COVID-19 and the cardiovascular system: A review of current data, summary of best practices, outline of controversies, and illustrative case reports

Prasad, Anand; Panhwar, Siyab; Hendel, Robert C.; Sheikh, Omar; Mushtaq, Zunair; Dollar, Fatima; Vinas, Ariel; Alraies, Chadi; Almonani, Ahmed; Nguyen, Tung T.; Amione‐Guerra, Javier; Foster, Mark; Sisson, Craig; Anderson, Allen S.; George, Jon C.; Kutkut, Issa; Casillas, Jorge; Badin, Auroa

doi:10.1016/j.ahj.2020.06.009

Cited by 14 publications

(8 citation statements)

References 85 publications

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“…The presence of myocardial injury, defined as high-sensitivity cardiac troponin (hs-cTn) elevation, was described especially among most critically ill patients with COVID-19 [ 5 , 6 , 7 ]. In these reports, older patients with acute myocardial injury suffered from more cardiovascular (CV) comorbidities and faced less favorable prognosis [ 8 ], and biomarker elevation was present also in patients without underlying obstructive coronary artery disease (CAD) [ 9 ]. Moreover, frequency of arrhythmias was noted to be higher in patients with myocardial injury [ 10 ], potentially leading to worse outcomes.…”

Section: Introductionmentioning

confidence: 99%

Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease

Schiavone

Gasperetti

Mancone

et al. 2020

JCM

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Background: Although studies assessing cardiovascular comorbidities and myocardial injury in Coronavirus disease 2019 (COVID-19) patients have been published, no reports focused on clinical outcomes of myocardial injury in patients with and without chronic coronary syndromes (CCS) are currently available. Methods: In this study, consecutive COVID-19 patients admitted to four different institutions were screened for enrolment. Patients were divided into two groups (CCS vs. no-CCS). Association with in-hospital mortality and related predictors represented the main study outcome; myocardial injury and its predictors were deemed secondary outcomes. Results: A total of 674 COVID-19 patients were enrolled, 112 (16.6%) with an established history of CCS. Myocardial injury occurred in 43.8% patients with CCS vs. 14.4% patients without CCS, as confirmed by high-sensitivity cardiac troponin (hs-cTn) elevation on admission or during hospitalization. The mortality rate in the CCS cohort was nearly three-fold higher. After adjusting for disease severity, myocardial injury resulted significantly associated with in-hospital mortality in the no-CCS group but not in CCS patients. Conclusions: Patients with CCS and COVID-19 showed high mortality rate. Myocardial injury may be a bystander in CCS patients and COVID-19, while in patients without known history of CCS, myocardial injury has a significant role in predicting poor outcomes.

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Section: Introductionmentioning

confidence: 99%

Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease

Schiavone

Gasperetti

Mancone

et al. 2020

JCM

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“…We also could not find any association between ACEI/ARB use and mortality. Nevertheless, evidence suggests that ACEI/ARB therapy should not be discontinued in patients at risk for or who have COVID-19 [16].…”

Section: Figure 1: Outcomes Per Age Classmentioning

confidence: 99%

Clinical Features and Prognostic Factors of 245 Portuguese Patients Hospitalized With COVID-19

Salvador¹,

Oliveira²,

Costa³

et al. 2021

Cureus

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Introduction Since the declaration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in March 2020, Portugal was considered a role model with regards to the first COVID-19 wave. However, a third wave started in 2021 started, turning the country into the worst in the world regarding new infections and death rate per capita in the last weeks of January 2021. No significant data regarding the country's first wave of hospitalized patients have been published. Those data may help understand the differences over time regarding patients and the clinical approach to them. Herein, we present data of COVID-19 patients hospitalized at the main tertiary hospital of the second-most affected county at the time and identify risk factors associated with disease progression and outcomes. Materials and methods We performed a prospective observational study of patients admitted with COVID-19 to a central hospital between March 20 and June 1, 2020. The primary endpoint of this study was 30-day mortality or the need for ventilatory support and the secondary outcomes were both outcomes individually. Results 245 patients were included, with a median age of 79 years, 52% males. Hypertension (n = 172) and dyslipidemia (n = 114) were the most frequent comorbidities. Half of the patients (n = 121) were treated with hydroxychloroquine. The primary outcome occurred in 114 patients; mortality at 30 days was 35%. Age (OR 1.05; 1.02-1.07) and active cancer (OR 3.89; 1.43-10.57) were associated with the primary outcome, with dyslipidemia being protective (OR 0.46; 0.25-0.80). Treatment with hydroxychloroquine or lopinavir/ritonavir was not associated with the main outcome. Patients who had been symptomatic for more than 7 days had lower mortality (OR 0.23; 0.09-0.63). Discussion In the present study, age and cancer were associated with higher mortality, as noted in prior articles. The population had a higher median age than reported in previous studies, which may explain the increased mortality. The protective association of dyslipidemia was not previously described. This association was not related to statin intake. Conclusion The reported high mortality of COVID-19 is rarely seen in other infectious diseases. Our elderly population probably reflects more reliably the incidence of COVID-19 in European countries with constricted age pyramids.

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“…Dessa forma, o COVID-19 atua como um fator de risco independente para IAM 23 . Outras possíveis complicações cardíacas incluem insuficiência cardíaca aguda, arritmias e choque cardiogênico 24,25 .…”

Section: Pcr Na Covid-19unclassified

Ressuscitação Cardiopulmonar (Rcp) Em Pacientes Com Covid-19 Durante O Perioperatório

Luz¹,

Silva

2020

J Surg Cl Res

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Tem sido observada elevada incidência de pacientes sintomáticos com diagnóstico de COVID-19 que necessitam de internamento hospitalar. Dentre esses, encontra-se pacientes que precisam se submetidos a procedimentos cirúrgicos. O estresse anestésico-cirúrgico aumenta morbidade e o risco de eventos adversos, podendo culminar com o evento de Parada Cardiorrespiratória (PCR). Durante o protocolo de atendimento à PCR, o contato direto com o paciente, as manobras de compressão torácica, ventilações manuais com pressão positiva e o manejo para obtenção de via aérea avançada envolvem a exposição dos profissionais a grandes quantidades de aerossóis e secreções. Além disso, partículas virais podem permanecerem suspensas no ar da sala operatória por até três horas. Dessa forma, monitorização do paciente potencialmente grave, prevenção e protocolos específicos de RCP para o paciente com COVID-19 são importantes no contexto perioperatório.

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COVID-19 and the cardiovascular system: A review of current data, summary of best practices, outline of controversies, and illustrative case reports

Cited by 14 publications

References 85 publications

Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease

Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease

Clinical Features and Prognostic Factors of 245 Portuguese Patients Hospitalized With COVID-19

Ressuscitação Cardiopulmonar (Rcp) Em Pacientes Com Covid-19 Durante O Perioperatório

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