SARS-CoV-2 has been circulating in population worldwide for the past year and a half, and thus a vast amount of scientific literature has been produced in order to study the biology of the virus and the pathophysiology of COVID-19, as well as to determine the best way to prevent infection, treat the patients and eliminate the virus. SARS-CoV-2 binding to the ACE2 receptor is the key initiator of COVID-19. The ability of SARS-CoV-2 to infect various types of cells requires special attention to be given to the cardiovascular system, as it is commonly affected. Thorough diagnostics and patient monitoring are beneficial in reducing the risk of cardiovascular morbidity and to ensure the most favorable outcomes for the infected patients, even after they are cured of the acute disease. The multidisciplinary nature of the fight against the COVID-19 pandemic requires careful consideration from the attending clinicians, in order to provide fast and reliable treatment to their patients in accordance with evidence-based medicine principles. In this narrative review, we reviewed the available literature on cardiovascular implications of COVID-19; both the acute and the chronic.

Obstructive sleep apnea (OSA) is a common sleep disorder leading to increased risk of developing cardiovascular diseases (CVDs) by supporting a low-grade chronic inflammation as one of the pathological mechanisms. The continuous positive airway pressure (CPAP) device is used as an effective treatment for moderate and severe OSA. Neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), white blood cell–mean platelet volume ratio (WMR), C-reactive protein–albumin ratio (CAR) and fibrinogen–albumin ratio (FAR) are new potential inflammatory biomarkers that are widely available and were shown to be possibly favorable screening or follow-up tools for moderate- or severe-grade OSA, as well as indirect indicators for cardiovascular risk. Our study evaluated the impact of CPAP therapy in patients with severe OSA and acceptable therapy adherence on NLR, PLR, WMR, FAR and CAR. Of 57 patients who were initially enrolled and had no exclusion criteria, 37 had a satisfactory CPAP adherence (usage of ≥4 h per night) after a minimum of 6 months of therapy. There was a statistically significant difference in NLR (2.122 ± 0.745 before therapy vs. 1.888 ± 0.735 after therapy) and FAR (86.445 ± 18.763 before therapy vs. 77.321 ± 19.133 after therapy) suggesting a positive effect of the CPAP therapy on chronic inflammatory states, thereby possibly reducing cardiovascular risk.

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Background: Mitral regurgitation (MR) represents the second most common valvular heart disease (VHD)1 . It is classified as primary (organic) and secondary (functional) MR, with secondary being more frequent 2 . Secondary MR is usually result of dilatative cardiomyopathy, ischemic heart disease, postmyocarditis and similar 2 . Its prevalence is approximately 1.6% to 19.4%, and is associated with worse prognosis than primary 3 . The aim of our study was to investigate the incidence of secondary MR according to gender. Patients and Methods:Retrospective study was conducted to assess the relation between MR with other VHD. A total of 686 patients, with male predominance of 55%, were included in the study.Results: Among all patients with MR 167 (24.3%) had secondary MR. The main cause was left ventricular enlargement with mitral annular dilatation, counting for 96 (57.5% of secondary MR patients and 14.0% of all MR patients). Other causes of secondary MR included ischemic and postmyocarditis causes, with frequency of 64 (38.3% of secondary MR patients and 9.3% of all MR patients) and 7 (4% of secondary MR patients and 1% of all MR patients), respectively. According to gender distribution, 99 (59.3%) males and 68 (40.7%) females had secondary MR. Dilatative cardiomyopathy was the main cause of secondary MR in both men and women (60.6% and 52.9%). Ischemic MR was present in 36 (36.4%) men, 28 (41%) women, while postmyocarditis MR was observed in 3 (3%) of men and 4(5.8%). Conclusion:Secondary MR presents high proportion of all MR causes. Dilatative cardiomyopathy was most common cause of secondary MR, regardless of gender groups, with men more affected. Ischemic cause was slightly more common in women than men.

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