Successful treatment of acute heart failure in COVID-19-induced cytokine storm with tocilizumab: a case report

Chitturi, Kalyan R.; Thacker, Sameer; Al-Saadi, Mukhtar; Kassi, Mahwash

doi:10.1093/ehjcr/ytaa188

Cited by 19 publications

(11 citation statements)

References 14 publications

(15 reference statements)

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“…55.5% of TTS (n = 15) patients were women and were more than 60 years of age (n = 8; 53.3%). Most of the reported cases were from the USA (43.7%) [8][9][10][11][12][13][14][15][16][17][18], Italy (31.25%) [19][20][21][22][23], and Spain (12.5%) [24,25], while Belgium [26] and Switzerland [27] contributed 1 case each. Among the cohort, 19 out of 26 (73.07%) patients were discharged, and three were hospitalized due to acute respiratory distress syndrome and on extracorporeal membrane oxygenation or ongoing maternal age.…”

Section: Resultsmentioning

confidence: 99%

Takotsubo Syndrome a Rare Entity in COVID-19: a Systemic Review—Focus on Biomarkers, Imaging, Treatment, and Outcome

Sharma

Desai

Patoliya

et al. 2021

SN Compr. Clin. Med.

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Takotsubo syndrome(TTS) is attributed to catecholamine surge, which is also observed in COVID-19 disease due to the cytokine storm. We performed a systematic literature search using PubMed, Embase, and the Cochrane Central Register of Controlled Trials retrospectively to identify COVID-19-associated TTS case reports and evaluated patient-level demographics, laboratory markers clinical attributes, treatment given, and outcomes. There are 27 cases reported of TTS associated with COVID-19 infection of which 44.5% were male. Reported median age was 57 years (IQR: 39-65) and 62.95 years (IQR: 50.5-73.5) in case series and individual patients' cases in database, respectively. The time interval from the symptom onset to TTS diagnosis was median 6.5 days (IQR: 1.0-8.0) in case series and 6.7 days (IQR: 4-10) in individual patients' database. The median LVEF was 36% (IQR: 35-37) and 38.15%(IQR: 30-42.5%-[male: 40.33% (IQR: 33-44.2)] and female [37.15% (IQR: 30-40)] in case series and individual-patients' database, respectively. Troponin was elevated in all patients except one patient. 77.2% patients of TTS with COVID-19 had an elevated C-reactive protein and/or D-dimer. Twelve out of 22 (54.5%) patients developed cardiac complication such as cardiogenic-shock, atrial fibrillation, acute heart failure, supraventricular tachycardia, and biventricular heart failure. Nineteen out of 26 (73.07%) patients were discharged, and three were hospitalized due to acute respiratory distress syndrome and needed extracorporeal membrane oxygenation or ongoing maternal age. There were 4 (14.8%) mortality. There was no major gender difference observed in development of TTS in COVID-19 unlike COVID-19 per se. Older median age group for TTS in COVID-19 patients irrespective of cardiovascular comorbidities and gender probably reflects age as an independent risk factor. Patients who developed TTS had higher mortality rate especially if they developed cardiogenic shock. Keywords Takotsubo cardiomyopathy. COVID-19. SARS-COV-2. Broken heart syndrome. Stress cardiomyopathy. Takotsubo syndrome. Apical ballooning syndrome This article is part of the Topical Collection on Covid-19

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Section: Resultsmentioning

confidence: 99%

Takotsubo Syndrome a Rare Entity in COVID-19: a Systemic Review—Focus on Biomarkers, Imaging, Treatment, and Outcome

Sharma

Desai

Patoliya

et al. 2021

SN Compr. Clin. Med.

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“…Among these symptoms, ARDS is the major cause in 70% of COVID-19-related patient deaths. 79,80 Cell infiltration mediates pulmonary damage through excessive secretion of proteases and reactive oxygen species, and subsequently those inflammatory cells can directly damage lung structure, hinder macrophage infiltration, and induce diffuse alveolar damage and pulmonary edema.…”

Section: Infection Mechanism and Immunological Pathogenesis Of Covid-19mentioning

confidence: 99%

Genomic variation, origin tracing, and vaccine development of SARS-CoV-2: A systematic review

Huang

Guo

et al. 2021

The Innovation

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COVID-19 has spread globally to over 200 countries with more than 40 million confirmed cases and one million deaths as of November 1, 2020. The SARS-CoV-2 virus, leading to COVID-19, shows extremely high rates of infectivity and replication, and can result in pneumonia, acute respiratory distress, or even mortality. SARS-CoV-2 has been found to be continue rapidly evolving, with several genomic variants emerging in different regions throughout the world. In addition, despite intensive study of the spike protein, its origin and molecular mechanisms in mediating host invasion are still only partially resolved. Finally, the repertoire of drugs for COVID-19 treatment is still limited, with several candidates still under clinical trial and no effective therapeutic yet reported. Although vaccines based on either DNA/mRNA or protein have been deployed, their efficacy against emerging variants requires ongoing study, with multivalent vaccines supplanting the first generation vaccines due to their low efficacy against new strains. Here, we provide a systematic review of studies on the epidemiology, immunological pathogenesis, molecular mechanisms and structural biology, as well as approaches for drug or vaccine development for SARS-CoV-2.

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“…Moreover, IL-1β and TNF-α produce negative inotropic effects and may induce cardiomyocyte pyroptosis and apoptosis, respectively (29,30). However, there are limited data on cytokine storminduced AHF (31,32), and its clinical presentations and echocardiographic findings are not consistent with EV71related AHF and TTS. Fifth, we did not perform specific immunohistological staining in this study.…”

Section: Limitationsmentioning

confidence: 99%

Catecholamine-Induced Secondary Takotsubo Syndrome in Children With Severe Enterovirus 71 Infection and Acute Heart Failure: A 20-year Experience of a Single Institute

Jan

Chi

et al. 2021

Front. Cardiovasc. Med.

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Background: Acute heart failure (AHF) is the major cause of death in children with severe enterovirus 71 (EV71) infection. This study aimed to report our clinical experience with EV71-related AHF, as well as to discuss its pathogenesis and relationship to Takotsubo syndrome (TTS).Methods: A total 27 children with EV71-related AHF between 1998 and 2018 were studied. The TTS diagnosis was based on the International Takotsubo Diagnostic Criteria.Results: Acute heart failure-related early death occurred in 10 (37%) of the patients. Sinus tachycardia, systemic hypertension, and pulmonary edema in 100, 85, and 81% of the patients, respectively, preceded AHF. Cardiac biomarkers were significantly increased in most patients. The main echocardiographic findings included transient and reversible left ventricular (LV) regional wall motion abnormality (RWMA) with apical ballooning. High concentrations of catecholamines either preceded or coexisted with AHF. Myocardial pathology revealed no evidence of myocarditis, which was consistent with catecholamine-induced cardiotoxic damage. Patients with EV71-related AHF who had received close monitoring of their cardiac function, along with early intervention involving extracorporeal life support (ECLS), had a higher survival rate (82 vs. 30%, p = 0.013) and better neurological outcomes (59 vs. 0%, p = 0.003).Conclusion: EV 71-related AHF was preceded by brain stem encephalitis-related hypercatecholaminemia, which resulted in a high mortality rate. Careful monitoring is merited so that any life-threatening cardiogenic shock may be appropriately treated. In view of the similarities in their clinical manifestations, natural course direction, pathological findings, and possible mechanisms, TTS and EV71-related AHF may represent the same syndrome. Therefore, we suggest that EV71-related AHF could constitute a direct causal link to catecholamine-induced secondary TTS.

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Successful treatment of acute heart failure in COVID-19-induced cytokine storm with tocilizumab: a case report

Cited by 19 publications

References 14 publications

Takotsubo Syndrome a Rare Entity in COVID-19: a Systemic Review—Focus on Biomarkers, Imaging, Treatment, and Outcome

Takotsubo Syndrome a Rare Entity in COVID-19: a Systemic Review—Focus on Biomarkers, Imaging, Treatment, and Outcome

Genomic variation, origin tracing, and vaccine development of SARS-CoV-2: A systematic review

Catecholamine-Induced Secondary Takotsubo Syndrome in Children With Severe Enterovirus 71 Infection and Acute Heart Failure: A 20-year Experience of a Single Institute

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