Management of Cardiovascular Disease During Coronavirus Disease (COVID-19) Pandemic

Ganatra, Sarju; Dani, Sourbha S.; Shah, Sachin; Asnani, Aarti; Neilan, Tomas G.; Lenihan, Daniel J.; Ky, Bonnie; Barac, Ana; Hayek, Salim S.; Leja, Monika; Herrmann, Joerg; Thavendiranathan, Paaladinesh; Fradley, Michael G.; Bang, Vigyan; Shreyder, Katherine; Parikh, Rohan; Patel, Rushin; Singh, Amitoj; Brar, Simarjeet; Guha, Avirup; Gupta, Dipti; Mascari, Paolo; Patten, Richard D.; Venesy, David M.; Nohria, Anju; Resnic, Frederic S.

doi:10.1016/j.tcm.2020.05.004

Cited by 51 publications

(61 citation statements)

References 29 publications

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“…The mortality in STEMI patients is in uenced by many factors. Patients with cardiovascular disease who develop COVID-19 may have a higher risk of mortality 18 . This is similar to the situation with acute respiratory syndrome coronavirus (SARS-CoV) 19 and the Middle East respiratory syndrome coronavirus (MERS-CoV) 20 .…”

Section: Discussionmentioning

confidence: 99%

Safety measures for COVID-19 do not compromise the outcomes of patients undergoing primary percutaneous coronary intervention: A single center study

Guan

Zhang

et al. 2020

Preprint

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Coronavirus disease 2019 (COVID-19) is a global pandemic impacting nearly 170 countries/regions and millions of patients worldwide. Patients with acute myocardial infarction (AMI) still need to be treated at percutaneous coronary intervention (PCI) centers with relevant safety measures. This study was conducted to assess the therapeutic outcomes of PCI performed under the safety measures and normal conditions. AMI patients undergoing PCI between January 24 to April 30, 2020 were performed under safety measures for COVID-19. Patients received pulmonary computed tomography (CT) and underwent PCI in negative pressure ICU. Cardiac catheterization laboratory (CCL) staff and physicians worked with level Ⅲ personal protection. Demographic and clinical data, such as door-to-balloon (DTB) time, operation time, complications for patients in this period (NCP group) and the same period in 2019 (2019 group) were retrieved and analyzed. NCP and 2019 groups had 37 and 96 patients, respectively. There was no significant difference in age, gender, BMI and comorbidity between the two groups. DTB time and operation time were similar between the two groups (60.0 ± 12.39 vs 58.83 ± 12.85 min, p = 0.636; 61.46 ± 9.91 vs 62.55 ± 10.72 min, p = 0.592). Hospital stay time in NCP group was significantly shorter (6.78 ± 2.14 vs 8.85 ± 2.64 days, p < 0.001). The incidences of malignant arrhythmia and Takotsubo Syndrome in NCP group were higher than 2019 group significantly (16.22% vs 5.21%, p = 0.039; 10.81% vs 1.04% p = 0.008). During hospitalization and 3-month follow-up, the incidence of major adverse cardiovascular events and mortality in the two groups were statistically similar (35.13% vs 14.58%, p = 0.094; 16.22% vs 8.33%, p =0.184). Our analysis showed that safety measures undertaken in this hospital, including screening of COVID-19 infection and use of personal protection equipment for conducting PCI did not compromise the surgical outcome as compared with PCI under normal condition, although there were slight increases in incidence of malignant arrhythmia and Takotsubo Syndrome.

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Section: Discussionmentioning

confidence: 99%

Safety measures for COVID-19 do not compromise the outcomes of patients undergoing primary percutaneous coronary intervention: A single center study

Guan

Zhang

et al. 2020

Preprint

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“…COVID-19 may cause myocardial injury either due to direct viral myocardial invasion (myocarditis) or secondary to CRS resulting from hyperinflammatory response to COVID-19, angiotensin-converting enzyme-2 receptor modulation-mediated cardiac and endothelial injury or due to microvascular dysfunction and thrombosis [ 49 ]. While any antineoplastic therapy may compromise the patient’s immune system and potentially worsen COVID-19 severity, immunotherapy—both ICI and CAR T cell therapy—present a complex problem as they just not can potentially exacerbate the severity of COVID-19 illness, but cardiovascular complications secondary to COVID-19 may mimic those of cardiotoxicity associated with ICI (myocarditis) and CAR T cell therapy (CRS-associated myocardial injury), and in turn can delay the diagnosis and appropriate management.…”

Section: Covid-19 and Immunotherapy For Cancermentioning

confidence: 99%

Cardiotoxicity of Contemporary Anticancer Immunotherapy

Dalbo

Patel

Parikh

et al. 2020

Curr Treat Options Cardio Med

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Purpose of review Contemporary anticancer immunotherapy, particularly immune checkpoint inhibitors (ICI) and chimeric antigen receptor (CAR) T cell therapy, has changed the landscape of treatment for patients with a variety of malignancies who historically had a poor prognosis. However, both immune checkpoint inhibitors and CAR T cell therapy are associated with serious cardiovascular adverse effects. As immunotherapy evolves to include high-risk patients with preexisting cardiovascular risk factors and disease, the risk and relevance of its associated cardiotoxicity will be even higher. Recent findings ICI can cause myocarditis, which usually occurs early after initiation, can be fulminant, and prompt treatment with high-dose corticosteroids is crucial. CAR T cell therapy frequently leads to cytokine release syndrome, which is associated with cardiomyopathy or arrhythmia development and may also result in circulatory collapse. Supportive treatment, as well as tocilizumab, an anti-interleukin-6 receptor antibody, is the cornerstone of treatment. Recent findings suggest that preexisting cardiovascular risk factors and disease may increase the risk of such cardiotoxicity, and prompt recognition, as well as treatment, may favorably alter the outcomes. Summary ICI and CAR T cell therapy have improved cancer-related outcomes; however, they both are associated with potentially therapy-limiting cardiotoxicity. Cardio-oncologists are required to play an important role in patient selection, pretherapy cardiovascular optimization, and prompt recognition and treatment of cardiotoxicity.

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“…53 Several studies indicate that COVID-19 demonstrates the various pattern of myocardial injury, arrhythmia, or heart failure. 55,56 In addition, elevated cardiac biomarkers in the cardio-oncology population may indicate cardiotoxicity from cancer physiology or from treatments. 56,57 Many reasons may be associated with elevated cardiac biomarkers, including receiving some drugs, invasive diagnostic/ treatment strategies, CRS from CAR-T, myocarditis from ICI therapy, or heart failure from proteasome inhibitor use.…”

Section: Prevention and Management Of Covid-19mentioning

confidence: 99%

“…55,56 In addition, elevated cardiac biomarkers in the cardio-oncology population may indicate cardiotoxicity from cancer physiology or from treatments. 56,57 Many reasons may be associated with elevated cardiac biomarkers, including receiving some drugs, invasive diagnostic/ treatment strategies, CRS from CAR-T, myocarditis from ICI therapy, or heart failure from proteasome inhibitor use. [56][57][58] Some of these disease processes may complicate the treatment of a cancer patient who is also affected by COVID-19, so multidisciplinary evaluation by a cardio-oncologist, may be necessary to provide appropriate treatment in this high-risk population.…”

Section: Prevention and Management Of Covid-19mentioning

confidence: 99%

“…12 SARS-CoV-2 infection may lead to myocardial damage, more difficulty and complexity in patient management, a higher risk of infection, and worse outcomes in vulnerable patients with pre-existing comorbidities, particularly cardiovascular disease (CVD) and cancer. 55,56 Patients with cancer and COVID-19 may not exhibit typical symptoms, despite experiencing a weakened immune system and severe underlying diseases. 30,53 In order to avoid under-diagnosis of CVD and decrease the spread of infection, vigilant monitoring is required for acute myocardial infarction or heart failure in patients with COVID-19 due to similarities between respiratory and cardiac symptoms.…”

Section: Dovepressmentioning

confidence: 99%

See 1 more Smart Citation

<p>Cancer Care Management During the COVID-19 Pandemic</p>

Jafari¹,

Rezaei‐Tavirani²,

Karami³

et al. 2020

RMHP

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New cases of the novel coronavirus, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are increasing around the world. Currently, health care services are mainly focused on responding to and controlling the unique challenges of the coronavirus disease 2019 (COVID-19) pandemic. These changes, along with the higher susceptibility of patients with cancer to infections, have profound effects on other critical aspects of care and pose a serious challenge for the treatment of such patients. During the COVID-19 pandemic, it is important to provide strategies for managing the treatment of patients with cancer to limit COVID-19-associated risks at this difficult time. The present study set out to summarize the latest research on epidemiology, pathogenesis, and clinical features of COVID-19. We also address some of the current challenges associated with the management of patients with cancer during the COVID-19 pandemic and provide practical guidance to clinically deal with these challenges.

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Management of Cardiovascular Disease During Coronavirus Disease (COVID-19) Pandemic

Cited by 51 publications

References 29 publications

Safety measures for COVID-19 do not compromise the outcomes of patients undergoing primary percutaneous coronary intervention: A single center study

Safety measures for COVID-19 do not compromise the outcomes of patients undergoing primary percutaneous coronary intervention: A single center study

Cardiotoxicity of Contemporary Anticancer Immunotherapy

<p>Cancer Care Management During the COVID-19 Pandemic</p>

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