Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) poses a significant threat to global health. As the disease progresses, a series of acute complications tend to develop in multiple organs. Beyond the supportive care, no specific treatment has been established for COVID-19. The effectiveness, both short-term and long-term, of some promising antivirals, such as the hydroxychloroquine combination with azithromycin, needs to be evaluated. This study aims to investigate the predictive role of cardiac biomarkers and pulmonary symptoms for late complications of COVID-19 coronavirus infection on the heart and lung in patients treated with the hydroxychloroquine / azithromycin combination therapy. Thus, COVID-19 coronavirus patients undergoing hydroxychloroquine / azithromycin combination therapy will be compared to patients not undergoing this therapy. The comparison will be made by the analysis of the relationships between (1) levels of ultrasensitive cardiac troponins collected at the beginning of the infection and cardiac magnetic resonance data in the 3rd and 12th months of troponin collection and (2) findings CT scans and the results of the ergospirometers tests performed in those same periods. It is expected to demonstrate that: (1) cardiac troponin and lung tomographic findings can predict late complications of COVID-19 coronavirus infection in the heart and lung, assessed by cardiac magnetic resonance and ergospirometers one year after the beginning of the infection, and (2) hydroxychloroquine / azithromycin combined therapy can abolish the onset of these complications late. Furthermore, the results may point to the need for more rigorous monitoring of cardiologists and pulmonologists of these patients, due to the risk of hemodynamic complications, arrhythmogenic and respiratory.
The aim of this study is to investigate the predictive role of cardiac biomarkers and
significant pulmonary complications for late infection complications COVID-19 coronavirus on
the heart and lung in patients treated with hydroxychloroquine / combination therapy
azithromycin.
COVID-19 positive test patients will be divided into two groups according to therapeutic
conduct. So, with a case-control distribution respecting age and sex, the two patient groups
will be defined as "arm" with therapy (study population) and "Arm" without therapy
(population control). This study is prospective and consists of three times:
1) T0- Moment of inclusion of the patient in the study, which coincides with the collection
of clinical data and laboratory tests.
(2) T3- In the 3rd month after inclusion in the study, the patient will make a medical visit
where data new laboratory tests will be acquired.
(3) T12- In the 12th month after inclusion in the study, the patient will make another
medical visit where data clinical data will be obtained. Laboratory tests, which were altered
during visit T3 will be repeated.
COVID-19 coronavirus patients undergoing therapy combined hydroxychloroquine / azithromycin
will be compared to patients not undergoing this therapy. The comparison will be performed by
analyzing the relationships between (1) troponin levels ultrasensitive cardiac data collected
at the beginning of the infection and data of cardiac magnetic resonances in the 3rd and 12th
month of collection troponins and (2) acute tomographic findings and the results the
ergospirometers tests performed in those same periods.
In our understanding of COVID-19, its diagnosis, prevention and treatment are evolving
quickly. As the disease spreads and new evidence emerges, it would be prudent to identify
risk factors for the development of late cardiorespiratory complications in patients
survivors of serious COVID-19 infections.
This prospective study of patients with COVID-19, involving a systematic record of
clinical-laboratory variables and chronic cardiorespiratory complications, will be beneficial
for the development of a risk model for these complications and to identify and / or predict
the response to various treatment modalities.
Other: BIOMARKERS IN THE LONG TERM IMPACT OF CORONAVIRUS INFECTION IN THE CARDIORRESPIRATORY SYSTEM
Organize care follow-up for patients who have had COVID-19 coronavirus infection for scientific purposes. Thus, it is expected to obtain relevant data on cardiac sequelae and pulmonary. These data are important for understanding the long-term prognosis of patients surviving this infection.
Inclusion Criteria:
- positive test for covid19
- high ultrasensitive troponin
- pulmonary damage > 25%
- no cardiac or lung known disease
- Consent inform signed
Exclusion Criteria:
- intensive care and mechanical ventilation needs
- chronic inflammatory disease
- active neoplasm
- use of immunosuppressant
- renal failure
- pregnant woman
Instituto do Coração - Hospital das Clínicas - Faculdade de Medicina da Universidade de São Paulo
São Paulo, SP, Brazil