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COVID-19 and Its Cardiovascular Effects: Risk Factors, Prevention and Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: closed (20 January 2023) | Viewed by 17620

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Prof. Dr. Raffaele Marfella

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Guest Editor

Professore Ordinario Medicina Interna, Università degli studi della Campania, Luigi Vanvitelli, Caserta, Italy
Interests: coronary artery diseases; heart failure; diabetes; atherosclerosis
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Celestino Sardu

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Guest Editor

1. Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
2. Department of Internal Medicine, Saint Camillus University, Rome, Italy
3. Department of Cardiovascular Diseases and Cardiovascular Surgery, "Gemelli Molise Sp.a.", Campobasso, Italy
Interests: heart failure; syncope; arrhythmias; cardiac resynchronization therapy; ischemic heart disease; diabetes mellitus; SARS-CoV-2; COVID-19
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The coronavirus responsible for severe acute respiratory syndrome (SARS-CoV-2) was first isolated in December 2019 in patients from the city of Wuhan. Patients that tested positive for SARS-CoV-2 experienced Coronavirus disease 2019 (COVID-19), with different stages shifting from asymptomatic patients (ASAP) towards patients requiring intubation, mechanical ventilation, intensive care unit (ICU) admission and deaths. Notably, in the different clinical manifestation of COVID-19, authors reported its hypercoagulative status, with acute thrombosis, over-inflammation and endothelial dysfunction. To date, subjects at higher risk of worse prognosis (intubation, mechanical ventilation, ICU admission) and death could be conditioned by metabolic dysfunction, as in the case of diabetes mellitus (DM), hyperglycemia, and the altered expression of Angiotensin Converting Enzyme 2 (ACE2) pathways. Indeed, in this case, there was a higher avidity of intramyocardial binding between ACE2 and SARS-CoV-2, with a consequent higher rate of myocarditis, cardiac complications, heart failure (HF) and deaths.

Thus, the definition and identification of these altered mechanisms that are responsible for worse prognosis could highlight a higher risk population (DM and hypertensive patients), and be attractive for early diagnosis, management and therapeutic approaches in COVID-19.

Conversely, new therapeutic approaches for COVID-19 could be necessary to reduce the cardiovascular effects and risk of mortality in SARS-CoV-2-positive patients. Therefore, it is increasingly crucial to find tailored treatment strategies to protect these patients, to reduce hospital readmission and mortality.

Therefore, in this Special Issue focused on cardiovascular effects in COVID-19 patients, we invite research concerning new diagnostic and therapeutic approaches related to molecular, cellular, and epigenetic biomarkers of cardiovascular disease in COVID-19 patients, with a particular interest in the development of treatment strategies to control and/or revert these clinical and pathological adaptive conditions. (Please note that case reports and short reviews are not accepted)

Prof. Dr. Raffaele Marfella
Prof. Dr. Celestino Sardu
Guest Editors

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Keywords

COVID-19
hypertension
diabetes mellitus
cardiovascular disease

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Published Papers (7 papers)

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Editorial

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4 pages, 208 KiB

Open AccessEditorial

COVID-19 and Its Cardiovascular Effects: Risk Factors, Prevention and Management

by Celestino Sardu and Raffele Marfella

J. Clin. Med. 2023, 12(13), 4457; https://doi.org/10.3390/jcm12134457 - 3 Jul 2023

Cited by 1 | Viewed by 796

Abstract

Coronavirus disease 2019 (COVID-19) is caused by a positive-stranded, single-stranded RNA virus, which is a member of the Sarbecovirus subgenus (beta-CoV lineage B) [...] Full article

(This article belongs to the Special Issue COVID-19 and Its Cardiovascular Effects: Risk Factors, Prevention and Management)

Research

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13 pages, 2016 KiB

Open AccessArticle

Association of Interleukin-32 and Interleukin-34 with Cardiovascular Disease and Short-Term Mortality in COVID-19

by Christoph C. Kaufmann, Amro Ahmed, Marie Muthspiel, Isabella Rostocki, Edita Pogran, David Zweiker, Achim Leo Burger, Bernhard Jäger, Gabriele Aicher, Alexander O. Spiel, Florian Vafai-Tabrizi, Michael Gschwantler, Peter Fasching, Johann Wojta and Kurt Huber

J. Clin. Med. 2023, 12(3), 975; https://doi.org/10.3390/jcm12030975 - 27 Jan 2023

Cited by 5 | Viewed by 1798

Abstract

Background: Excess cardiovascular (CV) morbidity and mortality has been observed in patients with COVID-19. Both interleukin-32 (IL-32) and interleukin-34 (IL-34) have been hypothesized to contribute to CV involvement in COVID-19. Methods: This prospective, observational study of patients with laboratory-confirmed COVID-19 infection was conducted from 6 June to 22 December 2020 in a tertiary care hospital in Vienna, Austria. IL-32 and IL-34 levels on admission were collected and tested for their association with CV disease and short-term mortality in patients with COVID-19. CV disease was defined by the presence of coronary artery disease, heart failure, stroke or atrial fibrillation and patients were stratified by CV disease burden. Results: A total of 245 eligible patients with COVID-19 were included, of whom 37 (15.1%) reached the primary endpoint of 28-day mortality. Of the total sample, 161 had no CV disease (65.7%), 69 had one or two CV diseases (28.2%) and 15 patients had ≥three CV diseases (6.1%). Median levels of IL-32 and IL-34 at admission were comparable across the three groups of CV disease burden. IL-32 and IL-34 failed to predict mortality upon both univariable and multivariable Cox regression analysis. The two CV disease groups, however, had a significantly higher risk of mortality within 28 days (one or two CV diseases: crude HR 4.085 (95% CI, 1.913–8.725), p < 0.001 and ≥three CV diseases: crude HR 13.173 (95% CI, 5.425–31.985), p < 0.001). This association persisted for those with ≥three CV diseases after adjustment for age, gender and CV risk factors (adjusted HR 3.942 (95% CI, 1.288–12.068), p = 0.016). Conclusion: In our study population of hospitalized patients with COVID-19, IL-32 and IL-34 did not show any associations with CV disease or 28-day mortality in the context of COVID-19. Patients with multiple CV diseases, however, had a significantly increased risk of short-term mortality. Full article

(This article belongs to the Special Issue COVID-19 and Its Cardiovascular Effects: Risk Factors, Prevention and Management)

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17 pages, 1653 KiB

Open AccessArticle

Preliminary Research on the Effect of Hyperbaric Oxygen Therapy in Patients with Post-COVID-19 Syndrome

by Diana Kitala, Wojciech Łabuś, Jerzy Kozielski, Przemysław Strzelec, Mariusz Nowak, Grzegorz Knefel, Piotr Dyjas, Krzysztof Materniak, Jolanta Kosmala, Jolanta Pająk, Jolanta Czop, Barbara Janda-Kalus, Barbara Marona, Anna Nowak-Wróżyna, Marcin Gierek, Jan Szczegielniak and Marek Kucharzewski

J. Clin. Med. 2023, 12(1), 308; https://doi.org/10.3390/jcm12010308 - 30 Dec 2022

Cited by 7 | Viewed by 4660

Abstract

Negative consequences and medical complications of COVID-19 can persist for up to several months after initial recovery. These consequences can include stroke, diabetes, decreased lung diffusing capacity, sleep apnea, pulmonary fibrosis, arrhythmia, myocarditis, fatigue, headaches, muscle aches, heart rate fluctuations, sleep problems, memory problems, nervousness, anxiety, and other neurological disorders. Thirty-one patients who reported symptoms related to previous COVID-19 disease of both sexes were enrolled in the initial program. The patients underwent compression sessions in a multiplace hyperbaric chamber. Each patient underwent a cycle of 15 compressions. Before the first session, each participant completed a venous blood gas test, a Fullerton test, and two spirometry tests (one before the Fullerton test and one after the test). Patients completed psychotechnical tests, a questionnaire on quality of life (Polish version of EQ-5D-5L), and a questionnaire on specific symptoms accompanying the disease and post-infection symptoms. The results showed significant improvements in areas such as quality of life, endurance and strength, some spirometric parameters, the anion gap and lactate levels, working memory, and attention in the group of treated patients. In contrast, there were no changes in pH, pO2, pCO2, glucose, and excess alkaline values. A follow-up interview confirmed that the beneficial effects were maintained over time. Considering the results obtained, including the apparent improvement in the patient’s clinical condition, it can be concluded that the use of 15 compression sessions was temporarily associated with a noticeable improvement in health and performance parameters as well as improvement in certain blood gas parameters. Full article

(This article belongs to the Special Issue COVID-19 and Its Cardiovascular Effects: Risk Factors, Prevention and Management)

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10 pages, 857 KiB

Open AccessArticle

Statins Use in Patients with Cardiovascular Diseases and COVID-19 Outcomes: An Italian Population-Based Cohort Study

by Ippazio Cosimo Antonazzo, Carla Fornari, Davide Rozza, Sara Conti, Raffaella Di Pasquale, Paolo Angelo Cortesi, Shaniko Kaleci, Pietro Ferrara, Alberto Zucchi, Giovanni Maifredi, Andrea Silenzi, Giancarlo Cesana, Lorenzo Giovanni Mantovani and Giampiero Mazzaglia

J. Clin. Med. 2022, 11(24), 7492; https://doi.org/10.3390/jcm11247492 - 17 Dec 2022

Cited by 5 | Viewed by 2526

Abstract

Background: The role of statins among patients with established cardiovascular diseases (CVDs) who are hospitalized with COVID-19 is still debated. This study aimed at assessing whether the prior use of statins was associated with a less severe COVID-19 prognosis. Methods: Subjects with CVDs infected with SARS-CoV-2 and hospitalized between 20 February 2020 and 31 December 2020 were selected. These were classified into two mutually exclusive groups: statins-users and non-users of lipid-lowering therapies (non-LLT users). The relationship between statins exposure and the risk of Mechanical Ventilation (MV), Intensive Care Unit (ICU) access and death were evaluated by using logistic and Cox regressions models. Results: Of 1127 selected patients, 571 were statins-users whereas 556 were non-LLT users. The previous use of statins was not associated with a variation in the risk of need of MV (Odds Ratio [OR]: 1.00; 95% Confidence Intervals [CI]: 0.38–2.67), ICU access (OR: 0.54; 95% CI: 0.22–1.32) and mortality at 14 days (Hazard Ratio [HR]: 0.42; 95% CI: 0.16–1.10). However, a decreased risk of mortality at 30 days (HR: 0.39; 95% CI: 0.18–0.85) was observed in statins-users compared with non-LLT users. Conclusions: These findings support the clinical advice for patients CVDs to continue their treatment with statins during SARS-CoV-2 infection. Full article

(This article belongs to the Special Issue COVID-19 and Its Cardiovascular Effects: Risk Factors, Prevention and Management)

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11 pages, 1231 KiB

Open AccessArticle

Prognostic Value of Catestatin in Severe COVID-19: An ICU-Based Study

by Toni Kljakovic-Gaspic, Daria Tokic, Dinko Martinovic, Marko Kumric, Daniela Supe-Domic, Sanda Stojanovic Stipic, Nikola Delic, Josip Vrdoljak, Marino Vilovic, Tina Ticinovic Kurir and Josko Bozic

J. Clin. Med. 2022, 11(15), 4496; https://doi.org/10.3390/jcm11154496 - 2 Aug 2022

Cited by 4 | Viewed by 1696

Abstract

Catestatin is a pleiotropic peptide with a wide range of immunomodulatory effects. Considering that patients with a severe COVID-19 infection have a major immunological dysregulation, the aim of this study was to evaluate catestatin levels in patients with COVID-19 treated in the intensive care unit (ICU) and to compare them between the fatal and non-fatal outcomes. The study included 152 patients with severe COVID-19, out of which 105 had a non-fatal outcome and 47 had a fatal outcome. Serum catestatin levels were estimated by an enzyme-linked immunosorbent assay in a commercially available diagnostic kit. The results show that catestatin levels were significantly lower in the fatal group compared to the non-fatal group (16.6 ± 7.8 vs. 23.2 ± 9.2 ng/mL; p < 0.001). Furthermore, there was a significant positive correlation between serum catestatin levels and vitamin D levels (r = 0.338; p < 0.001) while there was also a significant positive correlation between serum catestatin levels and growth differentiation factor-15 (GDF-15) levels (r = −0.345; p < 0.001). Furthermore, multivariate logistic regression showed that catestatin, GDF-15 and leukocyte count were significant predictors for COVID-19 survival. These findings imply that catestatin could be playing a major immunomodulatory role in the complex pathophysiology of the COVID-19 infection and that serum catestatin could also be a predictor of a poor COVID-19 outcome. Full article

(This article belongs to the Special Issue COVID-19 and Its Cardiovascular Effects: Risk Factors, Prevention and Management)

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8 pages, 1242 KiB

Open AccessArticle

Platelet Count in Patients with SARS-CoV-2 Infection: A Prognostic Factor in COVID-19

by Andrea Boccatonda, Damiano D’Ardes, Ilaria Rossi, Alice Grignaschi, Antonella Lanotte, Francesco Cipollone, Maria Teresa Guagnano and Fabrizio Giostra

J. Clin. Med. 2022, 11(14), 4112; https://doi.org/10.3390/jcm11144112 - 15 Jul 2022

Cited by 7 | Viewed by 1809

Abstract

COVID-19 patients may manifest thrombocytopenia and some of these patients succumb to infection due to coagulopathy. The aim of our study was to examine platelet count values in patients infected with SARS-CoV-2, comparing them to a control group consisting of non-COVID-19 patients. Moreover, we evaluated the correlation between the platelet value and the respiratory alteration parameters and the outcome (hospitalization and mortality) in COVID-19 patients. The mean platelet values (×10⁹/L) differed between patients with positive or negative SARS-CoV-2 swabs (242.1 ± 92.1 in SARS-CoV-2 negative vs. 215.2 ± 82.8 in COVID-19 patients, p < 0.001). In COVID-19 patients, the platelet count correlated with the A-aO₂ gradient (p = 0.001, rho = −0.149), with its increase over the expected (p = 0.013; rho = −0.115), with the PaO₂ values (p = 0.036; rho = 0.093), with the PCO₂ values (p = 0.003; rho = 0.134) and with the pH values (p = 0.016; rho = −0.108). In COVID-19 negative patients, the platelet values correlated only with the A-aO₂ gradient: (p = 0.028; rho = −0.101). Patients discharged from emergency department had a mean platelet value of 234.3 ± 68.7, those hospitalized in ordinary wards had a mean value of 204.3 ± 82.5 and in patients admitted to sub-intensive/intensive care, the mean value was 201.7 ± 75.1. In COVID-19 patients, the survivors had an average platelet value at entry to the emergency department of 220.1 ± 81.4, while that of those who died was 206.4 ± 87.7. Our data confirm that SARS-CoV-2 infection may induce thrombocytopenia, and that the reduction in platelet counts could be correlated with the main blood gas parameters and with clinical outcome; as a consequence, platelet count could be an important prognostic factor to evaluate and stratify COVID-19 patients. Full article

(This article belongs to the Special Issue COVID-19 and Its Cardiovascular Effects: Risk Factors, Prevention and Management)

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Review

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9 pages, 623 KiB

Open AccessReview

Effect of Hyperglycemia on COVID-19 Outcomes: Vaccination Efficacy, Disease Severity, and Molecular Mechanisms

by Celestino Sardu, Raffaele Marfella, Francesco Prattichizzo, Rosalba La Grotta, Giuseppe Paolisso and Antonio Ceriello

J. Clin. Med. 2022, 11(6), 1564; https://doi.org/10.3390/jcm11061564 - 12 Mar 2022

Cited by 15 | Viewed by 3348

Abstract

Background/Aims: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a positive-stranded single-stranded RNA virus, a member of the subgenus Sarbecovirus (beta-CoV lineage B) and responsible for the coronavirus disease 2019 (COVID-19). COVID-19 encompasses a large range of disease severity, from mild symptoms to severe forms with Intensive Care Unit admission and eventually death. The severe forms of COVID-19 are usually observed in high-risk patients, such as those with type two diabetes mellitus. Here, we review the available evidence linking acute and chronic hyperglycemia to COVID-19 outcomes, describing also the putative mediators of such interactions. Findings/Conclusions: Acute hyperglycemia at hospital admission represents a risk factor for poor COVID-19 prognosis in patients with and without diabetes. Acute and chronic glycemic control are both emerging as major determinants of vaccination efficacy, disease severity and mortality rate in COVID-19 patients. Mechanistically, it has been proposed that hyperglycemia might be a disease-modifier for COVID-19 through multiple mechanisms: (a) induction of glycation and oligomerization of ACE2, the main receptor of SARS-CoV-2; (b) increased expression of the serine protease TMPRSS2, responsible for S protein priming; (c) impairment of the function of innate and adaptive immunity despite the induction of higher pro-inflammatory responses, both local and systemic. Consistently, managing acute hyperglycemia through insulin infusion has been suggested to improve clinical outcomes, while implementing chronic glycemic control positively affects immune response following vaccination. Although more research is warranted to better disentangle the relationship between hyperglycemia and COVID-19, it might be worth considering glycemic control as a potential route to optimize disease prevention and management. Full article

(This article belongs to the Special Issue COVID-19 and Its Cardiovascular Effects: Risk Factors, Prevention and Management)

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