RESUMEN
AIMS: Infection by SARS-CoV-2 may result in a systemic disease and a proportion of patients ranging 15%-44% experienced cardiac injury (CI) diagnosed by abnormal troponin levels. The aim of the present study was to analyse the clinical characteristics of a large series of hospitalized patients for COVID-19 in order to identify predisposing and/or protective factors of CI and the outcome. METHODS AND RESULTS: This is an observational, retrospective study on patients hospitalized in two Italian centres (San Raffaele Hospital and Cremona Hospital) for COVID-19 and at least one high-sensitivity cardiac troponin (hs-cTnt) measurement during hospitalization. CI was defined if at least one hs-cTnt value was above the 99th percentile. The primary end-point was the occurrence of CI during hospitalization. We included 750 patients (median age 67, IQR 56-77 years; 69% males), of whom 46.9% had history of hypertension, 14.7% of chronic coronary disease and 22.3% of chronic kidney disease (CKD). Abnormal troponin levels (median troponin 74, IQR 34-147 ng/l) were detected in 390 patients (52%) during the hospitalization. At multivariable analysis age, CKD, cancer, C-reactive protein (CRP) levels were independently associated with CI. Independent predictors of very high troponin levels were chronic kidney disease and CRP levels. Patients with CI showed higher rate of all-cause mortality (40.0% vs. 9.1%, p = 0.001) compared to those without CI. CONCLUSION: This large, multicentre Italian study confirmed the high prevalence of CI and its prognostic role in hospitalized patients with COVID-19, highlighting the leading role of systemic inflammation for the occurrence of CI.
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COVID-19/diagnóstico , Cardiopatías/virología , Inflamación/virología , Anciano , COVID-19/mortalidad , Femenino , Hospitalización , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Troponina/sangreRESUMEN
Thrombotic complications are common in patients with severe COVID-19 pneumonia with important consequences on the diagnostic and therapeutic management. We report a consecutive series of five patients on long-term oral anticoagulation therapy who presented to our hospital for severe COVID-19 pneumonia associated with segmental acute pulmonary embolism despite adherence to therapy and with an adequate anticoagulant range at the time of the event. Four patients were receiving a direct oral anticoagulant (two with edoxaban, one with rivaroxaban and one with apixaban) and one patient a vitamin K antagonist. No significant thrombotic risk factors, active cancer, or detectable venous thromboembolism were present. In all cases, elevated d-dimer and fibrinogen levels with a parallel rise in markers of inflammation were documented. The combination of these findings seems to support the hypothesis that considers the local vascular damage determined by severe viral infection as the main trigger of thrombi detected in the lungs, rather than emboli from peripheral veins.
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Tratamiento Farmacológico de COVID-19 , COVID-19 , Embolia Pulmonar , Tromboembolia Venosa , Anticoagulantes/uso terapéutico , COVID-19/complicaciones , Humanos , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/etiología , Rivaroxabán/uso terapéutico , Tromboembolia Venosa/inducido químicamente , Tromboembolia Venosa/etiologíaRESUMEN
INTRODUCTION: Most of the drugs associations that have been used to treat patients with SARS-CoV-2 infection increase the risk of prolongation of the corrected QT interval (QTc). OBJECTIVE: To evaluate the effects of an association therapy of hydroxychloroquine (HY) plus ritonavir/darunavir (RD) or azithromycin (AZ) on QTc intervals. METHODS: At the beginning of COVID-19 pandemic patients admitted to our hospital were treated with the empiric association of HY/RD; one week later the therapeutic protocol was modified with the combination of HY/AZ. Patients underwent an ECG at baseline, then 3 and 7 days after starting therapy. We prospectively enrolled 113 patients (61 in the HY/RD group-52 in the HY/AZ group). RESULTS: A significant increase in median QTc was reported after seven days of therapy in both groups: from 438 to 452 ms in HY/RD patients; from 433 to 440 ms in HY/AZ patients (p = 0.001 for both). 23 patients (21.2%) had a QTc > 500 ms at 7 days. The risk of developing a QTc > 500 ms was greater in patients with prolonged baseline QTc values (≥ 440 ms for female and ≥ 460 ms for male patients) (OR 7.10 (95% IC 1.88-26.81); p = 0.004) and in patients with an increase in the QTc > 40 ms 3 days after onset of treatment (OR 30.15 (95% IC 6.96-130.55); p = 0.001). One patient per group suffered a malignant ventricular arrhythmia. CONCLUSION: Hydroxychloroquine with both ritonavir/darunavir or azithromycin therapy significantly increased the QTc-interval at 7 days. The risk of developing malignant arrhythmias remained relatively low when these drugs were administered for a limited period of time.
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Azitromicina/efectos adversos , Tratamiento Farmacológico de COVID-19 , Darunavir/efectos adversos , Electrocardiografía/efectos de los fármacos , Hidroxicloroquina/uso terapéutico , Síndrome de QT Prolongado/inducido químicamente , Ritonavir/efectos adversos , Anciano , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , COVID-19/epidemiología , Darunavir/uso terapéutico , Inhibidores Enzimáticos/uso terapéutico , Femenino , Humanos , Síndrome de QT Prolongado/fisiopatología , Masculino , Persona de Mediana Edad , Ritonavir/uso terapéutico , SARS-CoV-2RESUMEN
Left-ventricular non-compaction (LVNC) is a rare form of cardiomyopathy. Its clinical presentation is highly variable and during pregnancy is frequently associated with heart failure, embolic events, and arrhythmias. Herein we report a case of a woman with left ventricular non-compaction who had an automated defibrillator implantation for recurrent ventricular arrhythmias during pregnancy. During pregnancy and at long-term follow-up no interventions of the device were documented. In conclusion, the management of malignant arrhythmias during pregnancy is one of the concerns for patients with LVNC and requires a careful approach in third-level centers.
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Desfibriladores Implantables/efectos adversos , No Compactación Aislada del Miocardio Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatología , Adulto , Cuidados Posteriores , Cardiomiopatías/fisiopatología , Cesárea/métodos , Ecocardiografía/métodos , Femenino , Humanos , No Compactación Aislada del Miocardio Ventricular/complicaciones , No Compactación Aislada del Miocardio Ventricular/fisiopatología , Embarazo , Taquicardia Ventricular/terapia , Resultado del Tratamiento , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
Spontaneous pneumomediastinum is a benign entity but can worsen the underlying condition with which it is associated. We evaluated the incidence and the clinical relevance of spontaneous pneumomediastinum in a consecutive series of 102 patients with COVID-19 pneumonia. Six cases of pneumomediastinum were identified by high-resolution chest CT-scan. Three patients required early intubation, and one of them died, while in in the remaining subjects the clinical course was benign. The presence of pneumomediastinum required some changes in the management of mechanical ventilation. In conclusion, spontaneous pneumomediastinum is a possible complication of severe COVID-19 pneumonia that can affect patient management and clinical outcomes.
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Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico por imagen , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/epidemiología , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , COVID-19 , Infecciones por Coronavirus/terapia , Femenino , Humanos , Incidencia , Italia , Masculino , Enfisema Mediastínico/terapia , Persona de Mediana Edad , Pandemias , Neumonía Viral/terapia , Estudios Retrospectivos , SARS-CoV-2 , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To report the long-term safety and efficacy data of a third generation drug eluting stent (DES) with biodegradable polymer in the complex patient population of diabetes mellitus after a follow-up period of 5 years. BACKGROUND: After percutaneous coronary intervention patients with diabetes mellitus are under higher risk of death, restenosis and stent thrombosis (ST) compared to non-diabetic patients. METHODS: In 126 centers worldwide 3067 patients were enrolled in the NOBORI 2 registry, 888 patients suffered from diabetes mellitus (DM), 213 of them (14%) being insulin dependent (IDDM). Five years follow-up has been completed in this study. RESULTS: At 5 years, 89.3% of the patients were available for follow-up. The reported target lesion failure (TLF) rates at 5 years were 12.39% in DM group and 7.34% in non-DM group; (p < 0.0001). In the DM group, the TLF rate in patients with IDDM was significantly higher than in the non-IDDM subgroup (17.84 vs. 10.67%; p < 0.01). The rate of ST at 5 years was not different among diabetic versus non-diabetic patients or IDDM versus NIDDM. Only 10 (<0.4%) very late stent thrombotic events beyond 12 months occurred. CONCLUSIONS: The Nobori DES performed well in patients with DM. As expected patients with DM, particularly those with IDDM, had worse outcomes. However, the very low rate of very late stent thrombosis in IDDM patients might have significant clinical value in the treatment of these patients. Clinical trial registration ISRCTN81649913; http://www.controlled-trials.com/isrctn/search.html?srch=81649913&sort=3&dir=desc&max=10.
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Implantes Absorbibles , Enfermedad de la Arteria Coronaria/terapia , Diabetes Mellitus/tratamiento farmacológico , Stents Liberadores de Fármacos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Intervención Coronaria Percutánea/instrumentación , Polímeros/química , Anciano , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/mortalidad , Reestenosis Coronaria/etiología , Trombosis Coronaria/etiología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Femenino , Humanos , Hipoglucemiantes/efectos adversos , Insulina/efectos adversos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Estudios Prospectivos , Diseño de Prótesis , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Infarto del Miocardio con Elevación del ST/diagnóstico , Anciano , Anciano de 80 o más Años , Betacoronavirus/aislamiento & purificación , COVID-19 , Angiografía Coronaria , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/virología , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/virología , Factores de Riesgo , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/complicacionesAsunto(s)
Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Embolia Pulmonar/virología , Anciano , Betacoronavirus , COVID-19 , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pandemias , Embolia Pulmonar/diagnóstico por imagen , SARS-CoV-2 , Tomografía Computarizada por Rayos XRESUMEN
The Ultimaster coronary stent system (Terumo Corporation, Tokyo, Japan) represents a new iteration in drug-eluting stent (DES) technology that has recently received the Conformité Européenne (CE) mark approval for clinical use. The Ultimaster is a thin-strut, cobalt chromium, biodegradable-polymer, sirolimus-eluting coronary stent. The high elasticity of the biodegradable-polymer (PDLLA-PCL) and the abluminal gradient coating technology are additional novel features of this coronary device. The Ultimaster DES has undergone extensive clinical evaluation in two studies: The CENTURY I and II trials. Results from these two landmark studies suggested an excellent efficacy and safety profile of the Ultimaster DES across several lesion and patient subsets, with similar clinical outcomes to contemporary, new-generation DES. The aim of this review is to summarize the rationale behind this novel DES technology and to provide an update of available evidence about the clinical performance of the Ultimaster DES.
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Angioplastia de Balón/métodos , Stents Liberadores de Fármacos/efectos adversos , Sirolimus/administración & dosificación , Angioplastia de Balón/efectos adversos , Plásticos Biodegradables/efectos adversos , Plásticos Biodegradables/química , Ensayos Clínicos Fase I como Asunto , Ensayos Clínicos Fase II como Asunto , HumanosRESUMEN
OBJECTIVES: To evaluate the acute recoil of the ABSORB bioabsorbable vascular scaffold (BVS) and its relationship with procedural characteristics in a real world population. BACKGROUND: In vivo acute recoil of the BVS was evaluated in selected patients. METHODS: Acute recoil was studied with videodensitometry in a consecutive series of patients treated by means of a BVS, and the results were compared with those obtained in subjects receiving an everolimus-eluting stent (EES). Recoil was defined as the difference between the mean diameter of the fully expanded balloon on which the device was mounted (or the mean diameter of the post-dilatation balloon), and the mean luminal diameter of the treated segment immediately after the final inflation. RESULTS: Recoil was assessed in 106 lesions treated with a BVS and 71 treated with an EES. The absolute and percent recoil of the BVS were significantly greater (0.32 ± 0.16 mm and 10% ± 5% vs. 0.17 ± 0.07 and 5% ± 3%; P < 0.001). Multiple regression analysis showed that BVS use was associated with acute recoil (ß = 0.477; P<0.001). Suboptimal lesion preparation (residual stenosis after balloon angioplasty >20%) (ß = 0.217; P = 0.027) and a small vessel reference diameter (ß = 0.335; P = 0.002) were associated with increased BVS but not EES recoil. CONCLUSIONS: In unselected patients, the acute recoil of the BVS was significantly greater than that of the metal EES. In the BVS group, residual stenosis after predilatation correlated with percent recoil, and so optimal lesion preparation seems to be mandatory in order to maximize the mechanical properties of the scaffold.
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Implantes Absorbibles , Angioplastia Coronaria con Balón/métodos , Enfermedad de la Arteria Coronaria/terapia , Stents Liberadores de Fármacos , Everolimus/administración & dosificación , Adulto , Anciano , Angioplastia Coronaria con Balón/mortalidad , Estudios de Cohortes , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Italia , Masculino , Metales , Persona de Mediana Edad , Análisis Multivariante , Diseño de Prótesis , Falla de Prótesis , Análisis de Regresión , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Resultado del TratamientoAsunto(s)
Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Endocarditis Bacteriana/inducido químicamente , Glucocorticoides/efectos adversos , Glucocorticoides/uso terapéutico , Hidroxicloroquina/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Infecciones Estafilocócicas/inducido químicamente , Staphylococcus aureus/aislamiento & purificación , Anciano , Antibacterianos/uso terapéutico , COVID-19 , Coinfección/inducido químicamente , Coinfección/tratamiento farmacológico , Coinfección/virología , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/virología , Ecocardiografía Transesofágica , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/tratamiento farmacológico , Glucocorticoides/administración & dosificación , Humanos , Hidroxicloroquina/administración & dosificación , Imagen por Resonancia Magnética , Masculino , Pandemias , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/virología , SARS-CoV-2 , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tratamiento Farmacológico de COVID-19RESUMEN
OBJECTIVES: To evaluate the safety and effectiveness of the Kaname™ cobalt-chromium (Co-Cr), thin strut, bare metal stent (BMS) system for the treatment of coronary artery lesions. BACKGROUND: Despite widespread use of drug-eluting stents, a certain percentage of patients with coronary artery disease are still treated with BMS. Therefore, it is essential to evaluate their clinical performance. METHODS: Two hundred eighty-two patients were enrolled in this prospective, single-arm study including a predefined subset of 79 patients with small vessels. The primary end-point was freedom from target vessel failure (TVF) at 6 months. Key angiographic and intravascular ultrasound (IVUS) end-points were late loss, diameter stenosis, binary restenosis, and neointimal hyperplasia volume. RESULTS: Freedom from TVF at 6 months was 93.3% and at 1 year 90.8% in total population, and 92.4% and 87.3% in small vessels, respectively. Clinically driven target lesion revascularization (TLR) rates at 6 and 12 months were 4.3% and 6.4% in total population, and 3.8% and 7.6% in small vessels, respectively. At 6 months in-stent late loss was 0.75 ± 0.43 mm and binary restenosis rate was 16.9% in total population, and 0.64 ± 0.40 mm and 26.1% in small vessels, while IVUS assessed neointimal hyperplasia volume at 6 months was 128.9 ± 42.6 mm(3) for total population. There were no definite and probable stent thromboses up to 12 months. CONCLUSIONS: Results indicate good safety and effectiveness of the Kaname™ stent with clinically equivalent results in small and larger vessels, as such providing useful treatment option for patients with ischemic heart disease considered for BMS implantation.
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Angioplastia Coronaria con Balón , Enfermedad de la Arteria Coronaria/terapia , Stents , Anciano , Cromo , Cobalto , Angiografía Coronaria , Reestenosis Coronaria/epidemiología , Femenino , Francia/epidemiología , Humanos , Hiperplasia , Masculino , Persona de Mediana Edad , Neointima/patología , Estudios ProspectivosRESUMEN
BACKGROUND: Permanent polymer coatings on drug-eluting stents (DES) surface have been identified as triggers of adverse events following percutaneous coronary intervention (PCI). However, efficacy and safety data for the Nobori biolimus-eluting stent (BES), a biodegradable polymer DES, are limited, so the aim of this study was to evaluate clinical outcomes associated with the Nobori BES compared with permanent polymer DES in patients undergoing PCI. METHODS AND RESULTS: Randomized trials comparing Nobori BES vs. other DES were included in the meta-analysis. The 12-month clinical endpoints were: target lesion revascularization (TLR), all-cause mortality, myocardial infarction (MI) and stent thrombosis (ST). Seven trials totaling 12,090 PCI patients met the inclusion criteria. Nobori BES vs. other DES had a comparable risk of TLR (odds ratio [OR] 0.94; 95% confidence interval [CI], 0.66-1.34; P=0.74), mortality (OR 1.00; 95% CI, 0.78-1.28; P=0.98), MI (OR 1.10; 95% CI, 0.87-1.40; P=0.42) and definite/probable ST (OR 1.01; 95% CI, 0.45-2.25; P=0.99). Despite Nobori BES showing similar clinical results to sirolimus-, everolimus- and zotarolimus-eluting stents, it was superior to paclitaxel-eluting stents in reducing the risk of TLR (OR 0.31; 95% CI, 0.10-0.90; P=0.03)CONCLUSIONS:Nobori BES use is associated with a similar safety and efficacy as permanent polymer DES at 1-year follow-up, albeit it is superior to paclitaxel-eluting stents in terms of TLR. Long-term follow-up data are needed in order to establish whether polymer degradation related to Nobori BES implantation improves clinical outcomes.
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Antibióticos Antineoplásicos/uso terapéutico , Antineoplásicos Fitogénicos/uso terapéutico , Plásticos Biodegradables/uso terapéutico , Stents Liberadores de Fármacos , Paclitaxel/uso terapéutico , Intervención Coronaria Percutánea/métodos , Sirolimus/uso terapéutico , Femenino , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
OBJECTIVE: YouTube®, attracts billions of monthly viewers, including those seeking health-related content. However, the quality standards of information are highly variable. The study aimed to evaluate the educational merit of YouTube® concerning pacemakers, focusing on quality and reliability for educating both patients and physicians. METHODS: The term "pacemaker" was searched on YouTube®. Following the application of exclusion criteria based on video language, duration, and minimum view count, a total of 71 videos were analyzed. Quality was assessed using the Global Quality Score (GQS), while reliability was evaluated using the modified DISCERN (mDISCERN) score. Data and metrics available regarding the channel and the specific video were obtained. The Kolmogorov-Smirnov test was employed to assess data normality, and the Mann-Whitney U test was utilized to determine statistical significance. RESULTS: Youtube videos on cardiac pacemakers proved to be of moderate quality, with an average GQS score of 3.10, and of moderate reliability, indicated by a mean mDISCERN score of 3.08. Higher scores were reported for videos of more than five minute duration, the ones that were targeted at physicians, and the videos with higher view ratios. The presence of a board-certified MD yielded statistically greater mean GQS, but not mDISCERN score. No statistical difference was observed based on the number of likes. CONCLUSION: In conclusion, while YouTube® offers significant education opportunities, there is a clear need for enhanced oversight and quality control. Healthcare providers should guide patients towards valid resources and consider collaborating with platforms to develop content standards.
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Marcapaso Artificial , Educación del Paciente como Asunto , Medios de Comunicación Sociales , Grabación en Video , Humanos , Medios de Comunicación Sociales/normas , Educación del Paciente como Asunto/métodos , Educación del Paciente como Asunto/normas , Médicos/normas , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: To date, no published data are available regarding long-term follow-up of new generation DES implanted in coronary artery bypass graft (CABG) lesions. OBJECTIVES: To assess the long-term clinical outcome of patients receiving the new generation Biolimus A9-coated drug-eluting stent (DES) with biodegradable polymer in saphenous vein grafts (SVG). METHODS: Three thousand sixty-seven patients were included in the NOBORI 2 registry: 71 patients with a total of 117 lesions received at least 1 biolimus A9 DES in SVG lesions and 2,959 patients received percutaneous coronary intervention in other lesions. Clinical follow-up was performed at 1, 6, and 12 months, and annually up to 3 years. RESULTS: Compared to the non-CABG group, patients with CABG lesions were older (P < 0.001), had a higher Charlson Comorbidity Index (P = 0.004), and presented more often with acute coronary syndrome (P = 0.02). At 3-year follow-up, cardiac death occurred in 9.7% versus 2.1% (P < 0.001), myocardial infarction (MI) in 8.3% versus 3.0% (P = 0.02), target lesion failure in 13.9% versus 6.4% (P = 0.03), and major adverse cardiac event in 18.1% versus 8.6% (P = 0.01). No differences were observed in TV-MI and TLR, nor stent thrombosis (ST) which was generally low in both groups (1.4% vs 0.8%, P = NS). CONCLUSION: Albeit 3-year outcomes were less favorable in the CABG group, the higher cardiac mortality was apparently not driven by ST, target vessel MI, or TLR, but is likely due to advanced disease and age as well as comorbidity. The low TLR rate as well as the absence of late and very late ST suggest that BES are safe and effective for the treatment of CABG lesions.
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Implantes Absorbibles , Puente de Arteria Coronaria , Stents Liberadores de Fármacos , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Polímeros , Estudios Prospectivos , Vena Safena , Resultado del TratamientoRESUMEN
A 62-year-old woman with multiple myeloma and light-chain amyloidosis with significant heart involvement developed an in-hospital cardiac arrest. After cardiopulmonary resuscitation, a stable sinus rhythm without any cerebral damage was restored, and the patient was admitted to the coronary care unit. A cardioverter-defibrillator was implanted, and it successfully intervened in two sustained ventricular tachycardia episodes and one ventricular fibrillation episode, which were recorded during hospitalization. After achieving discrete cardiac compensation, the patient was transferred to the emergency medicine department where she underwent chemotherapy for multiple myeloma. The patient died 40 days after admission from refractory heart failure. In the literature, there are studies that describe the use of cardioverter-defibrillator implantation in cardiac amyloidosis; however, at present, there is no evidence of a beneficial effect on survival with the use of this intervention. A high index of suspicion for amyloid heart disease and early diagnosis are critical to improving outcomes.
RESUMEN
Data concerning the combined prognostic role of natriuretic peptide (NP) and troponin in patients with COVID-19 are lacking. The aim of the study is to evaluate the combined prognostic value of NPs and troponin in hospitalized COVID-19 patients. From March 1, 2020 to April 9, 2020, consecutive patients with COVID-19 and available data on cardiac biomarkers at admission were recruited. Patients admitted for acute coronary syndrome were excluded. Troponin levels were defined as elevated when greater than the 99th percentile of normal values. NPs were considered elevated if above the limit for ruling in acute heart failure (HF). A total of 341 patients were included in this study, mean age 68 ± 13 years, 72% were men. During a median follow-up period of 14 days, 81 patients (24%) died. In the Cox regression analysis, patients with elevated both NPs and troponin levels had higher risk of death compared with those with normal levels of both (hazard ratio 2.94; 95% confidence interval 1.31 to 6.64; p = 0.009), and this remained significant after adjustment for age, gender, oxygen saturation, HF history, and chronic kidney disease. Interestingly, NPs provided risk stratification also in patients with normal troponin values (hazard ratio 2.86; 95% confidence interval 1.21 to 6.72; p = 0.016 with high NPs levels). These data show the combined prognostic role of troponin and NPs in COVID-19 patients. NPs value may be helpful in identifying patients with a worse prognosis among those with normal troponin values. Further, NPs' cut-point used for diagnosis of acute HF has a predictive role in patients with COVID-19.