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Review
. 2021 Oct 5;8(10):128.
doi: 10.3390/jcdd8100128.

Acute and Chronic Effects of COVID-19 on the Cardiovascular System

Victor Arévalos  1   2 , Luis Ortega-Paz  1   2 , Juan José Rodríguez-Arias  1   2 , Margarita Calvo López  1 , Leticia Castrillo-Golvano  1 , Anthony Salazar-Rodríguez  1 , Marta Sabaté-Tormos  3 , Francesco Spione  1 , Manel Sabaté  1   2 , Salvatore Brugaletta  1   2
Affiliations
Review

Acute and Chronic Effects of COVID-19 on the Cardiovascular System

Victor Arévalos et al. J Cardiovasc Dev Dis. .

Abstract

COVID-19 has shown significant morbidity with the involvement of multiple systems, including the cardiovascular system. Cardiovascular manifestations in the acute phase can include myocardial injury itself, myocardial infarction, venous thromboembolic events, myocarditis, Takotsubo syndrome, and different arrhythmic events. Myocardial injury defined by the rise of cardiac biomarkers in blood has been found in multiple studies with a prevalence of about 20%. Its presence is related to worse clinical outcomes and in-hospital mortality. The mechanisms of myocardial injury have been the subject of intense research but still need to be clarified. The characterization of the cardiac affectation with echocardiography and cardiac magnetic resonance has found mixed results in different studies, with a striking incidence of imaging criteria for myocarditis. Regarding post-acute and chronic follow-up results, the persistence of symptoms and imaging changes in recovered COVID-19 patients has raised concerns about the duration and the possible significance of these findings. Even though the knowledge about this disease has increased incredibly in the last year, many aspects are still unclear and warrant further research.

Keywords: SARS-CoV-2; coronavirus disease 2019; long-term outcome; myocardial infarction; myocardial injury; myocarditis; pulmonary embolism.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
COVID-19 cardiovascular manifestations. Cardiovascular involvement due to COVID-19 ranges from asymptomatic myocardial injury to more severe complications such as type 1 myocardial infarction, arterial or venous thromboembolism, or myocarditis.
Figure 2
Figure 2
Relationship of angiotensin-converting enzyme 2 (ACE2) with SARS-CoV-2. SARS-CoV-2 binds to the cells through the transmembrane ACE2, which is present in several tissues. After the union to the receptor, the entrance to the cell is facilitated by another transmembrane protein (TPMPRSS2). Furthermore, the possible downregulation of the ACE2 activity with decreased conversion of angiotensin II to angiotensin 1–7 leads to detrimental effects in the myocardium and other systems. Sustained stimulation of the angiotensin receptors (AT1R) by angiotensin II and decreased stimulation of the angiotensin 1–7 receptor (MasR) is associated with adverse myocardial remodeling for predominance of profibrotic and pro-oxidative mechanisms. In addition, the sites of action of the ACE inhibitors and angiotensin receptor blockers (ARB) can be seen in the figure. These two drugs help to reduce the deleterious effects of the RAAS classic pathway overstimulation.
Figure 3
Figure 3
Cardiac imaging techniques main findings in COVID-19 patients with cardiac involvement. On the left, echocardiography findings are summarized. On the right, CMR findings. CMR, cardiac magnetic resonance; LGE, late gadolinium enhancement; LV, left ventricle; LVGLS, left ventricle global longitudinal strain; PASP, pulmonary artery systolic pressure; RV, right ventricle; TAPSE, anterior tricuspid plane systolic excursion.
Figure 4
Figure 4
Post-acute COVID-19 syndrome (PACS) and Long COVID key points. BB, beta blockers; CMR, cardiac magnetic resonance; POTS, postural orthostatic tachycardia syndrome.
See this image and copyright information in PMC

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