COVID-19 myocarditis and prospective heart failure burden

Abstract

Introduction: COVID-19 is causing considerable morbidity and mortality worldwide. Serious respiratory complications aside, the heart is also frequently involved. The mechanisms and the extent of the myocardial injury, along with the short and long-term cardiovascular (CV) outcomes in COVID-19 survivors remain unclear. Areas covered: myocardial injury has been found in a considerable proportion of hospitalized COVID-19 patients and is associated with a worse prognosis. The late onset of CV complications with myocarditis-like changes revealed by CMR has been reported in COVID-19 survivors. Previous observational studies on viral myocarditis provide evidence of a significant incomplete recovery with residual dysfunction and remodeling of left ventricle. Incomplete recovery is thought to be the result of persistent myocardial inflammation due to a post-viral autoimmune response. Considering the significant inflammatory nature of COVID-19, COVID-19 survivors may be at risk of developing persistent residual myocardial injury, the sequelae of which are unclear. Expert commentary: COVID-19 is an emerging threat for the heart. The extent of CV injury, along with the short and long-term sequelae, requires further investigation. The early detection of residual myocardial changes in COVID-19 survivors is of utmost importance in order to identify those patients at risk of CV complication development.

Myocarditis in COVID-19 patients: current problems

“…It should also be underlined the complexity of the COVID-19 and the possibility to die for reasons not necessarily related to the initial cardiac involvement and presentation [25]. Finally, there is the need for follow-up studies to clarify what is the outcome of patients with the clinically suspected and established COVID-19 myocarditis after hospital discharge [26].…”

Pathophysiological Processes Underlying the High Prevalence of Deep Vein Thrombosis in Critically Ill COVID-19 Patients

“…myocarditis and cardiac failure, low cardiac output may increase venous stasis (Shchedrygina et al, 2020). Moreover, during COVID-19 ARDS, pulmonary microcirculatory thrombosis may occur as a consequence of the disease participating in the increased pulmonary arterial resistance and right ventricular pressures and consequently may decrease velocities of venous return to the heart and contributes to peripheral venous stasis (Ackermann et al, 2020;Edler et al, 2020).…”

Serum CK-MB, COVID-19 severity and mortality: An updated systematic review and meta-analysis with meta-regression

“…In particular, COVID-19 patients might present with subclinical or overt evidence of myocardial necrosis, which might manifest as acute coronary syndrome, myocarditis, arrhythmias, or heart failure [ 10 ]. While the exact mechanisms involved in the pathogenesis of cardiac complications in COVID-19 remain to be established, the presence of myocardial necrosis has been shown to be independently associated with more severe disease, transfer to the intensive care unit (ICU) and mortality [ [11] , [12] , [13] ]. Biomarkers of myocardial damage, particularly creatine kinase-MB (CK-MB) and troponin, have been increasingly investigated in COVID-19 patients in terms of their predictive capacity and potential to assist with clinical decisions [ 14 ].…”