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BACKGROUND: Cardiovascular disease is associated with severe COVID-19. Our aim was to describe clinical and laboratory features (including electrocardiographic and echocardiographic ones) and outcomes of patients with cardiac disease hospitalized with COVID-19. METHODS: This is an observational retrospective study of consecutive adult patients admitted, between March and September of 2020, with confirmed SARSCoV-2 infection. Data were collected as per the ISARIC case report form and complemented with variables related to heart disease. RESULTS: One hundred twenty-one patients were included. Mean age was 60 SD 15.2 years and 80/121(66.1%) were male. Two-thirds of the patients (80/121, 66.1%) had COVID-19 at the time of hospital admission and COVID-19 was the reason for hospitalization in 42 (34.7%). Other reasons for hospital admission were acute coronary syndrome (26%) and decompensated heart failure (14.8%). Chronic cardiac diseases were found in 106/121 (87.6%), mostly coronary artery disease (62%) or valve disease (33.9%). A transthoracic echocardiogram was performed in 93/121(76.8%) and enlarged cardiac chambers were found in 71% (66/93); admission ECG was done in 93 cases (93/121, 76.8%), and 89.2% (83/93) were abnormal. Hospital-acquisition of COVID-19 occurred in 20 (16.5%) of patients and their mortality was 50%. On bivariate analysis for mortality, BNP levels and troponin levels were NOT associated with mortality. On multivariate analysis, only C reactive protein levels and creatinine levels were significant. CONCLUSIONS: COVID-19 impacted the profile of hospital admissions in cardiac patients. BNP and troponin levels were not associated with mortality and may not be good prognostic discriminators in cardiac patients.
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AbstractIntroduction:Coronary computed tomography angiography (CCTA) allows for non-invasive coronary artery disease (CAD) phenotyping. There are still some uncertainties regarding the impact this knowledge has on the clinical care of patients.Objective:To determine whether CAD phenotyping by CCTA influences clinical decision making by the prescription of cardiovascular drugs and their impact on non-LDL cholesterol (NLDLC) levels.Methods:We analysed consecutive patients from 2008 to 2011 submitted to CCTA without previous diagnosis of CAD that had two serial measures of NLDLC, one up to 3 months before CCTA and the second from 3 to 6 months after.Results:A total of 97 patients were included, of which 69% were men, mean age 64 ± 12 years. CCTA revealed that 18 (18%) patients had no CAD, 38 (39%) had non-obstructive (< 50%) lesions and 41 (42%) had at least one obstructive ≥ 50% lesion. NLDLC was similar at baseline between the grups (138 ± 52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectively, p = 0.32). We found significative reduction in NLDLC among patients with obstrctive lesions (-18%, p = 0.001). We also found a positive relationship between clinical treatment intensification with aspirin and cholesterol reducing drugs and the severity of CAD.Conclusion:Our data suggest that CCTA results were used for cardiovascular clinical treatment titration, with especial intensification seen in patients with obstructive ≥50% CAD.
ResumoFundamento:A Angiotomografia Coronariana (AngioTC Cor) permite a fenotipagem de Doença Arterial Coronariana (DAC) de forma não invasiva. Ainda há incertezas sobre o impacto que esse conhecimento promove no tratamento clínico do paciente.Objetivo:Avaliar se a fenotipagem da DAC por AngioTC Cor influencia na tomada de decisão sobre o início da terapêutica cardiovascular e seu impacto nos níveis séricos de colesterol não HDL (CNHDL).Métodos:Foram analisados pacientes consecutivos sem diagnóstico prévio de DAC que realizaram AngioTC Cor entre os anos 2008 e 2011 e que possuíam duas dosagens seriadas de colesterol até três meses antes da AngioTC Cor, e de três a seis meses após.Resultados:Um total de 97 pacientes foram incluídos, sendo 69% homens, idade média de 64 ± 12 anos. A AngioTC Cor revelou que 18 (18%) pacientes não tinham lesões detectáveis, 38 (39%) tinham lesões não obstrutivas < 50%, e 41 (42%) tinham ao menos uma lesão obstrutiva ≥ 50%. As medidas de CNHDL basal foram similares entre os grupos, (138 ± 52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectivamente, p = 0,32). Observou-se redução significativa do CNHDL apenas no grupo com lesões obstrutivas ≥ 50% (-18%, p = 0,001). Observa-se ainda relação entre a intensificação do tratamento clínico com AAS e drogas redutoras de colesterol proporcional à gravidade da DAC pela AngioTC Cor.Conclusão:Esses dados sugerem que o resultado da AngioTC Cor foi utilizado para a titulação terapêutica de pacientes com DAC, sendo o tratamento intensificado especialmente em DAC obstrutiva ≥ 50%.