Mechanism of COVID-19-Induced Cardiac Damage from Patient, In Vitro and Animal Studies

Abstract

Purpose of Review Though patient studies have been important for understanding the disease, research done in animals and cell culture complement our knowledge from patient data and provide insight into the mechanism of the disease. Understanding how COVID causes damage to the heart is essential to understanding possible long-term consequences. Recent Findings COVID-19 is primarily a disease that attacks the lungs; however, it is known to have important consequences in many other tissues including the heart. Though myocarditis does occur in some patients, for most cases of cardiac damage, the injury arises from scarring either due to myocardial infarction or micro-infarction. Summary The main focus is on how COVID affects blood flow through the coronaries. We review how endothelial activation leads to a hypercoagulative state in COVID-19. We also emphasize the effects that the cytokine storm can directly have on the regulation of coronary blood flow. Since the main two cell types that can be infected in the heart are pericytes and cardiomyocytes, we further describe the known effects on pericyte function and how that can further lead to microinfarcts within the heart. Though many of these effects are systemic, this review focuses on the consequences on cardiac tissue of this dysregulation and the role that it has in the formation of myocardial scarring.

Single intranasal immunization with attenuated Wuhan-like SARS-CoV-2 provides highly effective cross-protection against Delta and Omicron variants of concern

“…7, б). Эти результаты согласуются с данными других исследований, в которых были обнаружены патологические изменения, вирусная РНК и инфекционный вирус в сердце сирийских хомячков, заражённых SARS-CoV-2 [25,26]. Эти данные имеют особое значение в контексте того факта, что COVID-19 увеличивает риск развития миокардита у людей [27,28], что, вероятно, связано с повышенной экспрессией рецептора ACE2 в миоцитах человека [29].…”

Are Endomyocardial Ventricular Biopsies Useful for Assessing Myocardial Fibrosis?

“…Many authors have pointed to vascular-mediated myocardial damage in the acute period of infection with the development of hemorrhage, necrosis, and thrombosis, which will inevitably lead to the formation of foci of replacement fibrosis [ 32 , 33 , 34 , 35 , 36 , 37 ]. Moreover, in the postacute period of coronavirus infection in a part of patients, we can also see persisting damage in the myocardium, which can potentially lay the foundation for the formation of autoinflammatory diseases and promote progressive collagen deposition in the interstitium [ 38 ]. Also, impaired T-cell function has been observed in the background of coronavirus infection, thus potentially leading to overstimulation of myocardial myofibroblasts and contributing to the development of a profibrotic state [ 39 , 40 , 41 , 42 , 43 ].…”

MRI of cardiac involvement in COVID-19

“… 29 Another proposed mechanism underlying myocardial damage is ischaemic injury. 30 Upon examination of 40 hearts, Pellegrini et al identified microthrombus formation predominantly in small vessels as the main pathological cause of myocyte necrosis, accounting for 78.6% of cases. 31 …”