7545 KiB

Open AccessReview

Strain Echocardiography in Acute COVID-19 and Post-COVID Syndrome: More than Just a Snapshot

by Johannes Kersten, Jana Schellenberg, Achim Jerg, Johannes Kirsten, Hasema Persch, Yuefei Liu and Jürgen M. Steinacker

Biomedicines 2023, 11(4), 1236; https://doi.org/10.3390/biomedicines11041236 - 21 Apr 2023

Cited by 1 | Viewed by 2205

Abstract

Speckle-tracking echocardiography (STE) has become an established, widely available diagnostic method in the past few years, making its value clear in cases of COVID-19 and the further course of the disease, including post-COVID syndrome. Since the beginning of the pandemic, many studies have [...] Read more.

Speckle-tracking echocardiography (STE) has become an established, widely available diagnostic method in the past few years, making its value clear in cases of COVID-19 and the further course of the disease, including post-COVID syndrome. Since the beginning of the pandemic, many studies have been published on the use of STE in this condition, enabling, on the one hand, a better understanding of myocardial involvement in COVID-19 and, on the other, a better identification of risk to patients, although some questions remain unanswered in regard to specific pathomechanisms, especially in post-COVID patients. This review takes a closer look at current findings and potential future developments by summarising the extant data on the use of STE, with a focus on left and right ventricular longitudinal strain. Full article

(This article belongs to the Special Issue Emerging Trends in COVID-19 and Heart Failure)

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12 pages, 2379 KiB

Open AccessReview

Acute COVID-19 Management in Heart Failure Patients: A Specific Setting Requiring Detailed Inpatient and Outpatient Hospital Care

by Alberto Palazzuoli, Matteo Beltrami and Peter A. McCullough

Biomedicines 2023, 11(3), 790; https://doi.org/10.3390/biomedicines11030790 - 06 Mar 2023

Cited by 4 | Viewed by 2946

Abstract

The relationship existing between heart failure (HF) and COVID-19 remains questioned and poorly elucidated. Many reports suggest that HF events are reduced during pandemics, although other studies have demonstrated higher mortality and sudden death in patients affected by HF. Several vascular, thrombotic, and [...] Read more.

The relationship existing between heart failure (HF) and COVID-19 remains questioned and poorly elucidated. Many reports suggest that HF events are reduced during pandemics, although other studies have demonstrated higher mortality and sudden death in patients affected by HF. Several vascular, thrombotic, and respiratory features may deteriorate stable HF patients; therefore, the infection may directly cause direct myocardial damage, leading to cardiac function deterioration. Another concern is related to the possibility that antiviral, anti-inflammatory, and corticosteroid agents commonly employed during acute COVID-19 infection may have potentially deleterious effects on the cardiovascular (CV) system. For these reasons, HF patients deserve specific management with a tailored approach in order to avoid arrhythmic complications and fluid retention events. In this review, we describe the complex interplay between COVID-19 and HF, the evolving trend of infection with related CV events, and the specific management strategy to adopt in this setting. Full article

(This article belongs to the Special Issue Emerging Trends in COVID-19 and Heart Failure)

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12 pages, 1443 KiB

Open AccessReview

Cardiovascular Complications of Viral Respiratory Infections and COVID-19

by Paweł Franczuk, Michał Tkaczyszyn, Maria Kulak, Esabel Domenico, Piotr Ponikowski and Ewa Anita Jankowska

Biomedicines 2023, 11(1), 71; https://doi.org/10.3390/biomedicines11010071 - 27 Dec 2022

Cited by 8 | Viewed by 3063

Abstract

Viral respiratory infections (VRI) are the most prevalent type of infectious diseases and constitute one of the most common causes of contact with medical care. Regarding the pathophysiology of the cardiovascular system, VRI can not only exacerbate already existing chronic cardiovascular disease (such [...] Read more.

Viral respiratory infections (VRI) are the most prevalent type of infectious diseases and constitute one of the most common causes of contact with medical care. Regarding the pathophysiology of the cardiovascular system, VRI can not only exacerbate already existing chronic cardiovascular disease (such as coronary artery disease or heart failure) but also trigger new adverse events or complications (e.g., venous thromboembolism), the latter particularly in subjects with multimorbidity or disease-related immobilization. In the current paper, we provide a narrative review of diverse cardiovascular complications of VRI as well as summarize available data on the pathology of the circulatory system in the course of coronavirus disease 2019 (COVID-19). Full article

(This article belongs to the Special Issue Emerging Trends in COVID-19 and Heart Failure)

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Other

Jump to: Research, Review

9 pages, 625 KiB

Open AccessBrief Report

COVID-19 Associated Vasculitis Confirmed by the Tissues RT-PCR: A Case Series Report

by Konstantin E. Belozerov, Ilia S. Avrusin, Lyubov I. Andaryanova, Anna M. Guseva, Zaira S. Shogenova, Irina N. Belanovich, Anna V. Lobacheva, Tatiana L. Kornishina, Eugenia A. Isupova, Vera V. Masalova, Olga V. Kalashnikova, Andrey V. Nokhrin, Tatyana F. Panova, Yulia P. Dutova, Svetlana L. Myshkovskaya, Kirill Y. Kostyunin, Andrey B. Komissarov, Vyacheslav G. Chasnyk, Liudmila V. Bregel and Mikhail M. Kostik

Biomedicines 2023, 11(3), 870; https://doi.org/10.3390/biomedicines11030870 - 13 Mar 2023

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Abstract

Background: Several cases of skin and central nervous system vasculopathy associated with COVID-19 in children have been published, but the information is rather limited. Our study aimed to describe these cases of vasculitis associated with COVID-19 in children. Methods: In the retrospective-prospective case [...] Read more.

Background: Several cases of skin and central nervous system vasculopathy associated with COVID-19 in children have been published, but the information is rather limited. Our study aimed to describe these cases of vasculitis associated with COVID-19 in children. Methods: In the retrospective-prospective case series study we included information regarding four children with COVID-19-associated vasculitis. In every case, we had a morphological description and the etiology was confirmed via real-time polymerase chain reaction during a tissue biopsy. Results: The most involved systems were skin (4/4), respiratory (3/4), cardiovascular (2/4), nervous (1/4), eye (1/4), kidney (1/4), and inner year (1/4). All patients had increased inflammatory markers and thrombotic parameters (D-dimer). No patient met the criteria for multisystem inflammatory syndrome in children. Two patients met polyarteritis nodosa criteria, one met Henoch–Schonlein purpura criteria, and one met unclassified vasculitis criteria. All patients were treated with systemic glucocorticosteroids (two-pulse therapy). Non-biologic DMARDs were prescribed in all cases; 1/4 patients (25%) was treated with intravenous immunoglobuline, and 3/4 (75%) were treated with biologics (etanercept, tocilizumab, and adalimumab). Conclusions: Vasculitis associated with COVID-19 could be a life-threatening condition; SARS-CoV-2 might be a new trigger or etiological agent for vasculitis and other immune-mediated diseases. Further research and collection of similar cases are required. Full article

(This article belongs to the Special Issue Emerging Trends in COVID-19 and Heart Failure)

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