Coronavirus can break your heart / Heart - related study

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Coronavirus can break your heart / Heart - related study

Post by trader32176 »

Coronavirus can break your heart – literally – says new study

Sunday, September 13, 2020 ... study.html

Getting COVID-19 is heartbreaking news for anyone. But a new study reveals that the disease is heartbreaking in more ways than one, especially since it’s been found to tear heart muscles to shreds – at least in vitro.

The ability of SARS-CoV-2 – the virus behind the deadly pandemic – to invade the heart muscle and effectively “dice” it is already scary enough. However, the authors of the study warned that a similar process could be happening in the hearts of COVID-19 patients.

The study, led by researchers from the University of California, San Francisco, has been published to the preprint database bioRXiv. It has not been published in a peer-reviewed journal, or proven to happen in people.

SARS-CoV-2 can rip your heart into shreds

The study’s findings were so alarming that Tom McDevitt, a bioengineering professor at UCSF’s Gladstone Institute and senior author of the study, had trouble sleeping for nights afterward. He also noted that COVID-19 is possibly the only disease to affect heart cells in this manner.

“What we were seeing was completely abnormal,” McDevitt added.

The study is still in preprint, but McDevitt said that he and his team felt compelled to share their findings as soon as possible. He added that while their study might not provide a whole picture, it may provide clinicians with insights to the extent of SARS-CoV-2’s damage in a patient’s cardiovascular system. The findings can also explain why COVID-19 is particularly risky for those with cardiovascular disease, which already accounts for a third of all deaths around the world. It can even help doctors understand why some COVID-19 cases have heart abnormalities – including inflammation – even in relatively mild cases.

After exposing different types of heart cells to SARS-CoV-2, the team found that the virus could only infect and make copies of itself inside heart muscle cells, or cardiomyocytes. These cells contain sarcomeres – specialized filaments that are responsible for muscle contractions that produce a heartbeat. They found that heart muscle cells infected by SARS-COV-2 had their sarcomeres chopped into small fragments. This would make it impossible for the heart muscle to beat properly, the researchers added.

The team also studied autopsy samples of heart tissue from three COVID-19 patients and found sarcomere filaments that were disordered and rearranged in a pattern similar to that in their lab dish experiments. More studies, they added, are needed to determine if these changes are permanent. For one, this requires doing a special process to examine the sarcomeres. With their findings, the team hopes that doctors will look for these features in their own cases.

The research team also found that some infected heart cells did not have DNA inside their cells’ nucleus. This effectively makes the cells “brain dead” and unable to perform normal functions.

“Cell nuclei – the hubs of all the genetic information, all of the nuclear DNA – in many of the cells were gone,” McDevitt added. “There was a black hole literally where we would normally see the nuclear DNA. That’s also pretty bizarre.”

The damage that COVID-19 does to the heart is something that’s been seen in patients, regardless of their health.
Dr. Ossama Samuel, a cardiologist at Mount Sinai Hospital in New York City who wasn’t part of the study, said that his team has treated healthy people who recovered from COVID-19 who have developed myocarditis afterward.

Myocarditis – the inflammation of the heart muscle – can impair the heart’s ability to pump blood. According to healthcare experts, severe cases of myocarditis can significantly weaken the heart so that the rest of the body can’t get enough blood. This can ultimately lead to a stroke, or even a heart attack.

Like McDevitt, Samuel thinks that a small fraction of people with COVID-19 also sustain heart damage. (Related: Can heart enlargement predict coronavirus deaths?)

“When a disease is so widespread it is concerning that a tiny fraction is still sizable,” he added.

He also says that athletes, in particular, have a high risk of dying from COVID-19-related myocarditis through exercise or training. In fact, an Ohio State University cardiologist says that up to 13 percent of athletes who recover from COVID-19 may have myocarditis.

For his part, McDevitt warns that the risk of getting heart disease from COVID-19 is serious and that people should take their findings into account as they assess their own risk of being infected with COVID-19.

“I am more scared today of contracting the virus, by far, than I was four months ago,” he said.
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Re: Coronavirus can break your heart / Heart - related study

Post by trader32176 »

Post-COVID heart damage alarms researchers: There was a black hole in infected cells

3 days ago ... r-BB18Ugz2

Shelby Hedgecock contracted the coronavirus in April and thought she had fought through the worst of it — the intense headaches, severe gastrointestinal distress and debilitating fatigue — but early last month she started experiencing chest pain and a pounding heartbeat. Her doctor put her on a cardiac monitor and ordered blood tests, which indicated that the previously healthy 29-year-old had sustained heart damage, likely from her bout with COVID-19.

“I never thought I would have to worry about a heart attack at 29 years old,” Hedgecock told Yahoo News in an interview. “I didn’t have any complications before COVID-19 — no preexisting conditions, no heart issues. I can deal with my taste and smell being dull, I can fight through the debilitating fatigue, but your heart has to last you a really long time.”

Hedgecock’s primary-care physician has referred her to a cardiologist she will see this week; the heart monitor revealed that Hedgecock’s pulse rate is wildly irregular, ranging from 49 to 189 beats per minute, and she has elevated inflammatory markers and platelet counts. She was told to go to the emergency room if her chest pain intensifies before she can see the specialist. A former personal trainer who is now out of breath just from walking around the room, Hedgecock is worried about what the future holds.

She is far from alone in her struggle. Dr. Ossama Samuel is a cardiologist at New York’s Mount Sinai Hospital, where he routinely sees coronavirus survivors who are contending with cardiac complications. Samuel said his team has treated three young and otherwise healthy coronavirus patients who have developed myocarditis — an inflammation of the heart muscle — weeks to months after recovering from the virus.

Myocarditis can affect how the heart pumps blood and trigger rapid or abnormal heart rhythms. It is particularly dangerous for athletes, doctors say, because it can go undetected and can result in a heart attack during strenuous exercise. In recent weeks, some collegiate athletes have reported cardiac complications from the coronavirus, underscoring the seriousness of the condition.

Last month, former Florida State basketball center Michael Ojo died from a heart attack in Serbia; Ojo had recovered from the coronavirus before he collapsed on the basketball court. An Ohio State University cardiologist found that between 10 and 13 percent of university athletes who had recovered from COVID-19 had myocarditis. When the Big Ten athletic conference announced the cancellation of its season last month, Commissioner Kevin Warren cited the risk of heart failure in athletes. Researchers have estimated that up to 20 percent of people who get the coronavirus sustain heart damage.

Samuel said he feels an obligation to warn people, particularly since some of the patients he and Mount Sinai colleagues have seen with myocarditis had only mild cases of the coronavirus months ago.

“We are now seeing people three months after COVID who have pericarditis [inflammation of the sac around the heart] or myocarditis,” Samuel said. He said he believes a small fraction of coronavirus survivors are sustaining heart damage, “but when a disease is so widespread it is concerning that a tiny fraction is still sizable.”

Samuel said he worries particularly about athletes participating in team sports, since many live together and spend time in close quarters. Teammates may all get the coronavirus and recover together, Samuel said, but “the one who really gets that crazy myocarditis could be at risk of dying through exercise or training.”

“It’s a concern about what do you do: Should we do sports in general, should we do it in schools, should we do it in college, should we just do it for professionals who understand the risk and they're getting paid?” Samuel asked. “I hope we don’t scare the public, but we should make people aware.”

Samuel is recommending that patients recovering from COVID-19 with myocarditis avoid workouts for three to six months.

Todd McDevitt, who runs a stem-cell lab at Gladstone Institutes, which is affiliated with the University of California at San Francisco, recently published images that show how the coronavirus can directly invade the heart muscle. McDevitt said he was so alarmed when he saw a sample of heart muscle cells in a petri dish get “diced” by the coronavirus that he had trouble sleeping for nights afterward.

McDevitt said his team’s research was spurred by their desire to understand if the coronavirus is entering heart cells and how it is affecting them. He was surprised to see the heart muscle samples he was studying react to a very small amount of the coronavirus, usually within 24 to 48 hours. He said the virus decimated the heart cells in his petri dishes.

“Cell nuclei — the hubs of all the genetic information, all of the nuclear DNA — in many of the cells were gone,” McDevitt said. “There was a black hole literally where we would normally see the nuclear DNA. That’s also pretty bizarre.”

While McDevitt’s study has not yet been peer-reviewed — it is still in pre-print — he said he felt compelled to share the findings as soon as possible. He said his team also sampled tissues from three COVID-19 patient autopsies and found similar damage in the heart muscles of those patients, none of whom had been flagged for myocarditis or heart problems while they were alive.

“This is probably not the whole story yet, but we think we have insights into the beginning of when the virus would get into some of these people and what it might be doing that is concerning enough that we should probably let people know, because clinicians need to be thinking about this,” McDevitt said in an interview. “We don’t have any means of bringing heart muscle back. ... This virus is [causing] a very different type of injury, and one we haven't seen before.”

McDevitt said the chopped-up heart muscles he and his colleagues saw are so concerning because when the microfibers in the muscle are damaged, the heart can’t properly contract.

“If heart muscle cells are damaged and they can’t regenerate themselves, then what you’re looking at is someone who could prematurely have heart failure or heart disease due to the virus,” McDevitt said. “This could be a warning sign for a potential wave of heart disease that we could see in the future, and it’s in the survivors — that’s the concern.”

McDevitt said he believes the risk of heart disease is serious and one people should consider as they assess their own risk of getting the coronavirus.

“I am more scared today of contracting the virus, by far, than I was four months ago,” he said.

The medical journal the Lancet recently reported that an 11-year-old child had died of myocarditis and heart failure after a bout of COVID-induced multisystem inflammatory syndrome (MIS-C). An autopsy showed coronavirus embedded in the child’s cardiac tissue.

A recent study from Germany found that 78 percent of patients who had recovered from the coronavirus and who had only mild to moderate symptoms while ill with the disease had indications of cardiac involvement on MRIs conducted more than two months after their initial infection. Lead investigator Eike Nagel said it is concerning to see such widespread cardiac impact; six in 10 of the patients Nagel’s team studied experienced ongoing myocardial inflammation.

“We found an astonishingly high level of cardiac involvement approximately two months after COVID infection,” Nagel said in an email. “These changes are much milder than observed in patients with severe acute myocarditis.”

The scale of the cardiac impact on relatively healthy, young patients surprised many doctors
. Nagel said the findings are significant “on a population basis,” and that the impact of COVID-19 on the heart must be studied more.

Dr. Gregg Fonarow, chief of UCLA’s Division of Cardiology and director of the Ahmanson-UCLA Cardiomyopathy Center, said the picture is evolving, but the new studies showing cardiac impact in even young people with mild cases of COVID-19 have raised troubling new questions.

“We really do need to take seriously individuals that have had the infection and are having continued symptoms, [and] not just dismiss those symptoms,” Fonarow said. “There could be, in those who had milder or even asymptomatic cases, the potential for cardiac risk.”

Fonarow said it is important to understand whether a “more proactive screening and treatment approach” is needed to better address the needs of patients who have recovered from the coronavirus and who may still have weakened heart function. Fonarow said he found McDevitt’s research to be potentially significant because it proves “from a mechanistic standpoint that there can be direct cardiac injury from the virus itself.”

“Even if it were going to impact, say, 2 percent of the people that had COVID-19, when you think of the millions that have been infected, that ends up in absolute terms being a very large number of individuals,” Fonarow said in an interview. “You don’t want people to be unduly alarmed, but on the other hand you don’t want individuals to be complacent about, ‘Oh, the mortality rate is so low with COVID-19, I don’t really care if I’m infected because the chances that it will immediately or in the next few weeks kill me is small enough, I don’t need to be concerned.’ There are other consequences.”
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Re: Coronavirus can break your heart / Heart - related study

Post by trader32176 »

Researchers receive NIH grant to evaluate the impact of COVID-19 on heart disease patients

9/16/20 ... ients.aspx

A University of Illinois Chicago research study on how to improve care for heart disease patients struggling with hopelessness has been supplemented by the National Institutes of Health, or NIH, to determine whether the study intervention called "Heart Up!" limits the negative impact of COVID-19 shelter-in-place and physical distancing measures on health outcomes.

Prior to the COVID-19 pandemic, 43 patients had been enrolled in UIC's "Heart Up!" study aimed at motivating heart disease patients suffering from hopelessness to be more physically active.

The grant's supplement will allow researchers to evaluate the impact of the study by comparing the patients enrolled before COVID-19 shelter-in-place/physical distancing measures began with patients enrolled after the start of the pandemic. The supplement allows for followup with all patients for a longer period -- one year.

The funds also will support adding two COVID-19-related questionnaires for patients:

Multi-Ethnic Study of Atherosclerosis COVID-19 Questionnaire to assess COVID-19 symptoms, diagnosis, testing and social distancing.
Coronavirus Impact Scale to quantify how COVID-19 has changed the participant's life via routine; income/employment; access to food, medical care, mental health care, extended family; and stress/discord.

Susan Dunn, UIC associate professor of nursing and the study's principal investigator, said they will continue to measure multiple key variables -- hopelessness, depression, suicidal ideation, anxiety, perceived social support, motivation, quality of life, well-being and physical activity -- that may improve understanding of how the "Heart Up!" intervention may change the impact of the shelter-in-place/physical distancing measures on health outcomes.

Since the onset of the COVID-19 pandemic, the research project transitioned to remote delivery, so participants are not exposed to the virus.

Hopelessness is a negative outlook and sense of helplessness toward the future. It can be a temporary response to an event or a habitual outlook. Hopelessness is associated with decreased physical functioning and lower physical activity in individuals with heart disease.

Researchers have been trying to understand the links between hopelessness and physical activity, as well as a number of other mental, social and behavioral health outcomes in patients with heart disease.

"We are not focused on the virus itself, but on the effects of the COVID-19 shelter-in-place and physical distancing efforts on physical activity and other health outcomes."

"If physical activity is decreased, that puts heart disease patients at higher risk for complications and future development of heart disease and other chronic illnesses," said Dunn, who noted that the study's results can inform interventions during this and future pandemics.

Dunn is joined by co-investigators Ulf Bronas and Eileen Collins from the UIC College of Nursing.
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Re: Coronavirus can break your heart / Heart - related study

Post by trader32176 »

ACC’s initiative can help cardiologists address critical patient needs, deliver high-quality care

9/18/20 ... -care.aspx

The American College of Cardiology's ongoing COVID-19 response initiative is welcoming support from the Boehringer Ingelheim and Eli Lilly and Company Alliance to continue providing real-time clinical guidance on COVID-19.

The comprehensive initiative includes a robust set of activities and events implemented by ACC to help cardiologists address critical patient needs and continue to deliver high-quality care.

People with existing cardiovascular disease are at high risk of lung damage and cardiovascular complications if they contract COVID-19. This is further complicated by an increased risk of developing co-morbid conditions associated with heart disease.

As the pandemic progresses, many clinicians are looking for real-time guidance on managing care for these vulnerable patients, while minimizing risk to themselves and the entire cardiovascular care team.

The ACC has increasingly focused its COVID-19 response initiative on four broad areas of critical need, including key clinical/scientific guidance, optimizing cardiovascular care and operational considerations, clinician wellness, and disparities in care

This initiative, anchored by ACC's COVID-19 hub, provides a platform for providing education and resources around these areas that clinicians can immediately put into practice as the pandemic evolves.

" The ACC is committed to transforming cardiovascular care and improving heart health, and today, that can't be accomplished without addressing the impact the pandemic has had on our patients. Through this initiative, we are supporting members to answer pressing clinical questions, develop care delivery models and update the science for the health of our practices and our patients."

-Athena Poppas, MD, FACC, President, American College of Cardiology

Highlights of the programs and resources offered in ACC's COVID-19 response initiative include:

The Summer COVID-19 Education Series - A free weekly virtual meeting providing the health care community with actionable insights and solutions to address key clinical and operational concerns.

Quick Tips for Fast Thinking - A video library featuring ACC thought leaders providing structured reviews of emerging science, perspectives from the frontline, and guidance on non-clinical issues and sharing best practices.

"Cardiology care teams need support in navigating the unique challenges brought on by COVID-19 to ensure that this high-risk patient community continues to receive the best possible care, guided by the latest science and recommendations," said Mohamed Eid, MD, MPH, MHA, vice president, Clinical Development & Medical Affairs, Cardio-Metabolism & Respiratory Medicine, Boehringer Ingelheim Pharmaceuticals, Inc.

"The Boehringer Ingelheim and Lilly Alliance is proud to partner with the ACC to deliver real-time education to ensure the continuity of high-quality care to people with cardiovascular disease."
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Re: Coronavirus can break your heart / Heart - related study

Post by trader32176 »

Study identifies thousands of deaths caused by heart disease and stroke during COVID-19 pandemic

9/29/20 ... demic.aspx

A major new study has identified 2085 excess deaths in England and Wales due to heart disease and stroke during the peak of the COVID-19 pandemic. On average, that is 17 deaths each day over four months that probably could have been prevented.

Excess deaths are the number of deaths above what is normally expected - and the figure relates to the period from 2 March to 30 June, 2020.

The scientists believe the excess deaths were caused by people not seeking emergency hospital treatment for a heart attack or other acute cardiovascular illness requiring urgent medical attention, either because they were afraid of contracting COVID-19 or were not referred for treatment.

Over the same period, there was a sharp rise in the proportion of people who died at home or in a care home from acute cardiovascular diseases.

" It is entirely plausible that a number of deaths could have been prevented if people had attended hospital quickly when they began to experience their heart attack or stroke. The sad irony is that previous research we have undertaken showed that nationwide heart attack services remained fully operational and continued to deliver high quality care during the peak of the pandemic."

- Chris Gale, Professor, Cardiovascular Medicine, University of Leeds

The findings, based on an analysis of the information contained on death certificates, have ben published in the journal Heart.

The investigation was carried out by a team of data scientists and clinicians, led by academics at the University of Leeds. The other collaborators were from Keele University, NHS Digital, the Office for National Statistics, Barts Health NHS Trust, and University College London. This is the third major study from academics investigating how the peak of the COVID-19 pandemic affected emergency cardiovascular services.

Dr Jianhua Wu, Associate Professor in the School of Medicine at Leeds, led the latest study. He said: "This study is the first to give a detailed and comprehensive picture of what was happening to people who were acutely ill with cardiovascular disease cross England and Wales. "It reveals a large number of excess deaths. The findings will help Government and the NHS to develop messages that ensure people who are very ill do seek help."

Measuring excess deaths

The analysis looked at the information that is collected when a death certificate is issued. It details the cause of death and where the person died. To provide baseline data, the study looked at cardiovascular deaths from the 1 January 2014 through to 30 June 2020.

In the four months from 2 March, 2020 - when the first COVID-19 death was registered in the UK - to 30 June, there were 28,969 cardiovascular deaths. That was compared to the average number of deaths seen for the same period over each of the previous six years. It was eight percent higher, revealing 2085 excess deaths.

The excess cardiovascular deaths began to emerge in late March 2020 and peaked in early April - this was at the time the Government was promoting its 'Stay at home, Protect the NHS, Save lives' messages. That may have resulted in fewer people being prepared to go to hospital when they were becoming ill, either because they were worried about becoming infected by COVID-19 or were worried about overwhelming the NHS.

Previous studies by the researchers, published in The Lancet and European Heart Journal - Quality of Care and Clinical Outcomes, have revealed that the number of people arriving at hospital with a heart attack fell sharply, with some units seeing just over half the expected number of cases.

Changes in where people were dying

This latest analysis has revealed a shift in where people were dying. There were proportionately fewer deaths in hospital compared to the baseline data: 53.4 percent versus 63 percent. Proportionately more deaths were happening at home: 30.9 percent v 23.5 percent - and in care homes: 15.7 percent v 13.5 percent.

Excess deaths were disproportionately happening at home, up by 35 percent when compared with what would be expected, and in care homes, up by 32 percent increase. In the paper, the scientists noted: "This 'displacement of death', most likely, signifies that the public either did not seek help or were not referred to hospital during the pandemic..."

Cause of death

For people in care homes and hospices, the most prevalent cause of death was stroke and heart failure. For those who died at home, it was heart attack or heart failure. Pulmonary embolism and cardiogenic shock, where the heart can't supply enough blood to the body, were the most frequent causes of death for those who died in hospital.

Professor Gale said: "Our study has revealed that people who died at home were most likely to have had a heart attack. This is further support for the speculation that many people were staying away from hospital even though they were very ill with an acute cardiovascular illness. The reality of an untreated heart attack is that it will cause complications - and that will either lead to death, heart failure or life-threatening heart rhythms."

"The messages that went out at the time of lockdown were important. The NHS did need protecting from a potential surge of COVID-19 cases. But some people may have taken the messaging to mean that the NHS was not able to cope if they had a medical emergency, or that hospitals were a place where they would catch the contagion."

"As the NHS prepares for any future wave of COVID-19, it needs to ensure people clearly understand that hospitals are open and have processes in place to minimise the risks of patients becoming infected with COVID-19."
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Re: Coronavirus can break your heart / Heart - related study

Post by trader32176 »

COVID-19 has created a perfect storm for people with heart disease

9/30/20 ... sease.aspx

The COVID-19 pandemic is creating a perfect storm for heart health, the World Heart Federation (WHF) warns on World Heart Day. Three main factors are contributing to this phenomenon. First, people with COVID-19 and heart disease are among those with the highest risk of death and of developing severe conditions. Second, after the virus attacks, the heart might be adversely affected even in people without previous heart conditions, potentially resulting in long-term damage. Finally, fear of the virus has already led to a sharp decline in hospital visits by heart patients for routine and emergency care.

This World Heart Day is unlike any other that has come before. Public health is front and center as societies face the challenges of the COVID-19 pandemic and the physical, emotional and economic toll it has taken. Almost a million lives have been lost to COVID-19 this year. As a comparison, an estimated 17.8 million people died from cardiovascular disease in 2017. While patients steer clear of hospitals out of fear of catching the virus, their health is compromised even further.

WHF has the singular purpose of uniting the global health community to beat cardiovascular disease. This year, we are asking individuals, communities and governments to “use heart” to make better choices for society, our loved ones and ourselves. The “Use Heart” call to action is about using our head, influence and compassion to beat cardiovascular disease, the world’s number one killer. Given the current situation, WHF is also calling for recognition and urgent protection of frontline healthcare providers.

" In these trying times, it is paramount that we pay special attention to those who are at greater risk of complications from COVID-19 as well as better understand how the virus is affecting the hearts of otherwise healthy people. COVID-19 has created a perfect storm, in which those people with cardiovascular disease fare poorly, and those at risk don’t seek the treatment that they need to keep their hearts healthy. The heart and the entire vascular system are in danger and we need to act now. The world has not experienced a global event on this scale in decades – today we have a unique opportunity to unite, to mobilize our skills and to use our heart to act.”

-Professor Karen Sliwa, WHF President

Cardiovascular disease has many causes: from smoking to diabetes, high blood pressure, obesity, and air pollution. To combat these, WHF is calling not only for individual behavior change but for a societal one. With equity at the center of WHF’s work, it is vital to make access to healthcare, healthy foods and a healthy way of life accessible and affordable to all people. Regulating unhealthy products, while creating healthy environments are examples of such solutions for governments and communities.

WHF global study on cardiovascular disease and COVID-19

In order to better understand the relationship between cardiovascular disease and COVID-19, WHF has embarked on a global study which aims to better describe cardiovascular outcomes and identify cardiovascular risk factors associated with severe complications and death in hospitalized patients with COVID-19. This study is already underway in Argentina, Bosnia and Herzegovina, Brazil, Ghana, India, Iran, Japan, Kenya, Nigeria, Pakistan, Portugal, South Africa and Sudan. It is expected to publish preliminary data in late 2020, with a complete analysis in 2021. Hospitals around the world are currently preparing to start patient recruitment for the study and many additional countries will join the study in the coming months.

“World’s most urgent heart-to-heart” – panel series on behavioural and societal change

On World Heart Day, WHF will also launch the “World’s Most Urgent Heart-to-Heart”, a series of debates focused on how to unlock behavioral and societal change to beat cardiovascular disease. For many people, preventing cardiovascular disease comes down to behavior change. Yet, there is nothing harder than changing personal and societal behavior, thereby realizing lasting change. Comprised of experts from a number of disciplines, the debates will seek to uncover insights into the triggers and barriers to behavior change and how that manifests itself across societies. The first of this series of panel discussions will be livestreamed on September 29, 2020, with others to follow over the coming year.

To join the first livestreamed discussion to be held as part of the WHF’s “World’s Most Urgent Heart-to-Heart” panel series on Tuesday, September 29 at 3:00PM CET, please register here: ... set=1&id=7 or view the discussion live on Twitter @worldheartfed or by clicking here

Getting involved in World Heart Day

In light of restrictions on social gatherings due to COVID-19, this year the WHF will be moving most of its activities for World Heart Day online. To learn more and get involved, please visit
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Re: Coronavirus can break your heart / Heart - related study

Post by trader32176 »

New study investigates hospital cardiac arrest in people with COVID-19 infection

10/1/20 ... ction.aspx

Even when a sudden cardiac arrest happens inside a top hospital, where a code blue team is readily available, most people won't survive.

This year, while researchers continued exploring how to improve dismal cardiac arrest survival rates, clinicians started noticing a new population of patients who seemed to be experiencing cardiac arrest quite often: those hospitalized for COVID-19 infection.

This sparked an observational study led by experts at the Michigan Medicine Frankel Cardiovascular Center and Brigham and Women's Hospital that leveraged data from 68 hospitals across the United States, just published in The BMJ.

Researchers reviewed data from more than 5,000 U.S. patients, including those at Michigan Medicine, who were hospitalized in the intensive care unit for COVID-19. Fourteen percent of them experienced cardiac arrest within two weeks of being admitted to the ICU.

"Cardiac arrest is common in older patients with COVID-19, and survival rates after an arrest are poor," says lead study author Salim Hayek, M.D., an assistant professor of internal medicine at Michigan Medicine and a cardiologist at the Frankel CVC. "This is the first multicenter study to investigate in-hospital cardiac arrest in people with COVID-19 infection."

Along with older patients, those more likely to experience cardiac arrest included Black patients as well as those admitted to hospitals with fewer ICU beds.

"One of the more interesting findings was that patients who were admitted to smaller hospitals were more likely to experience cardiac arrest," says co-senior author David Leaf, M.D., MMSc, an assistant professor of medicine at Harvard Medical School. "Further, admission to a smaller hospital was independently associated with an increased risk of death among those who received CPR."

The researchers encourage medical centers to consider how they'll manage high rates of cardiac arrest in their sickest patients with COVID-19, especially if future patient surges occur.

"In general, only around one-fifth of people survive in-hospital cardiac arrest," says co-senior author Brahmajee Nallamothu, M.D., M.P.H., a professor of internal medicine at Michigan Medicine and an interventional cardiologist at the Frankel CVC, who has extensively studied in-hospital arrest procedures and outcomes.

"The numbers for patients with COVID-19 look worse; however, younger patients who receive CPR have reasonable survival rates compared with other critically-ill patients, though less than 3% of people older than 80 who received CPR lived long enough to go home from the hospital."

CPR for patients with COVID-19

Some have questioned whether patients with COVID-19 should be given CPR. In addition to concerns about the effectiveness, there's also worry about the chances of health care providers becoming infected and being taken out of circulation because COVID-19 can spread during resuscitation.

Hospitals have strict protocols in place that require providers be suited up in personal protective equipment before getting close to patients with a confirmed or suspected COVID-19 infection, but there is still a risk.

Despite these concerns, Hayek and colleagues found that all patients who did not have a do-not-resuscitate order received CPR. About a third of patients older than 80 received CPR, while more than three-quarters of those younger than age 45 did.

However, only 12% of those patients given CPR survived.

"These data should encourage people to have more discussions about end-of-life wishes, including decisions about resuscitation, ideally before anyone even becomes severely sick," Hayek says.

That's because in COVID-19, unexpected complications can arise quickly.

Leaf adds that the acute severity of illness may have played a larger role in the cardiac arrest rates than existing heart disease, which wasn't independently associated with arrest rates, such as in the case of one previously healthy COVID-19 patient without a cardiac history who experienced cardiac arrest four times.

Other common complications of COVID-19 include blood clots and acute kidney injury.

And going home from the hospital after surviving cardiac arrest and COVID-19 isn't the end of the health struggles; it's simply an initial victory.

Researchers say, in the small sample size of patients with COVID-19 who were able to leave the hospital after receiving CPR, nearly half of them (20 out of 48 people) went home with a moderate to severe neurological impairment.

This is the latest project to come from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID) group led by Harvard's Leaf, which includes detailed data on patients with COVID-19 infection who were admitted to ICUs at one of 68 hospitals across the country between March and June.

" It's impressive that this group led by David and Salim got together under stressful times to put together such a wonderful resource for asking these real world questions. It has provided those of us studying resuscitation in other contexts with invaluable information."

-Brahmajee Nallamothu, MD, MPH, Study Co-Senior Author and Professor of Internal Medicine, Michigan Medicine

CPR for patients with COVID-19
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Re: Coronavirus can break your heart / Heart - related study

Post by trader32176 »

Plasma ACE2 concentration associated with increased risk of major cardiovascular events

10/5/20 ... vents.aspx

Early in the coronavirus disease (COVID-19) pandemic, scientists have found a cellular gateway the virus uses to enter and invade cells. The angiotensin-converting enzyme 2 (ACE2) receptors act as the entrance of the virus into the cells by binding with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike proteins.

A team of scientists at the Population Health Research Institute, Hamilton Health Sciences, and McMaster University, Hamilton, in Ontario, Canada, revealed that increased plasma ACE2 levels in the blood could indicate a higher risk of major cardiovascular events. The study is published in the journal The Lancet.

There is an ongoing global effort to better understand ACE2, the receptor where the SARS-CoV-2 enter cells. ACE2 is a known regulator of cardiac function, and once the system becomes dysregulated, it could lead to health consequences. It is essential to know more about the role of ACE2 and how it can affect the cardiac health of patients infected with the coronavirus.

Small clinical studies have suggested that elevated levels of circulating ACE2 activity and concentration may serve as a marker of poor prognosis in people with a multitude of cardiovascular diseases. So far, no study has provided evidence in a large cohort in the general population.

The study

The study, called the Prospective Urban Rural Epidemiology (PURE) study, opens the door to explore the link between ACE2 levels with future cardiovascular disease events and deaths in a global community-based cohort.

The team aims to see the role of demographic and clinical characteristics as possible determinants of the concentration of ACE2 in the plasma, describe the link between plasma ACE2 levels and cardiovascular events and mortality, and explore the importance of ACE2 in the plasma as a risk marker.

To arrive at the study findings, the PURE study involved participants in 27 low-income, middle-income, and high-income countries. The team developed a biobanking initiative for the participants to assess genomic and proteomic markers of chronic disease risk. Further, they collected blood samples from the countries, and 14 countries even shipped samples, including Bangladesh, Brazil, Argentina, Canada, Colombia, Chile, India, Philippines, Pakistan, Iran, South Africa, Tanzania, Sweden, the United Arab Emirates, and Zimbabwe.

The researchers included cardiovascular events, such as stroke, heart failure, diabetes, myocardial infarction, and death.

Measuring proteins

After collecting blood samples from all over the globe, the team measures proteins and plasma concentration using an immunoassay based on proximity extension assay technology. Further, genotyping and genetic analysis were also conducted by the study researchers.

They found that sex accounted for the most variation in plasma ACE2 levels, followed by geographic ancestry, body mass index (BMI), diabetes, age, systolic blood pressure, smoking status, and low-density lipoprotein (LDL) cholesterol levels.

This study adds to the previous one noting that men are at a higher risk of developing severe COVID-19. The study shows that men had higher plasma ACE2 levels than women, while concentrations varied broadly by geographic ancestry.

Moreover, a higher BMI, older age, diabetes, higher blood pressure, higher LDL cholesterol levels, and smoking were all tied to elevated levels of circulating plasma ACE2.

When compared with clinical risk factors, such as diabetes, smoking, blood pressure, BMI, and lipid levels, ACE2 was the highest-ranked predictor of death.

“The ACE2 receptor facilitates viral entry for SARS-CoV-2. In patients with COVID-19, the ACE2 receptors might play a role in leading to cardiovascular complications such as thrombosis, cardiac injury, and heart failure. ACE2 is a possible link between SARS-CoV-2 and the cardiac presentations described in findings that have emerged from global data during the COVID-19 pandemic,” the researchers wrote in the paper.

The researchers noted that the plasma concentration of ACE2 exhibits an independent link with cardiovascular disease, including death.

“Compared with established clinical risk factors, ACE2 consistently emerges as a strong predictor of cardiovascular disease or death,” they added.
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Re: Coronavirus can break your heart / Heart - related study

Post by trader32176 »

People born with a heart defect have low risk of moderate or severe COVID-19 infection

10/14/20 ... ction.aspx

Results of a retrospective analysis suggest that people born with a heart defect who developed COVID-19 symptoms had a low risk of moderate or severe COVID-19 infection, according to a new article published today in the Journal of the American Heart Association, an open access journal of the American Heart Association.

In what may be the largest study of its kind to date, researchers at Columbia University Vagelos College of Physicians and Surgeons in New York City explored the impact of COVID-19 infection on patients with congenital heart disease (CHD). The specialty center follows more than 7,000 adult and pediatric patients born with a heart defect. Fifty-three CHD patients (median age 34) with COVID-19 infection were reported at their center between March and July 2020.

"At the beginning of the pandemic, many feared that congenital heart disease would be as big a risk factor for COVID-19 as adult-onset cardiovascular disease" the researchers wrote. However, they are "reassured by the low number of patients treated at their center and the patients' outcomes."

Among the 43 adults and 10 children with a congenital heart defect infected with COVID-19 , additional characteristics included: 58% had complex congenital anatomy; 15% had a genetic syndrome; 11% had pulmonary hypertension; and 17% had obesity.

Additional analysis found:

The presence of a concurrent genetic syndrome in all patients and advanced physiologic stage in adult patients were each associated with an increased risk of symptom severity.
Five patients had trisomy 21 (an extra chromosome at position 21); four patients had Eisenmenger's syndrome (abnormal blood circulation caused by structural defects in the heart); and two patients had DiGeorge syndrome (a condition caused by the deletion of a segment of chromosome 22). Nearly all patients with trisomy 21 and DiGeorge syndrome had moderate/severe COVID-19 symptoms.
As for outcomes among all 53 patients with CHD: nine patients (17%) had a moderate/severe infection, and three patients (6%) died.

In addition, the researchers note several limitations to their analysis:

"While our sample size is small, these results imply that specific congenital heart lesions may not be sufficient cause alone for severe COVID-19 infection."
"While it is possible that our patient population exercised stricter adherence to social distancing given early publicized concerns about cardiac risk, these early results appear reassuring."
"...the median age and the frequency of acquired cardiac risk factors were lower in hospitalized patients in our cohort compared to published reports of hospitalized patients from COVID-19 in NYC at large. This may be because the CHD community, at large, is younger than the general population or because individuals with CHD may have distinct risk factors for severe COVID-19 infection when compared to the general population. It is possible that a cohort of elderly CHD patients might have a different risk profile than the general population."

The researchers concluded, "Despite evidence that adult-onset cardiovascular disease is a risk factor for worse outcomes among patients with COVID-19, patients with CHD without concomitant genetic syndrome, and adults who are not at advanced physiological stage, do not appear to be disproportionately impacted."


American Heart Association

Journal reference:

Lewis, M.J., et al. (2020) The Impact of Coronavirus disease 2019 (COVID‐19) on Patients with Congenital Heart Disease across the Lifespan: The Experience of an Academic Congenital Heart Disease Center in New York City. Journal of the American Heart Association.
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Joined: Fri Jun 26, 2020 5:22 am

Re: Coronavirus can break your heart / Heart - related study

Post by trader32176 »

Patients with congenital heart defects have lower risk of severe COVID-19 symptoms

10/19/20 ... ptoms.aspx

Adults and children born with heart defects had a lower-than-expected risk of developing moderate or severe COVID-19 symptoms, finds a study of more than 7,000 patients from the congenital heart disease center at Columbia University Vagelos College of Physicians and Surgeons.

Throughout the course of the pandemic, evidence has shown that individuals with heart disease have a higher risk of life-threatening illness and complications from COVID-19. But the impact of SARS-CoV-2 infection on individuals with congenital heart defects, who are generally younger than those with adult-onset heart disease, was unknown.

About 1% (40,000) of babies born each year in the United States have one or more heart defects.

"At the beginning of the pandemic, many feared that congenital heart disease would be as big a risk factor for severe COVID-19 as adult-onset cardiovascular disease," says Matthew Lewis, MD, assistant professor of medicine at Columbia University Vagelos College of Physicians and Surgeons and co-leader of the study. "We were reassured by the low number of congenital heart patients who required hospitalization for COVID-19 and the relatively good outcomes of these patients."

Few congenital heart patients had COVID-19

Only 53 congenital heart patients (43 adults and 10 children)--less than 0.8% of patients at Columbia's congenital heart center--presented to their physician with symptoms of SARS-CoV-2 infection from March through June. (During the study period, an estimated 20% of people in the New York metropolitan area are thought to have been infected with the coronavirus.)

More than 80% (43) of these patients had mild symptoms. Of the 9 patients who developed moderate to severe symptoms, 3 died. (Another study performed at Columbia University Irving Medical Center during the same period found that roughly 22% of hospitalized patients from the general population became critically ill and about one-third of those patients died.)

In the new study, the researchers found that patients with a genetic syndrome and adults with advanced disease from their congenital heart defect were more likely to develop moderate to severe symptoms, though an individual's type of congenital heart defect did not impact symptoms severity.

Though the study sample was small, the researchers conclude that congenital heart disease alone may not be enough to increase the risk of severe COVID-19 symptoms.


It's unlikely that people with congenital heart disease have an intrinsically lower risk of becoming severely ill from the new coronavirus, and the researchers hypothesize that the patients in this study may have adhered more strictly to social distancing guidelines compared with the general population, given the publicity about increased COVID-19 risk in patients with heart disease.

The researchers caution that individuals with congenital heart disease should continue to practice strict social distancing and follow all CDC guidelines as these measures are likely contributing to the study findings.

They also note that the younger average age (34 years) of these patients and lower incidence of acquired cardiac risk factors compared with other individuals who had severe COVID-19 may explain why fewer congenital heart patients than expected had severe symptoms.

" It's possible that elderly patients with congenital heart disease might have a different risk profile than the general population. We have yet to define what those risk factors are."

- Brett Anderson, Study Co-Leader, Florence Irving Assistant Professor of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons


Columbia University Irving Medical Center

Journal reference:

Lewis, M. J., et al. (2020) The Impact of Coronavirus disease 2019 (COVID‐19) on Patients with Congenital Heart Disease across the Lifespan: The Experience of an Academic Congenital Heart Disease Center in New York City. JAHA.
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