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| EDITORIAL |
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| Year : 2020 | Volume
: 9
| Issue : 1 | Page : 1-2 |
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Coronavirus disease 2019 (COVID-19) and cardiovascular events
Mohammad Javad Alemzadeh-Ansari
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences; Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| Date of Submission | 16-Mar-2020 |
| Date of Decision | 30-Mar-2020 |
| Date of Acceptance | 10-Apr-2020 |
| Date of Web Publication | 24-Apr-2020 |
Correspondence Address:
Dr. Mohammad Javad Alemzadeh-Ansari
Cardiovascular Intervention Research Center, Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran
Iran
 Source of Support: None, Conflict of Interest: None  | 2 |
DOI: 10.4103/rcm.rcm_9_20
How to cite this article:
Alemzadeh-Ansari MJ. Coronavirus disease 2019 (COVID-19) and cardiovascular events. Res Cardiovasc Med 2020;9:1-2 |
In December 2019, for the first time, a cluster of atypical viral pneumonia associated with the new coronavirus (COVID-19) was reported in Wuhan, China. The rapid global outbreak of COVID-2019 lead to the World Health Organization (WHO) on March 11, 2020, reported that this is a pandemic disease. Simultaneously, the WHO stated that this is the first known pandemic that can be controlled.[1] The mortality rate of COVID-19 has reported between 1.5% and 3.6% in different countries.[2] The WHO reported that the time between symptom onset and death ranged from about 2 to 8 weeks.[3] The major conditions related to mortality in these patients are elderly, cardiovascular diseases, and diabetes.
Patients with pre-exciting cardiovascular disease are at higher risk of COVID-19 involvement and have a worse prognosis. About 40% of patients affected with COVID-19 had a history of cardiovascular diseases.[4] Interestedly, the mortality rate in patients with COVID-19 and pre-exciting cardiovascular disease is reach to 10.5%.[5] Further, cardiovascular events, including new or worsening heart failure, new or worsening arrhythmia, or myocardial infarction (MI), are common in patients with pneumonia. The previous studies demonstrated that pre-exciting coronary heart disease is associated with acute cardiovascular events and worse prognosis in patients with influenza and other respiratory viral infections.[6],[7],[8] In recent study, Zhou et al. in a retrospective and multicenter cohort study evaluated 191 admitted patients with COVID-19 and found that the elevated levels of blood high-sensitivity cardiac troponin I as a marker of acute cardiac injury are more commonly seen in those with severe COVID-19 illness. In addition, they demonstrated that acute cardiac injury during hospitalization is more than half of those who died (59% vs. 1%; P < 0.0001).[9]
The potential mechanisms of cardiovascular event following acute respiratory infections include:[9],[10],[11],[12]
- Increase in pro-inflammatory cytokines secondary to systemic inflammation can act as key mediators of atherosclerosis
- Increase in pro-inflammatory cytokines secondary to systemic inflammation may directly impact plaque rupture through local inflammation
- Induction of pro-coagulant factors and hemodynamic effects predisposes to ischemia and thrombosis
- Over-expression of angiotensin-converting enzyme 2, the receptor for severe acute respiratory syndrome coronavirus 2, on the myocytes and vascular endothelial cells (direct cardiac involvement by the virus)
- The interstitial mononuclear inflammatory infiltrates in a fatal case of COVID-19.
On the other hand, the highly contagious COVID-19 is obviously affecting the diagnosis and treatment of patients with acute MI. Zeng et al. recently reported a protocol for approach to patients with COVID-19 pneumonia. The transmission of patients to nearest primary percutaneous coronary intervention (PCI) center prefers to be done with emergency medical services with maximum protection. In this protocol, thrombolytic therapy in an isolation ward is a prefer strategy for stable hemodynamic patients with ST-elevated MI (STEMI) within first 12 h from symptom onset. STEMI patients within the reperfusion time window (<12 h from symptom onset) with contraindications for thrombolysis or failure of thrombolysis need to comprehensively evaluate the risks of PCI and infection control. Incredibly, they recommended conservative treatment for unstable hemodynamic patients with STEMI and severe pneumonia.[13] This is a protocol of single center; hence, regarding worldwide sparing of COVID-19 and also specific condition of these patients, the comprehensive guidelines based on clinical evidence and consensus opinions are needed. Finally, it is seen that awareness on cardiovascular events and complications in patients with COVID-19 is mandatory, and also, cardiologists should be prepared to assist other clinical specialties (team care) for immediate management of these patients.
| References | |  |
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| 2. | Baud D, Qi X, Nielsen-Saines K, Musso D, Pomar L, Favre G. Real estimates of mortality following COVID-19 infection. Lancet Infect Dis 2020. pii: S1473-3099 (20) 30195-X.  |
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| 4. | Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13. |
| 5. | Novel Coronavirus Pneumonia Emergency Response Epidemiology Teamexternal Iconexternal Icon. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi 2020;41:145-51. |
| 6. | Corrales-Medina VF, Musher DM, Shachkina S, Chirinos JA. Acute pneumonia and the cardiovascular system. Lancet 2013;381:496-505. |
| 7. | Udell JA, Zawi R, Bhatt DL, Keshtkar-Jahromi M, Gaughran F, Phrommintikul A, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: A meta-analysis. JAMA 2013;310:1711-20. |
| 8. | Blackburn R, Zhao H, Pebody R, Hayward A, Warren-Gash C. Laboratory-confirmed respiratory infections as predictors of hospital admission for myocardial infarction and stroke: Time-series analysis of English data for 2004–2015. Clin Infect Dis 2018;67:8-17. |
| 9. | Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020. pii: S0140-6736 (20) 30566-3. |
| 10. | Davidson JA, Warren-Gash C. Cardiovascular complications of acute respiratory infections: Current research and future directions. Expert Rev Anti Infect Ther 2019;17:939-42. |
| 11. | Mendoza-Torres E, Oyarzún A, Mondaca-Ruff D, Azocar A, Castro PF, Jalil JE, et al. ACE2 and vasoactive peptides: Novel players in cardiovascular/renal remodeling and hypertension. Ther Adv Cardiovasc Dis 2015;9:217-37. |
| 12. | Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020. pii: S2213-2600 (20) 30076-X. |
| 13. | Zeng J, Huang J, Pan LJ. How to balance acute myocardial infarction and COVID-19: The protocols from Sichuan Provincial People's Hospital. Intensive Care Med 2020. In press [ahead of print]. Published on-line: March 11, 2020. |
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