Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2020 Aug 21;41(32):3023-3027.
doi: 10.1093/eurheartj/ehaa706.

Understanding COVID-19: in the end it is the endothelium-what else?

Thomas F Lüscher  1   2   3
Affiliations
Comment

Understanding COVID-19: in the end it is the endothelium-what else?

Thomas F Lüscher. Eur Heart J. .
No abstract available

PubMed Disclaimer

Figures

Figure 1
Figure 1
Cytokine storm. Proinflammatory cytokines such as IL-1 and TNF-α induce each other’s gene expression, unleashing an amplification loop that sustains the cytokine storm. The endothelial cell is a key target of cytokines, as they induce action of a central proinflammatory transcriptional hub, nuclear factor-κB. IL-1 also cause substantial increases in production by endothelial and other cells of IL-6, the instigator of the hepatocyte acute phase response. The acute phase reactants include fibrinogen, the precursor of clot, and PAI-1, the major inhibitor of our endogenous fibrinolytic system. C-reactive protein, commonly elevated in COVID-19, provides a readily measured biomarker of inflammatory status. The alterations in the thrombotic/fibrinolytic balance due to the acute phase response predisposes towards thrombosis in arteries, in the microvasculature including that of organs such as the myocardium and kidney, and in veins, causing deep vein thrombosis and predisposing towards pulmonary embolism. Thus, the very same cytokines that elicit abnormal endothelial functions can unleash the acute phase response which together with local endothelial dysfunction can conspire to cause the clinical complications of COVID-19. The right side of this diagram aligns therapeutic agents that attack these mechanisms of the cytokine storm and may thus limit its devastating consequences (from Libby P, Lüscher T. COVID-19 is, in the end, an endothelial disease. See pages 3038–3044).
Figure 2
Figure 2
(A) Over a period of 60 days from 20 February, the cumulative incidence of COVID-19 per 100 000 inhabitants in the four provinces and in the overall territory (dotted line) (upper part), and the trend of the difference of OHCA between 2020 and 2019 per 100 000 inhabitants in the four provinces and in the overall territory (dotted line) (bottom part). (B) The cumulative incidence of the difference in OHCA between 2020 and 2019 per 100 000 inhabitants as a function of the cumulative incidence of COVID-19 per 100 000 inhabitants, since 20 February 2020. Dots are the observed values. The red line is the function fitted using fractional polynomials. The shaded area is the 95% CI for the estimates (from Baldi E, Maria Sechi G, Mare C, Canevari F, Brancaglione A, Primi R, Klersy C, Palo A, Contri E, Ronchi V, Beretta G, Reali F, Parogni P, Facchin F, Rizzi U, Bussi D, Ruggeri S, Visconti LO, Savastano S, on behalf of the Lombardia CARe researchers. COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests. See pages 3045–3054).
None
See this image and copyright information in PMC

Comment on

  • Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy.
    Inciardi RM, Adamo M, Lupi L, Cani DS, Di Pasquale M, Tomasoni D, Italia L, Zaccone G, Tedino C, Fabbricatore D, Curnis A, Faggiano P, Gorga E, Lombardi CM, Milesi G, Vizzardi E, Volpini M, Nodari S, Specchia C, Maroldi R, Bezzi M, Metra M. Inciardi RM, et al. Eur Heart J. 2020 May 14;41(19):1821-1829. doi: 10.1093/eurheartj/ehaa388. Eur Heart J. 2020. PMID: 32383763 Free PMC article.
  • COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests.
    Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Klersy C, Palo A, Contri E, Ronchi V, Beretta G, Reali F, Parogni P, Facchin F, Rizzi U, Bussi D, Ruggeri S, Oltrona Visconti L, Savastano S; Lombardia CARe researchers. Baldi E, et al. Eur Heart J. 2020 Jun 1;41(32):3045-3054. doi: 10.1093/eurheartj/ehaa508. Eur Heart J. 2020. PMID: 32562486 Free PMC article.
  • Pulmonary embolism in COVID-19 patients: a French multicentre cohort study.
    Fauvel C, Weizman O, Trimaille A, Mika D, Pommier T, Pace N, Douair A, Barbin E, Fraix A, Bouchot O, Benmansour O, Godeau G, Mecheri Y, Lebourdon R, Yvorel C, Massin M, Leblon T, Chabbi C, Cugney E, Benabou L, Aubry M, Chan C, Boufoula I, Barnaud C, Bothorel L, Duceau B, Sutter W, Waldmann V, Bonnet G, Cohen A, Pezel T; Critical Covid-19 France Investigators. Fauvel C, et al. Eur Heart J. 2020 Jul 1;41(32):3058-3068. doi: 10.1093/eurheartj/ehaa500. Eur Heart J. 2020. PMID: 32656565 Free PMC article.
  • COVID-19 is, in the end, an endothelial disease.
    Libby P, Lüscher T. Libby P, et al. Eur Heart J. 2020 Sep 1;41(32):3038-3044. doi: 10.1093/eurheartj/ehaa623. Eur Heart J. 2020. PMID: 32882706 Free PMC article. Review.

References

    1. Anker SD, Butler J, Khan MS, Abraham WT, Bauersachs J, Bocchi E, Bozkurt B, Braunwald E, Chopra VK, Cleland JG, Ezekowitz J, Filippatos G, Friede T, Hernandez AF, Lam CSP, Lindenfeld J, McMurray JJV, Mehra M, Metra M, Packer M, Pieske B, Pocock SJ, Ponikowski P, Rosano GMC, Teerlink JR, Tsutsui H, Van Veldhuisen DJ, Verma S, Voors AA, Wittes J, Zannad F, Zhang J, Seferovic P, Coats AJS.. Conducting clinical trials in heart failure during (and after) the COVID-19 pandemic: an Expert Consensus Position Paper from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J 2020;41:2109–2117. - PMC - PubMed
    1. Gao C, Cai Y, Zhang K, Zhou L, Zhang Y, Zhang X, Li Q, Li W, Yang S, Zhao X, Zhao Y, Wang H, Liu Y, Yin Z, Zhang R, Wang R, Yang M, Hui C, Wijns W, McEvoy JW, Soliman O, Onuma Y, Serruys PW, Tao L, Li F.. Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study. Eur Heart J 2020;41:2058–2066. - PMC - PubMed
    1. Sama IE, Ravera A, Santema BT, van Goor H, Ter Maaten JM, Cleland JGF, Rienstra M, Friedrich AW, Samani NJ, Ng LL, Dickstein K, Lang CC, Filippatos G, Anker SD, Ponikowski P, Metra M, van Veldhuisen DJ, Voors AA.. Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin–angiotensin–aldosterone inhibitors. Eur Heart J 2020;41:1810–1817. - PMC - PubMed
    1. Nicin L, Abplanalp WT, Mellentin H, Kattih B, Tombor L, John D, Schmitto JD, Heineke J, Emrich F, Arsalan M, Holubec T, Walther T, Zeiher AM, Dimmeler S.. Cell type-specific expression of the putative SARS-CoV-2 receptor ACE2 in human hearts. Eur Heart J 2020;41:1804–1806. - PMC - PubMed
    1. Kim IC, Kim JY, Kim HA, Han S.. COVID-19-related myocarditis in a 21-year-old female patient. Eur Heart J 2020;41:1859. - PMC - PubMed