Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19

Fath, Ayman R.; Aglan, Amro; Varkoly, Kyle S.; Beladi, Roxana; Forlemu, Arnold; Mihyawi, Nawfal; Solsi, Anup; Israr, Sharjeel; Lucas, Alexandra

doi:10.1177/23247096211019559

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…Other findings included positive myocardial anti-SARS COV nucleocapsid protein antibodies, cardiac hypertrophy, and multiple sites of ischemia and thrombosis with a left atrial and left pulmonary artery thrombus in one patient. 37 Only 1 (11.1%) patient had normal findings on biopsy.…”

Section: Resultsmentioning

confidence: 96%

COVID-19 Infection and Myocarditis: A State-of-the-Art Systematic Review

Jaiswal

Sarfraz

et al. 2021

J Prim Care Community Health

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Background: COVID-19 was initially considered to be a respiratory illness, but current findings suggest that SARS-CoV-2 is increasingly expressed in cardiac myocytes as well. COVID-19 may lead to cardiovascular injuries, resulting in myocarditis, with inflammation of the heart muscle. Objective: This systematic review collates current evidence about demographics, symptomatology, diagnostic, and clinical outcomes of COVID-19 infected patients with myocarditis. Methods: In accordance with PRISMA 2020 guidelines, a systematic search was conducted using PubMed, Cochrane Central, Web of Science and Google Scholar until August, 2021. A combination of the following keywords was used: SARS-CoV-2, COVID-19, myocarditis. Cohorts and case reports that comprised of patients with confirmed myocarditis due to COVID-19 infection, aged >18 years were included. The findings were tabulated and subsequently synthesized. Results: In total, 54 case reports and 5 cohorts were identified comprising 215 patients. Hypertension (51.7%), diabetes mellitus type 2 (46.4%), cardiac comorbidities (14.6%) were the 3 most reported comorbidities. Majority of the patients presented with cough (61.9%), fever (60.4%), shortness of breath (53.2%), and chest pain (43.9%). Inflammatory markers were raised in 97.8% patients, whereas cardiac markers were elevated in 94.8% of the included patients. On noting radiographic findings, cardiomegaly (32.5%) was the most common finding. Electrocardiography testing obtained ST segment elevation among 44.8% patients and T wave inversion in 7.3% of the sample. Cardiovascular magnetic resonance imaging yielded 83.3% patients with myocardial edema, with late gadolinium enhancement in 63.9% patients. In hospital management consisted of azithromycin (25.5%), methylprednisolone/steroids (8.5%), and other standard care treatments for COVID-19. The most common in-hospital complication included acute respiratory distress syndrome (66.4%) and cardiogenic shock (14%). On last follow up, 64.7% of the patients survived, whereas 31.8% patients did not survive, and 3.5% were in the critical care unit. Conclusion: It is essential to demarcate COVID-19 infection and myocarditis presentations due to the heightened risk of death among patients contracting both myocardial inflammation and ARDS. With a multitude of diagnostic and treatment options available for COVID-19 and myocarditis, patients that are under high risk of suspicion for COVID-19 induced myocarditis must be appropriately diagnosed and treated to curb co-infections.

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Section: Resultsmentioning

confidence: 96%

COVID-19 Infection and Myocarditis: A State-of-the-Art Systematic Review

Jaiswal

Sarfraz

et al. 2021

J Prim Care Community Health

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“…27,31,37,44 This combination of factors has been reported to be directly involved in the pathogenesis of myocardial damage in the form of myocarditis and in infarction with and without atheroma plaque formation. 6,8,9,61 Moreover, cytokines also play an important role in this aspect, with a different activity, since they are related to changes in the expression of calcium and potassium channels resulting from disturbances in the duration of the action potential. 58 Most patients with SARS-CoV-2 show nonspecific characteristics for the manifestation of myocarditis, with a presentation of sinus tachycardia, including ST-segment elevation, nonspecific intraventricular conduction delay, and T-wave abnormalities, with inversion in the previous leads, and the occasional appearance of atrioventricular block, corroborating the results of our study.…”

Section: Discussionmentioning

confidence: 99%

“…These factors together lead to myocardial injury, hypoxia, and cardiotoxicity, which cause myocarditis and aggravation in patients with preexisting coronary artery disease. [6][7][8][9] Viral infection is described as one of the most common infectious causes of myocarditis onset, particularly influenza and parvovirus B19. However, cardiac involvement as a complication of SARS-CoV-2 infection is still poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Covid-19 and Heart Involvement: A Systematic Review of Literature

Moraes¹,

Santos²,

Campos³

et al. 2023

International Journal of Cardiovascular Sciences

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Background: Recent reports in the literature have indicated that infection by coronavirus disease 2019 (COVID-19) causes cardiac complications, such as heart failure, arrhythmia, myocardial infarction, and even fulminant myocarditis. These complications have been identified as the cause of death in some patients infected with SARS-CoV-2. Objectives:To analyze echocardiographic and electrocardiographic changes, treatments used, and clinical outcomes in patients with myocarditis and COVID-19. Methods:The items described for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed. This review included articles in English, Portuguese, and Spanish that reported cardiac involvement, injury, or myocardial inflammation in patients who acquired COVID-19 (SARS-CoV-2).Results: Five databases were consulted to find 1,726 articles. After applying the eligibility criteria, a total of 22 studies were considered qualified. ST-segment (section of the electrocardiogram corresponding the end of the S wave to the beginning of the T wave) elevation and tachyarrhythmia were the most common changes found in the electrocardiographic analysis of patients affected with COVID-19. Concerning echocardiography, there was a high frequency of decreased ejection fraction and occurrence of pericardial effusion. Conclusion:This systematic review provides a potential tool for the analysis of cardiac changes and implications caused in patients affected by SARS-CoV-2 infection, with emphasis on the presence of tachyarrhythmia on electrocardiogram (ECG) and decreased ejection fraction on echocardiogram.

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“…It has a high mortality rate and is a considerable socioeconomic concern (2). AMI is mainly caused by coronary artery occlusion and the interruption of blood flow, leading to ischemic necrosis and irreversible cardiomyocyte loss through oxidative stress, inflammatory responses and morphological changes in myocardial fibroblasts (3)(4)(5). Cardiomyocyte loss comprises the necrosis or apoptosis of cardiomyocytes.…”

Section: Introductionmentioning

confidence: 99%

Exosomal miR‑152‑5p/ARHGAP6/ROCK axis regulates apoptosis and fibrosis in cardiomyocytes

et al. 2023

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Acute myocardial infarction (AMI) is a fatal cardiovascular disease with a high mortality rate. The discovery of effective biomarkers is crucial for the diagnosis and treatment of AMI. In the present study, miRNA sequencing and reverse transcription-quantitative polymerase chain reaction techniques revealed that the expression of exosome derived miR-152-5p was significantly downregulated in patients with AMI compared with healthy controls. A series of functional validation experiments were then performed using H9c2 cardiomyocytes. Following transfection of the cardiomyocytes using an miR-152-5p inhibitor, immunofluorescence staining of a-smooth muscle actin revealed a marked increase in fibrosis. Western blotting revealed that the expression levels of the apoptotic protein Bax, TNF-α and collagen-associated proteins were significantly increased, whereas those of the apoptosis-inhibiting factor Bcl-2 and vascular endothelial growth factor A were significantly decreased. Furthermore, the binding of Rho GTPase-activating protein 6 (ARHGAP6) to miR-152-5p was predicted using an online database and verified using a dual-luciferase reporter gene assay. The transfection of cardiomyocytes with miR-152-5p mimics was found to inhibit the activation of ARHGAP6 and Rho-associated coiled-coil containing kinase 2 (ROCK2). These results suggest that miR-152-5p targets ARHGAP6 through the ROCK signaling pathway to inhibit AMI, which implies that miR-152-5p may be a diagnostic indicator and potential target for treatment of myocardial infarction.

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Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19

Cited by 5 publications

References 24 publications

COVID-19 Infection and Myocarditis: A State-of-the-Art Systematic Review

COVID-19 Infection and Myocarditis: A State-of-the-Art Systematic Review

Covid-19 and Heart Involvement: A Systematic Review of Literature

Exosomal miR‑152‑5p/ARHGAP6/ROCK axis regulates apoptosis and fibrosis in cardiomyocytes

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