Myocardial Injury as a Prognostic Factor in Mid- and Long-Term Follow-Up of COVID-19 Survivors.
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ABSTRACT:
SUBMITTER: Izquierdo A
PROVIDER: S-EPMC8708676 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:While there is good evidence that symptoms of depression determine prognosis of patients with coronary heart disease (CHD), the role of psychological stress is less clear. We evaluated the prognostic value of stressful events in patients with initial myocardial infarction (MI) with respect to subsequent cardiovascular events. The KAROLA-study included patients with CHD who participated in an in-patient rehabilitation program. A total of 577 patients with initial MI were included and self-reported psychological stressful events before their MI was assessed by a structured questionnaire. Hazard ratios were used to evaluate the long-term association of stressful events with secondary cardiovascular events. Additionally, associations of stressful events with depression, anxiety and other cardiovascular risk factors were investigated. Unusual stress at work (26.5%) and sleep disorder (23.4%) were the most frequently reported stressful events that occurred in the last 4 weeks before MI. However, only death of a family member showed a statistically significant increase in risk for subsequent cardiovascular events (HR: 1.59; 95%-CI: 1.01-2.50) and this result was not corrected for multiple testing. Notably, we found higher symptom scores of anxiety and depression associated with all single stressful event items. In conclusion, we found no clear patterns that psychological stressful events before MI would increase the long-term risk of subsequent adverse CHD events directly. However, we saw increased symptom scores of anxiety and depression in persons with stressful events.
| S-EPMC8397004 | biostudies-literature
Project description: Not available
| S-EPMC6517170 | biostudies-literature
Project description:BackgroundReorganisation of clinical follow-up care in England was proposed by the National Cancer Survivorship Initiative (NCSI), based on cancer type and treatment, ranging from Level 1 (supported self-management) to Level 3 (consultant-led care). The objective of this study was to provide an investigation of the risks of serious adverse health-outcomes associated with NCSI Levels of clinical care using a large population-based cohort of childhood cancer survivors.MethodsThe British Childhood Cancer Survivor Study (BCCSS) was used to investigate risks of specific causes of death, subsequent primary neoplasms (SPNs) and non-fatal non-neoplastic outcomes by NCSI Level.ResultsCumulative (excess) risks of specified adverse outcomes by 45 years from diagnosis among non-leukaemic survivors assigned to NCSI Levels 1, 2 and 3 were for: SPNs-5% (two-fold expected), 14% (four-fold expected) and 21% (eight-fold expected); non-neoplastic death-2% (two-fold expected), 4% (three-fold expected) and 8% (seven-fold expected); non-fatal non-neoplastic condition-14%, 27% and 40%, respectively. Consequently overall cumulative risks of any adverse health outcome were 21%, 45% and 69%, respectively.ConclusionsDespite its simplicity the risk stratification tool provides clear and strong discrimination between survivors assigned to different NCSI Levels in terms of long-term cumulative and excess risks of serious adverse outcomes.
| S-EPMC5729444 | biostudies-literature
Project description:BackgroundThe aim of this study was to evaluate long-term longitudinal changes in chest computed tomography (CT) findings in coronavirus disease 2019 (COVID-19) survivors and their correlations with dyspnea after discharge.MethodsA total of 337 COVID-19 survivors who underwent CT scan during hospitalization and between 102 and 361 days after onset were retrospectively included. Subjective CT findings, lesion volume, therapeutic measures and laboratory parameters were collected. The severity of the survivors' dyspnea was determined by follow-up questionnaire. The evolution of the CT findings from the peak period to discharge and throughout follow-up and the abilities of CT findings and clinical parameters to predict survival with and without dyspnea were analyzed.ResultsNinety-one COVID-19 survivors still had dyspnea at follow-up. The age, comorbidity score, duration of hospital stays, receipt of hormone administration, receipt of immunoglobulin injections, intensive care unit (ICU) admission, receipt of mechanical ventilation, laboratory parameters, clinical classifications and parameters associated with lesion volume of the survivors with dyspnea were significantly different from those of survivors without dyspnea. Among the clinical parameters and CT parameters used to identify dyspnea, parameters associated with lesion volume showed the largest area under the curve (AUC) values, with lesion volume at discharge showing the largest AUC (0.820). Lesion volume decreased gradually from the peak period to discharge and through follow-up, with a notable decrease observed after discharge. Absorption of lesions continued 6 months after discharge.ConclusionsAmong the clinical parameters and subjective CT findings, CT findings associated with lesion volume were the best predictors of post-discharge dyspnea in COVID-19 survivors.
| S-EPMC8421980 | biostudies-literature
Project description:BackgroundThe Wake-Up T2MI Registry is a retrospective cohort study investigating patients with type 2 myocardial infarction (T2MI), acute myocardial injury, and chronic myocardial injury. We aim to explore risk stratification strategies and investigate clinical characteristics, management, and short- and long-term outcomes in this high-risk, understudied population.MethodsFrom 1 January 2009 to 31 December 2010, 2846 patients were identified with T2MI or myocardial injury defined as elevated cardiac troponin I with at least one value above the 99th percentile upper reference limit and coefficient of variation of 10% (>40 ng/L) and meeting our inclusion criteria. Data of at least two serial troponin values will be collected from the electronic health records to differentiate between acute and chronic myocardial injury. The Fourth Universal Definition will be used to classify patients as having (a) T2MI, (b) acute myocardial injury, or (c) chronic myocardial injury during the index hospitalization. Long-term mortality data will be collected through data linkage with the National Death Index and North Carolina State Vital Statistics.ResultsWe have collected data for a total of 2205 patients as of November 2018. The mean age of the population was 65.6 ± 16.9 years, 48% were men, and 64% were white. Common comorbidities included hypertension (71%), hyperlipidemia (35%), and diabetes mellitus (30%). At presentation, 40% were on aspirin, 38% on β-blockers, and 30% on statins.ConclusionImproved characterization and profiling of this cohort may further efforts to identify evidence-based strategies to improve cardiovascular outcomes among patients with T2MI and myocardial injury.
| S-EPMC6553563 | biostudies-literature
Project description:ObjectiveEvidence suggests benefits of long-term follow-up care attendance for childhood cancer survivors, but studies show poor inclusion of survivorship issues and needs. While information needs of childhood cancer survivors have been addressed previously, few studies specifically investigated the supportive care needs of survivors beyond the domain of information and communication. Therefore, this qualitative study aimed to assess the unmet needs of childhood cancer survivors with regards to their long-term survivorship.MethodsChildhood Cancer Switzerland invited survivors of childhood cancer to participate in our study. We used semistructured interviews to assess survivors' experiences regarding the impact of their disease and the (un)met needs during their survivorship. Data analysis followed the principles of qualitative content analysis.ResultsInterviews were conducted with 28 childhood cancer survivors (mean age 31 years, age at diagnosis 9 years, time since end of treatment 19 years). Key themes in relation to unmet needs of survivors were (1) lacking psychosocial support, (2) lacking collaboration and decentralization of care, (3) starting from zero, and (4) need for centralized, specialized, and individualized services.ConclusionsOur findings revealed a demand for integrating psychosocial support in long-term follow-up care and a strong need for personalized, centralized, and interdisciplinary long-term follow-up care. Current established interdisciplinary clinics should be further extended to provide centralized, personalized, and evidence-based long-term follow-up care including adequate psychosocial support for all childhood cancer survivors.
| S-EPMC8048447 | biostudies-literature
Project description:BackgroundWhile lung ultrasonography (LUS) has utility for the evaluation of the acute phase of COVID-19 related lung disease, its role in long-term follow-up of this condition has not been well described. The objective of this study is to compare LUS and chest computed tomography (CT) results in COVID-19 survivors with the intent of defining the utility of LUS for long-term follow-up of COVID-19 respiratory disease.MethodsProspective observational study that enrolled consecutive survivors of COVID-19 with acute hypoxemic respiratory failure (HARF) admitted to the Respiratory Intensive Care Unit. Three months following hospital discharge, patients underwent LUS, chest CT, body plethysmography and laboratory testing, the comparison of which forms the basis of this report.Results38 patients were enrolled, with a total of 190 lobes analysed: men 27/38 (71.1%), mean age 60.6 y (SD 10.4). LUS findings and pulmonary function tests outcomes were compared between patients with and without ILD, showing a statistically significant difference in terms of LUS score (p: 0.0002), FEV1 (p: 0.0039) and FVC (p: 0.012). ROC curve both in lobe by lobe and in patient's overall analysis revealed an outstanding ILD discrimination ability of LUS (AUC: 0.94 and 0.95 respectively) with a substantial Cohen's coefficient (K: 0.74 and 0.69).ConclusionsLUS has an outstanding discrimination ability compared to CT in identifying an ILD of at least mild grade in the post COVID-19 follow-up. LUS should be considered as the first-line tool in follow-up programs, while chest CT could be performed based on LUS findings.
| S-EPMC8010331 | biostudies-literature
Project description:A 67-year-old man without symptoms presented with significant negative T wave on electrocardiography. No significant abnormality was detected by echocardiography. Cardiac magnetic resonance imaging (CMR) showed trivial hypertrophied myocardium in apex. During follow up of 9 years, serial CMR scans revealed the appearance and expansion of late gadolinium enhancement in apex. The patient had never complained of cardiac symptoms such as chest pain, palpitation, or syncope during follow up. We experienced the appearance of significant myocardial fibrosis in a patient with apical hypertrophy. <Learning objective: Apical hypertrophy is characterized by hypertrophied apex and giant negative T wave. From this report, we appreciate the importance of serial cardiac magnetic resonance imaging to follow the progress of hypertrophied myocardium even for patients without significant gadolinium enhancement who can be in a premonitory state of irreversible fibrosis.>.
| S-EPMC6451050 | biostudies-literature
Project description:BackgroundUntil recently acute inflammatory peri-myocardial syndromes have been associated with global rather regional left ventricular (LV) dysfunction. Recent advances in cardiac imaging with echocardiographic techniques and magnetic resonance imaging (MRI) permit comprehensive evaluation of global and regional LV function. Our study was aimed to assess regional LV function in 100 patients with acute perimyocarditis, and correlate these findings with the clinical presentation.MethodsWe report on 100 patients with acute perimyocarditis admitted during 2008-2011, in whom LV function was assessed by semi-quantitative wall motion score analysis on conventional echo. Long-term mortality and recurrent hospitalization were also assessed.ResultsWall motion score in 100 patients with acute perimyocarditis demonstrated a significant predominance of regional wall motion abnormalities in the infero-postero-lateral LV wall. These data correspond well with speckle tracking results of a subgroup of these patients published earlier. Recent MRI data show frequent late enhancement of contrast in the infero-lateral region of the LV in patients with perimyocarditis. These observations were useful in re-classification of our patients into one of the following groups: pure or predominant pericarditis, and pure or predominant myocarditis. Over a mean period of 37 months, there was no mortality. Though recurrent hospitalizations were rather frequent, no significant differences were observed among groups.ConclusionsRegional wall motion abnormalities in the infero-postero-lateral segments of the LV are frequent in patients with acute perimyocarditis. Detailed echocardiographic examination early in the course of the disease should become a major factor in the clinical differentiation among the various clinical presentations of acute inflammatory peri-myocardial syndromes. The long-term outcome of these patients appears to be benign, though recurrent hospitalizations are not infrequent.
| S-EPMC3537585 | biostudies-literature
Project description:ContextDespite tremendous interest in hypoparathyroidism, large cohort studies describing typical treatment patterns, laboratory parameters, and rates of complications are lacking.ObjectiveOur objective was to characterize the course of disease in a large cohort of hypoparathyroid patients.Design and settingWe conducted a chart review of patients with permanent hypoparathyroidism identified via a clinical patient data registry. Patients were seen at a Boston tertiary-care hospital system between 1988 and 2009.PatientsWe identified 120 patients. Diagnosis was confirmed by documented hypocalcemia with a simultaneous low or inappropriately normal PTH level for at least 1 yr. Mean age at the end of the observation period was 52 ± 19 (range 2-87) yr, and the cohort was 73% female.Main outcome measureWe evaluated serum and urine laboratory results and renal and brain imaging.ResultsWe calculated time-weighted average serum calcium measurements for all patients. The time-weighted average for calcium was between 7.5 and 9.5 mg/dl for the majority (88%) of patients. Using linear interpolation, we estimated the proportion of time within the target calcium range for each patient with a median of 86% (interquartile range 67-98%). Of those with a 24-h urine collection for calcium (n = 53), 38% had at least one measurement over 300 mg/d. Of those with renal imaging (n = 54), 31% had renal calcifications, and 52% of those with head imaging (n = 31) had basal ganglia calcifications. Rates of chronic kidney disease stage 3 or higher were 2- to 17-fold greater than age-appropriate norms.ConclusionsHypoparathyroidism and its treatment carry a large burden of disease. Renal abnormalities are particularly common.
| S-EPMC3513540 | biostudies-literature