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Review
. 2020 Jul;8(7):649-651.
doi: 10.1016/S2213-2600(20)30244-7. Epub 2020 May 27.

Increased cardiovascular mortality in African Americans with COVID-19

Dennis McGonagle  1 , Sven Plein  2 , James S O'Donnell  3 , Kassem Sharif  4 , Charles Bridgewood  4
Affiliations
Review

Increased cardiovascular mortality in African Americans with COVID-19

Dennis McGonagle et al. Lancet Respir Med. 2020 Jul.
No abstract available

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Figures

Figure
Figure
Model for high mortality in COVID-19 in at-risk groups (A) SARS-CoV-2 driven lung inflammation is associated with PIC, including extensive thrombosis micro-haemorrhaging. (B) Fibrinolytic mechanisms fail to keep abreast of the immune driven thrombosis with subacute pulmonary hypertension development with elevations in troponin and other markers reflecting diffuse myocardial mechanical stressing and ischaemia, especially in the right ventricle. Factors including obesity and diabetes might also contribute to pulmonary inflammation and PIC seen in COVID-19. Cardiac factors (including pre-existing macrovascular or microvascular arterial disease, cardiomyocyte hypertrophy, increased extracellular matrix deposition, and fibrosis with diastolic dysfunction) associated with systemic hypertension, type 2 diabetes, obesity, metabolic syndrome, and other factors, might become clinically relevant in the most at-risk groups including African Americans. Other contributory factors including hypercytokinemia from pulmonary MAS-like activation that could perturb cardiac function in addition to causing peripheral vasodilation contributing to lower systemic vascular resistance. Finally, RNAaemia, viral proteins without actual viraemia, or actual viral myocarditis, could also contribute to dysregulation cardiac endothelial or myocyte function. PIC=pulmonary intravascular coagulopathy. CK-MB=creatine kinase myocardial band.
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