COVID-19 and cardiac injury: clinical manifestations, biomarkers, mechanisms, diagnosis, treatment, and follow up.

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has the characteristics of high transmission, diverse clinical manifestations, and a long incubation period. In addition to infecting the respiratory system, COVID-19 also has adverse effects on the cardiovascular system. COVID-19 causes acute myocardial injuries, as well as chronic damage to the cardiovascular system. AREAS COVERED The present review is aimed at providing current information on COVID-19 and the cardiovascular system. PubMed, Scopus, Science direct, and Google Scholar were searched. EXPERT OPINION It is suggested that heart injury caused by COVID-19 infection might be an important cause of severe clinical phenotypes or adverse events in affected patients. Myocardial damage is closely related to the severity of the disease and even the prognosis in patients with COVID-19. In addition to disorders that are caused by COVID-19 on the cardiovascular system, more protection should be employed for patients with preexisting cardiovascular disease (CVD). Hence, it is very important that once relevant symptoms appear, patients with COVID-19 be rapidly treated to reduce mortality. Thus, early measurements of cardiac damage via biomarkers following hospitalization for COVID-19 infections in a patient with preexisting CVD are recommended, together with careful monitoring of any myocardial injury that might be caused by the infection.Abbreviations ICU An intensive care unit; 2019-nCoV 2019 novel coronavirus; ACEI ACE inhibitor; ACS Acute coronary syndrome; ARDS Acute respiratory distress syndrome; AT1R Ang II type 1 receptor; ATP Adenosine triphosphate; ACC American College of Cardiology; ACE Angiotensin converting enzyme; Ang II Angiotensin II; ARB Angiotensin II receptor blocker; AV block Atrioventricular block; CAD Coronary artery disease; CVD Cardiovascular disease; CT Computerized tomography; CHF Congestive heart failure; CHD Coronary heart disease; CK-MB Creatine kinase isoenzyme-MB; CRP C-reactive protein; cTnI Cardiac troponin I; EAT Epicardial adipose tissue; ECMO Extracorporeal membrane oxygenation; FDA Food and Drug Administration; G-CSF Granulocyte colony-stimulating factor; HFrEF HF with a reduced ejection fraction; synhACE2 Human isoform of ACE2; IL Interleukin; IABP Intra-aortic balloon counterpulsation; IP10 Interferon γ-induced protein 10 kDa; LPC Lysophosphatidylcholine; Mas Mitochondrial assembly receptor; MCP1 Monocyte chemoattractant protein-1; MERS Middle East respiratory syndrome; MIP1a macrophage inflammatory protein 1a MOF Multiple organ failure; MI Myocardial infarction; MRI Magnetic resonance imaging; MYO Myohe-moglobin; NT-proBNP N-terminal pro-brain natriuretic peptide; PCPS Percutaneous cardiopulmonary assistance; rhACE2 Recombinant human ACE2; SARS Severe acute respiratory syndrome; Th T helper; RAS Renin-angiotensin system; TNF-α Tumor necrosis factor-α; WHO World Health Organization.