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The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The experience of clinical immunologists from China
Zhang W.; Zhao Y.; Zhang F.; Wang Q.; Li T.; Liu Z.; Wang J.; Qin Y.; Zhang X.; Yan X.; Zeng X.; Zhang S.
Clinical Immunology (2020) 214 Article Number: 108393. Date of Publication: 1 May 2020

ABSTRACT
The pandemic outbreak of coronavirus disease 2019 (COVID-19) is rapidly spreading all over the world. Reports from China showed that about 20% of patients developed severe disease, resulting in a fatality of 4%. In the past two months, we clinical immunologists participated in multi-rounds of MDT (multidiscipline team) discussion on the anti-inflammation management of critical COVID-19 patients, with our colleagues dispatched from Chinese leading PUMC Hospital to Wuhan to admit and treat the most severe patients. Here, from the perspective of clinical immunologists, we will discuss the clinical and immunological characteristics of severe patients, and summarize the current evidence and share our experience in anti-inflammation treatment, including glucocorticoids, IL-6 antagonist, JAK inhibitors and choloroquine/hydrocholoroquine, of patients with severe COVID-19 that may have an impaired immune system.


Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?
Fang L.; Karakiulakis G.; Roth M.
The Lancet Respiratory Medicine (2020) 8:4 (e21). Date of Publication: 1 Apr 2020


Italian Society of Interventional Cardiology (GISE) Position Paper for Cath lab-specific Preparedness Recommendations for Healthcare providers in case of suspected, probable or confirmed cases of COVID-19
Tarantini G.; Fraccaro C.; Chieffo A.; Marchese A.; Tarantino F.F.; Rigattieri S.; Limbruno U.; Mauro C.; La Manna A.; Castiglioni B.; Longoni M.; Berti S.; Greco F.; Musumeci G.; Esposito G.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2020). Date of Publication: 29 Mar 2020

ABSTRACT
COVID-19 pandemic raised the issue to guarantee the proper level of care to patients with acute cardiovascular diseases and concomitant suspected or confirmed COVID-19 and, in the meantime safety and protection of healthcare providers. The aim of this position paper is to provide standards to healthcare facilities and healthcare providers on infection prevention and control measures during the management of suspected and confirmed cases of 2019-nCoV infection accessing in cath-lab. The document represents the view of the Italian Society of Interventional Cardiology (GISE), and it is based on recommendations from the main World and European Health Organizations (WHO, and ECDC) as well as from the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI).


Clinical Characteristics of 54 medical staff with COVID-19: A retrospective study in a single center in Wuhan, China
Chu J.; Yang N.; Wei Y.; Yue H.; Zhang F.; Zhao J.; He L.; Sheng G.; Chen P.; Li G.; Wu S.; Zhang B.; Zhang S.; Wang C.; Miao X.; Li J.; Liu W.; Zhang H.
Journal of medical virology (2020). Date of Publication: 29 Mar 2020

ABSTRACT
BACKGROUND: In December 2019, an outbreak of the SARS-Cov-2 infection occurred in Wuhan, and rapidly spread to worldwide, which has attracted many people’s concerns about the patients. However, studies on the infection status of medical personnels is still lacking. METHODS: 54 cases of SARS-Cov-2 infected medical staff from Tongji Hospital between January 7th to February 11th of 2020 were analyzed in this retrospective study. Clinical and epidemiological characteristics were compared between different groups by statistical method. RESULTS: From January 7 to February 11, 2020, 54 medical staff of Tongji Hospital were hospitalized due to COVID-19. Most of them were from other clinical departments (72.2%) rather than emergency department (3.7%) or medical technology departments (18.5%). Among the 54 COVID-19 patients, the distribution of age had a significant difference between non-severe type and severe/critical cases (median age: 47 years vs. 38 years, p=0.0015). However, there was no statistical difference in terms of gender distribution and the first symptoms between theses two groups. Furthermore, we observed that the lesion regions in SARS-Cov-2 infected lungs with severe-/critical-type of medical staff were more likely to exhibit lesions in the right upper lobe (31.7% vs. 0%, P=0.028) and right lung (61% vs. 18.2%, P=0.012). CONCLUSIONS: Based on our findings with medical staff infection data, we suggest training for all hospital staff to prevent infection and preparation of sufficient protection and disinfection materials.

Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia
Zhang Y.; Cao W.; Xiao M.; Li Y.J.; Yang Y.; Zhao J.; Zhou X.; Jiang W.; Zhao Y.Q.; Zhang S.Y.; Li T.S.
Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi (2020) 41 (E006). Date of Publication: 28 Mar 2020

ABSTRACT
Objective: To investigate the clinical and coagulation characteristics of the critical Coronavirus disease 2019 (COVID-19) patients with acro-ischemia in the intensive care unit (ICU). Methods: The retrospective study included 7 critical COVID-19 patients with acro-ischemia in a single center in Wuhan, from Feb 4 to Feb 15, 2020. The clinical and laboratory data before and during the ICU stay were analyzed. Results: The median age of 7 patients was 59 years and 4 of them were men. 3 of them were associated with underlying comorbidities. Fever, cough, dyspnea and diarrhea were common clinical symptoms. All patients had acro-ischemia presentations including finger/toe cyanosis, skin bulla and dry gangrene. D-dimer, fibrinogen and fibrinogen degradation product (FDP) were significantly elevated in most patients. Prothrombin time (PT) were prolonged in 4 patients. D-dimer and FDP levels increased progressively when COVID-2019 exacerbated, and 4 patients were diagnosed with definite disseminated intravascular coagulation (DIC). 6 patients received low molecular weight heparin (LMWH) treatment, after which their D-dimer and FDP decreased, but there was no significant improvement in clinical symptoms. 5 patients died finally and the median time from acro-ischemia to death was 12 days. Conclusions: The existence of hypercoagulation status in critical COVID-2019 patients should be monitored closely, and anticoagulation therapy can be considered in selected patients. More clinical data is needed to investigate the role of anticoagulation in COVID-2019 treatment.


A Case of Novel Coronavirus Disease 19 in a Chronic Hemodialysis Patient Presenting with Gastroenteritis and Developing Severe Pulmonary Disease
Ferrey A.J.; Choi G.; Hanna R.M.; Chang Y.; Tantisattamo E.; Ivaturi K.; Park E.; Nguyen L.; Wang B.; Tonthat S.; Rhee C.M.; Reddy U.; Lau W.L.; Huang S.S.; Gohil S.; Amin A.N.; Hsieh L.; Cheng T.T.; Lee R.A.; Kalantar-Zadeh K.
American journal of nephrology (2020) (1-6). Date of Publication: 28 Mar 2020

ABSTRACT
Novel coronavirus disease 2019 (COVID-19) is a highly infectious, rapidly spreading viral disease with an alarming case fatality rate up to 5%. The risk factors for severe presentations are concentrated in patients with chronic kidney disease, particularly patients with end-stage renal disease (ESRD) who are dialysis dependent. We report the first US case of a 56-year-old nondiabetic male with ESRD secondary to IgA nephropathy undergoing thrice-weekly maintenance hemodialysis for 3 years, who developed COVID-19 infection. He has hypertension controlled with angiotensin receptor blocker losartan 100 mg/day and coronary artery disease status-post stent placement. During the first 5 days of his febrile disease, he presented to an urgent care, 3 emergency rooms, 1 cardiology clinic, and 2 dialysis centers in California and Utah. During this interval, he reported nausea, vomiting, diarrhea, and low-grade fevers but was not suspected of COVID-19 infection until he developed respiratory symptoms and was admitted to the hospital. Imaging studies upon admission were consistent with bilateral interstitial pneumonia. He was placed in droplet-eye precautions while awaiting COVID-19 test results. Within the first 24 h, he deteriorated quickly and developed acute respiratory distress syndrome (ARDS), requiring intubation and increasing respiratory support. Losartan was withheld due to hypotension and septic shock. COVID-19 was reported positive on hospital day 3. He remained in critical condition being treated with hydroxychloroquine and tocilizumab in addition to the standard medical management for septic shock and ARDS. Our case is unique in its atypical initial presentation and highlights the importance of early testing.


Perioperative Presentation of COVID-19 Disease in a Liver Transplant Recipient
Qin J.; Wang H.; Qin X.; Zhang P.; Zhu L.; Cai J.; Yuan Y.; Li H.
Hepatology (Baltimore, Md.) (2020). Date of Publication: 27 Mar 2020

ABSTRACT
Coronavirus disease 2019 (COVID-19) is highly contagious. It may rapidly progress to acute respiratory distress syndrome (ARDS) and result in multiorgan dysfunction or death in some cases.(1,2) Here, we report the case of a patient with hepatocellular carcinoma (HCC) who underwent liver transplantation and experienced COVID-19 infection during the perioperative period. This case may help clinicians by alerting them to potential COVID-19 infection in transplant recipients during the outbreak.


Elevated plasmin(ogen) as a common risk factor for COVID-19 susceptibility
Ji H.-L.; Zhao R.; Matalon S.; Matthay M.A.
Physiological reviews (2020). Date of Publication: 27 Mar 2020

ABSTRACT
Patients with hypertension, diabetes, coronary heart disease, cerebrovascular illness, COPD, and kidney dysfunction have worse clinical outcomes when infected with SARS-CoV-2, for unknown reasons. The purpose of this review is to summarize the evidence for the existence of elevated plasmin(ogen) in COVID-19 patients with these comorbid conditions. Plasmin, and other proteases, may cleave a newly inserted furin site in the S protein of SARS-CoV-2, extracellularly, which increases its infectivity and virulence. Hyper-fibrinolysis associated with plasmin leads to elevated D-dimer in severe patients. The plasmin(ogen) system may prove a promising therapeutic target for combating COVID-19.


Is There an Association Between COVID-19 Mortality and the Renin-Angiotensin System-a Call for Epidemiologic Investigations
Hanff T.C.; Harhay M.O.; Brown T.S.; Cohen J.B.; Mohareb A.M.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2020). Date of Publication: 26 Mar 2020

ABSTRACT
Mortality from coronavirus disease 2019 (COVID-19) is strongly associated with cardiovascular disease, diabetes, and hypertension. These disorders share underlying pathophysiology related to the renin-angiotensin system (RAS) that may be clinically insightful. In particular, activity of the angiotensin-converting enzyme 2 (ACE2) is dysregulated in cardiovascular disease, and this enzyme is used by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to initiate the infection. Cardiovascular disease and pharmacologic RAS inhibition both increase ACE2 levels, which may increase the virulence of SARS-CoV-2 within the lung and heart. Conversely, mechanistic evidence from related coronaviruses suggests that SARS-CoV-2 infection may downregulate ACE2, leading to toxic overaccumulation of Angiotensin II that induces acute respiratory distress syndrome and fulminant myocarditis. RAS inhibition could mitigate this effect. With conflicting mechanistic evidence, we propose key clinical research priorities necessary to clarify the role of RAS inhibition in COVID-19 mortality that could be rapidly addressed by the international research community.


Renin-Angiotensin System Blockers and the COVID-19 Pandemic: At Present There Is No Evidence to Abandon Renin-Angiotensin System Blockers
Danser A.H.J.; Epstein M.; Batlle D.
Hypertension (Dallas, Tex. : 1979) (2020) (HYPERTENSIONAHA12015082). Date of Publication: 25 Mar 2020

ABSTRACT
During the spread of the severe acute respiratory syndrome coronavirus-2, some reports of data still emerging and in need of full analysis indicate that certain groups of patients are at risk of COVID-19. This includes patients with hypertension, heart disease, diabetes mellitus, and clearly the elderly. Many of those patients are treated with reninangiotensin system blockers. Because the ACE2 (angiotensin-converting enzyme 2) protein is the receptor that facilitates coronavirus entry into cells, the notion has been popularized that treatment with renin-angiotensin system blockers might increase the risk of developing a severe and fatal severe acute respiratory syndrome coronavirus-2 infection. The present article discusses this concept. ACE2 in its full-length form is a membrane-bound enzyme, whereas its shorter (soluble) form circulates in blood at very low levels. As a mono-carboxypeptidase, ACE2 contributes to the degradation of several substrates including angiotensins I and II. ACE (angiotensin-converting enzyme) inhibitors do not inhibit ACE2 because ACE and ACE2 are different enzymes. Although angiotensin II type 1 receptor blockers have been shown to upregulate ACE2 in experimental animals, the evidence is not always consistent and differs among the diverse angiotensin II type 1 receptor blockers and differing organs. Moreover, there are no data to support the notion that ACE inhibitor or angiotensin II type 1 receptor blocker administration facilitates coronavirus entry by increasing ACE2 expression in either animals or humans. Indeed, animal data support elevated ACE2 expression as conferring potential protective pulmonary and cardiovascular effects. In summary, based on the currently available evidence, treatment with renin-angiotensin system blockers should not be discontinued because of concerns with coronavirus infection.


Analysis of Epidemiological and Clinical features in older patients with Corona Virus Disease 2019 (COVID-19) out of Wuhan
Lian J.; Jin X.; Hao S.; Cai H.; Zhang S.; Zheng L.; Jia H.; Hu J.; Gao J.; Zhang Y.; Zhang X.; Yu G.; Wang X.; Gu J.; Ye C.; Jin C.; Lu Y.; Yu X.; Yu X.; Ren Y.; Qiu Y.; Li L.; Sheng J.; Yang Y.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2020). Date of Publication: 25 Mar 2020

ABSTRACT
BACKGROUND: The outbreak of COVID-19 has become a big threat to China, with high contagious capacity and varied mortality. This study aimed to investigate the epidemiological and clinical characteristics of older patients with COVID-19 out of Wuhan. METHODS: A retrospective study was performed, with collecting data from medical records of confirmed COVID-19 patients in Zhejiang province from Jan 17 to Feb 12, 2020. Epidemiological, clinical and treatment data were analyzed between those older (≥60y) and younger (<60y) patients. RESULTS: Total 788 patients with confirmed COVID-19 were selected, where 136 were older patients with corresponding age of 68.28y±7.314y. There was a significantly higher frequency of women in the older patients compared with the younger patients (57.35% vs 46.47%, P=0.021). The presence of coexisting medical condition was significantly higher in older patients compared with younger patients (55.15% vs 21.93%, P<0.001), including the rate of hypertension, diabetes, heart diseases and COPD. Significantly higher rates of severe (older vs younger groups: 16.18% vs 5.98%, P<0.001)/critical (8.82% vs 0.77%, P<0.001) type, shortness of breath (12.50% vs 3.07%, P<0.001) and high temperature of >39.0℃ (13.97% vs 7.21%, P=0.010) were observed in older patients compared with younger patients. Finally, Higher rates of ICU admission (9.56% vs 1.38%, P<0.001) and methylprednisolone application (28.68% vs 9.36%, P<0.001) were also identified in older patients. CONCLUSIONS: The specific epidemiological and clinical features of older COVID-19 patients included significantly higher female gender, body temperature, co-existing of basic diseases and rate of severe and critical type.


Considerations for Cardiac Catheterization Laboratory Procedures During the COVID-19 Pandemic Perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) Members and Graduates
Szerlip M.; Anwaruddin S.; Aronow H.D.; Cohen M.G.; Daniels M.J.; Dehghani P.; Drachman D.E.; Elmariah S.; Feldman D.N.; Garcia S.; Giri J.; Kaul P.; Kapur N.; Kumbhani D.J.; Meraj P.M.; Morray B.; Nayak K.R.; Parikh S.A.; Sakhuja R.; Schussler J.M.; Seto A.; Shah B.; Swaminathan R.V.; Zidar D.A.; Naidu S.S.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2020). Date of Publication: 25 Mar 2020


Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China
Shi S.; Qin M.; Shen B.; Cai Y.; Liu T.; Yang F.; Gong W.; Liu X.; Liang J.; Zhao Q.; Huang H.; Yang B.; Huang C.
JAMA cardiology (2020). Date of Publication: 25 Mar 2020

ABSTRACT
Importance: Coronavirus disease 2019 (COVID-19) has resulted in considerable morbidity and mortality worldwide since December 2019. However, information on cardiac injury in patients affected by COVID-19 is limited. Objective: To explore the association between cardiac injury and mortality in patients with COVID-19. Design, Setting, and Participants: This cohort study was conducted from January 20, 2020, to February 10, 2020, in a single center at Renmin Hospital of Wuhan University, Wuhan, China; the final date of follow-up was February 15, 2020. All consecutive inpatients with laboratory-confirmed COVID-19 were included in this study. Main Outcomes and Measures: Clinical laboratory, radiological, and treatment data were collected and analyzed. Outcomes of patients with and without cardiac injury were compared. The association between cardiac injury and mortality was analyzed. Results: A total of 416 hospitalized patients with COVID-19 were included in the final analysis; the median age was 64 years (range, 21-95 years), and 211 (50.7%) were female. Common symptoms included fever (334 patients [80.3%]), cough (144 [34.6%]), and shortness of breath (117 [28.1%]). A total of 82 patients (19.7%) had cardiac injury, and compared with patients without cardiac injury, these patients were older (median [range] age, 74 [34-95] vs 60 [21-90] years; P < .001); had more comorbidities (eg, hypertension in 49 of 82 [59.8%] vs 78 of 334 [23.4%]; P < .001); had higher leukocyte counts (median [interquartile range (IQR)], 9400 [6900-13 800] vs 5500 [4200-7400] cells/μL) and levels of C-reactive protein (median [IQR], 10.2 [6.4-17.0] vs 3.7 [1.0-7.3] mg/dL), procalcitonin (median [IQR], 0.27 [0.10-1.22] vs 0.06 [0.03-0.10] ng/mL), creatinine kinase-myocardial band (median [IQR], 3.2 [1.8-6.2] vs 0.9 [0.6-1.3] ng/mL), myohemoglobin (median [IQR], 128 [68-305] vs 39 [27-65] μg/L), high-sensitivity troponin I (median [IQR], 0.19 [0.08-1.12] vs <0.006 [<0.006-0.009] μg/L), N-terminal pro-B-type natriuretic peptide (median [IQR], 1689 [698-3327] vs 139 [51-335] pg/mL), aspartate aminotransferase (median [IQR], 40 [27-60] vs 29 [21-40] U/L), and creatinine (median [IQR], 1.15 [0.72-1.92] vs 0.64 [0.54-0.78] mg/dL); and had a higher proportion of multiple mottling and ground-glass opacity in radiographic findings (53 of 82 patients [64.6%] vs 15 of 334 patients [4.5%]). Greater proportions of patients with cardiac injury required noninvasive mechanical ventilation (38 of 82 [46.3%] vs 13 of 334 [3.9%]; P < .001) or invasive mechanical ventilation (18 of 82 [22.0%] vs 14 of 334 [4.2%]; P < .001) than those without cardiac injury. Complications were more common in patients with cardiac injury than those without cardiac injury and included acute respiratory distress syndrome (48 of 82 [58.5%] vs 49 of 334 [14.7%]; P < .001), acute kidney injury (7 of 82 [8.5%] vs 1 of 334 [0.3%]; P < .001), electrolyte disturbances (13 of 82 [15.9%] vs 17 of 334 [5.1%]; P = .003), hypoproteinemia (11 of 82 [13.4%] vs 16 of 334 [4.8%]; P = .01), and coagulation disorders (6 of 82 [7.3%] vs 6 of 334 [1.8%]; P = .02). Patients with cardiac injury had higher mortality than those without cardiac injury (42 of 82 [51.2%] vs 15 of 334 [4.5%]; P < .001). In a Cox regression model, patients with vs those without cardiac injury were at a higher risk of death, both during the time from symptom onset (hazard ratio, 4.26 [95% CI, 1.92-9.49]) and from admission to end point (hazard ratio, 3.41 [95% CI, 1.62-7.16]). Conclusions and Relevance: Cardiac injury is a common condition among hospitalized patients with COVID-19 in Wuhan, China, and it is associated with higher risk of in-hospital mortality.


Hospital response to the COVID-19 outbreak: the experience in Shanghai, China
Zhang Y.; Sun Z.; Latour J.M.; Hu B.; Qian J.
Journal of advanced nursing (2020). Date of Publication: 25 Mar 2020

ABSTRACT
On 20th January 2020, the first COVID-19 case was reported in Shanghai, China. As of 12th March 2020, 344 cases with laboratory-confirmed COVID-19 infection have been detected in Shanghai, of which three died, 321 patients are discharged, 20 patients still receive ongoing treatments (Shanghai Municipal Health Commission, 2020).


The role of CT in case ascertainment and management of COVID-19 pneumonia in the UK: insights from high-incidence regions
Chua F.; Armstrong-James D.; Desai S.R.; Barnett J.; Kouranos V.; Kon O.M.; José R.; Vancheeswaran R.; Loebinger M.R.; Wong J.; Cutino-Moguel M.T.; Morgan C.; Ledot S.; Lams B.; Yip W.H.; Li L.; Lee Y.C.; Draper A.; Kho S.S.; Renzoni E.; Ward K.; Periselneris J.; Grubnic S.; Lipman M.; Wells A.U.; Devaraj A.
The Lancet. Respiratory medicine (2020). Date of Publication: 25 Mar 2020


COVID-19 in Europe: the Italian lesson
Saglietto A.; D’Ascenzo F.; Zoccai G.B.; De Ferrari G.M.
Lancet (London, England) (2020). Date of Publication: 24 Mar 2020


Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease
Clerkin K.J.; Fried J.A.; Raikhelkar J.; Sayer G.; Griffin J.M.; Masoumi A.; Jain S.S.; Burkhoff D.; Kumaraiah D.; Rabbani L.; Schwartz A.; Uriel N.
Circulation (2020). Date of Publication: 21 Mar 2020


SARS-CoV2: should inhibitors of the renin-angiotensin system be withdrawn in patients with COVID-19?
Kuster G.M.; Pfister O.; Burkard T.; Zhou Q.; Twerenbold R.; Haaf P.; Widmer A.F.; Osswald S.
European heart journal (2020). Date of Publication: 20 Mar 2020


COVID-19: social distancing, ACE 2 receptors, protease inhibitors and beyond?
Thomson G.
International journal of clinical practice (2020) (e13503). Date of Publication: 18 Mar 2020

ABSTRACT
I am most grateful to Dr Stein for his thoughtful and considered response to my recent letter(1) . However, completely as he predicted, his answers only raised more questions. I was struck by the analysis of the known mortality data from COVID-19. It is interesting that for a respiratory pathogen, risk of mortality seems to be lower for those with underlying respiratory disease than with pre-existing cardiac pathology.


Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic
Driggin E.; Madhavan M.V.; Bikdeli B.; Chuich T.; Laracy J.; Bondi-Zoccai G.; Brown T.S.; Nigoghossian C.; Zidar D.A.; Haythe J.; Brodie D.; Beckman J.A.; Kirtane A.J.; Stone G.W.; Krumholz H.M.; Parikh S.A.
Journal of the American College of Cardiology (2020). Date of Publication: 18 Mar 2020

ABSTRACT
The coronavirus disease-2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 that has significant implications for the cardiovascular care of patients. First, those with COVID-19 and preexisting cardiovascular disease (CVD) have an increased risk of severe disease and death. Second, infection has been associated with multiple direct and indirect cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias and venous thromboembolism. Third, therapies under investigation for COVID-19 may have cardiovascular side effects. Fourth, the response to COVID-19 can compromise the rapid triage of non-COVID-19 patients with cardiovascular conditions. Finally, the provision of cardiovascular care may place health care workers in a position of vulnerability as they become host or vectors of virus transmission. We hereby review the peer-reviewed and preprint literature pertaining to cardiovascular considerations related to COVID-19 and highlight gaps in knowledge that require further study pertinent to patients, health care workers, and health systems.


Successful recovery of COVID-19 pneumonia in a renal transplant recipient with long-term immunosuppression
Zhu L.; Xu X.; Ma K.; Yang J.; Guan H.; Chen S.; Chen Z.; Chen G.
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (2020). Date of Publication: 17 Mar 2020

ABSTRACT
The current outbreak of Coronavirus Disease 2019 (COVID-19) has raised great concern worldwide, but its impact on transplant recipients is unknown. We report here the clinical features and therapeutic course of the first reported renal transplant recipient with confirmed COVID-19 pneumonia. This is a 52-year-old man who received kidney transplantation 12 years ago. His overall clinical characteristics (symptoms, laboratory examinations, and chest CT) were similar to those of non-transplanted COVID-19 patients. Following a treatment regimen consisting of reduced immunosuppressant use and low dose methylprednisolone-based therapy, the COVID-19 pneumonia in this long-term immunosuppressive patient was successfully recovered. This effectively treated case has reference value for the future treatment of other transplant patients with COVID-19 pneumonia.


Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on ST-Segment-Elevation Myocardial Infarction Care in Hong Kong, China
Tam C.-C.F.; Cheung K.-S.; Lam S.; Wong A.; Yung A.; Sze M.; Lam Y.-M.; Chan C.; Tsang T.-C.; Tsui M.; Tse H.-F.; Siu C.-W.
Circulation. Cardiovascular quality and outcomes (2020) (CIRCOUTCOMES120006631). Date of Publication: 17 Mar 2020


Catheterization Laboratory Considerations During the Coronavirus (COVID-19) Pandemic: From ACC’s Interventional Council and SCAI
Welt F.G.P.; Shah P.B.; Aronow H.D.; Bortnick A.E.; Henry T.D.; Sherwood M.W.; Young M.N.; Davidson L.J.; Kadavath S.; Mahmud E.; Kirtane A.J.
Journal of the American College of Cardiology (2020). Date of Publication: 16 Mar 2020


Impact of complicated myocardial injury on the clinical outcome of severe or critically ill COVID-19 patients
He X.W.; Lai J.S.; Cheng J.; Wang M.W.; Liu Y.J.; Xiao Z.C.; Xu C.; Li S.S.; Zeng H.S.
Zhonghua xin xue guan bing za zhi (2020) 48 (E011). Date of Publication: 15 Mar 2020

ABSTRACT
Objective: To analyze the clinical characteristics of the severe or critically ill patients with novel coronavirus pneumonia (COVID-19), and evaluate the impact of complicated myocardial injury on the prognosis of these patients. Methods: A retrospective study was conducted in 54 patients who admitted to Tongji hospital from February 3, 2020 to February 24, 2020 and met the criteria of severe or critical conditions of COVID-19. The clinical characteristics and hospital mortality rate were analyzed and compared between the patients with or without myocardial injury, which was defined with 3 times higher serum cardiac troponin value. Results: The median age of the 54 patients was 68 (59.8, 74.3) years. Among all the patients, 24 (44.4%) patients were complicated with hypertension, 13 (24.1%) with diabetes, 8 (14.8%) with coronary heart disease, and 3 (5.6%) with previous cerebral infarction. During hospitalization, 24 (44.4%) of the patients were complicated with myocardial injury and 26 (48.1%) patients died in hospital. In-hospital mortality was significantly higher in patients with myocardial injury than in patients without myocardial injury (14 (60.9%) vs. 8 (25.8%), P=0.013). Moreover, the levels of C-reactive protein (153.6 (80.3, 240.7) ng/L vs. 49.8 (15.9, 101.9) ng/L) and N-terminal pro-B-type natriuretic peptide (852.0 (400.0, 2 315.3) ng/L vs. 197.0 (115.3, 631.0) ng/L) were significantly higher than patients without myocardial injury (all P<0.01). Conclusions: Prevalence of myocardial injury is high among severe or critically ill COVID-19 patients. Severe or critically ill COVID-19 patients with myocardial injury face a significantly higher risk of in-hospital mortality. The study suggests that it is important to monitor and manage the myocardial injury during hospitalization for severe or critically ill COVID-19 patients.


Combination of western medicine and Chinese traditional patent medicine in treating a family case of COVID-19 in Wuhan
Ni L.; Zhou L.; Zhou M.; Zhao J.; Wang D.W.
Frontiers of medicine (2020). Date of Publication: 13 Mar 2020

ABSTRACT
In December 2019, an outbreak of novel Coronavirus (2019-nCoV) occurred in Wuhan, Hubei Province, China. By February 14, 2020, it has led to 66 492 confirmed patients in China and high mortality up to ∼2.96% (1123/37 914) in Wuhan. Here we report the first family case of coronavirus disease 2019 (COVID-19) confirmed in Wuhan and treated using the combination of western medicine and Chinese traditional patent medicine Shuanghuanglian oral liquid (SHL). This report describes the identification, diagnosis, clinical course, and management of three cases from a family, suggests the expected therapeutic effects of SHL on COVID-19, and warrants further clinical trials.


Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19
Chen C.; Yan J.T.; Zhou N.; Zhao J.P.; Wang D.W.
Zhonghua xin xue guan bing za zhi (2020) 48 (E008). Date of Publication: 6 Mar 2020

ABSTRACT
Objective: To evaluate the cardiovascular damage of patients with COVID-19, and determine the correlation of serum N-terminal pro B-type natriuretic peptide (NT-proBNP) and cardiac troponin-I (cTnI) with the severity of COVID-19, and the impact of concomitant cardiovascular disease on severity of COVID-19 was also evaluated. Methods: A cross-sectional study was designed on 150 consecutive patients with COVID-19 in the fever clinic of Tongji Hospital in Wuhan from January to February in 2020, including 126 mild cases and 24 cases in critical care. Both univariate and multivariate logistic regression were used to analyze the correlation of past medical history including hypertension, diabetes and coronary heart disease (CHD) , as well as the levels of serum NT-proBNP and cTnI to the disease severity of COVID-19 patients. Results: Age, hypersensitive C-reactive protein(hs-CRP) and serum creatinine levels of the patients were higher in critical care cases than in mild cases(all P<0.05). Prevalence of male, elevated NT-proBNP and cTnI, hypertension and coronary heart disease were significantly higher in critical cases care patients than in the mild cases(all P<0.05). Univariate logistic regression analysis showed that age, male, elevated NT-proBNP, elevated cTnI, elevated hs-CRP, elevated serum creatinine, hypertension, and CHD were significantly correlated with critical disease status(all P<0.05). Multivariate logistic regression analysis showed that elevated cTnI(OR=26.909, 95%CI 4.086-177.226, P=0.001) and CHD (OR=16.609, 95%CI 2.288-120.577, P=0.005) were the independent risk factors of critical disease status. Conclusions: COVID-19 can significantly affect the heart function and lead to myocardial injury. The past medical history of CHD and increased level of cTnI are two independent determinants of clinical disease status in patients with COVID-19.


Comparison of heart failure and 2019 novel coronavirus pneumonia in chest CT features and clinical characteristics
Zhu Z.W.; Tang J.J.; Chai X.P.; Fang Z.F.; Liu Q.M.; Hu X.Q.; Xu D.Y.; Tang L.; Tai S.; Wu Y.Z.; Zhou S.H.
Zhonghua xin xue guan bing za zhi (2020) 48 (E007). Date of Publication: 4 Mar 2020

ABSTRACT
Objective: To identify the characteristics including clinical features and pulmonary computed tomography (CT) features of heart failure and novel coronavirus pneumonia(COVID-19). Methods: This study was a retrospective study. A total of 7 patients with Heart failure and 12 patients with COVID-19 in the Second Xiangya Hospital of Central South University between December 1, 2019 and February 15, 2020 were enrolled. The baseline clinical and imaging features of the two groups were statistically analyzed. Results: There was no significant difference in age and sex between the two groups, but the incidence of epidemiological contact history, fever or respiratory symptoms in the COVID-19 group was significantly higher than that in the heart failure group (12/12 vs. 2/7, P=0.001; 12/12 vs. 4/7, P<0.001). While the proportion of cardiovascular diseases and impaired cardiac function was significantly less than that of the heart failure group(2/12 vs.7/7, P<0.001; 0/12 vs.7/7, P<0.001). For imaging features, both groups had ground-glass opacity and thickening of interlobular septum, but the ratio of central and gradient distribution was higher in patients with heart failure than that in patients with COVID-19 (4/7 vs. 1/12, P=0.04). In heart failure group, the ratio of the expansion of small pulmonary veins was also higher (3/7 vs. 0, P=0.013), and the lung lesions can be significantly improved after effective anti-heart failure treatment. Besides, there are more disease with rounded morphology in COVID-19 (9/12 vs. 2/7, P=0.048) . Conclusions: More patients with COVID-19 have epidemiological history and fever or respiratory symptoms. There are significant differences in chest CT features, such as enlargement of pulmonary veins, lesions distribution and morphology between heart failure and COVID-19.


Cardiac manifestations of patients with COVID-19 pneumonia and related treatment recommendations
Tan Z.C.; Fu L.H.; Wang D.D.; Hong K.
Zhonghua xin xue guan bing za zhi (2020) 48 (E005). Date of Publication: 2 Mar 2020


Myocardial injury in patients with COVID-19 pneumonia
Wei Z.Y.; Qian H.Y.
Zhonghua xin xue guan bing za zhi (2020) 48 (E006). Date of Publication: 2 Mar 2020


Preliminary study of the relationship between novel coronavirus pneumonia and liver function damage: a multicenter study
Liu C.; Jiang Z.C.; Shao C.X.; Zhang H.G.; Yue H.M.; Chen Z.H.; Ma B.Y.; Liu W.Y.; Huang H.H.; Yang J.; Wang Y.; Liu H.Y.; Xu D.; Wang J.T.; Yang J.Y.; Pan H.Q.; Zou S.Q.; Li F.J.; Lei J.Q.; Li X.; He Q.; Gu Y.; Qi X.L.
Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology (2020) 28:2 (148-152). Date of Publication: 20 Feb 2020

ABSTRACT
Objective: To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage. Methods: Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate. Results: 32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34- ~ 21.15) mmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31- ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) mmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) mmol/L, respectively. Conclusion: The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.


Characteristics of and public health responses to the coronavirus disease 2019 outbreak in China
Deng S.-Q.; Peng H.-J.
Journal of Clinical Medicine (2020) 9:2 Article Number: 575. Date of Publication: 1 Feb 2020

ABSTRACT
In December 2019, cases of unidentified pneumonia with a history of exposure in the Huanan Seafood Market were reported in Wuhan, Hubei Province. A novel coronavirus, SARS-CoV-2, was identified to be accountable for this disease. Human-to-human transmission is confirmed, and this disease (named COVID-19 by World Health Organization (WHO)) spread rapidly around the country and the world. As of 18 February 2020, the number of confirmed cases had reached 75,199 with 2009 fatalities. The COVID-19 resulted in a much lower case-fatality rate (about 2.67%) among the confirmed cases, compared with Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). Among the symptom composition of the 45 fatality cases collected from the released official reports, the top four are fever, cough, short of breath, and chest tightness/pain. The major comorbidities of the fatality cases include hypertension, diabetes, coronary heart disease, cerebral infarction, and chronic bronchitis. The source of the virus and the pathogenesis of this disease are still unconfirmed. No specific therapeutic drug has been found. The Chinese Government has initiated a level-1 public health response to prevent the spread of the disease. Meanwhile, it is also crucial to speed up the development of vaccines and drugs for treatment, which will enable us to defeat COVID-19 as soon as possible.


COVID-19 and the cardiovascular system
Zheng Y.-Y.; Ma Y.-T.; Zhang J.-Y.; Xie X.
Nature Reviews Cardiology (2020). Date of Publication: 2020


How to balance acute myocardial infarction and COVID-19: the protocols from Sichuan Provincial People’s Hospital
Zeng J.; Huang J.; Pan L.
Intensive Care Medicine (2020). Date of Publication: 2020


Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China
Li B.; Yang J.; Zhao F.; Zhi L.; Wang X.; Liu L.; Bi Z.; Zhao Y.
Clinical Research in Cardiology (2020). Date of Publication: 2020

ABSTRACT
Background: Studies have reminded that cardiovascular metabolic comorbidities made patients more susceptible to suffer 2019 novel corona virus (2019-nCoV) disease (COVID-19), and exacerbated the infection. The aim of this analysis is to determine the association of cardiovascular metabolic diseases with the development of COVID-19. Methods: A meta-analysis of eligible studies that summarized the prevalence of cardiovascular metabolic diseases in COVID-19 and compared the incidences of the comorbidities in ICU/severe and non-ICU/severe patients was performed. Embase and PubMed were searched for relevant studies. Results: A total of six studies with 1527 patients were included in this analysis. The proportions of hypertension, cardia-cerebrovascular disease and diabetes in patients with COVID-19 were 17.1%, 16.4% and 9.7%, respectively. The incidences of hypertension, cardia-cerebrovascular diseases and diabetes were about twofolds, threefolds and twofolds, respectively, higher in ICU/severe cases than in their non-ICU/severe counterparts. At least 8.0% patients with COVID-19 suffered the acute cardiac injury. The incidence of acute cardiac injury was about 13 folds higher in ICU/severe patients compared with the non-ICU/severe patients. Conclusion: Patients with previous cardiovascular metabolic diseases may face a greater risk of developing into the severe condition and the comorbidities can also greatly affect the prognosis of the COVID-19. On the other hand, COVID-19 can, in turn, aggravate the damage to the heart.


Antihypertensive treatment with ACEI/ARB of patients with COVID-19 complicated by hypertension
Li G.; Hu R.; Zhang X.
Hypertension Research (2020). Date of Publication: 2020


Interaction between RAAS inhibitors and ACE2 in the context of COVID-19
Mourad J.-J.; Levy B.I.
Nature Reviews Cardiology (2020). Date of Publication: 2020


Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study
Zhou F.; Yu T.; Du R.; Fan G.; Liu Y.; Liu Z.; Xiang J.; Wang Y.; Song B.; Gu X.; Guan L.; Wei Y.; Li H.; Wu X.; Xu J.; Tu S.; Zhang Y.; Chen H.; Cao B.
The Lancet (2020). Date of Publication: 2020

ABSTRACT
Background: Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods: In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings: 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation: The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding: Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.


COVID-19 coronavirus: What implications for cardiology?
Di Pasquale G.
Giornale Italiano di Cardiologia (2020) 21:4 (243-245). Date of Publication: 2020


Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis
Rodriguez-Morales A.J.; Cardona-Ospina J.A.; Gutiérrez-Ocampo E.; Villamizar-Peña R.; Holguin-Rivera Y.; Escalera-Antezana J.P.; Alvarado-Arnez L.E.; Bonilla-Aldana D.K.; Franco-Paredes C.; Henao-Martinez A.F.; Paniz-Mondolfi A.; Lagos-Grisales G.J.; Ramírez-Vallejo E.; Suárez J.A.; Zambrano L.I.; Villamil-Gómez W.E.; Balbin-Ramon G.J.; Rabaan A.A.; Harapan H.; Dhama K.; Nishiura H.; Kataoka H.; Ahmad T.; Sah R.
Travel Medicine and Infectious Disease (2020) Article Number: 101623. Date of Publication: 2020

ABSTRACT
Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) began in December 2019 in China leading to a Public Health Emergency of International Concern (PHEIC). Clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews on COVID-19 have been published to date. Methods: We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of COVID-19 confirmed cases. Observational studies and also case reports, were included, and analyzed separately. We performed a random-effects model meta-analysis to calculate pooled prevalences and 95% confidence intervals (95%CI). Results: 660 articles were retrieved for the time frame (1/1/2020-2/23/2020). After screening, 27 articles were selected for full-text assessment, 19 being finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5–92.9%), cough (57.6%, 95%CI 40.8–74.4%) and dyspnea (45.6%, 95%CI 10.9–80.4%) were the most prevalent manifestations. Among the patients, 20.3% (95%CI 10.0–30.6%) required intensive care unit (ICU), 32.8% presented with acute respiratory distress syndrome (ARDS) (95%CI 13.7–51.8), 6.2% (95%CI 3.1–9.3) with shock. Some 13.9% (95%CI 6.2–21.5%) of hospitalized patients had fatal outcomes (case fatality rate, CFR). Conclusion: COVID-19 brings a huge burden to healthcare facilities, especially in patients with comorbidities. ICU was required for approximately 20% of polymorbid, COVID-19 infected patients and hospitalization was associated with a CFR of >13%. As this virus spreads globally, countries need to urgently prepare human resources, infrastructure and facilities to treat severe COVID-19.


Cardiovascular Implications of Fatal Outcomes of Patients with Coronavirus Disease 2019 (COVID-19)
Guo T.; Fan Y.; Chen M.; Wu X.; Zhang L.; He T.; Wang H.; Wan J.; Wang X.; Lu Z.
JAMA Cardiology (2020). Date of Publication: 2020

ABSTRACT
Importance: Increasing numbers of confirmed cases and mortality rates of coronavirus disease 2019 (COVID-19) are occurring in several countries and continents. Information regarding the impact of cardiovascular complication on fatal outcome is scarce. Objective: To evaluate the association of underlying cardiovascular disease (CVD) and myocardial injury with fatal outcomes in patients with COVID-19. Design, Setting, and Participants: This retrospective single-center case series analyzed patients with COVID-19 at the Seventh Hospital of Wuhan City, China, from January 23, 2020, to February 23, 2020. Analysis began February 25, 2020. Main Outcomes and Measures: Demographic data, laboratory findings, comorbidities, and treatments were collected and analyzed in patients with and without elevation of troponin T (TnT) levels. Result: Among 187 patients with confirmed COVID-19, 144 patients (77%) were discharged and 43 patients (23%) died. The mean (SD) age was 58.50 (14.66) years. Overall, 66 (35.3%) had underlying CVD including hypertension, coronary heart disease, and cardiomyopathy, and 52 (27.8%) exhibited myocardial injury as indicated by elevated TnT levels. The mortality during hospitalization was 7.62% (8 of 105) for patients without underlying CVD and normal TnT levels, 13.33% (4 of 30) for those with underlying CVD and normal TnT levels, 37.50% (6 of 16) for those without underlying CVD but elevated TnT levels, and 69.44% (25 of 36) for those with underlying CVD and elevated TnTs. Patients with underlying CVD were more likely to exhibit elevation of TnT levels compared with the patients without CVD (36 [54.5%] vs 16 [13.2%]). Plasma TnT levels demonstrated a high and significantly positive linear correlation with plasma high-sensitivity C-reactive protein levels (β = 0.530, P <.001) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (β = 0.613, P <.001). Plasma TnT and NT-proBNP levels during hospitalization (median [interquartile range (IQR)], 0.307 [0.094-0.600]; 1902.00 [728.35-8100.00]) and impending death (median [IQR], 0.141 [0.058-0.860]; 5375 [1179.50-25695.25]) increased significantly compared with admission values (median [IQR], 0.0355 [0.015-0.102]; 796.90 [401.93-1742.25]) in patients who died (P =.001; P <.001), while no significant dynamic changes of TnT (median [IQR], 0.010 [0.007-0.019]; 0.013 [0.007-0.022]; 0.011 [0.007-0.016]) and NT-proBNP (median [IQR], 352.20 [174.70-636.70]; 433.80 [155.80-1272.60]; 145.40 [63.4-526.50]) was observed in survivors (P =.96; P =.16). During hospitalization, patients with elevated TnT levels had more frequent malignant arrhythmias, and the use of glucocorticoid therapy (37 [71.2%] vs 69 [51.1%]) and mechanical ventilation (41 [59.6%] vs 14 [10.4%]) were higher compared with patients with normal TnT levels. The mortality rates of patients with and without use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 36.8% (7 of 19) and 25.6% (43 of 168). Conclusions and Relevance: Myocardial injury is significantly associated with fatal outcome of COVID-19, while the prognosis of patients with underlying CVD but without myocardial injury is relatively favorable. Myocardial injury is associated with cardiac dysfunction and arrhythmias. Inflammation may be a potential mechanism for myocardial injury. Aggressive treatment may be considered for patients at high risk of myocardial injury.


Cardiac Involvement in a Patient with Coronavirus Disease 2019 (COVID-19)
Inciardi R.M.; Lupi L.; Zaccone G.; Italia L.; Raffo M.; Tomasoni D.; Cani D.S.; Cerini M.; Farina D.; Gavazzi E.; Maroldi R.; Adamo M.; Ammirati E.; Sinagra G.; Lombardi C.M.; Metra M.
JAMA Cardiology (2020). Date of Publication: 2020

ABSTRACT
Importance: Virus infection has been widely described as one of the most common causes of myocarditis. However, less is known about the cardiac involvement as a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Objective: To describe the presentation of acute myocardial inflammation in a patient with coronavirus disease 2019 (COVID-19) who recovered from the influenzalike syndrome and developed fatigue and signs and symptoms of heart failure a week after upper respiratory tract symptoms. Design, Setting, and Participant: This case report describes an otherwise healthy 53-year-old woman who tested positive for COVID-19 and was admitted to the cardiac care unit in March 2020 for acute myopericarditis with systolic dysfunction, confirmed on cardiac magnetic resonance imaging, the week after onset of fever and dry cough due to COVID-19. The patient did not show any respiratory involvement during the clinical course. Exposure: Cardiac involvement with COVID-19. Main Outcomes and Measures: Detection of cardiac involvement with an increase in levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T, echocardiography changes, and diffuse biventricular myocardial edema and late gadolinium enhancement on cardiac magnetic resonance imaging. Results: An otherwise healthy 53-year-old white woman presented to the emergency department with severe fatigue. She described fever and dry cough the week before. She was afebrile but hypotensive; electrocardiography showed diffuse ST elevation, and elevated high-sensitivity troponin T and NT-proBNP levels were detected. Findings on chest radiography were normal. There was no evidence of obstructive coronary disease on coronary angiography. Based on the COVID-19 outbreak, a nasopharyngeal swab was performed, with a positive result for SARS-CoV-2 on real-time reverse transcriptase-polymerase chain reaction assay. Cardiac magnetic resonance imaging showed increased wall thickness with diffuse biventricular hypokinesis, especially in the apical segments, and severe left ventricular dysfunction (left ventricular ejection fraction of 35%). Short tau inversion recovery and T2-mapping sequences showed marked biventricular myocardial interstitial edema, and there was also diffuse late gadolinium enhancement involving the entire biventricular wall. There was a circumferential pericardial effusion that was most notable around the right cardiac chambers. These findings were all consistent with acute myopericarditis. She was treated with dobutamine, antiviral drugs (lopinavir/ritonavir), steroids, chloroquine, and medical treatment for heart failure, with progressive clinical and instrumental stabilization. Conclusions and Relevance: This case highlights cardiac involvement as a complication associated with COVID-19, even without symptoms and signs of interstitial pneumonia.


Association of Coronavirus Disease 2019 (COVID-19) with Myocardial Injury and Mortality
Bonow R.O.; Fonarow G.C.; O’Gara P.T.; Yancy C.W.
JAMA Cardiology (2020). Date of Publication: 2020


Potential Effects of Coronaviruses on the Cardiovascular System: A Review
Madjid M.; Safavi-Naeini P.; Solomon S.D.; Vardeny O.
JAMA Cardiology (2020). Date of Publication: 2020

ABSTRACT
Importance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) has reached a pandemic level. Coronaviruses are known to affect the cardiovascular system. We review the basics of coronaviruses, with a focus on COVID-19, along with their effects on the cardiovascular system. Observations: Coronavirus disease 2019 can cause a viral pneumonia with additional extrapulmonary manifestations and complications. A large proportion of patients have underlying cardiovascular disease and/or cardiac risk factors. Factors associated with mortality include male sex, advanced age, and presence of comorbidities including hypertension, diabetes mellitus, cardiovascular diseases, and cerebrovascular diseases. Acute cardiac injury determined by elevated high-sensitivity troponin levels is commonly observed in severe cases and is strongly associated with mortality. Acute respiratory distress syndrome is also strongly associated with mortality. Conclusions and Relevance: Coronavirus disease 2019 is associated with a high inflammatory burden that can induce vascular inflammation, myocarditis, and cardiac arrhythmias. Extensive efforts are underway to find specific vaccines and antivirals against SARS-CoV-2. Meanwhile, cardiovascular risk factors and conditions should be judiciously controlled per evidence-based guidelines.


An Acute Respiratory Infection Runs into the Most Common Noncommunicable Epidemic – COVID-19 and Cardiovascular Diseases
Yang C.; Jin Z.
JAMA Cardiology (2020). Date of Publication: 2020