LitCovid-sentences  

PMC:7102662 / 5786-18861 JSONTXT 14 Projects

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Id Subject Object Predicate Lexical cue
T52 0-17 Sentence denotes 2 Search methods
T53 18-243 Sentence denotes A literature search was done using PubMed and Google search engines for original and review articles, advisories from professional societies, and expert commentaries published since the onset of the current COVID-19 epidemic.
T54 244-415 Sentence denotes Search terms “COVID-19” and “coronavirus” were used in combination with “cardiac”, “cardiovascular”, “arrhythmia”, “myocardial infarction”, “troponin” and “heart failure”.
T55 416-502 Sentence denotes Relevant cross-references for previous studies about SARS and MERS were also reviewed.
T56 504-534 Sentence denotes 2.1 Pathogenic considerations
T57 535-598 Sentence denotes SARS-CoV-2 is caused by a novel enveloped RNA beta-coronavirus.
T58 599-828 Sentence denotes Seven species of these beta-coronaviruses are known to cause human infections, with four mainly causing mild flulike symptoms and the remaining three resulting in potentially fatal illnesses (SARS, MERS and the ongoing COVID-19).
T59 829-947 Sentence denotes Although respiratory tract is the primary target for SARS-CoV-2, CV system may get involved in several different ways.
T60 948-1037 Sentence denotes Following are the common mechanisms responsible for CV complications in COVID-19 [3,4]-1.
T61 1039-1226 Sentence denotes Direct myocardial injury- SARS-CoV-2 enters human cells by binding to angiotensin-converting enzyme 2 (ACE2), a membrane bound aminopeptidase which is highly expressed in heart and lungs.
T62 1227-1354 Sentence denotes ACE2 plays an important role in neurohumoral regulation of CV system in normal health as well as in various disease conditions.
T63 1355-1492 Sentence denotes The binding of SARS-CoV-2 to ACE2 can result in alteration of ACE2 signaling pathways, leading to acute myocardial and lung injury [3,4].
T64 1493-1495 Sentence denotes 2.
T65 1497-1704 Sentence denotes Systemic inflammation- More severe forms of COVID-19 are characterized by acute systemic inflammatory response and cytokine storm, which can result in injury to multiple organs leading to multiorgan failure.
T66 1705-1825 Sentence denotes Studies have shown high circulatory levels of proinflammatory cytokines in patients with severe/critical COVID-19 [5,6].
T67 1826-1828 Sentence denotes 3.
T68 1830-2091 Sentence denotes Altered myocardial demand-supply ratio- Increased cardiometabolic demand associated with the systemic infection coupled with hypoxia caused by acute respiratory illness can impair myocardial oxygen demand-supply relationship and lead to acute myocardial injury.
T69 2092-2094 Sentence denotes 4.
T70 2096-2301 Sentence denotes Plaque rupture and coronary thrombosis- Systemic inflammation as well as increased shear stress due to increased coronary blood flow can precipitate plaque rupture resulting in acute myocardial infarction.
T71 2302-2383 Sentence denotes Prothrombotic milieu created by systemic inflammation further increases the risk.
T72 2384-2386 Sentence denotes 5.
T73 2388-2565 Sentence denotes Adverse effects of various therapies- Various antiviral drugs, corticosteroids and other therapies aimed at treating COVID-19 can also have deleterious effects on the CV system.
T74 2566-2568 Sentence denotes 6.
T75 2570-2739 Sentence denotes Electrolyte imbalances- Electrolyte imbalances can occur in any critical systemic illness and precipitate arrhythmias, esp. in patients with underlying cardiac disorder.
T76 2740-2878 Sentence denotes There is particular concern about hypokalemia in COVID-19, due to interaction of SARS-CoV-2 with renin-angiotensin-aldosterone system [7].
T77 2879-2943 Sentence denotes Hypokalemia increases vulnerability to various tachyarrhythmias.
T78 2945-2986 Sentence denotes 2.1.1 Role of underling CV comorbidities
T79 2987-3158 Sentence denotes The patients with pre-existing CVD appear to have heightened vulnerability to develop COVID-19 and tend to have more severe disease with worse clinical outcomes [1,4,6,8].
T80 3159-3311 Sentence denotes Various CV risk factors also adversely affect porgnosis of these patients, although they do not seem to increase likleihood of developing the infection.
T81 3312-3522 Sentence denotes A meta-analysis of six published studies from China including 1527 patients with COVID-19 reported 9.7%, 16.4% and 17.1% prevalence of diabetes, cardio-cerebrovascular disease and hypertension respectively [4].
T82 3523-3711 Sentence denotes Although the prevalence of diabetes and hypertension in this cohort was same as in the Chinese general population, the prevalence of cardio-cerebrovascular disease was considerably higher.
T83 3712-3985 Sentence denotes More importantly, the presence of diabetes, cardio-cerebrovascular disease and hypertension was associated with a 2-fold, 3-fold and 2-fold greater risk of severe disease or requiring intensive care unit (ICU) admission, suggesting prognostic impact of these comorbidities.
T84 3986-4135 Sentence denotes A much larger report from the Chinese Center for Disease Control and Prevention described clinical outcomes in 44672 confirmed cases of COVID-19 [1].
T85 4136-4310 Sentence denotes The overall case fatality rate (CFR) was 2.3% in the entire cohort but significantly higher (6%, 7.3% and 10.5% respectively) in patients with hypertension, diabetes and CVD.
T86 4311-4482 Sentence denotes Although data is lacking, the prevalence of various CV comorbidities and their impact on clinical outcomes seem to vary considerably across different geographic locations.
T87 4483-4610 Sentence denotes The CFRs have been lower in China outside Hubei province and many other countries but much higher in some European nations [2].
T88 4611-4733 Sentence denotes A small report including 21 patients from Washington, United States of America presented a particularly grim scenario [9].
T89 4734-4845 Sentence denotes Comorbidities were common in this cohort, with diabetes present in 33.3% and congestive heart failure in 42.9%.
T90 4846-4923 Sentence denotes Acute cardiac dysfunction occurred in 33.3% patients and 52.4% patients died.
T91 4924-5163 Sentence denotes However, the overall CFR in the United States seems to be much lower (201 deaths out of 15219 confirmed cases) [2], although it is likely to rise as many of the patients are currently hospitalized and have not yet had the definite outcome.
T92 5165-5211 Sentence denotes 2.2 Cardiovascular manifestations of COVID-19
T93 5213-5243 Sentence denotes 2.2.1 Acute myocardial injury
T94 5244-5337 Sentence denotes Acute myocardial injury is the most commonly described CV complication in COVID-19 (Table 1).
T95 5338-5529 Sentence denotes Different reports have used different definitions for acute myocardial injury, including rise in cardiac enzymes (different biomarkers and cut-offs) and/or electrocardiographic abnormalities.
T96 5530-5686 Sentence denotes However, an elevation of high-sensitivity cardiac troponin I (cTnI) above 99th percentile upper reference limit is the most commonly used definition.Table 1
T97 5687-5847 Sentence denotes The overall incidence of acute cardiac injury has been variable but roughly 8–12% of the positive cases are known to develop significant elevation of cTnI [10].
T98 5848-6117 Sentence denotes The aforementioned meta-analysis of the Chinese studies [4] reported 8% incidence of acute cardiac injury whereas another study including only those patients who had had a definite outcome (death or discharge from hospital) reported 17% incidence of cTnI elevation [5].
T99 6118-6279 Sentence denotes Regardless of the actual incidence, acute cardiac injury has been consistently shown to be a strong negative prognostic marker in patients with COVID-19 [5,6,8].
T100 6280-6398 Sentence denotes The patients admitted to ICU or having severe/fatal illness have several-fold higher likelihood of troponin elevation.
T101 6399-6537 Sentence denotes In contrast, the incidence of elevated troponin has been very low (only 1–2%) in patients having mild illness not requiring ICU admission.
T102 6538-6665 Sentence denotes Any of the mechanisms described above can lead to acute cardiac injury and rise in cardiac troponins in patients with COVID-19.
T103 6666-6890 Sentence denotes The relative role of these different mechanisms has not been described but direct (i.e. non-coronary) myocardial injury due to viral myocarditis or the effect of systemic inflammation appear to be the most common mechanisms.
T104 6891-7027 Sentence denotes These observations are supported by a previous autopsy study in patients who had died due to SARS during the Toronto SARS outbreak [11].
T105 7028-7189 Sentence denotes In this study, the viral ribonucleic acid was detected in 35% of the autopsied human heart samples, providing evidence for direct myocardial injury by the virus.
T106 7190-7311 Sentence denotes No study has described the incidence of ST-segment elevation myocardial infarction in COVID-19, but it appears to be low.
T107 7312-7461 Sentence denotes Similarly, the incidence of left ventricular systolic dysfunction, acute left ventricular failure and cardiogenic shock have also not been described.
T108 7462-7546 Sentence denotes Only one Chinese study reported incidence of heart failure in COVID-19 patients [5].
T109 7547-7684 Sentence denotes Heart failure had occurred in 52% of the patients who subsequently died and in 12% of the patients who were discharged from the hospital.
T110 7686-7704 Sentence denotes 2.2.2 Arrhythmias
T111 7705-7770 Sentence denotes Both tachy- and brady-arrhythmias are known to occur in COVID-19.
T112 7771-7901 Sentence denotes A study describing clinical profile and outcomes in 138 Chinese patients with COVID-19 reported 16.7% incidence of arrhythmia [8].
T113 7902-8029 Sentence denotes The incidence was much higher (44.4%) in those requiring ICU admission as compared to those not requiring ICU admission (8.9%).
T114 8030-8071 Sentence denotes The type of arrhythmia was not described.
T115 8073-8112 Sentence denotes 2.2.3 Potential long-term consequences
T116 8113-8251 Sentence denotes COVID-19 has emerged only a few months ago and it is too early to predict long-term outcome of the patients who recover from this illness.
T117 8252-8409 Sentence denotes However, some important messages can be gleaned from previous experiences with SARS, caused by SARS-CoV which shares considerable similarity with SARS-CoV-2.
T118 8410-8634 Sentence denotes It was reported that among patients who had recovered from SARS, 68% continued to have abnormalities of lipid metabolism at 12-years follow-up; CV abnormalities were present in 40% and altered glucose metabolism in 60% [12].
T119 8635-8744 Sentence denotes Similar findings have also been reported in patients recovering from other respiratory tract infections [13].
T120 8745-8948 Sentence denotes Considering this, careful follow-up of those recovering from the current COVID-19 would be important to understand the long-term impact of this illness and also to protect these patients from future CVD.
T121 8950-8978 Sentence denotes 2.3 Management implications
T122 8979-9160 Sentence denotes The overall management principles for patients presenting with COVID-19 who develop CV complications or who have pre-existing CVD are same as for any other patient without COVID-19.
T123 9161-9229 Sentence denotes However, there are a few important points that need consideration-1.
T124 9230-9350 Sentence denotes As caregivers, it is our utmost responsibility to protect ourselves from getting infected while managing these patients.
T125 9351-9475 Sentence denotes Therefore, all heathcare personnel engaged in the care of COVID-19 patients must observe necessary precautions at all times.
T126 9476-9626 Sentence denotes All of them should be trained in donning, usage, and doffing of the personal protective equipment in accordance with the existing practice guidelines.
T127 9627-9629 Sentence denotes 2.
T128 9630-9790 Sentence denotes The hospital systems need to ensure preparedness for dealing with large volume of COVID-19 patients, many of whom would need ICU care and/or acute cardiac care.
T129 9791-9950 Sentence denotes Appropriate protocols for rapid diagnosis, triage, isolation, and management of COVID-19 patients with CV complications should be developed and well-rehearsed.
T130 9951-10119 Sentence denotes Rapid triaging and management of these patients is crucial, not only to allow efficient utilization of healthcare resources but also to minimize exposure to caregivers.
T131 10120-10274 Sentence denotes There are already reports highlighting delays in delivering acute cardiac care due to extra precautions that need to be observed in view of COVID-19 [14].
T132 10275-10322 Sentence denotes Efforts should be made to minimize such delays.
T133 10323-10325 Sentence denotes 3.
T134 10326-10466 Sentence denotes Strong emphasis should be placed on avoiding unwarranted diagnostic tests (e.g. cardiac troponin, echocardiography, etc.) in these patients.
T135 10467-10700 Sentence denotes This is required to minimize unwarranted downstream diagnostic/therapeutic procedures which would further strain the already stretched healthcare resources and would also subject caregivers to added risk of exposure to the infection.
T136 10701-10863 Sentence denotes The American College of Cardiology has released an advisory discouraging random measurement of cardiac biomarkers such as troponins and natriuretic peptides [15].
T137 10864-11028 Sentence denotes It urges all the clinicians to reserve these assays for circumstances in which they would actually meaningfully add to the management of the patients with COVID-19.
T138 11029-11166 Sentence denotes The American Society of Echocardiography has also issued a similar advisory regarding the use of echocardiography in these patients [16].
T139 11167-11169 Sentence denotes 4.
T140 11170-11381 Sentence denotes The individual hospitals may also have to reconsider risk-benefit ratio of primary percutaneous intervention vs fibrinolysis in patients with COVID-19 who present with ST-segment elevation myocardial infarction.
T141 11382-11384 Sentence denotes 5.
T142 11385-11533 Sentence denotes There has been a concern regarding the safety of ACE inhibitors (ACEi) and angiotensin receptor blockers (ARB) during the ongoing COVID-19 pandemic.
T143 11534-11630 Sentence denotes These agents upregulate expression of ACE2 in various tissues, including on cardiomyocytes [17].
T144 11631-11855 Sentence denotes Since SARS-CoV-2 binds to ACE2 to gain entry into human cells, there is a potentially increased risk of developing COVID-19 or developing more severe disease in patients who are already on background treatment with ACEi/ARB.
T145 11856-11946 Sentence denotes However, to date, no experimental or clinical data have emerged to support these concerns.
T146 11947-12023 Sentence denotes At the same time, the risks of discontinuing these therapies are well known.
T147 12024-12202 Sentence denotes Therefore, several leading professional societies have strongly urged to not discontinue clinically-indicated ACEi/ARB therapy in the event the patient develops COVID-19 [18,19].
T148 12203-12205 Sentence denotes 6.
T149 12206-12363 Sentence denotes Clinicians caring for these patients also need to be fully aware of the potential CV side-effects of various therapies used for treating the viral infection.
T150 12364-12525 Sentence denotes Additionally, various anti-retroviral drugs have significant interactions with cardiac drugs, which need to be considered and appropriate dose modification done.
T151 12526-12677 Sentence denotes More recently, chloroquine/hydroxychloroquine and azathioprine have been proposed as potential therapeutic options, based on preliminary evidence [20].
T152 12678-12792 Sentence denotes Both these drugs are known to prolong QT interval and due caution must be exercised when prescribing these agents.
T153 12793-13075 Sentence denotes Their combination is best avoided and even when using chloroquine/hydroxychloroquine alone, daily electrocardiogram for monitoring QT interval is warranted, esp. in patients with hepatic or renal dysfunction and in those receiving another drug with potential to prolong QT interval.