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RESUMEN Introducción y objetivos: La Organización Mundial de la Salud calificó la enfermedad por coronavirus de 2019 (COVID-19) como una pandemia global. No está claro si el tratamiento previo con inhibidores de la enzima de conversión de la angiotensina (IECA) y antagonistas de los receptores de la angiotensina II (ARA-II) tiene un impacto en el pronóstico de los pacientes infectados con COVID-19. El objetivo es evaluar la implicación clínica del tratamiento previo con IECA/ARA-II en el pronóstico de la COVID-19. Métodos: Estudio observacional, retrospectivo, unicéntrico y de cohortes basado en todos los habitantes del área de salud. El análisis de los resultados principales (mortalidad, insuficiencia cardiaca, hospitalización, ingreso en la unidad de cuidados intensivos [UCI] y eventos cardiovasculares agudos mayores [un compuesto de mortalidad e insuficiencia cardiaca]), se ajustó mediante modelos de regresión logística multivariada y modelos de coincidencia de puntuación de propensión. Resultados: De una población total de 447.979 habitantes, se diagnosticó de infección por COVID-19 a 965 pacientes (0,22%), de los que 210 (21,8%) estaban en tratamiento con IECA o ARA-II en el momento del diagnóstico. El tratamiento con IECA/ARA-II (combinado o individual) no tuvo efecto en la mortalidad (OR = 0,62; IC95%, 0,17-2,26; p = 0,486), la insuficiencia cardiaca (OR = 1,37; IC95%, 0,39-4,77; p = 0,622), la tasa de hospitalizaciones (OR = 0,85; IC95%, 0,45-1,64; p = 0,638), los ingresos en UCI (OR = 0,87; IC95%, 0,30-2,50; p = 0,798) y los eventos cardiovasculares agudos mayores (OR = 1,06; IC95%, 0,39-2,83; p = 0,915). En el análisis del subgrupos de pacientes que requirieron hospitalización, el efecto se mantuvo neutral. Conclusiones: El tratamiento previo con IECA/ARA-II en pacientes con COVID-19 no tuvo efecto en la mortalidad, la aparición de insuficiencia cardiaca o la necesidad de hospitalización o ingreso en UCI. La supresión de los IECA/ARA-II en pacientes con COVID-19 no estaría justificada en ningún caso según las recomendaciones actuales de las sociedades científicas y las agencias gubernamentales.

Background Coronavirus disease (COVID-19) was labelled a global pandemic in April 2020 by the World Health Organisation. By December of the same year the disease caused by SARS-COV-2, known as COVID-19 (Coronavirus disease 2019), had spread over 200 countries, infecting more than 70 million people, causing more that 1.5 million of deaths. Recent studies suggest SARS-CoV-2 infection may be related to cardiovascular and thrombotic events although the strength of association remains unclear. Aims Evaluate the emergence of cardiovascular and thrombotic events (such as major acute cardiovascular events, ictus and other thrombosis) in the acute moment and in medium-term follow-up in COVID-19 patients. Methods Single-Center, retrospective, observational study of cohorts based on all the inhabitants of the health area. Survival analysis of main outcomes (mortality, heart failure [HF], and major acute cardiovascular events – MACE - [a composite of cardiovascular mortality, myocardial infarction and stroke]) were adjusted by multivariate logistic regression. Results Of the total population studied, 447,979 inhabitants, 1,030 (0.23%) were diagnosed with COVID-19 infection, of which 14,8% were smokers, 31,2% had high blood pressure (HTA), 12,8% had diabetes, 29,2% had dyslipidaemia, 2,7% had peripheral artery disease, 4,7% had ischemic heart disease, 3,3% had had a previous transient ischemic attack, 10% were in anti-aggregation treatment and 5,8% were in anticoagulation treatment at the time of diagnosis. Concerning the analytics middle values, the group treated with ACEI/ARAB had higher troponins and ferritin than the group without ACEI/ARAB treatment, whereas higher reactive C protein and D-dimer were found in this last group. The main results showed that COVID-19 infection had no effect regarding to cardiovascular and thrombotic disease on mortality (OR: 1.64, 95% CI 0.98 2.76, p=0.062), heart failure (OR: 0.98, 95% CI 0.53 1.79, p=0.942), thrombotic events (OR: 1.02, 95% CI 0.22 4.83, p=0.98) and major acute cardiovascular events (OR: 0.88, 95% CI 0.48 1.60, p=0.665). Conclusions In conclusion, COVID-19 infection had no effect on the emergence of cardiovascular or thrombotic events taking into account the 6-month prognosis, defined as mortality, heart failure, or major acute cardiovascular events. Funding Acknowledgement Type of funding sources: None.

Hypertension is a prevalent condition among SARS-CoV-2 infected patients. Whether renin-angiotensin-aldosterone system (RAAS) inhibitors are beneficial or harmful is controversial.We have performed a national retrospective, nonexperimental comparative study from two tertiary hospitals to evaluate the impact of chronic use of RAAS inhibitors in hypertensive COVID-19 patients. A meta-analysis was performed to strengthen our findings.Of 849 patients, 422 (49.7%) patients were hypertensive and 310 (73.5%) were taking RAAS inhibitors at baseline. Hypertensive patients were older, had more comorbidities, and a greater incidence of respiratory failure (-0.151 [95% CI -0.218, -0.084]). Overall mortality in hypertensive patients was 28.4%, but smaller among those with prescribed RAAS inhibitors before (-0.167 [95% CI -0.220, -0.114]) and during hospitalization (0.090 [-0.008,0.188]). Similar findings were observed after two propensity score matches that evaluated the benefit of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers among hypertensive patients. Multivariate logistic regression analysis of hypertensive patients found that age, diabetes mellitus, C-reactive protein, and renal failure were independently associated with all-cause mortality. On the contrary, ACEIs decreased the risk of death (OR 0.444 [95% CI 0.224-0.881]). Meta-analysis suggested a protective benefit of RAAS inhibitors (OR 0.6 [95% CI 0.42-0.8]) among hypertensive COVID-19.Our data suggest that RAAS inhibitors may play a protective role in hypertensive COVID-19 patients. This finding was supported by a meta-analysis of the current evidence. Maintaining these medications during hospital stay may not negatively affect COVID-19 outcomes.La hipertensión es una condición prevalente entre los pacientes infectados por el SARS-CoV-2. Es controvertido si los inhibidores del sistema renina-angiotensina-aldosterona (SRAA) son beneficiosos o perjudiciales.Hemos desarrollado un estudio comparativo nacional retrospectivo y no experimental en 2 hospitales terciarios para evaluar el impacto del uso crónico de inhibidores del SRAA en pacientes hipertensos con COVID-19. Se realizó un metaanálisis para reforzar los hallazgos.De 849 pacientes, 422 (49,7%) eran hipertensos y 310 (73,5%) tomaban inhibidores del SRAA al inicio del estudio. Los pacientes hipertensos eran mayores, tenían más comorbilidades y una mayor incidencia de insuficiencia respiratoria (−0,151; IC 95%: [−0,218; −0,084]). La mortalidad global en los pacientes hipertensos fue del 28,4%, pero fue menor entre los que tenían prescritos inhibidores del SRAA antes (−0,167; IC 95%: [−0,220; −0,114]) y durante la hospitalización (0,090; [−0,008; 0,188]). Se observaron hallazgos similares tras 2 emparejamientos de puntuación de propensión que evaluaron el beneficio de los inhibidores de la enzima convertidora de angiotensina y los bloqueadores de los receptores de angiotensina entre los pacientes hipertensos. El análisis de regresión logística multivariante de los pacientes hipertensos reveló que la edad, la diabetes mellitus, la proteína C reactiva y la insuficiencia renal se asociaban de forma independiente con la mortalidad por todas las causas. Por el contrario, los inhibidores de la enzima convertidora de angiotensina disminuyeron el riesgo de muerte (OR 0,444; IC 95%: 0,224-0,881). El metaanálisis indicó un beneficio protector de los inhibidores del SRAA (OR 0,6; IC 95%: 0,42-0,8) entre los hipertensos con COVID-19.Nuestros datos indican que los inhibidores del SRAA pueden desempeñar un papel protector en los pacientes hipertensos con COVID-19. Este hallazgo fue apoyado por un metaanálisis de la evidencia actual. Su mantenimiento durante la estancia hospitalaria puede no afectar negativamente a los resultados de la COVID-19.

Background There is an association between aortic stenosis and anaemia known as Heyde's syndrome. It is caused by an acquired von Willebrand (VW) deficiency related to turbulent flow. Patients with significant paravalvular leak (SPL) remain with VW deficit. The aim of this work is to assess impact on prognosis and anaemia of SPL. Methods Observational analytic study developed at two university hospitals, including all consecutive patients who underwent TAVI during a 10-year period (2009 to 2018). A logistic regression model was created to determine independent predictors of anaemia at 3 months. Time to event outcomes were analysed with Cox regression. Median follow-up was 21.3±21.9 months. Results 5.3% of 788 patients had SPL, with no differences on their basal characteristics compared to the rest of the cohort. SPL was an independent predictor of anaemia 3 months after TAVI (Odds Ratio: 8.31, Confidence Interval 95% [CI]: 2.06–33.50). SPL had negative impact on mortality: Hazard Ratio (HR): 1.85, CI 1.2–2.9; but not on cardiovascular mortality (CV): HR 1.13, CI 0.4–3.1. Patients who had anaemia three months after TAVI had an increased mortality. (HR 2.17, CI 1.5–3.3) Conclusion SPL after TAVI increases mortality with no impact on CV mortality. SPL is independent predictor of anaemia 3 months after TAVI, a condition that doubles the mortality. The impact of SPL on mortality could be explained by the increase in anaemia that SPL causes. More aggressive approach to SPL could have a benefit on prognosis. Figure 1 Funding Acknowledgement Type of funding source: None

BACKGROUND: Cardiovascular risk factors and usage of cardiovascular medication are prevalent among coronavirus disease 2019 (COVID-19) patients. Little is known about the cardiovascular implications of COVID-19. The goal herein, was to evaluate the prognostic impact of having heart disease (HD) and taking cardiovascular medications in a population diagnosed of COVID-19 who required hospitalization. Also, we studied the development of cardiovascular events during hospitalization. METHODS: Consecutive patients with definitive diagnosis of COVID-19 made by a positive real time- -polymerase chain reaction of nasopharyngeal swabs who were admitted to the hospital from March 15 to April 14 were included in a retrospective registry. The association of HD with mortality and with mortality or respiratory failure were the primary and secondary objectives, respectively. RESULTS: A total of 859 patients were included in the present analysis. Cardiovascular risk factors were related to death, particularly diabetes mellitus (hazard ratio in the multivariate analysis: 1.810 [1.159- -2.827], p = 0.009). A total of 113 (13.1%) patients had HD. The presence of HD identified a group of patients with higher mortality (35.4% vs. 18.2%, p < 0.001) but HD was not independently related to prognosis; renin-angiotensin-aldosterone system inhibitors, calcium channel blockers, diuretics and beta-blockers did not worsen prognosis. Statins were independently associated with decreased mortality (0.551 [0.329-0.921], p = 0.023). Cardiovascular events during hospitalization identified a group of patients with poor outcome (mortality 31.8% vs. 19.3% without cardiovascular events, p = 0.007). CONCLUSIONS: The presence of HD is related to higher mortality. Cardiovascular medications taken before admission are not harmful, statins being protective. The development of cardiovascular events during the course of the disease is related to poor outcome.