Cardiovascular, Pulmonary, and Neuropsychiatric Short- and Long-Term Complications of COVID-19.

Beginning with the various strategies of the SARS-CoV-2 virus to invade our bodies and manifest infection, and ending with the recent long COVID, we are witnessing the evolving course of the disease in addition to the pandemic. Given the partially controlled course of the COVID-19 pandemic, the greatest challenge currently lies in managing the short- and long-term complications of COVID-19. We have assembled current knowledge of the broad spectrum of cardiovascular, pulmonary, and neuropsychiatric sequelae following SARS-CoV-2 infection to understand how these clinical manifestations collectively lead to a severe form of the disease. The ultimate goal would be to better understand these complications and find ways to prevent clinical deterioration.

Relationships between Circulating Matrix Metalloproteinases, Tissue Inhibitor TIMP-2, and Renal Function in Patients with Myocarditis.

INTRODUCTION: Under physiological conditions, the myocardial extracellular matrix (ECM) is maintained by matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). However, changes in the balance between MMPs and TIMPs can lead to pathological remodeling of the ECM, which contributes to cardiovascular and kidney diseases. The aim of our study was to assess levels of MMPs and TIMP-2 in patients with myocarditis and their relationship to renal function. MATERIALS AND METHODS: Forty five patients with myocarditis who underwent CMR were included, comprising 11 with concurrent chronic kidney disease (CKD). Blood samples were obtained to assess serum levels of MMP-2, MMP-3, MMP-9, and TIMP-2. RESULTS: Serum MMP-2, MMP-3, and TIMP-2 levels negatively correlated with the ejection fraction in patients with myocarditis, while MMP-3 levels correlated with longitudinal deformation (p < 0.05). Serum MMP-2, MMP-3, and TIMP-2 levels also negatively correlated with renal function, as assessed by the estimated glomerular filtration rate (eGFR) (p < 0.05). Patients with myocarditis and concurrent CKD had higher levels of MMP-2 and TIMP-2 than those without kidney damage. CONCLUSIONS: (1) We demonstrated that MMP-2, MMP-3, and TIMP-2 concentrations were related to left-ventricular ejection fraction, and MMP-3 levels correlated with longitudinal deformation, indicating MMPs play an important role in the post-inflammatory remodeling of the myocardium. (2) A negative correlation between the eGFR and MMP-2, MMP-3, and TIMP-2 and a positive correlation between creatinine and MMP-3 levels indicate the role of MMPs and TIMP-2 in renal dysfunction.

The Links between Cardiovascular Diseases and Alzheimer's Disease.

The root cause of non-inherited Alzheimer's disease (AD) remains unknown despite hundreds of research studies performed to attempt to solve this problem. Since proper prophylaxis remains the best strategy, many scientists have studied the risk factors that may affect AD development. There is robust evidence supporting the hypothesis that cardiovascular diseases (CVD) may contribute to AD progression, as the diseases often coexist. Therefore, a lack of well-defined diagnostic criteria makes studying the relationship between AD and CVD complicated. Additionally, inflammation accompanies the pathogenesis of AD and CVD, and is not only a consequence but also implicated as a significant contributor to the course of the diseases. Of note, АроЕε4 is found to be one of the major risk factors affecting both the cardiovascular and nervous systems. According to genome wide association and epidemiological studies, numerous common risk factors have been associated with the development of AD-related pathology. Furthermore, the risk of developing AD and CVDs appears to be increased by a wide range of conditions and lifestyle factors: hypertension, dyslipidemia, hypercholesterolemia, hyperhomocysteinemia, gut/oral microbiota, physical activity, and diet. This review summarizes the literature and provides possible mechanistic links between CVDs and AD.

Response to antiplatelet therapy in patients undergoing invasive treatment due to acute coronary syndrome complicated by cardiogenic shock.

INTRODUCTION: There are limited data on platelet reactivity and response to antiplatelet drugs in patients with cardiogenic shock. AIM: To assess platelet reactivity on dual antiplatelet therapy with acetylsalicylic acid (ASA) and ticagrelor, a novel potent P2Y12 receptor inhibitor, in patients with cardiogenic shock in the course of acute coronary syndrome (ACS) who received invasive treatment. MATERIAL AND METHODS: We enrolled 12 consecutive patients with ACS complicated by cardiogenic shock. To assess response to antiplatelet therapy during cardiogenic shock, only patients with symptoms persisting for at least 3 days and who completed a 5-day follow-up were included in the study. Patients received a loading dose of ASA (300 mg) and ticagrelor (180 mg), followed by a maintenance dose (ASA, 1 × 75 mg; ticagrelor, 2 × 90 mg). Blood samples for platelet function tests were collected. Platelet aggregation was assessed with a Multiplate whole-blood impedance aggregometer. Arachidonic acid (AA), adenosine diphosphate (ADP), and thrombin receptor-activating peptide (TRAP) were used as aggregation agonists. RESULTS: Response to antiplatelet therapy assessed by aggregometry showed numerically higher on-ASA platelet reactivity on day one and statistically significant higher on-ticagrelor platelet reactivity on day one in comparison with following days. There were 2 patients with high on ASA platelet reactivity and 3 with high on ticagrelor platelet reactivity, but only on the day one. CONCLUSIONS: Some patients with cardiogenic shock in the course of ACS treated invasively show a lower response to ASA and ticagrelor only on the first day after invasive treatment, with a good response on subsequent days.

Münchausen Syndrome as an Unusual Cause of Pseudo-resistant Hypertension: A Case Report.

Münchausen syndrome can be characterized by simulated illness, pathological lying and wandering from place to place (the patient typically presents to numerous hospitals). Individuals with elevated blood pressure due to non-adherence to medication have the so-called pseudo-resistant hypertension. A 45-year-old woman was admitted to hospital on an emergency basis because of a hypertensive crisis. Despite combination antihypertensive treatment, normalization of blood pressure was not achieved and a device to produce a therapeutic arteriovenous fi stula was implanted. Aft er the procedure, a signifi cant increase in pulmonary artery pressure was observed and closure of the fistula was performed by implantation of the stent graft . The suspicion was raised that the patient had not been taking her prescribed medications. Therefore, blood samples were taken and the serum was analyzed for presence of the prescribed drugs (atorvastatin, bisoprolol, chlorthalidone, clonidine, doxazosin, furosemide, nitrendipine, oxazepam and valsartan). The results confirmed suspected failure of the patient to take the prescribed medications. Münchausen syndrome is usually first suspected when inexplicable laboratory test results are noted. To our knowledge, this is the first reported case of Münchausen syndrome with pseudo-resistant hypertension leading to the implantation of a device to produce a therapeutic arteriovenous fi stula.

Determinants of the beneficial effect of mineralocorticoid receptor antagonism on exercise capacity in heart failure with reduced ejection fraction.

BACKGROUND: The determinants of the impact of mineralocorticoid receptor antagonism (MRA) on exercise tolerance in heart failure with reduced ejection fraction (HFrEF) have not been sufficiently characterised. AIM: We sought to investigate the factors associated with improvement in exercise capacity following the introduction of spironolactone to therapy in HFrEF patients, as well as to assess the association between improvement in exercise capacity and changes in cardiac functional characteristics with treatment. METHODS: In 120 patients (age 62 ± 11 years) with stable chronic HFrEF, remaining on optimal pharmacotherapy, spironolactone 25 mg/d was added to treatment. Echocardiographic assessment, including myocardial deformation, and treadmill exercise tests were performed at baseline and at six-month follow-up. RESULTS: According to the functional improvement at follow-up, patients were stratified into two groups: with increase in exercise capacity > 20% (IMPRpos, n = 68) and < 20% (IMPRneg, n = 52) of the baseline value. The IMPRpos subset demonstrated significantly larger improvement in left ventricular systolic and diastolic functions at follow-up, as assessed by global longitudinal deformation (GLS), ejection fraction, and tissue e' velocity. Functional improvement > 20% was independently predicted by diabetes (odds ratio [OR] 5.62, p = 0.011), estimated glomerular filtration rate (OR 0.95, p = 0.008), and B-type natriuretic peptide (BNP) at baseline (OR 0.54, p = 0.027), and associated with increase in GLS at follow-up (OR 1.40, p = 0.019). CONCLUSIONS: In patients with HFrEF, improvement in exercise capacity in response to the addition of spironolactone to treatment is more evident in the presence of diabetes, decreased renal function and lower BNP, and improvement in GLS is a contributor to this beneficial effect of MRA.

MMP-2 and TIMP-2 in Patients with Heart Failure and Chronic Kidney Disease.

The aim of the study was to assess MMP-2 (matrix metalloproteinase-2) and TIMP-2 (tissue inhibitor of metalloproteinase-2) serum levels in patients with diverse types of heart failure (HF) and chronic kidney disease (CKD). 101 patients with chronic HF were enrolled. Each patient has assessed the serum levels of MMP-2, TIMP-2, and NT-proBNP. Patients were initially classified into 2 groups based on their LVEF. 43 patients were classified into the HFREF group (HF with Reduced Ejection Fraction) and 58 characterized as HFPEF (HF with Preserved Ejection Fraction). Next, all patients were subdivided into 4 groups according to the degree of diastolic dysfunction. 38 patients with CKD were classified into HF/CKD(+) group. The HF/CKD(-) (HF without CKD) group comprised 61 patients. This study provides original data on positive correlation between ejection fraction and MMP-2 levels in all patients with heart failure. Elevated levels of MMP-2 and TIMP-2 were found in serum from patients with chronic kidney disease; in addition, serum levels of MMP-2 were correlated with the degree of kidney failure. In all groups of patients there was positive correlation between MMP-2 and TIMP-2. Among patients with heart failure etiology was not related to MMP-2 and TIMP-2 serum levels.

Characteristics of chaotic processes in electrocardiographically identified ventricular arrhythmia.

BACKGROUND: The theory of chaos proves a deterministic mechanism of induction of multiple complex processes previously thought to be random in nature. This research explains how these complex processes develop. The aim of the study was to test the hypothesis of the chaotic nature of myocardial electrical events during ventricular tachycardia (VT) and ventricular fibrillation (VF). METHODS: Original hardware and software was developed for digitalization of on-line electrocardiography (ECG) data, with the functions of automatic and manual identification as well as categoriza-tion of specific ventricular arrhythmias. Patient ECGs were recorded by specially developed measuring equipment (M2TT). Available ECG sampling frequency was 20,000 Hz, and it was possible to analyze the signal retrospectively. Digital ECG of the sinus rhythm (SR) was analyzed with non-sustained VT, VT and VF. The signals were then subjected to mathematical analysis. Using wavelet analysis, signals carrying frequencies from various ranges were isolated from baseline and each of these isolated signals was subjected to Fourier transformation to check on differences in the Fourier power spectra of the analyzed VT and VF signals. RESULTS: Ventricular tachycardia identified based on ECG fulfills the criteria of a chaotic process, while no such properties were found for SR and VF. Information obtained by the ECG is used to record myo-cardial electrical signals, but they are not sufficient to differentiate between an advanced chaotic state and the process of linear expansion of electrical activation within the myocardium. CONCLUSIONS: Electrophysiological study requires advanced methods to record the signal of myocardial electrical activity, as ECG is not sufficiently sensitive to identify the features of a chaotic process during VF. (Cardiol J 2017; 24, 2: 151-158).

A suicide attempt by intoxication with Taxus baccata leaves and ultra-fast liquid chromatography-electrospray ionization-tandem mass spectrometry, analysis of patient serum and different plant samples: case report.

BACKGROUND: Taxus (yew) is one of the most frequently reported plants causing potentially fatal outcome when taken incidentally or for suicidal reasons. A fast and reliable method of detection of poisonous compounds or their metabolites is critical in life-saving procedures in cases of yew ingestion. Previously, several chromatographic analytical procedures have been described usually taking longer than one hour of total analysis time. CASE PRESENTATION: In this report we describe a suicide case study and an ad hoc developed fast method of detection and quantitation of 3,5-dimethoxyphenol - the main taxane metabolite in the blood plasma from the patient as well as the determination of major taxine components in the plant material (Taxus baccata). At present, there is no reasonable alternative for mass spectrometry that could match its high sensitivity and accuracy, and Multiple Reaction Monitoring could be adequate and useful mass spectrometry technique in analyzing and identification of plants material compounds that cause severe poisoning in humans. In the reported case, intensive cardiac care together with the astuteness of the treating physicians not only saved the patient's life, but also allowed for his complete recovery and return to work. CONCLUSIONS: The development of ultra fast liquid chromatography tandem mass spectrometry UFLC-MS/MS method provides a fast means to confirm yew alkaloids and their metabolite in various material. The applied analytical procedure allows early detection of main metabolite in patient material as well as comparing to those extracted from the plant. In our study, the taxanes remained undetected, probably due to the time elapsing from the patient admittance and collection of plasma. In cases like those reported in this study, retaining the gastric material should be obligatory to confirm the ingestion of yew. The possibility of using this approach in detection of native taxine compounds in human plasma remains to be verified.

Expression of Proinflammatory Factors, Proangiogenic Factors and Endostatin in Patients with Heart Failure and Different Grades of Collateral Circulation Development.

BACKGROUND: The process of collateral vessel maturation is stimulated by numerous factors affecting the endothelium and smooth muscle cells building the vessel wall. Looking for arteriogenesis stimulating factors means looking for a potential innovative heart failure treatment method in the patients unresponsive to traditional therapies. OBJECTIVES: The purpose of this study was to assess the changes in serum concentrations of pro-inflammatory factor IL-6, growth factors FGF (FGFa, FGFb, FGFbH), HGF, VEGF and endostatin in heart failure patients in relation to the coronary collaterals development stage. MATERIAL AND METHODS: This study included 22 patients with chronic heart failure NYHA II or III (mean age 62.5 ± 11.6 years) and 8 control patients (mean age 58.4 ± 10.7 years). Coronary angiography was performed and the presence and grade of collateral circulation was assessed by a four-level scale proposed by Rentrop and Cohen. The level of the studied factors was determined in the blood samples collected during the angiographic procedure. RESULTS: The concentration of IL-6 was significantly higher in the heart failure patients than in the control group (p < 0.001) and in NYHA III vs. NYHA II patients (p < 0.02). Patients with heart failure and collaterals grade 1 or 2 exhibited higher serum concentrations of FGFbH (from p < 0.03 to p < 0.01). The serum VEGF level in NYHA III patients was significantly higher than in NYHA II individuals (from p < 0.03 to p < 0.01). CONCLUSIONS: Higher levels of IL-6 and FGFbH were observed in patients with heart failure. Collaterals formation seems to be associated with the activation of pro-inflammatory factors, growth factors and endostatin.

Effect of intravenous dopamine infusion on pituitary and thyroid function and on nephroprotection.

UNLABELLED: INTRODUCTION; Catecholamines, including dopamine, are used in cardiac intensive care. OBJECTIVES: The aim of the study was to assess the effect of intravenous dopamine infusion on the function of pituitary gland in patients with acute cardiac failure. We analyzed changes in the serum levels of thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH), as well as potential nephroprotection. PATIENTS AND METHODS: The study involved 29 patients with chronic decompensated heart failure (New York Heart Association class III/IV; mean age 77.4 ± 13.3 years). Dopamine was administered intravenously in doses varying from 1 to 5 µg/kg/min. Measurements of TSH, free triiodothyronine (FT3), free thyroxine (FT4), and ACTH were taken directly before dopamine infusion, after 12 hours of continuous infusion, and 12 hours after the 72-hour infusion was completed. RESULTS: Serum FT3 levels were significantly higher before dopamine infusion than at 12 hours post infusion (5.12 ± 1.16 vs. 4.27 ± 0.89 pmol/l, P < 0.005). Serum FT4 levels before the infusion were significantly higher than after 12 hours of continuous infusion as well as after 12 hours post infusion (18.79 ± 5.33 vs. 17.06 ± 4.61 pmol/l, P < 0.05; 18.79 ± 5.33 vs. 16.26 ± 4.53 pmol/l, P < 0.05, respectively). There were no statistically significant differences between serum TSH and ACTH levels or in creatinine clearance before, during, and 12 hours post infusion. CONCLUSIONS: Intravenous infusion of dopamine may downregulate endocrine thyroid function; however, it has no significant effect on the pituitary gland-derived TSH and ACTH. There was no significant nephroprotective effect of low-dose dopamine infusion in patients with chronic decompensated chronic heart failure.

[Myocardial infarction without coronary arteries stenoses in a patient with Jervell and Lange-Nielsen syndrome--diagnostic dilemmas]. / Zawal serca bez przewezen w tetnicach wiencowych u pacjentki z zespolem Jervella i Lange-Nielsena--dylematy diagnostyczne.

According to the rules of differential diagnostics an acute coronary syndrome (ACS) often constitutes an initial diagnosis while a subsequent patient's follow-up with troponin determination results in further verification of the diagnosis. A 55 year-old female with congenital hearing loss, poorly controlled hypertension, type 2 diabetes treated with oral medications, and hypothyreosis was admitted to the Department of Cardiology with 6 h long severe chest pain radiating over her back with concomitant dyspnea. She underwent urgent coronary angiography which showed no epicardial coronary narrowing. Acute heart failure symptoms occurred immediately after coronary angiography in the form of cardiogenic shock. Even though an ACS was diagnosed on the basis of typical biochemical, electrocardiographic and clinical criteria, a further follow-up suggested a possibility of a co-existance of other diseases which occurred to be a Jervell and Lange-Nielsen syndrome.

[Neurohormonal effects following treatment with dopamine. More advantages or disadvantages?]. / Neurohormonalne nastepstwa leczenia dopamina. Wiecej korzysci czy dzialarí ubocznych?

Due to a big amount of dopaminergic receptors set in the vertebrate central nervous system (CNS), endogenously freed dopamine determines motor and cognitive activities of an organism. It influences neurohormonal regulation of the body, among all, other catecholamines' production; it also regulates kidney's functioning, the cardiovascular system and alimentary canal. Dopamine (a natural catecholamine) containing specimens are often used for the sake of intensive medical care. A particular effect, which is natriuretic, inotropic and vasopressive, is expected under inpatient treatment conditions depending on a selected dose. In practice, however, a potential influence of such treatment on neurohormonal processes, among all, an impact on hypothalamo-hypophyseal-adrenal axis is rarely taken into account. Considering numerous adverse events, a risk of renal failure development and blood redistribution disorders in the mucous membrane of the gastrointestinal tract, a negative impact on the respiratory system, as well as in the event of insufficient evidence for dopamine's effectiveness in both prevention and acute renal failure) treatment, dopamine's implementation in so called diuretic doses is controversial. Its implementation as a drug with the vasopressor effect must be reconsidered and individualised.

[Cardiac tamponade of unknown aetiology in a dialyzed patient]. / Tamponada serca u pacjenta dializowanego.

A case of a 58 year-old male with renal failure and recurrent cardiac tamponade is presented. In spite of extensive work-up, aetiology of pericardial effusion remained unknown. Diagnostic difficulties in this setting are discussed.

Impact of nebivolol on levels of serum nitric oxide, plasma von Willebrand factor and exercise stress testing parameters in hypertensive and ischemic heart disease patients.

BACKGROUND: The dysfunction of vascular endothelium precedes the development of atherosclerosis in patients with arterial hypertension. Nebivolol is a very specific beta-blocker, which can be characterized by a strong endothelial vasodilatative effect. The aim of the study was the assessment of changes in concentrations of serum nitric oxide (NO), plasma von Willebrand factor (vWf) and selected parameters of electrocardiographic exercise tests after 4-week nebivolol treatment. METHODS: Twenty-one patients were included in the study, aged from 34 to 82 years with primary arterial hypertension or primary arterial hypertension and ischemic heart disease. Blood samples were taken for measurements of serum NO and plasma vWf. Electrocardiographic stress tests were also performed. Subsequently, nebivolol was administered for four weeks and the aforementioned measurements were repeated. RESULTS: A significant increase in serum NO concentration was found in all the investigated patients after nebivolol treatment. A prolongation of exercise time, increase in metabolic equivalent and decrease in double product were also noted in patients after nebivolol treatment. CONCLUSIONS: Nebivolol treatment improves parameters of electrocardiographic exercise test in patients with arterial hypertension. The improvement of the parameters of the exercise test was not observed in those patients who showed no significant increase in serum NO concentration following nebivolol treatment.

[Catheter malposition in the renal vein--a rare complication related to a peripherally inserted central catheter]. / Niezamierzona lokalizacja cewnika w zyle nerkowej--rzadkie powiklanie kaniulizacji zyl centralnych z dostepu obwodowego.

In cardiology intensive care units central venous access is often needed for intravenous infusion of multiple strong acting or hypertonic therapeutic agents such as catecholamines, antibiotics, kalium chloride solutions or parenteral nutrition, as well as for central venous pressure measurements. Currently, access devices include centrally inserted central venous catheters (CVC) and peripherally inserted central venous catheters (PICC). Because of the relative ease of placement, reduced rates of severe complications, such as pneumothorax, great vessel perforation or bleeding, and lower costs in comparison to CVCs, PICCs have been widely used. The PICC has risks, however, with the most frequently occurring complications being catheter malposition followed sometimes by thrombosis, infection or even perforation of the vessel. We present a case of an uncomplicated unsatisfactory location of the catheter tip in the right renal vein, found accidentally during chest angio-CT. Although PICCs are considered to be safe and easy to insert, the proper catheter tip placement is highly unreliable and should be carefully assessed.

Chemokines and left ventricular function in patients with acute myocardial infarction.

BACKGROUND: Leukocytes are activated in the inflammatory process involving locally atherosclerotic lesions through adhesive molecules attaching to the surface of endothelial cells, especially during acute myocardial infarction. The aim of the study was to assess MCP-1, MIP-1alpha, and RANTES serum levels in patients with STEMI and to correlate them with the severity of left ventricle (LV) dysfunction. METHODS: Forty patients were initially divided into two groups, with group 1 having an ejection fraction (EF) above 40% and group 2 an EF of 40% or less. Next, the patients were divided on the basis of wall motion score index (WMSI): group 3 had a WMSI of 1.3 or lower and group 4 had a WMSI above 1.3. A control group of ten volunteers was also included in the study. Serum samples were taken at admission as well as 3, 24, 48, 72 h, and 7 days after. RESULTS: The baseline serum levels of MCP-1 and RANTES in group 1 were significantly higher than in the controls (p<0.05 and p<0.005, respectively). The highest concentrations of chemokines were observed 3 h after admission. The serum levels of MIP-1alpha on admission and 3 h later were significantly higher in group 1 than in group 2 (p<0.03 and p<0.01, respectively). Maximum MIP-1 concentrations were observed 3 h after admission in group 3 and 24 h after admission in group 4 (p<0.006). In group 1, MIP-1alpha 3 h after admission correlated positively with the EF (r=0.444, p<0.05). In group 1 there was a negative correlation between MIP-1alpha concentration 3 h after admission and LV end-diastolic dimension (r=-0.492, p<0.02). CONCLUSIONS: Patients with myocardial infarction with an elevated ST segment had a significant increase in MCP-1, MIP-1alpha, and RANTES serum levels.

Thrombolysis during cardiopulmonary resuscitation.

Numerous experimental researches and clinical observations reveal that immediately after cardiac arrest a significant platelet activation appears which is not counterbalanced by endogenous fibrinolysis and leads to disseminated laying down of fibrin's concrement in arteria and microclots' formation. The process is being developed during cardiopulmonary resuscitation and extended to a post-resuscitation period. There have been some experimental works and clinical examinations revealing that treatment with heparin and thrombolysis' application can increase the survival rate after an incident of cardiac arrest. Thrombolysis therapy becomes a new method facilitating prognosis as to patient's health after cardiac arrest. Presently one can state undoubtedly that either fibrinolysis therapy or thrombolysis therapy is justified at suspicion of an acute pulmonary embolism contributing to patient's hemodynamic stabilization. In the results it has been obtained hitherto that this sort of therapy, applied during cardiopulmonary resuscitation after prolonged cardiac arrest at acute coronary syndrome increases survival rate and improves patient's neurological state during a post-resuscitation period. Full confirmation of these observations needs some further multi-centered, randomized studies of the issues under consideration. (Cardiol J 2007; 14: 24-28).