Clinical Characterization and Possible Pathological Mechanism of Acute Myocardial Injury in COVID-19

Abstract

COVID-19 is a respiratory disease that can cause damage to multiple organs throughout the body. Cardiovascular complications related to COVID-19 mainly include acute myocardial injury, heart failure, acute coronary syndrome, arrhythmia, myocarditis. Among them, myocardial injury is the most common complication in COVID-19 hospitalized patients, and is associated with poor prognosis such as death and arrhythmias. There is a continuous relationship between myocardial injury and the severity of COVID-19. The incidence of myocardial injury is higher in critically ill patients and dead patients, and myocardial injury is more likely to occur in the elderly critically ill patients with comorbidities. Myocardial injury is usually accompanied by more electrocardiogram abnormalities, higher inflammation markers and more obvious echocardiographic abnormalities. According to reports, COVID-19 patients with a history of cardiovascular disease have a higher in-hospital mortality, especially in the elder patients. At present, the mechanism of myocardial injury in COVID-19 is still unclear. There may be direct injury of myocardial cells, systemic inflammatory response, hypoxia, prethrombotic and procoagulant state, myocardial interstitial fibrosis, interferon-mediated immune response and coronary artery plaque instability and other related factors, and angiotensin-converting enzyme-2 receptor may play a key role in the myocardial injury in COVID-19.

Screening for Myocardial Injury after Mild SARS-CoV-2 Infection with Advanced Transthoracic Echocardiography Modalities

“…This is caused by direct endothelial infection through ACE2 receptors, but perhaps more importantly secondary to endothelial activation caused by excessive immune system activation. This hyperinflammatory state plays a major role in the course of the infection and its pulmonary involvement, but its cardiac effect must be equally emphasized [ 16 ]. Especially this pathomechanism can lead to severe illness in both children (Multisystem Inflammatory Syndrome in Children, MIS-C) and adults (MIS-A) weeks after initial infection [ 17 ].…”

Lung Transplantation for COVID-19 Pulmonary Sequelae

“…Other notable late complications, which led to the sole death in this series, were COVID-19–related myocarditis and cardiac arrhythmias. Because of the high frequency of cardiac manifestations in severely ill COVID patients, 23 the team caring for sick patients with COVID-19-related lung failure must pay attention to the possibility of COVID-19–related myocarditis and the progress of its unique pathology. Serial Doppler ultrasound tests in extremities and echocardiography‚ which are scheduled at postoperatively 2 wk, 3 and 6 mo following lung transplantation‚ are currently part of the standard protocol for posttransplant follow-up of these patients at our institution.…”

COVID-19 and atrial fibrillation: Intercepting lines

“…A distinctive hallmark of SARS-CoV-2 infection is systemic immune cell over-activation, with an imbalance between T-helper-1 (Th1) and Th2 cells, elevated levels of IL-1β, IL-2, IL-6, IL-7, interferons, TNF-α, monocyte chemoattractant protein-1 and macrophage inflammatory protein-1A among others (69)(70)(71)(72). At the cardiac level, pro-inflammatory cytokines, in particular IL-6, stimulates vascular smooth muscle proliferation, endothelial cell and platelets activation, and leads to apoptosis or necrosis of myocardial cells, which may mediate intra-atrial repolarization and conduction disturbances (73). Raised levels of IL-6 in COVID-19 deaths suggest that virus-driven hyper-inflammation is strictly correlated to and increased susceptibility to lethal arrhythmia (74).…”