Impaired Myocardial Function Is Prognostic for Severe Respiratory Failure in the Course of COVID-19 Infection

Petersen-Uribe, Álvaro; Avdiu, Alban; Martus, Peter; Witzel, Katja; Jaeger, Philippa; Zdanytė, Monika; Heinzmann, David; Tavlaki, Elli; Warm, Verena; Geisler, Tobias; Müller, K.; Gawaz, Meinrad; Rath, Dominik

doi:10.3389/fcvm.2021.584108

Cited by 7 publications

(8 citation statements)

References 28 publications

(23 reference statements)

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“…A study by Covino et al showed, however, that in patients aged ≥ 80 years and severe dementia were associated with poor outcome rather than increasing age itself. We and others have previously shown, that impaired myocardial function and elevated concentrations of cardiac biomarkers are associated with worse prognosis in COVID-19 [6 – 8] . SARS-CoV-2 promotes a pro-coagulant environment by inducing platelet activation and inhibiting fibrinolysis [9 – 12] , leading to thromboembolic complications including deep vein thrombosis, pulmonary embolism and myocardial infarction.…”

Section: Introductionmentioning

confidence: 72%

“…We have previously shown that elevated PAPsys, most probably due to elevated pulmonary vascular resistance, caused by alveolar and vascular damage, leads to RV-distress in COVID-19. Consequently, elevated cardiac biomarkers are common findings in these patients [7 , 8] . On the contrary, LV-dysfunction is more common in influenza, confirming the findings by Erden et al [21] .…”

Section: Discussionmentioning

confidence: 99%

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COVID-19 versus seasonal influenza: myocardial injury and prognostic importance

et al. 2022

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Background Acute myocardial injury is associated with poor prognosis in respiratory tract infections. We aimed to highlight the differences in prevalence of myocardial injury and its impact on prognosis in patients with COVID-19 compared to those with seasonal influenza. Methods This was a single-center prospective cohort study with a historical control group. 300 age-/sex-matched SARS-CoV-2 and seasonal influenza positive patients were enrolled. Myocardial injury was assessed by electrocardiogram (ECG), transthoracic echocardiography and biomarkers including high-sensitivity troponin-I. All patients were followed-up for 30 days after enrollment for all-cause mortalitiy, admission to the intensive care unit (ICU) and mechanical ventilation. Results Right ventricular distress was more common in COVID-19 whereas pathological ECG findings and impaired left ventricular function were more prevalent among influenza patients. COVID-19 patients suffered from a higher percentage of hypertension and dyslipidaemia. Contrary to COVID-19, pericardial effusion at admission was associated with poor outcome in the influenza group. Severe course of disease and respiratory failure resulted in significantly higher rates of ICU treatment and mechanical ventilation in COVID-19 patients. Although distribution of myocardial injury was similar, significantly fewer cardiac catheterizations were performed in COVID-19 patients. However, number of cardiac catheterizations was low in both groups. Finally, 30-day mortality was significantly higher in COVID-19 compared to influenza patients. Conclusions In adults requiring hospitalization due to COVID-19 or seasonal influenza, cardiovascular risk factors and signs of myocardial distress differ significantly. Furthermore, cardiovascular comorbidities may impair prognosis in COVID-19 patients to a higher degree than in their influenza counterparts.

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Section: Introductionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

COVID-19 versus seasonal influenza: myocardial injury and prognostic importance

et al. 2022

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“…Patients with HF have elevated plasma ACE2 levels due to increased shedding of tissue ACE2, which may predispose them to the RAS imbalance mediated by SARS-CoV-2 that further depletes ACE2-mediated protection in both the heart and lungs (47,48). Patients with COVID-19 having impaired myocardial function as well as high levels of myocardial distress markers, including NT-proBNP, had poor outcomes (49,50). NT-proBNP is a good indicator of cardiac overload/stress.…”

Section: Discussionmentioning

confidence: 99%

Renin-Angiotensin-System Inhibitors Are Associated With Lower In-hospital Mortality in COVID-19 Patients Aged 80 and Older

Spannella

Giulietti²,

Pentima³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundOlder adults are at higher risk of morbidity and mortality for coronavirus disease 2019 (COVID-19). Renin-angiotensin-system inhibitors (RASi) were found to have a neutral or protective effect against mortality in COVID-19 adult patients.AimsWe investigated whether this association was confirmed also in COVID-19 older patients.MethodsThis is a prospective observational study on 337 hospitalized older adults (aged 80 years and older). We classified the study population according to usage of RASi before and during hospitalization. A propensity score analysis was also performed to confirm the findings.ResultsThe mean age was 87.4 ± 6.1 years. Patients taking RASi at home were 147 (43.6%). During hospitalization, 38 patients (11.3% of the entire study population) discontinued RASi, while 57 patients (16.9% of the entire study population) started RASi. In-hospital mortality was 43.9%. Patients taking RASi during hospitalization (patients who maintained their home RASi therapy + patients who started RASi during hospitalization) had a significantly lower in-hospital mortality than untreated patients [HR 0.48 (95% CI: 0.34–0.67)], even after adjustment for required respiratory support, functional status, albumin, inflammation, and cardiac biomarkers. The analysis of the groups derived from the “propensity score matching” (58 patients in each group) confirmed these results [HR 0.46 (95% CI: 0.23–0.91)].DiscussionDespite the high risk of death in older COVID-19 patients, RASi therapy during hospitalization was associated with a clinically relevant lower in-hospital mortality, likely due to the benefit of RAS modulation on the cardiopulmonary system during the acute phase of the disease.ConclusionOur findings confirm the protective role of RASi even in COVID-19 patients aged 80 years and older.

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“…We recently showed that a multivariable model including N‐terminal prohormone of brain natriuretic peptide (NT pro‐BNP), TnI, and d ‐dimer showed good discrimination performance for mechanical ventilation and ACM in a 30‐day follow‐up period. However, echocardiographic parameters failed to discriminate between favorable and adverse outcomes in COVID‐19 patients 15 …”

Section: Introductionmentioning

confidence: 94%

“…However, echocardiographic parameters failed to discriminate between favorable and adverse outcomes in COVID‐19 patients. 15 …”

Section: Introductionmentioning

confidence: 99%

Risk assessment in COVID‐19: Prognostic importance of cardiovascular parameters

Zdanytė

Martus²,

Nestele

et al. 2022

Clinical Cardiology

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Background Cardiovascular risk factors and comorbidities are highly prevalent among COVID‐19 patients and are associated with worse outcomes. Hypothesis We therefore investigated if established cardiovascular risk assessment models could efficiently predict adverse outcomes in COVID‐19. Furthermore, we aimed to generate novel risk scores including various cardiovascular parameters for prediction of short‐ and midterm outcomes in COVID‐19. Methods We included 441 consecutive patients diagnosed with SARS‐CoV‐2 infection. Patients were followed‐up for 30 days after the hospital admission for all‐cause mortality (ACM), venous/arterial thromboembolism, and mechanical ventilation. We further followed up the patients for post‐COVID‐19 syndrome for 6 months and occurrence of myocarditis, heart failure, acute coronary syndrome (ACS), and rhythm events in a 12‐month follow‐up. Discrimination performance of DAPT, GRACE 2.0, PARIS‐CTE, PREDICT‐STABLE, CHA2‐DS2‐VASc, HAS‐BLED, PARIS‐MB, PRECISE‐DAPT scores for selected endpoints was evaluated by ROC‐analysis. Results Out of established risk assessment models, GRACE 2.0 score performed best in predicting combined endpoint and ACM. Risk assessment models including age, cardiovascular risk factors, echocardiographic parameters, and biomarkers, were generated and could successfully predict the combined endpoint, ACM, venous/arterial thromboembolism, need for mechanical ventilation, myocarditis, ACS, heart failure, and rhythm events. Prediction of post‐COVID‐19 syndrome was poor. Conclusion Risk assessment models including age, laboratory parameters, cardiovascular risk factors, and echocardiographic parameters showed good discrimination performance for adverse short‐ and midterm outcomes in COVID‐19 and outweighed discrimination performance of established cardiovascular risk assessment models.

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Impaired Myocardial Function Is Prognostic for Severe Respiratory Failure in the Course of COVID-19 Infection

Cited by 7 publications

References 28 publications

COVID-19 versus seasonal influenza: myocardial injury and prognostic importance

COVID-19 versus seasonal influenza: myocardial injury and prognostic importance

Renin-Angiotensin-System Inhibitors Are Associated With Lower In-hospital Mortality in COVID-19 Patients Aged 80 and Older

Risk assessment in COVID‐19: Prognostic importance of cardiovascular parameters

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