Cardiovascular damage due to COVID-19: what do we need to know?

SUMMARY Severe Acute Respiratory Syndrome Coronavirus 2 is part of the Cononaviridae family and is the causative agent of the 2019 (Covid-19) Coronavirus pandemic declared by the World Health Organization in March, 2020. This virus has a high rate of transmission, affecting several individuals, and has caused thousands of deaths. The clinical manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 infection are not restricted only to the respiratory tract, and there is an express involvement of the cardiovascular system with a higher risk of death in this group. In such patients there is an overactivation of renin-angiotensin-aldosterone system, which promotes an increase in the expression of angiotensin-converting enzyme - 2 that acts as a receptor for the SPIKE protein expressed by the virus and enables the interaction between the host cell and Severe Acute Respiratory Syndrome Coronavirus 2. This process of infection causes a hyperinflammatory state that increases the inflammatory markers of cardiac injury. Hence, an adequate understanding and clinical guidance regarding the monitoring, and controlling the damage in these patients is essential to avoid worsening of their clinical condition and to prevent death.

Prognostic Implication of QRS Variability during Hospitalization in Patients with Acute Decompensated Heart Failure

BACKGROUND AND OBJECTIVES: Heart failure (HF) patients display more varied QRS duration. We investigated whether QRS variability during hospitalization for acute decompensated HF is associated with poor clinical outcomes after discharge. SUBJECTS AND METHODS: One hundred seventy three patients (64% males; age 60+/-13 years) admitted for acute decompensated HF with severe left ventricular (LV) dysfunction (LV ejection fraction < or =35%) were consecutively enrolled. QRS variability was calculated by the difference between maximum and minimum QRS duration acquired during hospitalization. The prognostic implications on composite endpoints of death or urgent heart transplantation were analyzed. RESULTS: Forty-two patients (24.3%) died and three patients (1.7%) underwent urgent heart transplantation during the follow-up of 51+/-18 months. Patients who reached composite endpoints (n=45) showed greater QRS variability than those who did not (n=128) (20+/-23 ms vs. 14+/-14 ms, p=0.046). Patients who had high QRS variability (more than 22 ms; n=36) tended to have a higher event rate than those with QRS variability <22 ms {39% vs. 23%, hazard ratio (HR), 1.88; 95% confidence interval (CI) 1.001-3.539, p=0.05}. Adjusting with other variables, high QRS variability was an independent predictor for composite outcome (HR 1.94; 95% CI 1.023-3.683, p=0.042). CONCLUSION: QRS variability measured during hospitalization for acute decompensated HF has a prognostic impact in HF patients with severe LV dysfunction.