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1.
PLoS One ; 16(2): e0246732, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33571321

RESUMEN

BACKGROUND: A high proportion of COVID-19 patients were reported to have cardiac involvements. Data pertaining to cardiac sequalae is of urgent importance to define subsequent cardiac surveillance. METHODS: We performed a systematic cardiac screening for 97 consecutive COVID-19 survivors including electrocardiogram (ECG), echocardiography, serum troponin and NT-proBNP assay 1-4 weeks after hospital discharge. Treadmill exercise test and cardiac magnetic resonance imaging (CMR) were performed according to initial screening results. RESULTS: The mean age was 46.5 ± 18.6 years; 53.6% were men. All were classified with non-severe disease without overt cardiac manifestations and did not require intensive care. Median hospitalization stay was 17 days and median duration from discharge to screening was 11 days. Cardiac abnormalities were detected in 42.3% including sinus bradycardia (29.9%), newly detected T-wave abnormality (8.2%), elevated troponin level (6.2%), newly detected atrial fibrillation (1.0%), and newly detected left ventricular systolic dysfunction with elevated NT-proBNP level (1.0%). Significant sinus bradycardia with heart rate below 50 bpm was detected in 7.2% COVID-19 survivors, which appeared to be self-limiting and recovered over time. For COVID-19 survivors with persistent elevation of troponin level after discharge or newly detected T wave abnormality, echocardiography and CMR did not reveal any evidence of infarct, myocarditis, or left ventricular systolic dysfunction. CONCLUSION: Cardiac abnormality is common amongst COVID-survivors with mild disease, which is mostly self-limiting. Nonetheless, cardiac surveillance in form of ECG and/or serum biomarkers may be advisable to detect more severe cardiac involvement including atrial fibrillation and left ventricular dysfunction.


Asunto(s)
/fisiopatología , Cardiopatías/fisiopatología , Adulto , Anciano , Arritmias Cardíacas/sangre , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/fisiopatología , Biomarcadores/sangre , /complicaciones , Electrocardiografía , Femenino , Cardiopatías/sangre , Cardiopatías/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Estudios Prospectivos , Análisis de Supervivencia , Sobrevivientes , Disfunción Ventricular Izquierda/sangre , Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/fisiopatología
3.
J Cardiovasc Med (Hagerstown) ; 22(1): 29-35, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33186239

RESUMEN

INTRODUCTION: During the coronavirus disease-19 (COVID-19) outbreak in spring 2020, people may have been reluctant to seek medical care fearing infection. We aimed to assess the number, characteristics and in-hospital course of patients admitted for acute cardiovascular diseases during the COVID-19 outbreak. METHODS: We enrolled all consecutive patients admitted urgently for acute myocardial infarction, heart failure or arrhythmias from 1 March to 31 May 2020 (outbreak period) and 2019 (control period). We evaluated the time from symptoms onset to presentation, clinical conditions at admission, length of hospitalization, in-hospital medical procedures and outcome. The combined primary end point included in-hospital death for cardiovascular causes, urgent heart transplant or discharge with a ventricular assist device. RESULTS: A similar number of admissions were observed in 2020 (N = 210) compared with 2019 (N = 207). Baseline characteristics of patients were also similar. In 2020, a significantly higher number of patients presented more than 6 h after symptoms onset (57 versus 38%, P < 0.001) and with signs of heart failure (33 versus 20%, P = 0.018), required urgent surgery (13 versus 5%, P = 0.004) and ventilatory support (26 versus 13%, P < 0.001). Hospitalization duration was longer in 2020 (median 10 versus 8 days, P = 0.03). The primary end point was met by 19 (9.0%) patients in 2020 versus 10 (4.8%) in 2019 (P = 0.09). CONCLUSION: Despite the similar number and types of unplanned admissions for acute cardiac conditions during the 2020 COVID-19 outbreak compared with the same period in 2019, we observed a higher number of patients presenting late after symptoms onset as well as longer and more complicated clinical courses.


Asunto(s)
Arritmias Cardíacas/epidemiología , Insuficiencia Cardíaca/epidemiología , Hospitalización/estadística & datos numéricos , Infarto del Miocardio con Elevación del ST/epidemiología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Femenino , Hospitales de Enseñanza , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias
4.
Eur Heart J ; 42(5): 520-528, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33321517

RESUMEN

AIMS: Our objective was to determine the ventricular arrhythmia burden in implantable cardioverter-defibrillator (ICD) patients during COVID-19. METHODS AND RESULTS: In this multicentre, observational, cohort study over a 100-day period during the COVID-19 pandemic in the USA, we assessed ventricular arrhythmias in ICD patients from 20 centres in 13 states, via remote monitoring. Comparison was via a 100-day control period (late 2019) and seasonal control period (early 2019). The primary outcome was the impact of COVID-19 on ventricular arrhythmia burden. The secondary outcome was correlation with COVID-19 incidence. During the COVID-19 period, 5963 ICD patients underwent remote monitoring, with 16 942 episodes of treated ventricular arrhythmias (2.8 events per 100 patient-days). Ventricular arrhythmia burden progressively declined during COVID-19 (P < 0.001). The proportion of patients with ventricular arrhythmias amongst the high COVID-19 incidence states was significantly reduced compared with those in low incidence states [odds ratio 0.61, 95% confidence interval (CI) 0.54-0.69, P < 0.001]. Comparing patients remotely monitored during both COVID-19 and control periods (n = 2458), significantly fewer ventricular arrhythmias occurred during COVID-19 [incident rate ratio (IRR) 0.68, 95% CI 0.58-0.79, P < 0.001]. This difference persisted when comparing the 1719 patients monitored during both the COVID-19 and seasonal control periods (IRR 0.69, 95% CI 0.56-0.85, P < 0.001). CONCLUSIONS: During COVID-19, there was a 32% reduction in ventricular arrhythmias needing device therapies, coinciding with measures of social isolation. There was a 39% reduction in the proportion of patients with ventricular arrhythmias in states with higher COVID-19 incidence. These findings highlight the potential role of real-life stressors in ventricular arrhythmia burden in individuals with ICDs. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry; URL: https://www.anzctr.org.au/; Unique Identifier: ACTRN12620000641998.


Asunto(s)
Arritmias Cardíacas/epidemiología , Desfibriladores Implantables , Fibrilación Ventricular/epidemiología , Adulto , Anciano , Arritmias Cardíacas/etiología , Arritmias Cardíacas/terapia , /prevención & control , Costo de Enfermedad , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Pandemias , Factores Protectores , Sistema de Registros , Factores de Riesgo , Estrés Psicológico , Telemedicina , Estados Unidos/epidemiología , Fibrilación Ventricular/etiología , Fibrilación Ventricular/terapia
5.
Indian Heart J ; 72(6): 500-507, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33357637

RESUMEN

INTRODUCTION: Since the epidemic of COVID-19 attracted the attention, reports were surrounding electrocardiographic changes in the infected individuals. We aimed at pinpointing different observed ECG findings and discussing their clinical significance. METHODS: We conducted a systematic search in PubMed, Embase, and Scopus databases. We included eligible original papers, reports, letters to the editors, and case reports published from December 2019 to May 10, 2020. RESULTS: The team identified 20 articles related to this topic. We divided them into articles discussing drug-induced and non-drug-induced changes. Studies reported an increased risk of QTc interval prolongations influenced by different therapies based on chloroquine, hydroxychloroquine, and azithromycin. Although these medications increased risks of severe QTc prolongations, they induced no arrhythmia-related deaths. In the non-drug-induced group, ST-T abnormalities, notably ST elevation, accounted for the most observed ECG finding in the patients with COVID-19, but their relation with myocardial injuries was under dispute. CONCLUSION: This systematic review suggests that identifying ECG patterns that might be related to COVID-19 is vital. Provided that physicians do not recognize these patterns, they might erroneously risk the lives of their patients. Furthermore, important drug-induced ECG changes provide awareness to the health-care workers on the risks of possible therapies.


Asunto(s)
Arritmias Cardíacas/diagnóstico , Electrocardiografía , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/fisiopatología , Comorbilidad , Humanos , Pandemias
6.
Ter Arkh ; 92(10): 70-77, 2020 Nov 24.
Artículo en Ruso | MEDLINE | ID: mdl-33346482

RESUMEN

Cardiovascular complications including arrhythmias and cardiac conduction disorders are one of the main reasons of high mortality rate in acromegaly, while they have not been well explored. AIM: To estimate arrhythmias frequency in acromegaly, identify risk factors leading to the development of arrhythmia and cardiac conduction disorder, to determine the role of cardiac MRI in detecting structural and functional changes. MATERIALS AND METHODS: A single-center prospective cohort study, which included 461 patients (151 men and 310 women) with acromegaly, was conducted. All the patients underwent a standard medical examination, including hormonal blood test, electrocardiogram, echocardiography, electrocardiogram daily monitoring. 18 patients with arrhythmias (11 men and 7 women) had cardiac MRI with gadolinium-based contrast. RESULTS: The results of our research show high frequency of arrhythmias and cardiac conduction disorders in patients with acromegaly 42%. Most frequent kinds of arrhythmias and cardiac conduction disorders were sinus bradycardia 19.1% of the cases and conduction disorders of bundle branch blocks 14.5%. Men were more likely to suffer from arrhythmias and cardiac conduction disorders than women (54.2% and 37.4%, respectively,p=0.0005). Not acromegaly activity but duration of the disease was a main risk factor of arrhythmias and cardiac conduction disorders. Patients with arrhythmias had a long anamnesis of acromegaly (10 and 7 years, respectively, p=0.04). Meanwhile, cardiac conduction disorders were commonly observed in the patients who were treated with somatostatin analogs comparing to the patients who didnt undergo this therapy (50% and 38.6% respectively,p=0.004). We showed that 61% of patients with acromegaly and cardiac conduction disorders who underwent magnetic resonance imaging (MRI) had the signs of myocardial fibrosis. The value of the ejection fraction of the left ventricle according to MRI was higher than with echocardiography (p=0.04). CONCLUSION: Arrhythmias and cardiac conduction disorders are often observed in patients with acromegaly even with remission of the disease. High risk group need careful diagnostic and monitoring approaches. Cardiac MRI is the gold standard for visualization of structural and morphological changes in the heart. Use of cardiac MRI in acromegalic patients expands our understanding of arrhythmias and cardiac conduction disorders in this disease. There are no specific laboratory markers of diffuse myocardial fibrosis, and the role of myocardial fibrosis in the occurrence of cardiac arrhythmias and conduction disorders needs further studying.


Asunto(s)
Acromegalia , Acromegalia/complicaciones , Acromegalia/diagnóstico por imagen , Acromegalia/epidemiología , Arritmias Cardíacas/diagnóstico por imagen , Arritmias Cardíacas/epidemiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Miocardio , Estudios Prospectivos
7.
Orv Hetil ; 161(50): 2117-2123, 2020 12 13.
Artículo en Húngaro | MEDLINE | ID: mdl-33310925

RESUMEN

Összefoglaló. Bevezetés és célkituzés: Az obstruktív alvási apnoe (OSA) a felnott lakosság jelentos részét érinto betegség, mely ismert rizikófaktora a cardiovascularis és metabolicus betegségeknek és a korai halálozásnak. Mindazonáltal kevés magyarországi adat áll rendelkezésre az OSA-ban szenvedo betegek demográfiai és klinikai jellemzoirol, így vizsgálatunk célja ennek bemutatása volt. Módszer: Retrospektív vizsgálatunkban a Semmelweis Egyetem Pulmonológiai Klinikájának Alváslaboratóriumában kivizsgált 394 személy (58 [46-66] év, 73% férfi, testtömegindex [BMI] = 32,5 [29,2-37,5]) adatait elemeztük, akik kitöltötték az Epworth Álmosság Skálát, poliszomnográfiás vizsgálaton estek át; felvettük az anamnézist, és 255 esetben reggeli éhomi vérvétel történt. Eredmények: 282 esetben igazolódott OSA. Ebben a csoportban magasabb volt a férfiak aránya (66 vs. 35%), magasabb volt az életkor (59 [48-66] vs. 47 [39-60] év) és a BMI (32,11 [27,78-37,18] vs. 25,29 [22,04-29,03] kg/m2), magasabbak voltak a C-reaktív protein értékek (3,0 [1,71-5,34] mg/l vs. 1,71 [0,91-3,31] mg/l), illetve a betegek gyakrabban szenvedtek társbetegségekben a kontrollcsoporthoz képest (magas vérnyomás 74% vs. 39%, cukorbetegség 24% vs. 11%, dyslipidaemia 46% vs. 30%, szív- és érrendszeri betegség 22% vs. 5%, szívritmuszavar 27% vs. 16%; minden p<0,05). Bár az OSA valószínusége progresszívan nott az életkorral és az Epworth Álmosság Skála emelkedésével, a trendekben szignifikáns különbségeket észleltünk a férfiak és a nok között (mindketto p<0,05). Ezzel szemben az OSA valószínuségének BMI-függése nemektol független volt (p = 0,94). Következtetés: Az OSA valószínusége progresszívan emelkedik a kor, a BMI és a nappali aluszékonyság függvényében, ugyanakkor ezt befolyásolja a nem is. Közleményünk rámutat a társbetegségek szurésének fontosságára is az OSA különbözo súlyossági fokaiban. Orv Hetil. 2020; 161(50): 2117-2123. INTRODUCTION AND OBJECTIVE: Obstructive sleep apnoea (OSA) is a common disease which is a known risk factor for cardiovascular and metabolic disease and mortality as well. However, the demographic and clinical characteristics of Hungarian patients with OSA are less known. The aim of this study was to describe them. METHOD: We analysed the data of 394 subjects (58 [46-66] years, 73% male, body mass index [BMI] = 32.5 [29.2-37.5]) who attended the Sleep Laboratory of the Department of Pulmonology at Semmelweis University. The volunteers filled out the Epworth Sleepiness Scale, we performed a polysomnography and took medical history. In 255 subjects, fasting blood samples were collected. RESULTS: OSA was diagnosed in 282 cases. This group had higher proportion of males (66 vs. 35%) and comorbidities (hypertension 74% vs. 39%, diabetes 24% vs. 11%, dyslipidaemia 46% vs. 30%, cardiovascular diseases 22% vs. 5%, arrhythmia 27% vs. 16%), the patients were older (59 [48-66] vs. 47 [39-60] years) and had higher BMI (32.11 [27.78-37.18] vs. 25.29 [22.04-29.03] kg/m2) and C-reactive protein levels (3.0 [1.71-5.34] mg/l vs. 1.71 [0.91-3.31] mg/l, all p<0.05). There was a significant relationship between the propensity of OSA along increasing age, BMI and Epworth Sleepiness Scale; however, the relationship depended on gender for age and Epworth Sleepiness Scale (both p<0.05). CONCLUSION: The propensity of OSA increases with age, BMI and symptoms burden and it is affected by the gender. Our study highlights the importance of screening comorbidities in different severity grades of OSA. Orv Hetil. 2020; 161(50): 2117-2123.


Asunto(s)
Arritmias Cardíacas/epidemiología , Hipertensión/epidemiología , Apnea Obstructiva del Sueño/diagnóstico , Factores de Edad , Anciano , Índice de Masa Corporal , Proteína C-Reactiva/metabolismo , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Dislipidemias/epidemiología , Femenino , Humanos , Hungría/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Apnea Obstructiva del Sueño/epidemiología
8.
Eur Rev Med Pharmacol Sci ; 24(21): 11395-11401, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33215461

RESUMEN

OBJECTIVE: Many studies have reported arrhythmia to be associated with coronavirus disease (COVID-19), but no meta-analysis has explored whether arrhythmia is related to COVID-19 severity. Therefore, the purpose of this study was to evaluate arrhythmia in patients with severe and non-severe COVID-19 during the current COVID-19 pandemic. MATERIALS AND METHODS: We searched PubMed, Embase, Web of Science, and the Cochrane Library for case control studies that were published between January 1 and July 25, 2020, and that had data on arrhythmia in patients with COVID-19. Random effects model was used with the odds ratio as the effect size. The frequency of arrhythmia was compared between COVID-19 patients with and without the composite endpoint of severity. We also determined the pooled prevalence of arrhythmia in patients with COVID-19. Publication bias and heterogeneity were considered by using subgroup analyses, meta-regression, and the trim and fill method. RESULTS: A total of 1553 patients with COVID-19 were included in the 5 articles we obtained. Of these, 349 cases (22.47%) and 1204 cases (77.53%) were severely ill and non-severely ill inpatients with COVID-19 pneumonia, respectively. There were 790 (50.87%) male patients. A total of 105 cases (30.09%) of severely ill inpatients with COVID-19 pneumonia had arrhythmia complications, and 34 cases (2.82%) of non-severely ill inpatients with COVID-19 pneumonia had arrhythmia complications. We found arrhythmia to be significantly associated with severely ill inpatients with COVID-19 pneumonia, with a pooled odds ratio of 17.97 (95% CI (11.30, 28.55), p<0.00001). CONCLUSIONS: This study showed that the incidence of arrhythmia in patients with severe COVID-19 was greater than that of those with non-severe COVID-19. Patients with severe COVID-19 had a higher risk of arrhythmia complications, which further showed that COVID-19 may be a risk factor for arrhythmia and that the incidence of arrhythmia may increase with the progression of the disease. More importantly, this meta-analysis graded the reliability of evidence for further basic and clinical research into arrhythmia in patients with COVID-19.


Asunto(s)
Arritmias Cardíacas/epidemiología , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Arritmias Cardíacas/etiología , Arritmias Cardíacas/terapia , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/terapia , Humanos , Incidencia , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/inmunología , Neumonía Viral/terapia , Factores de Riesgo , Índice de Severidad de la Enfermedad
9.
Rev. esp. cardiol. (Ed. impr.) ; 73(11): 910-918, nov. 2020. tab
Artículo en Español | IBECS | ID: ibc-192006

RESUMEN

La pandemia producida por la infección por el coronavirus SARS-CoV-2 (COVID-19) ha cambiado la forma de entender nuestras consultas. Para reducir el riesgo de contagio de los pacientes más vulnerables (aquellos con cardiopatías) y del personal sanitario, se han suspendido la mayoría de las consultas presenciales y se han puesto en marcha las consultas telemáticas. Este cambio se ha implementado en muy poco tiempo, pero parece que ha venido para quedarse. No obstante, hay grandes dudas sobre aspectos organizativos, legales, posibilidades de mejora, etc. En este documento de consenso de la Sociedad Española de Cardiología, tratamos de dar las claves para mejorar la calidad asistencial en nuestras nuevas consultas telemáticas, revisando las afecciones que el cardiólogo clínico atiende con más frecuencia en su consulta ambulatoria y proponiendo unos mínimos en ese proceso asistencial. Estas enfermedades son la cardiopatía isquémica, la insuficiencia cardiaca y las arritmias. En los 3 escenarios tratamos de clarificar los aspectos fundamentales que hay que revisar en la entrevista telefónica, a qué pacientes habrá que atender en una consulta presencial y cuáles serán los criterios para su seguimiento en atención primaria. El documento también recoge distintas mejoras que pueden introducirse en la consulta telemática para mejorar la asistencia de nuestros pacientes


The coronavirus disease 2019 (COVID-19) pandemic has changed how we view our consultations. To reduce the risk of spread in the most vulnerable patients (those with heart disease) and health personnel, most face-to-face consultations have been replaced by telemedicine consultations. Although this change has been rapidly introduced, it will most likely become a permanent feature of clinical practice. Nevertheless, there remain serious doubts about organizational and legal issues, as well as the possibilities for improvement etc. In this consensus document of the Spanish Society of Cardiology, we attempt to provide some keys to improve the quality of care in this new way of working, reviewing the most frequent heart diseases attended in the cardiology outpatient clinic and proposing some minimal conditions for this health care process. These heart diseases are ischemic heart disease, heart failure, and arrhythmias. In these 3 scenarios, we attempt to clarify the basic issues that must be checked during the telephone interview, describe the patients who should attend in person, and identify the criteria to refer patients for follow-up in primary care. This document also describes some improvements that can be introduced in telemedicine consultations to improve patient care


Asunto(s)
Humanos , Telecardiología , Consulta Remota/métodos , Infecciones por Coronavirus/epidemiología , Isquemia Miocárdica/epidemiología , Insuficiencia Cardíaca/epidemiología , Arritmias Cardíacas/epidemiología , Pautas de la Práctica en Medicina/tendencias , Pandemias/estadística & datos numéricos , Cuarentena/estadística & datos numéricos , Distancia Social , Infecciones por Coronavirus/transmisión , Mejoramiento de la Calidad/tendencias
10.
BMC Public Health ; 20(1): 1524, 2020 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-33032561

RESUMEN

BACKGROUND: Arrhythmia is a common cardiovascular event that is associated with increased cardiovascular health risks. Previous studies that have explored the association between air pollution and arrhythmia have obtained inconsistent results, and the association between the two in China is unclear. METHODS: We collected daily data on air pollutants and meteorological factors from 1st January 2014 to 31st December 2016, along with daily outpatient visits for arrhythmia in Hangzhou, China. We used a quasi-Poisson regression along with a distributed lag nonlinear model to study the association between air pollution and arrhythmia morbidity. RESULTS: The results of the single-pollutant model showed that each increase of 10 µg/m3 of Fine particulate matter (PM2.5), Coarse particulate matter (PM10), Sulphur dioxide (SO2), Nitrogen dioxide (NO2), and Ozone (O3) resulted in increases of 0.6% (- 0.9, 2.2%), 0.7% (- 0.4, 1.7%), 11.9% (4.5, 19.9%), 6.7% (3.6, 9.9%), and - 0.9% (- 2.9, 1.2%), respectively, in outpatient visits for arrhythmia; each increase of 1 mg/m3 increase of carbon monoxide (CO) resulted in increase of 11.3% (- 5.9, 31.6%) in arrhythmia. The short-term effects of air pollution on arrhythmia lasted 3 days, and the most harmful effects were observed on the same day that the pollution occurred. Results of the subgroup analyses showed that SO2 and NO2 affected both men and women, but differences between the sexes were not statistically significant. The effect of SO2 on the middle-aged population was statistically significant. The effect of NO2 was significant in both the young and middle-aged population, and no significant difference was found between them. Significant effects of air pollution on arrhythmia were only detected in the cold season. The results of the two-pollutants model and the single-pollutant model were similar. CONCLUSIONS: SO2 and NO2 may induce arrhythmia, and the harmful effects are primarily observed in the cold season. There is no evidence of PM2.5, PM10, CO and O3 increasing arrhythmia risk. Special attention should be given to sensitive populations during the high-risk period.


Asunto(s)
Contaminación del Aire/efectos adversos , Atención Ambulatoria/estadística & datos numéricos , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/terapia , Contaminantes Atmosféricos/análisis , Contaminación del Aire/análisis , China/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estaciones del Año
11.
Stroke ; 51(10): 3156-3168, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32897811

RESUMEN

Understanding the relationship between infection and stroke has taken on new urgency in the era of the coronavirus disease 2019 (COVID-19) pandemic. This association is not a new concept, as several infections have long been recognized to contribute to stroke risk. The association of infection and stroke is also bidirectional. Although infection can lead to stroke, stroke also induces immune suppression which increases risk of infection. Apart from their short-term effects, emerging evidence suggests that poststroke immune changes may also adversely affect long-term cognitive outcomes in patients with stroke, increasing the risk of poststroke neurodegeneration and dementia. Infections at the time of stroke may also increase immune dysregulation after the stroke, further exacerbating the risk of cognitive decline. This review will cover the role of acute infections, including respiratory infections such as COVID-19, as a trigger for stroke; the role of infectious burden, or the cumulative number of infections throughout life, as a contributor to long-term risk of atherosclerotic disease and stroke; immune dysregulation after stroke and its effect on the risk of stroke-associated infection; and the impact of infection at the time of a stroke on the immune reaction to brain injury and subsequent long-term cognitive and functional outcomes. Finally, we will present a model to conceptualize the many relationships among chronic and acute infections and their short- and long-term neurological consequences. This model will suggest several directions for future research.


Asunto(s)
Aterosclerosis/epidemiología , Infecciones/epidemiología , Accidente Cerebrovascular/epidemiología , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/fisiopatología , Aterosclerosis/inmunología , Aterosclerosis/fisiopatología , Bacteriemia/epidemiología , Bacteriemia/inmunología , Bacteriemia/fisiopatología , Betacoronavirus , Enfermedad Crónica , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/fisiopatología , Infecciones por Citomegalovirus/epidemiología , Infecciones por Citomegalovirus/inmunología , Infecciones por Citomegalovirus/fisiopatología , Endotelio/fisiopatología , Infecciones por VIH/epidemiología , Infecciones por VIH/inmunología , Infecciones por VIH/fisiopatología , Humanos , Huésped Inmunocomprometido/inmunología , Infecciones/inmunología , Infecciones/fisiopatología , Inflamación/inmunología , Gripe Humana/epidemiología , Gripe Humana/inmunología , Gripe Humana/fisiopatología , Pandemias , Activación Plaquetaria , Agregación Plaquetaria , Neumonía/epidemiología , Neumonía/inmunología , Neumonía/fisiopatología , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Neumonía Viral/fisiopatología , Pronóstico , Factores de Riesgo , Accidente Cerebrovascular/inmunología , Trombosis/epidemiología , Trombosis/inmunología , Infección por el Virus de la Varicela-Zóster/epidemiología , Infección por el Virus de la Varicela-Zóster/inmunología , Infección por el Virus de la Varicela-Zóster/fisiopatología
12.
Intern Emerg Med ; 15(8): 1445-1456, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32889687

RESUMEN

COVID-19 outbreak had a major impact on the organization of care in Italy, and a survey to evaluate provision of for arrhythmia during COVID-19 outbreak (March-April 2020) was launched. A total of 104 physicians from 84 Italian arrhythmia centres took part in the survey. The vast majority of participating centres (95.2%) reported a significant reduction in the number of elective pacemaker implantations during the outbreak period compared to the corresponding two months of year 2019 (50.0% of centres reported a reduction of > 50%). Similarly, 92.9% of participating centres reported a significant reduction in the number of implantable cardioverter-defibrillator (ICD) implantations for primary prevention, and 72.6% a significant reduction of ICD implantations for secondary prevention (> 50% in 65.5 and 44.0% of the centres, respectively). The majority of participating centres (77.4%) reported a significant reduction in the number of elective ablations (> 50% in 65.5% of the centres). Also the interventional procedures performed in an emergency setting, as well as acute management of atrial fibrillation had a marked reduction, thus leading to the conclusion that the impact of COVID-19 was disrupting the entire organization of health care, with a massive impact on the activities and procedures related to arrhythmia management in Italy.


Asunto(s)
Arritmias Cardíacas/diagnóstico , Infecciones por Coronavirus/complicaciones , Electrofisiología/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Neumonía Viral/complicaciones , Adulto , Anciano , Arritmias Cardíacas/epidemiología , Terapia de Resincronización Cardíaca/estadística & datos numéricos , Electrofisiología/métodos , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Médicos/psicología , Médicos/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Encuestas y Cuestionarios
13.
Am J Cardiol ; 134: 24-31, 2020 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-32892989

RESUMEN

Clinical trials have shown improved outcomes with an early invasive approach for non-ST-elevation myocardial infarction (NSTEMI). However, real-world data on clinical characteristics and outcomes based on time to revascularization are lacking. We aimed to analyze NSTEMI rates, revascularization timing, and mortality using the 2016 Nationwide Readmissions Database. We identify patients who underwent diagnostic angiography and subsequently received either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Finally, revascularization timing and mortality rates (in-hospital and 30-day) were extracted. Our analysis included 748,463 weighted NSTEMI hospitalizations in 2016. Of these hospitalizations, 50.3% (376,695) involved diagnostic angiography, with 34.1% (255,199) revascularized. Of revascularized patients, 77.6% (197,945) underwent PCI and 22.4% (57,254) underwent CABG. Patients with more comorbidities tended to have more delayed revascularization. PCI was most commonly performed on the day of admission (32.9%; 65,155). This differs from CABG, which was most commonly performed on day 3 after admission (13.7%; 7,823). The in-hospital mortality rate increased after day 1 for PCI patients and after day 4 for CABG patients, whereas 30-day in-hospital mortality for both populations increased as revascularization was delayed. Our study shows that patients undergoing early revascularization differ from those undergoing later revascularization. Mortality is generally high with delayed revascularization, as these are sicker patients. Randomized clinical trials are needed to evaluate whether very early revascularization (<90 minutes) is associated with improved long-term outcomes in high-risk patients.


Asunto(s)
Puente de Arteria Coronaria/estadística & datos numéricos , Mortalidad Hospitalaria , Infarto del Miocardio sin Elevación del ST/cirugía , Intervención Coronaria Percutánea/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Anemia/epidemiología , Arritmias Cardíacas/epidemiología , Trastornos de la Coagulación Sanguínea/epidemiología , Comorbilidad , Angiografía Coronaria , Diabetes Mellitus/epidemiología , Intervención Médica Temprana , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Revascularización Miocárdica/estadística & datos numéricos , Infarto del Miocardio sin Elevación del ST/epidemiología , Estados Unidos/epidemiología
14.
Anesth Analg ; 131(4): 1164-1172, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32925337

RESUMEN

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common occurrence after cardiac surgery. However, in contrast to other surgical populations, routine PONV prophylaxis is not a standard of care in cardiac surgery. We hypothesized that routine administration of a single prophylactic dose of ondansetron (4 mg) at the time of stopping postoperative propofol sedation before extubation in the cardiac surgery intensive care unit would decrease the incidence of PONV. METHODS: With institutional human ethics board approval and written informed consent, we conducted a randomized controlled trial in patients ≥19 years of age with no history of PONV undergoing elective or urgent cardiac surgery procedures requiring cardiopulmonary bypass. The primary outcome was the incidence of PONV in the first 24 hours postextubation, compared by the χ test. Secondary outcomes included the incidence and times to first dose of rescue antiemetic treatment administration, the incidence of headaches, and the incidence of ventricular arrhythmias. RESULTS: PONV within the first 24 hours postextubation occurred in 33 of 77 patients (43%) in the ondansetron group versus 50 of 82 patients (61%) in the placebo group (relative risk, 0.70 [95% confidence interval {CI}, 0.51-0.95]; absolute risk difference, -18% [95% CI, -33 to -2]; number needed to treat, 5.5 [95% CI, 3.0-58.4]; χ test, P = .022). Kaplan-Meier "survival" analysis of the times to first rescue antiemetic treatment administration over 24 hours indicated that patients in the ondansetron group fared better than those in the placebo group (log-rank [Mantel-Cox] test; P = .028). Overall, 32 of 77 patients (42%) in the ondansetron group received rescue antiemetic treatment over the first 24 hours postextubation versus 47 of 82 patients (57%) in the placebo group (relative risk, 0.73 [95% CI, 0.52-1.00]; absolute risk difference, -16% [95% CI, -31 to 1]); P = .047. There were no significant differences between the groups in the incidence of postoperative headache (ondansetron group, 5 of 77 patients [6%] versus placebo group, 4 of 82 patients [5%]; Fisher exact test; P = .740) or ventricular arrhythmias (ondansetron group, 2 of 77 patients [3%] versus placebo group, 4 of 82 patients [5%]; P = .68). CONCLUSIONS: These findings support the routine administration of ondansetron prophylaxis at the time of discontinuation of postoperative propofol sedation before extubation in patients following cardiac surgery. Further research is warranted to optimize PONV prophylaxis in cardiac surgery patients.


Asunto(s)
Antieméticos/uso terapéutico , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Ondansetrón/uso terapéutico , Náusea y Vómito Posoperatorios/prevención & control , Anciano , Arritmias Cardíacas/epidemiología , Puente Cardiopulmonar , Método Doble Ciego , Femenino , Cefalea/epidemiología , Cefalea/etiología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/epidemiología , Resultado del Tratamiento
17.
Food Chem Toxicol ; 145: 111742, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32916218

RESUMEN

SARS-CoV-2 (Covid-19) infection has recently become a worldwide challenge with dramatic global economic and health consequences. As the pandemic is still spreading, new data concerning Covid-19 complications and related mechanisms become increasingly available. Accumulating data suggest that the incidence of cardiac arrest and its outcome are adversely affected during the Covid-19 period. This may be further exacerbated by drug-related cardiac toxicity of Covid-19 treatment regimens. Elucidating the underlying mechanisms that lead to Covid-19 associated cardiac arrest is imperative, not only in order to improve its effective management but also to maximize preventive measures. Herein we discuss available epidemiological data on cardiac arrest during the Covid-19 pandemic as well as possible associated causes and pathophysiological mechanisms and highlight gaps in evidence warranting further investigation. The risk of transmission during cardiopulmonary resuscitation (CPR) is also discussed in this review. Finally, we summarize currently recommended guidelines on CPR for Covid-19 patients including CPR in patients with cardiac arrest due to suspected drug-related cardiac toxicity in an effort to underscore the most important common points and discuss discrepancies proposed by established international societies.


Asunto(s)
Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/fisiopatología , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Paro Cardíaco/epidemiología , Paro Cardíaco/fisiopatología , Neumonía Viral/complicaciones , Arritmias Cardíacas/etiología , Reanimación Cardiopulmonar/normas , Cardiotoxicidad/epidemiología , Cardiotoxicidad/etiología , Cardiotoxicidad/fisiopatología , Infecciones por Coronavirus/tratamiento farmacológico , Transmisión de Enfermedad Infecciosa/prevención & control , Paro Cardíaco/etiología , Humanos , Pandemias , Neumonía Viral/tratamiento farmacológico
18.
JACC Clin Electrophysiol ; 6(9): 1193-1204, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32972561

RESUMEN

Current understanding of the impact of coronavirus disease-2019 (COVID-19) on arrhythmias continues to evolve as new data emerge. Cardiac arrhythmias are more common in critically ill COVID-19 patients. The potential mechanisms that could result in arrhythmogenesis among COVID-19 patients include hypoxia caused by direct viral tissue involvement of lungs, myocarditis, abnormal host immune response, myocardial ischemia, myocardial strain, electrolyte derangements, intravascular volume imbalances, and drug sides effects. To manage these arrhythmias, it is imperative to increase the awareness of potential drug-drug interactions, to monitor QTc prolongation while receiving COVID therapy and provide special considerations for patients with inherited arrhythmia syndromes. It is also crucial to minimize exposure to COVID-19 infection by stratifying the need for intervention and using telemedicine. As COVID-19 infection continues to prevail with a potential for future surges, more data are required to better understand pathophysiology and to validate management strategies.


Asunto(s)
Arritmias Cardíacas/etiología , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Pandemias , Neumonía Viral/complicaciones , Arritmias Cardíacas/epidemiología , Infecciones por Coronavirus/epidemiología , Salud Global , Humanos , Morbilidad/tendencias , Neumonía Viral/epidemiología
19.
Mayo Clin Proc ; 95(8): 1696-1700, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32753141

RESUMEN

Among candidate drugs to treat coronavirus disease 2019 (COVID-19), the combination of hydroxychloroquine (HCQ) and azithromycin (AZ) has received intense worldwide attention. Even as the efficacy of this combination is under evaluation, clinicians have begun to use it largely. As these medications are known to prolong the QT interval, we analyzed serial electrocardiograms recorded in patients hospitalized for COVID-19 pneumonia and treated with HCQ + AZ. Fifty consecutive patients received the combination of HCQ (600 mg/d for 10 days) and AZ (500 mg/d on day 1 and 250 mg/d from day 2 to day 5). Twelve-lead electrocardiograms were recorded before treatment, at day 3, at day 5, and at discharge. The median age of patients was 68 years (interquartile range, 53-81 years); 28 (56%) were men. The main comorbidities were hypertension (36%; n=18) and diabetes (16%; n=8). The mean corrected QT (QTc) interval was 408 ms at baseline and increased up to 437 ms at day 3 and to 456 ms at day 5. Thirty-eight patients (76%) presented short-term modifications of the QTc duration (>30 ms). Treatment discontinuation was decided in 6 patients (12%), leading to QTc normalization in 5 of them. No deaths and no cardiac arrhythmic events were observed in this cohort. Our report confirms that a short duration treatment with HCQ + AZ modifies the QTc interval. The treatment had to be discontinued for QTc modifications in 12% of patients. Nevertheless, in inpatients hospitalized for COVID-19, we did not observe any clinically relevant consequences of these transitory modifications. In conclusion, when patients are treated with HCQ + AZ, cardiac monitoring should be regularly performed and hospital settings allow monitoring under in safe conditions.


Asunto(s)
Antivirales/efectos adversos , Arritmias Cardíacas/inducido químicamente , Azitromicina/efectos adversos , Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Hidroxicloroquina/efectos adversos , Neumonía Viral/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiología , Azitromicina/uso terapéutico , Esquema de Medicación , Quimioterapia Combinada , Electrocardiografía , Femenino , Humanos , Hidroxicloroquina/uso terapéutico , Masculino , Persona de Mediana Edad , Pandemias , Resultado del Tratamiento
20.
Rev Esp Anestesiol Reanim ; 67(8): 425-437, 2020 10.
Artículo en Inglés, Español | MEDLINE | ID: mdl-32800622

RESUMEN

BACKGROUND: The clinical course of COVID-19 critically ill patients, during their admission in the intensive care unit (UCI), including medical and infectious complications and support therapies, as well as their association with in-ICU mortality has not been fully reported. OBJECTIVE: This study aimed to describe clinical characteristics and clinical course of ICU COVID-19 patients, and to determine risk factors for ICU mortality of COVID-19 patients. METHODS: Prospective, multicentre, cohort study that enrolled critically ill COVID-19 patients admitted into 30 ICUs from Spain and Andorra. Consecutive patients from March 12th to May 26th, 2020 were enrolled if they had died or were discharged from ICU during the study period. Demographics, symptoms, vital signs, laboratory markers, supportive therapies, pharmacological treatments, medical and infectious complications were reported and compared between deceased and discharged patients. RESULTS: A total of 663 patients were included. Overall ICU mortality was 31% (203 patients). At ICU admission non-survivors were more hypoxemic [SpO2 with non-rebreather mask, 90 (IQR 83 to 93) vs. 91 (IQR 87 to 94); P<.001] and with higher sequential organ failure assessment score [SOFA, 7 (IQR 5 to 9) vs. 4 (IQR 3 to 7); P<.001]. Complications were more frequent in non-survivors: acute respiratory distress syndrome (ARDS) (95% vs. 89%; P=.009), acute kidney injury (AKI) (58% vs. 24%; P<10-16), shock (42% vs. 14%; P<10-13), and arrhythmias (24% vs. 11%; P<10-4). Respiratory super-infection, bloodstream infection and septic shock were higher in non-survivors (33% vs. 25%; P=.03, 33% vs. 23%; P=.01 and 15% vs. 3%, P=10-7), respectively. The multivariable regression model showed that age was associated with mortality, with every year increasing risk-of-death by 1% (95%CI: 1 to 10, P=.014). Each 5-point increase in APACHE II independently predicted mortality [OR: 1.508 (1.081, 2.104), P=.015]. Patients with AKI [OR: 2.468 (1.628, 3.741), P<10-4)], cardiac arrest [OR: 11.099 (3.389, 36.353), P=.0001], and septic shock [OR: 3.224 (1.486, 6.994), P=.002] had an increased risk-of-death. CONCLUSIONS: Older COVID-19 patients with higher APACHE II scores on admission, those who developed AKI grades ii or iii and/or septic shock during ICU stay had an increased risk-of-death. ICU mortality was 31%.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos/estadística & datos numéricos , Neumonía Viral/mortalidad , APACHE , Lesión Renal Aguda/epidemiología , Factores de Edad , Anciano , Andorra/epidemiología , Antivirales/uso terapéutico , Arritmias Cardíacas/epidemiología , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Enfermedad Crítica , Femenino , Humanos , Hipoxia/epidemiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Oxígeno/administración & dosificación , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Estudios Prospectivos , Análisis de Regresión , Terapia Respiratoria/métodos , Factores de Riesgo , Síndrome Respiratorio Agudo Grave/epidemiología , Choque/epidemiología , España/epidemiología
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