COVID-19 pneumonia: different respiratory treatment for different phenotypes? - The Surviving Sepsis Campaign panel (ahead of print, DOI: 10.1007/s00134-020-06022-5) recently recommended that “mechanically ventilated patients with COVID-19 should be managed similarly to
other patients with acute respiratory failure in the ICU.” Yet, COVID-19 pneumonia [1], despite falling in most of the circumstances under the Berlin definition of ARDS [2], is a specific disease, whose distinctive features are severe hypoxemia often associated with near normal respiratory system compliance (more than 50% of the 150 patients measured by the authors and further confirmed by several colleagues in Northern Italy). This remarkable combination is almost never seen in severe ARDS. These severely hypoxemic patients despite sharing a single etiology (SARS-CoV-2) may present quite differently from one another: normally breathing (“silent” hypoxemia) or remarkably dyspneic; quite responsive to nitric oxide or not; deeply hypocapnic or normo/ hypercapnic; and either responsive to prone position or not. Therefore, the same disease actually presents itself with impressive non-uniformity. More..
Shock Wave Therapy Enhances Mitochondrial Delivery into Target Cells and Protects against Acute Respiratory Distress Syndrome - The respiratory system (i.e., oral-nasal-laryngeal tract, bronchus, trachea, and alveolar sacs in the lungs) is critical for maintenance of an adequate oxygen supply and excretion of carbon dioxide (CO2). For this purpose, the lung parenchyma has a dense capillary network mediating gaseous exchange. The lung is vulnerable to damage from a variety of causes, including viruses, bacteria, toxic chemicals/smoke, food aspiration, septic or cardiogenic shock, resuscitation after circulatory arrest, alveolar-type pulmonary edema, massive blood transfusion, and ischemia-reperfusion injury after bypass surgery or organ transplantation. Moreover, sustained insults may ultimately develop into clinical acute respiratory distress syndrome (ARDS) . Despite pharmacologic advances and continuous renewal of management strategies, in-hospital mortality from ARDS remains unacceptably high. Consequently, there is an urgent need for a safe and efficacious alternative treatment for this high-risk group of patients. More..
Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) - 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). More..
Analysis of heart injury laboratory parameters in 273 COVID-19 patients in one hospital in Wuhan, China - Since December, 2019, an outbreak of pneumonia caused by a novel coronavirus (SARS-CoV-2) has raised intense attention in Wuhan, Hubei
province, China. 1-3 This disease, named COVID-19 by World Health Organization (WHO), spreads rapidly around the country and worldwide.
Coronaviruses can infect a variety of livestock, poultry, and humans, in which they can cause respiratory, enteric, cardiovascular, and neurological diseases. SARS-CoV-2 appears to have greater infectivity and a lower case fatality rate (CFR) as compared to severe acute respiratory syndrome coronavirus (SARS) and Middle East respiratory syndrome coronavirus (MERS). 8 So far, a few patients with SARS-CoV-2 have developed severe pneumonia, pulmonary oedema, acute respiratory distress syndrome (ARDS), or multiple organ failure and died.
According to a summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention, the overall case-fatality rate was 2.3% (1023 deaths among 44 672 confirmed cases). 9 No deaths were reported among mild and severe cases. The CFR was 49.0% among critical cases. More..
End-stage Heart Failure with COVID-19: Strong Evidence of Myocardial Injury by 2019-nCoV - A novel coronavirus (2019-nCoV) was identified as the cause associated with emerging pneumonia (COVID-19) detected in Wuhan on Jan 7th. Since the number of patients rising rapidly worldwide, COVID-19 has become a throny international public health event. As of Mar 24th, China has cumulatively diagnosed 81747 cases and 147 new cases, while the number of cases in other countries is growing rapidly with a total of 291070 cases confirmed and 22027 new cases identified that day. Emerging studies suggest that COVID-19 preferentially afflicts the elderly, particularly those with chronic comorbidities1, 2. However, the clinical profiles of
COVID-19 in refractory heart failure patients is unknown. Herein, we reported the clinical features in a group of end-stage heart failure patients with COVID-19, providing strong evidence of cardiac injury by the virus. More..
Angiotensin Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin Angiotensin System - Angiotensin-converting enzyme (ACE2) has a multiplicity of physiological roles that revolve around its trivalent function: a negative regulator of the renin-angiotensin system (RAS), facilitator of
amino acid transport, and the SARS-CoV and SARS-CoV-2 receptor. ACE2 is widely expressed, including, in the lungs, cardiovascular system, gut, kidneys, central nervous system, and adipose tissue. ACE2 has recently been identified as the SARS-CoV-2 receptor, the infective agent responsible for COVID-19,
providing a critical link between immunity, inflammation, ACE2, and cardiovascular disease. Although sharing a close evolutionary relationship with SARS-CoV, the receptor-binding domain of SARS-CoV-2 differs in several key amino acid residues, allowing for stronger binding affinity with the human ACE2
receptor, which may account for the greater pathogenicity of SARS-CoV-2. More..
other patients with acute respiratory failure in the ICU.” Yet, COVID-19 pneumonia [1], despite falling in most of the circumstances under the Berlin definition of ARDS [2], is a specific disease, whose distinctive features are severe hypoxemia often associated with near normal respiratory system compliance (more than 50% of the 150 patients measured by the authors and further confirmed by several colleagues in Northern Italy). This remarkable combination is almost never seen in severe ARDS. These severely hypoxemic patients despite sharing a single etiology (SARS-CoV-2) may present quite differently from one another: normally breathing (“silent” hypoxemia) or remarkably dyspneic; quite responsive to nitric oxide or not; deeply hypocapnic or normo/ hypercapnic; and either responsive to prone position or not. Therefore, the same disease actually presents itself with impressive non-uniformity. More..
Shock Wave Therapy Enhances Mitochondrial Delivery into Target Cells and Protects against Acute Respiratory Distress Syndrome - The respiratory system (i.e., oral-nasal-laryngeal tract, bronchus, trachea, and alveolar sacs in the lungs) is critical for maintenance of an adequate oxygen supply and excretion of carbon dioxide (CO2). For this purpose, the lung parenchyma has a dense capillary network mediating gaseous exchange. The lung is vulnerable to damage from a variety of causes, including viruses, bacteria, toxic chemicals/smoke, food aspiration, septic or cardiogenic shock, resuscitation after circulatory arrest, alveolar-type pulmonary edema, massive blood transfusion, and ischemia-reperfusion injury after bypass surgery or organ transplantation. Moreover, sustained insults may ultimately develop into clinical acute respiratory distress syndrome (ARDS) . Despite pharmacologic advances and continuous renewal of management strategies, in-hospital mortality from ARDS remains unacceptably high. Consequently, there is an urgent need for a safe and efficacious alternative treatment for this high-risk group of patients. More..
Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) - 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). More..
Analysis of heart injury laboratory parameters in 273 COVID-19 patients in one hospital in Wuhan, China - Since December, 2019, an outbreak of pneumonia caused by a novel coronavirus (SARS-CoV-2) has raised intense attention in Wuhan, Hubei
province, China. 1-3 This disease, named COVID-19 by World Health Organization (WHO), spreads rapidly around the country and worldwide.
Coronaviruses can infect a variety of livestock, poultry, and humans, in which they can cause respiratory, enteric, cardiovascular, and neurological diseases. SARS-CoV-2 appears to have greater infectivity and a lower case fatality rate (CFR) as compared to severe acute respiratory syndrome coronavirus (SARS) and Middle East respiratory syndrome coronavirus (MERS). 8 So far, a few patients with SARS-CoV-2 have developed severe pneumonia, pulmonary oedema, acute respiratory distress syndrome (ARDS), or multiple organ failure and died.
According to a summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention, the overall case-fatality rate was 2.3% (1023 deaths among 44 672 confirmed cases). 9 No deaths were reported among mild and severe cases. The CFR was 49.0% among critical cases. More..
End-stage Heart Failure with COVID-19: Strong Evidence of Myocardial Injury by 2019-nCoV - A novel coronavirus (2019-nCoV) was identified as the cause associated with emerging pneumonia (COVID-19) detected in Wuhan on Jan 7th. Since the number of patients rising rapidly worldwide, COVID-19 has become a throny international public health event. As of Mar 24th, China has cumulatively diagnosed 81747 cases and 147 new cases, while the number of cases in other countries is growing rapidly with a total of 291070 cases confirmed and 22027 new cases identified that day. Emerging studies suggest that COVID-19 preferentially afflicts the elderly, particularly those with chronic comorbidities1, 2. However, the clinical profiles of
COVID-19 in refractory heart failure patients is unknown. Herein, we reported the clinical features in a group of end-stage heart failure patients with COVID-19, providing strong evidence of cardiac injury by the virus. More..
Angiotensin Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin Angiotensin System - Angiotensin-converting enzyme (ACE2) has a multiplicity of physiological roles that revolve around its trivalent function: a negative regulator of the renin-angiotensin system (RAS), facilitator of
amino acid transport, and the SARS-CoV and SARS-CoV-2 receptor. ACE2 is widely expressed, including, in the lungs, cardiovascular system, gut, kidneys, central nervous system, and adipose tissue. ACE2 has recently been identified as the SARS-CoV-2 receptor, the infective agent responsible for COVID-19,
providing a critical link between immunity, inflammation, ACE2, and cardiovascular disease. Although sharing a close evolutionary relationship with SARS-CoV, the receptor-binding domain of SARS-CoV-2 differs in several key amino acid residues, allowing for stronger binding affinity with the human ACE2
receptor, which may account for the greater pathogenicity of SARS-CoV-2. More..
