Кафедра пропедевтики внутрішньої медицини № 1, основ біоетики та біобезпеки

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    A Prognostic Model and Pre-Discharge Predictors of Post-COVID-19 Syndrome After Hospitalization for SARS-CoV-2 Infection
    (Frontiers Media S.A., 2023-11) Honchar, Oleksii; Ashcheulova, Tetiana; Гончарь, Олексій Володимирович; Ащеулова, Тетяна Вадимівна; Chumachenko, Tetyana; Чумаченко, Тетяна Олександрівна; Chumachenko, Dmytro; Чумаченко, Дмитро Ігоревич; Bobeiko, Alla; Бобейко, Алла Євгенівна; Khodosh, Eduard; Ходош, Едуард Михайлович; Blazhko, Viktor; Блажко, Віктор Іванович; Matiash, Nataliia; Матяш, Наталія Михайлівна; Ambrosova, Tetiana; Амбросова, Тетяна Миколаївна; Herasymchuk, Nina; Герасимчук, Ніна Миколаївна; Kochubiei, Oksana; Кочубєй, Оксана Анатоліївна; Smyrnova, Viktoriia; Смирнова, Вікторія Іванівна
    Background. Post-COVID-19 syndrome (PCS) has been increasingly recognized as an emerging problem: 50% of patients report ongoing symptoms 1 year after acute infection, with most typical manifestations (fatigue, dyspnea, psychiatric and neurological symptoms) having potentially debilitating effect. Early identification of high-risk candidates for PCS development would facilitate the optimal use of resources directed to rehabilitation of COVID-19 convalescents. Objective. To study the in-hospital clinical characteristics of COVID-19 survivors presenting with self-reported PCS at 3 months and to identify the early predictors of its development. Methods. 221 hospitalized COVID-19 patients underwent symptoms assessment, 6-minute walk test, and echocardiography pre-discharge and at 1 month; presence of PCS was assessed 3 months after discharge. Unsupervised machine learning was used to build a SANN-based binary classification model of PCS development. Results. PCS at 3 months has been detected in 75% patients. Higher symptoms level in the PCS group was not associated with worse physical functional recovery or significant echocardiographic changes. Despite identification of a set of pre-discharge predictors, inclusion of parameters obtained at 1 month proved necessary to obtain a high accuracy model of PCS development, with inputs list including age, sex, inhospital levels of CRP, eGFR and need for oxygen supplementation, and level of post-exertional symptoms at 1 month after discharge (fatigue and dyspnea in 6MWT and MRC Dyspnea score). Conclusions. Hospitalized COVID-19 survivors at 3 months were characterized by 75% prevalence of PCS, the development of which could be predicted with an 89% accuracy using the derived neural network-based classification model.
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    Short-term echocardiographic follow-up after hospitalization for COVID-19: a focus on early post-acute changes
    (Frontiers Media S.A., 2023-11) Honchar, Oleksii; Ashcheulova, Tetiana; Гончарь, Олексій Володимирович; Ащеулова, Тетяна Вадимівна
    Background: Impaired physical functional status is one of the typical long-term sequelae of COVID-19 infection that significantly affects the quality of life and work capacity. Minor changes in cardiac structure and function that are unable to cause the manifestation of overt heart failure may remain undetected in COVID-19 convalescents, at the same time potentially contributing to the persistence of symptoms and development of long COVID syndrome. Purpose: To study the typical features and short-term dynamics of cardiac remodeling and possible signs of cardiac dysfunction following hospitalization for COVID-19. Methods: This is a combined cross-sectional and longitudinal cohort study in which 176 hospitalized patients (93 female and 83 male, mean age 53.4 ± 13.6 years) with COVID-19 infection underwent comprehensive transthoracic echocardiography pre-discharge (22.6 ± 7.1 days from the onset of symptoms) with repeated evaluation after 1 month. The control group included 88 age-, sex-, height- and weight-matched healthy individuals, with a subset of those (n = 53) matched to the subset of non-hypertensive study participants (n = 106). Results: Concentric left ventricular geometry was revealed in 59% of participants, including 43% of non-hypertensive subjects; predominantly Grade I diastolic dysfunction was found in 35 and 25% of patients, respectively. Other findings were naturally following from described phenotype of the left venticle and included a mild increase in the absolute and relative wall thickness (0.45 ± 0.07 vs. 0.39 ± 0.04, p < 0.001), worsening of diastolic indices (e’ velocity 9.2 ± 2.2 vs. 11.3 ± 2.6 cm/s, p < 0.001, E/e’ ratio 7.5 ± 1.8 vs. 6.8 ± 1.7, p = 0.002) and global longitudinal strain (17.5 ± 2.4 vs. 18.6 ± 2.2, p < 0.001). No significant improvement was found on re-evaluation at 1 month. Conclusions: Hospitalized patients recovering from COVID-19 were characterized by a high prevalence of left ventricular concentric remodeling, predominantly Grade I diastolic dysfunction, and a mild decrease in the longitudinal systolic function. These changes were less frequent but still prevalent in the non-hypertensive subgroup and largely persisted throughout the 1-month follow-up.
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    Cardiac remodeling in hypertensive patients with COVID-19: pre-discharge assessment and a 1-month follow-up
    (2023-06) Honchar, Oleksii; Гончарь, Олексій Володимирович
    Objective: To study the impact of hypertension on the formation of structural and functional cardiac changes during hospitalization for COVID-19 and the dynamics of detected changes in the early post-discharge period. Design and method: 212 hospitalized COVID-19 patients (mean age 53.4+-13.6 years, 53% female) underwent comprehensive transthoracic echocardiographic examination and the 6-minute walk test at the baseline 1-2 days prior to discharge and after 31 days of follow-up, being compared to 88 matched controls. Results: COVID-19 patients had increased absolute (10.1 ± 1.5 vs 9.1 ± 0.9 mm, p < 0.001) and relative LV walls thickness (0.45 ± 0, 07 vs 0.39 ± 0.04, p < 0.001), LV myocardial mass index (38.1 ± 8.9 vs 33.9 ± 5.8 g/m2.7, p < 0.001) and left atrial volume index (28.6 ± 6.6 vs 25.1 ± 4.9 ml/m2, p < 0.001), as well as decrease in LV global longitudinal strain (-17.5 ± 2.4 vs -18.6 ± 2, 2%, p < 0.001) and diastolic filling parameters (e’ 9.2 ± 2.2 vs 11.3 ± 2.6 cm/s, p < 0.001; E/e’ 7.5 ± 1.8 vs 6.8 ± 1.7, p = 0.002). The observed changes were more pronounced in the cohort of hypertensive participants, but also persisted among normotensive patients, resulting in a high prevalence of concentric LV geometry (78% and 43%, respectively, p < 0.001 between groups and vs control), predominantly grade I diastolic dysfunction (51% and 25%, p < 0.001 between groups and vs control), and abnormal values of global longitudinal strain (32% and 19%, p = 0.027 between groups, p < 0.001 vs control), all of which persisted throughout 1-month follow-up. The increase in the % of predicted 6-minute walk distance was 11.2 ± 7.5 in hypertensives vs 12.8 ± 7.6 in non-hypertensive participants, p > 0.05. Conclusions: Hospitalised COVID-19 patients at the pre-discharge period were characterized by the high prevalence of LV concentric geometry and diastolic dysfunction, as well as the minor decrease of its longitudinal contractility, which were more pronounced in the presence of concomitant hypertension and did not improve during 1 month of follow-up.
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    Systematic long COVID symptoms assessment in hypertensive and non-hypertensive individuals during the 12-months follow-up after hospital discharge
    (2023-06) Honchar, Oleksii; Гончарь, Олексій Володимирович
    Objective: To study the impact of hypertension on the dynamics of physical, emotional and cognitive symptoms during the 12-months follow-up after hospitalization for COVID-19. Design and method: 212 patients hospitalized for COVID-19 (50% hypertensive, 53% female, mean age 53,4±13,6 years) underwent comprehensive questionnaire survey evaluating physical (CAT, CCQ and mMRC dyspnea scales for respiratory and EFTER-COVID for other related symptoms), emotional (HADS) and cognitive well-being (Memory, Thinking and Communication subscale of SBQ-LC questionnaire, MTC-SBQ-LC) that was performed pre-discharge and repeated after 1, 3, and 12 months. Results: Despite being older (57,8±11,8 vs 50,7±13,9, p<0,001) and having higher BMI (31,7±5,3 vs 27,4±4,4 kg/m2, p<0,001), hypertensive patrticipants had similar baseline summary scores of symptoms severity but slightly higher mMRC dyspnea score (2,7±1,1 vs 2,3±1,1, p = 0,023), and no significant difference in trends of summary scores have been detected by ANOVA (see graphic abstract). Non-hypertensive subjects had worse baseline limitation of everyday activity, cough and sputum production by respective CAT and CCQ sections that were characterized by better dynamics during follow-up. The residual level of respiratory-related symptoms at 12 months was higher in hypertensive cohort (CAT score 8,1±5,1 vs 5,8±5,0, p = 0,003, CCQ score 7,5±6,1 vs 4,5±5,1, p<0,001, mMRC dyspnea score 1,57±0,63 vs 1,27±0,54, p<0,001), most likely due to more frequent concomitant obesity and diastolic dysfunction. The most striking data was obtained in the MTC-SBQ-LC: yonger and healthier non-hypertensive participants displayed similar trends of most cognitive symptoms to the hypertensive cohort, but had persistently worse brain fog, difficulties in understanding others’ speech, planning, concentrating, and word-finding, that resulted in significantly higher summary score at 12 months after discharge (1,71±2,36 vs 0,96±1,30, p = 0,010). No differences were detected in anxiety and depression levels as assessed by HADS. Conclusions: Hypertensive patients that had been hospitalized for COVID-19 displayed similar trends of resolving physical, emotional and cognitive symptoms throughout the 12-month follow-up but had higher levels of residual respiratory-related symptoms and dyspnoea compared to the non-hypertensive participants, whereas the latter were characterized by significantly higher level of cognitive dysfunction as assessed by the dedicated SBQ-LC subscale.
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    Pre-discharge systolic blood pressure in hospitalized COVID-19 patients is an independent predictor of imrovement in 6-minute walk test during 1-month follow-up
    (2023-06) Honchar, Oleksii; Ashcheulova, Tetiana; Гончарь, Олексій Володимирович; Ащеулова, Тетяна Вадимівна
    Objective: To study the relation of hypertensive status and systolic blood pressure (SBP) pre-discharge values to the dynamics of functional re-conditioning as assessed by 6-minute walk distance during the 1-month follow-up after hospitalization for COVID-19. Design and method: 6-minute walk distance (6MWD) was assessed pre-discharge in 176 patients hospitalized for COVID-19 (40% hypertensive, 47% male, mean age 53,2 ± 13,5 years) using the 20 m walkway and an extended protocol that included monitoring of peripheral pulse and capillary blood oxygen saturation (SpO2) every 30 seconds via bluetooth-connected pulse oximeter. The repeated evaluation was performed after 1 month of follow-up. Results: Hypertensive participants were characterised by older age (57,8±11,8 vs 50,7±13,9, p < 0,001), higher weight and body mass index (31,7±5,3 vs 27,4±4,4 kg/m2, p < 0,001). As a result, 6MWD in them was shorter (378±57 vs 418±75 m, p = 0,001) but no difference in reached percent of predicted distance (6MWD%) was detected (63,0±8,5 vs 63,2±11,1 %, p = 0,939). The described relation persisted at 1 month, with no difference in absolute (72±43 vs 68±43 m, p = 0,324) and percentage gain of 6MWD (12,8±6,6 vs 11,2±7,5 %, p = 0,266) between groups. Multiple regression analysis has allowed to build the model that accounted for 94% of variability in the 6MWD% gain between visits (85% for dedicated hypertensive cohort model). After adjustment for age, sex, height, weight, Remdesivir treatment, minimal SpO2 levels during acute COVID-19, changes of SpO2 and pulse rate throughout the 6MWT, SBP remained a potent independent predictor of 6MWD% gain, with 10 mmHg higher values at baseline evaluation being associated with 21,5% lesser 6MWD% gain in hypertensive subjects and 8,2% lesser – in normotensives. Conclusions: Hypertensive status did not have an impact on 6MWD% in pre-discharge COVID-19 patients. Moderate-to-high quality multiple regression models have demonstrated an independent role of SBP, demographic and anthropometric data, changes of SpO2 and pulse rate throughout the 6MWT in prediction of 6MWD% gain during 1 month after discharge, both in hypertensive and normotensive patients.
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    COVID-19, ремоделювання серця та функціональне відновлення після виписки: вплив артеріальної гіпертензії
    (2023-09) Honchar, Oleksii; Ashcheulova, Tetiana; Гончарь, Олексій Володимирович; Ащеулова, Тетяна Вадимівна
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    One month follow-up of post-discharge COVID-19 patients shows persistent sonographic signs of cardiac remodeling and mildly impaired longitudinal function regardless of presence of hypertension
    (2023-05) Honchar, Oleksii; Гончарь, Олексій Володимирович
    Background. Impaired functional status is one of the typical longterm sequelae of COVID19 infection. Minor impairment of cardiac function that is unable to cause manifestation of overt congestive heart failure may remain undetected in COVID19 convalescents, in the same time contributing to persistence of symptoms and development of long COVID syndrome. Purpose. To study the typical features and shortterm dynamics of cardiac remodeling and possible signs of cardiac dycfunction in hypertensive and nonhypertensive patients with COVID19 infection.
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    Spontaneous physical functional recovery after hospitalization for COVID-19: insights from a 1 month follow-up and a model to predict poor trajectory
    (2023-07) Honchar, Oleksii; Ashcheulova, Tetiana; Гончарь, Олексій Володимирович; Ащеулова, Тетяна Вадимівна