Imaging Evaluation of Pulmonary and Non-Ischaemic Cardiovascular Manifestations of COVID-19

Abstract

Coronavirus Disease 2019 (COVID-19) has been a pandemic challenge for the last year. Cardiovascular disease is the most described comorbidity in COVID-19 patients, and it is related to the disease severity and progression. COVID-19 induces direct damage on cardiovascular system, leading to arrhythmias and myocarditis, and indirect damage due to endothelial dysfunction and systemic inflammation with a high inflammatory burden. Indirect damage leads to myocarditis, coagulation abnormalities and venous thromboembolism, Takotsubo cardiomyopathy, Kawasaki-like disease and multisystem inflammatory syndrome in children. Imaging can support the management, assessment and prognostic evaluation of these patients. Ultrasound is the most reliable and easy to use in emergency setting and in the ICU as a first approach. The focused approach is useful in management of these patients due its ability to obtain quick and focused results. This tool is useful to evaluate cardiovascular disease and its interplay with lungs. However, a detailed echocardiography evaluation is necessary in a complete assessment of cardiovascular involvement. Computerized tomography is highly sensitive, but it might not always be available. Cardiovascular magnetic resonance and nuclear imaging may be helpful to evaluate COVID-19-related myocardial injury, but further studies are needed. This review deals with different modalities of imaging evaluation in the management of cardiovascular non-ischaemic manifestations of COVID-19, comparing their use in emergency and in intensive care.

SARS-CoV-2 and Endothelial Cells: Vascular Changes, Intussusceptive Microvascular Growth and Novel Therapeutic Windows

“…Nevertheless, viral entry into the respiratory tract and subsequent pneumonia were detected, often worsening to thromboembolism and vessel damage requiring timely treatment for aggressive COVID-19. However, this failed to disentangle the mechanism underlying the SARS-CoV-2 distinct pattern of lung and cardiovascular system changes [ 35 ]. Histologic studies boosted our insight into the complex underlying pathobiology, revealing several vascular features to be relevant, as well as respiratory findings [ 87 ].…”

“…Firstly, thromboresistance is accomplished to some extent by the presence of natural anticoagulants, including tissue factor pathway inhibitor (TFPI), antithrombin (AT), and thrombomodulin [ 32 , 33 , 34 ]. Secondly, platelet modulators expressed by endothelial cells contribute to thromboresistance via ADP/ATPase on the endothelial cell surface, inhibiting platelet aggregation, the production of nitric oxide (NO) through the action of NO synthase 3 (NOS3) and prostacyclin-2 (PGI-2) via cyclooxygenase (COX) [ 32 , 33 , 34 , 35 ]. Endothelial cells are also critical for vascular integrity and are actively involved in angiogenesis via the inter-endothelial cell junctions [ 36 , 37 , 38 ].…”

Right Ventricular Hypertrophy among COVID-19 Patients

“…A recent meta-analysis review of studies of COVID-19 patients developing right ventricular impairment and pulmonary hypertension on mortality concluded that the consensus is that patients who develop PH or RVD through COVID-19 are more likely to die [20]. Similarly, a review by Cicco et al [21] about cardiac imaging evaluation of COVID-19 patients concluded that RV hypertrophy may be caused by mechanical ventilation. The proposed mechanism is that mechanical ventilation can increase RV afterload, causing the RV to thicken in response to increased intrathoracic pressure.…”

“…The proposed mechanism is that mechanical ventilation can increase RV afterload, causing the RV to thicken in response to increased intrathoracic pressure. Cicco et al [21] suggest that hypoxic pulmonary vasoconstriction is probably the main factor behind increased arterial pressure.…”

Lung Ultrasound Is Useful for Evaluating Lung Damage in COVID-19 Patients Treated with Bamlanivimab and Etesevimab: A Single-Center Pilot Study

“…LUS was identified for this purpose since the pandemic’s beginning. Serial ultrasound examinations on patients with confirmed COVID-19 can promptly detect changes in the affected lung tissue [ 5 , 6 ]. Moreover, many resources have been used to identify an adequate and effective treatment.…”