Betacoronavirus/complications

ABC

Research Letter

Orthotopic Heart Transplantation in a Covid-19 Recipient

Leonardo Rufino Garcia et al. André Monti Garzesi Julia Bazzo Sinatora Rejane Maria Tommasini Grotto … Andréia Cristina Passaroni Nelson Leonardo Kerdahi Leite de Campos Antônio Sérgio Martins Marcello Laneza Felicio Flávio de Souza Brito

Introduction

The coronavirus pandemic has affected more than 480 million people around the world. Solid organ recipients constitute a highly vulnerable group due to the need for immunosuppression and the various comorbidities that may be associated, many of which persist even after transplantation.

Transplanted patients can present a spectrum of clinical manifestations resulting from COVID-19: from asymptomatic, mild symptoms or acute respiratory failure and death. Some studies suggest that in the case of conditions with a favorable outcome, previous immunization and irreplaceable post-transplantation immunosuppression contribute to a response of less exacerbated inflammation and, consequently, less organic damage.^, Nonetheless, some reports and literature reviews show worse prognosis in transplanted patients, possibly due to comorbidities, advanced age, and lymphopenia often present.^,,

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ABCHF

Editorial

Cardiovascular Burden of COVID-19 and the Post-Covid Era

Samuel D. Moscavitch et al. Jefferson L. Vieira Peter Libby

Why COVID-19 became an issue for cardiovascular specialists? SARS-CoV-2- related myocardial injury and myocarditis

Approximately 20-30% of hospitalized patients with COVID-19 have evidence of cardiac injury, as indicated by elevated levels of high-sensitivity troponins. The presence and magnitude of troponin elevation is associated with more severe disease and worse outcomes, even after adjusting for relevant risk factors. Myocardial injury portends a fatal outcome of COVID-19, while the prognosis of patients without myocardial injury, even with underlying cardiovascular disease, is more favorable.

The pathophysiology of SARS-CoV-2-induced myocardial injury remains a topic of active research. COVID-19 can unfavorably affect the balance between myocardial oxygen supply and demand, as with other overwhelming viral or bacterial infections (). Fever, metabolic stress, sympathetic activation, and tachycardia increase the energy expenditure and oxygen consumption of the myocardium.^, This imbalance can provoke type 2 (or “demand” type) myocardial infarction. Hypoxia from respiratory impairment can favor the production of reactive oxygen species and oxidative stress, acidosis, mitochondrial damage, and cell death.^,^, Other mechanisms of myocardial injury during COVID-19 include ischemia from microvascular thrombi and toxic levels of cytokines. Cardiac damage due to direct SARS-CoV-2 infection of cardiac myocytes appears uncommon.^– Indeed, the pericytes, smooth-muscle like cells that surround microvessels, express high levels of the receptor for SARS-CoV-2, angiotensin converting enzyme 2 (ACE2), while cardiac myocytes themselves have few, if any, of these portals of entry used by the virus.

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IJCS

Original Article

Emergency Department Visits and Deaths from Cardiovascular Diseases at a Referral Center for Cardiology During the COVID-19 Pandemic

Luis Sérgio Carvalho Luciano et al. Luiz Eduardo Koenig São Thiago Isabela de Carlos Back Leandro Waldrich … Luiza Di Bernardi de São Thiago Amabile Rodrigues Alves Beatriz Campos Comelli Mariane Janning Santos Luiz Carlos Giuliano

Abstract

Background

The COVID-19 pandemic has imposed measures of social distancing and, during this time, there has been an elevation in cardiovascular mortality rates and a decrease in the number of emergency visits.

Objectives

To assess and compare in-hospital mortality for cardiovascular diseases and emergency department visits during the COVID-19 pandemic and the same period in 2019.

Methods

Retrospective, single-center study that evaluated emergency visits and in-hospital deaths between March 16, 2020 and June 16, 2020, when the steepest fall in the number of emergency admissions for COVID-19 was registered. These data were compared with the emergency visits and in-hospital deaths between March 16 and June 16, 2019. We analyzed the total number of deaths, and cardiovascular deaths. The level of significance was set at p < 0.05.

Results

There was a 35% decrease in the number of emergency visits and an increase in the ratio of the number of deaths to the number of emergency visits in 2020. The increase in the ratio of the number of all-cause deaths to the number of emergency visits was 45.6% and the increase in the ratio of the number of cardiovascular deaths to the number of emergency visits was 62.1%. None of the patients who died in the study period in 2020 tested positive for COVID-19.

Conclusion

In-hospital mortality for cardiovascular diseases increased proportionally to the number of emergency visits during the COVID-19-imposed social distancing compared with the same period in 2019. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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ABC

Review Article

Cancer and Cardiovascular Diseases during the COVID-19 Pandemic

Lucas Tokio Kawahara et al. Isabela Bispo Santos da Silva Costa Cecília Chie Sakaguchi Barros Gabriel Coelho de Almeida … Cristina Salvadori Bittar Stephanie Itala Rizk Laura Testa Camila Motta Venchiarutti Moniz Juliana Pereira Gláucia Maria Moraes de Oliveira Maria Del Pilar Estevez Diz Patricia Oliveira Guimarães Ibraim Masciarelli Pinto Roberto Kalil Filho Ludhmila Abrahão Hajjar Paulo M. Hoff

Abstract

The challenges that the COVID-19 pandemic cretead to the healthcare system have made it necessary to adapt routines and services, with the objectives of controlling the spread of the virus and preserving health. Safe and correct management of patients in risks groups, such as elderly patients, patients with cardiovascular diseases, and patients with cancer, has become even more important. Thus, cardio-oncology has gained a new dimension, with the aim of adapting to patients’ needs during the pandemic by restructuring the system of care in a manner that offers quality and safety in healthcare.

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ABC

Research Letter

Pericardial Affections in Patients with COVID-19: A Possible Cause of Hemodynamic Deterioration

Fábio Fernandes et al. Felix José Alvarez Ramires Fábio Danziato Fernandes Marcus Vinicius Simões … Evandro Tinoco Mesquita Charles Mady

Introduction

The clinical course of the SARS-CoV-2 infection is characterized by respiratory symptoms, fever, cough, sore throat, fatigue, and complications related to the acute respiratory distress syndrome. However, some patients with initially mild symptoms can present clinical deterioration approximately one week after onset of the symptoms.

The acute progression of COVID-19 can be divided into 3 different phases: early infection, pulmonary phase, and hyperinflammation, and significant overlaps between these phases can occur.

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ABC

Research Letter

Adapted Catheterization Laboratory Practices during the COVID-19 Pandemic: The Instituto Dante Pazzanese de Cardiologia Protocol

Daniel Chamié et al. Fernanda Oliveira Sérgio Braga José Ribamar Costa … Dimytri Alexandre Alvim de Siqueira Rodolfo Staico Ricardo Costa Galo Maldonado Luiz Fernando Leite Tanajura Marinella Patrizia Centemero Áurea Jacob Chaves Andrea Cláudia Sousa Leão Abizaid Rafaela Andrade Penalva Freitas Nancy Toledo Coelho Louis Nakayama Ohe Cely Abboud Fausto Feres

Introduction

The global coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus began in Wuhan, China, in December 2019, and it has affected over 4.4 million people worldwide, with 302,169 deaths as of May 16, 2020. ¹

Though respiratory symptoms are the most common presentation of COVID-19, cardiac involvement is a prominent feature of this disease, occurring in 20% to 30% of hospitalized patients and contributing to 40% of deaths. ^2-4 COVID-19-related cardiac involvement has been documented by elevations in cardiac biomarkers, and it often presents with changes in the ST-T segment in the 12-lead electrocardiogram (ECG), for which the catheterization laboratory team is often activated. Furthermore, catheterization laboratory activities must continue for care of non-COVID-19 patients who present with genuine acute coronary syndrome (ACS), ST-elevation myocardial infarction (STEMI), and highly symptomatic stable ischemic heart disease.

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