Ciddi COVID-19 Hastalığında Akut Sonlanım ve Kardiyak Fonksiyonlar

Öz

Giriş: Ciddi COVID-19, sistemik inflamasyon ve koagülasyon bozukluklarından kaynaklanan kardiyovasküler komplikasyonlarla ilişkilidir. Uzun vadeli etkileri ele almak için, kısa vadeli kardiyovasküler etkilerin bilinmesi hasta yönetimini iyileştirmek ve olumsuz sonuçları en aza indirmek için önemlidir. Amaç: Bu çalışma, ciddi ve ciddi olmayan COVID-19 hastalarında akut kardiyak sonuçları ve fonksiyonları karşılaştırmayı amaçlamıştır, kardiyovasküler komplikasyonlara ve prognostik implikasyonlara odaklanmıştır. Gereç ve Yöntem: Mayıs 2021'den Temmuz 2021'e kadar bir üçüncü basamak sağlık kuruluşunda yürütülen kesitsel bir çalışma, 216 katılımcıyı içermiş olup, bunlar yaş ve cinsiyete göre eşleştirilmiş 108'şer kişilik iki gruba ayrılmıştır: ciddi ve ciddi olmayan vakalar. Ciddi grup hastaneye yatış veya yoğun bakım gerektirirken, ciddi olmayan grup ambulatuar olarak tedavi edilmiştir. Değerlendirmeler, ekokardiyografik değerlendirmeler, 12 derivasyonlu elektrokardiyogramlar ve kardiyak biyobelirteçler için laboratuvar testlerini içermiştir. Bulgular: Ciddi durumdaki hastaların ortalama yaşı 63.7 yıl iken, durumu ciddi olmayan hastaların yaşı 58.4 yıl idi (p < 0.001). Ayrıca, diyabet (54.6% karşı 27.8%) ve hipertansiyon (39.8% karşı 25.0%, p < 0.05) gibi komorbiditelerin daha yüksek prevalansı gözlemlendi. Ekokardiyografi, sol ventrikül ejeksiyon fraksiyonunun gruplar arasında (LVEF) 42.5% karşı 60.0% (p < 0.001) olduğunu ve E/Em oranının 14.5'e karşı 10 (p < 0.001) olduğunu gösterdi. Sağ ventrikül boyutları daha büyüktü, 4.1 cm karşı 3.0 cm (p < 0.001), miyokard performans indeksi ise 0.58 karşı 0.40 (p < 0.001) olarak daha yüksekti. Ciddi vakalarda mortalite oranı %39.8 iken, ciddi olmayan vakalarda oran %2.8 idi (p < 0.001). Sonuç: Ciddi COVID-19, kardiyak fonksiyonu önemli ölçüde bozarak, sonuçları iyileştirmek için kapsamlı kardiyovasküler değerlendirme ve hedefe yönelik müdahaleler gerektirir.

Anahtar Kelimeler

• COVİD-19
• Kardiyak fonksiyonlar
• Ekokardiyografi
• Ölüm

Acute Outcomes and Cardiac Functions in Severe COVID-19

Öz

Background: Severe COVID-19 is linked to cardiovascular complications from systemic inflammation and coagulation disorders. Addressing long-term COVID effects requires knowledge of its short-term cardiovascular impacts to enhance patient management and minimize adverse outcomes. Objective: This study aimed to compare acute cardiac outcomes and function in severe versus non-severe COVID-19 patients, focusing on cardiovascular complications and prognostic implications. Material and Methods: A cross-sectional study from May to July 2021 at a tertiary care facility included 216 participants, split evenly into two groups of 108: severe and non-severe cases, matched by age and sex. The severe group required hospitalization or ICU care, while the non-severe group was treated outpatient. Evaluations included echocardiographic assessments, 12-lead electrocardiograms, and lab tests for cardiac biomarkers. Results: Patients with severe conditions had an average age of 63.7 years, compared to 58.4 years for those with no severe conditions (p < 0.001). They also showed a higher prevalence of comorbidities such as diabetes (54.6% vs. 27.8%) and hypertension (39.8% vs. 25.0%, p < 0.05). Echocardiography indicated a reduced left ventricular ejection fraction (LVEF) of 42.5% versus 60.0% (p < 0.001) and an increased E/Em ratio of 14.5 compared to 10.0 (p < 0.001) among the groups. Right ventricular dimensions were larger, measuring 4.1 cm versus 3.0 cm (p < 0.001), with a higher myocardial performance index of 0.58 vs. 0.40 (p < 0.001). Severe cases had a mortality rate of 39.8% compared to 2.8% in no severe cases (p < 0.001). Conclusion: Severe COVID-19 significantly impairs cardiac function, necessitating comprehensive cardiovascular evaluation and targeted interventions to improve outcomes

Anahtar Kelimeler

• COVID-19
• Cardiac function
• Echocardiography
• Mortality

Kaynakça

1. Argulian, E., Sud, K., Vogel, B., Bohra, C., Garg, V. P., Talebi, S., Lerakis, S., & Narula, J. (2020). Right ventricular dilation in hospitalized patients with COVID-19 infection. JACC: Cardiovascular Imaging, 13(11), 2459–2462.
2. Coromilas, E. J., Kochav, S., Goldenthal, I., Biviano, A., Garan, H., & Wan, E. Y. (2021). Worldwide survey of COVID-19–associated arrhythmias. Circulation: Arrhythmia and Electrophysiology, 14(3), e009458.
3. Giustino, G., Pinney, S. P., Lala, A., Goyal, P., Sharma, S. K., & Kini, A. S. (2020). Coronavirus and cardiovascular disease, myocardial injury, and arrhythmia: JACC state-of-the-art review. Journal of the American College of Cardiology, 76(17), 2011–2023.
4. Guo, T., Fan, Y., Chen, M., Wu, X., Zhang, L., He, T., Wang, H., Wan, J., Wang, X., & Lu, Z. (2020). Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiology, 5(7), 811–818.
5. Klok, F. A., Kruip, M. J. H. A., van der Meer, N. J. M., Arbous, M. S., Gommers, D. A. M. P. J., Kant, K. M., Kaptein, F. H. J., van Paassen, J., Stals, M. A. M., Huisman, M. V., & Endeman, H. (2020). Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research, 191, 145–147.
6. Libby, P., & Lüscher, T. (2020). COVID-19 is, in the end, an endothelial disease. European Heart Journal, 41(32), 3038–3044.
7. Lindner, D., Fitzek, A., Bräuninger, H., Aleshcheva, G., Edler, C., Meissner, K., Scherschel, K., Kirchhof, P., Escher, F., Schultheiss, H.-P., Blankenberg, S., Püschel, K., & Westermann, D. (2020). Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases. JAMA Cardiology, 5(11), 1281–1285.
8. Nascimento, J. H. P., Costa, L. F., & Vissoci, J. R. N. (2023). Cardiovascular complications of long COVID: A systematic review and meta-analysis. Journal of Infection, 86(5), 483–485.

9. Olszanecka, A., Wojciechowska, W., Bednarek, A., Kusak, P., Wizner, B., Terlecki, M., Stolarz-Skrzypek, K., Klocek, M., Drożdż, T., Sładek, K., Bociąga-Jasik, M., Garlicki, A., Rewiuk, K., Matyja, A., Małecki, M., Sydor, W., Krzanowski, M., Grodzicki, T., & Rajzer, M. (2023). Serial echocardiographic evaluation of COVID-19 patients without prior history of structural heart disease: A 1-year follow-up CRACoV-HHS study. Frontiers in Cardiovascular Medicine, 10, Article 1231258.
10. Pagnesi, M., Baldetti, L., Beneduce, A., Calvo, F., Gramegna, M., Pazzanese, V., Ingallina, G., Napolano, A., Finazzi, R, Ruggeri, A., Ajello, S., Melisurgo, G., Camici, P. G., Scarpellini, P., Landoni, G., Ciceri, F., Scandroglio, A. M., Agricola, E., & Cappelletti, A. M. (2020). Pulmonary hypertension and right ventricular involvement in hospitalised patients with COVID-19. Heart, 106(18), 1324–1331.
11. REMAP-CAP Investigators. (2021). Therapeutic anticoagulation with heparin in noncritically ill patients with COVID-19. New England Journal of Medicine, 385(9), 790–802.
12. Richardson, S., Hirsch, J. S., Narasimhan, M., Crawford, J. M., McGinn, T., Davidson, K. W., Barnaby, D. P., Becker, L. B., Chelico, J. D., Cohen, S. L., Cookingham, J., Coppa, K., Diefenbach, M. A., Dominello, A. J., Duer-Hefele, J., Falzon, L., Gitlin, J., Hajizadeh, N., Harvin, T. G., ... Zanos, T. P. (2020). Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA, 323(20), 2052–2059. Ruan, Q., Yang, K., Wang, W., Jiang, L., & Song, J. (2020). Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Medicine, 46(5), 846–848.
13. 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. (2020). Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiology, 5(7), 802–810.
14. Shrestha, A. B., Jha, S., & Regmi, S. (2023). Incidence of cardiovascular complications in post-COVID-19 syndrome: A systematic review and meta-analysis. Journal of Clinical Medicine, 12(15), Article 5049.
15. South, A. M., Diz, D. I., & Chappell, M. C. (2020). COVID-19, ACE2, and the cardiovascular consequences. American Journal of Physiology-Heart and Circulatory Physiology, 318(5), H1084–H1090.
16. Sud, K., Vogel, B., Bohra, C., Garg, V., Talebi, S., Lerakis, S., Narula, J., & Argulian, E. (2020). Echocardiographic findings in patients with COVID-19 with significant myocardial injury. Journal of the American Society of Echocardiography, 33(11), 1419–1420.
17. Szekely, Y., Lichter, Y., Taieb, P., Banai, A., Hochstadt, A., Merdler, I., Gal Oz, A., Rothschild, E., Baruch, G., Peri, Y., Shacham, Y., & Topilsky, Y. (2020). Spectrum of cardiac manifestations in COVID-19: A systematic echocardiographic study. Circulation, 142(4), 342–353.
18. Tang, N., Li, D., Wang, X., & Sun, Z. (2020). Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis, 18(4), 844–847. Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., Wang, B., Xiang, H., Cheng, Z., Xiong, Y, Zhao, Y., Li, Y., Wang, X., & Peng, Z. (2020). Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA, 323(11), 1061–1069. Wiersinga, W. J., Rhodes, A., Cheng, A. C., Peacock, S. J., & Prescott, H. C. (2020). Pathophysiology, transmission, 30 diagnosis, and treatment of coronavirus disease 2019 (COVID-19): A review. JAMA, 324(8), 782–793.
19. Wu, Z., & McGoogan, J. M. (2020). Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA, 323(13), 1239–1242.
20. Xie, Y., Xu, E., Bowe, B., & Al-Aly, Z. (2022). Long-term cardiovascular outcomes of COVID-19. Nature Medicine, 28(3), 583–590.