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Cardiac Fibrosis Is a Risk Factor for Severe COVID-19.
Mustroph, Julian; Hupf, Julian; Baier, Maria J; Evert, Katja; Brochhausen, Christoph; Broeker, Katharina; Meindl, Christine; Seither, Benedikt; Jungbauer, Carsten; Evert, Matthias; Maier, Lars S; Wagner, Stefan.
  • Mustroph J; Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
  • Hupf J; Emergency Department, University Hospital Regensburg, Regensburg, Germany.
  • Baier MJ; Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
  • Evert K; Institute of Pathology, University of Regensburg, Regensburg, Germany.
  • Brochhausen C; Institute of Pathology, University of Regensburg, Regensburg, Germany.
  • Broeker K; Department of Physiology, University of Regensburg, Regensburg, Germany.
  • Meindl C; Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
  • Seither B; Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
  • Jungbauer C; Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
  • Evert M; Institute of Pathology, University of Regensburg, Regensburg, Germany.
  • Maier LS; Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
  • Wagner S; Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
Front Immunol ; 12: 740260, 2021.
Article in English | MEDLINE | ID: covidwho-1506482
ABSTRACT
Increased left ventricular fibrosis has been reported in patients hospitalized with coronavirus disease 2019 (COVID-19). It is unclear whether this fibrosis is a consequence of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection or a risk factor for severe disease progression. We observed increased fibrosis in the left ventricular myocardium of deceased COVID-19 patients, compared with matched controls. We also detected increased mRNA levels of soluble interleukin-1 receptor-like 1 (sIL1-RL1) and transforming growth factor ß1 (TGF-ß1) in the left ventricular myocardium of deceased COVID-19 patients. Biochemical analysis of blood sampled from patients admitted to the emergency department (ED) with COVID-19 revealed highly elevated levels of TGF-ß1 mRNA in these patients compared to controls. Left ventricular strain measured by echocardiography as a marker of pre-existing cardiac fibrosis correlated strongly with blood TGF-ß1 mRNA levels and predicted disease severity in COVID-19 patients. In the left ventricular myocardium and lungs of COVID-19 patients, we found increased neuropilin-1 (NRP-1) RNA levels, which correlated strongly with the prevalence of pulmonary SARS-CoV-2 nucleocapsid. Cardiac and pulmonary fibrosis may therefore predispose these patients to increased cellular viral entry in the lung, which may explain the worse clinical outcome observed in our cohort. Our study demonstrates that patients at risk of clinical deterioration can be identified early by echocardiographic strain analysis and quantification of blood TGF-ß1 mRNA performed at the time of first medical contact.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Fibrosis / SARS-CoV-2 / COVID-19 / Heart Ventricles / Myocardium Type of study: Etiology study / Prognostic study / Risk factors Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Front Immunol Year: 2021 Document Type: Article Affiliation country: Fimmu.2021.740260

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Fibrosis / SARS-CoV-2 / COVID-19 / Heart Ventricles / Myocardium Type of study: Etiology study / Prognostic study / Risk factors Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Front Immunol Year: 2021 Document Type: Article Affiliation country: Fimmu.2021.740260