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open access

Vol 27, No 5 (2020)
Review Article
Submitted: 2020-04-30
Accepted: 2020-07-21
Published online: 2020-08-07
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Cardiovascular disease during the COVID-19 pandemic: Think ahead, protect hearts, reduce mortality

Guoliang Li123, Ardan M. Saguner4, Jiaqi An256, Yuye Ning125, John D. Day7, Ligang Ding8, Xavier Waintraub3, Jie Wang19
DOI: 10.5603/CJ.a2020.0101
·
Pubmed: 32789839
·
Cardiol J 2020;27(5):616-624.
Affiliations
  1. Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
  2. Atrial Fibrillation Centre, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
  3. Cardiology Institute, Rhythmology Unit, Hôpital Universitaire La Pitié-Salpêtrière, Paris, France
  4. Department of Cardiology, University Heart Center Zurich, Switzerland
  5. Stroke Centre and Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
  6. Department of Neurology, Massachusetts General Hospital, Boston, United States
  7. Intermountain Medical Center Heart Institute, United States
  8. Department of Cardiovascular Medicine, Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  9. Department of Hematology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China

open access

Vol 27, No 5 (2020)
Review articles — COVID-19
Submitted: 2020-04-30
Accepted: 2020-07-21
Published online: 2020-08-07

Abstract

Coronavirus disease 2019 (COVID-19) is rapidly spreading globally. As of October 3, 2020, the number of confirmed cases has been nearly 34 million with more than 1 million fatalities. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is accountable for COVID-19. Newly diagnosed and worsening cardiovascular disease are common complications in COVID-19 patients, including acute cardiac injury, hypertension, arrhythmia, myocardial infarction, heart failure and sudden cardiac arrest. The mechanisms contributing to cardiac disease burden include hypoxemia, inflammatory factor storm, dysfunctional angiotensin converting enzyme 2 (ACE2), and drug-induced cardiac toxicity.
Notably, the macrophages expressing ACE2 as direct host cells of SARS-CoV-2 secrete chemokine and inflammatory cytokines, as well as a decrease in cellular immune responses to SARS-CoV-2 infection due to elevated exhaustion levels and dysfunctional diversity of T cells, that may be accountable for the “hyperinflammation and cytokine storm syndrome” and subsequently acute cardiac injury and deteriorating
cardiovascular disease in COVID-19 patients. However, no targeted medication or vaccines for COVID-19 are yet available. The management of cardiovascular disease in patients with COVID-19 include general supportive treatment, circulatory support, other symptomatic treatment, psychological assistance as well as online consultation. Further work should be concentrated on better understanding the pathogenesis of COVID-19 and accelerating the development of drugs and vaccines to reduce the cardiac disease burden and promote the management of COVID-19 patients, especially those with a severe disease course and cardiovascular complications.

Abstract

Coronavirus disease 2019 (COVID-19) is rapidly spreading globally. As of October 3, 2020, the number of confirmed cases has been nearly 34 million with more than 1 million fatalities. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is accountable for COVID-19. Newly diagnosed and worsening cardiovascular disease are common complications in COVID-19 patients, including acute cardiac injury, hypertension, arrhythmia, myocardial infarction, heart failure and sudden cardiac arrest. The mechanisms contributing to cardiac disease burden include hypoxemia, inflammatory factor storm, dysfunctional angiotensin converting enzyme 2 (ACE2), and drug-induced cardiac toxicity.
Notably, the macrophages expressing ACE2 as direct host cells of SARS-CoV-2 secrete chemokine and inflammatory cytokines, as well as a decrease in cellular immune responses to SARS-CoV-2 infection due to elevated exhaustion levels and dysfunctional diversity of T cells, that may be accountable for the “hyperinflammation and cytokine storm syndrome” and subsequently acute cardiac injury and deteriorating
cardiovascular disease in COVID-19 patients. However, no targeted medication or vaccines for COVID-19 are yet available. The management of cardiovascular disease in patients with COVID-19 include general supportive treatment, circulatory support, other symptomatic treatment, psychological assistance as well as online consultation. Further work should be concentrated on better understanding the pathogenesis of COVID-19 and accelerating the development of drugs and vaccines to reduce the cardiac disease burden and promote the management of COVID-19 patients, especially those with a severe disease course and cardiovascular complications.

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Keywords

COVID-19, angiotensin converting enzyme 2, cardiovascular complications, inflammatory factor storm, endotheliitis, online consultation

About this article
Title

Cardiovascular disease during the COVID-19 pandemic: Think ahead, protect hearts, reduce mortality

Journal

Cardiology Journal

Issue

Vol 27, No 5 (2020)

Article type

Review Article

Pages

616-624

Published online

2020-08-07

Page views

3138

Article views/downloads

2554

DOI

10.5603/CJ.a2020.0101

Pubmed

32789839

Bibliographic record

Cardiol J 2020;27(5):616-624.

Keywords

COVID-19
angiotensin converting enzyme 2
cardiovascular complications
inflammatory factor storm
endotheliitis
online consultation

Authors

Guoliang Li
Ardan M. Saguner
Jiaqi An
Yuye Ning
John D. Day
Ligang Ding
Xavier Waintraub
Jie Wang

References (49)
  1. Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020; 579(7798): 270–273.
    CrossRef
  2. Wölfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020; 581(7809): 465–469.
    CrossRefPubMed
  3. Vaduganathan M, Vardeny O, Michel T, et al. Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19. N Engl J Med. 2020; 382(17): 1653–1659.
    CrossRefPubMed
  4. Letko M, Marzi A, Munster V. Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses. Nat Microbiol. 2020; 5(4): 562–569.
    CrossRefPubMed
  5. Grasselli G, Zangrillo A, Zanella A, et al. COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to icus of the lombardy region, Italy. JAMA. 2020 [Epub ahead of print].
    CrossRefPubMed
  6. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229): 1054–1062.
    CrossRefPubMed
  7. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223): 497–506.
    CrossRefPubMed
  8. Bian XW. Autopsy of COVID-19 victims in China. National Science Review. 2020.
    CrossRef
  9. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in china: summary of a report of 72 314 cases from the chinese center for disease control and prevention. JAMA. 2020 [Epub ahead of print].
    CrossRefPubMed
  10. Shi S, Qin Mu, Shen Bo, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020 [Epub ahead of print].
    CrossRefPubMed
  11. Li JW, Han TW, Woodward M, et al. The impact of 2019 novel coronavirus on heart injury: A Systematic review and Meta-analysis. Prog Cardiovasc Dis. 2020 [Epub ahead of print].
    CrossRefPubMed
  12. Lippi G, Lavie CJ, Sanchis-Gomar F. Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis. Prog Cardiovasc Dis. 2020 [Epub ahead of print].
    CrossRefPubMed
  13. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020; 8(4): 420–422.
    CrossRef
  14. Inciardi RM, Lupi L, Zaccone G, et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 [Epub ahead of print].
    CrossRefPubMed
  15. Hu H, Ma F, Wei X, et al. Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin. Eur Heart J. 2020 [Epub ahead of print].
    CrossRefPubMed
  16. Deng Q, Hu Bo, Zhang Y, et al. Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China. Int J Cardiol. 2020; 311: 116–121.
    CrossRefPubMed
  17. Wang C, Xie J, Zhao L, et al. Aveolar macrophage activation and cytokine storm in the pathogenesis of severe COVID-19. 2020.
    CrossRef
  18. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395(10223): 507–513.
    CrossRef
  19. National Center for Gerontology/ National Clinical Research Center for Geriatric Disorders, Cardiovascular Branch of Chinese Geriatrics Society, Imaging Group of Cardiovascular Department, Beijing Medical Association Expert Recommendations for Clinical Management of Myocardial Injury Associated With Coronavirus Disease 2019 (First Edition). Chinese Circulation Journal. .
    CrossRef
  20. Bangalore S, Sharma A, Slotwiner A, et al. ST-Segment elevation in patients with COVID-19 - a case series. N Engl J Med. 2020; 382(25): 2478–2480.
    CrossRefPubMed
  21. Chorin E, Dai M, Shulman E, et al. The QT interval in patients with COVID-19 treated with hydroxychloroquine and azithromycin. Nat Med. 2020; 26(6): 808–809.
    CrossRefPubMed
  22. Li Y, Liu T, Liu M, et al. Electrocardiogramic abnormities in patients with COVID-19. Chinese Journal of Arhythmia. 2020.
    CrossRef
  23. Mitra RL, Greenstein SA, Epstein LM. An algorithm for managing QT prolongation in coronavirus disease 2019 (COVID-19) patients treated with either chloroquine or hydroxychloroquine in conjunction with azithromycin: Possible benefits of intravenous lidocaine. HeartRhythm Case Rep. 2020 [Epub ahead of print].
    CrossRefPubMed
  24. Gabriels J, Saleh M, Chang D, et al. Inpatient use of mobile continuous telemetry for COVID-19 patients treated with hydroxychloroquine and azithromycin. HeartRhythm Case Rep. 2020 [Epub ahead of print].
    CrossRefPubMed
  25. Rosenberg ES, Dufort EM, Udo T, et al. Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York state. JAMA. 2020 [Epub ahead of print].
    CrossRefPubMed
  26. Peng YD, Meng K, Guan HQ, et al. [Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV]. Zhonghua Xin Xue Guan Bing Za Zhi. 2020 [Epub ahead of print]; 48(0): E004.
    CrossRefPubMed
  27. Han Y, Zeng H, Jiang H, et al. CSC expert consensus on principles of clinical management of patients with severe emergent cardiovascular diseases during the COVID-19 epidemic. Circulation. 2020; 141(20): e810–e816.
    CrossRefPubMed
  28. Jing ZC, Zhu HD, Yan XW, et al. Recommendations from the Peking Union Medical College Hospital for the management of acute myocardial infarction during the COVID-19 outbreak. Eur Heart J. 2020; 41(19): 1791–1794.
    CrossRefPubMed
  29. Clerkin KJ, Fried JA, Raikhelkar J, et al. COVID-19 and cardiovascular disease. Circulation. 2020; 141(20): 1648–1655.
    CrossRefPubMed
  30. Zheng HY, Zhang Mi, Yang CX, et al. Elevated exhaustion levels and reduced functional diversity of T cells in peripheral blood may predict severe progression in COVID-19 patients. Cell Mol Immunol. 2020; 17(5): 541–543.
    CrossRefPubMed
  31. Thevarajan I, Nguyen THO, Koutsakos M, et al. Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19. Nat Med. 2020; 26(4): 453–455.
    CrossRefPubMed
  32. Kuba K, Imai Y, Rao S, et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nat Med. 2005; 11(8): 875–879.
    CrossRefPubMed
  33. Yang P, Gu H, Zhao Z, et al. Angiotensin-converting enzyme 2 (ACE2) mediates influenza H7N9 virus-induced acute lung injury. Sci Rep. 2014; 4: 7027.
    CrossRefPubMed
  34. Oudit GY, Kassiri Z, Jiang C, et al. SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest. 2009; 39(7): 618–625.
    CrossRefPubMed
  35. Wrapp D, Wang N, Corbett KS, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020; 367(6483): 1260–1263.
    CrossRefPubMed
  36. Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020; 395(10234): 1417–1418.
    CrossRefPubMed
  37. Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrobial Agents. 2020: 105949.
    CrossRef
  38. Joyce E, Fabre A, Mahon N. Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review. Eur Heart J Acute Cardiovasc Care. 2013; 2(1): 77–83.
    CrossRefPubMed
  39. Cao B, Wang Y, Wen D, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe COVID-19. N Engl J Med. 2020; 382(19): 1787–1799.
    CrossRefPubMed
  40. Raoult D. Hydroxychloroquine-COVID-19 study did not meet publishing society's "expected standard. 2020.
  41. Molina JM, Delaugerre C, Le Goff J, et al. No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection. Med Mal Infect. 2020; 50(4): 384.
    CrossRefPubMed
  42. Guan L, Zhou L, Zhang J, et al. More awareness is needed for severe acute respiratory syndrome coronavirus 2019 transmission through exhaled air during non-invasive respiratory support: experience from China. Eur Respir J. 2020; 55(3).
    CrossRefPubMed
  43. Russell C, Millar J, Baillie J. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020; 395(10223): 473–475.
    CrossRef
  44. Yao H, Chen JH, Xu YF. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry. 2020; 7(4): e21.
    CrossRef
  45. Brooks S, Webster R, Smith L, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020; 395(10227): 912–920.
    CrossRef
  46. Jiménez-Pavón D, Carbonell-Baeza A, Lavie CJ. Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: Special focus in older people. Prog Cardiovasc Dis. 2020 [Epub ahead of print].
    CrossRefPubMed
  47. Walls AC, Park YJ, Tortorici MA, et al. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein. Cell. 2020; 181(2): 281–292.e6.
    CrossRefPubMed
  48. Lan J, Ge J, Yu J, et al. Structure of the SARS-CoV-2 spike receptor-binding domain bound to the ACE2 receptor. Nature. 2020; 581(7807): 215–220.
    CrossRefPubMed
  49. Lam TTY, Jia Na, Zhang YW, et al. Identifying SARS-CoV-2-related coronaviruses in Malayan pangolins. Nature. 2020; 583(7815): 282–285.
    CrossRefPubMed

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