European Heart Journal | 2021
COVID-19 and the heart: insights from the National Societies of Cardiology Journals
Abstract
The outbreak of COVID-19 has generated an enormous publication activity from both international-oriented journals and National Societies of Cardiology Journals (NSCJ). The later provided many nationalor regional-specific features of the pandemic spread. In a bibliometric analysis of publications of COVID-19 and their scientific impact during the first 3 months of the pandemic, DieguezCampa et al. from Mexico identified 2530 publications on COVID-19 recorded from PubMed/MEDLINE. They were written by authors from 67 countries (China 39%, USA 16.7%), and they subsequently generated 59 104 citations. While taking into account all 67 countries of origin, the authors showed a correlation between the number of publications per country, and the numbers of confirmed cases of COVID-19 and deaths related to the disease. Böhm et al. attributed the increase in submission rate to Clinical Research in Cardiology during the shutdown to travel restrictions, cancellation of medical congresses, reduction of clinical and scientific meetings, and advisory boards. Of note, a shorter review time and a shorter time to acceptance or rejection were observed concomitantly. The containment policy and related shutdown directly impacted cardiovascular practice. In a multicenter study from France, Huet et al. showed that before containment, the nine participating intensive cardiac care units (ICCUs) admitted 4.8 6 1.6 patients per day for acute myocardial infarction (AMI) or heart failure (HF) vs. 2.6 6 1.5 only during containment. In a Spanish nationwide registry (75 ICCUs) of patients with ST-segment elevation myocardial infarction (STEMI), Rodriguez-Leor et al. showed that suspected and confirmed patients with STEMI decreased by 27% during the COVID-19. There was no difference in time from first medical contact to reperfusion nor in reperfusion strategies, with 94% primary percutaneous coronary interventions (PCI). However, in-hospital mortality was higher during COVID-19 (7.5% vs. 5.1%). Among patients treated during the COVID, the incidence of confirmed SARS-CoV2 infection was only 6.3%. These changes significantly impacted interventional cardiology procedures with a reduction in diagnosis procedures ( 56%), PCI ( 48%), structural interventions ( 81%), and primary PCI for STEMI. In a meta-analysis of cardiovascular complications of COVID-19 published by Momtazmanesh et al. in the Egyptian Heart Journal, acute cardiac injury occurred in 25% of the 10 898 patients included from 35 studies. Admission to intensive care units of patients with cardiac involvement was 13.5-fold and mortality was 20-fold higher as compared with patients without cardiac manifestations. Arrhythmias accounted for 11.7% of 692 patients admitted to 35 hospitals with COVID-19 according to the Portuguese Association of Arrhythmias. Older patients were the most exposed (median age 73.5 years) as well as patients with hypertension (64%). Observed arrhythmias included paroxysmal supraventricular tachycardia (26.6%), atrial fibrillation (AF, 62.5%), sinus bradycardia (7.8%), and ventricular tachycardia (3.1%). An arrhythmia or a prolongation of QT interval was observed in 10.8% of 53 patients to whom any experimental drug regimen against SARS-CoV2 was administered. Diagnosis of myocardial involvement with SARS-CoV2 remains often challenging until MRI is performed. Along with d-dimer and troponin assessment, the level and significance of anti-cardiac antibodies has been examined in a Russian study by Blagova et al. Among 86 patients admitted to hospital for moderate-to-severe COVID-19, cardiac damage (45.3% of patients) included new-onset AF (9.3%), HF (9.3%), low QRS voltage (11.4%), repolarization abnormalities (41.5%), and pericardial effusion (30%). Anti-cardiac antibodies were found with three-fold higher titres in 25 patients (73.5%), and their level correlated with pericardial effusion and mortality. Pulmonary artery circulation in patients with COVID-19 has been extensively reviewed by Jansa and Ascherman, from Praha, who showed that prevalence of COVID-19 is not increased in patients with pulmonary arterial hypertension (PAH). A potential explanation of this