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COVID-19-Associated Myocardial Injury and Other Cardiovascular Diseases

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (15 April 2024) | Viewed by 11538

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Special Issue Editors

Dr. Allegra Battistoni

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Guest Editor

Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy
Interests: cardiovascular prevention; cardio-oncology; hypertension

Prof. Dr. Damiano Magrì

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Guest Editor

Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, 00186 Rome, Italy
Interests: heart failure; CPET

Special Issue Information

Dear Colleagues,

The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the lives of billions of people and healthcare systems worldwide. Despite being caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), besides the lung, this infectious disease also has severe implications in the cardiovascular system. There is a growing body of evidence suggesting worse outcomes and increased mortality among COVID-19 patients with preexisting cardiovascular diseases.

Systemic inflammation and angiotensin-converting enzyme 2-involved signaling networking in SARS-CoV-2 infection and the cardiovascular system may contribute to the manifestation of cardiovascular diseases.

Indeed, SARS-CoV-2 infection can directly or indirectly cause a series of cardiac complications, including acute myocardial injury and myocarditis, acute myocardial infarction, heart failure, and cardiogenic shock and arrhythmias.

The aim of this Special Issue is to investigate different aspects of the relationship between COVID-19 and the cardiovascular system, to promote our understanding of the underlying mechanisms, which would aid in identifying and appropriately treating cardiovascular diseases in patients with COVID-19.

Dr. Allegra Battistoni
Prof. Dr. Damiano Magrì
Guest Editors

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Keywords

COVID-19
SARS-CoV-2
cardiovascular disease
myocardial injury
acute coronary syndromes
myocarditis

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Published Papers (7 papers)

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Research

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13 pages, 719 KiB

Open AccessArticle

Assessment of the Concentrations of Selected Aminothiols in Patients after COVID-19

by Izabela Szołtysek-Bołdys, Wioleta Zielińska-Danch, Danuta Łoboda, Krzysztof S. Gołba and Beata Sarecka-Hujar

J. Clin. Med. 2024, 13(14), 4108; https://doi.org/10.3390/jcm13144108 - 14 Jul 2024

Cited by 1 | Viewed by 1228

Abstract

Background: Data show that due to endothelial damage and thrombogenic effects, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may accelerate the development of atherosclerosis and increase the risk of cardiovascular diseases (CVDs). The impaired metabolism of aminothiols increases oxidative stress, as these molecules are involved in antioxidant defense as well as in thiol redox control. In this study, total levels of selected aminothiols (i.e., cysteine (Cys), homocysteine (HCy), and glutathione) in convalescents after coronavirus disease of 2019 (COVID-19) were evaluated. The analyses were made according to the sex of the patients, time from COVID-19 onset, and COVID-19 severity. Methods: The study group consisted of 212 patients after COVID-19. Levels of total aminothiols were assessed in the blood plasma using high-performance liquid chromatography (HPLC). Results: The mean Cys concentrations were higher in men than in women (229.92 µmol/L ± 51.54 vs. 210.35 µmol/L ± 41.90, respectively; p = 0.003). Differences in Cys levels were also noticed in the total study group between patients distinguished due to time from disease onset (226.82 µmol/L ± 40.57 in <12 weeks, 232.23 µmol/L ± 47.99 in patients 12–24 weeks, and 208.08 µmol/L ± 48.43 in patients >24 weeks; p = 0.005). In addition, over 11% of total patients 12–24 weeks from disease onset had Cys levels above 300 µmol/L compared to almost 4% of patients <12 weeks and 2% of patients >24 weeks (p = 0.046). In sex-adjusted subgroups, significant differences due to time from COVID-19 were found in Cys levels in women (p = 0.004) and in glutathione levels in men (p = 0.024). None of the aminothiol levels differed between the subgroups based on the severity of COVID-19. Conclusions: Men had overall higher Cys levels than women. Cys levels were lower >24 weeks after COVID-19 onset than in the earlier period after disease onset. A partial elevation in Cys levels 12–24 weeks after the disease onset may contribute to the increase in CVD risk in the post-COVID-19 period. Full article

(This article belongs to the Special Issue COVID-19-Associated Myocardial Injury and Other Cardiovascular Diseases)

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18 pages, 2231 KiB

Open AccessArticle

Myocardial Work Indices in Patients Recently Recovered from Mild-to-Moderate COVID-19

by Rafał Dankowski, Wioletta Sacharczuk, Julita Fedorowicz, Małgorzata Małek-Elikowska, Stefan Ożegowski and Artur Baszko

J. Clin. Med. 2024, 13(14), 4090; https://doi.org/10.3390/jcm13144090 - 12 Jul 2024

Viewed by 1070

Abstract

Background/Objectives: Persistent cardiovascular issues are common in COVID-19 survivors, making the detection of subtle myocardial injuries critical. This study evaluates myocardial work (MW) indices in patients recently recovering from mild-to-moderate COVID-19. Methods: A total of 105 recently recovered COVID-19 patients (who had a mean age of 52 years) underwent comprehensive laboratory testing and advanced echocardiographic assessments. The median time since their COVID-19 infections was 56 days (IQR: 42–71). The cohort was stratified based on high-sensitive troponin I (hs-TnI) levels: undetectable versus detectable. The echocardiographic analysis utilized pressure-strain loops to evaluate MW indices. Results: Detectable hs-TnI levels were observed in 42% of patients. The median values of MW indices for the entire group were slightly below normal values: global work index (GWI)—1834 mmHg% (IQR 1168–2054 mmHg%), global constructive work (GCW)—2130 mmHg% (IQR 2010–2398 mmHg%), global wasted work (GWW)—119 mmHg% (IQR 78–175 mmHg%), and global work efficiency (GWE)—94% (IQR 92–96%). Patients with detectable hs-TnI had higher GWW (168 vs. 97 mmHg%, p < 0.005) and lower GWE (93% vs. 95%, p < 0.005). In multiple regression analysis, strain dispersion (PSD) was the sole predictor for GWW (β = 0.67, p < 0.001), while for GWE, PSD (β = −0.67, p < 0.001) and LVEF (β = 0.16, p = 0.05) were significant predictors. Conclusions: Among patients recently recovering from mild-to-moderate COVID-19, elevated hs-TnI levels are linked with a reduction in GWE and an increase in GWW. PSD is an important predictor of myocardial inefficiency and wasted work. In this group, disruptions in the timing and coordination of cardiac muscle contractions may play a key pathophysiological role in reducing the efficiency of the heart’s performance. Full article

(This article belongs to the Special Issue COVID-19-Associated Myocardial Injury and Other Cardiovascular Diseases)

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11 pages, 1366 KiB

Open AccessArticle

Comparison of Incidence and Prognosis of Myocardial Injury in Patients with COVID-19-Related Respiratory Failure and Other Pulmonary Infections: A Contemporary Cohort Study

by Manoela Astolfi Vivan, Vania Naomi Hirakata, Maria Antônia Torres Arteche, Débora Marques de Araujo, Sandra C. Fuchs and Flávio D. Fuchs

J. Clin. Med. 2023, 12(19), 6403; https://doi.org/10.3390/jcm12196403 - 8 Oct 2023

Cited by 1 | Viewed by 1203

Abstract

Myocardial injury (MI) is frequent in critically ill patients with COVID-19, but its pathogenesis remains unclear. We hypothesized that MI is not solely due to viral infection by SARS-CoV-2 but rather due to the common pathophysiological mechanisms associated with severe pulmonary infections and respiratory failure. This contemporary cohort study was designed to compare the incidence of MI in patients with acute respiratory failure caused by COVID-19 to patients with other pulmonary infections. In addition, we aimed to investigate whether MI was a distinct risk factor for in-hospital mortality in patients with COVID-19 compared to those with non-COVID-19 infections. This study included 1444 patients with COVID-19 (55.5% men; age 58 (46;68) years) and 182 patients with other pulmonary infections (46.9% men; age 62 (44;73) years). The incidence of MI at ICU admission was lower in COVID-19 patients (36.4%) compared to non-COVID-19 patients (56%), and this difference persisted after adjusting for age, sex, coronary artery disease, heart failure, SOFA score, lactate, and C-reactive protein (RR 0.84 (95% CI, 0.71–0.99)). MI at ICU admission was associated with a 59% increase in mortality (RR 1.59 (1.36–1.86); p < 0.001), and there was no significant difference in the mortality between patients with COVID-19 and those with other pulmonary infections (p = 0.271). We concluded that MI is less frequent in patients with critical COVID-19 pneumonia and respiratory failure compared to those with other types of pneumonia. The occurrence of MI is a significant risk factor for in-hospital mortality, regardless of the etiology of the pulmonary infection. Full article

(This article belongs to the Special Issue COVID-19-Associated Myocardial Injury and Other Cardiovascular Diseases)

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14 pages, 281 KiB

Open AccessArticle

Dyspnea in Post-Acute COVID-19: A Multi-Parametric Cardiopulmonary Evaluation

by Antonella Cecchetto, Gabriella Guarnieri, Gianpaolo Torreggiani, Andrea Vianello, Giulia Baroni, Chiara Palermo, Leonardo Bertagna De Marchi, Giulia Lorenzoni, Patrizia Bartolotta, Emanuele Bertaglia, Filippo Donato, Patrizia Aruta, Sabino Iliceto and Donato Mele

J. Clin. Med. 2023, 12(14), 4658; https://doi.org/10.3390/jcm12144658 - 13 Jul 2023

Cited by 3 | Viewed by 1417

Abstract

Post-acute COVID-19 is characterized by the persistence of dyspnea, but the pathophysiology is unclear. We evaluated the prevalence of dyspnea during follow-up and factors at admission and follow-up associated with dyspnea persistence. After five months from discharge, 225 consecutive patients hospitalized for moderate to severe COVID-19 pneumonia were assessed clinically and by laboratory tests, echocardiography, six-minute walking test (6MWT), and pulmonary function tests. Fifty-one patients reported persistent dyspnea. C-reactive protein (p = 0.025, OR 1.01 (95% CI 1.00–1.02)) at admission, longer duration of hospitalization (p = 0.005, OR 1.05 (95% CI 1.01–1.10)) and higher body mass index (p = 0.001, OR 1.15 (95% CI 1.06–1.28)) were independent predictors of dyspnea. Absolute drop in SpO₂ at 6MWT (p = 0.001, OR 1.37 (95% CI 1.13–1.69)), right ventricular (RV) global longitudinal strain (p = 0.016, OR 1.12 (95% CI 1.02–1.25)) and RV global longitudinal strain/systolic pulmonary artery pressure ratio (p = 0.034, OR 0.14 (95% CI 0.02–0.86)) were independently associated with post-acute COVID-19 dyspnea. In conclusion, dyspnea is present in many patients during follow-up after hospitalization for COVID-19 pneumonia. While higher body mass index, C-reactive protein at admission, and duration of hospitalization are predictors of persistent dyspnea, desaturation at 6MWT, and echocardiographic RV dysfunction are associated with this symptom during the follow-up period. Full article

(This article belongs to the Special Issue COVID-19-Associated Myocardial Injury and Other Cardiovascular Diseases)

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13 pages, 895 KiB

Open AccessArticle

Cardiopulmonary Exercise Testing in Children and Young Adolescents after a Multisystem Inflammatory Syndrome: Physical Deconditioning or Residual Pathology?

by Federica Gentili, Giulio Calcagni, Nicoletta Cantarutti, Emma Concetta Manno, Giulia Cafiero, Eliana Tranchita, Annamaria Salvati, Paolo Palma, Ugo Giordano, Fabrizio Drago and Attilio Turchetta

J. Clin. Med. 2023, 12(6), 2375; https://doi.org/10.3390/jcm12062375 - 19 Mar 2023

Cited by 3 | Viewed by 1986

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a serious health condition that imposes a long-term follow-up. The purpose of our pilot study is to evaluate the usefulness of the cardiopulmonary stress test (CPET) in the follow-up after MIS-C. All patients admitted for MIS-C in our hospital in the 12 months preceding the date of observation were considered for inclusion in the study. Pre-existing cardio-respiratory diseases and/or the lack of collaboration were the exclusion criteria. At enrolment, each subject passed a cardiological examination, rest ECG, echocardiogram, 24 h Holter-ECG, blood tests, and a CPET complete of spirometry. A total of 20 patients met the inclusion criteria (11.76 ± 3.29 years, 13 male). In contrast to the normality of all second-level investigations, CPET showed lower-than-expected peakVO₂ and peak-oxygen-pulse values (50% of cases) and higher-than-expected VE/VCO_2-slope values (95% of cases). A statistically significant inverse correlation was observed between P-reactive-protein values at admission and peakVO₂/kg values (p = 0.034), uric acid values at admission, and peakVO₂ (p = 0.011) or peak-oxygen-pulse expressed as a percentage of predicted (p = 0.021), NT-proBNP values at admission and peakVO₂ expressed as a percentage of predicted (p = 0.046). After MIS-C (4–12 months) relevant anomalies can be observed at CPET, which can be a valuable tool in the follow-up after this condition. Full article

(This article belongs to the Special Issue COVID-19-Associated Myocardial Injury and Other Cardiovascular Diseases)

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14 pages, 1303 KiB

Open AccessArticle

Cardiopulmonary Long-Term Sequelae in Patients after Severe COVID-19 Disease

by Julia Hanne Niebauer, Christina Binder-Rodriguez, Ahmet Iscel, Sarah Schedl, Christophe Capelle, Michael Kahr, Simona Cadjo, Simon Schamilow, Roza Badr-Eslam, Michael Lichtenauer, Aurel Toma, Alexander Zoufaly, Rosmarie Valenta, Sabine Hoffmann, Silvia Charwat-Resl, Christian Krestan, Wolfgang Hitzl, Christoph Wenisch and Diana Bonderman

J. Clin. Med. 2023, 12(4), 1536; https://doi.org/10.3390/jcm12041536 - 15 Feb 2023

Cited by 4 | Viewed by 1876

Abstract

We aimed to identify cardiopulmonary long-term effects after severe COVID-19 disease as well as predictors of Long-COVID in a prospective registry. A total of 150 consecutive, hospitalized patients (February 2020 and April 2021) were included six months post hospital discharge for a clinical follow-up. Among them, 49% experienced fatigue, 38% exertional dyspnea and 75% fulfilled criteria for Long-COVID. Echocardiography detected reduced global longitudinal strain (GLS) in 11% and diastolic dysfunction in 4%. Magnetic resonance imaging revealed traces of pericardial effusion in 18% and signs of former pericarditis or myocarditis in 4%. Pulmonary function was impaired in 11%. Chest computed tomography identified post-infectious residues in 22%. Whereas fatigue did not correlate with cardiopulmonary abnormalities, exertional dyspnea was associated with impaired pulmonary function (OR 3.6 [95% CI: 1.2–11], p = 0.026), reduced GLS (OR 5.2 [95% CI: 1.6–16.7], p = 0.003) and/or left ventricular diastolic dysfunction (OR 4.2 [95% CI: 1.03–17], p = 0.04). Predictors of Long-COVID included length of in-hospital stay (OR: 1.15 [95% CI: 1.05–1.26], p = 0.004), admission to intensive care unit (OR cannot be computed, p = 0.001) and higher NT-proBNP (OR: 1.5 [95% CI: 1.05–2.14], p = 0.026). Even 6 months after discharge, a majority fulfilled criteria for Long-COVID. While no associations between fatigue and cardiopulmonary abnormalities were found, exertional dyspnea correlated with impaired pulmonary function, reduced GLS and/or diastolic dysfunction. Full article

(This article belongs to the Special Issue COVID-19-Associated Myocardial Injury and Other Cardiovascular Diseases)

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11 pages, 959 KiB

Open AccessReview

SARS-CoV-2 Related Myocarditis: What We Know So Far

by Raffaella Mistrulli, Armando Ferrera, Melwyn Luis Muthukkattil, Massimo Volpe, Emanuele Barbato and Allegra Battistoni

J. Clin. Med. 2023, 12(14), 4700; https://doi.org/10.3390/jcm12144700 - 15 Jul 2023

Cited by 4 | Viewed by 2012

Abstract

A minority of patients with severe acute respiratory syndrome coronavirus 2 (COVID-19) develop cardiovascular complications, such as acute cardiac lesions with elevated troponins, de novo systolic heart failure, pericardial effusion and, rarely, acute myocarditis. The prevalence of COVID-19-related myocarditis ranges from 10 to 105 cases per 100,000 COVID-19-infected individuals, with a male predominance (58%) and a median age of 50 years. The etiopathogenetic mechanism is currently unclear, but may involve direct virus-mediated damage or an exaggerated immune response to the virus. Mortality is high, as fulminant myocarditis (FM) develops very often in the form of cardiogenic shock and ventricular arrhythmias. Hence, medical therapy with ACE inhibitors and beta-blockers may not always be sufficient, in which case inotropic and immunosuppressive drugs, most commonly corticosteroids, may be necessary. In this review we analyze the current data on COVID-19 myocarditis, management strategies and therapy, with a brief description of COVID-19 vaccine-associated myocarditis to help clinicians dealing with this peculiar form of myocarditis. Full article

(This article belongs to the Special Issue COVID-19-Associated Myocardial Injury and Other Cardiovascular Diseases)

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