Razi Journal of Medical Sciences

fa آنزیم‌های قلبی به عنوان نشانگرهای پیش آگهی در COVID-19: ارتباط بیماری با تغییرات نوار قلب، اکوکاردیوگرافی و مرگ و میر Cardiac Enzymes as Prognostic Markers in COVID-19: Associations of the Disease with ECG, Echocardiography, and Mortality بیماریهای عفونی Infectious Disease پژوهشي Research <div style="text-align: justify;">زمینه و هدف: بیماری کووید19 غالبا با مشکلات تنفسی بروز می‌کند، اما تعدادی از بیماران، تظاهرات درگیری قلبی-عروقی داشتند. لذا این مطالعه با هدف بررسی تغییرات نوار قلب، اکوکاردیوگرافی و آنزیم‌های قلبی در بیماران بستری کووید-19 با شدت متوسط و شدید و ارتباط آنها با مرگ و میر انجام شد. روش کار: مطالعه بین 350  بیمار در دو گروه با شدت متوسط و شدیدکووید19، بستری شده در بیمارستان رسول اکرم تهران در سال 1400، با داشتن اکوکاردیوگرافی و آزمایشگاهی قلبی و نوار قلب صورت گرفت و برای آنالیز داده‌ها از نرم افزار  SPSSنسخه 25 استفاده شد. یافته‌ها: در 6/12 درصد بیماران، آنزیم PRO-BNP افزایش یافته بود و 6/22 درصد بیماران فوت شدند. ارتباط معناداری بین سن بالای 60 سال و شدت بیماری و مرگ و میر بیشتر و همینطور بین یافتنLBBB  و ریتم غیرنرمال  با شدت بالای بیماری دیده شد. ارتباطی بین جنسیت و شدت بیماری نبود. در افراد با فشار دیاستولیک بالا شدت بیماری وخیم‌تر بود. سابقه‌ی دیابت و فشار خون، در شدت بیماری تاثیر گذار بود. در گروه با شدت  بالای بیماری، آنزیم‌های CK-MB و pro BNP و مارکر دی دایمر  بالاتری وجود داشت. CK-MB افزایش یافته با مرگ و میر بیشتر و افزایش مارکرهای PRO-BNP و دی دایمر مرتبط بود. نتیجه‌گیری: نتایج گواه بر این بود که PRO-BNP و CK-MB می‌توانند به عنوان مارکرهای پیش بینی‌کننده‌ی پیش آگهی بیماران مبتلا به کووید-19 در نظر گرفته شوند. </div> <div style="text-align: justify;"> Background & Aims: The global outbreak of Coronavirus Disease 2019 (abbreviated as COVID-19), a disease caused by severe acute respiratory syndrome coronavirus 2 (known as SARS-CoV-2), and its adverse effects on health stability is clear to anyone since the disease's emergence. The increase in the severity of the illness, the involvement of body organs, and ultimately the death caused by the disease have challenged the human public health and healthcare systems at both national and international scales. Although COVID-19 often affects the respiratory system, many patients have pre-existing cardiovascular diseases or suffer from cardiac dysfunction during the virus pandemic that necessitates attention to extrapulmonary symptoms and organ involvements. Since ACE2, a key regulator of the renin-angiotensin-aldosterone system (RAAS) and the cellular receptor used by SARS-CoV-2, is widely expressed in the human body, including in the endothelium, vascular smooth muscle, and organs such as the heart, kidneys, lungs, and digestive system, the heart and other organs can be susceptible to damage. Investigating the course of COVID-19 in hospitalized patients and identifying the markers that affect the course of illness can play an important role in managing the treatment of patients. This study was conducted with the aim of investigating changes in ECG, echocardiography, and cardiac enzymes in hospitalized patients with moderate and severe COVID-19 and their relationship with mortality. Methods: The present investigation is a cross-sectional study that was conducted among 350 patients in two groups with moderate severity (lung involvement below 50% and Oxygen saturation (SpO2) between 90 and 94%) and severe (lung involvement above 50% and SPO2 below 90%) in two groups hospitalized in Rasul Akram Hospital in Tehran in the year of 2021. The checklist includes age and sex and laboratory findings (troponin, D-dimer, PRO-BNP, CK-MB), ECG findings (arrhythmia, Q wave, and LBBB), and echocardiography (systolic function, diastolic function, right ventricular size, ejection fraction left ventricle and pulmonary artery pressure). Patients who have a pacemaker, stroke, and malignancy and those who have received beta-blocker and antiarrhythmic drugs were excluded from the study. Only patients whose echocardiography and cardiac laboratory markers were checked during the course of the disease were included for further studies. In order to analyze data, t-tests of two independent samples were used in SPSS version 25 software. Results: The results showed that 53.4% and 46.6% of the participants in the study were male and female, respectively, and 30% of them were over 60 years old. In 12.6% of the participants, the PRO_BNP marker level was above normal, and 22.6% of the participants had a mortality rate. In this study, a significant relationship was found between the level of cardiac markers with the severity of the disease and the prediction of the course of the disease (discharge or death) (P<0.05). A significant association between age over 60 years and the severity of the illness, and higher mortality, as well as the finding of LBBB and abnormal rhythm in the ECG, were seen in the high-intensity group. The results showed that there is no significant difference between men and women and generally there is no relationship between gender and the severity of the disease. In people with high diastolic pressure, the severity of the disease was worse. The history of DM and HTN affected the severity, and in the group with severe illness, CKMB enzymes, PRO-BNP, and D_dimer markers were higher (P<0.05). In particular, increased CKMB was associated with the presence of DM and higher mortality and increased PRO-BNP and D_dimer markers (P<0.05). Factors such as the difference in the studied clinical samples, the impact of underlying diseases, and even the quality of medical services provided in hospitals are among the reasons for the difference in the results of our study with others. Conclusion: According to the results of the present study, the severity of COVID-19 had a significant impact on cardiac markers. Considering mortality as a possible outcome of the disease, the results proved that PRO_BNP and CK_MB can be used as markers to predict death or discharge of patients with severe infection. According to the results obtained from the study of the relationship between the level of cardiac enzymes and the examination of the echocardiogram and electrocardiogram, and the consequences of the disease, it can be suggested that among these markers, CK_MB is more capable of predicting the course and outcome of the disease. This study suggests more studies to investigate additional markers in the future so that the course of the disease and its outcome can be better predicted and subsequently managed by them. </div> دی دایمر, PRO-BNP, CK-MB, کووید-19,تروپونین, اکوکاردیوگرام, ECG IL-6, COVID-19, Mortality, CK-MB, Troponin, PRO-BNP, ECG, Echocardiogram, D-dimer 1 12 http://rjms.iums.ac.ir/browse.php?a_code=A-10-8294-1&slc_lang=fa&sid=1 Sharare Noruzi شراره نوروزی shararenoruzi1371@gmail.com 3900319475328460090133 0009-0006-3277-1792 Yes Assistant Professor, Department of Infectious Diseases, School of Medicine, Iran University of Medical Sciences, Tehran, Iran, & Firoozabadi Clinical Research Development Unit (FACRDU), Department of Infectious Diseases, School of Medicine, Iran University of Medical Sciences, Tehran, Iran استادیار، گروه بیماری‌های عفونی، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران، و واحد توسعه تحقیقات بالینی فیروزآبادی، گروه بیماری‌های عفونی، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران Zeynab Yassin زینب یاسین 3900319475328460090134 3900319475328460090134 No Assistant Professor, Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran استادیار، مرکز تحقیقات مقاومت میکروبی، انستیتو ایمونولوژی و بیماری‌های عفونی، دانشگاه علوم پزشکی ایران، تهران، ایران Marjan Hajahmadi مرجان حاج احمدی 3900319475328460090135 3900319475328460090135 No Associate Professor, Department of Cardiology, School of Medicine, Iran University of medical Sciences, Tehran, Iran دانشیار، گروه کاردیولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران Mahshid Talebi Taher مهشید طالبی طاهر 3900319475328460090136 3900319475328460090136 No Professor, Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran استاد، مرکز تحقیقات مقاومت میکروبی، انستیتو ایمونولوژی و بیماری‌های عفونی، دانشگاه علوم پزشکی ایران، تهران، ایران Mahboubeh Pazoki محبوبه پازکی 3900319475328460090137 3900319475328460090137 No Assistant Professor, Department of Cardiology, School of Medicine, Iran University of medical Sciences, Tehran, Iran استادیار، گروه کاردیولوژی، دانشکده پزشکی،دانشگاه علوم پزشکی ایران، تهران، ایران