Previous and First Detected Cardiovascular Diseases in Patients with New Coronavirus Pneumonia: Possible Mechanisms and Place in a Unified Prognostic Model

Abstract

<b><i>Purpose:</i></b> The aim of this study is to evaluate the frequency of cardiac involvement in patients with coronavirus disease 2019 (COVID-19), possible immune mechanisms of myocardial injury, and the place of cardiovascular pathology among other prognostic factors. <b><i>Methods:</i></b> The study included 86 patients (48 male, 60.2 ± 16.6 years) with COVID-19. In addition to common investigation, examination of troponin T (<i>n</i> = 18) and anti-heart antibodies (AHA, <i>n</i> = 34) were used. The average hospital period was 14 [12; 18] days. <b><i>Results:</i></b> The incidence of cardiovascular disease and symptoms was 45.3%. Arrhythmias, heart failure, low-QRS voltage, repolarization disorders, and pericardial effusion were the typical for coronavirus cardiac injury. The level of AHA was increased in 73.5%. Significant (<i>p</i> < 0.05) correlations of AHA level with inflammatory activity, pneumonia, respiratory failure, cardiac symptoms, and death were found. D-dimer >0.5 μg/mL had a sensitivity of 79.2% and specificity of 60% in the prediction of cardiovascular manifestations. Cardiac failure was one of the causes of death in 3/8 patients (37.5%). Lethality in the presence of cardiovascular pathology was 17.9 versus 2.2% without it, <i>p</i> < 0.05. The most powerful prognostic model includes age, diabetes, oxygen therapy volume, maximum leukocyte level, C-reactive protein, and D-dimer (correlation coefficient 0.871, <i>p</i> < 0.001). The model with only age, diabetes, and cardiovascular disease included also had predictive power (correlation coefficient 0.568, <i>p</i> < 0.001). <b><i>Conclusions:</i></b> The cardiovascular pathology is frequent in patients with COVID-19 and strong correlates with the D-dimer. It indicates the high significance of prothrombotic and ischemic mechanisms. High AHA levels may reflect an inflammatory heart injury. The cardiovascular pathology is associated with higher lethality.

Cardiac Arrhythmias in Patients with Myocarditis in the Post-COVID-19 Period

“…Arrhythmia can be the first and only symptom of myocarditis(Blagova et al, 2021). If the patient suddenly develops an arrhythmia of unknown origin, a possibility of myocarditis can be taken into account(Li et al, 2020).…”