Diagnosis and Management of Cardiovascular Disease (CVD) during the COVID-19 Pandemic

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 31 March 2024 | Viewed by 18363

Special Issue Editor

Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, NY, USA
Interests: preventive cardiology; epidemiology; cardiovascular health; cardiovascular risk prediction; cardiovascular rehabilitation; rehabilitation medicine; atherosclerotic cardiovascular risk; body volume measurement; body composition; obesity; artificial intelligence

Special Issue Information

Dear Colleagues,

As we know, COVID-19 reached pandemic levels in March 2020, resulting in almost 60 million confirmed cases and over 1.41 million deaths as of November 25, 2020. This has not only pushed the capacities of public health services, but has also radically changed how medical care is provided, making it essential to reorganize and adapt health systems across various specialties in order to prioritize and individualize patient care as necessary.

Patients with pre-existing cardiovascular diseases and risk factors (such as obesity, hypertension, and diabetes) have increased severity and mortality during SARS-CoV-2 infection compared to these comorbidities individually. It is suggested that a combined effect of these comorbidities may play a key role, as these conditions share several standard features with infectious disorders, including a chronic pro-inflammatory state and the attenuation of the innate immune response, which may make individuals more susceptible to disease complications. For example, severe obesity (BMI≥35 kg/mt2), is one of the comorbidities most related to admissions (i.e., hospitalization or ICU) and fatalities; however, the pathophysiological mechanism explaining the associations between obesity and fatal and non-fatal outcomes in COVID patients are not fully understood.

Several demographic and clinical characteristics are significant predictors of hospitalization and severe outcomes. COVID-19 disproportionately affects the African American and Hispanic populations, who have high rates of comorbid conditions and obesity. Regarding gender, male sex (at age 60 years or older) has shown a trend toward a higher risk of fatal outcomes in COVID-19 patients. With effective novel therapeutics and vaccines on the horizon, the direct and indirect consequences of COVID-19 continue to strain the practice of cardiovascular medicine. Understanding the current and future impacts of the COVID-19 pandemic on public health, patient care, cardiovascular management, and outcomes for patients with and without underlying cardiovascular diseases and risk factors is of the utmost importance. In this Special Issue, we welcome a diverse array of submissions that will increase the knowledge on the topic.

Dr. Jose Medina-Inojosa
Guest Editor

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Keywords

  • COVID-19 pandemic
  • public health
  • cardiovascular disease
  • cardiovascular risk factors
  • cardiovascular outcomes
  • cardiovascular manangement
  • diversity
  • vaccines
  • therapeutics
  • obesity
  • multi-morbidity

Published Papers (9 papers)

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Research

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13 pages, 1073 KiB  
Article
Effect of COVID-19 on Blood Pressure Profile and Oxygen Pulse during and after the Cardiopulmonary Exercise Test in Healthy Adults
by Kamila Miętkiewska-Szwacka, Remigiusz Domin, Małgorzata Kwissa, Mikołaj Żołyński, Jan Niziński, Elżbieta Turska and Maciej Cymerys
J. Clin. Med. 2023, 12(13), 4483; https://doi.org/10.3390/jcm12134483 - 04 Jul 2023
Cited by 3 | Viewed by 1308
Abstract
Several reports have shown the impact of COVID-19 history on exercise capacity. This study compared the blood pressure (BP) response and oxygen pulse (O2 pulse) characteristics in normotensive patients with and without a history of COVID-19 during the cardiopulmonary exercise test (CPET) [...] Read more.
Several reports have shown the impact of COVID-19 history on exercise capacity. This study compared the blood pressure (BP) response and oxygen pulse (O2 pulse) characteristics in normotensive patients with and without a history of COVID-19 during the cardiopulmonary exercise test (CPET) and post-exercise recovery. This cross-sectional study involved 130 healthy Caucasian adult volunteers (71 participants with a history of COVID-19). All patients underwent the CPET with blood pressure measurements during exercise and post-exercise recovery. The post-COVID group had significantly higher systolic, diastolic, and mean blood pressure after 9 min of recovery and achieved a significantly lower max O2 pulse (2.02 mL/beat on average) than the controls. It should be noted that the COVID group tended to have higher blood pressure values in all steps, with no differences in heart rate, pulse pressure, and saturation at any step. The COVID-19 outbreak was associated with a higher blood pressure response, significantly, in post-exercise recovery, a lower maximum O2 pulse, and a lower maximum load achievement. Future studies are needed to determine if these abnormalities during the CPET and the blood pressure variation have prognostic value. Full article
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17 pages, 965 KiB  
Article
Cardiac Biomarkers and Risk Scores in Relation with History of Atherosclerotic Cardiovascular Disease in Patients Admitted with COVID-19: The Experience of an Eastern European Center
by Catalina Lionte, Victorita Sorodoc, Raluca Ecaterina Haliga, Cristina Bologa, Alexandr Ceasovschih, Oana Sirbu, Victoria Gorciac, Andrei-Costin Chelariu, Alexandra Stoica, Roxana Elena Tocila, Minerva Codruta Badescu, Irina-Iuliana Costache, Christiana Brigitte Sandu, Elisabeta Jaba and Laurentiu Sorodoc
J. Clin. Med. 2022, 11(19), 5671; https://doi.org/10.3390/jcm11195671 - 26 Sep 2022
Cited by 1 | Viewed by 1498
Abstract
Background: Data regarding the combined prognostic role of biomarkers and risk scores in relation with the history of atherosclerotic cardiovascular disease (ASCVD) in COVID-19 patients are lacking. Methods: The aim of this observational cohort study was to evaluate the combined prognostic value of [...] Read more.
Background: Data regarding the combined prognostic role of biomarkers and risk scores in relation with the history of atherosclerotic cardiovascular disease (ASCVD) in COVID-19 patients are lacking. Methods: The aim of this observational cohort study was to evaluate the combined prognostic value of N-terminal pro B-type natriuretic peptide (NT-pro BNP), troponin and risk scores in relation with ASCVD history in hospitalized COVID-19 patients. The primary composite endpoint was Intensive Care Unit (ICU) admission and death. Results: From April 2020 to June 2022, 1066 consecutive COVID-19 patients with available biomarkers upon admission were included. During a median follow-up period of 12 days, 176 patients (16.5%) died. Independent predictors of ICU admission and death in patients with ASCVD were NT-pro BNP (HR 2.63; 95% CI, 1.65–4.18) and troponin (HR 1.51; 95% CI, 1.13–2.03). In patients without ASCVD, only NT-pro BNP was predictive for the primary endpoint (HR 1.66; 95% CI, 1.10–2.53). This remained significant after adjustment for other relevant covariates (HR 3.54; 95% CI, 1.98–6.33) in patients with ASCVD and in patients without ASCVD (HR 1.82; 95% CI, 1.02–3.26). Conclusions: These data showed the combined prognostic accuracy of NT-pro BNP and troponin in relation with ASCVD history for ICU admission and death in COVID-19 patients. Full article
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14 pages, 1201 KiB  
Article
Management of Out-of-Hospital Cardiac Arrest during COVID-19: A Tale of Two Cities
by Shir Lynn Lim, Lekshmi Kumar, Seyed Ehsan Saffari, Nur Shahidah, Rabab Al-Araji, Qin Xiang Ng, Andrew Fu Wah Ho, Shalini Arulanandam, Benjamin Sieu-Hon Leong, Nan Liu, Fahad Javaid Siddiqui, Bryan McNally and Marcus Eng Hock Ong
J. Clin. Med. 2022, 11(17), 5177; https://doi.org/10.3390/jcm11175177 - 01 Sep 2022
Cited by 1 | Viewed by 1402
Abstract
Variations in the impact of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) have been reported. We aimed to, using population-based registries, compare community response, Emergency Medical Services (EMS) interventions and outcomes of adult, EMS-treated, non-traumatic OHCA in Singapore and metropolitan Atlanta, before [...] Read more.
Variations in the impact of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) have been reported. We aimed to, using population-based registries, compare community response, Emergency Medical Services (EMS) interventions and outcomes of adult, EMS-treated, non-traumatic OHCA in Singapore and metropolitan Atlanta, before and during the pandemic. Associations of OHCA characteristics, pre-hospital interventions and pandemic with survival to hospital discharge were analyzed using logistic regression. There were 2084 cases during the pandemic (17 weeks from the first confirmed COVID-19 case) and 1900 in the pre-pandemic period (corresponding weeks in 2019). Compared to Atlanta, OHCAs in Singapore were older, received more bystander interventions (cardiopulmonary resuscitation (CPR): 65.0% vs. 41.4%; automated external defibrillator application: 28.6% vs. 10.1%), yet had lower survival (5.6% vs. 8.1%). Compared to the pre-pandemic period, OHCAs in Singapore and Atlanta occurred more at home (adjusted odds ratio (aOR) 2.05 and 2.03, respectively) and were transported less to hospitals (aOR 0.59 and 0.36, respectively) during the pandemic. Singapore reported more witnessed OHCAs (aOR 1.96) yet less bystander CPR (aOR 0.81) during pandemic, but not Atlanta (p < 0.05). The impact of COVID-19 on OHCA outcomes did not differ between cities. Changes in OHCA characteristics and management during the pandemic, and differences between Singapore and Atlanta were likely the result of systemic and sociocultural factors. Full article
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9 pages, 687 KiB  
Article
Impact of the COVID-19 Pandemic on In-Patient Treatment of Peripheral Artery Disease in Germany during the First Pandemic Wave
by Christian Scheurig-Muenkler, Florian Schwarz, Thomas J. Kroencke and Josua A. Decker
J. Clin. Med. 2022, 11(7), 2008; https://doi.org/10.3390/jcm11072008 - 03 Apr 2022
Cited by 4 | Viewed by 1355
Abstract
Patients with peripheral artery disease (PAD) belong to a vulnerable population with relevant comorbidity. Appropriate care and timely treatment are imperative, but not readily assured in the current pandemic. What impact did the first wave have on in-hospital treatment in Germany? Nationwide healthcare [...] Read more.
Patients with peripheral artery disease (PAD) belong to a vulnerable population with relevant comorbidity. Appropriate care and timely treatment are imperative, but not readily assured in the current pandemic. What impact did the first wave have on in-hospital treatment in Germany? Nationwide healthcare remuneration data for inpatient care of the years 2019 and 2020 were used to compare demographic baseline data including the assessment of comorbidity (van Walraven score), as well as the encoded treatments. A direct comparison was made between the first wave of infections in 2020 and the reference period in 2019. The number of inpatient admissions decreased by 10.9%, with a relative increase in hospitalizations due to PAD Fontaine IV (+13.6%). Baseline demographics and comorbidity showed no relevant differences. The proportion of emergency admissions increased from 23.4% to 28.3% during the first wave to the reference period in 2019, and in-hospital mortality increased by 21.9% from 2.5% to 3.1%. Minor and major amputations increased by 24.5% and 18.5%. Endovascular and combined surgical/endovascular treatment strategies increased for all stages. Already in the first, comparatively mild wave of the pandemic, significantly fewer patients with predominantly higher-grade PAD stages were treated as inpatients. Consecutively, in-hospital mortality and amputation rates increased. Full article
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12 pages, 1633 KiB  
Article
Continuous Decline in Myocardial Infarction and Heart Failure Hospitalizations during the First 12 Months of the COVID-19 Pandemic in Israel
by Gil Lavie, Yael Wolff Sagy, Moshe Hoshen, Walid Saliba and Moshe Y. Flugelman
J. Clin. Med. 2022, 11(6), 1577; https://doi.org/10.3390/jcm11061577 - 13 Mar 2022
Cited by 6 | Viewed by 1868
Abstract
Background: A decline in cardiovascular hospitalizations was observed during the initial phases of the COVID-19 pandemic. We examine the continuous effect of the COVID-19 pandemic in reducing cardiovascular hospitalization and associated mortality rates during the first year of the pandemic in Israel. Methods: [...] Read more.
Background: A decline in cardiovascular hospitalizations was observed during the initial phases of the COVID-19 pandemic. We examine the continuous effect of the COVID-19 pandemic in reducing cardiovascular hospitalization and associated mortality rates during the first year of the pandemic in Israel. Methods: We conduct a retrospective cohort study using the data of Clalit Health Services, the largest healthcare organization in Israel. We divide the Corona year into six periods (three lockdowns and three post-lockdowns) and compare the incidence rates of cardiovascular hospitalizations and 30-day all-cause mortality during each period to the previous three years. Results: The number of non-STEMI hospitalizations during the first year of the pandemic was 13.7% lower than the average of the previous three years (95% CI 11–17%); STEMI hospitalizations were 15.7% lower (95% CI 13–19%); CHF (Congestive heart failure) hospitalizations were 23.9% lower (95%, CI 21–27%). No significant differences in 30-day all-cause mortality rates were observed among AMI (acute myocardial infarction) patients during most of the periods, whereas the annual 30-day all-cause mortality rate among CHF patients was 23% higher. Conclusions: AMI and CHF hospitalizations were significantly lower during the first year of the pandemic relative to 2017–9. Mortality rates were higher in the case of CHF patients but not in the case of AMI patients, possibly due to a change in the clinical acuity of patients arriving at the hospitals. We conclude that targeted public health messaging should be implemented together with proactive monitoring, in order to identify residual disability in patients who may have received non-optimal treatment during the pandemic. Full article
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11 pages, 885 KiB  
Article
Treatment Delay and Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction during the COVID-19 Pandemic
by Tomasz Tokarek, Artur Dziewierz, Krzysztof Piotr Malinowski, Tomasz Rakowski, Stanisław Bartuś, Dariusz Dudek and Zbigniew Siudak
J. Clin. Med. 2021, 10(17), 3920; https://doi.org/10.3390/jcm10173920 - 30 Aug 2021
Cited by 12 | Viewed by 1590
Abstract
Pandemic-specific protocols require additional time to prepare medical staff and catheterization laboratories. Thus, we sought to investigate treatment delay and clinical outcomes in COVID-19 positive and negative patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) during on- and [...] Read more.
Pandemic-specific protocols require additional time to prepare medical staff and catheterization laboratories. Thus, we sought to investigate treatment delay and clinical outcomes in COVID-19 positive and negative patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) during on- and off-hours. All consecutive patients with STEMI treated with PCI between 1 March and 31 December 2020 were enrolled in the analysis. A propensity score match was used to compare COVID-19 positive and negative patients for on- and off-hours. The study group was comprised of 877 paired patients treated during regular hours (every day 7:00 a.m. to 16:59 p.m.) and 418 matched pairs with PCI performed during off-hours (every day 17:00 p.m. to 06:59 a.m.) (ORPKI Polish National Registry). No difference in periprocedural mortality was observed between the two groups (on-hours: COVID-19 negative vs. COVID-19 positive: 17 (1.9%) vs. 11 (1.3%); p = 0.3; off-hours: COVID-19 negative vs. COVID-19 positive: 4 (1.0%) vs. 7 (1.7%); p = 0.5). Additionally, a similar rate of periprocedural complications was reported. Patients diagnosed with COVID-19 were exposed to longer time from first medical contact to angiography (on-hours: 133.8 (±137.1) vs. 117.1 (±135.8) (min); p = 0.001) (off-hours: 148.1 (±201.6) vs. 112.2 (±138.7) (min); p = 0.003). However, there was no influence of COVID-19 diagnosis on mortality and the prevalence of other periprocedural complications irrespective of time of intervention. Full article
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14 pages, 3189 KiB  
Article
The Spectrum of COVID-19-Associated Myocarditis: A Patient-Tailored Multidisciplinary Approach
by Giovanni Peretto, Andrea Villatore, Stefania Rizzo, Antonio Esposito, Giacomo De Luca, Anna Palmisano, Davide Vignale, Alberto Maria Cappelletti, Moreno Tresoldi, Corrado Campochiaro, Silvia Sartorelli, Marco Ripa, Monica De Gaspari, Elena Busnardo, Paola Ferro, Maria Grazia Calabrò, Evgeny Fominskiy, Fabrizio Monaco, Giulio Cavalli, Luigi Gianolli, Francesco De Cobelli, Alberto Margonato, Lorenzo Dagna, Mara Scandroglio, Paolo Guido Camici, Patrizio Mazzone, Paolo Della Bella, Cristina Basso and Simone Salaadd Show full author list remove Hide full author list
J. Clin. Med. 2021, 10(9), 1974; https://doi.org/10.3390/jcm10091974 - 04 May 2021
Cited by 16 | Viewed by 3425
Abstract
Background. Myocarditis lacks systematic characterization in COVID-19 patients. Methods. We enrolled consecutive patients with newly diagnosed myocarditis in the context of COVID-19 infection. Diagnostic and treatment strategies were driven by a dedicated multidisciplinary disease unit for myocarditis. Multimodal outcomes were assessed during prospective [...] Read more.
Background. Myocarditis lacks systematic characterization in COVID-19 patients. Methods. We enrolled consecutive patients with newly diagnosed myocarditis in the context of COVID-19 infection. Diagnostic and treatment strategies were driven by a dedicated multidisciplinary disease unit for myocarditis. Multimodal outcomes were assessed during prospective follow-up. Results. Seven consecutive patients (57% males, age 51 ± 9 y) with acute COVID-19 infection received a de novo diagnosis of myocarditis. Endomyocardial biopsy was of choice in hemodynamically unstable patients (n = 4, mean left ventricular ejection fraction (LVEF) 25 ± 9%), whereas cardiac magnetic resonance constituted the first exam in stable patients (n = 3, mean LVEF 48 ± 10%). Polymerase chain reaction (PCR) analysis revealed an intra-myocardial SARS-CoV-2 genome in one of the six cases undergoing biopsy: in the remaining patients, myocarditis was either due to other viruses (n = 2) or virus-negative (n = 3). Hemodynamic support was needed for four unstable patients (57%), whereas a cardiac device implant was chosen in two of four cases showing ventricular arrhythmias. Medical treatment included immunosuppression (43%) and biological therapy (29%). By the 6-month median follow-up, no patient died or experienced malignant arrhythmias. However, two cases (29%) were screened for heart transplantation. Conclusions. Myocarditis associated with acute COVID-19 infection is a spectrum of clinical manifestations and underlying etiologies. A multidisciplinary approach is the cornerstone for tailored management. Full article
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8 pages, 369 KiB  
Article
Home Management of Heart Failure and Arrhythmias in Patients with Cardiac Devices during Pandemic
by Andrea Matteucci, Michela Bonanni, Marco Centioni, Federico Zanin, Francesco Geuna, Gianluca Massaro and Giuseppe Sangiorgi
J. Clin. Med. 2021, 10(8), 1618; https://doi.org/10.3390/jcm10081618 - 11 Apr 2021
Cited by 4 | Viewed by 1629
Abstract
Background: The in-hospital management of patients with cardiac implantable electronic devices (CIEDs) changed early in the COVID-19 pandemic. Routine in-hospital controls of CIEDs were converted into remote home monitoring (HM). The aim of our study was to investigate the impact of the lockdown [...] Read more.
Background: The in-hospital management of patients with cardiac implantable electronic devices (CIEDs) changed early in the COVID-19 pandemic. Routine in-hospital controls of CIEDs were converted into remote home monitoring (HM). The aim of our study was to investigate the impact of the lockdown period on CIEDs patients and its influence on in-hospital admissions through the analysis of HM data. Methods: We analysed data recorded from 312 patients with HM during the national quarantine related to COVID-19 and then compared data from the same period of 2019. Results: We observed a reduction in the number of HM events in 2020 when compared to 2019. Non-sustained ventricular tachycardia episodes decreased (18.3% vs. 9.9% p = 0.002) as well as atrial fibrillation episodes (29.2% vs. 22.4% p = 0.019). In contrast, heart failure (HF) alarm activation was lower in 2019 than in 2020 (17% vs. 25.3% p = 0.012). Hospital admissions for critical events recorded with CIEDs dropped in 2020, including those for HF. Conclusions: HM, combined with telemedicine use, has ensured the surveillance of CIED patients. In 2020, arrhythmic events and hospital admissions decreased significantly compared to 2019. Moreover, in 2020, patients with HF arrived in hospital in a worse clinical condition compared to previous months. Full article
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Review

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15 pages, 674 KiB  
Review
Acute Coronary Syndrome in the COVID-19 Era—Differences and Dilemmas Compared to the Pre-COVID-19 Era
by Ratko Lasica, Lazar Djukanovic, Igor Mrdovic, Lidija Savic, Arsen Ristic, Marija Zdravkovic, Dragan Simic, Gordana Krljanac, Dejana Popovic, Dejan Simeunovic, Dubravka Rajic and Milika Asanin
J. Clin. Med. 2022, 11(11), 3024; https://doi.org/10.3390/jcm11113024 - 27 May 2022
Cited by 10 | Viewed by 2698
Abstract
The COVID-19 pandemic has led to numerous negative implications for all aspects of society. Although COVID-19 is a predominant lung disease, in 10–30% of cases, it is associated with cardiovascular disease (CVD). The presence of myocardial injury in COVID-19 patients occurs with a [...] Read more.
The COVID-19 pandemic has led to numerous negative implications for all aspects of society. Although COVID-19 is a predominant lung disease, in 10–30% of cases, it is associated with cardiovascular disease (CVD). The presence of myocardial injury in COVID-19 patients occurs with a frequency between 7–36%. There is growing evidence of the incidence of acute coronary syndrome (ACS) in COVID-19, both due to coronary artery thrombosis and insufficient oxygen supply to the myocardium in conditions of an increased need. The diagnosis and treatment of patients with COVID-19 and acute myocardial infarction (AMI) is a major challenge for physicians. Often the presence of mixed symptoms, due to the combined presence of COVID-19 and ACS, as well as possible other diseases, nonspecific changes in the electrocardiogram (ECG), and often elevated serum troponin (cTn), create dilemmas in diagnosing ACS in COVID-19. Given the often-high ischemic risk, as well as the risk of bleeding, in these patients and analyzing the benefit/risk ratio, the treatment of patients with AMI and COVID-19 is often associated with dilemmas and difficult decisions. Due to delays in the application of the therapeutic regimen, complications of AMI are more common, and the mortality rate is higher. Full article
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