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Author(s):
Iziah E Sama e1 ,
Alice Ravera e1 , e2 ,
Bernadet T Santema e1 ,
Harry van Goor e3 ,
Jozine M ter Maaten e1 ,
John G F Cleland e4 ,
Michiel Rienstra e1 ,
Alex W Friedrich e5 ,
Nilesh J Samani e6 ,
Leong L Ng e6 ,
Kenneth Dickstein e7 , e8 ,
Chim C Lang e9 ,
Gerasimos Filippatos e10 , e11 ,
Stefan D Anker e12 , e13 ,
Piotr Ponikowski e14 ,
Marco Metra e2 ,
Dirk J van Veldhuisen e1 ,
Adriaan A Voors e1
Publication date (Electronic): 10 May 2020
Journal: European Heart Journal
Publisher: Oxford University Press
Keywords: Men, Heart failure, Coronavirus disease (COVID-19), ACE2
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The current pandemic coronavirus SARS-CoV-2 infects a wide age group but predominantly elderly individuals, especially men and those with cardiovascular disease. Recent reports suggest an association with use of renin–angiotensin–aldosterone system (RAAS) inhibitors. Angiotensin-converting enzyme 2 (ACE2) is a functional receptor for coronaviruses. Higher ACE2 concentrations might lead to increased vulnerability to SARS-CoV-2 in patients on RAAS inhibitors. We measured ACE2 concentrations in 1485 men and 537 women with heart failure (index cohort). Results were validated in 1123 men and 575 women (validation cohort). The median age was 69 years for men and 75 years for women. The strongest predictor of elevated concentrations of ACE2 in both cohorts was male sex (estimate = 0.26, P < 0.001; and 0.19, P < 0.001, respectively). In the index cohort, use of ACE inhibitors, angiotensin receptor blockers (ARBs), or mineralocorticoid receptor antagonists (MRAs) was not an independent predictor of plasma ACE2. In the validation cohort, ACE inhibitor (estimate = –0.17, P = 0.002) and ARB use (estimate = –0.15, P = 0.03) were independent predictors of lower plasma ACE2, while use of an MRA (estimate = 0.11, P = 0.04) was an independent predictor of higher plasma ACE2 concentrations. In two independent cohorts of patients with heart failure, plasma concentrations of ACE2 were higher in men than in women, but use of neither an ACE inhibitor nor an ARB was associated with higher plasma ACE2 concentrations. These data might explain the higher incidence and fatality rate of COVID-19 in men, but do not support previous reports suggesting that ACE inhibitors or ARBs increase the vulnerability for COVID-19 through increased plasma ACE2 concentrations. Abstract
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Clinical Characteristics of Coronavirus Disease 2019 in China
Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)
Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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A pneumonia outbreak associated with a new coronavirus of probable bat origin
Peng Zhou, Xing-Lou Yang, Xian-Guang Wang … (2020)
Since the outbreak of severe acute respiratory syndrome (SARS) 18years ago, a large number of SARS-related coronaviruses (SARSr-CoVs) have been discovered in their natural reservoir host, bats 1–4 . Previous studies have shown that some bat SARSr-CoVs have the potential to infect humans 5–7 . Here we report the identification and characterization of a new coronavirus (2019-nCoV), which caused an epidemic of acute respiratory syndrome in humans in Wuhan, China. The epidemic, which started on 12 December 2019, had caused 2,794 laboratory-confirmed infections including 80 deaths by 26 January 2020. Full-length genome sequences were obtained from five patients at an early stage of the outbreak. The sequences are almost identical and share 79.6% sequence identity to SARS-CoV. Furthermore, we show that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus. Pairwise protein sequence analysis of seven conserved non-structural proteins domains show that this virus belongs to the species of SARSr-CoV. In addition, 2019-nCoV virus isolated from the bronchoalveolar lavage fluid of a critically ill patient could be neutralized by sera from several patients. Notably, we confirmed that 2019-nCoV uses the same cell entry receptor—angiotensin converting enzyme II (ACE2)—as SARS-CoV.
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Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study
Xiaobo Yang, Yuan Yu, Jiqian Xu … (2020)
Summary Background An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia. Methods In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2-related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation. Findings Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3–11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients. Interpretation The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1–2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced. Funding None.
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Author and article information
Journal
Journal ID (nlm-ta): Eur Heart J
Journal ID (iso-abbrev): Eur. Heart J
Journal ID (publisher-id): eurheartj
Title: European Heart Journal
Publisher: Oxford University Press
ISSN (Print): 0195-668X
ISSN (Electronic): 1522-9645
Publication date (Print): 14 May 2020
Publication date (Electronic): 10 May 2020
Volume: 41
Issue: 19 , Focus Issue on COVID-19 and CVD
Pages: 1810-1817
Affiliations
[e1 ] Department of Cardiology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
[e2 ] Cardiology, Department of Medical and Surgical Specialties, Radiologic Sciences and Public Health, University of Brescia , Brescia, Italy
[e3 ] Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
[e4 ] Robertson Centre for Biostatistics & Clinical Trials Unit, University of Glasgow and National Heart & Lung Institute , Imperial College, London, UK
[e5 ] Department of Medical Microbiology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
[e6 ] Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, and NIHR Leicester Biomedical Research Centre , Leicester, UK
[e9 ] Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee Ninewells Hospital and Medical School , Dundee, UK
[e12 ] Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT) , Germany
Author notes
Corresponding author. Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. Tel: +31 (0)50 3616161; Fax: +31 (0)50 3618062; Email: a.a.voors@ 123456umcg.nl
Author information
Bernadet T Santema http://orcid.org/0000-0002-4663-7213
Michiel Rienstra http://orcid.org/0000-0002-2581-070X
Leong L Ng http://orcid.org/0000-0002-6553-5749
Stefan D Anker http://orcid.org/0000-0003-3331-7314
Adriaan A Voors http://orcid.org/0000-0002-5417-4415
Article
Publisher ID: ehaa373
DOI: 10.1093/eurheartj/ehaa373
PMC ID: 7239195
PubMed ID: 32388565
SO-VID: c0346264-e027-422c-ba26-e768525d635c
Copyright © Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
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This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.
History
Date received : 22 March 2020
Date revision received : 03 April 2020
Date accepted : 20 April 2020
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Page count
Pages: 8
Funding
Funded by: European Commission, DOI 10.13039/501100000780;
Award ID: FP7-242209-BIOSTAT-CHF
Funded by: Dutch Heart Foundation;
Award ID: 2019T094
Categories
Subject: Fast Track Clinical Research
Subject: Heart Failure/Cardiomyopathy
Subject: Editor's Choice
ScienceOpen disciplines: Cardiovascular Medicine
Keywords: men,heart failure,coronavirus disease (covid-19),ace2
Data availability:
ScienceOpen disciplines: Cardiovascular Medicine
Keywords: men, heart failure, coronavirus disease (covid-19), ace2
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