Reply to “SARS-CoV-2-associated Takotsubo is not necessarily triggered by the infection”

We hereby take the opportunity to thank Dr. Finsterer for his comments on our manuscript titled, ‘‘COVID-19 Presenting as Takotsubo Cardiomyopathy (TTC) Complicated with Atrial Fibrillation”. The points raised by Dr. Finsterer are indeed very pertinent and ought to be addressed. In accordance with the question raised by the author, the exclusion of acute coronary syndrome (ACS) prior to the diagnosis of TTC is mandated in order to meet all inclusion criteria stipulated by the Mayo Clinic. In our manuscript, we have highlighted that coronary angiography was not performed due to a concoction of factors. Our patient manifested a predilection towards not wanting to undergo angiography.</div

Does everybody with mildly elevated HsTnT without ECG changes have a high risk of cardiovascular events and mortality?

With interest we read the study by Mahmoud et al. about ‘‘Comparative outcome analysis of stable mildly elevated high sensitivity troponin T in patients presenting with chest pain”. The author reported higher frequency of all-cause and cardiovascular mortality up to 1 year in patients with low level hsTnT elevation.</p

Additional file 1: of Top 100 cited articles in cardiovascular magnetic resonance: a bibliometric analysis

List of top 100 citations. (DOCX 26 kb

Trends and outcomes of cardiogenic shock in Asian populations compared with non-Asian populations in the US: NIS Analysis (2002-2019)

Current understanding of outcomes of cardiogenic shock (CS) in Asian populations is limited. We aim to study the clinical outcomes of CS in Asian population compared with non-Asians in the US. The National Inpatient Sample (NIS) database was queried between 2002-2019 to identify hospitalizations with CS. Race was classified as Asians and non-Asians. The adjusted odds ratios (aOR) for in-hospital outcomes were calculated using multivariate logistic regression analysis. A total of 1,573,285 hospitalizations were identified between 2002-2019 for CS, of which 48,398 (3%) were Asians and 1,524,887 (97%) were non-Asians. Adjusted odds of in-hospital mortality (aOR 1.03, 95% CI 1.01-1.05), and use of intra-aortic balloon pump (IABP) (aOR 1.15, 95% CI 1.12-1.17) were significantly higher among Asians compared with non-Asians. The in-hospital mean cost of hospitalization was higher in Asian population ($63787±$80261) with CS compared with non-Asians ($56207±$76120, p Asian populations with CS have higher in-hospital mortality, increased requirement of IABP and higher mean cost of hospitalization compared with non-Asians.</p

Lymphocyte-to-C-reactive protein ratio: a novel predictor of adverse outcomes in COVID-19

Background: Systemic inflammation elicited by a cytokine storm is considered a hallmark of coronavirus disease 2019 (COVID-19). This study aims to assess the validity and clinical utility of the lymphocyte-to-C-reactive protein (CRP) ratio (LCR), typically used for gastric carcinoma prognostication, versus the neutrophil-to-lymphocyte ratio (NLR) for predicting in-hospital outcomes in COVID-19.Methods: A retrospective cohort study was performed to determine the association of LCR and NLR with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aORs) with its 95% confidence interval (CI), respectively.Results: The mean age for NLR patients was 63.6 versus 61.6, and for LCR groups, it was 62.6 versus 63.7 years, respectively. The baseline comorbidities across all groups were comparable except that the higher LCR group had female predominance. The mean NLR was significantly higher for patients who died during hospitalization (19 vs. 7, P ≤ 0.001) and those requiring IMV (12 vs. 7, P = 0.01). Compared to alive patients, a significantly lower mean LCR was observed in patients who did not survive hospitalization (1,011 vs. 632, P = 0.04). For patients with a higher NLR (> 10), the unadjusted odds of mortality (odds ratios (ORs) 11.0, 3.6 - 33.0, P Conclusions: A high NLR and decreased LCR value predict higher odds of in-hospital mortality. A high LCR at presentation might indicate impending clinical deterioration and the need for IMV.</div

Safety and efficacy of hydroxychloroquine in COVID-19: a systematic review and meta-analysis

Background: During the initial phases of the coronavirus disease 2019 (COVID-19) epidemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ); however, recently, the Centers for Disease Control and Prevention (CDC) has recommended against routine use of HCQ outside of study protocols citing possible adverse outcomes.Methods: Multiple databases were searched to identify articles on COVID-19. An unadjusted odds ratio (OR) was used to calculate the safety and efficacy of HCQ on a random effect model.Results: Twelve studies comprising 3,912 patients (HCQ 2,512 and control 1400) were included. The odds of all-cause mortality (OR: 2.23, 95% confidence interval (CI): 1.58 - 3.13, P value Conclusions: HCQ might offer no benefits in terms of decreasing the viral load and radiological improvement in patients with COVID-19. HCQ appears to be associated with higher odds of all-cause mortality and NAEs.</div