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Echocardiographic Assessment of the Right Heart in Mice
Published on: November 27, 2013
Integrated Echocardiographic and Biomarker Assessment Reveal Progressive Cardiovascular Injury After Moderate and
Cuma Süleymanoğlu1, Fuat Polat2, Deniz Elçik3
1Department of Cardiology, Osmaniye Training and Research Hospital, Osmaniye, Turkey.
Insights
COVID-19 survivors experience worsening cardiovascular health, especially severe cases with right ventricular dysfunction. Fractional exhaled nitric oxide (FeNO) and endothelin-1 (ET-1) show promise as biomarkers for predicting mortality in severe COVID-19 patients.
Area of Science:
- Cardiology
- Pulmonology
- Infectious Diseases
Background:
- COVID-19 is linked to significant cardiovascular complications.
- Long-term effects and prognostic biomarkers in moderate vs. severe COVID-19 are not fully understood.
Purpose of the Study:
- Evaluate longitudinal cardiovascular changes in COVID-19 survivors.
- Identify mortality predictors.
- Assess fractional exhaled nitric oxide (FeNO) and endothelin-1 (ET-1) as prognostic biomarkers.
Main Methods:
- Prospective cohort study of 480 hospitalized COVID-19 survivors (moderate vs. severe).
- Assessed echocardiography, FeNO, ET-1, and clinical outcomes at baseline and 1 year.
- Used Cox regression and ROC analysis for mortality prediction and biomarker performance.
Main Results:
- Severe COVID-19 survivors showed baseline right ventricular dysfunction and progressive deterioration over 1 year.
- Hypertension, hyperlipidemia, diabetes, and left atrial volume index predicted mortality.
- FeNO and ET-1 predicted mortality in severe disease with high discriminative ability (AUC > 0.86).
Conclusions:
- COVID-19 survivors, particularly severe cases, exhibit progressive cardiovascular decline.
- FeNO and ET-1 are effective severity-specific prognostic biomarkers for COVID-19 survivors.
- These biomarkers can aid in risk stratification protocols for COVID-19 survivors.
Background:
COVID-19 has been associated with significant cardiovascular complications, yet the long-term cardiovascular consequences and prognostic biomarkers in moderate versus severe disease remain incompletely characterized. This study aimed to evaluate longitudinal cardiovascular changes, identify mortality predictors, and assess the discriminative performance of fractional exhaled nitric oxide (FeNO) and endothelin-1 (ET-1) in hospitalized COVID-19 survivors.
Methods:
This prospective cohort study enrolled 480 hospitalized COVID-19 patients (240 moderate, 240 severe by WHO criteria) who survived to discharge between June 2020 and December 2023. Baseline and 1-year echocardiography, inflammatory biomarkers including FeNO and ET-1, and clinical outcomes were assessed. Multivariable Cox regression identified mortality predictors, and ROC analysis evaluated biomarker discriminative performance.
Results:
Severe COVID-19 patients demonstrated significant baseline right ventricular dysfunction with reduced TAPSE (16.63 ± 2.43 vs. 20.36 ± 3.68 mm, p < 0.001) and impaired RVPA coupling (0.60 ± 0.14 vs. 0.88 ± 0.45, p < 0.001). Progressive cardiovascular deterioration occurred over 1 year, with pulmonary artery pressure increasing 17.8% in severe versus 7.1% in moderate disease. Two-year mortality was 16.9% overall. Independent mortality predictors included hypertension (HR 3.02), hyperlipidemia (HR 2.51), diabetes (HR 2.23), and left atrial volume index (HR 1.08 per mL/m2). FeNO and ET-1 predicted mortality specifically in severe disease (HR 1.028 and 1.035, respectively) and demonstrated excellent discriminative ability (AUC 0.892 and 0.865) for identifying severe COVID-19.
Conclusions:
Moderate and severe COVID-19 survivors exhibit progressive cardiovascular deterioration, particularly affecting right ventricular function. FeNO and ET-1 serve as severity-specific prognostic biomarkers and demonstrate excellent discriminative performance, supporting their integration into risk stratification protocols for COVID-19 survivors.
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