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SARS-CoV-2 proteins

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    CardiOvaScular Mechanisms MESHD In Covid-19 MESHD: Methodology of a prospective observational multimodality imaging study (COSMIC-19 study)

    Authors: Shirjel Alam; Anoop Shah; Kevin Onyinkwa; Edward Nganga; Samuel Gitau; Khalid Makhdomi; Michael Chung; Sudhir Vinayak

    doi:10.21203/rs.3.rs-77405/v2 Date: 2020-09-14 Source: ResearchSquare

    Background: 8-28% of patients infected with COVID-19 MESHD have evidence of cardiac injury MESHD, and this is associated with an adverse prognosis. The cardiovascular mechanisms of injury MESHD are poorly understood and speculative. We aim to use multimodality cardiac imaging including cardiac magnetic resonance (CMR) imaging, computed tomography coronary angiography (CTCA) and positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose integrated with computed tomography (18F-FDG-PET/CT) to identify the cardiac pathophysiological mechanisms related to COVID-19 MESHD infections.Methods: This is a single-centre exploratory observational study aiming to recruit 50 patients with COVID-19 MESHD infection who will undergo cardiac biomarker sampling. Of these, 30 patients will undergo combined CTCA & 18F-FDG-PET/CT, followed by CMR. Prevalence of obstructive and non-obstructive atherosclerotic coronary disease MESHD will be assessed using CTCA. CMR will be used to identify and characterise myocardial disease MESHD including presence of cardiac dysfunction MESHD, myocardial fibrosis MESHD, myocardial oedema MESHD and myocardial infarction MESHD. 18F-FDG-PET/CT will identify vascular and cardiac inflammation MESHD. Primary endpoint will be the presence of cardiovascular pathology and the association with troponin levels. Discussion: The results of the study will identify the presence and modality of cardiac injury MESHD associated COVID-19 MESHD infection, and the utility of multi-modality imaging in diagnosing such injury. This will further inform clinical decision making during the pandemic. TRIAL REGISTRATION:          This study has been retrospectively registered at the ISRCTN registry (ID ISRCTN12154994) on 14th August 2020. Accessible at www.isrctn.com/ISRCTN12154994

    COVID-19 MESHD Myocardial Pathology Evaluated Through scrEening Cardiac Magnetic Resonance (COMPETE CMR)

    Authors: Daniel Eugene Clark; Amar Parikh; Jeffrey M Dendy; Alex B Diamond; Kristen George-Durrett; Frank A Fish; Warne Fitch; Sean G Hughes; Jonathan H Soslow

    doi:10.1101/2020.08.31.20185140 Date: 2020-09-02 Source: medRxiv

    Background Myocarditis MESHD is a leading cause of sudden cardiac death MESHD among competitive athletes and may occur without antecedent symptoms. COVID-19 MESHD-associated myocarditis MESHD has been well-described, but the prevalence of myocardial inflammation MESHD and fibrosis MESHD in young athletes after COVID-19 MESHD infection is unknown. Objectives This study sought to evaluate the prevalence and extent of cardiovascular involvement in collegiate athletes that had recently recovered from COVID-19 MESHD. Methods We conducted a retrospective cohort analysis of collegiate varsity athletes with prior COVID-19 MESHD infection, all of whom underwent cardiac magnetic resonance (CMR) prior to resumption of competitive sports in August 2020. Results Twenty-two collegiate athletes with prior COVID-19 MESHD infection underwent CMR. The median time from SARS-CoV-2 infection MESHD to CMR was 52 days. The mean age was 20.2 years. Athletes represented 8 different varsity sports. This cohort was compared to 22 healthy controls and 22 tactical athlete controls. Most athletes experienced mild illness (N=17, 77%), while the remainder (23%) were asymptomatic. No athletes had abnormal troponin I, electrocardiograms, or LVEF < 50% on echocardiography. Late gadolinium enhancement was found in 9% of collegiate athletes MESHD and one athlete (5%) met formal criteria for myocarditis MESHD. Conclusions Our study suggests that the prevalence of myocardial inflammation MESHD or fibrosis MESHD after an asymptomatic or mild course of ambulatory COVID-19 MESHD among competitive athletes is modest (9%), but would be missed by ECG, Ti, and strain echocardiography. Future investigation is necessary to further phenotype cardiovascular manifestations of COVID-19 MESHD in order to better counsel athletes on return to sports participation.

    Comparative analysis of immune-associated genes in COVID-19 MESHD, cardiomyopathy and venous thromboembolism

    Authors: Grant E Castaneda; Abby C Lee; Wei Tse Li; Chengyu Chen; Jaideep Chakladar; Eric Chang; Weg Ongkeko

    doi:10.1101/2020.08.28.20184234 Date: 2020-09-02 Source: medRxiv

    As of 28 August 2020, there have been 5.88 million Coronavirus Disease 2019 MESHD ( COVID-19 MESHD) cases and 181,000 COVID-19 MESHD related deaths in the United States alone. Given the lack of an effective pharmaceutical treatment for COVID-19 MESHD, the high contagiousness of the disease and its varied clinical outcomes, identifying patients at risk of progressing to severe disease is crucial for the allocation of valuable healthcare resources during this pandemic. Current research has shown that there is a higher prevalence of cardiovascular comorbidities amongst patients with severe COVID-19 MESHD or COVID-19 MESHD-related deaths, but the link between cardiovascular disease MESHD and poorer prognosis is poorly understood. We believe that pre-existing immune dysregulation that accompanies cardiovascular disease MESHD predisposes patients to a harmful inflammatory immune response, leading to their higher risk of severe disease. Thus, in this project, we aim to characterize immune dysregulation MESHD in patients with cardiomyopathy MESHD, venous thromboembolism MESHD and COVID-19 MESHD patients by looking at immune-associated gene dysregulation, immune infiltration and dysregulated immunological pathways and gene signatures.

    Early Risk Factors for Extrapulmonary Organ Injury in Adult COVID-19 MESHD Patients

    Authors: Fang Huang; Wenxia Ma; Jun Jin; Hui Zheng; Yan Ye; Hui Chen; Nan Su; Xinyue Li; Xiaoping Li; Xiangqiong Lu; Yang He; Yuyu Wang; Yongsheng Li; Jun Wang

    doi:10.21203/rs.3.rs-70751/v1 Date: 2020-09-02 Source: ResearchSquare

    Objective COVID-19 MESHD is becoming a global pandemic and often develops extrapulmonary organ injury. However, the risk factors for extrapulmonary organ injury are still unclear. We aim to explore the risk factors for extrapulmonary organ injury for COVID-19 MESHD and the association between extrapulmonary organ injury and the prognosis of COVID-19 MESHD patients. Methods This is a single-center, retrospective, observational study and total 349 confirmed COVID-19 MESHD patients admitted to Tongji Hospital from January 25 to February 25, 2020 were enrolled. We collected demographic, clinical, laboratory and treatment data from electronic medical records. Potential risk factors for extrapulmonary organ injury of COVID-19 MESHD patients were analyzed by a multivariable binary logistic model, and multivariable COX proportional hazard regression model was used for survival analysis in the patients with extrapulmonary organ injury. Results Average age of the included patients was 61.73±14.64 years. In the final logistic model, variables including aged 60 or older (OR 1.826, 95% CI 1.060-3.142), ARDS (OR 2.748, 95% CI 1.051-7.185), lymphocytes count lower than 1.1 ×109/L (OR 0.478, 95% CI 0.240-0.949), level of IL-6 HGNC greater than 7 pg/ml (OR 1.664, 95% CI 1.005-2.751) and D-Dimer greater than 0.5 μg/ml (OR 2.190, 95% CI 1.176-4.084) were significantly associated with the extrapulmonary organ injury. Kaplan-Meier curve and log-rank test showed that the probabilities of survival for patients with extrapulmonary organ injury MESHD were significantly lower than those without extrapulmonary organ injury.between Multivariate COX proportional hazards model showed that only myocardial injury MESHD (P=0.000, HR: 5.068, 95% CI: 2.728-9.417) and circulatory system injury MESHD (P=0.000, HR: 4.076, 95% CI: 2.216-7.498) were the independent factors associated with COVID-19 MESHD patients’ poor prognosis. Conclusion Older age, lymphocytopenia MESHD, high level of D-Dimer and IL-6 HGNC and the severity of lung injury MESHD were the high-risk factors of extrapulmonary organ injury in COVID-19 MESHD patients. Myocardial and circulatory system injury MESHD were the most important risk factors related to poor outcomes of COVID-19 MESHD patients. It may help clinicians to identify extrapulmonary organ injury early and provide relevant management strategy.

    Outcomes and risk factors for the survival of COVID-19 MESHD related ARDS patients treated with extracorporeal membrane oxygenation

    Authors: Luyun Wang; Kengquan Chen; Peng Chen; Li Ni; Jiangang Jiang; Daowen Wang

    doi:10.21203/rs.3.rs-58688/v1 Date: 2020-08-13 Source: ResearchSquare

    Background: In current pandemic of COVID-19 MESHD, approximately 15% to 30% of critically ill COVID-19 MESHD patients developed acute respiratory distress syndrome MESHD ( ARDS MESHD) with a high mortality. Extracorporeal membrane of oxygenation (ECMO) provides direct support for both lung and heart in ARDS MESHD. However, the role of ECMO in COVID-19 MESHD related ARDS MESHD was still controversial. The aim of this study was to provide insights into the mortality, intensive care unit (ICU) management, risk factors for mortality, 180-day short term prognosis of the COVID-19 MESHD related severe ARDS MESHD patients receiving ECMO treatment. Methods: From Feb 2nd, 2020 to April 27th, 2020, we included adult COVID-19 MESHD related ARDS MESHD patients admitted to intensive care unit in Tongji Hospital. Totally, 53 patients were retrospectively analyzed. They were divided into ECMO (mechanical ventilation with ECMO, n=16) and non-ECMO group (mechanical ventilation, n=37). The primary outcome was all-cause 60-day mortality. The secondary outcomes were complications on ECMO, successful weaning from ECMO, and all-cause 180-day mortality. Results: The all-cause 60-day mortality was 37.5% (6/16) in ECMO group and 86.5% (32/37) in non-ECMO group (HR, 0.196; 95% CI, 0.053-0.721; p=0.014). 10 (62.5%) patients were successfully weaned from ECMO. The all-cause 180-day mortality was 56.3% (9/16) in ECMO group and 33 (89.2%, 33/37) in non-ECMO group (HR, 0.298; 95% CI, 0.130-0.680; p=0.004). All the patients in ECMO group suffered from at least one device-related complication with coagulopathy MESHD (81.3%) being most frequently seen. Up to 180-day follow up after disease onset, the ECMO-treated survivors maintained good quality of life without severe complications or disabilities. Hypercapnia MESHD, thrombopenia MESHD, myocardial injury MESHD and elevation of IL-8 HGNC and IL-10 HGNC during ECMO treatment were strongly associated with death MESHD.Conclusion: This study showed the COVID-19 MESHD patients significantly benefited from ECMO treatment during severe ARDS MESHD, which supported the application of ECMO as an indicated strategy in the management of COVID-19 MESHD related ARDS MESHD.

    Cardiac involvement in COVID-19 MESHD patients: mid-term follow up by cardiac magnetic resonance imaging

    Authors: Hui Wang; Ruili Li; Hong Jiang; Zixu Yan; Xinyan Tao; Hongjun Li; Lei Xu

    doi:10.21203/rs.3.rs-57104/v1 Date: 2020-08-11 Source: ResearchSquare

    Background: Coronavirus disease 2019 MESHD ( COVID-19 MESHD) induces myocardial injury MESHD, either direct myocarditis MESHD or indirect injury due to systemic inflammatory response. Myocardial involvement MESHD has been proved to be one of the primary manifestations of COVID-19 MESHD infection, according to laboratory test, autopsy, and cardiac magnetic resonance imaging (CMRI). However, the middle-term outcome of cardiac involvement MESHD after the patients were discharged from the hospital is yet unknown. The present study aimed to evaluate mid-term cardiac sequelae in recovered COVID-19 MESHD patients by CMRIMethods: A total of 47 recovered COVID-19 MESHD patients were prospectively recruited and underwent CMRI examination in this study. The CMRI protocol consisted of black blood fat-suppressed T2 weighted imaging (BB-T2WI), T2 star mapping, left ventricle cine imaging, pre- and post-contrast T1 mapping, and late gadolinium enhancement (LGE). Myocardium edema MESHD and LGE were assessed in recovered COVID-19 MESHD patients. The left ventricle ( LV MESHD) and right ventricle (RV) function and LV mass were assessed and compared with normal controls.Results: Finally, 44 recovered COVID-19 MESHD patients and 31 normal controls were included in this study. No edema MESHD was observed in any patient. LGE was found in 13 patients. All LGE lesions were located in the middle myocardium and/or sub-epicardium with a scattered distribution. Further analysis showed that LGE-positive patients had significantly decreased left ventricle peak global circumferential strain (LVpGCS), right ventricle peak global circumferential strain (RVpGCS), right ventricle peak global longitudinal strain (RVpGLS) as compared to non-LGE patients (p<0.05), while no difference was detected between the non-LGE patients and normal controls.Conclusion: Myocardium injury MESHD existed in about 30% of COVID-19 MESHD patients. These patients had peak right ventricle strain that decreased at the 3-month follow-up. Cardiac MRI can monitor the COVID-19 MESHD-induced myocarditis MESHD progression, and CMR strain analysis is a sensitive tool to evaluate the recovery of left ventricle circumferential contraction dysfunction MESHD and right ventricular dysfunction MESHD.

    The Spectrum of Cardiovascular Complications in COVID-19 MESHD- A Comprehensive Literature Review

    Authors: Raja Shakeel Mushtaque; Rabia Mushtaque; Shahbano Baloch; Aadil Raza; Haseeb Bhatti; Zohaib Khan

    id:10.20944/preprints202008.0257.v1 Date: 2020-08-11 Source: Preprints.org

    A newly identified novel coronavirus named as severe acute respiratory syndrome MESHD-related coronavirus2 (SARS‐CoV 2) has given rise to the global pandemic. SARS-CoV2 which causes coronavirus disease 2019 MESHD ( COVID-19 MESHD), is a positive-stranded RNA virus with nucleocapsid. It binds to host angiotensin-converting enzyme2 HGNC (ACE2) receptor through surface glycoprotein (S PROTEIN protein). These ACE 2 HGNC receptors are attached to the cell membranes of many organs. Thus, COVID-19 MESHD does not only result in acute respiratory distress syndrome MESHD but also affects multiple organ systems, requiring a multidisciplinary approach to manage this disease. COVID-19 MESHD can damage the myocardial cells and result in fulminant myocarditis MESHD, acute cardiac injury MESHD, cardiomyopathy MESHD, heart failure MESHD, cardiogenic shock MESHD, or arrhythmia MESHD. COVID-19 MESHD seeds harmful immune response through cytokine storm leading to indirect organ damage. In this literature review, the available data is comprehended regarding cardiovascular complications in COVID-19 MESHD, and the correlation of biomarkers with the disease activity is discussed. This literature review also highlights the important treatment options and outcomes of the individual study.

    A Systematic Review of the Cardiovascular Manifestations and Outcomes in the Setting of Coronavirus-19 Disease

    Authors: Samarthkumar Thakkar; Shilpkumar Arora; Ashish Kumar; Rahul Jaswaney; Mohammed Faisaluddin; Mohammad Ammad Ud Din; Mariam Shariff; Kirolos Barssoum; Harsh P. Patel; Nirav Arora; Chinmay Jani; Sejal Savani; Christopher DeSimone; Siva Mulpuru; Abhishek Deshmukh

    doi:10.1101/2020.08.09.20171330 Date: 2020-08-11 Source: medRxiv

    The impact of coronavirus disease MESHD, 2019 ( COVID-19 MESHD), has been profound. Though COVID-19 MESHD primarily affects the respiratory system, it has also been associated with a wide range of cardiovascular (CV) manifestations portending extremely poor prognosis. The principal hypothesis for CV involvement is through direct myocardial infection MESHD and systemic inflammation MESHD. We conducted a systematic review of the current literature to provide a foundation for understanding the CV manifestations and outcomes of COVID-19 MESHD. PubMed and EMBASE databases were electronically searched from the inception of the databases through April 27th, 2020. A second literature review was conducted to include major trials and guidelines that were published after the initial search but before submission. The inclusion criteria for studies to be eligible were case reports, case series, and observation studies reporting CV outcomes among patients with COVID-19 MESHD infection. This review of the current COVID-19 MESHD disease and CV outcomes literature revealed a myriad of CV manifestations with potential avenues for treatment and prevention. Future studies are required to understand on a more mechanistic level the effect of COVID-19 MESHD on the myocardium and thus provide avenues to improve mortality and morbidity.

    Association Between Antecedent Statin Use and Decreased Mortality in Hospitalized Patients with COVID-19 MESHD

    Authors: Aakriti Gupta; Mahesh V. Madhavan; Timothy J. Poterucha; Ersilia M. DeFilippis; Jessica A. Hennessey; Bjorn Redfors; Christina Eckhardt; Behnood Bikdeli; Jonathan Platt; Ani Nalbandian; Pierre Elias; Matthew J. Cummings; Shayan N. Nouri; Matthew Lawlor; Lauren S. Ranard; Jianhua Li; Claudia Boyle; Raymond Givens; Daniel Brodie; Harlan M. Krumholz; Gregg W. Stone; Sanjum S. Sethi; Daniel Burkhoff; Nir Uriel; Allan Schwartz; Martin B. Leon; Ajay J. Kirtane; Elaine Y. Wan; Sahil A. Parikh

    doi:10.21203/rs.3.rs-56210/v1 Date: 2020-08-09 Source: ResearchSquare

    The coronavirus disease 2019 MESHD ( COVID-19 MESHD), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can result in a hyperinflammatory state, leading to acute respiratory distress syndrome MESHD ( ARDS MESHD), myocardial injury MESHD, and thrombotic complications MESHD, among other sequelae. Statins, which are known to have anti-inflammatory and antithrombotic properties, have been studied in the setting of other viral infections MESHD and ARDS, but their benefit has not been assessed in COVID-19 MESHD. Thus, we sought to determine whether antecedent statin use is associated with lower in-hospital mortality in patients hospitalized for COVID-19 MESHD. This is a retrospective analysis of patients admitted with COVID-19 MESHD from February 1st through May 12th, 2020 with study period ending on June 11th, 2020. Antecedent statin use was assessed using medication information available in the electronic medical record. We constructed a multivariable logistic regression model to predict the propensity of receiving statins, adjusting for baseline socio-demographic and clinical characteristics, and outpatient medications. The primary endpoint included in-hospital mortality within 30 days. A total of 2626 patients were admitted during the study period, of whom 951 (36.2%) were antecedent statin users. Among 1296 patients (648 statin users, 648 non-statin users) identified with 1:1 propensity-score matching, demographic, baseline, and outpatient medication information were well balanced. Statin use was significantly associated with lower odds of the primary endpoint in the propensity-matched cohort (OR 0.48, 95% CI 0.36 – 0.64, p<0.001). We conclude that antecedent statin use in patients hospitalized with COVID-19 MESHD was associated with lower inpatient mortality. Randomized clinical trials evaluating the utility of statin therapy in patients with COVID-19 MESHD are needed.

    Intravenous immunoglobulin treatment for patients with severe COVID-19 MESHD: a retrospective multi-center study

    Authors: Jiao Liu; Yizhu Chen; Ranran Li; Xuan Dong; Yizhong Li; Qianghong Xu; Huibin Feng; Sisi Huang; Jun Guo; Lidi Zhang; Xiaofei Ye; Wei Zhu; Hangxiang Du; Yong’an Liu; Tao Wang; Limin Chen; Zhenliang Wen; Jean-Louis Teboul; Dechang Chen

    doi:10.21203/rs.3.rs-52428/v1 Date: 2020-08-01 Source: ResearchSquare

    Background: Intravenous immunoglobulin (IVIG) is commonly used to treat severe COVID-19 MESHD, although the clinical outcomes remain unclear. This study evaluated the effectiveness of IVIG treatment for severe COVID-19 MESHD.Methods: This retrospective multi-center study evaluated 28-day mortality and time for SARS-CoV-2 RNA clearance in severe COVID-19 MESHD patients with or without IVIG treatment. Propensity score matching was used to control confounding factors. Logistic regression and competing risk analyses were performed.Results: The study included 850 patients (421 patients received IVIG). No significant differences in 28-day mortality or time for SARS-CoV-2 RNA clearance were observed (p=0.357 and p=0.123, respectively). High-dose of IVIG treatment (>10 g/day) (n=27) was associated with decreased 28-day mortality (OR: 0.33, 95% CI: 0.14–0.77; p=0.011). The IVIG group had prolonged median hospitalization, less shock, and higher incidences of acute respiratory distress syndrome MESHD, myocardial injury MESHD. Furthermore, IVIG-treated patients were more likely to require non-invasive mechanical ventilation and less likely to require invasive mechanical ventilation.Conclusions: IVIG treatment for severe COVID-19 MESHD patients was not associated with significant improvements in 28-day mortality or time for SARS-CoV-2 RNA clearance. However, some improvements in 28-day survival were observed for high-dose IVIG treatment (>10 g/day).

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