Infectious Disease

In contrast to previous coronaviruses, SARS-CoV-2 has a multi-faceted involvement of the life cycle

September 10, 2021

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Bozkurt B. COVID-19. Presented at: Heart in Diabetes Annual Meeting; 10-12 September 2021 (hybrid meeting).

Disclosure:
Bozkurt reports that he has advised Amgen, Baxter, Bristol Myers Squibb, Relypsa, Sanofi Aventis and scPharmaceuticals.

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Unlike previous coronaviruses, SARS-CoV-2, the virus that causes COVID-19, has many cardiovascular consequences, according to a presentation at the Heart in Diabetes CME Conference.

“In the COVID-19 era, the spectrum of cardiovascular presentations ranged from acute coronary syndrome to heart failure and cardiogenic shock, most of them [had] a characterization of a myocarditis-like presentation or an acute inflammatory cardiomyopathy “, Biykem Bozkurt, MD, PhD, FHFSA, FACC, FAHA, FESC, Mary and Gordon Cain Chair and Professor of Medicine, Director of the Winters Center for HF Research and Associate Director of the Cardiovascular Research Institute at Baylor College of Medicine, the WA “Tex” and Deborah Moncrief Jr., Chair and Medicine Chief at DeBakey VA Medical Center and former president of the Heart Failure Society of America said during her presentation. “The spectrum was so broad that we saw cases in the cardiovascular arena that ranged from cardiac arrhythmia presentations to acute coronary syndrome to heart failure and cardiogenic shock to venous thromboembolism, and we began to see that the underlying mechanism was likely multifactorial was and was believed to be due to a variety of causes, including cytokine storms, microvascular endothelial and thrombotic damage, hypoxemia, and possibly direct myocardial cell infection. “

COVID-19

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Early reports showed evidence of myocardial damage in 25 to 30% of patients hospitalized for COVID-19, most commonly in those with pre-existing CVD, Bozkurt said, noting that elevated heart injury biomarkers such as troponin are linked to mortality was.

Biykem Bozkurt

Such elevated biomarkers were present in proportions ranging from 12% in those without known CVD to 46% in those who died from COVID-19, up to 22% in those in intensive care, and they were present in about 1% of patients with one non-acute infection from previously present coronaviruses, Bozkurt said.

Abnormal cardiac findings on echocardiography are common in patients hospitalized with COVID-19, particularly right ventricular dilation or dysfunction, Bozkurt said.

COVID-19 has also been linked to increased rates of out-of-hospital cardiac arrest and multi-system inflammation syndrome, she said.

Post-acute consequences of COVID-19 include palpitations and tachycardia, especially postural orthostatic tachycardia, she said.

Cardiac MRIs have found cardiac abnormalities in many patients who have recovered from COVID-19, even those who had mild illness, Bozkurt said.

“This sparked a lot of controversy about the safety of returning to exercise in people who had COVID-19 infection,” she said, noting that rates in later studies with controls and strict diagnostic criteria were lower than early studies without she.

A likely mechanism for all cardiovascular complications of COVID-19 is that “SARS-CoV-2 can penetrate the heart muscle cells – we know this from the ability to bind to the receptors that are created in the heart muscle cells by the ACE2 -mediated is expressed entry, ”said Bozkurt. “Initial case studies supported acute viral myocarditis with laboratory echoes, but not with histology. We also knew SARS-CoV-2 was present in the heart by measuring RNA copies, but histology does not show fulminant or lymphocytic myocarditis. The heart structure seems to have been preserved [unlike] with other viral infections. SARS-CoV-2 can be identified in the interstitial cells or the subendothelium, but not in the heart muscle cells, increasing the possibility that it was present in other circulating macrophages or in the interstitium. There is also evidence of microangiopathy and thrombosis in the context of SARS-CoV-2 in the vessels throughout the body. But if the heart does not show myocarditis or confluent myocyte necrosis, then the question arises, how does the heart hurt? The predominant trait seem to be macrophages. ”

She said treatment recommendations include treating COVID-19 itself, treating any CV presentations of infection, and treating any underlying CV disease.

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Heart in diabetes

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