Role of Neuroimmune Interactions in COVID-19-related Cardiovascular Damage

Coronavirus disease 2019(COVID-19)has caused a global pandemic impacting over 200 countries/regions and more than 200 million patients worldwide.Among the infected patients,there is a high prevalence of COVID-19-related cardiovascular injuries.However,the specific mechanisms linking cardiovascular damage and COVID-19 remain unclear.The COVID-19 pandemic also has exacerbated the mental health burden of humans.Considering the close association between neuroimmune interactions and cardiovascular disease,this review assessed the complex pathophysiological mechanisms connecting neuroimmune interactions and cardiovascular disease.It was revealed that the mental health burden might be a pivotal accomplice causing COVID-19-associated cardiovascular damage.Specifically,the proinflammatory status of patients with a terrible mood state is closely related to overdrive of the hypothalamus-pituitary-adrenal(HPA)axis,sympathovagal imbalance,and endothelial dysfunction,which lead to an increased risk of developing cardiovascular injury during COVID-19.Therefore,during the prevention and treatment of cardiovascular complications in COVID-19 patients,particular attention should be given to relieve the mental health burden of these patients.

Clinical risk score for postoperative pneumonia following heart valve surgery

Background:Postoperative pneumonia(POP)is one of the most common infections following heart valve surgery(HVS)and is associated with a significant increase in morbidity,mortality,and health care costs.This study aimed to identify the major risk factors associated with the occurrence of POP following HVS and to derive and validate a clinical risk score.Methods:Adults undergoing open HVS between January 2016 and December 2019 at a single institution were enrolled in this study.Patients were randomly assigned to the derivation and validation sets at 1:1 ratio.A prediction model was developed with multivariable logistic regression analysis in the derivation set.Points were assigned to independent risk factors based on their regression coefficients.Results:POP occurred in 316 of the 3853 patients(8.2%).Multivariable analysis identified ten significant predictors for POP in the derivation set,including older age,smoking history,chronic obstructive pulmonary disease,diabetes mellitus,renal insufficiency,poor cardiac function,heart surgery history,longer cardiopulmonary bypass,blood transfusion,and concomitant coronary and/or aortic surgery.A 22-point risk score based on the multivariable model was then generated,demonstrating good discrimination(C-statistic:0.81),and calibration(Hosmer-Lemeshowχ^(2)=8.234,P=0.312).The prediction rule also showed adequate discriminative power(C-statistic:0.83)and calibration(Hosmer-Lemeshowχ^(2)=5.606,P=0.691)in the validation set.Three risk intervals were defined as low-,medium-,and high-risk groups.Conclusion:We derived and validated a 22-point risk score for POP following HVS,which may be useful in preventive interventions and risk management.Trial Registration:Chictr.org,ChiCTR1900028127;http://www.chictr.org.cn/showproj.aspx?proj=46932.