Gamut of Cardiac Manifestations and Complications of COVID-19: A Contemporary Review

Abstract

COVID-19 has posed an extraordinary burden on health and the economy worldwide. Patients with cardiovascular diseases are more likely to have severe illness due to COVID-19 and are at increased risk for complications and mortality. We performed a narrative literature review to assess the burden of COVID-19 and cardiovascular morbidity and mortality. Myocardial injury has been reported in 20%–30% of patients hospitalized due to COVID-19 and is associated with a worse prognosis and high mortality (~50%–60%). Proposed mechanisms of myocardial injury include inflammation within the myocardium (due to direct viral infection or cytokine storm), endotheliitis, coronary vasculitis, myocarditis, demand ischemia, plaque destabilization and right ventricular failure. The right ventricle is particularly vulnerable to injury and failure in COVID-19-infected patients, given the hypoxic pulmonary vasoconstriction, pulmonary microthrombi or pulmonary embolism. Echocardiography is an effective and accessible tool to evaluate left and right ventricular functions and risk stratify patients with COVID-19 infection. Cardiac MRI has detected and characterized myocardial injury, with changes compatible with other inflammatory cardiomyopathies. The long-term consequences of these inflammatory changes are unknown, but accumulating data will provide insight regarding the longitudinal impact of COVID-19 infection on cardiovascular morbidity and mortality.

Cardiac abnormalities in athletes after SARS-CoV-2 infection: a systematic review

“…We therefore aimed to address the following research questions: in athletes recovered form SARS-CoV-2 infection: (1) what is the prevalence of SARS-CoV-2 cardiac involvement (as found using imaging investigations), stratified by study quality? ; (2) what is the incidence of ventricular tachyarrhythmia's (and SCA/SCD) in athletes with documented cardiac involvement?…”

“…1 Most studies performed early in the pandemic focused on cardiac complications in hospitalised and severely ill patients, but recently, there has been marked interest in SARS-CoV-2 cardiac complications and sequelae in young and healthy individuals, including athletes. 2 The initial studies in asymptomatic athletes or athletes with a mild or moderate course of illness reported considerable sustained cardiac involvement after recovery from SARS-CoV-2 infection. Later studies have not replicated these findings.…”

Clinical variants of myocardial involvement in COVID-19-positive patients: a cumulative experience of 2020

“…The final result may also be a product of the both processes when direct viral entry and replication in myocardium may enhance the susceptibility to myocardial injury, which then leads to myocarditis as a part of inflammatory response. Right ventricular dysfunction can also result from the strain caused by increased pulmonary vascular resistance and the workload on the right heart [3]. HF in COVID-19 patients is usually acute and represents de novo cases rather than exacerbation of previously diagnosed condition.…”

CD47 as a potential biomarker for the early diagnosis of severe COVID-19

“…Results indicated an ageing-related increase in CD47 expression, which may contribute the increased COVID-19 vulnerability in older patients [Hokello et al, 2020]. Moreover, high CD47 levels are known to be involved in vascular disease, vasoconstriction, and hypertension, which may predispose SARS-CoV-2-infected individuals to various conditions associated with severe COVID-19 related, including pulmonary hypertension, lung fibrosis, myocardial injury, stroke, and acute kidney injury [Soto-Pantoja et al, 2013;Rogers et al, 2017a;Cruz Rodriguez et al, 2020;Fabrizi et al, 2020;Karmouty-Quintana et al, 2020;Scutelnic and Heldner, 2020;Leeming et al, 2021;Sanghvi et al, 2021;Shah et al, 2021].…”