Search

Aim. To assess the association of hypertension with the severe forms and fatal outcomes of Coronavirus disease 2019 (COVID-19).Material and Methods. This retrospective cohort study involved adult patients (≥18 years old), admitted to the University hospital №4 of Sechenov University (Moscow, Russia) between 08 April 2020 and 19 November 2020 with clinically diagnosed or laboratory-confirmed COVID-19. The cohort included 1637 patients. The primary outcome was all-cause in-hospital mortality. The secondary outcomes included intensive care unit admission (ICU) and invasive ventilation. Multiple logistic regression was performed to assess the independent association between risk factors and endpoints.Results. A total of 1637 patients were included in the study. 51.80% (n=848) of the subjects were males. The median age was 59.0 (48.0; 70.0) years and 55.90% (n=915) had pre-existing diagnosis of hypertension. Patients with hypertension had significantly more severe lung injury based on chest CT scan findings as well as lower oxygen saturation (SрO2). More of them were admitted to ICU and placed on invasive ventilation. The hypertension group also had higher mortality. Age, hypertension, glucose, C-reactive protein and decreased platelet count were independently associated with mortality, hypertension having the strongest association (OR 1.827, 95% CI 1.174-2.846, p=0.008). Age, hypertension, neutrophil count, platelet count, glucose, and CRP were independently associated with ICU admission, with hypertension having the strongest association (OR 1.595, 95% CI 1.178-2.158, p=0.002). Age, hypertension, glucose, CRP and decreased platelet count were independently associated with invasive ventilation, with hypertension having the strongest association (OR 1.703, 95% CI 1.151-2.519, p=0.008).Based on the multiple logistic regression models, odds of death, ICU admission, and invasive ventilation were higher in the hypertension group as compared to the group without hypertension.Conclusion. Hypertension can be an independent predictor of severe COVID-19 and adverse outcomes, namely death, ICU admission, and invasive ventilation in hospitalized patients.

Aim. To study changes in myocardial contractile function when prescribing mineralocorticoid receptor antagonists of spironolactone in patients after coronavirus infection SARS-CoV-2 with symptoms of chronic heart failure (CHF).Materials and methods. The study included 90 hospitalized patients with a diagnosis of SARS-CoV-2 coronavirus infection. The inclusion criteria were: age from 18 to 85 years; the presence of CHF with a preserved or mildly reduced left ventricular ejection fraction (LVEF). The patients were randomized into two groups: group I (n=60) included patients who, for 6 months after discharge from the hospital, in addition to standard drug therapy for CHF, took spironolactone at a dose of 25 mg per day; group II (comparison group; n=30) included patients who received standard drug therapy without additional prescription of spironolactone. The study groups were comparable in age, gender, prevalence of hypertension, coronary heart disease, diabetes mellitus, obesity and severity of CHF; the drug therapy given to the patients had no significant differences. Assessment of LV systolic function, exercise tolerance (six-minute walk test, TSW), quality of life (questionnaire EQ-5D-5L) were performed.Results. When repeated echocardiography was performed after 6 months of treatment, there was a significant improvement in LV systolic function in group I patients. In group I, after 6 months of treatment, there was a significant decrease in the proportion of patients with moderately reduced LVEF (from 30 [50%] to 12 [20%]; p

Aim. To evaluate the effect of sinus tachycardia and reduced left ventricular ejection fraction (LVEF) on the prognosis of patients with a verified diagnosis of a new coronavirus infection SARS-CoV-2.Material and methods. The study included 1,637 patients with a verified diagnosis of a new coronavirus infection SARS-CoV-2. The average age of the patients was 58.8±16.1 years. More than half of the patients admitted to the hospital had a history of cardiovascular diseases: hypertension was diagnosed in 915 (56%) patients, coronary artery disease – in 563 (34%), chronic heart failure – in 410 (25%). 294 (17.9%) patients suffered from diabetes mellitus. The unfavorable course of new coronavirus infection was assessed by the fact of being in the intensive care unit (ICU), the use of mechanical ventilation and death.Results. An unfavorable course of coronavirus infection was observed in 160 (9.8%) patients. Statistical analysis revealed that 341 (20.8%) patients with COVID-19 were diagnosed with sinus tachycardia, which required the appointment of pulse-reducing therapy. The occurrence of sinus tachycardia in patients with COVID-19 significantly increased the risk of death (odds ratio [OR] 1.248, confidence interval [CI] 1.038-1.499, p=0.018), increased the likelihood of mechanical ventilation use (OR 1.451, CI 1.168-1.803, p

Aim. To evaluate the changes of the N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration in patients with sinus tachycardia after coronavirus disease 2019 (COVID-19) during ivabradine monotherapy or in combination with β-blockers (BBs) compared to BB monotherapy.Material and methods. This randomized comparative study included 90 patients discharged from the hospital after an acute period of COVID-19. The main group (n=60) included patients who received ivabradine monotherapy or in combination with BB in addition to standard therapy, while the control group (n=30) — standard therapy in combination with BB. The follow-up period lasted 24 weeks. Serum NT-proBNP concentration was determined by enzyme immunoassay at the first and last visit (0 and 24 weeks). Statistical processing was performed using STATISTICA 8.0 software. The level of statistical significance was p

Aim. To assess the change in the activity of the matrix metalloproteinase (MMP) system after 6-month spironolactone therapy in patients with heart failure (HF) with preserved (HFpEF) and mildly reduced ejection fraction (HFmrEF) after coronavirus disease 2019 (COVID-19).Material and methods. The study included 90 patients treated at the University Clinical Hospital № 4 of the I.M. Sechenov First Moscow State Medical University with a laboratory-confirmed COVID-19. There were following inclusion criteria: age of 18-85 years; the presence of HFpEF and HFmrEF. The patients were randomized into two groups: group I (n=60) — patients with 6-month spironolactone therapy (25 mg/day) in addition to the standard therapy for HF, spironolactone was taken at a dose of 25 mg/day; Group II (comparison group, n=30) — patients who received standard therapy without spironolactone. All patients were determined plasma MMP concentrations.Results. There were no significant differences in the levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) between the groups when included in the study. A repeated investigation revealed a significant decrease in the concentrations of MMP-9 and TIMP-1 only in group I. In patients of group II, there were no significant changes in the plasma concentrations of MMP-9 and TIMP-1. The MMP-9/TIMP-1 ratio during the initial examination of patients did not have significant differences. After 6-months therapy, a significant decrease in the ratio of MMP-9/TIMP-1 was observed only in patients taking spironolactone.Conclusion. The results obtained confirm a significant decrease in MMP system activity after 6-month spironolactone therapy in patients with HFpEF and HFmrEF after COVID-19. The described antifibrotic effects of spironolactone make it possible to recommend the use of this drug in this category of patients to reduce the negative effect of MMPs on cardiovascular system.

Aim. To assess the changes of heart rate (HR), exercise tolerance and quality of life in patients after coronavirus disease 2019 (COVID-19) during treatment with ivabradine monotherapy or in combination with beta-blockers (BB) compared with BB monotherapy.Material and methods. This randomized comparative study included 90 patients discharged from a university hospital after an acute COVID-19. The main group (n=60) received, in addition to standard therapy, ivabradine monotherapy or in combination with BB, while the control one (n=30) — standard therapy in combination with BB. The follow-up period lasted 24 weeks. Statistical processing was performed using the STATISTICA 8.0 program. The level of statistical significance was p

The coronavirus pandemic showed not only an increase in levels of excess morbidity and mortality in the acute phase, but also persisting symptoms 4 weeks after the onset of the disease. A review of international studies on the prevalence and diversity of the manifestations of postcoid syndrome is presented. The data on such a manifestation of post-COVID syndrome as postural orthostatic tachycardia syndrome (POTS) are accumulating. Pathogenetic mechanisms, modern diagnostic criteria and research data on the prevalence of this syndrome are presented in the article. The Canadian Cardiovascular Society has proposed medications as a treatment for POTS, including the sinus node If channel inhibitor ivabradine. Data from several studies showing the effectiveness of this drug for POTS, including after suffering COVID-19, are presented in the article. Clinical data on the prevalence of tachycardia among patients admitted to the Sechenov University hospital are presented. About 18% of patients with hypertension and 21% of patients with normal blood pressure had a high heart rate. A clinical example of the use of ivabradine in a patient after a coronavirus infection is presented. Drug interactions and individual tolerance of ivabradine in patients after coronavirus infection are being discussed. The authors put forward the hypothesis about the further prospect of using ivabradine in the treatment of clinical manifestations of postcoid syndrome on the basis of literature data and their own experience.