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1. Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study

Author

Pagnesi, M., Inciardi, R. M., Lombardi, C. M., Agostoni, P., Ameri, P., Barbieri, L., Bellasi, A., Camporotondo, R., Canale, C., Carubelli, V., Carugo, S., Catagnano, F., Dalla Vecchia, L. A., Danzi, G. B., Di Pasquale, M., Gaudenzi, M., Giovinazzo, S., Gnecchi, M., Guazzi, M., Iorio, A., La Rovere, M. T., Leonardi, S., Maccagni, G., Mapelli, M., Margonato, D., Merlo, M., Monzo, L., Mortara, A., Nuzzi, V., Piepoli, M., Porto, I., Pozzi, A., Sarullo, F., Sinagra, G., Tedino, C., Tomasoni, D., Volterrani, M., Zaccone, G., Senni, M., Metra, M., Pagnesi, M, Inciardi, R, Lombardi, C, Agostoni, P, Ameri, P, Barbieri, L, Bellasi, A, Camporotondo, R, Canale, C, Carubelli, V, Carugo, S, Catagnano, F, Dalla Vecchia, L, Danzi, G, Di Pasquale, M, Gaudenzi, M, Giovinazzo, S, Gnecchi, M, Guazzi, M, Iorio, A, La Rovere, M, Leonardi, S, Maccagni, G, Mapelli, M, Margonato, D, Merlo, M, Monzo, L, Mortara, A, Nuzzi, V, Piepoli, M, Porto, I, Pozzi, A, Sarullo, F, Sinagra, G, Tedino, C, Tomasoni, D, Volterrani, M, Zaccone, G, Senni, M, Metra, M, Pagnesi, M., Inciardi, R. M., Lombardi, C. M., Agostoni, P., Ameri, P., Barbieri, L., Bellasi, A., Camporotondo, R., Canale, C., Carubelli, V., Carugo, S., Catagnano, F., Dalla Vecchia, L. A., Danzi, G. B., Di Pasquale, M., Gaudenzi, M., Giovinazzo, S., Gnecchi, M., Guazzi, M., Iorio, A., La Rovere, M. T., Leonardi, S., Maccagni, G., Mapelli, M., Margonato, D., Merlo, M., Monzo, L., Mortara, A., Nuzzi, V., Piepoli, M., Porto, I., Pozzi, A., Sarullo, F., Sinagra, G., Tedino, C., Tomasoni, D., Volterrani, M., Zaccone, G., Senni, M., and Metra, M.

Subjects
SARS-CoV-2, Short Communication, COVID-19, corticosteroid, glucocorticoid, steroid, Glucocorticoid, Italy, Corticosteroid, Steroid, Hospital Mortality, Humans, Retrospective Studies, Glucocorticoids
Abstract

Background: Glucocorticoid therapy has emerged as an effective therapeutic option in hospitalized patients with coronavirus disease 2019 (COVID-19). This study aimed to focus on the impact of relevant clinical and laboratory factors on the protective effect of glucocorticoids on mortality. Methods: A sub-analysis was performed of the multicenter Cardio-COVID-Italy registry, enrolling consecutive patients with COVID-19 admitted to 13 Italian cardiology units between 01 March 2020 and 09 April 2020. The primary endpoint was in-hospital mortality. Results: A total of 706 COVID-19 patients were included (349 treated with glucocorticoids, 357 not treated with glucocorticoids). After adjustment for relevant covariates, use of glucocorticoids was associated with a lower risk of in-hospital mortality (adjusted HR 0.44; 95% CI 0.26–0.72; p = 0.001). A significant interaction was observed between the protective effect of glucocorticoids on mortality and PaO2/FiO2 ratio on admission (p = 0.042), oxygen saturation on admission (p = 0.017), and peak CRP (0.023). Such protective effects of glucocorticoids were mainly observed in patients with lower PaO2/FiO2 ratio (100 mg/L). Conclusions: The protective effects of glucocorticoids on mortality in COVID-19 were more evident among patients with worse respiratory parameters and higher systemic inflammation.

Published
2021

2. The prognostic value of serial troponin measurements in patients admitted for COVID-19

Author

Giulia Peveri, Stefano Carugo, Maria Teresa La Rovere, Michele Senni, Annamaria Iorio, Andrea Pozzi, Stefano Giovinazzo, Davide Margonato, Massimiliano Gnecchi, Gianfranco Sinagra, Massimo F Piepoli, Claudia Canale, Piergiuseppe Agostoni, Marco Metra, Antonio Bellasi, Vincenzo Nuzzi, Gloria Maccagni, Sergio Leonardi, Francesco Catagnano, Maurizio Volterrani, Marco Guazzi, Valentina Carubelli, Massimo Mapelli, Claudia Specchia, Giovanni Provenzale, Chiara Oriecuia, Andrea Mortara, Carlo Lombardi, Filippo M. Sarullo, Rita Camporotondo, Daniela Tomasoni, Riccardo M. Inciardi, Gian Battista Danzi, Italo Porto, Laura Adelaide Dalla Vecchia, Pietro Ameri, Luca Monzo, Marco Merlo, Nuzzi, V, Merlo, M, Specchia, C, Lombardi, C, Carubelli, V, Iorio, A, Inciardi, R, Bellasi, A, Canale, C, Camporotondo, R, Catagnano, F, Dalla Vecchia, L, Giovinazzo, S, Maccagni, G, Mapelli, M, Margonato, D, Monzo, L, Oriecuia, C, Peveri, G, Pozzi, A, Provenzale, G, Sarullo, F, Tomasoni, D, Ameri, P, Gnecchi, M, Leonardi, S, Agostoni, P, Carugo, S, Danzi, G, Guazzi, M, La Rovere, M, Mortara, A, Piepoli, M, Porto, I, Volterrani, M, Senni, M, Metra, M, Sinagra, G, Nuzzi, V., Merlo, M., Specchia, C., Lombardi, C. M., Carubelli, V., Iorio, A., Inciardi, R. M., Bellasi, A., Canale, C., Camporotondo, R., Catagnano, F., Dalla Vecchia, L. A., Giovinazzo, S., Maccagni, G., Mapelli, M., Margonato, D., Monzo, L., Oriecuia, C., Peveri, G., Pozzi, A., Provenzale, G., Sarullo, F., Tomasoni, D., Ameri, P., Gnecchi, M., Leonardi, S., Agostoni, P., Carugo, S., Danzi, G. B., Guazzi, M., La Rovere, M. T., Mortara, A., Piepoli, M., Porto, I., Volterrani, M., Senni, M., Metra, M., and Sinagra, G.

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Troponin trajectories, COVID-19, COVID-19 outcome, myocardial injury, troponin trajectories, COVID‐19, Original Research Articles, Internal medicine, medicine, Diseases of the circulatory (Cardiovascular) system, Humans, In patient, Original Research Article, Hospital Mortality, biology, business.industry, Hazard ratio, COVID‐19 outcome, medicine.disease, Prognosis, Troponin, Confidence interval, Hospitalization, Myocardial injury, Italy, Heart failure, RC666-701, biology.protein, Cardiology, Population study, Risk of death, Cardiology and Cardiovascular Medicine, business, Troponin trajectorie
Abstract

Aims Myocardial injury (MI) in coronavirus disease‐19 (COVID‐19) is quite prevalent at admission and affects prognosis. Little is known about troponin trajectories and their prognostic role. We aimed to describe the early in‐hospital evolution of MI and its prognostic impact. Methods and results We performed an analysis from an Italian multicentre study enrolling COVID‐19 patients, hospitalized from 1 March to 9 April 2020. MI was defined as increased troponin level. The first troponin was tested within 24 h from admission, the second one between 24 and 48 h. Elevated troponin was defined as values above the 99th percentile of normal values. Patients were divided in four groups: normal, normal then elevated, elevated then normal, and elevated. The outcome was in‐hospital death. The study population included 197 patients; 41% had normal troponin at both evaluations, 44% had elevated troponin at both assessments, 8% had normal then elevated troponin, and 7% had elevated then normal troponin. During hospitalization, 49 (25%) patients died. Patients with incident MI, with persistent MI, and with MI only at admission had a higher risk of death compared with those with normal troponin at both evaluations (P

Published
2021

3. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era

Author

De Rosa, Salvatore, Spaccarotella, Carmen, Basso, Cristina, Calabrò, Maria Pia, Curcio, Antonio, Filardi, Pasquale Perrone, Mancone, Massimo, Mercuro, Giuseppe, Muscoli, Saverio, Nodari, Savina, Pedrinelli, Roberto, Sinagra, Gianfranco, Indolfi, Ciro, Angelini, Filippo, Barillà, Francesco, Bartorelli, Antonio, Benedetto, Francesco, Bernabò, Paola, Bolognese, Leonardo, Briani, Martina, Cacciavillani, Luisa, Calabrese, Alice, Calabrò, Paolo, Caliendo, Luigi, Calò, Leonardo, Casella, Gianni, Casu, Gavino, Cavallini, Claudio, Ciampi, Quirino, Ciccone, Marco, Comito, Michele, Corrada, Elena, Crea, Filippo, D’Andrea, Antonello, D’Urbano, Maurizio, De Caterina, Raffaele, De Ferrari, Gaetano, De Ponti, Roberto, Della Mattia, Alessio, Di Mario, Carlo, Donazzan, Luca, Esposito, Giovanni, Fedele, Francesco, Ferraro, Alessandro, Galasso, Gennaro, Galiè, Nazzareno, Gnecchi, Massimiliano, Golino, Paolo, Golia, Bruno, Guarini, Pasquale, Leonardi, Sergio, Locuratolo, Nicola, Luzza, Francesco, Manganiello, Vincenzo, Francesca Marchetti, Maria, Marenzi, Giancarlo, Margonato, Alberto, Meloni, Luigi, Metra, Marco, Milo, Marco, Mongiardo, Annalisa, Monzo, Luca, Morisco, Carmine, Novo, Giuseppina, Pancaldi, Stefano, Parollo, Matteo, Paternò, Giovanni, Patti, Giuseppe, Priori, Silvia, Ravera, Amelia, Giuseppe Rebuzzi, Antonio, Rossi, Massimo, Scherillo, Marino, Semprini, Franco, Senni, Michele, Sibilio, Gerolamo, Siviglia, Massimo, Tamburino, Corrado, Tortorici, Gianfranco, Versace, Francesco, Villari, Bruno, Volpe, Massimo, De Rosa S., Spaccarotella C., Basso C., Calabro M.P., Curcio A., Filardi P.P., Mancone M., Mercuro G., Muscoli S., Nodari S., Pedrinelli R., Sinagra G., Indolfi C., Angelini F., Barilla F., Bartorelli A., Benedetto F., Bernabo P., Bolognese L., Briani M., Cacciavillani L., Calabrese A., Calabro P., Caliendo L., Calo L., Casella G., Casu G., Cavallini C., Ciampi Q., Ciccone M., Comito M., Corrada E., Crea F., D'Andrea A., D'Urbano M., De Caterina R., De Ferrari G., De Ponti R., Della Mattia A., DI Mario C., Donnazzan L., Esposito G., Fedele F., Ferraro A., Galasso G., Galie N., Gnecchi M., Golino P., Golia B., Guarini P., Leonardi S., Locuratolo N., Luzza F., Manganiello V., Francesca Marchetti M., Marenzi G., Margonato A., Meloni L., Metra M., Milo M., Mongiardo A., Monzo L., Morisco C., Novo G., Pancaldi S., Parollo M., Paterno G., Patti G., Priori S., Ravera A., Giuseppe Rebuzzi A., Rossi M., Scherillo M., Semprini F., Senni M., Sibilio G., Siviglia M., Tamburino C., Tortorici G., Versace F., Villari B., Volpe M., De Rosa, S., Spaccarotella, C., Basso, C., Calabro, M. P., Curcio, A., Filardi, P. P., Mancone, M., Mercuro, G., Muscoli, S., Nodari, S., Pedrinelli, R., Sinagra, G., Indolfi, C., Angelini, F., Barilla, F., Bartorelli, A., Benedetto, F., Bernabo, P., Bolognese, L., Briani, M., Cacciavillani, L., Calabrese, A., Calabro, P., Caliendo, L., Calo, L., Casella, G., Casu, G., Cavallini, C., Ciampi, Q., Ciccone, M., Comito, M., Corrada, E., Crea, F., D'Andrea, A., D'Urbano, M., De Caterina, R., De Ferrari, G., De Ponti, R., Della Mattia, A., DI Mario, C., Donnazzan, L., Esposito, G., Fedele, F., Ferraro, A., Galasso, G., Galie, N., Gnecchi, M., Golino, P., Golia, B., Guarini, P., Leonardi, S., Locuratolo, N., Luzza, F., Manganiello, V., Francesca Marchetti, M., Marenzi, G., Margonato, A., Meloni, L., Metra, M., Milo, M., Mongiardo, A., Monzo, L., Morisco, C., Novo, G., Pancaldi, S., Parollo, M., Paterno, G., Patti, G., Priori, S., Ravera, A., Giuseppe Rebuzzi, A., Rossi, M., Scherillo, M., Semprini, F., Senni, M., Sibilio, G., Siviglia, M., Tamburino, C., Tortorici, G., Versace, F., Villari, B., Volpe, M., De Rosa, S, Spaccarotella, C, Basso, C, Calabro, M, Curcio, A, Filardi, P, Mancone, M, Mercuro, G, Muscoli, S, Nodari, S, Pedrinelli, R, Sinagra, G, Indolfi, C, Angelini, F, Barilla, F, Bartorelli, A, Benedetto, F, Bernabo, P, Bolognese, L, Briani, M, Cacciavillani, L, Calabrese, A, Calabro, P, Caliendo, L, Calo, L, Casella, G, Casu, G, Cavallini, C, Ciampi, Q, Ciccone, M, Comito, M, Corrada, E, Crea, F, D'Andrea, A, D'Urbano, M, De Caterina, R, De Ferrari, G, De Ponti, R, Della Mattia, A, DI Mario, C, Donnazzan, L, Esposito, G, Fedele, F, Ferraro, A, Galasso, G, Galie, N, Gnecchi, M, Golino, P, Golia, B, Guarini, P, Leonardi, S, Locuratolo, N, Luzza, F, Manganiello, V, Francesca Marchetti, M, Marenzi, G, Margonato, A, Meloni, L, Metra, M, Milo, M, Mongiardo, A, Monzo, L, Morisco, C, Novo, G, Pancaldi, S, Parollo, M, Paterno, G, Patti, G, Priori, S, Ravera, A, Giuseppe Rebuzzi, A, Rossi, M, Scherillo, M, Semprini, F, Senni, M, Sibilio, G, Siviglia, M, Tamburino, C, Tortorici, G, Versace, F, Villari, B, Volpe, M, De Rosa, Salvatore, Spaccarotella, Carmen, Basso, Cristina, Calabrò, Maria Pia, Curcio, Antonio, Filardi, Pasquale Perrone, Mancone, Massimo, Mercuro, Giuseppe, Muscoli, Saverio, Nodari, Savina, Pedrinelli, Roberto, Sinagra, Gianfranco, and Indolfi, Ciro

Subjects
Male, Myocardial Infarction, 030204 cardiovascular system & hematology, Settore MED/11, 0302 clinical medicine, Acute myocardial infarction, Cardiac care units, STEMI, Aged, Aged, 80 and over, COVID-19, Female, Hospitalization, Humans, Italy, Male, Middle Aged, SARS-CoV-2, Betacoronavirus, Coronavirus Infections, Myocardial Infarction, Pandemics, Pneumonia, Viral, Case fatality rate, 80 and over, Medicine, 030212 general & internal medicine, Myocardial infarction, Viral, Aged, 80 and over, Acute myocardial infarction, Cardiac care units, COVID-19, SARS-CoV2, STEMI, Aged, Female, Hospitalization, Humans, Italy, Middle Aged, Betacoronavirus, Coronavirus Infections, Pandemics, Pneumonia, Viral, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Fast Track Clinical Research, 03 medical and health sciences, Cardiac care unit, cardiovascular diseases, Betacoronaviru, Pandemic, business.industry, Coronavirus Infection, SARS-CoV-2, Pneumonia, medicine.disease, acute myocardial infarction, cardiac care units, Confidence interval, Relative risk, Emergency medicine, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Myocardial infarction complications, Observational study, Myocardial infarction diagnosis, business, Complication
Abstract

Aims To evaluate the impact of the COVID-19 pandemic on patient admissions to Italian cardiac care units (CCUs). Methods and Results We conducted a multicentre, observational, nationwide survey to collect data on admissions for acute myocardial infarction (AMI) at Italian CCUs throughout a 1 week period during the COVID-19 outbreak, compared with the equivalent week in 2019. We observed a 48.4% reduction in admissions for AMI compared with the equivalent week in 2019 (P < 0.001). The reduction was significant for both ST-segment elevation myocardial infarction [STEMI; 26.5%, 95% confidence interval (CI) 21.7–32.3; P = 0.009] and non-STEMI (NSTEMI; 65.1%, 95% CI 60.3–70.3; P < 0.001). Among STEMIs, the reduction was higher for women (41.2%; P = 0.011) than men (17.8%; P = 0.191). A similar reduction in AMI admissions was registered in North Italy (52.1%), Central Italy (59.3%), and South Italy (52.1%). The STEMI case fatality rate during the pandemic was substantially increased compared with 2019 [risk ratio (RR) = 3.3, 95% CI 1.7–6.6; P < 0.001]. A parallel increase in complications was also registered (RR = 1.8, 95% CI 1.1–2.8; P = 0.009). Conclusion Admissions for AMI were significantly reduced during the COVID-19 pandemic across Italy, with a parallel increase in fatality and complication rates. This constitutes a serious social issue, demanding attention by the scientific and healthcare communities and public regulatory agencies.

Published
2020

4. Association of Troponin Levels with Mortality in Italian Patients Hospitalized with Coronavirus Disease 2019: Results of a Multicenter Study

Author

Davide Margonato, Gianfranco Sinagra, Giulia Peveri, Riccardo M. Inciardi, Carlo Lombardi, Maurizio Volterrani, Pietro Ameri, Marco Merlo, Annamaria Iorio, Piergiuseppe Agostoni, Sergio Leonardi, Massimo F Piepoli, Gloria Maccagni, Francesco Catagnano, Gian Battista Danzi, Luca Monzo, Valentina Carubelli, Italo Porto, Vincenzo Nuzzi, Laura Adelaide Dalla Vecchia, Maria Teresa La Rovere, Chiara Oriecuia, Claudia Canale, Daniela Tomasoni, Massimo Mapelli, Michele Senni, Antonio Bellasi, Rita Camporotondo, Andrea Pozzi, Massimiliano Gnecchi, Claudia Specchia, Giovanni Provenzale, Filippo M. Sarullo, Andrea Mortara, Stefano Carugo, Stefano Giovinazzo, Marco Metra, Marco Guazzi, Lombardi, C. M., Carubelli, V., Iorio, A., Inciardi, R. M., Bellasi, A., Canale, C., Camporotondo, R., Catagnano, F., Dalla Vecchia, L. A., Giovinazzo, S., Maccagni, G., Mapelli, M., Margonato, D., Monzo, L., Nuzzi, V., Oriecuia, C., Peveri, G., Pozzi, A., Provenzale, G., Sarullo, F., Tomasoni, D., Ameri, P., Gnecchi, M., Leonardi, S., Merlo, M., Agostoni, P., Carugo, S., Danzi, G. B., Guazzi, M., La Rovere, M. T., Mortara, A., Piepoli, M., Porto, I., Sinagra, G., Volterrani, M., Specchia, C., Metra, M., Senni, M., Lombardi, C, Carubelli, V, Iorio, A, Inciardi, R, Bellasi, A, Canale, C, Camporotondo, R, Catagnano, F, Dalla Vecchia, L, Giovinazzo, S, Maccagni, G, Mapelli, M, Margonato, D, Monzo, L, Nuzzi, V, Oriecuia, C, Peveri, G, Pozzi, A, Provenzale, G, Sarullo, F, Tomasoni, D, Ameri, P, Gnecchi, M, Leonardi, S, Merlo, M, Agostoni, P, Carugo, S, Danzi, G, Guazzi, M, La Rovere, M, Mortara, A, Piepoli, M, Porto, I, Sinagra, G, Volterrani, M, Specchia, C, Metra, M, and Senni, M

Subjects
Male, Cross-sectional study, coronavirus, Comorbidity, 030204 cardiovascular system & hematology, 0302 clinical medicine, Risk Factors, Cardiovascular Disease, troponin, myocardial injury, Troponin I, 80 and over, Prevalence, 030212 general & internal medicine, Hospital Mortality, Aged, 80 and over, Troponin T, biology, Mortality rate, Brief Report, Middle Aged, Hospitalization, Italy, Cardiovascular Diseases, Female, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Acute coronary syndrome, Coronavirus disease 2019 (COVID-19), 03 medical and health sciences, Internal medicine, medicine, aged, aged, 80 and over, COVID-19, cardiovascular diseases, comorbidity, cross-sectional studies, female, hospital mortality, hospitalization, humans, italy, male, middle aged, prevalence, risk factors, SARS-CoV-2, troponin i, troponin t, Humans, Aged, Cross-Sectional Studie, business.industry, Risk Factor, medicine.disease, Troponin, Cross-Sectional Studies, biology.protein, business
Abstract

Importance: Myocardial injury, detected by elevated plasma troponin levels, has been associated with mortality in patients hospitalized with coronavirus disease 2019 (COVID-19). However, the initial data were reported from single-center or 2-center studies in Chinese populations. Compared with these patients, European and US patients are older, with more comorbidities and higher mortality rates. Objective: To evaluate the prevalence and prognostic value of myocardial injury, detected by elevated plasma troponin levels, in a large population of White Italian patients with COVID-19. Design, Setting, and Participants: This is a multicenter, cross-sectional study enrolling consecutive patients with laboratory-confirmed COVID-19 who were hospitalized in 13 Italian cardiology units from March 1 to April 9, 2020. Patients admitted for acute coronary syndrome were excluded. Elevated troponin levels were defined as values greater than the 99th percentile of normal values. Main Outcomes and Measures: Clinical characteristics and outcomes stratified as elevated or normal cardiac troponin levels at admission, defined as troponin T or troponin I at a level greater than the 99th percentile of normal values. Results: A total of 614 patients with COVID-19 were included in this study (mean age [SD], 67 [13] years; 70.8% male), of whom 148 patients (24.1%) died during the hospitalization. Elevated troponin levels were found in 278 patients (45.3%). These patients were older (mean [SD] age, 64.0 [13.6] years vs 71.3 [12.0] years; P

Published
2020

5. Combined Role of Troponin and Natriuretic Peptides Measurements in Patients With Covid-19 (from the Cardio-COVID-Italy Multicenter Study)

Author

Annamario Iorio, Carlo Mario Lombardi, Caludia Specchia, Marco Merlo, Vincenzo Nuzzi, Ilenia Ferraro, Giulia Peveri, Chiara Oriecuia, Andrea Pozzi, Riccardo Maria Inciardi, Valentina Carubelli, Antonio Bellasi, Claudia Canale, Rita Camporotondo, Francesco Catagnano, Laura Dalla Vecchia, Stefano Giovinazzo, Gloria Maccagni, Massimo Mapelli, Davide Margonato, Luca Monzo, Giovanni Provenzale, Filippo Sarullo, Daniela Tomasoni, Pietro Ameri, Massimiliano Gnecchi, Sergio Leonardi, Piergiuseppe Agostoni, Stefano Carugo, Gian Battista Danzi, Marco Guazzi, Maria Teresa La Rovere, Andrea Mortara, Massimo Piepoli, Italo Porto, Maurizio Volterrani, Gianfranco Sinagra, Michele Senni, Marco Metra, Iorio, A, Lombardi, C, Specchia, C, Merlo, M, Nuzzi, V, Ferraro, I, Peveri, G, Oriecuia, C, Pozzi, A, Inciardi, R, Carubelli, V, Bellasi, A, Canale, C, Camporotondo, R, Catagnano, F, Dalla Vecchia, L, Giovinazzo, S, Maccagni, G, Mapelli, M, Margonato, D, Monzo, L, Provenzale, G, Sarullo, F, Tomasoni, D, Ameri, P, Gnecchi, M, Leonardi, S, Agostoni, P, Carugo, S, Danzi, G, Guazzi, M, La Rovere, M, Mortara, A, Piepoli, M, Porto, I, Volterrani, M, Sinagra, G, Senni, M, Metra, M, Iorio, Annamario, Lombardi, Carlo Mario, Specchia, Caludia, Merlo, Marco, Nuzzi, Vincenzo, Ferraro, Ilenia, Peveri, Giulia, Oriecuia, Chiara, Pozzi, Andrea, Inciardi, Riccardo Maria, Carubelli, Valentina, Bellasi, Antonio, Canale, Claudia, Camporotondo, Rita, Catagnano, Francesco, Dalla Vecchia, Laura, Giovinazzo, Stefano, Maccagni, Gloria, Mapelli, Massimo, Margonato, Davide, Monzo, Luca, Provenzale, Giovanni, Sarullo, Filippo, Tomasoni, Daniela, Ameri, Pietro, Gnecchi, Massimiliano, Leonardi, Sergio, Agostoni, Piergiuseppe, Carugo, Stefano, Danzi, Gian Battista, Guazzi, Marco, La Rovere, Maria Teresa, Mortara, Andrea, Piepoli, Massimo, Porto, Italo, Volterrani, Maurizio, Sinagra, Gianfranco, Senni, Michele, and Metra, Marco

Subjects
Male, Covid-19, COVID-19 outcome, myocardial injury, troponin trajectories, Prognosi, Risk Assessment, Article, Peptide Fragment, Troponin T, Natriuretic Peptide, Natriuretic Peptide, Brain, 80 and over, Humans, Hospital Mortality, Aged, Proportional Hazards Models, Aged, 80 and over, Heart Failure, COVID-19, Female, Italy, Middle Aged, Peptide Fragments, Prognosis, SARS-CoV-2, Troponin I, Brain, Proportional Hazards Model, Cardiology and Cardiovascular Medicine, Human
Abstract

Data concerning the combined prognostic role of natriuretic peptide (NP) and troponin in patients with COVID-19 are lacking. The aim of the study is to evaluate the combined prognostic value of NPs and troponin in hospitalized COVID-19 patients. From March 1, 2020 to April 9, 2020, consecutive patients with COVID-19 and available data on cardiac biomarkers at admission were recruited. Patients admitted for acute coronary syndrome were excluded. Troponin levels were defined as elevated when greater than the 99th percentile of normal values. NPs were considered elevated if above the limit for ruling in acute heart failure (HF). A total of 341 patients were included in this study, mean age 68 +/-& nbsp;13 years, 72% were men. During a median follow-up period of 14 days, 81 patients (24%) died. In the Cox regression analysis, patients with elevated both NPs and troponin levels had higher risk of death compared with those with normal levels of both (hazard ratio 2.94; 95% confidence interval 1.31 to 6.64; p = 0.009), and this remained significant after adjustment for age, gender, oxygen saturation, HF history, and chronic kidney disease. Interestingly, NPs provided risk stratification also in patients with normal troponin values (hazard ratio 2.86; 95% confidence interval 1.21 to 6.72; p = 0.016 with high NPs levels). These data show the combined prognostic role of troponin and NPs in COVID-19 patients. NPs value may be helpful in identifying patients with a worse prognosis among those with normal troponin values. Further, NPs' cut-point used for diagnosis of acute HF has a predictive role in patients with COVID-19.

Published
2022

6. Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study

Author

Valentina Carubelli, Carlo Lombardi, Marco Metra, Davide Margonato, Massimiliano Gnecchi, Antonio Bellasi, Maurizio Volterrani, Marco Guazzi, Gregorio Zaccone, Riccardo M. Inciardi, Massimo F Piepoli, Mattia Di Pasquale, Laura Adelaide Dalla Vecchia, Francesco Catagnano, Stefano Carugo, Michele Senni, Sergio Leonardi, Vincenzo Nuzzi, Pietro Ameri, Filippo M. Sarullo, Stefano Giovinazzo, Luca Monzo, Rita Camporotondo, Gianfranco Sinagra, Andrea Mortara, Giovanni Provenzale, Daniela Tomasoni, Marco Merlo, Anita Iorio, Maria Teresa La Rovere, Chiara Tedino, Andrea Pozzi, Claudia Canale, Giambattista Danzi, Piergiuseppe Agostoni, Italo Porto, Gloria Maccagni, Massimo Mapelli, Ameri, Pietro, Inciardi, Riccardo M, Di Pasquale, Mattia, Agostoni, Piergiuseppe, Bellasi, Antonio, Camporotondo, Rita, Canale, Claudia, Carubelli, Valentina, Carugo, Stefano, Catagnano, Francesco, Danzi, Giambattista, Vecchia, Laura Dalla, Giovinazzo, Stefano, Gnecchi, Massimiliano, Guazzi, Marco, Iorio, Anita, La Rovere, Maria Teresa, Leonardi, Sergio, Maccagni, Gloria, Mapelli, Massimo, Margonato, Davide, Merlo, Marco, Monzo, Luca, Mortara, Andrea, Nuzzi, Vincenzo, Piepoli, Massimo, Porto, Italo, Pozzi, Andrea, Provenzale, Giovanni, Sarullo, Filippo, Sinagra, Gianfranco, Tedino, Chiara, Tomasoni, Daniela, Volterrani, Maurizio, Zaccone, Gregorio, Lombardi, Carlo Mario, Senni, Michele, Metra, Marco, Ameri, P, Inciardi, R, Di Pasquale, M, Agostoni, P, Bellasi, A, Camporotondo, R, Canale, C, Carubelli, V, Carugo, S, Catagnano, F, Danzi, G, Dalla Vecchia, L, Giovinazzo, S, Gnecchi, M, Guazzi, M, Iorio, A, La Rovere, M, Leonardi, S, Maccagni, G, Mapelli, M, Margonato, D, Merlo, M, Monzo, L, Mortara, A, Nuzzi, V, Piepoli, M, Porto, I, Pozzi, A, Provenzale, G, Sarullo, F, Sinagra, G, Tedino, C, Tomasoni, D, Volterrani, M, Zaccone, G, Lombardi, C, Senni, M, and Metra, M

Subjects
Male, 030204 cardiovascular system & hematology, Cohort Studies, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Coagulopathy, 80 and over, Medicine, 030212 general & internal medicine, Hospital Mortality, Anticoagulant, COVID-19, d-dimer, Death, Thromboembolism, Tomography, Aged, 80 and over, education.field_of_study, Incidence (epidemiology), Incidence, Respiration, General Medicine, Middle Aged, Pulmonary embolism, X-Ray Computed, Hospitalization, Italy, Artificial, Breathing, Cardiology, Female, Cardiology and Cardiovascular Medicine, medicine.drug, medicine.medical_specialty, Population, Hemorrhage, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Tocilizumab, Internal medicine, Humans, D-dimer, Aged, Follow-Up Studies, Pulmonary Embolism, Respiration, Artificial, Retrospective Studies, Tomography, X-Ray Computed, education, Original Paper, business.industry, medicine.disease, chemistry, Heart failure, Ritonavir, business, Kidney disease
Abstract

Background Pulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited. Methods Data were retrospectively obtained from consecutive COVID-19 patients admitted to 13 Cardiology Units in Italy, from March 1st to April 9th, 2020, and followed until in-hospital death, discharge, or April 23rd, 2020. The association of baseline variables with computed tomography-confirmed PE was investigated by Cox hazards regression analysis. The relationship between d-dimer levels and PE incidence was evaluated using restricted cubic splines models. Results The study included 689 patients (67.3 ± 13.2 year-old, 69.4% males), of whom 43.6% were non-invasively ventilated and 15.8% invasively. 52 (7.5%) had PE over 15 (9–24) days of follow-up. Compared with those without PE, these subjects had younger age, higher BMI, less often heart failure and chronic kidney disease, more severe cardio-pulmonary involvement, and higher admission d-dimer [4344 (1099–15,118) vs. 818.5 (417–1460) ng/mL, p p p = 0.06). In multivariate regression, only d-dimer was associated with PE (HR 1.72, 95% CI 1.13–2.62; p = 0.01). The relation between d-dimer concentrations and PE incidence was linear, without inflection point. Only two subjects had a baseline d-dimer Conclusions PE occurs in a sizable proportion of hospitalized COVID-19 patients. The implications of bleeding events and the role of d-dimer in this population need to be clarified. Graphic abstract

Published
2021

7. Implications of atrial fibrillation on the clinical course and outcomes of hospitalized COVID-19 patients. results of the Cardio-COVID-italy multicentre study

Author

Luca Monzo, Carlo Lombardi, Sara Paris, Chiara Tedino, Maurizio Volterrani, Rita Camporotondo, Marco Metra, Filippo M. Sarullo, Piergiuseppe Agostoni, Antonio Bellasi, Marco Guazzi, Mattia Di Pasquale, Daniela Tomasoni, Sergio Leonardi, Francesco Catagnano, Vincenzo Nuzzi, Riccardo M. Inciardi, Pietro Ameri, Gianfranco Sinagra, Stefano Carugo, Valentina Carubelli, Annamaria Iorio, Claudia Specchia, Italo Porto, Laura Adelaide Dalla Vecchia, Giovanni Provenzale, Michele Senni, Andrea Mortara, Stefano Giovinazzo, Maria Teresa La Rovere, Andrea Pozzi, Massimiliano Gnecchi, Marco Merlo, Gregorio Zaccone, Gloria Maccagni, Davide Margonato, Massimo Mapelli, Claudia Canale, Giambattista Danzi, Massimo F Piepoli, Paris, Sara, Inciardi, Riccardo M, Lombardi, Carlo Mario, Tomasoni, Daniela, Ameri, Pietro, Carubelli, Valentina, Agostoni, Piergiuseppe, Canale, Claudia, Carugo, Stefano, Danzi, Giambattista, Di Pasquale, Mattia, Sarullo, Filippo, La Rovere, Maria Teresa, Mortara, Andrea, Piepoli, Massimo, Porto, Italo, Sinagra, Gianfranco, Volterrani, Maurizio, Gnecchi, Massimiliano, Leonardi, Sergio, Merlo, Marco, Iorio, Annamaria, Giovinazzo, Stefano, Bellasi, Antonio, Zaccone, Gregorio, Camporotondo, Rita, Catagnano, Francesco, Dalla Vecchia, Laura, Maccagni, Gloria, Mapelli, Massimo, Margonato, Davide, Monzo, Luca, Nuzzi, Vincenzo, Pozzi, Andrea, Provenzale, Giovanni, Specchia, Claudia, Tedino, Chiara, Guazzi, Marco, Senni, Michele, Metra, Marco, Paris, S, Inciardi, R, Lombardi, C, Tomasoni, D, Ameri, P, Carubelli, V, Agostoni, P, Canale, C, Carugo, S, Danzi, G, Di Pasquale, M, Sarullo, F, La Rovere, M, Mortara, A, Piepoli, M, Porto, I, Sinagra, G, Volterrani, M, Gnecchi, M, Leonardi, S, Merlo, M, Iorio, A, Giovinazzo, S, Bellasi, A, Zaccone, G, Camporotondo, R, Catagnano, F, Dalla Vecchia, L, Maccagni, G, Mapelli, M, Margonato, D, Monzo, L, Nuzzi, V, Pozzi, A, Provenzale, G, Specchia, C, Tedino, C, Guazzi, M, Senni, M, and Metra, M

Subjects
Male, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Hospitalized patients, Cardiovascular risk factors, Atrial fibrillation, Coronavirus disease 2019, Outcome, Severe acute respiratory syndrome coronavirus-2 infection, Aged, Aged, 80 and over, Female, Hospital Mortality, Humans, Italy, Middle Aged, Risk Factors, SARS-CoV-2, Atrial Fibrillation, COVID-19, Heart Failure, 030204 cardiovascular system & hematology, 03 medical and health sciences, coronavirus disease 2019, 0302 clinical medicine, Interquartile range, Clinical Research, Physiology (medical), Internal medicine, severe acute respiratory syndrome coronavirus-2 infection, 80 and over, Medicine, Clinical significance, AcademicSubjects/MED00200, atrial fibrillation, 030212 general & internal medicine, Stroke, business.industry, outcome, Clinical course, medicine.disease, Cardiology and Cardiovascular Medicine, business
Abstract

Aims To assess the clinical relevance of a history of atrial fibrillation (AF) in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods and results We enrolled 696 consecutive patients (mean age 67.4 ± 13.2 years, 69.7% males) admitted for COVID-19 in 13 Italian cardiology centres between 1 March and 9 April 2020. One hundred and six patients (15%) had a history of AF and the median hospitalization length was 14 days (interquartile range 9–24). Patients with a history of AF were older and with a higher burden of cardiovascular risk factors. Compared to patients without AF, they showed a higher rate of in-hospital death (38.7% vs. 20.8%; P 0.05 for both) and was not related to stroke or bleeding events. Conclusion Among hospitalized patients with COVID-19, a history of AF contributes to worse clinical course with a higher mortality and in-hospital events including new-onset AF, acute HF, and multiorgan failure. The mortality risk remains significant after adjustment for variables associated with COVID-19 severity and comorbidities.

Published
2021

8. Impact of heart failure on the clinical course and outcomes of patients hospitalized for COVID-19. Results of the Cardio-COVID-Italy multicentre study

Author

Gloria Maccagni, Stefano Giovinazzo, Filippo M. Sarullo, Piergiuseppe Agostoni, Massimo F Piepoli, Marco Metra, Vincenzo Nuzzi, Luca Monzo, Maria Teresa La Rovere, Margherita Gaudenzi, Andrea Pozzi, Massimo Mapelli, Claudia Canale, Lucia Barbieri, Italo Porto, Valentina Carubelli, Gian Battista Danzi, Andrea Mortara, Chiara Tedino, Marco Merlo, Gianfranco Sinagra, Marco Guazzi, Annamaria Iorio, Antonio Bellasi, Francesco Catagnano, Laura Adelaide Dalla Vecchia, Riccardo M. Inciardi, Carlo Lombardi, Daniela Tomasoni, Stefano Carugo, Mattia Di Pasquale, Maurizio Volterrani, Massimiliano Gnecchi, Gregorio Zaccone, Michele Senni, Davide Margonato, Pietro Ameri, Rita Camporotondo, Sergio Leonardi, Tomasoni, D, Inciardi, R, Lombardi, C, Tedino, C, Agostoni, P, Ameri, P, Barbieri, L, Bellasi, A, Camporotondo, R, Canale, C, Carubelli, V, Carugo, S, Catagnano, F, Dalla Vecchia, L, Danzi, G, Di Pasquale, M, Gaudenzi, M, Giovinazzo, S, Gnecchi, M, Iorio, A, La Rovere, M, Leonardi, S, Maccagni, G, Mapelli, M, Margonato, D, Merlo, M, Monzo, L, Mortara, A, Nuzzi, V, Piepoli, M, Porto, I, Pozzi, A, Sarullo, F, Sinagra, G, Volterrani, M, Zaccone, G, Guazzi, M, Senni, M, and Metra, M

Subjects
Male, Comorbidity, 030204 cardiovascular system & hematology, Severity of Illness Index, 0302 clinical medicine, Adrenal Cortex Hormones, Interquartile range, COVID-19, Heart failure, Outcome, SARS-CoV-2 Infection, Acute Disease, Age Factors, Aged, Aged, 80 and over, Anticoagulants, Blood Gas Analysis, Chronic Disease, Disease Progression, Female, Heart Failure, Heparin, Humans, Italy, Length of Stay, Middle Aged, Multiple Organ Failure, Multivariate Analysis, Partial Pressure, Prognosis, Proportional Hazards Models, Protective Factors, SARS-CoV-2, Sepsis, Hospital Mortality, Fraction of inspired oxygen, heart failure, outcome, acute disease, adrenal cortex hormones, age factors, aged, aged, 80 and over, anticoagulants, blood gas analysis, chronic disease, comorbidity, disease progression, female, heparin, humans, italy, length of stay, male, middle aged, multiple organ failure, multivariate analysis, partial pressure, prognosis, proportional hazards models, protective factors, sepsis, severity of illness index, hospital mortality, 80 and over, Oxygen saturation (medicine), Hazard ratio, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, 03 medical and health sciences, Internal medicine, medicine, business.industry, Proportional hazards model, medicine.disease, Confidence interval, business
Abstract

Aims: To assess the prognostic value of a history of heart failure (HF) in patients with coronavirus disease 2019 (COVID-19). Methods and results: We enrolled 692 consecutive patients admitted for COVID-19 in 13 Italian cardiology centres between 1 March and 9 April 2020. Mean age was 67.4± 13.2 years, 69.5% of patients were males, 90 (13.0%) had a history of HF, median hospitalization length was 14 days (interquartile range 9–24). In-hospital death occurred in 37 of 90 patients (41.1%) with HF history vs. 126 of those with no HF history (20.9%). The increased risk of death associated with HF history remained significant after adjustment for clinical variables related to COVID-19 and HF severity, including comorbidities, oxygen saturation, lymphocyte count and plasma troponin [adjusted hazard ratio (HR) for death: 2.25; 95% confidence interval (CI) 1.26–4.02; P= 0.006 at multivariable Cox regression model including 404 patients]. Patients with a history of HF also had more in-hospital complications including. acute HF (33.3% vs. 5.1%, P< 0.001), acute renal failure (28.1% vs. 12.9%, P< 0.001), multiorgan failure (15.9% vs. 5.8%, P= 0.004) and sepsis (18.4% vs. 8.9%, P= 0.006). Other independent predictors of outcome were age, sex, oxygen saturation and oxygen partial pressure at arterial gas analysis/fraction of inspired oxygen ratio (PaO2/FiO2). In-hospital treatment with corticosteroids and heparin had beneficial effects (adjusted HR for death: 0.46; 95% CI 0.29–0.74; P= 0.001; n= 404 for corticosteroids, and adjusted HR 0.41; 95% CI 0.25–0.67; P< 0.001; n= 364 for heparin). Conclusions: Hospitalized patients with COVID-19 and a history of HF have an extremely poor outcome with higher mortality and in-hospital complications. HF history is an independent predictor of increased in-hospital mortality.

Published
2020

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