Post-covid-19 Syndrome: Role Of Cardiac Biomarkers Cordoba Melo, Brayan Daniel; Montero Echeverri, Juan Manuel; Escalante Forero, Manuela ...
Journal of cardiac failure,
January 2024, 2024-01-00, Letnik:
30, Številka:
1
Journal Article
Recenzirano
COVID-19 has caused about 700M cases and 7M deaths worldwide. Cardiac injury is common, linked to poor outcomes and can be detected by high troponin levels. Studies on these biomarkers are focused ...mostly on acute in-hospitalized patients. More research is needed to study the relevance of cardiac biomarkers in post-COVID-19 syndrome.
Evaluate the variation of cardiac biomarkers over time in a cohort of patients with previous hospitalization for severe COVID-19 between May/2020 and June/2021 (CARDIO COVID 19-20 Registry) and who were followed during February/2022 and March/2023 (CARDIO COVID 20-21 Registry)
The CARDIO COVID 19-20 Registry included 3260 hospitalized patients with confirmed COVID-19. CARDIO COVID 20-21 Registry planned to follow those discharged and alive patients (in-person or virtually) who had severe COVID-19 to evaluate long-term cardiac complications and post-COVID-19 syndrome. Blood tests performed included hemogram, troponin, NT-proBNP (N-Terminal pro-brain natriuretic peptide), D-dimer and creatinine. Qualitative variables were presented in frequency tables and quantitative variables with measures of central tendency depending on the normality of the distribution.
CARDIO COVID 19-20 registry included 3260 patients of which 1980 had severe COVID-19. 30 days after hospital discharge, 1626 patients (82.1%) were alive. For CARDIO COVID 20-21 registry, 272 patients (13.6%) from 5 Latin American countries were included and 188 of those patients (69.1%) had laboratory tests performed and were included in this analysis. Median age was 59 years (IQR 50-68) with a male predominance of 58.5%. The main cardiovascular complication was new-onset hypertension (5.3%) and myocardial injury (4.3%). During hospitalization, Troponin was elevated in 21.8%, D-dimer in 72.1% and NT-proBNP in 88.9% of cases. Regarding biomarkers after more than 20 months of follow-up, troponin was elevated in 8.7% of cases, D-dimer in 34.2% and NT-proBNP in 22.9%. There was a decreasing trend of those values over time (Figure 1).
A considerable percentage of patients show a persistent elevated cardiac biomarkers level almost 2 years after a severe COVID-19 episode. Further analysis models (like Generalized Linear Mixed Models) should be conducted to evaluate the correlation between different cardiac biomarkers and outcomes.
Heart failure (HF) is a significant health problem with a prevalence around 26 million people worldwide. Prevalence is increasing because of ageing of the population and improved cardiovascular ...treatment. Except for North America, information about HF for the rest of the continent is limited; therefore, regional clinical research is needed with the aim of creating consolidated data about the diagnosis, behavior, and clinical management of HF in the continent.
Describe demographic, clinical and hemodynamic characteristics of HF patients in the Americas, based on information collected in the AMERICCAASS Registry.
Descriptive, observational, prospective, multicenter registry, including patients older than 18 years with HF divided into two groups: hospitalized and ambulatory. Sociodemographic, comorbidities, physical examination, laboratory, diagnostic, clinical and hemodynamic variables were included. Information was collected in the REDCap platform. Univariate analysis was performed, qualitative variables were expressed as frequency and percentage. The normality of quantitative variables was found using the Shapiro Wilk test and they were expressed as median and interquartile range.
The first 2500 patients recruited from 67 institutions in 20 countries in the American continent were included, 882 hospitalized and 1618 ambulatory. Overall median age was 66.2 years (RIC 56.1, 75.3), 59.7% were male. For both groups (hospitalized and ambulatory), the most prevalent comorbidity was arterial hypertension, and the most prevalent etiology was ischemic. More than half of patients for both groups had reduced left ventricular ejection fraction (LVEF) (<40), 61.2% and 58.2%, respectively. In ambulatory patients, NYHA II predominate (57.9%). In hospitalized patients, NYHA III predominate (47.7%), as well as warm/wet hemodynamic profile (62.7%) and decompensated HF as clinical profile (72.1%). (Table 1 and 2).
AMERICCAASS registry is the first continental project in patients with HF. The results show a high prevalence of patients with reduced LVEF. The clinical and hemodynamic conditions of ambulatory and hospitalized patients show great similarities with international registries; however, we expect that further analysis may show significant differences in population of the American continent.
Many therapies for heart failure (HF) have shown differential impact across the spectrum of left ventricular ejection fraction (LVEF).
In this prespecified analysis, the authors assessed the effects ...of semaglutide across the baseline LVEF strata in patients with the obesity phenotype of HF with preserved ejection fraction (HFpEF) in the STEP-HFpEF (Semaglutide Treatment Effect in People with obesity and HFpEF) trial.
STEP-HFpEF randomized 529 patients (263 semaglutide; 266 placebo). For this prespecified analysis, patients were categorized into 3 groups based on LVEF: 45% to 49% (n = 85), 50% to 59% (n = 215), and ≥60% (n = 229).
At 52 weeks, semaglutide improved the dual primary endpoints of Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (estimated treatment difference: EF ejection fraction 45%-49%: 5.0 points 95% CI: -2.7 to 12.8 points, EF 50%-59%: 9.8 points 95% CI: 5.0 to 14.6 points, and EF ≥60%: 7.4 points 95% CI: 2.8 to 12.0 points; P interaction = 0.56) and body weight (EF: 45%-49%: -7.6 95% CI: -10.7 to -4.4, EF 50%-59%: -10.6 95% CI: -12.6 to -8.6 and EF ≥60%: -11.9 95% CI: -13.8 to -9.9; P interaction = 0.08), to a similar extent across LVEF categories. Likewise, LVEF did not influence the benefit of semaglutide on confirmatory secondary endpoints: 6-minute walk distance (P interaction = 0.19), hierarchal composite endpoint (P interaction = 0.43), and high-sensitivity C-reactive protein (P interaction = 0.26); or exploratory endpoint of N-terminal pro-brain natriuretic peptide (P interaction = 0.96). Semaglutide was well-tolerated across LVEF categories.
In patients with HFpEF and obesity, semaglutide 2.4 mg improved symptoms, physical limitations, and exercise function, and reduced inflammation and body weight to a similar extent across LVEF categories. These data support treatment with semaglutide in patients with the obesity phenotype of HFpEF regardless of LVEF. (Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity STEP-HFpEF; NCT04788511).
The glucagon-like peptide-1 receptor agonist, semaglutide, improved health status and reduced body weight in patients with obesity-related heart failure (HF) with preserved ejection fraction (HFpEF) ...in the STEP-HFpEF (Semaglutide Treatment Effect in People with Obesity and HFpEF) program. Whether benefits were due to mechanical unloading or effects on HF pathobiology is uncertain.
This study sought to determine if semaglutide 2.4 mg reduced N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with obesity-related HFpEF and compare treatment responses by baseline NT-proBNP.
This was a prespecified secondary analysis of pooled data from 2 double-blind, placebo-controlled, randomized trials (STEP-HFpEF Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity and STEP-HFpEF DM Research Study to Look at How Well Semaglutide Works in People Living With Heart Failure, Obesity and Type 2 Diabetes) testing effects of semaglutide in patients with obesity-related HFpEF. The main outcomes were change in NT-proBNP at 52 weeks and change in the dual primary endpoints of Kansas City Cardiomyopathy Questionnaire Clinical Summary Score and body weight by baseline NT-proBNP.
In total, 1,145 patients were randomized. Semaglutide compared with placebo reduced NT-proBNP at 52 weeks (estimated treatment ratio: 0.82; 95% CI: 0.74-0.91; P = 0.0002). Improvements in health status were more pronounced in those with higher vs lower baseline NT-proBNP (estimated difference: tertile 1: 4.5 points, 95% CI: 0.8-8.2; tertile 2: 6.2 points, 95% CI: 2.4-10.0; tertile 3: 11.9 points, 95% CI: 8.1-15.7; P interaction = 0.02; baseline NT-proBNP as a continuous variable: P interaction = 0.004). Reductions in body weight were consistent across baseline NT-proBNP levels (P interaction = 0.21).
In patients with obesity-related HFpEF, semaglutide reduced NT-proBNP. Participants with higher baseline NT-proBNP had a similar degree of weight loss but experienced larger reductions in HF-related symptoms and physical limitations with semaglutide than those with lower NT-proBNP.
Abstract Background and Objectives Mortality from ST-segment elevation myocardial infarction remains high, with most deaths occurring before hospital admission. Despite effective pre- and in-hospital ...reperfusion strategies becoming standard over the past 2 decades, time-to-admission and time-to-treatment remain prolonged. We reviewed temporal trends in these times in published clinical trials. Methods All major randomized clinical trials reporting on reperfusion strategies for acute myocardial infarction published between 1993 and 2003 were evaluated. Strategies included pre- and in-hospital thrombolysis, primary percutaneous coronary intervention (pPCI) with or without transfer, and “facilitated” PCI. We generated overall estimates of time-to-admission, time-to-treatment, door-to-balloon (DTB), and door-to-needle (DTN) times and evaluated temporal trends in the length of time-to-admission and time-to-treatment. Results In studies that evaluated only in-hospital thrombolysis, the time-to-admission was 149 ± 45 minutes; the mean time-to-treatment was 181 ± 29 minutes. In studies that considered only in-hospital pPCI (without transfer), the mean time-to-admission was 153 ± 41 minutes; the mean time-to-treatment was 234 ± 43 minutes. In studies that compared in-hospital pPCI with in-hospital thrombolytic therapy, the mean time-to-admission was 155 ± 47 and 150 ± 48 minutes, respectively. The DTN time was 65 ± 10 minutes, whereas DTB time was 81 ± 39 minutes. In other trials evaluating in-hospital thrombolysis and pPCI with transfer to a referral center, the time-to-admission in subjects treated with thrombolysis (n = 1345) was 127 ± 32 minutes vs 131 ± 36 minutes for pPCI (n = 1528). For in-hospital thrombolysis, time-to-treatment was 151 ± 23 minutes vs 203 ± 15 minutes for pPCI patients with transfer. The DTN time in the thrombolysis group was 44 ± 28 minutes as compared with DTB time of 78 ± 38 minutes in the pPCI group. Throughout the last decade, time-to-admission decreased significantly ( P = .02) but time-to-treatment remained unchanged ( P = .38) for patients undergoing thrombolysis. In the pPCI arm, time-to-admission remained unchanged ( P = .11) but a insignificant trend toward reduction was demonstrated in time-to-treatment ( P = .11). Conclusion Time-to-admission and time-to-treatment for ST-segment elevation myocardial infarction are still prolonged. Resources should be directed to early recognition of the acute myocardial infarction, improved utilization of emergency services for transportation, and prehospital diagnosis and triaging. Ambulances equipped with wireless capability to transmit electrocardiograms to the on-call cardiologist seem to be promising tools to achieve earlier diagnosis and triaging with high diagnostic sensitivity and specificity.
Hepatitis C virus(HCV)infection affects about 170 million people worldwide and it is a major cause of liver cirrhosis and hepatocellular carcinoma.HCV is a hepatotropic non-cytopathic virus able to ...persist in a great percentage of infected hosts due to its ability to escape from the immune control.Liver damage and disease progression during HCV infection are driven by both viral and host factors.Specifically,adaptive immune response carries out an essential task in controllingnon-cytopathic viruses because of its ability to recognize infected cells and to destroy them by cytopathic mechanisms and to eliminate the virus by non-cytolytic machinery.HCV is able to impair this response by several means such as developing escape mutations in neutralizing antibodies and in T cell receptor viral epitope recognition sites and inducing HCV-specific cytotoxic T cell anergy and deletion.To impair HCV-specific T cell reactivity,HCV affects effector T cell regulation by modulating T helper and Treg response and by impairing the balance between positive and negative co-stimulatory molecules and between pro-and antiapoptotic proteins.In this review,the role of adaptive immune response in controlling HCV infection and the HCV mechanisms to evade this response are reviewed.
In the STEP-HFpEF (NCT04788511) and STEP-HFpEF DM (NCT04916470) trials, the GLP-1 receptor agonist semaglutide improved symptoms, physical limitations, bodyweight, and exercise function in people ...with obesity-related heart failure with preserved ejection fraction. In this prespecified pooled analysis of the STEP-HFpEF and STEP-HFpEF DM trials, we aimed to provide a more definitive assessment of the effects of semaglutide across a range of outcomes and to test whether these effects were consistent across key patient subgroups.
We conducted a prespecified pooled analysis of individual patient data from STEP-HFpEF and STEP-HFpEF DM, randomised, double-blind, placebo-controlled trials at 129 clinical research sites in 18 countries. In both trials, eligible participants were aged 18 years or older, had heart failure with a left ventricular ejection fraction of at least 45%, a BMI of at least 30 kg/m2, New York Heart Association class II–IV symptoms, and a Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS; a measure of heart failure-related symptoms and physical limitations) of less than 90 points. In STEP-HFpEF, people with diabetes or glycated haemoglobin A1c concentrations of at least 6·5% were excluded, whereas for inclusion in STEP-HFpEF DM participants had to have been diagnosed with type 2 diabetes at least 90 days before screening and to have an HbA1c of 10% or lower. In both trials, participants were randomly assigned to either 2·4 mg semaglutide once weekly or matched placebo for 52 weeks. The dual primary endpoints were change from baseline to week 52 in KCCQ-CSS and bodyweight in all randomly assigned participants. Confirmatory secondary endpoints included change from baseline to week 52 in 6-min walk distance, a hierarchical composite endpoint (all-cause death, heart failure events, and differences in changes in KCCQ-CSS and 6-min walk distance); and C-reactive protein (CRP) concentrations. Heterogeneity in treatment effects was assessed across subgroups of interest. We assessed safety in all participants who received at least one dose of study drug.
Between March 19, 2021 and March 9, 2022, 529 people were randomly assigned in STEP-HFpEF, and between June 27, 2021 and Sept 2, 2022, 616 were randomly assigned in STEP-HFpEF DM. Overall, 1145 were included in our pooled analysis, 573 in the semaglutide group and 572 in the placebo group. Improvements in KCCQ-CSS and reductions in bodyweight between baseline and week 52 were significantly greater in the semaglutide group than in the placebo group (mean between-group difference for the change from baseline to week 52 in KCCQ-CSS 7·5 points 95% CI 5·3 to 9·8; p<0·0001; mean between-group difference in bodyweight at week 52 −8·4% −9·2 to −7·5; p<0·0001). For the confirmatory secondary endpoints, 6-min walk distance (mean between-group difference at week 52 17·1 metres 9·2 to 25·0) and the hierarchical composite endpoint (win ratio 1·65 1·42 to 1·91) were significantly improved, and CRP concentrations (treatment ratio 0·64 0·56 to 0·72) were significantly reduced, in the semaglutide group compared with the placebo group (p<0·0001 for all comparisons). For the dual primary endpoints, the efficacy of semaglutide was largely consistent across multiple subgroups, including those defined by age, race, sex, BMI, systolic blood pressure, baseline CRP, and left ventricular ejection fraction. 161 serious adverse events were reported in the semaglutide group compared with 301 in the placebo group.
In this prespecified pooled analysis of the STEP-HFpEF and STEP-HFpEF DM trials, semaglutide was superior to placebo in improving heart failure-related symptoms and physical limitations, and reducing bodyweight in participants with obesity-related heart failure with preserved ejection fraction. These effects were largely consistent across patient demographic and clinical characteristics. Semaglutide was well tolerated.
Novo Nordisk.
Cardiogenic Shock is one of the main causes of death in ST segment Elevation Myocardial Infarction. To know the clinical characteristics, in-hospital evolution and mortality of patients with ...Cardiogenic Shock. Patients enrolled in the ARGEN-IAM-ST Registry were analyzed. Predictors of Cardiogenic Shock and death during hospital stay were established. A total of 6122 patients were admitted between 2015 and 2022. Cardiogenic Shock was present in 10.75% of cases. Patients with CS were older (64.5 vs 60 years), more females (41% vs 36%), with more antecedents of infarction and a higher prevalence of anterior location of infarction and multivessel disease. They were also less revascularized (88.5% vs 91.5%) and had a higher incidence of failed angioplasty (15.7% vs 2.7%). They also evidenced a higher occurrence of mechanical complications (6.8% vs 0.4%), ischemic recurrence (7.4% vs 3.4%) and cardiac arrest on admission (44.8% vs 2.6%). All the differences described showed statistical significance with P < 0.05. Overall mortality was 58% in contrast to 2.77% in patients without Cardiogenic Shock (P < 0.001). Only age, DBT, and early cardiac arrest were independent predictors of shock on admission whereas age, female gender, cardiac arrest on admission and failed angioplasty were independent predictors of death. One out of 10 patients with ST Elevation Myocardial Infarction presented cardiogenic shock. Its clinical characteristics were similar to those described more than 20 years ago. Despite a high use of reperfusion strategy cardiogenic shock continues to have a very high mortality Argentina.
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