Hamostaseologie 2021; 41(05): 350-355
DOI: 10.1055/a-1539-8711
Review Article

Cardiovascular Risk Assessment in COVID-19

Monika Zdanyte
1   Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
,
Dominik Rath
1   Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
› Author Affiliations

Zusammenfassung

COVID-19 bezeichnet eine der schlimmsten Krisen unserer Generation und stellt (nicht nur) für das Gesundheitssystem eine schwer bewältigbare Herausforderung dar. Mortalität und Morbidität sind im Vergleich zu anderen saisonalen Erkrankungen wie der Influenza deutlich erhöht. COVID-19 bedroht allerdings nicht die gesamte Bevölkerung in gleichem Maße. Hochrisikopatienten sind älter und leiden an kardiovaskulären Erkrankungen wie Bluthochdruck, Diabetes mellitus oder einer koronaren Herzerkrankung. Um das Risiko für einen schweren Erkrankungsverlaufs zu quantifizieren bedarf es einer multimodalen Herangehensweise. Verschiedene Risikostratifizierungssysteme stehen zu Verfügung um ungünstige Verläufe wie Intensivbehandlung oder Gesamtmortalität vorauszusagen. Biomarker wie Troponin-I, D-Dimere und NT pro-BNP kombiniert mit echokardiographischen Parametern wie links- und rechtsventrikulärer Pumpfunktion sowie pulmonalarteriellem Druck können hilfreich sein um Hochrisikopatienten zu identifizieren, die ein intensiviertes Monitoring und eine stringentere Behandlung benötigen. Da kardiovaskuläre Risikofaktoren und Komorbiditäten von großer Bedeutung zur Abschätzung des Verlaufs einer SARS-CoV-2 Infektion sind, könnten alle hospitalisierten COVID-19 Patienten von einer routinemäßigen kardiologischen Betreuung durch ein COVID-19-Heart-Team profitieren. Ein frühzeitiges Erkennen von (kardiovaskulären) Hochrisikopatienten könnte das Management erleichtern sowie die Prognose einer schweren SARS-CoV-2 Infektion verbessern.

Abstract

The COVID-19 pandemic represents one of the largest burdens of our generation with enormous consequences on socioeconomics and healthcare around the globe. COVID-19 is associated with increased morbidity and mortality. However, the course of disease differs among the population. Advanced age and a compromised immune system among others are associated with significantly worse outcomes. Furthermore, cardiovascular comorbidities are of utmost importance and may influence severity of SARS-CoV-2 infection to a considerable degree. This review aims to identify risk factors, biomarkers, and echocardiographic parameters associated with a severe course of SARS-CoV-2 infection and give a brief overview of the management of COVID-19 patients with cardiovascular comorbidities. Furthermore, available models identifying high-risk patients and their performance in prediction of severe outcomes of SARS-CoV-2 are addressed.



Publication History

Received: 30 March 2021

Accepted: 27 June 2021

Article published online:
11 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Richardson S, Hirsch JS, Narasimhan M. et al; The Northwell COVID-19 Research Consortium. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020; 323 (20) 2052-2059
  • 2 Gerotziafas GT, Catalano M, Colgan M-P. et al; Scientific Reviewer Committee. Guidance for the management of patients with vascular disease or cardiovascular risk factors and COVID-19: position paper from VAS-European Independent Foundation in Angiology/Vascular Medicine. Thromb Haemost 2020; 120 (12) 1597-1628
  • 3 Zheng Z, Peng F, Xu B. et al. Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis. J Infect 2020; 81 (02) e16-e25
  • 4 Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020; 46 (05) 846-848
  • 5 Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323 (13) 1239-1242
  • 6 Yang G, Tan Z, Zhou L. et al. Effects of angiotensin II receptor blockers and ACE (angiotensin-converting enzyme) inhibitors on virus infection, inflammatory status, and clinical outcomes in patients with COVID-19 and hypertension: a single-center retrospective study. Hypertension 2020; 76 (01) 51-58
  • 7 CDC COVID-19 Response Team. Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019 - United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (13) 382-386
  • 8 Roncon L, Zuin M, Rigatelli G, Zuliani G. Diabetic patients with COVID-19 infection are at higher risk of ICU admission and poor short-term outcome. J Clin Virol 2020; 127: 104354
  • 9 Zhu L, She Z-G, Cheng X. et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab 2020; 31 (06) 1068-1077.e3
  • 10 Gao F, Zheng KI, Wang X-B. et al. Obesity is a risk factor for greater COVID-19 severity. Diabetes Care 2020; 43 (07) e72-e74
  • 11 Singh AK, Gillies CL, Singh R. et al. Prevalence of co-morbidities and their association with mortality in patients with COVID-19: a systematic review and meta-analysis. Diabetes Obes Metab 2020; 22 (10) 1915-1924
  • 12 Shi S, Qin M, Shen B. et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol 2020; 5 (07) 802-810
  • 13 Alvarez-Garcia J, Lee S, Gupta A. et al. Prognostic impact of prior heart failure in patients hospitalized with COVID-19. J Am Coll Cardiol 2020; 76 (20) 2334-2348
  • 14 Rath D, Petersen-Uribe Á, Avdiu A. et al. Impaired cardiac function is associated with mortality in patients with acute COVID-19 infection. Clin Res Cardiol 2020; 109 (12) 1491-1499
  • 15 Oudit GY, Kassiri Z, Jiang C. et al. SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest 2009; 39 (07) 618-625
  • 16 Zheng Y-Y, Ma Y-T, Zhang J-Y, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020; 17 (05) 259-260
  • 17 Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Expert Rev Hematol 2020; 13 (11) 1265-1275
  • 18 Zhou F, Yu T, Du R. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229): 1054-1062
  • 19 Aboughdir M, Kirwin T, Abdul Khader A, Wang B. Prognostic value of cardiovascular biomarkers in COVID-19: a review. Viruses 2020; 12 (05) 527
  • 20 Cardiology TES for ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic. Accessed June 10, 2020 at: https//www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19-Guidance
  • 21 Han H, Xie L, Liu R. et al. Analysis of heart injury laboratory parameters in 273 COVID-19 patients in one hospital in Wuhan, China. J Med Virol 2020; 92 (07) 819-823
  • 22 Figliozzi S, Masci PG, Ahmadi N. et al. Predictors of adverse prognosis in COVID-19: a systematic review and meta-analysis. Eur J Clin Invest 2020; 50 (10) e13362
  • 23 Giustino G, Croft LB, Stefanini GG. et al. Characterization of myocardial injury in patients with COVID-19. J Am Coll Cardiol 2020; 76 (18) 2043-2055
  • 24 Haimovich AD, Ravindra NG, Stoytchev S. et al. Development and validation of the quick COVID-19 severity index: a prognostic tool for early clinical decompensation. Ann Emerg Med 2020; 76 (04) 442-453
  • 25 Lim WS, van der Eerden MM, Laing R. et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58 (05) 377-382
  • 26 Seymour CW, Liu VX, Iwashyna TJ. et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (08) 762-774
  • 27 Liang W, Liang H, Ou L. et al; China Medical Treatment Expert Group for COVID-19. Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19. JAMA Intern Med 2020; 180 (08) 1081-1089
  • 28 Knight SR, Ho A, Pius R. et al; ISARIC4C Investigators. Risk stratification of patients admitted to hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: development and validation of the 4C Mortality Score. BMJ 2020; 370: m3339
  • 29 Galloway JB, Norton S, Barker RD. et al. A clinical risk score to identify patients with COVID-19 at high risk of critical care admission or death: an observational cohort study. J Infect 2020; 81 (02) 282-288
  • 30 King Jr JT, Yoon JS, Rentsch CT. et al. Development and validation of a 30-day mortality index based on pre-existing medical administrative data from 13,323 COVID-19 patients: the Veterans Health Administration COVID-19 (VACO) Index. PLoS One 2020; 15 (11) e0241825
  • 31 Yeh RW, Secemsky EA, Kereiakes DJ. et al; DAPT Study Investigators. Development and validation of a prediction rule for benefit and harm of Dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA 2016; 315 (16) 1735-1749
  • 32 Fox KAA, Eagle KA, Gore JM, Steg PG, Anderson FA. GRACE and GRACE2 Investigators. The global registry of acute coronary events, 1999 to 2009-GRACE. Heart 2010; 96 (14) 1095-1101
  • 33 Fox KAA, Gore JM, Eagle KA. et al; GRACE Investigators. Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project: a multinational registry of patients hospitalized with acute coronary syndromes. Am Heart J 2001; 141 (02) 190-199
  • 34 Droppa M, Tschernow D, Müller KAL. et al. Evaluation of clinical risk factors to predict high on-treatment platelet reactivity and outcome in patients with stable coronary artery disease (PREDICT-STABLE). PLoS One 2015; 10 (03) e0121620
  • 35 Petersen-Uribe A, Avdiu A, Martus P. et al. Impaired myocardial function is prognostic for severe respiratory failure in the course of COVID-19 infection. Front Cardiovasc Med 2021; 8: 584108
  • 36 Driggin E, Madhavan MV, Bikdeli B. et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol 2020; 75 (18) 2352-2371
  • 37 Lopes RD, Macedo AVS, de Barros E Silva PGM. et al; BRACE CORONA Investigators. Effect of discontinuing vs continuing angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on days alive and out of the hospital in patients admitted with COVID-19: a randomized clinical trial. JAMA 2021; 325 (03) 254-264
  • 38 South AM, Diz DI, Chappell MC. COVID-19, ACE2, and the cardiovascular consequences. Am J Physiol Heart Circ Physiol 2020; 318 (05) H1084-H1090
  • 39 Bianconi V, Violi F, Fallarino F, Pignatelli P, Sahebkar A, Pirro M. Is acetylsalicylic acid a safe and potentially useful choice for adult patients with COVID-19?. Drugs 2020; 80 (14) 1383-1396
  • 40 Xu L, Liu J, Lu M, Yang D, Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver Int 2020; 40 (05) 998-1004