Early markers of cardiovascular unfavorable evolution of hospitalized patients for COVID-19 and accompained over 3 months

Abstract

Patients with COVID-19 with advanced age and/or known cardiorespiratory diseases have a worse disease evolution when compared to healthy young individuals. Disorders of the heart rhythm and alteration in myocardial necrosis markers have also been prevalent in patients hospitalized for the disease and the cardiovascular evolution in ambulatory follow-up is still unknown. It is not known if these changes can persist over the course of these patients and whether there is a correlation with unfavorable outcomes. Objectives: (i) To evaluate clinical, laboratory, electrocardiographic and echocardiographic parameters that may be associated with an unfavorable cardiovascular evolution over 3 months of follow-up in hospitalized patients as a result of COVID-19 infection. (ii) Monitor patients who were admitted with a confirmed diagnosis of COVID-19 and who were discharged for a period of 3 months after discharge, in order to determine the cardiovascular consequences of the disease during this observation period. Methods: Prospective longitudinal observational clinical study with approximately 50 patients, aged 18 years and over diagnosed and admitted to the University Hospital of the Federal University of São Carlos (UFSCar) with infection by COVID-19. All patients included will be evaluated for clinical symptoms compatible with COVID-19. For cardiovascular investigation, all patients with a confirmed diagnosis of COVID-19 will be evaluated for the presence of comorbidities, cardiovascular risk factors, use of medications and cardiovascular symptoms. All study participants will undergo laboratory tests and 12-lead electrocardiogram upon admission. Patients who survive the acute period of infection by COVID-19 will be monitored at 1 and 3 months of hospital discharge, in order to determine the presence of cardiovascular impairment after COVID-19 infection. For this, patients will undergo periodic clinical evaluation and the following complementary tests at 1 and 3 months: electrocardiogram, transthoracic echocardiogram, quality of life questionnaire and laboratory tests. Unfavorable outcomes: the presence of diastolic and / or systolic dysfunction without a diagnosis prior to infection, the persistence of electrocardiographic changes diagnosed in admission, readmission or death from any cause in the 3 months of follow-up. The characterization of this sample will be carried out by a descriptive statistical analysis of the clinical and laboratory data obtained during the entire period of hospitalization of the patients. Statistical analysis will be performed to determine clinical, laboratory and complementary exam markers that correlated with unfavorable clinical outcomes at admission and after 3 months of study. Expected results: It is expected that patients with rhythm disturbances on the admission electrocardiogram and/or elevated troponin with or without symptoms of palpitation may have a more unfavorable evolution when compared to patients without these changes. It is expected that patients who present more severe hypoxemia, greater impairment of the pulmonary parenchyma at hospital admission or those who require orotracheal intubation and mechanical ventilation during hospitalization will present impairment of lung and cardiovascular function in 3 months after hospital discharge. (AU)