natriuretic-peptide--brain and Pneumonia--Viral

As the coronavirus disease 2019 (COVID-19) epidemic worsens, this global pandemic is impacting more than 200 countries/regions and more than 4,500,000 confirmed cases worldwide. COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which might attack not only the respiratory system, but also the other important organs, including the heart. It was reported that COVID-19 patients with a past history of cardiovascular diseases would have a higher mortality. Meanwhile, elevated troponin levels were frequently observed in COVID-19 cases. Besides the comprehensive treatments for COVID-19, as a cardiologist, we should also remain vigilant about the cardiac injuries, especially those with severe emergent cardiovascular symptoms.

Topics: Adult; Betacoronavirus; Biomarkers; Comorbidity; Coronary Disease; Coronavirus Infections; COVID-19; Humans; Interleukin-6; Male; Myocarditis; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; Risk Factors; SARS-CoV-2; Treatment Outcome; Troponin I

The coronavirus disease-2019 (COVID-19) pandemic has resulted in the worst global pandemic of our generation, affecting 215 countries with nearly 5.5 million cases. The association between COVID-19 and the cardiovascular system has been well described. We sought to systematically review the current published literature on the different cardiac manifestations and the use of cardiac-specific biomarkers in terms of their prognostic value in determining clinical outcomes and correlation to disease severity.. A systematic literature review across PubMed, Cochrane database, Embase, Google Scholar, and Ovid was performed according to PRISMA guidelines to identify relevant articles that discussed risk factors for cardiovascular manifestations, cardiac manifestations in COVID-19 patients, and cardiac-specific biomarkers with their clinical implications on COVID-19.. Sixty-one relevant articles were identified which described risk factors for cardiovascular manifestations, cardiac manifestations (including heart failure, cardiogenic shock, arrhythmia, and myocarditis among others) and cardiac-specific biomarkers (including CK-MB, CK, myoglobin, troponin, and NT-proBNP). Cardiovascular risk factors can play a crucial role in identifying patients vulnerable to developing cardiovascular manifestations of COVID-19 and thus help to save lives. A wide array of cardiac manifestations is associated with the interaction between COVID-19 and the cardiovascular system. Cardiac-specific biomarkers provide a useful prognostic tool in helping identify patients with the severe disease early and allowing for escalation of treatment in a timely fashion.. COVID-19 is an evolving pandemic with predominate respiratory manifestations, however, due to the interaction with the cardiovascular system; cardiac manifestations/complications feature heavily in this disease, with cardiac biomarkers providing important prognostic information.

Topics: Betacoronavirus; Biomarkers; Cardiovascular Diseases; Coronavirus Infections; COVID-19; Creatine Kinase; Creatine Kinase, MB Form; Humans; Myoglobin; Natriuretic Peptide, Brain; Pandemics; Pneumonia, Viral; Prognosis; Risk Factors; SARS-CoV-2; Shock, Cardiogenic; Troponin

The PARADIGM-HF (Prospective Comparison of Angiotensin II Receptor Blocker Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial reported that sacubitril/valsartan (S/V), an angiotensin receptor-neprilysin inhibitor, significantly reduced mortality and heart failure (HF) hospitalization in HF patients with a reduced ejection fraction (HFrEF). However, fewer than 1% of patients in the PARADIGM-HF study had New York Heart Association (NYHA) functional class IV symptoms. Accordingly, data that informed the use of S/V among patients with advanced HF were limited. The LIFE (LCZ696 in Hospitalized Advanced Heart Failure) study was a 24-week prospective, multicenter, double-blinded, double-dummy, active comparator trial that compared the safety, efficacy, and tolerability of S/V with those of valsartan in patients with advanced HFrEF. The trial planned to randomize 400 patients ≥18 years of age with advanced HF, defined as an EF ≤35%, New York Heart Association functional class IV symptoms, elevated natriuretic peptide concentration (B-type natriuretic peptide [BNP] ≥250 pg/ml or N-terminal pro-B-type natriuretic peptide [NT-proBNP] ≥800 pg/ml), and ≥1 objective finding of advanced HF. Following a 3- to 7-day open label run-in period with S/V (24 mg/26 mg twice daily), patients were randomized 1:1 to S/V titrated to 97 mg/103 mg twice daily versus 160 mg of V twice daily. The primary endpoint was the proportional change from baseline in the area under the curve for NT-proBNP levels measured through week 24. Secondary and tertiary endpoints included clinical outcomes and safety and tolerability. Because of the COVID-19 pandemic, enrollment in the LIFE trial was stopped prematurely to ensure patient safety and data integrity. The primary analysis consists of the first 335 randomized patients whose clinical follow-up examination results were not severely impacted by COVID-19. (Entresto [LCZ696] in Advanced Heart Failure [LIFE STUDY] [HFN-LIFE]; NCT02816736).

Topics: Aminobutyrates; Angiotensin Receptor Antagonists; Betacoronavirus; Biphenyl Compounds; Cardiotonic Agents; Coronavirus Infections; COVID-19; Dose-Response Relationship, Drug; Double-Blind Method; Drug Combinations; Early Termination of Clinical Trials; Glomerular Filtration Rate; Heart Failure; Heart Transplantation; Heart-Assist Devices; Hospitalization; Humans; Hypotension; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; SARS-CoV-2; Stroke Volume; Tetrazoles; Valsartan

Topics: Betacoronavirus; Biomarkers; Cardiovascular Diseases; China; Coronavirus Infections; COVID-19; Cross-Sectional Studies; Female; Humans; Male; Myocardium; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; Prognosis; SARS-CoV-2; Troponin I

Increasing numbers of confirmed cases and mortality rates of coronavirus disease 2019 (COVID-19) are occurring in several countries and continents. Information regarding the impact of cardiovascular complication on fatal outcome is scarce.. To evaluate the association of underlying cardiovascular disease (CVD) and myocardial injury with fatal outcomes in patients with COVID-19.. This retrospective single-center case series analyzed patients with COVID-19 at the Seventh Hospital of Wuhan City, China, from January 23, 2020, to February 23, 2020. Analysis began February 25, 2020.. Demographic data, laboratory findings, comorbidities, and treatments were collected and analyzed in patients with and without elevation of troponin T (TnT) levels.. Among 187 patients with confirmed COVID-19, 144 patients (77%) were discharged and 43 patients (23%) died. The mean (SD) age was 58.50 (14.66) years. Overall, 66 (35.3%) had underlying CVD including hypertension, coronary heart disease, and cardiomyopathy, and 52 (27.8%) exhibited myocardial injury as indicated by elevated TnT levels. The mortality during hospitalization was 7.62% (8 of 105) for patients without underlying CVD and normal TnT levels, 13.33% (4 of 30) for those with underlying CVD and normal TnT levels, 37.50% (6 of 16) for those without underlying CVD but elevated TnT levels, and 69.44% (25 of 36) for those with underlying CVD and elevated TnTs. Patients with underlying CVD were more likely to exhibit elevation of TnT levels compared with the patients without CVD (36 [54.5%] vs 16 [13.2%]). Plasma TnT levels demonstrated a high and significantly positive linear correlation with plasma high-sensitivity C-reactive protein levels (β = 0.530, P < .001) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (β = 0.613, P < .001). Plasma TnT and NT-proBNP levels during hospitalization (median [interquartile range (IQR)], 0.307 [0.094-0.600]; 1902.00 [728.35-8100.00]) and impending death (median [IQR], 0.141 [0.058-0.860]; 5375 [1179.50-25695.25]) increased significantly compared with admission values (median [IQR], 0.0355 [0.015-0.102]; 796.90 [401.93-1742.25]) in patients who died (P = .001; P < .001), while no significant dynamic changes of TnT (median [IQR], 0.010 [0.007-0.019]; 0.013 [0.007-0.022]; 0.011 [0.007-0.016]) and NT-proBNP (median [IQR], 352.20 [174.70-636.70]; 433.80 [155.80-1272.60]; 145.40 [63.4-526.50]) was observed in survivors (P = .96; P = .16). During hospitalization, patients with elevated TnT levels had more frequent malignant arrhythmias, and the use of glucocorticoid therapy (37 [71.2%] vs 69 [51.1%]) and mechanical ventilation (31 [59.6%] vs 14 [10.4%]) were higher compared with patients with normal TnT levels. The mortality rates of patients with and without use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 36.8% (7 of 19) and 21.4% (36 of 168) (P = .13).. Myocardial injury is significantly associated with fatal outcome of COVID-19, while the prognosis of patients with underlying CVD but without myocardial injury is relatively favorable. Myocardial injury is associated with cardiac dysfunction and arrhythmias. Inflammation may be a potential mechanism for myocardial injury. Aggressive treatment may be considered for patients at high risk of myocardial injury.

Topics: Adult; Aged; Betacoronavirus; Cardiovascular Diseases; China; Coronavirus Infections; COVID-19; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; Retrospective Studies; Risk Factors; SARS-CoV-2; Survival Rate; Troponin T

An outbreak of severe acute respiratory syndrome novel coronavirus (SARS-CoV-2) epidemic spreads rapidly worldwide. SARS-CoV-2 infection caused mildly to seriously and fatally respiratory, enteric, cardiovascular, and neurological diseases. In this study, we detected and analyzed the main laboratory indicators related to heart injury, creatine kinase isoenzyme-MB (CK-MB), myohemoglobin (MYO), cardiac troponin I (ultra-TnI), and N-terminal pro-brain natriuretic peptide (NT-proBNP), in 273 patients with COVID-19 and investigated the correlation between heart injury and severity of the disease. It was found that higher concentration in venous blood of CK-MB, MYO, ultra-TnI, and NT-proBNP were associated with the severity and case fatality rate of COVID-19. Careful monitoring of the myocardiac enzyme profiles is of great importance in reducing the complications and mortality in patients with COVID-19.

Topics: Adult; Aged; Betacoronavirus; Biomarkers; China; Coronavirus Infections; COVID-19; Creatine Kinase, MB Form; Female; Heart Injuries; Hospitals; Humans; Male; Middle Aged; Myoglobin; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; Retrospective Studies; SARS-CoV-2; Severity of Illness Index; Survival Analysis; Troponin I

The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China has been declared a public health emergency of international concern. The cardiac injury is a common condition among the hospitalized patients with COVID-19. However, whether N terminal pro B type natriuretic peptide (NT-proBNP) predicted outcome of severe COVID-19 patients was unknown.. The study initially enrolled 102 patients with severe COVID-19 from a continuous sample. After screening out the ineligible cases, 54 patients were analyzed in this study. The primary outcome was in-hospital death defined as the case fatality rate. Research information and following-up data were obtained from their medical records.. The best cut-off value of NT-proBNP for predicting in-hospital death was 88.64 pg/mL with the sensitivity for 100% and the specificity for 66.67%. Patients with high NT-proBNP values (> 88.64 pg/mL) had a significantly increased risk of death during the days of following-up compared with those with low values (≤88.64 pg/mL). After adjustment for potential risk factors, NT-proBNP was independently correlated with in-hospital death.. NT-proBNP might be an independent risk factor for in-hospital death in patients with severe COVID-19.. ClinicalTrials, NCT04292964. Registered 03 March 2020.

Topics: Adult; Aged; Betacoronavirus; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Female; Hospital Mortality; Humans; Male; Middle Aged; Mortality; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; Predictive Value of Tests; Prognosis; Reference Values; Retrospective Studies; Risk Factors; SARS-CoV-2

Topics: Betacoronavirus; Cardiovascular Diseases; Coronavirus Infections; COVID-19; HIV Infections; Humans; Natriuretic Peptide, Brain; Pandemics; Pneumonia, Viral; SARS-CoV-2

We sought to explore the prevalence and immediate clinical implications of acute myocardial injury in a cohort of patients with COVID-19 in a region of China where medical resources are less stressed than in Wuhan (the epicentre of the pandemic).. We prospectively assessed the medical records, laboratory results, chest CT images and use of medication in a cohort of patients presenting to two designated covid-19 treatment centres in Sichuan, China. Outcomes of interest included death, admission to an intensive care unit (ICU), need for mechanical ventilation, treatment with vasoactive agents and classification of disease severity. Acute myocardial injury was defined by a value of high-sensitivity troponin T (hs-TnT) greater than the normal upper limit.. A total of 101 cases were enrolled from January to 10 March 2020 (average age 49 years, IQR 34-62 years). Acute myocardial injury was present in 15.8% of patients, nearly half of whom had a hs-TnT value fivefold greater than the normal upper limit. Patients with acute myocardial injury were older, with a higher prevalence of pre-existing cardiovascular disease and more likely to require ICU admission (62.5% vs 24.7%, p=0.003), mechanical ventilation (43.5% vs 4.7%, p<0.001) and treatment with vasoactive agents (31.2% vs 0%, p<0.001). Log hs-TnT was associated with disease severity (OR 6.63, 95% CI 2.24 to 19.65), and all of the three deaths occurred in patients with acute myocardial injury.. Acute myocardial injury is common in patients with COVID-19 and is associated with adverse prognosis.

Topics: Adult; Age Factors; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Betacoronavirus; Biomarkers; C-Reactive Protein; Cardiovascular Agents; China; Cohort Studies; Coronavirus Infections; COVID-19; Glomerular Filtration Rate; Humans; Intensive Care Units; Middle Aged; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; Prognosis; SARS-CoV-2; Severity of Illness Index; Troponin T

To compare demographic characteristics, clinical presentation, and outcomes of patients with and without concomitant cardiac disease, hospitalized for COVID-19 in Brescia, Lombardy, Italy.. The study population includes 99 consecutive patients with COVID-19 pneumonia admitted to our hospital between 4 March and 25 March 2020. Fifty-three patients with a history of cardiac disease were compared with 46 without cardiac disease. Among cardiac patients, 40% had a history of heart failure, 36% had atrial fibrillation, and 30% had coronary artery disease. Mean age was 67 ± 12 years, and 80 (81%) patients were males. No differences were found between cardiac and non-cardiac patients except for higher values of serum creatinine, N-terminal probrain natriuretic peptide, and high sensitivity troponin T in cardiac patients. During hospitalization, 26% patients died, 15% developed thrombo-embolic events, 19% had acute respiratory distress syndrome, and 6% had septic shock. Mortality was higher in patients with cardiac disease compared with the others (36% vs. 15%, log-rank P = 0.019; relative risk 2.35; 95% confidence interval 1.08-5.09). The rate of thrombo-embolic events and septic shock during the hospitalization was also higher in cardiac patients (23% vs. 6% and 11% vs. 0%, respectively).. Hospitalized patients with concomitant cardiac disease and COVID-19 have an extremely poor prognosis compared with subjects without a history of cardiac disease, with higher mortality, thrombo-embolic events, and septic shock rates.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Betacoronavirus; Coronavirus Infections; COVID-19; Creatinine; Female; Heart Diseases; Heart Failure; Hospitalization; Humans; Italy; Male; Middle Aged; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; Prognosis; Respiratory Distress Syndrome; Risk Factors; SARS-CoV-2; Shock, Septic; Thromboembolism; Troponin T

To describe the clinical profiles and risk factors for critical illness in hospitalized children and adolescents with coronavirus disease 2019 (COVID-19).. Children 1 month to 21 years of age with COVID-19 from a single tertiary care children's hospital between March 15 and April 13, 2020 were included. Demographic and clinical data were collected.. In total, 67 children tested positive for COVID-19; 21 (31.3%) were managed as outpatients. Of 46 admitted patients, 33 (72%) were admitted to the general pediatric medical unit and 13 (28%) to the pediatric intensive care unit (PICU). Obesity and asthma were highly prevalent but not significantly associated with PICU admission (P = .99). Admission to the PICU was significantly associated with higher C-reactive protein, procalcitonin, and pro-B type natriuretic peptide levels and platelet counts (P < .05 for all). Patients in the PICU were more likely to require high-flow nasal cannula (P = .0001) and were more likely to have received Remdesivir through compassionate release (P < .05). Severe sepsis and septic shock syndromes were observed in 7 (53.8%) patients in the PICU. Acute respiratory distress syndrome was observed in 10 (77%) PICU patients, 6 of whom (46.2%) required invasive mechanical ventilation for a median of 9 days. Of the 13 patients in the PICU, 8 (61.5%) were discharged home, and 4 (30.7%) patients remain hospitalized on ventilatory support at day 14. One patient died after withdrawal of life-sustaining therapy because of metastatic cancer.. We describe a higher than previously recognized rate of severe disease requiring PICU admission in pediatric patients admitted to the hospital with COVID-19.

Topics: Adenosine Monophosphate; Adolescent; Alanine; Antiviral Agents; Asthma; Betacoronavirus; Blood Urea Nitrogen; C-Reactive Protein; Child; Child, Preschool; Coronavirus Infections; COVID-19; Creatinine; Critical Illness; Dyspnea; Female; Hospitalization; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Intensive Care Units, Pediatric; Male; Natriuretic Peptide, Brain; New York City; Pandemics; Pediatric Obesity; Platelet Count; Pneumonia, Viral; Procalcitonin; Respiration, Artificial; Retrospective Studies; SARS-CoV-2; Sepsis; Shock, Septic; Tertiary Care Centers; Young Adult

Topics: Betacoronavirus; C-Reactive Protein; Coronavirus Infections; COVID-19; Cytokine Release Syndrome; Endothelium, Vascular; Humans; Interleukin-1; Macrophage Activation; Multiple Organ Failure; Myocardial Ischemia; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; SARS-CoV-2; Troponin I

Current pandemic caused by SARS-CoV-2 inducing viral COVID-19 pneumonia, is categorized in 3 stages. Some biomarkers could be assigned to one of these stages, showing a correlation to mortality in COVID-19 patients. Laboratory findings in COVID-19, especially when serially evaluated, may represent individual disease severity and prognosis. These may help planning and controlling therapeutic interventions. Biomarkers for myocardial injury (high sensitive cardiac troponin, hsTn) or hemodynamic stress (NTproBNP) may occur in COVID-19 pneumonia such as in other pneumonias, correlating with severity and prognosis of the underlying disease. In hospitalized COVID-19 patients' mild increases of hsTn or NTproBNP may be explained by cardiovascular comorbidities and direct or indirect cardiac damage or stress caused by or during COVID-19 pneumonia. In case of suspected NSTE-ACS and COVID-19, indications for echocardiography or reperfusion strategy should be carefully considered against the risk of contamination.. PHäNOTYPISIERUNG UND RISIKOSTRATIFIZIERUNG BEI COVID-19: Die aktuelle COVID-19-Erkrankung verläuft in 3 Stadien. Einige Serum-Biomarker können einem der 3 Stadien zugeordnet werden und es besteht ein Zusammenhang mit der Mortalität. Laborwerte können insbesondere bei serieller Erfassung helfen, Aussagen zur Schwere der Erkrankung und Prognose zu liefern. In Zukunft könnten diese dann ggf. zur Steuerung der Therapie genutzt werden. COVID-19-KARDIOVASKULäRE ERKRANKUNGEN UND MYOKARDSCHADEN:  Biomarker von Myokardschaden (high-sensitives kardiales Troponin, hs-cTn) oder hämodynamischem Stress (NT-proBNP) können bei COVID-19, wie bei anderen Pneumonien, auftreten und korrelieren mit der Schwere und Prognose der Grunderkrankung. Bei hospitalisierten Patienten mit COVID-19 erklären sich milde Erhöhungen von hs-cTn oder NT-proBNP durch deren kardiovaskuläre Komorbidität und durch die direkte oder indirekte akute Herzschädigung bzw. den Stress durch und während der COVID-19-Pneumonie. Bei gegebenem Verdacht auf einen Nicht-ST-Hebungsinfarkt und COVID-19 sollte eine sorgfältige Abwägung der Indikation für eine Echokardiografie und invasive Diagnostik gegen das Risiko der Kontamination abgewogen werden.

Topics: Adult; Biomarkers; Cardiomyopathies; Comorbidity; Coronavirus Infections; COVID-19; Humans; Male; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Phenotype; Pneumonia, Viral; Risk; Troponin C

A 17-year-old obese male was admitted to the pediatric intensive care unit after presenting with fluid-responsive septic shock following 7 days of fever, gastrointestinal symptoms and neck pain. Initial workup was positive for SARS-CoV-2 and elevated troponin I and brain natriuretic peptide. Echocardiography and cardiac magnetic resonance imaging confirmed acute myocarditis. One week after discharge, repeat echocardiogram demonstrated improved heart function with only residual myocardial dysfunction.

Topics: Adolescent; Betacoronavirus; Coronavirus Infections; COVID-19; Echocardiography; Heart; Humans; Intensive Care Units; Magnetic Resonance Imaging; Male; Myocarditis; Natriuretic Peptide, Brain; New York City; Pandemics; Pneumonia, Viral; SARS-CoV-2; Shock, Septic

To assess clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2-associated multisystem inflammatory syndrome in children (MIS-C).. Children with MIS-C admitted to pediatric intensive care units in New York City between April 23 and May 23, 2020, were included. Demographic and clinical data were collected.. Of 33 children with MIS-C, the median age was 10 years; 61% were male; 45% were Hispanic/Latino; and 39% were black. Comorbidities were present in 45%. Fever (93%) and vomiting (69%) were the most common presenting symptoms. Depressed left ventricular ejection fraction was found in 63% of patients with median ejection fraction of 46.6% (IQR, 39.5-52.8). C-reactive protein, procalcitonin, d-dimer, and pro-B-type natriuretic peptide levels were elevated in all patients. For treatment, intravenous immunoglobulin was used in 18 (54%), corticosteroids in 17 (51%), tocilizumab in 12 (36%), remdesivir in 7 (21%), vasopressors in 17 (51%), mechanical ventilation in 5 (15%), extracorporeal membrane oxygenation in 1 (3%), and intra-aortic balloon pump in 1 (3%). The left ventricular ejection fraction normalized in 95% of those with a depressed ejection fraction. All patients were discharged home with median duration of pediatric intensive care unit stay of 4.7 days (IQR, 4-8 days) and a hospital stay of 7.8 days (IQR, 6.0-10.1 days). One patient (3%) died after withdrawal of care secondary to stroke while on extracorporeal membrane oxygenation.. Critically ill children with coronavirus disease-2019-associated MIS-C have a spectrum of severity broader than described previously but still require careful supportive intensive care. Rapid, complete clinical and myocardial recovery was almost universal.

Topics: Adolescent; Betacoronavirus; C-Reactive Protein; Child; Child, Preschool; Coronavirus Infections; COVID-19; COVID-19 Drug Treatment; Female; Fibrin Fibrinogen Degradation Products; Humans; Infant; Intensive Care Units, Pediatric; Male; Natriuretic Peptide, Brain; New York City; Pandemics; Pneumonia, Viral; Procalcitonin; Retrospective Studies; SARS-CoV-2; Systemic Inflammatory Response Syndrome; Treatment Outcome; Ventricular Function, Left; Young Adult

The prognostic power of circulating cardiac biomarkers, their utility, and pattern of release in coronavirus disease 2019 (COVID-19) patients have not been clearly defined. In this multicentered retrospective study, we enrolled 3219 patients with diagnosed COVID-19 admitted to 9 hospitals from December 31, 2019 to March 4, 2020, to estimate the associations and prognostic power of circulating cardiac injury markers with the poor outcomes of COVID-19. In the mixed-effects Cox model, after adjusting for age, sex, and comorbidities, the adjusted hazard ratio of 28-day mortality for hs-cTnI (high-sensitivity cardiac troponin I) was 7.12 ([95% CI, 4.60-11.03]

Topics: Betacoronavirus; Biomarkers; China; Coronavirus Infections; COVID-19; Creatine Kinase, MB Form; Female; Heart Diseases; Hospitalization; Humans; Male; Middle Aged; Mortality; Natriuretic Peptide, Brain; Outcome Assessment, Health Care; Pandemics; Peptide Fragments; Pneumonia, Viral; Predictive Value of Tests; Prognosis; Retrospective Studies; SARS-CoV-2; Troponin I

Topics: Adult; Aged; Autopsy; Betacoronavirus; Biomarkers; Cardiovascular Diseases; Cell Death; Comorbidity; Coronavirus Infections; COVID-19; Diabetes Mellitus; Endothelium; Female; Heart; Humans; Lymphopenia; Male; Microscopy, Electron; Middle Aged; Muscle Cells; Myocarditis; Myocardium; Natriuretic Peptide, Brain; Obesity; Pandemics; Pneumonia, Viral; Renal Insufficiency, Chronic; SARS-CoV-2; Troponin I

Topics: Adolescent; Adult; Asymptomatic Infections; Betacoronavirus; C-Reactive Protein; Chest Pain; Coronavirus Infections; COVID-19; Edema; Female; Ferritins; Fibrin Fibrinogen Degradation Products; Humans; Magnetic Resonance Imaging; Magnetic Resonance Imaging, Cine; Male; Myocarditis; Natriuretic Peptide, Brain; Pandemics; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Puerperal Disorders; SARS-CoV-2; Troponin I; Troponin T

Topics: Aged; Betacoronavirus; C-Reactive Protein; Coronavirus Infections; COVID-19; Critical Illness; Echocardiography; Female; Ferritins; Heart; Humans; Male; Middle Aged; Myocardial Contraction; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pericardial Effusion; Pneumonia, Viral; Respiratory Distress Syndrome; SARS-CoV-2; Stroke Volume; Troponin T; Ventricular Dysfunction, Left

Risk stratification is crucial to optimise treatment strategies in patients with COVID-19. We aimed to evaluate the impact on mortality of an early assessment of cardiac biomarkers in patients with COVID-19.. Humanitas Clinical and Research Hospital (Rozzano-Milan, Lombardy, Italy) is a tertiary centre that has been converted to the management of COVID-19. Patients with confirmed COVID-19 were entered in a dedicated database for cohort observational analyses. Outcomes were stratified according to elevated levels (ie, above the upper level of normal) of high-sensitivity cardiac troponin I (hs-TnI), B-type natriuretic peptide (BNP) or both measured within 24 hours after hospital admission. The primary outcome was all-cause mortality.. A total of 397 consecutive patients with COVID-19 were included up to 1 April 2020. At the time of hospital admission, 208 patients (52.4%) had normal values for cardiac biomarkers, 90 (22.7%) had elevated both hs-TnI and BNP, 59 (14.9%) had elevated only BNP and 40 (10.1%) had elevated only hs-TnI. The rate of mortality was higher in patients with elevated hs-TnI (22.5%, OR 4.35, 95% CI 1.72 to 11.04), BNP (33.9%, OR 7.37, 95% CI 3.53 to 16.75) or both (55.6%, OR 18.75, 95% CI 9.32 to 37.71) as compared with those without elevated cardiac biomarkers (6.25%). A multivariate analysis identified concomitant elevation of both hs-TnI and BNP as a strong independent predictor of all-cause mortality (OR 3.24, 95% CI 1.06 to 9.93).. An early detection of elevated hs-TnI and BNP predicts mortality in patients with COVID-19. Cardiac biomarkers should be systematically assessed in patients with COVID-19 at the time of hospital admission in order to optimise risk stratification.

Topics: Aged; Aged, 80 and over; Betacoronavirus; Biomarkers; Cardiovascular Diseases; Coronavirus Infections; COVID-19; Early Diagnosis; Female; Hospitalization; Humans; Italy; Male; Middle Aged; Natriuretic Peptide, Brain; Pandemics; Pneumonia, Viral; Predictive Value of Tests; Retrospective Studies; Risk Assessment; SARS-CoV-2; Troponin I

A new virus broke out in Wuhan, Hubei, China, that was later named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical characteristics of severe pneumonia caused by SARS-CoV-2 are still not clear.. The aim of this study was to explore the clinical characteristics and risk factors of severe pneumonia caused by the SARS-CoV-2 in Wuhan, China.. The study included patients hospitalized at the Central Hospital of Wuhan who were diagnosed with COVID-19. Clinical features, chronic comorbidities, demographic data, laboratory examinations, and chest computed tomography (CT) scans were reviewed through electronic medical records. SPSS was used for data analysis to explore the clinical characteristics and risk factors of patients with severe pneumonia caused by SARS-CoV-2.. A total of 110 patients diagnosed with COVID-19 were included in the study, including 38 with severe pneumonia and 72 with nonsevere pneumonia. Statistical analysis showed that advanced age, increased D-Dimer, and decreased lymphocytes were characteristics of the patients with severe pneumonia. Moreover, in the early stage of the disease, chest CT scans of patients with severe pneumonia showed that the illness can progress rapidly.. Advanced age, decreased lymphocytes, and D-Dimer elevation are important characteristics of patients with severe COVID-19. Clinicians should focus on these characteristics to identify high-risk patients at an early stage.

Topics: Adult; Age Factors; APACHE; Betacoronavirus; C-Reactive Protein; China; Comorbidity; Coronavirus Infections; Cough; COVID-19; Disease Progression; Dyspnea; Fatigue; Female; Fever; Fibrin Fibrinogen Degradation Products; Humans; Hypertension; Lung; Lymphocyte Count; Male; Middle Aged; Natriuretic Peptide, Brain; Organ Dysfunction Scores; Pandemics; Pneumonia, Viral; Procalcitonin; Pulmonary Disease, Chronic Obstructive; Respiratory Distress Syndrome; Risk Assessment; SARS-CoV-2; Serum Albumin; Severity of Illness Index; Sex Factors; Tomography, X-Ray Computed

Topics: Arterial Occlusive Diseases; Asthma; Betacoronavirus; Catheterization; Computed Tomography Angiography; Coronavirus Infections; COVID-19; Extracorporeal Membrane Oxygenation; Fibrin Fibrinogen Degradation Products; Fibrinolytic Agents; Heparin; Humans; Lung; Natriuretic Peptide, Brain; Pandemics; Pneumonia, Viral; Pulmonary Artery; Respiration, Artificial; SARS-CoV-2; Thrombolytic Therapy; Thrombosis; Tissue Plasminogen Activator; Ventricular Dysfunction, Right

During the COVID-19 pandemic, non-urgent outpatient activities were temporarily suspended. The aim of this study was to assess the impact of this measure on the management of the heart failure outpatient clinic at our institution.. We analyzed the clinical outcome of 110 chronic heart failure patients (mean age 73 ± 9 years) whose follow-up visit had been delayed.. At their last visit before the lockdown, 80.9% was in NYHA class II, had an ejection fraction of 37 ± 7%, and B-type natriuretic peptide level was moderately elevated (266 ± 138 pg/ml). All patients received loop diuretics, 97.2% beta-blockers, 64.9% an aldosterone antagonist, 60.9% sacubitril/valsartan (S/V), and 72.2% of the remaining patients were on angiotensin-converting enzyme inhibitor or valsartan therapy. Patients were contacted by phone during and at the end of the lockdown period to fix a new appointment and underwent a structured interview to assess their clinical conditions and ongoing therapy and to verify whether they had contracted SARS-CoV-2 infection. Twelve patients (13.2%) contracted COVID-19. None was hospitalized for worsening heart failure or reported defibrillator shocks and none changed autonomously the prescribed therapy. Overall, 75% of patients reported stable or improved general well-being from the last in-person visit, while 25% described subjective worsening due to the social effect of the pandemic. Unchanged body weight and blood pressure values were reported by 86% and 78.4% of patients, respectively. Lower blood pressure values compared to baseline were recorded in 15.2% of patients on conventional renin-angiotensin system inhibition vs 21% of those on S/V, one of whom had to down-titrate S/V for persistent but asymptomatic hypotension; 4 patients up-titrated S/V to 200 mg/day following phone indications.. Cancellation of scheduled follow-up visits during 3 months did not have significant negative effects in a cohort of stable patients with chronic heart failure on optimized medical therapy. Telephone support was effective in keeping connections with the patients during the lockdown, allowing appropriate management and implementation of drug therapy. In particular, patients who received S/V were not affected by delays in scheduled visits, confirming the tolerability and safety of this novel therapy in terms of both clinical and biohumoral parameters.

Topics: Adrenergic beta-Antagonists; Aged; Ambulatory Care Facilities; Aminobutyrates; Angiotensin-Converting Enzyme Inhibitors; Betacoronavirus; Biphenyl Compounds; Chronic Disease; Continuity of Patient Care; Coronavirus Infections; COVID-19; Delivery of Health Care; Disease Progression; Drug Combinations; Female; Heart Failure; Humans; Italy; Male; Mineralocorticoid Receptor Antagonists; Natriuretic Peptide, Brain; Pandemics; Pneumonia, Viral; Quarantine; Recurrence; SARS-CoV-2; Sodium Potassium Chloride Symporter Inhibitors; Stroke Volume; Telephone; Tetrazoles; Valsartan; Withholding Treatment

Topics: Betacoronavirus; Biomarkers; Child; Coronavirus Infections; COVID-19; Heart Diseases; Heart Failure; Humans; Infant, Newborn; Mucocutaneous Lymph Node Syndrome; Natriuretic Peptide, Brain; Neoplasms; Pandemics; Peptide Fragments; Pneumonia, Viral; Renal Insufficiency, Chronic; SARS-CoV-2; Troponin I; Troponin T; Virus Diseases

The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has spread worldwide. Cardiac injury after SARS-CoV-2 infection is a major concern. The present study investigated impact of the biomarkers indicating cardiac injury in coronavirus disease 2019 (COVID-19) on patients' outcomes.. This study enrolled patients who were confirmed to have COVID-19 and admitted at a tertiary university referral hospital between February 19, 2020 and March 15, 2020. Cardiac injury was defined as an abnormality in one of the following result markers: 1) myocardial damage marker (creatine kinase-MB or troponin-I), 2) heart failure marker (N-terminal-pro B-type natriuretic peptide), and 3) electrical abnormality marker (electrocardiography). The relationship between each cardiac injury marker and mortality was evaluated. Survival analysis of mortality according to the scoring by numbers of cardiac injury markers was also performed.. A total of 38 patients with COVID-19 were enrolled. Twenty-two patients (57.9%) had at least one of cardiac injury markers. The patients with cardiac injuries were older (69.6 ± 14.9 vs. 58.6 ± 13.9 years old,. The increased number of cardiac injury markers is related to in-hospital mortality in patients with COVID-19.

Topics: Age Factors; Aged; Aged, 80 and over; Betacoronavirus; Coronavirus Infections; COVID-19; Creatine Kinase, MB Form; Electrocardiography; Female; Heart Injuries; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardium; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; SARS-CoV-2; Sex Factors; Tertiary Care Centers; Troponin I

COVID-19 causes severe pulmonary involvement, but the cardiovascular system can also be affected by myocarditis, heart failure and shock. The increase in cardiac biomarkers has been associated with a worse prognosis.. To evaluate the prognostic value of Troponin-T (TNT) and natriuretic peptide (BNP) in patients hospitalized for Covid-19.. This was a convenience sample of patients hospitalized for COVID-19. Data were collected from medical records to assess the association of TnT and BNP measured in the first 24 hours of hospital admission with the combined outcome (CO) of death or need for mechanical ventilation. Univariate analysis was used to compare the groups with and without the CO. Cox's multivariate model was used to determine independent predictors of the CO.. We evaluated 183 patients (age = 66.8±17 years, 65.6% of which were males). The time of follow-up was 7 days (range 1 to 39 days). The CO occurred in 24% of the patients. The median troponin-T and BNP levels were 0.011 and 0.041ng/dL (p <0.001); 64 and 198 pg/dL (p <0.001), respectively, for the groups without and with the CO. In the univariate analysis, in addition to TnT and BNP, age, presence of coronary disease, oxygen saturation, lymphocytes, D-dimer, t-CRP and creatinine, were different between groups with and without outcomes. In the bootstrap multivariate analysis, only TnT (1.12 [95% CI 1.03-1.47]) and t-CRP (1.04 [95% CI 1.00-1.10]) were independent predictors of the CO.. In the first 24h of admission, TnT, but not BNP, was an independent marker of mortality or need for invasive mechanical ventilation. This finding further reinforces the clinical importance of cardiac involvement in COVID-19. (Arq Bras Cardiol. 2020; 115(4):660-666).. A COVID-19 causa grave acometimento pulmonar, porém o sistema cardiovascular também pode ser afetado por miocardite, insuficiência cardíaca e choque. A elevação de biomarcadores cardíacos tem sido associada a um pior prognóstico.. Avaliar o valor prognóstico da Troponina T (TnT) e do peptídeo natriurético tipo B (BNP) em pacientes internados por Covid-19.. Amostra de conveniência de pacientes hospitalizados por COVID-19. Foram coletados dados dos prontuários com o objetivo de avaliar a relação da TnT e o BNP medidos nas primeiras 24h de admissão com o desfecho combinado (DC) óbito ou necessidade de ventilação mecânica. Análise univariada comparou os grupos com e sem DC. Modelo multivariado de Cox foi utilizada para determinar preditores independentes do DC.. Avaliamos 183 pacientes (idade=66,8±17 anos, sendo 65,6% do sexo masculino). Tempo de acompanhamento foi de 7 dias (1 a 39 dias). O DC ocorreu em 24% dos pacientes. As medianas de TnT e BNP foram 0,011 e 0,041 ng/dl (p<0,001); 64 e 198 pg/dl (p<0,001) respectivamente para os grupos sem e com DC. Na análise univariada, além de TnT e BNP, idade, presença de doença coronariana, saturação de oxigênio, linfócitos, dímero-D, proteína C reativa titulada (PCR-t) e creatinina, foram diferentes entre os grupos com e sem desfechos. Na análise multivariada boostraped apenas TnT (1,12[IC95%1,03-1,47]) e PCR-t (1,04[IC95%1,00-1,10]) foram preditores independentes do DC.. Nas primeiras 24h de admissão, TnT, mas não o BNP, foi marcador independente de mortalidade ou necessidade de ventilação mecânica invasiva. Este dado reforça ainda mais a importância clínica do acometimento cardíaco da COVID-19. (AArq Bras Cardiol. 2020; 115(4):660-666).

Topics: Aged; Aged, 80 and over; Betacoronavirus; Biomarkers; Cardiovascular System; Coronavirus Infections; COVID-19; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Pandemics; Pneumonia, Viral; Prognosis; SARS-CoV-2; Troponin T

Topics: Aftercare; Betacoronavirus; Comorbidity; Convalescence; Coronavirus Infections; COVID-19; Echocardiography; Electrocardiography; General Practice; Heart Diseases; Humans; Magnetic Resonance Imaging, Cine; Natriuretic Peptide, Brain; Pandemics; Patient Acuity; Peptide Fragments; Pneumonia, Viral; Recovery of Function; SARS-CoV-2; Symptom Assessment; Troponin

Coronavirus disease 2019 (COVID-19) has become a global pandemic. Studies showed COVID-19 affected not only the lung but also other organs. In this study, we aimed to explore the cardiac damage in patients with COVID-19.. We collected data of 100 patients diagnosed as severe type of COVID-19 from February 8 to April 10, 2020, including demographics, illness history, physical examination, laboratory test, and treatment. In-hospital mortality were observed. Cardiac damage was defined as plasma hypersensitive troponin I (hsTnI) over 34.2 pg/ml and/or N-terminal-pro brain natriuretic peptide (NTproBNP) above 450 pg/ml at the age < 50, above 900 pg/ml at the age < 75, or above 1800 pg/ml at the age ≥ 75.. The median age of the patients was 62.0 years old. 69 (69.0%) had comorbidities, mainly presenting hypertension, diabetes, and cardiovascular disease. Fever (69 [69.0%]), cough (63 [63.0%]), chest distress (13 [13.0%]), and fatigue (12 [12.0%]) were the common initial symptoms. Cardiac damage occurred in 25 patients. In the subgroups, hsTnI was significantly higher in elder patients (≥ 60 years) than in the young (median [IQR], 5.2 [2.2-12.8] vs. 1.9 [1.9-6.2], p = 0.018) and was higher in men than in women (4.2 [1.9-12.8] vs. 2.9 [1.9-7.4], p = 0.018). The prevalence of increased NTproBNP was significantly higher in men than in women (32.1% vs. 9.1%, p = 0.006), but was similar between the elder and young patients (20.0% vs. 25.0%, p = 0.554). After multivariable analysis, male and hypertension were the risk factors of cardiac damage. The mortality was 4.0%.. Cardiac damage exists in patients with the severe type of COVID-19, especially in male patients with hypertension. Clinicians should pay more attention to cardiac damage.

Topics: Age Factors; Aged; Biomarkers; China; Comorbidity; Coronavirus Infections; COVID-19; Female; Heart Diseases; Hospital Mortality; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Sex Factors; Troponin I