Emerging cardiological issues during the COVID‐19 pandemic

Abstract

Today the modern world is facing an unprecedented health crisis. The COVID-19 pandemic is putting extensive strain on health care systems, hospitals and medical workers worldwide.Epidemiological data are emerging that COVID-19 patients with cardiac risk factors or preexisting cardiac conditions are at increased risk for complications and mortality from COVID-19.As we just begin to understand the pathophysiology underlying the disease, the involvement of the heart, whether through direct myocardial infection and damage or due to cardiac complications, is already evident. Also, the current therapy for COVID-19 using anti-viral agents, (hydroxy)chloroquine and other off-label used medications is not without risk for cardiac side effects. Furthermore, the pandemic puts stress on the organization of cardiac health care, both for COVID-19 patients as well as for the acute and chronic care of cardiac patients in which patient as well as physician-related delays in treatment could potentially lead to harm. Epidemiological data, are cardiac patients at higher risk?Is there a relation between cardiac risk factors or cardiac injury and the mortality risk in COVID-19? Early reports from China 1 indeed show markedly elevated mortality rates in patients with hypertension, diabetes and pre-existing coronary artery disease (up to 10-fold in the latter) compared to patients without underlying health conditions. In a recent report of Shi et al. 2 hospitalized COVID-19 patients in Wuhan, China, presenting with elevated high-sensitive cardiac troponin I levels had a higher frequency of complications such as ARDS (58.5% vs. 14.7%) and acute kidney injury (8.5 vs. 0.3%), required more invasive mechanical ventilation (22% vs. 4.2%) and had a significant increase in in-hospital mortality than patients without cardiac injury (51.2% vs. 4.5%). The percentage of hospitalized COVID-19 patients with elevated troponins is in the range of 20-28% 2,3 and in patients with pre-existing cardiovascular disease with elevated troponins the mortality can be as high as 69.4%. 3 These data indicate that patients with cardiac Accepted ArticleThis article is protected by copyright. All rights reserved risk factors or pre-existing coronary artery disease are at high risk during this COVID-19 pandemic and that cardiac injury is an important predictor of adverse outcomes.

Incidence and outcomes of hospital treated acute myocarditis from 2003 to 2015 in Spain

“…In this sense, as many idiopathic AM could be of viral origin, 1 it is interesting to highlight that an increase in influenza burden was observed in Spain from 2010 to 2015 30 . Another factor that could be of interest in future years is the coronavirus disease 2019, which has been associated also with myocardial damage and AM 31,32 . Indeed, AM caused by this viral infection has been described as the main or contributing cause of mortality in up to one third of cases in some series 31 .…”

QTc evaluation in COVID‐19 patients treated with chloroquine/hydroxychloroquine: A letter to the editor

“…2 Since the advent of the COVID-19 pandemic, there has been increasing reports of various phenotypes of QTc prolongation and its sequelae in COVID-19 patients on treatment with CQ/HCQ. 2 Whilst the compelling need for preventing the deterioration of COVID-19 patients required CQ/HCQ administration in those patients (until recently), Monzani et al 1 have offered some expert opinion on measures to mitigate and reduce the risk of probable cardiac toxicity due to these drugs. 1 Indeed, we recently reported on the utility of a novel tool (Liverpool Adverse Drug Reactions Avoidability tool [LAAT]) for identifying whether an adverse drug reaction (ADR) was avoidable or not.…”

“…Her report highlights the therapeutic morbidities that have unfortunately evolved as part of the measures to control COVID‐19 pandemic. Cardiac toxicity including QTc prolongation has been well established as part of the syndrome of adverse events associated with CQ/HCQ administration 2 . Since the advent of the COVID‐19 pandemic, there has been increasing reports of various phenotypes of QTc prolongation and its sequelae in COVID‐19 patients on treatment with CQ/HCQ 2 .…”

“…Cardiac toxicity including QTc prolongation has been well established as part of the syndrome of adverse events associated with CQ/HCQ administration 2 . Since the advent of the COVID‐19 pandemic, there has been increasing reports of various phenotypes of QTc prolongation and its sequelae in COVID‐19 patients on treatment with CQ/HCQ 2 . Whilst the compelling need for preventing the deterioration of COVID‐19 patients required CQ/HCQ administration in those patients (until recently), Monzani et al 1 have offered some expert opinion on measures to mitigate and reduce the risk of probable cardiac toxicity due to these drugs 1 .…”

The challenging pathway towards the identification of SARS-CoV-2/COVID-19 therapeutics

“…[15][16][17] Additionally, an increasing number of studies are describing how the SARS-CoV-2 infection can cause damage to different organs and tissues including the CNS, kidneys and heart. [18][19][20] Therefore, a comprehensive evaluation of the safety profile of potential therapeutic agents is of paramount importance, especially when considering repurposed drugs at higher doses than for the treatment of their original indication(s) and which can be characterized by concentration-dependent toxicities (e.g. QT prolongation).…”