Special Issues

Special Issue Title: Utilizing Technology in the COVID 19 era

· Print Special Issue Flyer

· Deadline for manuscript submissions:  1 December 2020

Special Issue Editor

Guest Editor

        Prof. Dr. Krishnaswami Vijayaraghavan

        Institute of Congestive Heart Failure, Abrazo Arizona Heart Hospital, Phoenix, AZ, USA

Website | E-Mail

Interests: Congenital heart defects; Coronary artery disease; Heart rhythm disorders and heart failure

        Dr. Snehil Dixit

        Medical Rehabilitation Sciences, King Khalid University, Saudi Arabia

Website | E-Mail

Interests: Cardiopulmonary rehabilitation diabetes; Diabetic foot; Diabetic wound; Exercise training; Low-level laser therapy; Magnetic therapy; Shortwave diathermy

Special Issue Information

Dear Colleagues,

    The landscape of COVID 19 is evolving every day and as it changes, we have had to face some terrible situations that have caused disruptions across all sectors. Events of the last few months have given us a perspective of the thin line of association between life and death and a stark reminder of how public health and policies play a major role in our everyday lives. We have also come to realize the role of science and technological advances and their impact on our health from prevention and screening to early diagnostics and fast track therapeutics. We believe that through collaborative effort between health care professionals and technology experts, our community will brave the challenges and solve the growing problems through dissemination of education, sharing of knowledge and power of passion. To that end, we have organized a unique set of manuscripts written by experts in their fields that will address the Interoperability of IOS, health care Apps, Bluetooth Low Energy (BLE) apps to address contact tracing issues, aspects of privacy, transparency and consenting, role of A.I and algorithm development using big data in wearable technology for health status monitoring of multiple populations at risk. A few other papers will address telehealth, virtual technology, and role of social media at this time of pandemic. There are focused articles on Disparities in COVID 19, comorbidities and their impact on health and wealth. prevention of hospitalization as well as genomic exploration, lab testing and their imperfections, challenges in treatment strategies and in development of vaccines. A couple of papers on preventive strategies using non pharmacological approaches and exercise programs through virtual reality will add significant value to our knowledge base around this pandemic. Another article on mental health at time of COVID will allude to the anxiety, social isolation, and complications thereof and discuss opportunities for alleviation and healing. During this time, while we continue to grasp the nuances of the virus and gain knowledge on anticontagion strategies, early detection, control and developing therapies to attack the condition and comorbidities, let us not forget some of the most powerful values that are already embedded in each and every one of you and has sustained over time. These values include love and kindness, compassion and service to others, inclusion, and impact as well as innovation and creativity. When all is said and done, we all should be asking the question, “how can I help, as an individual and as someone who is part of the larger community, in playing my role in this pandemic and perhaps in the next one and fundamentally improve all aspects of medical care for one and all.” We hope that the manuscripts presented in this special issue will satisfy our goal in creating informed committed health care professions ready to solve the most pressing problems. We hope that the insightful messages in this issue would have cut through the ice, debunked some of the myths, and invoked a sense of passion and courage in you to communicate the knowledge gained in pursuit of a healthier, more equitable world.

Prof. Dr. Krishnaswami Vijayaraghavan and Dr. Snehil Dixit

Guest Editors


Manuscript Submission Information

Manuscripts should be submitted online at https://rcm.imrpress.org by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a double-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Reviews in Cardiovascular Medicine is an international peer-reviewed open access quarterly journal published by IMR Press.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is $1950. Submitted papers should be well formatted and use good English.


COVID-19; Technology

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Early combination therapy with hydroxychloroquine and azithromycin reduces mortality in 10,429 COVID-19 outpatients
Matthieu MILLION, Jean-Christophe LAGIER, Hervé TISSOT-DUPONT, Isabelle RAVAUX, Catherine DHIVER, Christelle TOMEI, Nadim CASSIR, Léa DELORME, Sébastien CORTAREDONA, Sophie AMRANE, Camille AUBRY, Karim BENDAMARDJI, Cyril BERENGER, Barbara DOUDIER, Sophie EDOUARD, Marie HOCQUART, Morgane MAILHE, Coralie PORCHETO, Piseth SENG, Catherine TRIQUET, Stéphanie GENTILE, Elisabeth JOUVE, Audrey GIRAUD-GATINEAU, Herve CHAUDET, Laurence CAMOIN-JAU, Philippe COLSON, Philippe GAUTRET, Pierre-Edouard FOURNIER, Baptiste MAILLE, Jean-Claude DEHARO, Paul HABERT, Jean-Yves GAUBERT, Alexis JACQUIER, Stéphane HONORE, Katell GUILLON-LORVELLEC, Yolande OBADIA, Philippe PAROLA, Philippe BROUQUI, Didier RAOULT
Reviews in Cardiovascular Medicine    2021, 22 (3): 1063-1072.   DOI: 10.31083/j.rcm2203116
Abstract35977)   HTML1642)    PDF(pc) (2238KB)(3468)       Save
We evaluated the age-specific mortality of unselected adult outpatients infected with SARS-CoV-2 treated early in a dedicated COVID-19 day hospital and we assessed whether the use of hydroxychloroquine (HCQ) + azithromycin (AZ) was associated with improved survival in this cohort. A retrospective monocentric cohort study was conducted in the day hospital of our center from March to December 2020 in adults with PCR-proven infection who were treated as outpatients with a standardized protocol. The primary endpoint was 6-week mortality, and secondary endpoints were transfer to the intensive care unit and hospitalization rate. Among 10,429 patients (median age, 45 [IQR 32–57] years; 5597 [53.7%] women), 16 died (0.15%). The infection fatality rate was 0.06% among the 8315 patients treated with HCQ+AZ. No deaths occurred among the 8414 patients younger than 60 years. Older age and male sex were associated with a higher risk of death, ICU transfer, and hospitalization. Treatment with HCQ+AZ (0.17 [0.06–0.48]) was associated with a lower risk of death, independently of age, sex and epidemic period. Meta-analysis evidenced consistency with 4 previous outpatient studies (32,124 patients—Odds ratio 0.31 [0.20–0.47], I2 = 0%). Early ambulatory treatment of COVID-19 with HCQ+AZ as a standard of care is associated with very low mortality, and HCQ+AZ improve COVID-19 survival compared to other regimens.
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A case of COVID-19 infection quickly relieved after nasal instillations and gargles with povidone iodine
Claudio Blasi
Reviews in Cardiovascular Medicine    2021, 22 (2): 269-270.   DOI: 10.31083/j.rcm2202033
Abstract612)   HTML121)    PDF(pc) (70KB)(441)       Save
No abstract present.
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Thrombotic risk in patients with COVID-19
Edoardo Pancaldi, Greta Pascariello, Giuliana Cimino, Angelica Cersosimo, Ludovica Amore, Fabio Alghisi, Nicola Bernardi, Emiliano Calvi, Carlo Mario Lombardi, Enrico Vizzardi, Marco Metra
Reviews in Cardiovascular Medicine    2021, 22 (2): 277-286.   DOI: 10.31083/j.rcm2202035
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Emerging evidences prove that the ongoing pandemic of coronavirus disease 2019 (COVID-19) is strictly linked to coagulopathy even if pneumonia appears as the major clinical manifestation. The exact incidence of thromboembolic events is largely unknown, so that a relative significant number of studies have been performed in order to explore thrombotic risk in COVID-19 patients. Cytokine storm, mediated by pro-inflammatory interleukins, tumor necrosis factor α and elevated acute phase reactants, is primarily responsible for COVID-19-associated hypercoagulopathy. Also comorbidities, promoting endothelial dysfunction, contribute to a higher thromboembolic risk. In this review we aim to investigate epidemiology and clarify the pathophysiological pathways underlying hypercoagulability in COVID-19 patients, providing indications on the prevention of thromboembolic events in COVID-19. Furthermore we aim to reassume the pathophysiological paths involved in COVID-19 infection.
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Revisiting pulmonary rehabilitation during COVID-19 pandemic: a narrative review
Snehil Dixit, Audrey Borghi-Silva, Kalyana Chakravarthy Bairapareddy
Reviews in Cardiovascular Medicine    2021, 22 (2): 315-327.   DOI: 10.31083/j.rcm2202039
Abstract574)   HTML108)    PDF(pc) (424KB)(1051)       Save
There has been an apparent association between the risks of complications with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with a history of existing chronic respiratory diseases during the pandemic of coronavirus disease 2019 (COVID-19). SARS-CoV-2 poses a severe risk in cardiopulmonary management. Moreover, chronic respiratory diseases may further amplify the risk of morbidity and mortality among the afflicted population in the pandemic era. The present review outlines the importance of pulmonary rehabilitation (PR) in persons with chronic respiratory diseases (Chronic obstructive pulmonary disease (COPD) and Asthma) during the COVID-19 era. In this context, amongst the population with a pre-existing pulmonary diagnosis who have contracted SARS-CoV-2, following initial medical management and acute recovery, exercise-based pulmonary rehabilitation (PR) may play a crucial role in long-term management and recovery. The energy conservation techniques will play a pragmatic role in PR of mild to moderate severity cases to counter post-COVID-19 fatigue. Moreover, there is also an urgent need to effectively address post-COVID-19 anxiety and depression, affecting the PR delivery system.
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COVID-19 and cardiovascular system—a comprehensive review
Ibrahim AlShahrani, Jagadish Hosmani, Vidya Gurram Shankar, Abdulaziz AlShahrani, Rafi Ahmad Togoo, Syed M Yassin, Shahrukh Khan, Shankargouda Patil
Reviews in Cardiovascular Medicine    2021, 22 (2): 343-351.   DOI: 10.31083/j.rcm2202041
Abstract312)   HTML53)    PDF(pc) (625KB)(561)       Save
Coronavirus disease 2019 (COVID-19), a mystified cryptic virus has challenged the mankind that has brought life to a standstill. Catastrophic loss of life, perplexed healthcare system and the downfall of global economy are some of the outcomes of this pandemic. Humans are raging a war with an unknown enemy. Infections, irrespective of age and gender, and more so in comorbidities are escalating at an alarming rate. Cardiovascular diseases, are the leading cause of death globally with an estimate of 31% of deaths worldwide out of which nearly 85% are due to heart attacks and stroke. Theoretically and practically, researchers have observed that persons with pre-existing cardiovascular conditions are comparatively more vulnerable to the COVID-19 infection. Moreover, they have studied the data between less severe and more severe cases, survivors and non survivors, intensive care unit (ICU) patients and non ICU patients, to analyse the relationship and the influence of COVID-19 on cardiovascular health of an individual, further the risk of susceptibility to submit to the virus. This review aims to provide a comprehensive particular on the possible effects, either direct or indirect, of COVID-19 on the cardiovascular heath of an individual.
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SARS-CoV-2 infection and the COVID-19 pandemic: a call to action for therapy and interventions to resolve the crisis of hospitalization, death, and handle the aftermath
Peter A. McCullough, Kris Vijay
Reviews in Cardiovascular Medicine    2021, 22 (1): 9-10.   DOI: 10.31083/j.rcm.2021.01.301
Abstract1968)   HTML575)    PDF(pc) (820KB)(1551)       Save
No abstract present.
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Rethinking heart failure care and health technologies from early COVID-19 experiences - A narrative review
Sakine Satici, Pupalan Iyngkaran, Sharon Andrew, Arun Patil, Niranjan Bidargaddi, Malcolm Battersby, Maximilian De Courten
Reviews in Cardiovascular Medicine    2021, 22 (1): 105-114.   DOI: 10.31083/j.rcm.2021.01.272
Abstract237)   HTML37)    PDF(pc) (1299KB)(704)       Save
Heart Failure (HF), a common chronic disease, requires multidisciplinary care to optimise outcomes. The COVID-19 pandemic, its impact on people's movement and access to health services, introduced severe challenges to chronic disease management. The era that will evolve after this pandemic is likely to provide uncertainty and service model disruptions. HF treatment is based on guidelines derived from randomised clinical trial evidence. Translational shortfalls from trials into practice have been overcome with post-trial service improvement studies like OPTIMIZE-HF where a team using a process of care can translate evidence to the general population. However, gaps remain for vulnerable populations e.g. those with more severe HF, with multiple comorbid conditions, and certain demographic groups and/or residents in remote locations. Health technology has come with great promise, to fill some of these gaps. The COVID-19 pandemic provides an opportunity to observe, from Australian healthcare lens, HF management outside the traditional model of care. This narrative review describes relatively recent events with health technology as a solution to improve on service gaps.
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Promoting healthy lifestyles using information technology during the COVID-19 pandemic
Snehil Dixit, Girish Nandakumar
Reviews in Cardiovascular Medicine    2021, 22 (1): 115-125.   DOI: 10.31083/j.rcm.2021.01.187
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In this pandemic era there exist a relationship between a sedentary lifestyle during lockdown with periods of anxiety and stress among the population. Moreover, the population with chronic disease will be vulnerable to the ill effects of a physically inactive lifestyle. Besides, social media platforms and technological advances also appear to be another potential tool for promoting health and wellbeing, however, the capability of these interventions during the pandemic era is largely unknown. To explore the possible role of technological advances and social media platforms as an alternate tool in promoting a healthy living style during the COVID-19 era. The studies with the predefined criteria were used to synthesize information regarding the opportunities and challenges. Studies delivering lifestyle intervention using social media platforms, technologies for health promotion were considered for the review. The studies included to synthesize evidence were randomized controlled trials, systematic reviews and meta-analysis. Database like Medline, Scopus, and Science Direct were searched independently by two reviewers. A total of 17 studies were included in the review, Internet and lifestyle modification n = 2, mHealth and lifestyle modification n = 3, Social media and lifestyle modifications n = 3, technology adoption for lifestyle modification n = 4, and hazards = 5. Technology and social media-based interventions appear to be a promising technique for promoting health and wellbeing and it is the only effective method for delivering an intervention during a pandemic situation. However, there also appears a need for the development of guidelines for social media usage to prevent probable hazards.
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Unfavorable hydroxychloroquine COVID-19 research associated with authors having a history of political party donations
Andrew C. Berry, Russell S. Gonnering, Ivan Rodriguez, Qianying Zhang, Bruce B. Berry
Reviews in Cardiovascular Medicine    2021, 22 (1): 191-198.   DOI: 10.31083/j.rcm.2021.01.262
Abstract659)   HTML60)    PDF(pc) (190KB)(436)       Save
We explored the degree to which political bias in medicine and study authors could explain the stark variation in Hydroxychloroquine (HCQ)/Chloroquine (CQ) study favorability in the US compared to the rest of the world. COVID-19/SARS-CoV-2 preprint and published papers between January 1, 2020-July 26, 2020 with Hydroxychloroquine and/or Chloroquine; 267 met study criteria, 68 from the US. A control subset was selected. HCQ/CQ study result favorability (favorable, unfavorable, or neutral) was noted. First and last main authors of each US study were entered into FollowTheMoney.org Website, extracting any history of political party donation. Of all US studies (68 total), 39/68 (57.4%) were unfavorable, with only 7/68 (10.3%) of US studies yielding favorable results-compared to 199 non-US studies, 66/199 (33.2%) unfavorable, 69/199 (34.7%) favorable, and 64/199 (32.2%) neutral. Studies with at least one US main author were 20.4% (SE 0.053, P < 0.05) more likely to report unfavorable results than non-US studies. US Studies with at least one main author donating to any political party were 25.6% (SE 0.085, P < 0.01) more likely to have unfavorable results. US studies with at least one author donating to the Democratic party were 20.4% (SE 0.045, P < 0.05) more likely to have unfavorable results. US authors were more likely to publish studies with medically harmful conclusions than non-US authors. Cardiology-specific HCQ/CQ studies were 44.2% more likely to yield harmful conclusions (P < 0.01). Inaccurate propagation of HCQ/CQ cardiac adverse effects with individual scientific author political bias has contributed to unfavorable US HCQ/CQ publication patterns and political polarization of the medications.
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Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19)
Peter A. McCullough, Paul E. Alexander, Robin Armstrong, Cristian Arvinte, Alan F. Bain, Richard P. Bartlett, Robert L. Berkowitz, Andrew C. Berry, Thomas J. Borody, Joseph H. Brewer, Adam M. Brufsky, Teryn Clarke, Roland Derwand, Alieta Eck, John Eck, Richard A. Eisner, George C. Fareed, Angelina Farella, Silvia N. S. Fonseca, Charles E. Geyer Jr., Russell S. Gonnering, Karladine E. Graves, Kenneth B. V. Gross, Sabine Hazan, Kristin S. Held, H. Thomas Hight, Stella Immanuel, Michael M. Jacobs, Joseph A. Ladapo, Lionel H. Lee, John Littell, Ivette Lozano, Harpal S. Mangat, Ben Marble, John E. McKinnon, Lee D. Merritt, Jane M. Orient, Ramin Oskoui, Donald C. Pompan, Brian C. Procter, Chad Prodromos, Juliana Cepelowicz Rajter, Jean-Jacques Rajter, C. Venkata S. Ram, Salete S. Rios , Harvey A. Risch, Michael J. A. Robb, Molly Rutherford, Martin Scholz, Marilyn M. Singleton, James A. Tumlin, Brian M. Tyson, Richard G. Urso, Kelly Victory, Elizabeth Lee Vliet, Craig M. Wax, Alexandre G. Wolkoff, Vicki Wooll, Vladimir Zelenko
Reviews in Cardiovascular Medicine    2020, 21 (4): 517-530.   DOI: 10.31083/j.rcm.2020.04.264
Abstract93736)   HTML6249)    PDF(pc) (774KB)(28343)       Save
The SARS-CoV-2 virus spreading across the world has led to surges of COVID-19 illness, hospitalizations, and death. The complex and multifaceted pathophysiology of life-threatening COVID-19 illness including viral mediated organ damage, cytokine storm, and thrombosis warrants early interventions to address all components of the devastating illness. In countries where therapeutic nihilism is prevalent, patients endure escalating symptoms and without early treatment can succumb to delayed in-hospital care and death. Prompt early initiation of sequenced multidrug therapy (SMDT) is a widely and currently available solution to stem the tide of hospitalizations and death. A multipronged therapeutic approach includes 1) adjuvant nutraceuticals, 2) combination intracellular anti-infective therapy, 3) inhaled/oral corticosteroids, 4) antiplatelet agents/anticoagulants, 5) supportive care including supplemental oxygen, monitoring, and telemedicine. Randomized trials of individual, novel oral therapies have not delivered tools for physicians to combat the pandemic in practice. No single therapeutic option thus far has been entirely effective and therefore a combination is required at this time. An urgent immediate pivot from single drug to SMDT regimens should be employed as a critical strategy to deal with the large numbers of acute COVID-19 patients with the aim of reducing the intensity and duration of symptoms and avoiding hospitalization and death.
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Cardiac rehabilitation using telemedicine: the need for tele cardiac rehabilitation
Ritu Thamman, Rajesh Janardhanan
Reviews in Cardiovascular Medicine    2020, 21 (4): 497-500.   DOI: 10.31083/j.rcm.2020.04.201
Abstract875)   HTML150)    PDF(pc) (249KB)(1303)       Save
Cardiac Rehabilitation programs have shown to improve outcomes. The COVID-19 pandemic has posed barriers to these programs. A virtual platform might be a good solution to these challenges. Tele Cardiac Rehabilitation and remote patient monitoring provide an excellent alternative practical solution.
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Early multidrug regimens in new potentially fatal medical problems
Peter A. McCullough, Ramin Oskoui
Reviews in Cardiovascular Medicine    2020, 21 (4): 507-508.   DOI: 10.31083/j.rcm.2020.04.270
Abstract552)   HTML99)    PDF(pc) (138KB)(725)       Save
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Pandemic lockdown, healthcare policies and human rights: integrating opposed views on COVID-19 public health mitigation measures
Alexandru Burlacu, Radu Crisan-Dabija, Adrian Covic, Catalin Raiu, Ionut Mavrichi, Iolanda Valentina Popa, Manuel Lillo-Crespo
Reviews in Cardiovascular Medicine    2020, 21 (4): 509-516.   DOI: 10.31083/j.rcm.2020.04.274
Abstract1055)   HTML123)    PDF(pc) (253KB)(1285)       Save
The issue of the COVID-19 pandemic occupies the agenda of the whole world. The pivot of this pandemic is a crucial element that has become almost as important as the virus itself, namely the lockdown. Although, the rationale for lockdown is well-sustained by strong epidemiological arguments, exploring the 'other' unwanted consequences of the contemporary COVID-19 pandemic is mandatory for coagulating a robust agreed position against the numerous problems generated by the SARS-CoV-2 virus. Starting from the rationale of the lockdown, in this paper we explored and exposed the other consequences of the COVID19 pandemic measures such as the use or abuse of human rights and freedom restrictions, economic issues, marginalized groups and eclipse of all other diseases. Our scientific attempt is to coagulate a stable position and integrate current opposing views by advancing the idea that rather than applying the uniform lockdown policy, one could recommend instead an improved model targeting more strict and more prolonged lockdowns to vulnerable risk/age groups while enabling less stringent measures for the lower-risk groups, minimizing both economic losses and deaths. Rigorous (and also governed by freedom) debating may be able to synchronize the opposed perspectives between those advocating an extreme lockdown (e.g., most of the epidemiologists and health experts), and those criticizing all restrictive measures (e.g., economists and human rights experts). Confronting the multiple facets of the public health mitigation measures is the only way to avoid contributing to history with yet another failure, as seen in other past epidemics.
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Integration of cardiovascular risk assessment with COVID-19 using artificial intelligence
Jasjit S. Suri, Anudeep Puvvula, Misha Majhail, Mainak Biswas, Ankush D. Jamthikar, Luca Saba, Gavino Faa, Inder M. Singh, Ronald Oberleitner, Monika Turk, Saurabh Srivastava, Paramjit S. Chadha, Harman S. Suri, Amer M. Johri, Vijay Nambi, J Miguel Sanches , Narendra N. Khanna, Klaudija Viskovic, Sophie Mavrogeni, John R. Laird, Arindam Bit, Gyan Pareek, Martin Miner, Antonella Balestrieri, Petros P. Sfikakis, George Tsoulfas, Athanasios Protogerou, Durga Prasanna Misra, Vikas Agarwal, George D. Kitas, Raghu Kolluri, Jagjit Teji, Michele Porcu, Mustafa Al-Maini, Ann Agbakoba, Meyypan Sockalingam, Ajit Sexena, Andrew Nicolaides, Aditya Sharma, Vijay Rathore, Vijay Viswanathan, Subbaram Naidu, Deepak L. Bhatt
Reviews in Cardiovascular Medicine    2020, 21 (4): 541-560.   DOI: 10.31083/j.rcm.2020.04.236
Abstract899)   HTML75)    PDF(pc) (4581KB)(3115)       Save
Artificial Intelligence (AI), in general, refers to the machines (or computers) that mimic "cognitive" functions that we associate with our mind, such as "learning" and "solving problem". New biomarkers derived from medical imaging are being discovered and are then fused with non-imaging biomarkers (such as office, laboratory, physiological, genetic, epidemiological, and clinical-based biomarkers) in a big data framework, to develop AI systems. These systems can support risk prediction and monitoring. This perspective narrative shows the powerful methods of AI for tracking cardiovascular risks. We conclude that AI could potentially become an integral part of the COVID-19 disease management system. Countries, large and small, should join hands with the WHO in building biobanks for scientists around the world to build AIbased platforms for tracking the cardiovascular risk assessment during COVID-19 times and long-term follow-up of the survivors.
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Positive and negative impact of social media in the COVID-19 era
A. Verner Venegas-Vera, Gates B Colbert, Edgar V. Lerma
Reviews in Cardiovascular Medicine    2020, 21 (4): 561-564.   DOI: 10.31083/j.rcm.2020.04.195
Abstract5574)   HTML884)    PDF(pc) (339KB)(3423)       Save
Social Media usage has been shown to increase in situations of natural disaster and other crises. It is crucial for the scientific community to understand how social media works in order to enhance our capabilities and make a more resilient community. Through social media communication, the scientific community can collaborate around the globe in a faster way the most important findings of a disease, with a decreased knowledge transition time to other healthcare providers (HCPs). This is greatly important to coordinate research and knowledge during a time of uncertainty and protentional fake news. During the 2020 global pandemic, social media has become an ally but also a potential threat. High volumes of information compressed into a short period can result in overwhelmed HCPs trying to discern fact from noise. A major limitation of social media currently is the ability to quickly disseminate false information which can confuse and distract. Society relies on educated scientists and physicians to be leaders in delivering fact-based information to the public. For this reason, in times of crises it is important to be leaders in the conversation of social media to guide correct and helpful information and knowledge to the masses looking for answers.
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Utility of telemedicine in the COVID-19 era
Gates B. Colbert, A. Verner Venegas-Vera, Edgar V. Lerma
Reviews in Cardiovascular Medicine    2020, 21 (4): 583-587.   DOI: 10.31083/j.rcm.2020.04.188
Abstract1512)   HTML304)    PDF(pc) (1958KB)(2372)       Save
Previously it has been demonstrated that telehealth (TH) could help cover the gaps in health attention in remote locations. Today the expanded capabilities have transformed TH delivery, and from the beginning of the coronavirus pandemic, it has remained one of our biggest allies. Telehealth has become a central piece in patient healthcare delivery during COVID-19 pandemic era. Telehealth allows health care services to reach patients in their homes, keeping other patients safe through social distancing and maintaining self-quarantine. Within this administration of health, TH allows health care providers to focus more resources to pandemic usage and at the same time continue caring for the health of non COVID-19 patients. During this time, clinicians are expanding knowledge about TH capabilities, such as application of forward triage as a tool to avoid patient contact in emergency departments. While previously TH was mainly used for primary care needs, specialized and urgent care health is now being utilized more than ever before. These advantages comes with limitations, some of them include a limited physical exam, lack of access to diagnostic testing or imaging, and many other pitfalls and persistent unmet needs. The 2020 pandemic has led to significant improvements leading into the next generation of telemedicine.
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Usefulness of machine learning in COVID-19 for the detection and prognosis of cardiovascular complications
Allison Zimmerman, Dinesh Kalra
Reviews in Cardiovascular Medicine    2020, 21 (3): 345-352.   DOI: 10.31083/j.rcm.2020.03.120
Abstract830)   HTML92)    PDF(pc) (326KB)(1487)       Save

Since January 2020, coronavirus disease 2019 (COVID-19) has rapidly become a global concern, and its cardiovascular manifestations have highlighted the need for fast, sensitive and specific tools for early identification and risk stratification. Machine learning is a software solution with the ability to analyze large amounts of data and make predictions without prior programming. When faced with new problems with unique challenges as evident in the COVID-19 pandemic, machine learning can offer solutions that are not apparent on the surface by sifting quickly through massive quantities of data and making associations that may have been missed. Artificial intelligence is a broad term that encompasses different tools, including various types of machine learning and deep learning. Here, we review several cardiovascular applications of machine learning and artificial intelligence and their potential applications to cardiovascular diagnosis, prognosis, and therapy in COVID-19 infection.

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Endothelial dysfunction contributes to COVID-19-associated vascular inflammation and coagulopathy
Jun Zhang, Kristen M. Tecson, Peter A. McCullough
Reviews in Cardiovascular Medicine    2020, 21 (3): 315-319.   DOI: 10.31083/j.rcm.2020.03.126
Abstract2340)   HTML399)    PDF(pc) (923KB)(3757)       Save

Great attention has been paid to endothelial dysfunction (ED) in coronavirus disease 2019 (COVID-19). There is growing evidence to suggest that the angiotensin converting enzyme 2 receptor (ACE2 receptor) is expressed on endothelial cells (ECs) in the lung, heart, kidney, and intestine, particularly in systemic vessels (small and large arteries, veins, venules, and capillaries). Upon viral infection of ECs by severe acute respiratory syndrome coronarvirus 2 (SARS-CoV-2), ECs become activated and dysfunctional. As a result of endothelial activation and ED, the levels of pro-inflammatory cytokines (interleukin -1, interleukin-6 (IL-6), and tumor necrosis factor-α), chemokines (monocyte chemoattractant protein-1), von Willebrand factor (vWF) antigen, vWF activity, and factor VIII are elevated. Higher levels of acute phase reactants (IL-6, C-reactive protein, and D-dimer) are also associated with SARS-CoV-2 infection. Therefore, it is reasonable to assume that ED contributes to COVID-19-associated vascular inflammation, particularly endotheliitis, in the lung, heart, and kidney, as well as COVID-19-associated coagulopathy, particularly pulmonary fibrinous microthrombi in the alveolar capillaries. Here we present an update on ED-relevant vasculopathy in COVID-19. Further research for ED in COVID-19 patients is warranted to understand therapeutic opportunities.

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Vitamin D deficiency in association with endothelial dysfunction: Implications for patients with COVID-19
Jun Zhang, Peter A. McCullough, Kristen M. Tecson
Reviews in Cardiovascular Medicine    2020, 21 (3): 339-344.   DOI: 10.31083/j.rcm.2020.03.131
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There is emerging evidence to suggest that vitamin D deficiency is associated with adverse outcomes in COVID-19 patients. Conversely, vitamin D supplementation protects against an initial alveolar diffuse damage of COVID-19 becoming progressively worse. The mechanisms by which vitamin D deficiency exacerbates COVID-19 pneumonia remain poorly understood. In this review we describe the rationale of the putative role of endothelial dysfunction in this event. Herein, we will briefly review (1) anti-inflammatory and anti-thrombotic effects of vitamin D, (2) vitamin D receptor and vitamin D receptor ligand, (3) protective role of vitamin D against endothelial dysfunction, (4) risk of vitamin D deficiency, (5) vitamin D deficiency in association with endothelial dysfunction, (6) the characteristics of vitamin D relevant to COVID-19, (7) the role of vitamin D on innate and adaptive response, (8) biomarkers of endothelial cell activation contributing to cytokine storm, and (9) the bidirectional relationship between inflammation and homeostasis. Finally, we hypothesize that endothelial dysfunction relevant to vitamin D deficiency results from decreased binding of the vitamin D receptor with its ligand on the vascular endothelium and that it may be immune-mediated via increased interferon 1 α. A possible sequence of events may be described as (1) angiotensin II converting enzyme-related initial endothelial injury followed by vitamin D receptor-related endothelial dysfunction, (2) endothelial lesions deteriorating to endothelialitis, coagulopathy and thrombosis, and (3) vascular damage exacerbating pulmonary pathology and making patients with vitamin D deficiency vulnerable to death.

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Cardiovascular system and COVID-19: manifestations and therapeutics
Ajay K. Mahenthiran, Ashorne K. Mahenthiran, Jo Mahenthiran
Reviews in Cardiovascular Medicine    2020, 21 (3): 399-409.   DOI: 10.31083/j.rcm.2020.03.124
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The world is currently in the midst of a daunting global pandemic due to SARS-CoV-2 viral infection and associated COVID-19 disease. Healthcare professionals are tasked with the challenge of managing diverse multisystem clinical manifestations of this infection. Although acute hypoxic respiratory failure is the hallmark of severe COVID-19 disease, there have been diverse manifestations within the cardiovascular (CV) system that each pose unique therapeutic challenges. Of these manifestations, myocardial injury and right ventricular dysfunction are the most common, however, heart failure, circulatory shock, cardiomyopathy, arrhythmia, and vascular thrombosis have been noted as well. Furthermore, these CV related manifestations portend greater morbidity and mortality, which requires clinicians to be familiar with the most recent information to provide informed patient care. Although there are limited treatment options available for COVID-19, it is imperative that the potential cardiovascular implications of these therapies are considered in these patients. This review highlights the pathophysiological mechanisms of and therapeutics for CV manifestations of COVID-19 as well as the CV implications of proposed COVID-19 therapies. Since our hospital-based providers are the frontline caregivers battling this pandemic, the aim of this review is to assist with clinical decision-making for optimal patient outcomes while maintaining a safe environment for healthcare personnel.

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