Impaired cardiac function is associated with mortality in patients with acute COVID-19 infection
Tóm tắt
COVID-19 infection may cause severe respiratory distress and is associated with increased morbidity and mortality. Impaired cardiac function and/or pre-existing cardiovascular disease may be associated with poor prognosis. In the present study, we report a comprehensive cardiovascular characterization in the first consecutive collective of patients that was admitted and treated at the University Hospital of Tübingen, Germany. 123 consecutive patients with COVID-19 were included. Routine blood sampling, transthoracic echocardiography and electrocardiography were performed at hospital admission. We found that impaired left-ventricular and right-ventricular function as well as tricuspid regurgitation > grade 1 were significantly associated with higher mortality. Furthermore, elevated levels of myocardial distress markers (troponin-I and NT pro-BNP) were associated with poor prognosis in this patient collective. Impaired cardiac function is associated with poor prognosis in COVID-19 positive patients. Consequently, treatment of these patients should include careful guideline-conform cardiovascular evaluation and treatment. Thus, formation of a competent Cardio-COVID-19 team may represent a major clinical measure to optimize therapy of cardiovascular patients during this pandemic.
Tài liệu tham khảo
Mahase E (2020) Coronavirus covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate. BMJ 368:m641. https://doi.org/10.1136/bmj.m641
Zheng YY, Ma YT, Zhang JY, Xie X (2020) COVID-19 and the cardiovascular system. Nat Rev Cardiol 17(5):259–260. https://doi.org/10.1038/s41569-020-0360-5
Bajwa EK, Boyce PD, Januzzi JL, Gong MN, Thompson BT, Christiani DC (2007) Biomarker evidence of myocardial cell injury is associated with mortality in acute respiratory distress syndrome. Crit Care Med 35(11):2484–2490. https://doi.org/10.1097/01.ccm.0000281852.36573.22
Li G, Li H, Lu J (2020) No adequate evidence indicating hypertension as an independent risk factor for COVID-19 severity. Clin Res Cardiol. https://doi.org/10.1007/s00392-020-01653-6
Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, Bi Z, Zhao Y (2020) Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. https://doi.org/10.1007/s00392-020-01626-9
Kobayashi M, Girerd N, Duarte K, Preud'homme G, Pitt B, Rossignol P (2020) Prognostic impact of plasma volume estimated from hemoglobin and hematocrit in heart failure with preserved ejection fraction. Clin Res Cardiol. https://doi.org/10.1007/s00392-020-01639-4
European Society of Cardiology (2020) ESC guidance for the diagnosis and management of CV disease during the COVID-19 pandemic. https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19-Guidance. Accessed 30 Apr 2020
Oren OKS, Gluckman TJ, Gersh BJ, Blumenthal RS (2020) Coronavirus disease 2019 (COVID-19): epidemiology, clinical spectrum and implications for the cardiovascular clinician. https://www.acc.org/latest-in-cardiology/articles/2020/04/06/11/08/covid-19-epidemiology-clinical-spectrum-and-implications-for-the-cv-clinician. Accessed 30 Apr 2020
Lakkireddy DR, Chung MK, Gopinathannair R, Patton KK, Gluckman TJ, Turagam M, Cheung J, Patel P, Sotomonte J, Lampert R, Han JK, Rajagopalan B, Eckhardt L, Joglar J, Sandau K, Olshansky B, Wan E, Noseworthy PA, Leal M, Kaufman E, Gutierrez A, Marine JM, Wang PJ, Russo AM (2020) Guidance for cardiac electrophysiology during the coronavirus (COVID-19) pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2020.03.028
Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, Cani DS, Cerini M, Farina D, Gavazzi E, Maroldi R, Adamo M, Ammirati E, Sinagra G, Lombardi CM, Metra M (2020) Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol. https://doi.org/10.1001/jamacardio.2020.1096
Lippi G, Lavie CJ, Sanchis-Gomar F (2020) Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis. Prog Cardiovasc Dis. https://doi.org/10.1016/j.pcad.2020.03.001
World Medical Association Declaration of Helsinki (1997) Recommendations guiding physicians in biomedical research involving human subjects. Cardiovasc Res 35(1):2–3
ICH Harmonised Tripartite Guideline: Guideline for Good Clinical Practice (2001). J Postgrad Med 47 (3):199–203
Directive 2001/20/EC of the European Parliament and of the Council of 4 April 2001 on the approximation of the laws, regulations and administrative provisions of the member states relating to the implementation of good clinical practice in the conduct of clinical trials on medicinal products for human use (2002). Med Etika Bioet 9(1–2):12–19
Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I et al (1989) Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 2(5):358–367. https://doi.org/10.1016/s0894-7317(89)80014-8
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(1):1–39. https://doi.org/10.1016/j.echo.2014.10.003
Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, Hagendorff A, Monin JL, Badano L, Zamorano JL, European Association of E (2010) European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr 11(4):307–332. https://doi.org/10.1093/ejechocard/jeq031
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM 3rd, Thomas JD, American College of Cardiology/American Heart Association Task Force on Practice G (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63(22):2438–2488. https://doi.org/10.1016/j.jacc.2014.02.537
Lancellotti P, Tribouilloy C, Hagendorff A, Moura L, Popescu BA, Agricola E, Monin JL, Pierard LA, Badano L, Zamorano JL, European Association of E (2010) European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr 11(3):223–244. https://doi.org/10.1093/ejechocard/jeq030
Parasuraman S, Walker S, Loudon BL, Gollop ND, Wilson AM, Lowery C, Frenneaux MP (2016) Assessment of pulmonary artery pressure by echocardiography—a comprehensive review. Int J Cardiol Heart Vasc 12:45–51. https://doi.org/10.1016/j.ijcha.2016.05.011
Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, Gong W, Liu X, Liang J, Zhao Q, Huang H, Yang B, Huang C (2020) Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. https://doi.org/10.1001/jamacardio.2020.0950
Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, Ji R, Wang H, Wang Y, Zhou Y (2020) Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis. https://doi.org/10.1016/j.ijid.2020.03.017
Barnett R (2019) Influenza. Lancet 393(10170):396. https://doi.org/10.1016/S0140-6736(19)30148-5
Ikonomidis I, Pavlidis G, Katsimbri P, Andreadou I, Triantafyllidi H, Tsoumani M, Varoudi M, Vlastos D, Makavos G, Kostelli G, Betaenas D, Lekakis J, Parissis J, Boumpas D, Alexopoulos D, Iliodromitis E (2019) Differential effects of inhibition of interleukin 1 and 6 on myocardial, coronary and vascular function. Clin Res Cardiol 108(10):1093–1101. https://doi.org/10.1007/s00392-019-01443-9
Solaimanzadeh I (2020) Acetazolamide, nifedipine and phosphodiesterase inhibitors: rationale for their utilization as adjunctive countermeasures in the treatment of coronavirus disease 2019 (COVID-19). Cureus 12(3):e7343. https://doi.org/10.7759/cureus.7343
Deng Q, Hu B, Zhang Y, Wang H, Zhou X, Hu W, Cheng Y, Yan J, Ping H, Zhou Q (2020) Suspected myocardial injury in patients with COVID-19: evidence from front-line clinical observation in Wuhan, China. Int J Cardiol. https://doi.org/10.1016/j.ijcard.2020.03.087