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      Cardio-oncology care in the era of the coronavirus disease 2019 (COVID-19) pandemic: An International Cardio-Oncology Society (ICOS) statement : C-O guidance in times of viral pandemic

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          Abstract

          The severe acute respiratory syndrome coronavirus 2 (SARS–CoV-2) has given rise to a pandemic of unprecedented proportions in the modern era because of its highly contagious nature and impact on human health and society: coronavirus disease 2019 (COVID-19). Patients with cardiovascular (CV) risk factors and established CV disease (CVD) are among those initially identified at the highest risk for serious complications, including death. Subsequent studies have pointed out that patients with cancer are also at high risk for a critical disease course. Therefore, the most vulnerable patients are seemingly those with both cancer and CVD, and a careful, unified approach in the evaluation and management of this patient population is especially needed in times of the COVID-19 pandemic. This review provides an overview of the unique implications of the viral outbreak for the field of cardiooncology and outlines key modifications in the approach to this ever-increasing patient population. These modifications include a shift toward greater utilization of cardiac biomarkers and a more focused CV imaging approach in the broader context of modifications to typical practice pathways. The goal of this strategic adjustment is to minimize the risk of SARS–CoV-2 infection (or other future viral outbreaks) while not becoming negligent of CVD and its important impact on the overall outcomes of patients who are being treated for cancer.

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

            In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
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              SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor

              Summary The recent emergence of the novel, pathogenic SARS-coronavirus 2 (SARS-CoV-2) in China and its rapid national and international spread pose a global health emergency. Cell entry of coronaviruses depends on binding of the viral spike (S) proteins to cellular receptors and on S protein priming by host cell proteases. Unravelling which cellular factors are used by SARS-CoV-2 for entry might provide insights into viral transmission and reveal therapeutic targets. Here, we demonstrate that SARS-CoV-2 uses the SARS-CoV receptor ACE2 for entry and the serine protease TMPRSS2 for S protein priming. A TMPRSS2 inhibitor approved for clinical use blocked entry and might constitute a treatment option. Finally, we show that the sera from convalescent SARS patients cross-neutralized SARS-2-S-driven entry. Our results reveal important commonalities between SARS-CoV-2 and SARS-CoV infection and identify a potential target for antiviral intervention.
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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                CAAC
                CA: A Cancer Journal for Clinicians
                CA A Cancer J Clin
                Wiley
                00079235
                September 10 2020
                Affiliations
                [1 ]Cardio-Oncology Center of Excellence; Washington University in St Louis; St Louis Missouri
                [2 ]Division of Cardiology; University of Pennsylvania; Philadelphia Pennsylvania
                [3 ]Cardiovascular Medicine; Cardio-Oncology Unit; University of Kansas Medical Center; Kansas City Kansas
                [4 ]Department of Medicine/Cardiology Service; Memorial Sloan Kettering Cancer Center; New York New York
                [5 ]Department of Medicine; Duke Cancer Institute, Duke University; Durham North Carolina
                [6 ]Department of Medicine; Division of Cardiology; Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, University of Toronto; Toronto Ontario Canada
                [7 ]Cardio-Oncology Program; Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School; Boston Massachusetts
                [8 ]Division of Oncology; Washington University School of Medicine; St Louis Missouri
                [9 ]Division of Hematology/Oncology; University of Minnesota; Minneapolis Minnesota
                [10 ]Cardio-Oncology Service; Royal Brompton Hospital and Imperial College London; London United Kingdom
                [11 ]Cardio-Oncology Program; Department of Cardiovascular Medicine; Lahey Hospital and Medical Center; Burlington Massachusetts
                [12 ]Cardiac Imaging and Cardio-Oncology Unit; Division of Cardiology; La Paz University Hospital; La Paz Hospital Institute for Health Research; Network Research Center for Cardiovascular Diseases; Madrid Spain
                [13 ]Department of Medicine; University Campus Bio-Medico; Rome Italy
                [14 ]Department of Pulmonary Circulation; Thromboembolic Diseases, and Cardiology; Center of Postgraduate Medical Education; European Health Center; Otwock Poland
                [15 ]Cardio-Oncology Unit; European Institute of Oncology; IRCCS; Milan Italy
                [16 ]European Institute of Oncology; IRCCS; Milan Italy
                [17 ]Department of Oncology and Hemato-Oncology; University of Milan; Milano Italy
                [18 ]Cardio-Oncology Program; Division of Cardiology; Department of Medicine; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
                [19 ]Department of Cardiovascular Disease; Mayo Clinic; Rochester Minnesota
                Article
                10.3322/caac.21635
                7934086
                32910493
                4332c216-1915-4491-8336-4c427a9bfa43
                © 2020

                http://doi.wiley.com/10.1002/tdm_license_1.1

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