Las alteraciones metabólicas y funcionales asociadas a la COVID-19

The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has been classified as a pandemic by the World Health Organization. Based on the characteristics of COVID-19 during the acute phase of the disease, it can be considered as the paradigm of viral sepsis. In daily clinical practice, much attention has been focused on identifying prognostic factors during the acute phase of the disease, with findings similar to those previously described in sepsis. However, these patients may also present metabolic and functional alterations, the exact pathophysiological mechanism of which is currently poorly understood. Research on COVID-19 and its chronicity will allow us to deepen our understanding of these alterations. The main objective is to describe the metabolic alterations and functional sequelae during the follow-up of patients with a previous history of SARS-CoV-2 infection or COVID-19. Secondary objectives include characterizing the behavior of the lipid profile in each phase of the disease, identifying existing prognostic associations, and comparing the functional parameters evaluated in patients with persistent symptoms. Our analysis showed that COVID-19 is associated with a transient decrease in the lipid profile (total cholesterol, LDL-c, and HDL-), likely secondary to increased oxidative stress and inflammation. LDL-c, along with inflammatory markers (C-reactive protein and IL-6), were independent biomarkers associated with all-cause mortality during the acute phase of COVID-19. Furthermore, long-term follow-up revealed an atherogenic profile among COVID-19 survivors with more intense oxidative responses at admission. We also observed that patients with persistent symptoms during follow-up had worse quality of life and a depressed functional class. Findings from the cardiopulmonary exercise testing suggest the presence of ventilatory inefficiency or hyperventilation syndrome.La enfermedad por coronavirus 2019 (COVID-19) es causada por el virus del síndrome respiratorio agudo grave 2 (SARS-CoV-2) y ha sido declarada como una pandemia por la Organización Mundial de la Salud. Durante la fase aguda de la enfermedad, la COVID-19 comparte características con la sepsis viral. Además de los factores pronósticos comunes a la sepsis, los pacientes también pueden experimentar alteraciones metabólicas y funcionales cuyo mecanismo fisiopatológico aún no se comprende completamente. Estudiar la COVID-19 y su cronicidad nos ayudará a ampliar nuestro conocimiento sobre estas alteraciones. El objetivo principal de este estudio es describir las alteraciones metabólicas y las secuelas funcionales en pacientes con antecedentes de infección por SARS-CoV-2 o COVID-19 durante su seguimiento. Como objetivos secundarios, pretendemos caracterizar el perfil lipídico en cada fase de la enfermedad, identificar asociaciones pronósticas y comparar parámetros funcionales en pacientes con síntomas persistentes. En nuestro análisis, encontramos que la COVID-19 se relaciona con una disminución transitoria del perfil lipídico (colesterol total, LDL-c y HDL-c), posiblemente debido al aumento del estrés oxidativo e inflamación. Durante la fase aguda de la enfermedad, tanto el LDL-c como los marcadores inflamatorios (proteína C-reactiva e IL-6) se asociaron de forma independiente con la mortalidad por todas las causas. En el seguimiento a largo plazo, los supervivientes de la COVID-19 mostraron un perfil lipídico aterogénico y respuestas oxidativas más intensas al momento del ingreso. Además, aquellos pacientes que experimentaron síntomas persistentes presentaron una peor calidad de vida y una capacidad funcional deprimida. Los hallazgos de la ergoespirometría indicaron la presencia de una ineficiencia ventilatoria o síndrome de hiperventilación.Escuela de DoctoradoDoctorado en Investigación en Ciencias de la Salu

Exercise Intolerance in Post-Acute Sequelae of COVID-19 and the Value of Cardiopulmonary Exercise Testing- a Mini-Review

Coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with systemic organ damage in the most severe forms. Long-term complications of SARS-CoV-2 appear to be restricted to severe presentations of COVID-19, but many patients with persistent symptoms have never been hospitalized. Post-acute sequelae of COVID-19 (PASC) represents a heterogeneous group of symptoms characterized by cardiovascular, general, respiratory, and neuropsychiatric sequelae. The pace of evidence acquisition with PASC has been rapid, but the mechanisms behind it are complex and not yet fully understood. In particular, exercise intolerance shares some features with other classic respiratory and cardiac disorders. However, cardiopulmonary exercise testing (CPET) provides a comprehensive assessment and can unmask the pathophysiological mechanism behind exercise intolerance in gray-zone PASC. This mini-review explores the utility of CPET and aims to provide a comprehensive assessment of PASC by summarizing the current evidence

Exercise Ventilatory Inefficiency in Post-COVID-19 Syndrome: Insights from a Prospective Evaluation

The present study was partially granted by Gerencia Regional de Salud de Castilla y León under grant number GRS COVID 111/A/20 and a grant from the Spanish Society of Cardiology SEC/FEC-INVCLI 2.Introduction: Coronavirus disease 2019 (COVID-19) is a systemic disease characterized by a disproportionate inflammatory response in the acute phase. This study sought to identify clinical sequelae and their potential mechanism. Methods: We conducted a prospective single-center study (NCT04689490) of previously hospitalized COVID-19 patients with and without dyspnea during mid-term follow-up. An outpatient group was also evaluated. They underwent serial testing with a cardiopulmonary exercise test (CPET), transthoracic echocardiogram, pulmonary lung test, six-minute walking test, serum biomarker analysis, and quality of life questionaries. Results: Patients with dyspnea (n = 41, 58.6%), compared with asymptomatic patients (n = 29, 41.4%), had a higher proportion of females (73.2 vs. 51.7%; p = 0.065) with comparable age and prevalence of cardiovascular risk factors. There were no significant differences in the transthoracic echocardiogram and pulmonary function test. Patients who complained of persistent dyspnea had a significant decline in predicted peak VO2 consumption (77.8 (64–92.5) vs. 99 (88–105); p 50% of COVID-19 survivors present a symptomatic functional impairment irrespective of age or prior hospitalization. Our findings suggest a potential ventilation/perfusion mismatch or hyperventilation syndrome.Fac. de MedicinaTRUEJunta de Castilla y León. Gerencia Regional de Salud de Castilla y LeónSociedad Española de Cardiologíapu

Intracoronary imaging: review and clinical use

ABSTRACT Invasive coronary angiography is the standard approach in the routine clinical practice. Intracoronary imaging modalities provide real-time images of intracoronary anatomy. On this basis, optical coherence tomography and intravascular ultrasound have a positive impact on diagnosis and percutaneous coronary intervention. This summary provides an insight on these imaging modalities for the interventional and clinical cardiologist with the currently available evidence

Imagen intracoronaria: revisión y utilidad clínica

RESUMEN La coronariografía es el método de elección para el estudio de la anatomía coronaria en la práctica clínica diaria. Las diferentes modalidades de imagen intracoronaria permiten valorar en tiempo real la anatomía de la pared arterial coronaria. Sobre esta base, la tomografía de coherencia óptica y la ecografía intravascular tienen un impacto positivo en el diagnóstico y en el intervencionismo percutáneo. La presente revisión proporciona un resumen de las técnicas de imagen intracoronaria basadas en la evidencia actual disponible

Myocardial injury in COVID-19 and its implications in short- and long-term outcomes

COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still a pandemic with high mortality and morbidity rates. Clinical manifestation is widely variable, including asymptomatic or mild respiratory tract illness to severe pneumonia and death. Myocardial injury is a significant pathogenic feature of COVID-19 and it is associated with worse in-hospital outcomes, mainly due to a higher number of hospital readmissions, with over 50% mortality. These findings suggest that myocardial injury would identify COVID-19 patients with higher risk during active infection and mid-term follow-up. Potential contributors responsible for myocardial damage are myocarditis, vasculitis, acute inflammation, type 1 and type 2 myocardial infarction. However, there are few data about cardiac sequelae and its long-term consequences. Thus, the optimal screening tool for residual cardiac sequelae, clinical follow-up, and the benefits of a specific cardiovascular therapy during the convalescent phase remains unknown. This mini-review explores the different mechanisms of myocardial injury related to COVID-19 and its short and long-term implications

Exercise Intolerance in post-acute sequelae of COVID-19 and the value of cardiopulmonary exercise testing- a mini-review

Coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with systemic organ damage in the most severe forms. Long-term complications of SARS-CoV-2 appear to be restricted to severe presentations of COVID-19, but many patients with persistent symptoms have never been hospitalized. Post-acute sequelae of COVID-19 (PASC) represents a heterogeneous group of symptoms characterized by cardiovascular, general, respiratory, and neuropsychiatric sequelae. The pace of evidence acquisition with PASC has been rapid, but the mechanisms behind it are complex and not yet fully understood. In particular, exercise intolerance shares some features with other classic respiratory and cardiac disorders. However, cardiopulmonary exercise testing (CPET) provides a comprehensive assessment and can unmask the pathophysiological mechanism behind exercise intolerance in gray-zone PASC. This mini-review explores the utility of CPET and aims to provide a comprehensive assessment of PASC by summarizing the current evidence

Crop-load effects on vegetative growth, mineral nutrient concentration and leaf water potential in Catherine' peach

Variations of crop-load in the peach (Prunus persica (L.) Batsch.) cv. Catherine by thinning the fruitlets at petal fall affected fruit and vegetative growth of trees. Shoot length, and fresh and dry weight decreased exponentially as the cropping level increased, while the relative increment in trunk girth decreased linearly. Yield increased following a quadratic pattern, while fruit size, measured as mean fruit weight, decreased exponentially as the crop load increased. Mineral element analysis in leaves has shown that Mn concentration decreased linearly with increasing numbers of fruits borne by the tree, both before and after harvest, while the other elements analysed (P, K, Ca, Mg, Fe, Cu, and Zn) did not show any variation. Leaf water potential during the time of fruit growth also decreased exponentially as the crop-load increased.Peer reviewe